1. 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.

2. 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 per 100,000
Male to female ratio 1.4:1
Occurs most commonly during spring and summer and weekends
Chapter 26 slides in Children with Disabilities, Seventh Edition, Online Companion Materials. Copyright © 2013 Paul H. Brookes Publishing Co., Inc. All rights reserved.

3. 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.

4. Types of Brain Injuries
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.

5. 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.

6. 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.

7. 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.

8. 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.

9. 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.

10. 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.

11. 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.

12. 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.

13. 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.

14. 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.