Transcript Traumatic Brain Injury

Intellectual Disabilities
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Prevalence
• a high-incidence disability -- the third
largest disability category but varies
depending on the state (Heward, 2003)
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Characteristics: Cognitive
• Failure to meet intellectual development markers
• Inability to meet educational demands of school
• Decreased learning ability; Learning is slower and less
efficient--While most students only need 2 or 3 trials with
feedback to learn a task, “a child with mental retardation
may need 20 to 30 or more trials to learn the same
information” (Heward, 2003, p. 207).
• Deficits in attention, short-term memory,working memory,
and memory strategy
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Characteristics: Academic
Lower skills in: Reading, Writing,
Basic Math, & Skills needed in a
workplace
Children often receive direct
instruction because they have:
– poor incidental learning (Mercer & Snell, 1977).
– poor abstract reasoning skills
– poor ability to transfer information to a new
context (generalize) and to categorize
information
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Characteristics Social-Personal
-Communicating with others
-Taking care of personal needs
-Health and safety
-Home living skills
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Characteristics Social
• rejected or neglected at school
• expect failure and therefore more likely to
come to rely on external control
• less likely to develop self-determination and
transition to adult status.
• high levels of social stress from interpersonal
experiences (Hartley & Maclean, 2005).
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Characteristics: Communication
• Usually do not learn to speak with words
until around 3 years and do not speak in
sentences until around 5 years.
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Accommodations
• More likely to learn self determination
and self-esteem when allowed to make choices
(e.g., what to wear, which shoes to buy) and
when allowed to set goals (Copeland & Hughes, 2002).
• More likely to learn when presented with direct
instruction; usually do not benefit from
unstructured lessons
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Interventions
In actual settings, teaching life skills (e.g.,
dressing, tasks for a job, cooking)
produces
1. more success than in a restrictive
classroom (Katsiyannis & Zhang, 2002).
2. better independent living after
completion of school (Wehmeyer & Agran,
2005).
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Interventions--social
• Interventions used for social skills training not successful. In
contrast, when students with MiMH were taught problem
solving skills based on their own interests there is higher
retention over time (Edeh, 2006).
• Inclusion or heterogeneous grouping: provides “social
advantages from positive peer modeling and greater
achievement” (Freeman, 2000, p. 2).
• Students need to learn to evaluate the controllability of
situations. 3 types of coping: active, distraction, and avoidant.
Only active coping (gaining control over a stressful situation
or over one’s emotions) decreases social stress in MiMH
(Hartley & Maclean, 2005). Distraction and avoidant coping
are associated with aggression, depression, anxiety, and
delinquency.
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DOWN SYNDROME
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Look at this link
• http://youtube.com/watch?v=-_-P4t2jR1g
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Physical
• Facial features
– Epicanthic fold
– Brushfield spots-
white dots located on the iris which don’t
affect vision
– Small and low set ears--
smaller canals causing them to
retain water which causes frequent ear infections
– Under developed nasal bridge
often have problems
breathing and sleep apnea
– Small jaw bone and mouth
– Small teeth and smaller space for tongue
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MEDICAL COMPLICATIONS
• Seizures= 5-10% in the first 3 years
• Congenital heart defects-- 50-75% of newborns
less blood is getting to the body parts fatigue and problems
breathing, eating, and moving
• Sensory impairments
– Visual problems
– Hearing impairments - 75% recurrent ear infections
• Digestive problems-- 5-10%
• Immune system weaknesses-- 50% decrease in the
amount of the proteins that act as antibodies
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Characteristics: Behavior
• Higher distractibility and less
persistence
• Sometimes stubborn or strong willed
• Increased tendency to escape/avoid
undesirable tasks
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SOCIAL
Negative
• Depression
– Low social status
compared to others
– Set apart as their
own group from other
students
– Frustrated when not
understood because
of communication
problems
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Positive
• Affectionate
– Very sensitive of
own needs & needs
of others
• Loveable
• Nice
– Friendly (want to be
friends with
everyone)
• Cheerful
• Generous
• Fun
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Traumatic Brain
Injury
Not degenerative
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Case Study
From a survivors perspective:
“ after a car accident, I awoke in the hospital to a
world I didn’t understand. I had to learn to ask
people to talk slower. Some stranger had taken
over my body. She reacted in ways that were
foreign to me, like making obscene gestures and
saying things that I would never be caught dead
saying.”
-Before her injury she had no emotional or
psychiatric problems.
(Bryant, 2002)
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Prevalence
1. Main cause of death and disability in youth in U.S.
a. fastest growing disability group in U.S. due to
increased survival rates
b. 25% of all pediatric injuries are brain injuries
c. called “the silent epidemic”
2. 65-75 % mild in nature MTBI (missing a lot of these
kids)
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Look at this link
Leading causes of TBI:
http://www.cdc.gov/Injur
yViolenceSafety/
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Child Biogenetic Factors
Family Factors
(Cognitive & Behavioral)
Environmental Etiologies
No Oxygen
External Force
Types of Damage
CONCEPT
MAP
Concussion
Contusion
Shearing
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Child Risk Factors
BEHAVIORAL FACTORS
Active & Risk –Taking
(e.g., ADHD)
COGNITIVE FACTORS
LD & MI/MH
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Family Factors
– Disorganized families
– 1/4 of TBI occur for
children less than 2 yrs.
