Transcript Definitions of Brain Injury

Definition
Causes
Incidence
Judy L. Dettmer
Definitions of Brain Injury
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Traumatic Brain Injury (TBI): a physical force
applied to the brain that results in a traumatic
injury
U.S. Department of Education, Federal Register, 1992
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Acquired Brain Injury (ABI): an injury to the
brain that occurs following birth, and can be
classified as traumatic or non-traumatic
Educational Dimensions of Acquired Brain Injury, Savage, Wolcott, 1994
Common Causes of TBI
Infants: Physical abuse
Toddlers: Falls
Young Children: Passengers in vehicles
School-aged Children: Bicycle and pedestrian
collisions with vehicles
Adolescents: Drivers and passengers in motor
vehicle accidents
Sports & TBI
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Amateur Boxing
 Injuries consistent with acute TBI
 Post-concussive syndrome
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Football
 20% high school players
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Soccer
 5%
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Horseback Riding
 17% of all equestrian injuries are brain injuries
(Brain Injury Association of America)
Open v. Closed Brain Injury
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Open Brain Injury
 Skull is fractured
 Blood & swelling have a place to go
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Closed Brain Injury
 Concussion
 Swelling results in further (secondary) injury
○ May go unidentified if no loss of consciousness
○ Damage great or greater than open brain injury
Common Causes of
Non-Traumatic Brain Injuries
Illness (e.g. high fever)
 Infections (e.g. meningitis, encephalitis)
 Anoxic injuries
 Strokes, vascular accidents
 Brain tumors
 Poisoning (e.g. ingestion, inhalation)
 Metabolic disorders (e.g. insulin shock)
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Does not always predict outcome
Mild TBI (an oxymoron)
Also called post-concussive syndrome
 Brief or no loss of consciousness
 90% of concussions resolve in a few weeks
 10% have symptoms that last a lifetime
 Symptoms are not “mild”
Moderate TBI
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Loss of consciousness for < 24hrs
 Skull fracture, contusions, hemorrhage, or
focal damage
 In children may result in
○ Physical weakness
○ Cognitive-communication impairments
○ Difficulty learning new information
○ Psycho-social problems
Severe TBI
Loss of consciousness > 24 hours
 Multiple cognitive, communicative,
physical, social, emotional &
behavioral problems
 20% return with minimal changes

 Approx 80% have life long changes
Is it a “low incidence” disability?
Breast
Cancer
Spinal Cord
HIV/AIDS
Injuries
43,681
11,000
176,300
Multiple
Sclerosis
10,400
Traumatic Brain
Injuries
1,500,000
Comparison of Annual Incidence
Data compiled by the Brain Injury Association of America based of data from the Centers for Disease
Control and Prevention, American Cancer Society and National Multiple Sclerosis Society
Gender, Age and TBI
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After infancy boys are injured twice as
frequently

Young adults age 16 - 24 are most at risk
TBI in Children

1.4 million children injured annually
 About 1/2 are between 16-21
 Highest risk groups ages 0-4 and 15-19
 More likely to survive than adults
 Less likely to be unconscious
National Data

Brain injury is the leading cause of death and
disability of children in the U.S. (Pediatric Registry)

CDC reports annual incidence of TBI for
Children 0-14:
- 2,685 deaths
- 37,000 hospitalizations
- 435,000 ED visits
These numbers do not include children who sustained
a TBI and did not seek medical care or were treated
and released without mention of potential TBI
National Data

