Chapter 26 Traumatic Brain Injury Overview Incidence and causes of traumatic brain injury (TBI) in children Types of brain injuries that can occur Different severities of brain injury Treatment and rehabilitation processes associated with TBI Comprehensive and multidisciplinary approach during TBI recovery Ways to reduce the risk of TBI in children Chapter 26 slides in Children with Disabilities, Seventh Edition, Online Companion Materials. Copyright © 2013 Paul H. Brookes Publishing Co., Inc. All rights reserved.

Incidence of Traumatic Brain Injury TBI is nongenerative, noncongenital insult to brain resulting from mechanical force 1.7 million Americans sustain TBI each year 275,000 are hospitalized; 52,000 die 511,000 TBIs in children under age 14 Rate of hospitalization in children 17 years and younger is 119 per 100,000 Male to female ratio 1.4:1 Occurs most commonly during spring and summer and weekends https://www.youtube.com/watch?v=T0WBMM7WKL4 Chapter 26 slides in Children with Disabilities, Seventh Edition, Online Companion Materials. Copyright © 2013 Paul H. Brookes Publishing Co., Inc. All rights reserved.

Causes of Traumatic Brain Injury TBI can come from motor vehicle accidents, falls, sports and recreational injuries, and assault. Most common causes for different ages: Children less than 1 year: physical abuse Toddlers: falls Younger school-age: transportation-related injuries (bicycle crashes) Older school-age: motor vehicle accidents; sports and recreational activities Adolescence through mid-20s: motor vehicle accidents Chapter 26 slides in Children with Disabilities, Seventh Edition, Online Companion Materials. Copyright © 2013 Paul H. Brookes Publishing Co., Inc. All rights reserved.

Types of Brain Injuries https://www.youtube.com/watch?v=9Wl4-nNOGJ0 Primary (occurs at the moment of impact): Brain contusions Vascular injuries causing hemorrhage or meatomas Scalp injuries and skull fractures Cranial nerve injuries Secondary (within 24 hours) Brain swelling/edema Elevated intracranial pressure Seizures Electrolyte disturbances (changes in sodium) Hydrocephalus (increased fluid in brain) Diffuse axonal injury: extensive injury to white matter tracks of brain caused by inertial forces at moment of impact Chapter 26 slides in Children with Disabilities, Seventh Edition, Online Companion Materials. Copyright © 2013 Paul H. Brookes Publishing Co., Inc. All rights reserved.

Concussions Definition: closed-head brain injury that occurs when head strikes an object or when moving object strikes head Causes: motor vehicle accidents, falls, sport injuries Symptoms: confusion, headache, nausea, vomiting, dizziness, hypersensitivity to lights or sounds, loss of balance, blurry vision, double vision, loss of vision, loss of consciousness, seizures, personality changes, slurred speech, body/facial weakness or numbness Diagnostic systems: Maddocks questions Standardized assessment of concussion (SAC) McGill Abbreviated Concussion Evaluation (McGill ACE) See the textbook Children with Disabilities, Seventh Edition, for full citation and reference information. Chapter 26 slides in Children with Disabilities, Seventh Edition, Online Companion Materials. Copyright © 2013 Paul H. Brookes Publishing Co., Inc. All rights reserved.

Detection of Traumatic Brain Injury Signs and symptoms: Change in mental status Weakness in arms or legs Complaints of severe headaches or changes in hearing or vision Nausea and projectile vomiting Loss of consciousness Evaluation may include: Neurological exam Neurological imaging (CT scan or MRI) Chapter 26 slides in Children with Disabilities, Seventh Edition, Online Companion Materials. Copyright © 2013 Paul H. Brookes Publishing Co., Inc. All rights reserved.

Severity of Traumatic Brain Injury Two major ways to determine severity of TBI: Glasgow Coma Scale (GCS) assesses and scores Motor response Verbal response Eye opening Duration of post traumatic amnesia (PTA) Includes the length of time in coma and the time it takes after coma to remember events and store new memories Mild TBI—duration of PTA is less than one hour Moderate TBI—duration of PTA between one hour and one day Severe TBI—duration of PTA is longer than one day Chapter 26 slides in Children with Disabilities, Seventh Edition, Online Companion Materials. Copyright © 2013 Paul H. Brookes Publishing Co., Inc. All rights reserved.

