1. TBI and ABI
IN
CHILDREN
“Working with students who have
brain injuries through Transition.”
Andrea Buening
IL Special Projects Coordinator
The Independent Living Center
2. My EASY description of
how the brain works:
• Consistency of soft jello
• Millions of nerve cells
• Brain sends messages back through the nerves
In MILLISECONDS the nerves transport messages to different
parts of the brain.
Those messages travel to other parts of the brain for
interpretation.
Then finally the brain sends out what it is, and what to do
with it:
EAT it, JUMP over it, LOOK at it, or maybe CRY about it.
A person may concentrate on it, digest it, add it, subtract it,
discuss it, prioritize it, or just ignore it.
The brain does it all and it’s amazing!
3. This is the brain and what it does:
The brain works out all the time. It depends on
itself to make all things work together. It also
depends on its owner to feed it and to care for
it as it is a matter of life and death.
Children need help caring for their brain.
4. Brain injury (TBI) can happen to anyone.
Children and older adults are at the highest risk
TBI – Traumatic Brain Injury
External force to the head
Closed or open (penetrating head injury)
Disrupts normal brain function
6. • An estimated 1.7 million people sustain a TBI
annually.
• Children aged 0 to 4 years, older adolescents 15 to 19
years, and adults aged 65 years + are at the highest risk
to sustain a TBI.
• Almost half a million (473,947) emergency
department visits for TBI are made annually by
children aged 0 to 14 years.
____________________________________________________
Among children and youth aged 0 to 14 years in the U.S.:
****Each year traumatic brain injury results in an estimated****
• 3,000 deaths
• 29,000 hospitalizations
• 400,000 emergency department visits.*
Statistics:
7. Classifications
“Mild”
TBI - brief change in mental status or consciousness. (a mild
concussion)
“Severe”
Suggested by the length of time a person is unconscious or their “score” on
either the Glasgow Coma Scale, or the Ranchos Los Amigos Cognitive
Recovery Scale – e.g. (Is a 7-level scale for assessing early recovery in the
brain injury rehabilitation setting.)
Mild brain injuries can result in
temporary or permanent
neurological symptoms
8. e.g. (GCS = Glasgow Coma Scale, PTA = Post Traumatic
Amnesia, LOC = Loss of Consciousness)
Glasgow Coma Scale
Every brain injury is different, but
generally, brain injury is classified as:
• Severe: GCS 3-8 (You cannot
score lower than a 3.)
• Moderate: GCS 9-12
• Mild: GCS 13-15
10. Causes of TBI in children
1. Shaken Baby – coup,
contracoup
2. Any form of child abuse where
the child’s head is involved
3. Playground accidents
4. Sports injuries
Shaken Baby Syndrome and Sports Concussions are in the news
so brain injury awareness is increasing.
11. Abusive Head Trauma can be caused by direct
blows to the head, dropping or throwing a child, or
shaking a child. Head trauma is the leading cause
of death in child abuse cases in the United States.
Childhood brain trauma can result in:
Learning and cognitive disabilities
Behavioral disorders
Blindness
Paresis, or hemiplegia
Trauma-induced seizure disorders
Loss of motor control
Communication disorders
Hearing loss
12.
13.
14. Concussion and Kids-Sports
• Football has the highest rate of concussions in high
school sports, girls soccer 2nd highest rate (New York
times 10.2.07)
• 29167 concussions suffered by US high school girl
soccer players, 20,929 concussions suffered by high
school boy soccer players 2005-2008 (Time Magazine
2008)
• Female concussion rates in high school basketball were
almost 3xs higher than among boys.
• In girls, symptoms take longer to resolve (NYR 10.1.07)
I invite you to read the,
"Interscholastic Youth
Sports Brain Injury
Prevention Act“ of 2011
15. DANGER SIGNS!
Be alert for symptoms that worsen over time. Your child or teen should be
seen in an emergency department right away if s/he has:
• One pupil (the black dot in the middle of the eye) larger than the
other
• Drowsiness or cannot be awakened
• A headache that gets worse and does not go away
• Weakness, numbness, or decreased coordination
• Repeated vomiting or nausea
• Slurred speech
• Convulsions or seizures
• Difficulty recognizing people or places
• Increasing confusion, restlessness, or agitation
• Unusual behavior
• Loss of consciousness (even a brief loss of consciousness should
be taken seriously)
If a child is taken out of the
game, an assessment
should be done by a
professional.
