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The Long Term Impact of Brain Injury on Children & Families . Martine Simons &Suzanne Benson Senior Social Worker Senior Clinical Psychologist and Clinical Neuropsychologist Brain Injury Service, Department of Rehabilitation. Rehabilitation at CHW.

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The Long Term Impact of Brain Injury on Children & Families

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The long term impact of brain injury on children families l.jpg

The Long Term Impact of Brain Injury on Children & Families

Martine Simons &Suzanne Benson

Senior Social Worker Senior Clinical Psychologist

and Clinical Neuropsychologist

Brain Injury Service, Department of Rehabilitation


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Rehabilitation at CHW

  • Brain Injury Service is part of the Rehabilitation Department

  • State wide service providing inpatient and outpatient rehabilitation services to approximately 600 children.

  • The team consists of medical, nursing & allied health professionals.


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Overview

  • Impact of Brain Injury on children

  • Long term issues for children & families


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Factors impacting on families

  • Immediate:

    • Injury & hospitalisation

    • Medical

    • Legal

    • Highly charged emotional situation

    • Disruption to family life

    • Being away from community and supports


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Factors impacting on families

  • Emerging picture of long term consequences

  • Process of change and adaptation for the family


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NAI/SBS

  • Mostly injured under 12 months

  • Often show good physical recovery in early stages after injury

  • Problems emerge as neurodevelopment does not proceed in typical pattern


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Early NAI Research

Kriel, Kruch & Panser (1989)

Bonnier (1995)

Duhaime et al (1996)

Haviland J, Ross, Russell RI (1997)

Ewing-Cobbs et al (1998;1999)

Kyriagis, Waugh & Epps (2003)

Barlow (2005)


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Summary

“…inflicted TBI has a very poor outcome.”

“…deficits in preschoolers are often underestimated.”

Barlow, KM et al, (2005)


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Changes in child

  • Physical and medical problems

    • post trauma epilepsy

    • hemiplegia

    • coordination problems

    • headaches

    • physical and cognitive fatigue

    • sensory deficits (vision, hearing, smell)


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Cognition

  • Cognitive deficits

    • Learning and memory

    • Speed of processing

    • Language

    • Attention

    • Executive functions

    • Intellectual impairment


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Cognitive problems

  • Executive problems

    • working out solutions

    • planning and organisation

    • inhibition

    • perseveration

    • lack of flexibility

    • concrete reasoning


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Behavioural Problems

  • Non-compliance

  • Overactivity

  • Lack of persistence

  • Physical aggression

  • Verbal aggression

  • Sleep & bedtime problems


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Social Issues

  • Social problems

    • poor communicator

    • lack of friends

    • rejected by others

    • Bullying / teasing


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Emotional problems

  • Anger

    • low frustration tolerance

    • overly sensitive

    • impulsive

  • Depression

    • feeling helpless

    • feeling different

  • Anxiety

    • ability to complete work

    • future

    • dependence on others


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Behaviour & Emotions

  • Difficult behaviour is the result of the interaction of many factors

  • No particular behaviour is “all brain injury” or “not brain injury”


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Behaviour & School

  • Emotional and behavioural issues may not be present at school

  • Environment will impact on manifestation of problems

  • Family coping will depend on many factors


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Families & Coping

  • Stress on families tends to increase, not decrease

  • Supports in community and school tend to decrease

  • Unfavourable family circumstances exacerbate problems from TBI


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Role changes

who has paid work? (at home, community)

therapy needs

Carers

Family structure

losses/absences

location

Nature/cause of TBI

Financial burdens

Family Stressors


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A multidisciplinary team approach

  • Case managers

  • Allied health

  • Nursing and medical response


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Interventions

  • Support

  • Therapeutic needs

    • behavioural interventions

    • emotional support

    • individual therapy

    • family therapy


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Schooling

  • All children return to school

    • Crucial part of child’s reintegration and ongoing development

    • Engagement and connectedness


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Implications

  • Non accidental brain injury is a serious form of child abuse

  • Long term costs to individuals, families and communities

  • Prevention programmes are essential


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