History of Disability Legal Advocacy Network - NASUAD- National ...


History of Disability Legal Advocacy Network - NASUAD- National ...


September 12, 2012


Sandra Knutson, CRC, CDMS, CCM

TBI Technical Assistance Center

Laurie Ehlhardt Powell, PhD, CCC-SLP

Center on Brain Injury Research and Training

Elizabeth Priaulx, JD

National Disability Rights Network (NDRN)

A = Aging (normal changes)


Physical Changes

� hearing

� vision

� balance

� movement


Cognitive Changes

� reaction time

� processing speed

� recalling the details of new


� solving new problems

NOTE: Long term memory &

language skills often preserved.

B = Brain injury


Physical Changes

� hearing

� vision

� balance

� movement

� coordination

� speech


Cognitive Changes

� reaction time

� processing speed

� recalling details of new


� attention/concentration

� working memory

� executive functions (initiation,

organization, planning, follow

through, problem solving)

� language

� emotional control

A + B = C

Aging + Brain Injury = Complications!

� Falls – the most common cause of TBI in this


� Older patients (55-60 yrs +) with TBI = worse


� Increased mortality (severe TBI), longer

hospital/inpatient rehabilitation stays, & lower

rate of discharge to the community.

A + B = C

Why C - Complications?

� Aging brain

� Co-morbidities (other physical and mental health

illnesses –e.g., depression)

� Poly-pharmacy

� Societal factors (ageism)

A + B = C

Other complications:

� deconditioning

� fatigue

� depression

� headaches

� seizures

� sleep disturbance

� metabolic (hormone)


� sexual dysfunction

� chronic pain

� spasticity

� visual-perceptual loss

� swallowing/gastrointestinal


Additional Rapids, Waterfalls and


� GAO recognized the intersection between aging

and disability is especially relevant for elder


� Physical and cognitive impairments, mental

problems, and low social support among victims

have been associated with negative effects on

victims’ health and longevity.” GAO Rpt., 2011.

Stereotypes of older adults as dependent and

disengaged, can lead to unintentional

discrimination against older adults.

Discrimination that can lead to unequal

access to medical care.

See Binstock, Contemporary Politics, supra note 38, at 266.

Hypothetical for Group Discussion

� Mrs. T – 76 year old woman

� Injured while trying to reach a high shelf & fell from a


� Sustained several minor injuries: sprained ankle,

bruised elbow & knee abrasion

� Discovered by her daughter on the floor an hour after

the fall

� Transported to local hospital & treated for minor


Hypothetical (cont.)

� Observed for a few hours in hospital

� Discharged to daughter’s care

� Several months later, Mrs. T reports frequent headaches

� Daughter reports Mrs. T is more forgetful & Mrs. T is

disinclined to engage in light household activities despite

recovery from other injuries

� Medical consult yielded no significant findings and doctor

indicated it was due to her age.

Questions for Discussion

� How might this woman’s age affect the identification

and treatment she receives?

� What steps could your agency take to educate

individuals with TBI, family members and providers

about the effect societal attitudes have on medical

treatment for individuals who are elderly?


To date, research on rehabilitation practices specifically

tailored to this population is sparse (e.g., Stippler et

al., 2012).


… available research shows

improvement is possible!!!


� Educate families, friends, & health care professionals,

particularly ER personnel, to screen for TBI.

Following injury:

� Medical treatment AND rehabilitation therapies (PT,

OT, SLP)- Ethically driven

� Mobility, activities of daily living, communication,

prevent complications (e.g., headaches/dizziness,

contractures, bed sores, nutrition-hydration)

Long-term Strategies

Fall prevention

� Strength and balance training program

� Vitamin D & calcium supplements

� Carefully manage medications, especially psychotropics

� Maximize vision and hearing to fullest potential

See Fact of the Matter handout on “Aging with a TBI”

Long-term Strategies (cont.)

What other people can do to compensate for cognitive


Tell, Don’t Ask!

Ex. Upon entering the room, say “My name is Laurie.”

NOT “Do you remember my name?”


Say “Today is Wednesday.” NOT “What day is today?”

Long-term Strategies (cont.)

� Environmental changes (Ex. decrease noise; pace

activities; extra support from family, friends, paid

caregivers to complete activities of daily living)

� Situation-specific routines (Ex. self-care routines;

social routines)


Long-term Strategies (cont.)

� External aids (Ex. calendar system; checklist;

medication box)-


NOTE: Using computer-based training programs for

improving cognitive processes such as memory—

not recommended!

Designing a Seaworthy Program responsive

to the needs of seniors with TBI

� Knowing your Senior Citizen Culture

� Societal, medical, family attitudes

� Outreach

� Boards, Senior centers, nursing facilities, advocates,

newspapers, health professionals

� Infrastructure development

� Permanency

� Review and improvement

Building the ship to meet the

needs of seniors with TBI

� Identifying a Lead Agency

� Advisory Board/Council

� Collaboration and Coalition Building

� Identifying Potential Partners

� Needs Assessment Process

� Statewide Action Plan

� Buy-in

Yap SG, Chua KS. Rehabilitation outcomes in elderly patients with traumatic brain injury in Singapore. J

Head Trauma Rehabil. 2008;23(3):158-63.

Frankel JE, Marwitz JH, Cifu DX, Kreutzer JS, Englander J, Rosenthal M. A follow-up study of older adults

with traumatic brain injury: taking into account decreasing length of stay. Arch Phys Med Rehabil.


Stippler M, Holguin E, Nemoto E. (2012). Traumatic Brain Injury in Elders. Annals of Longterm Care.

2012;20(5): 41-46.



Sandra Knutson – knutson-sandra@norc.org

Laurie Ehlhardt Powell – ehlhardtl@wou.edu

Elizabeth Priaulx – elizabeth.priaulx@ndrn.org

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