16. WHEN NERVE CELLS ARE DAMAGED
• Messages to and from the brain are interrupted
• Any combination, All, or NONE of the following may
occur
• The child may not
see
taste
smell
have balance
tolerate lights
tolerate stimulation
noise
tolerate ANY stress
These are PHYSICAL impacts
17. The most common consequence of
brain injury is
IMPAIRED MEMORY
19. Possible consequences cont.
Cognitive Impairments
• short term memory deficits
• impaired concentration
• slowness of thinking
• limited attention span
• impairments of perception
• communication skills
• planning
• writing
• reading
• judgment
20. MORE possible consequences
Emotional Impairments
• mood swings
• denial
• self-centeredness
• anxiety
• depression
• lowered self-esteem
• sexual dysfunction
• restlessness
• lack of motivation
• difficulty controlling emotions
21. Possible consequences
Physical Impairments
speech
vision
hearing
headaches
motor coordination
spasticity of muscles
paresis or paralysis
seizure disorders
balance
fatigue
22. A little Science and Anatomy
Maturation of the Prefrontal cortex
23. The Prefrontal Cortex
The prefrontal cortex is one of the last regions of the brain to
reach maturation. This delay may help to explain why some
adolescents act the way they do. The so-called “executive
functions” of the human prefrontal cortex include:
Focusing attention
Organizing thoughts and problem solving
Foreseeing and weighing possible consequences of behavior
Considering the future and making predictions
Forming strategies and planning
Ability to balance short-term rewards with long term goals
Shifting/adjusting behavior when situations change
We don’t see these develop until the child is a teenager.
In a child with a brain injury, they may not develop at all.
24. Cognition is a term referring to the mental processes involved in
gaining knowledge and comprehension. These processes include
thinking, knowing, remembering, judging, and problem-solving.
These are higher-level functions of the brain and encompass
language, imagination, perception, and planning.
25. Adolescent Brain Development
Neural pruning
If a teen is routinely doing music, sports,
or academics, those are the connections
that will be hard wired. If they’re lying on
the couch or playing video games or MTV,
those are the cells and connections that are
going to survive.
Experiential and rote learning continues and is
necessary for the child with a brain injury.
27. Why do children experience such dramatic consequences from
brain injury if their brain has plasticity?
1. Age at injury and Fund of knowledge
2. Brain development and functioning
3. Experiential learning
4. Undeveloped brain functions
29. Children do not always “look” like they have a brain injury. Be aware of
a possible injury.
As they grow and mature, they are introduced to more complex skills
and have more social demands.
Researchers found that children may cope better at school since it is a
highly structured environment.
They show difficulty in a more independent and less structured modern
working environments.
• attention deficit and fatigue
• impaired planning and problem solving,
• lack of initiative,
• inflexibility,
• impulsiveness,
• irritability and temper tantrums,
• opposition,
• socially inappropriate behavior
LOOK FOR
IDENTIFICATION OF POSSIBLE BRAIN INJURY
30. Provide
• Structure
• Rest periods
• Watch for frustration
• Have realistic expectations
• Evaluate frequently
• Communicate with parents!
• At age 14, begin looking at Transition
31. Teacher Directives
• Make your expectations clear
• Stay focused on the task
• Praise effort, not outcome
• Say, “Try again”
• Ask questions and give choices
• Speak with respect, calmly and firmly
• Describe and model the behavior you want
• Pick your battles
Work on Attention and Concentration
• Seat the student where there are few distractions
• Use materials appropriate to the child’s attention span
• Use cues to redirect attention (verbal and non-verbal)
• Use a timer
• Use highlighters to draw attention
• Provide well placed rest periods
32. Strategies
Organization
• Keep your daily schedules consistent (Routines are necessary)
• Use a daily assignment book or planner
• Keep materials organized in one place
• Break tasks into manageable steps and write the steps on cue cards.
• Set interim deadlines for long-term projects
• Use notebook system, not loose paper.
Memory and Comprehension
• Use active listening strategies
• Use study guides or other study strategies
• Provide opportunities for sufficient practice and review to increase
acquisition and retention
• Organize materials graphically (illustrations, visual cues, graphs)
• Muse memory aids (assignment books, cue cards)
• Use mnemonics
• Relate information to personal experience
33. Initiating Tasks
• Use a prosthetic initiator such as a watch, sign, or pager
• Identify peer buddies to work with the student
• Engage in highly structured activities
• Review tasks and responsibilities
• Check for understanding prior to the beginning of an activity
Rigidity/Inflexibility
• Prepare student in advance for new situations, transitions,
changes in routine
• Provide an explanation for the changes
• Use alerting signals and reminders (“In 5 minutes, we will
leave for music class”)
• Refer to the student’s schedule to identify the next activity
• Have the student repeat back what is going to happen next
Strategies to help
children with brain
injuries
34. Educating Children and Youth who have
brain injuries
Recommended reading
Students with Brain Injury: Challenges for
Identification, Learning and Behavior in the
Classroom
Katherine Kimes, Ed.D., Marilyn Lash, M.S.W. and Ron
Savage, Ed.D.
