Brain Injury among Children and Youth: Myths and Facts • Marilyn Lash, M.S.W. • Lash and Associates Publishing/Training • www.lapublishing.com
Traumatic Brain Injury • External force • blow, beating, assault • collision (speed and force) • fall • open versus closed • gunshot • penetrating wound
Acquired brain injury • strokes • tumor • anoxia (near drowning, strangulation, choking) • disease (encephalitis, meningitis) • toxicity (lead, chemicals)
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
Secondary effects • occur after the initial impact • swelling, bleeding, infections • increased intracranial pressure
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
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
Severe brain injury • coma more than 24 hours • persistent vegetative state • 80% have multiple long-term impairments
Predictors of outcome • length of coma • duration of post traumatic amnesia • area of brain damaged • mechanism of injury • age when injured
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
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.
Myth: Mild brain injury has no long term effects.Fact: “It’s more than just a bump on the head.”
Myth: Younger child is when injured, better the recovery.Fact: Younger brain is more vulnerable to damage.
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
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.
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
Incidence • Leading cause of death and disability in children • Incidence estimated at 2/1,000 or1 out of every 500 school age children hospitalized for TBI annually. • Most frequent diagnosis in National Pediatric Trauma Registry
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.
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
Wording affects responses • head injury vs. brain injury • concussion vs. mild brain injury • foster children
Physical changes • seizures • headaches • reduced stamina and fatigue • hearing and vision impairments • coordination and balance • one sided weakness • paralysis • respiration • swallowing
Cognitive changes • memory • attention and concentration • new learning • easily distracted • unable to generalize learning • lack of initiation • disorganized • impulsive
Behavioral changes • disinhibition • temper outbursts • low frustration tolerance • mood swings • inappropriate sexual language or behavior • altered personality
Social changes • acts younger than age • poor social skills; interrupts; misses cues • doesn’t fit in with peers • lacks self-awareness of changes
Communication • expressive and receptive language • reading • writing • language development
Talking with Parents • verbal snapshot • give them navigational tools • find a mentor • learn from them • recognize as constant link and resource