Examples are:
• shaken babies
• tossed babies
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Environmental Etiologies
Environmental CAUSES
External Forces
LACK Oxygen
– Birthing
process
– Drowning
– Strokes
• External Force
 10% from firearms but 9/10 of these die
 Falls: younger than 5 & older than 75
• Opposing Forces
Vehicles (car, bike, pedestrian)
account for ½ adolescent TBIs
 Contact sports
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Contact sports in high school
About 63,000 cases of MTBI annually in H.S.
varsity athletes
(Powell, 2000)
Football accounts for 63% of the cases.
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See the effect of some sports at
this link
http://nz.youtube.com/watch?v=M9q87i2xDzQ&NR=1
Bananas Comedy Bob Nelson
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Types of Damage
1. Concussion
2. Contusion
3. Shearing
1. bruising = focal effects that
are recovered --no damage
of tissue
2. bleeding and toxic effects to
brain = focal damage to
brain cells
3. layers riding up on each
other therefore cutting of
nerve pathways = global
damage
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Indicators of Damage
1. Seizures and types
2. Auras (warnings that may be
motor or sensory)
3. Coma
4. Secondary (co-occurring)
disabilities
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Look at this link
• http://www.hbo.com/docs/programs/coma/i
ndex.html
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Physical Outcomes
Physical stamina can by less (fatigue)
Gross motor coordination--73% have good
recovery of these functions but (severe injury
may require wheelchairs)
Fine motor speech impairments
Headaches (even 1 year out)
Seizures (within 2 years of injury)
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Sensory & Somatic Outcomes
Dizziness
Insomnia
Nausea
Vision problems (e.g.,
blurred or double, low
vision/blindness, visual
field cuts)
Loss of smell or taste
(CDC, 2003)
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Possible Cognitive Outcomes
Declines in general intelligence—especially
nonverbal abilities
Slowed processing and response speed
Cognitive fatigue and attention/concentration deficits
Language and visual processing deficits
Deficits in memory and new learning
Problems with executive functions (e.g., working
memory)
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Cognitive Characteristics
Focal mild
– attention/concentration
– visual perceptual
Different
– short term memory
– judgment
– loss of academic new
learning or language
(naming and receptive)
Global
– attention/concentration
– visual perceptual
Different
– long term memory
– IQ--problemsolving/disorganization
-- loss of old learning
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School and Vocational Outcomes
1.
2.
3.
4.
Problems initiating and completing work
Slowed work pace
Increased impulsivity
Trouble navigating physical surroundings,
especially in new settings (e.g., motor
limitations, spatial deficits)
5. Decreased productivity
6. Loss of employment
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Social
Characteristics
Communication
 May say inappropriate things
 Difficulty understanding another’s perspective
 Poor awareness of social environment
Functioning losses
 Relationships: loss of friends, relationships
 Loss of the ability to manage home or school
environment
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Emotional
In general, the presence of an acquired brain
injury places individuals at greater risk for
developing a new psychiatric disorder
(about 5 times expectancies)
Depression
Anxiety
Sleep disturbances
Frequent mood changes or
difficulty regulating emotions
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Which type of disability is more likely to
have secondary psychiatric disorders?
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Case Study II
 A 15 year old girl with a history of anorexia nervosa.
 She sustained a head injury when she fell from her bicycle.
 Initially she was drowsy, slow to respond, and disoriented in
time but oriented in place and person.
 During the following 3 weeks, she was tired, lost interest in
activities, and had poor hygiene, slept excessively, and
worried about not being able to remember the accident.
 Then difficulties in thinking, and hearing voices, but was
unable to elaborate on her thinking and hearing.
 Finally diagnosed with Bipolar disorder from sustaining the
head injury.
(Sayal, 2000)
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Interventions
Interventions may depend upon which area of the brain was
affected:
• Memory
– Reviewing
– Consistent Routine
• Comprehension
– Repetition
– Emphasize Main Points
• Attention
– Break down large assignments into smaller tasks
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Interventions:
May require changes in instructional
formatting:
1. Advance Organizers
Draw maps in planning the day
List solutions when giving them a problem
Use outlines
2. Groupings
Use groups with different disabilities
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Prevention of Mild TBI
Supervision
Safety rules and education
 Never drive while under the influence
Protective gear
 Wear a seat belt.
 Wear a helmet and make sure your children wear
helmets
 Avoid falling at home by:
using a step stool,
installing handrails,
installing window guards,
and using safety gates.
(CDC,2003)
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T or F in Response to Seizure
1. put something soft
5. call for assistance if
under the person’s
the seizure is longer
head
than 5 min
2. put something in the 6. try to revive the
person’s mouth
student and bring
him/her around
3. hold onto the person’s
tongue
7. turn person onto their
side
4. clear the floor around
the person
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Answers
1.
2.
3.
4.
5.
6.
7.
T
F
F
T
T
F
T
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