Transcript Brain Injury among Children and Youth: Myths and Facts

Brain Injury among Children and
Youth: Myths and Facts
• Marilyn Lash, M.S.W.
• Lash and Associates
Publishing/Training
• www.lapublishing.com
Defining Brain Injury
Traumatic Brain Injury
• External force
– blow, beating, assault
– collision (speed and force)
– fall
• open versus closed
– gunshot
– penetrating wound
Acquired brain injury
• strokes
• tumor
• anoxia (near drowning, strangulation,
choking)
• disease (encephalitis, meningitis)
• toxicity (lead, chemicals)
Primary injury
• coup - contra coup effect
• damage from brain striking another
surface
• brain moves around inside skull hitting
bony surfaces
• shearing and rotation as tissues stretch
and tear
Secondary effects
• occur after the initial impact
• swelling, bleeding, infections
• increased intracranial pressure
Severity of Injuries
Mild brain injury
• brief or no loss of consciousness
• signs of concussion
• post concussion syndrome
• 90% recover within 6-8 weeks,
often within hours or days
Moderate brain injury
• coma more than 20-30 minutes but less
than 24 hours
• skull fractures with bruising or bleeding
• signs on EEG or CT scan or MRI
• 33-50% have long-term difficulties in
one or more areas
Severe brain injury
• coma more than 24 hours
• persistent vegetative state
• 80% have multiple long-term
impairments
Predictors of outcome
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length of coma
duration of post traumatic amnesia
area of brain damaged
mechanism of injury
age when injured
Myths and Facts
about Brain Injury
Myth: Looks good, is good
Facts
• Physical recovery outpaces cognitive
recovery.
• Better the student looks, harder it is to
recognize cognitive needs.
• Misidentified as ADD or LD
Myth:
More severe injury =
permanent disability.
Fact: Types of disabilities vary.
Fact: Changes in behavior and learning
jeopardize independent adulthood.
Fact: Not all disabilities are equal.
Myth:
Mild brain injury
has no long term effects.
Fact:
“It’s more than just a
bump on the head.”
Myth:
Younger child is when
injured, better the recovery.
Fact:
Younger brain is more
vulnerable to damage.
Myth:
Tests in normal range,
therefore can learn okay.
Fact:
Testing old knowledge not
indication for new learning.
Fact:
Testing environment not
indicative of classroom
Myth:
Time heals.
Fact:
Time reveals.
Myth:
TBI means student is
eligible for special education.
Fact:
Diagnosis not automatic
qualifier for eligibility.
Fact:
Educational impact may
change as brain matures and
school work changes.
Children are different than adults.
• Less likely to lose consciousness
• Higher survival rates for serious injuries
• Quicker physical recovery of motor skills
• Damage to developing brain
• Harder to learn new skills
• Effects not always seen immediately
• Long term impact on development
Incidence
• Leading cause of death and disability in
children
• Incidence estimated at 2/1,000 or
1 out of every 500 school age children
hospitalized for TBI annually.
• Most frequent diagnosis in National
Pediatric Trauma Registry
Causes vary by age
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infants:
physical abuse
toddlers:
falls and mva passengers
preschoolers: falls, mva passenger/peds.
elementary school: motor vehicles,
bicycling, falls, recreation.
• adolescents: mvas, sports, assaults
and gun shots.
Incidence and Identification
Screening questions to ask…
has this student ever
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been involved in a motor vehicle crash
fallen from a height over 8 feet
been hit in head during sports or play
seemed dazed, confused, unlike “normal”
self for period of time
• had one or more concussions
• lost consciousness
Wording affects responses
• head injury vs. brain injury
• concussion vs. mild brain injury
• foster children
Consequences of Brain Injury
in the Classroom
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Physical changes
seizures
headaches
reduced stamina and fatigue
hearing and vision impairments
coordination and balance
one sided weakness
paralysis
respiration
swallowing
Cognitive changes
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memory
attention and concentration
new learning
easily distracted
unable to generalize learning
lack of initiation
disorganized
impulsive
Behavioral changes
• disinhibition
• temper outbursts
• low frustration tolerance
• mood swings
• inappropriate sexual language or
behavior
• altered personality
Social changes
• acts younger than age
• poor social skills; interrupts; misses
cues
• doesn’t fit in with peers
• lacks self-awareness of changes
Communication
• expressive and receptive language
• reading
• writing
• language development
Talking with Parents
• verbal snapshot
• give them navigational tools
• find a mentor
• learn from them
• recognize as constant link and resource