Signs and Strategies for Educating Students with
Brain Injuries
Marilyn Lash, M.S.W., Gary Wolcott, M.Ed., and Sue
Pearson, M.A.
35. Resources
• Slide Share www.slideshare.net
• CDC Centers for Disease Control Injury Prevention & Control: Traumatic Brain Injury
http://www.cdc.gov/TraumaticBrainInjury/
• Brain Injury Association of America http://www.biausa.org/brain-injury-children.htm
• Traumatic Brain Injury.Com http://www.traumaticbraininjury.com/symptoms-of-
tbi/ranchos-los-amigos-scale/
• About Education http://psychology.about.com/od/cindex/g/def_cognition.htm
• Undiagnosed Brain Injuries in youth and adults, Michael P. Mozzoni, Ph.D.,/B.C.B.A. and
Marilyn Lash, M.S.W.
• ABC News http://www.abc.net.au/news/2012-04-17/neuroplasticity-and-early-
intervention3a-q26a/3952432
• Brain Injury Association of America http://www.biausa.org/FAQRetrieve.aspx?ID=43913
• Brain Injury.Com http://www.braininjury.com/children.shtml
• Lash and Associates, Publishers http://www.lapublishing.com/home.php
• Supporting Students with Brain Injuries, Susan M. Rivers, EdS, Director, TBI Training
Institute University of South Carolina School of Medicine Columbia, South Carolina
37. Materials for parents of children with brain injuries
National Institute of Child Health and Human Development (NICHD)
http://www.nichd.nih.gov
Family, friends, and caregivers speaking out on behalf of children with special health care needs, addressing
policy, managed care, advocacy-training for parents, publications available.
http://www.familyvoices.org
The Sarah Jane Brain Foundation – The Mission is to create a model system for children suffering from all
Pediatric Acquired Brain Injuries.
http://www.thebrainproject.org/
Shaken Baby Alliance
http://www.shakenbaby.com
Parents and Special Education
http://www.parentpals.com
National Information Center on Children and Youth with Disabilities – Includes TBI fact sheets
http://www.sst13.org/wp-content/uploads/2014/11/TBI-Basics-Powerpoint.pdf
Interesting site with forms you can download
http://free.braininjurypartners.com/page/0100/
The mission of PACER Center (Parent Advocacy Coalition for Educational Rights) is to expand
opportunities and enhance the quality of life of children and young adults with disabilities
http://www.pacer.org/about/
Neuroscience for Children – Helping students and teachers learn more ab out the nervous system
http://faculty.washington.edu/chudler/neurok.html
38. Materials for teachers and school personnel
Office of Special Education and Rehab Services
http://www.ed.gov/about/offices/list/osers/nidrr/index.html
NICHCY is nw the National Dissemination Center for Children with Disabilities, funded by the U.S. Department
of Education, Office of Special Education Programs (OSEP). The site contains material useful in discharge
packets for guiding families as they learn about the law and about access to programs for kids.
http://www.nichcy.org
National Database of Educational Resources on Traumatic Brain Injury
http://www.tbicommunity.org/html/tbiresources/b_advancequeryItem.asp
George Washington School hosts an educational clearinghouse on postsecondary education for individuals with
disabilities. Support from the U.S. Department of Education enables the clearinghouse to serve as an information
exchange about educational support services, policies, procedures, adaptations, and opportunities at American
campuses, vocational-technical schools, and other postsecondary training entities.
http://gsehd.gwu.edu/
Council for Exceptional Children
http://www.cec.sped.org
Exceptional Educational Services – Especially for children with Acquired Brain Injury includes power point
presentation and article on how to assess children with mild brain injury
. http://www.helpingkidsbrains.com/
Family and Advocates Partnership for Education – includes info on IDEA and laws.
http://www.fape.org/
School Psychology Resources Online
http://school-psychology.org/
Technical Assistance Alliance for Parent Centers – useful publications to print
http://www.taalliance.org/
The Brain Injury Guide and Resources - Missouri
braininjuryguide@health.missouri.edu
