1. Brain Injury among Children and Youth: Myths and Facts Marilyn Lash, M.S.W. Lash and Associates Publishing/Training www.lapublishing.com

2. Defining Brain Injury

3. Traumatic Brain Injury External force –blow, beating, assault –collision (speed and force) –fall open versus closed –gunshot –penetrating wound

4. Acquired brain injury strokes tumor anoxia (near drowning, strangulation, choking) disease (encephalitis, meningitis) toxicity (lead, chemicals)

5. 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

6. Secondary effects occur after the initial impact swelling, bleeding, infections increased intracranial pressure

7. Severity of Injuries

8. 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

9. 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

10. Severe brain injury coma more than 24 hours persistent vegetative state 80% have multiple long-term impairments

11. Predictors of outcome length of coma duration of post traumatic amnesia area of brain damaged mechanism of injury age when injured

12. Myths and Facts about Brain Injury

13. 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

14. 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.

15. Myth: Mild brain injury has no long term effects. Fact: “It’s more than just a bump on the head.”

16. Myth: Younger child is when injured, better the recovery. Fact: Younger brain is more vulnerable to damage.

17. 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

18. Myth: Time heals. Fact: Time reveals.

19. 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.

20. 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

21. 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

22. Causes vary by age 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.

23. Incidence and Identification

24. Screening questions to ask… has this student ever 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

25. Wording affects responses head injury vs. brain injury concussion vs. mild brain injury foster children

26. Consequences of Brain Injury in the Classroom

27. Physical changes seizures headaches reduced stamina and fatigue hearing and vision impairments coordination and balance one sided weakness paralysis respiration swallowing

28. Cognitive changes memory attention and concentration new learning easily distracted unable to generalize learning lack of initiation disorganized impulsive

29. Behavioral changes disinhibition temper outbursts low frustration tolerance mood swings inappropriate sexual language or behavior altered personality

30. Social changes acts younger than age poor social skills; interrupts; misses cues doesn’t fit in with peers lacks self-awareness of changes

31. Communication expressive and receptive language reading writing language development

32. Talking with Parents verbal snapshot give them navigational tools find a mentor learn from them recognize as constant link and resource