Acute Treatment of Traumatic Brain Injury Initial treatment: assessment of breathing and circulation, head and spinal exam and imaging, GCS score Based on scan, treatment may include monitoring of blood pressure, oxygen levels and brain pressure; surgery Preventing/limiting secondary brain damage: ventilator management, medications for brain swelling, surgery Seizures may occur and may require medication Prevention of complications related to bed rest, nutrition, urinary and bowel incontinence Medication to treat autonomic instability Chapter 26 slides in Children with Disabilities, Seventh Edition, Online Companion Materials. Copyright © 2013 Paul H. Brookes Publishing Co., Inc. All rights reserved.

Rehabilitation of Children with Traumatic Brain Injury Rehabilitation strives to Prevent complications caused by immobilization and disuse Increase use of abilities regained Teach strategies to compensate for impaired or lost function Alleviate effects on growth and development Chapter 26 slides in Children with Disabilities, Seventh Edition, Online Companion Materials. Copyright © 2013 Paul H. Brookes Publishing Co., Inc. All rights reserved.

Rehabilitation of Children with Traumatic Brain Injury (continued) Motor impairments—prognosis is related to duration of coma; medications and/or surgery may be used to treat motor impairments related to movement patterns and tone Sensory impairments—double vision common; traumatic injury to optic nerve can cause blindness; sensorineural hearing loss generally unilateral Feeding disorders—difficulty in swallowing affects oral nutrition, hydration, and possibility of aspiration; child may need feeding tube for some time Chapter 26 slides in Children with Disabilities, Seventh Edition, Online Companion Materials. Copyright © 2013 Paul H. Brookes Publishing Co., Inc. All rights reserved.

Rehabilitation of Children with Traumatic Brain Injury (continued) Communication skills impairments—can be expressive or receptive; can result in less appropriate use of language, style of speech, conversation ability Cognition impairments—attention, memory, executive function, and speed of process can be affected; long-term outcome depends on severity of injury and environmental factors Behavioral and social impairments—adjustment difficulties, psychiatric disorders, impulsivity, social withdrawal, inappropriate social behavior; family support is critical Chapter 26 slides in Children with Disabilities, Seventh Edition, Online Companion Materials. Copyright © 2013 Paul H. Brookes Publishing Co., Inc. All rights reserved.

Outcomes Mild TBI—generally complete recovery; some postconcussive symptoms possible Moderate to severe TBI—based on variables such as severity of injury, family factors, age, and developmental stage at time of injury Recovery significant during first year, slowing over next year Neurocognitive stall: slowing or lack of further progression in intellectual, motor, and social development one year after injury Rehabilitation—multidisciplinary intervention may be necessary Chapter 26 slides in Children with Disabilities, Seventh Edition, Online Companion Materials. Copyright © 2013 Paul H. Brookes Publishing Co., Inc. All rights reserved.

Outcomes (continued) School reentry—TBI places child at risk for long-term academic difficulties in reading, math, attention, concentration, and memory TBI is special education eligibility category (IDEA) Planning for school reentry, transition support, education of school staff, and long-term monitoring critical Chapter 26 slides in Children with Disabilities, Seventh Edition, Online Companion Materials. Copyright © 2013 Paul H. Brookes Publishing Co., Inc. All rights reserved.

Prevention Falls Use window guards and gates at stairways; avoid using infant walkers Motor vehicle accidents Car and booster seats Seat belts Limited nighttime driving, limited teen passengers, graduated licensing measures (teenagers) Pedestrian injuries Street-crossing skills Bicycle, sport, and other recreation-related injuries Helmets and protective gear General Child, parent, and community education Chapter 26 slides in Children with Disabilities, Seventh Edition, Online Companion Materials. Copyright © 2013 Paul H. Brookes Publishing Co., Inc. All rights reserved.