Traumatic Brain Injury 1 Not degenerative

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. 2 (Bryant, 2002)

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” % mild in nature MTBI (missing a lot of these kids) 3

CONCEPT MAP 4 Environmental Etiologies Family Factors No OxygenExternal Force Types of Damage Concussion Contusion Shearing Child Biogenetic Factors (Cognitive & Behavioral)

Child Risk Factors BEHAVIORAL FACTORS Active & Risk –Taking (e.g., ADHD) 5 COGNITIVE FACTORS LD & MI/MH

6 Family Factors –Disorganized families –1/4 of TBI occur for children less than 2 yrs. Examples are: shaken babies tossed babies

Environmental Etiologies Birthing process Birthing process Drowning Drowning Strokes Strokes 7 Environmental CAUSES LACK Oxygen 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 External Forces

Contact sports in high school About 63,000 cases of MTBI annually in H.S. varsity athletes Football accounts for 63% of the cases. 8 (Powell, 2000)

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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 10

Indicators of Damage 1. Seizures and types types 2. Auras (warnings that may be motor or sensory) 3. Coma 4. Secondary (co-occurring) disabilities 11

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) 12

Sensory & Somatic Outcomes  Dizziness  Insomnia  Nausea  Vision problems (e.g., blurred or double, low vision/blindness, visual field cuts)  Loss of smell or taste 13 (CDC, 2003)

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) 14

Cognitive Characteristics Focal mild attention/concentration attention/concentration visual perceptual visual perceptual Different Different short term memory short term memory judgment judgment loss of academic new learning or language (naming and receptive) loss of academic new learning or language (naming and receptive) Global attention/concentration visual perceptual Different long term memory IQ--problem- solving/disorganization -- loss of old learning 15

School and Vocational Outcomes 1. Problems initiating and completing work 2. Slowed work pace 3. Increased impulsivity 4. Trouble navigating physical surroundings, especially in new settings (e.g., motor limitations, spatial deficits) 5. Decreased productivity 6. Loss of employment 16

Social Characteristics Communication May say inappropriate things May say inappropriate things Difficulty understanding another’s perspective Difficulty understanding another’s perspective Poor awareness of social environment Poor awareness of social environment Functioning losses Relationships: loss of friends, relationships Relationships: loss of friends, relationships Loss of the ability to manage home or school environment Loss of the ability to manage home or school environment 17

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 Depression Anxiety Anxiety Sleep disturbances Sleep disturbances Frequent mood changes or Frequent mood changes or difficulty regulating emotions 18

19 Which type of disability is more likely to have secondary psychiatric disorders?

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. 20 (Sayal, 2000)

Interventions Interventions may depend upon which area of the brain was affected: Memory Memory Reviewing Reviewing Consistent Routine Consistent Routine Comprehension Comprehension Repetition Repetition Emphasize Main Points Emphasize Main Points Attention Attention Break down large assignments into smaller tasks Break down large assignments into smaller tasks 21

Interventions: May require changes in instructional formatting: 1. Advance Organizers Draw maps in planning the day Draw maps in planning the day List solutions when giving them a problem List solutions when giving them a problem Use outlines Use outlines 2. Groupings Use groups with different disabilities Use groups with different disabilities 22

Prevention of Mild TBI Supervision Safety rules and education Never drive while under the influence Never drive while under the influence Protective gear Wear a seat belt. Wear a seat belt. Wear a helmet and make sure your children wear helmets Wear a helmet and make sure your children wear helmets Avoid falling at home by: Avoid falling at home by: using a step stool, installing handrails, installing window guards, and using safety gates. 23 (CDC,2003)

T or F in Response to Seizure T or F in Response to Seizure 1. put something soft under the person’s head 2. put something in the person’s mouth 3. hold onto the person’s tongue 4. clear the floor around the person 5. call for assistance if the seizure is longer than 5 min 6. try to revive the student and bring him/her around 7. turn person onto their side 24

Answers 1. T 2. F 3. F 4. T 5. T 6. F 7. T 25