Each year an average of 475,000 TBIs
occurred among children.
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Most children who sustained a TBI (91.5%)
were treated and released from the
emergency department without further
treatment.
CDC
2005
Simplified Brain Behavior Relationships
Frontal Lobe
• Initiation
• Problem solving
• Judgment
• Inhibition of behavior
• Planning/anticipation
• Self-monitoring
• Motor planning
• Personality/emotions
• Awareness of
abilities/limitations
• Organization
• Attention/concentration
• Mental flexibility
• Speaking
(expressive language)
Temporal Lobe
• Memory
• Hearing
• Understanding language
(receptive language)
• Organization and sequencing
Parietal Lobe
• Sense of touch
• Differentiation:
size, shape, color
• Spatial perception
• Visual perception
Occipital Lobe
• Vision
Cerebellum
• Balance
• Coordination
• Skilled motor activity
Brain Stem
• Breathing
• Heart rate
• Arousal/consciousness
• Sleep/wake functions
• Attention/concentration
Executive Functions:
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Initiate
Inhibit
Shift
Plan
Organize
Self-Monitor
Emotional Control
Working Memory
Executive Functions:
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Attention
Planning
Judgment
Organization
Problem-solving
Emotion Regulation (lability)
Social Skills
Some are more academically
based:
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memory – “making new learning stick”
processing speed
abstract concepts
money and time concepts
sequencing learning
simultaneous learning
shifting/changing sets
perseveration
handwriting
inconsistent learning curve
learning plateau
Some are more organizationally
based:
initiation - completion
 time on task
 visual over-stimulation
 auditory over-stimulation
 planning
 under-arousal
 emotional load
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Typical effects of mild to
moderate BI
Mental fatigue
 Slowed processing speed
 Difficulty transferring “new learning” into
memory – affects sequential thinking
 Problems with Executive Function
 Social Skill problems
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Typical effects of moderate to severe
BI:
Tend to see:
 Mental Fatigue
 Motor problems
 Feeding problems
 Cognitive problems – concrete thinking
 Emotional and Behavior regulation
 Seizures
How BI issues “manifest” in the
classroom
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Mental fatigue
 Head down, tired,
“lazy”
Slowed processing
speed
 Dragging work out
Difficulty transferring  Inconsistent learning –
“new learning” into
“you had it yesterday
memory – affects
and not today, faking”
sequential thinking  Behavior problems,
Problems with
ADHD, messy,
Executive Function  Can’t get along with
Social Skill problems
others
U.S. Department of Education Data
Students (ages 6-21)

During the 1991-92 school year there were a
total of 4,499,824 students receiving special
education services of that total only 245 were
served under the TBI disability category

During the 1999-2000 school year there were a
total of 5,683,707 students receiving special
education services of that total there were
13,874 served under the TBI disability category
U.S. Department of Education, Office of
Special Education Services: Annual Report
to Congress, 2000
U.S. Department of Education
Data Students (ages 6-21)
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2005 data shows there were a total of 6,021,462
students receiving special education services of
that total there were 23,449 served under the TBI
disability category
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Interesting fact, Autism became a disability category
in 1991 also; in 1992, 15,302 students were
identified, in 2000, 79,085 were identified and in
2005 192,643 students were identified under the
autism disability category
Let’s Recap: You do the Math…
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Each year an average of 475,000 TBIs occurred
among children (0-14)
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The National Pediatric Registry reports that it is
estimated that 19% of youth who sustained a brain
injury will have long term disabilities
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Reviewing data from USDOE in 2004 there were
23,204 students with TBI receiving special
education services. In 2005 there were 23,449
served under the TBI disability category (0-21).
Totaling an increase of 245 students.
Let’s Recap: You do the Math…
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Conservatively, using the 19% guideline, we could
estimate roughly 90,250 with long term disabilities
resulting from brain injury annually.
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Get your calculators out……………
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19% of 475,000 = 90,250, USDOE increased by 245 in
one year…………
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Are we missing 90,005 students with brain injury?
Colorado Picture
Where Does Colorado Stand?
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According to data from the Colorado Department of
Public Health and Environment, on average during
2004-2006 annually there were 693 children (5-21)
discharged from an acute care hospital with TBI
diagnosis.
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There are an estimated 3,000 youth living with brain
injury in Colorado.
Where Does Colorado Stand?
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In 2007 Colorado reported 413 students
identified with brain injury as their primary
disability category for special education. In
2008 Colorado reported 419, an increase of 6
students.
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Calculators please………
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693 new injuries, CDE increase of 6
students…..
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Are we missing 687 students annually?
Why Are We Missing
These Kids?
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Transition support from medical setting is rare or
poorly coordinated
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From hospital fewer than 2% are recommended for
special education (though 19% have cognitive
limitations) (National Pediatric Registry)
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Treat and Release from the EDs
Why Are We Missing
These Kids?
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Brain injury often goes undiagnosed
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The effects of brain injury can be very
subtle
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Families and school personnel have
limited knowledge about brain injury
The Importance Of Accurate
Identification
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Student receives appropriate interventions
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Prevent a cycle of failure
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Allows the student to begin developing self
advocacy skills
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Accurate identification ensures more
appropriate funding and subsequent service
provision
TNT Website
 www.cokidswithbraininjury.com