Post on 23-Feb-2016
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RECOVERING BRAINS:
Understanding Traumatic Brain Injury and the Supports
Needed for Student Success
Kim Leaf M.A. CCC- SLP
WHAT’S IN A NAME: Traumatic brain injury (TBI)- occurs
when a sudden, external, physical assault damages the brain.
Acquired Brain Injury (ABI)- a injury
caused by an internal force such as a stroke, or disease impacting the brain.
AGENDA
DEMOGRAPHICS 1.4 million a year in US Incidence doubles for children 5-14 and
15-24. Children are more likely to survive than adults
Peaks for children and adolescence and early adulthood
250 per 100,000: 80-90,000 sustain lifelong disability
50,000 die annually Currently 5.3 American’s are living with
a TBI (2% of US pop.)
WHO DOES TBI IMPACT? Males are 1.5X more likely than females to
sustain a TBI Highest incidence among age groups is 15
to 24, followed by 75 and older, then under age 4
Leading cause of death and disability in children and young adults.
Family, Friends, and the Community
TYPES OF TBI’S2 type of Brain Injuries
1) Closed Head Injury- no break in the skull
2) Penetrating brain injury- a break in the skull
CAUSES OF TBI Most Common cause is Motor Vehicle
Accidents (MVA’s). Falls in Children (bicycles) and Elderly Sporting Activity-post concussive
syndrome (PCS) Violence- Gunshots, Shaken Baby
Syndrome, Domestic Violence
TBI’S AND CHILDREN
Age 15-24 most likely to have TBI Children’s brains are not little adult brains TBI’s in childhood is the leading cause of
death and long term disability Rapid recovery may be misleading- recovery
continues over years Two phases immediate and latent recovery Present both cognitive and psychiatric
symptoms
CAUSES OF ABI (ACQUIRED BRAIN INJURY)
Occurance during/after birth- lack of oxygen
Alcohol or drugs- slow onset CVA’s, brain attacks/strokes aneurysms Brain diseases: Tumors, AIDS,
Alzheimer’s, MS Lack of oxygen: Heart Attack
SEVERITY OF TBI Mild
Brief or no loss of consciousnessShow signs of concussion
ModerateComa <24 hoursNeurological signs of brain traumaFocal findings on EEG or CT Scan
SevereComa >24 hours
POST CONCUSSIVE SYNDROME (PSC)
EVALUATION OF CHILD BRAIN INJURY Primary injury: force of the injury,
bruising, location and bleeding. Secondary injury: hypoxia, ICP, seizures,
cerebral swelling, axonal injury Soft signs: less efficient thinking,
problems getting along, executive function changes, moodiness
Severity: any LOC, duration Morbidity increases with repetitive injury
DIFFUSE AXONAL INJURY (DAI) DAI occurs when there is shearing
(tearing) of the long connecting fibers (axons) as the brain shifts and rotates inside the skull. Microscopic changes not even seen in CT or MRI scans. (Coup-Contra Coup Injuries)
Primary brain injury-occurs at the time of impact.
Secondary BI- evolves over time (hrs-days)
http://www.youtube.com/watch?v=fY7J7bccNoU&feature=related
THE BRAIN The 3 pound universe, 2% of the bodies
weight Soft, jelly-like organ with billions of
neural cross connections 2 halves and 4 lobes and cerebellum Floating in cerebrospinal fluid Brain stem connects with rest of the
body
COMPLICATIONS FROM TBIChanges in Skill Areas: Cognitive Physical Sensory/Perceptual Communication Social Emotional/Behavioral
Post Concussive Syndrome-PCS
CONSEQUENCES: COGNITIVE CHANGES Confusion Decreased attention/concentration Memory problems Problem solving deficits Judgment/ insight problems Inability to understand abstract
concepts Decreased awareness of self/ others Loss of sense of time/space Trouble Multi-tasking Difficulty with processing information
PHYSICAL CONSEQUENCES Paralysis or weakness Spasticity Decreased balance, endurance Delays in initiation, tremors Swallowing problems Poor coordination Headaches Fatigue
PERCEPTUAL/SENSORY CHANGES Changes in vision, hearing, taste, smell,
touch Loss of sensation, heightened sensation Left/right neglect Difficulty understanding limbs in relation
to body Visual problems-double vision, acuity Sensitivity to Light
COMMUNICATION/ LANGUAGE Difficulty speaking/ understanding
(aphasia) Difficulty choosing and saying words
(anomia, apraxia, dysarthria) Problems with speech articulation Problems identifying objects, functions Problems with reading, writing, math
SOCIAL DIFFICULTIES Impaired social capacity-appears self
centered Difficulties in making and keeping
friends Difficulties in understanding social rules
and subtle nuances in social interactions Socially inappropriate
acts and remarks
REGULATORY CHANGES Fatigue Changes in sleep patterns, eating Dizziness Headaches Bowel and bladder problems Body temperature
PERSONALITY CHANGES Apathy Decreased motivation Emotional lability Irritability Anxiety and depression Disinhibition
CHALLENGES: OUTCOME FACTORS Age at the time of injury Severity and location of injury Length of coma Pre-injury personality, intelligence Motivation to recover Quickness and quality of hospital care Family involvement and support network
REHABILITATION Acute Rehabilitation- should start as
soon as possible. From 3- 5 hours a day of active rehabilitation a day is optimal. Focus on achieving independent functioning.
Post-acute/ Community Based- the person no longer needs a hospital program. Focus on community living skills
THE RECOVERY PROCESS: MILD TBI Mild Injury: Brief to No LOC, Concussion
Symptoms (nausea, disorientation, lack of recall of incident, headache)
No treatment/ER visit, Observation, Screening, possible Outpatient services
Return to school: Observations, Accommodations based on need
KEY POINTS FOR RETURN TO SCHOOL: MILD TBI Cognitive changes may impact learning
styles TBI interrupts normal development Needs may change rapidly Effects may be delayed Headache and fatigue common Subtle changes may result in
adjustment problems
RECOVERY: MODERATE TBIS LOC Less than 24 hours
ER, Outpatient/Inpatient Rehab care
Return to School: Work with hospital transition team, Specialized TBI Services, Accommodations and Modifications, possible IEP based on need.
KEY POINTS FOR RETURN TO SCHOOL: MODERATE TBI Whole Person changes: Cognitive,
Emotional, Physical TBI interrupts normal development Slower processing/thinking speed Slower recovery rate than with mild TBI But should improve more rapidly than
student with Specific LD Effects may be delayed Adjustment issues are pronounced
RECOVERY: SEVERE TBIS LOC more than 24 hours
ER, ICU, Extended hospitalization/rehab.
Return to School: Work with hospital transition team, Specialized TBI Services, Accommodations and Modifications, IEP based on need.
KEY POINTS FOR RETURN TO SCHOOL: SEVERE TBI Whole Person changes: Cognitive,
Emotional, Physical TBI interrupts normal development Slower recovery rate Effects may be delayed Deficits more significant and long lasting Adjustment issues are pronounced
OUTSIDE RESOURCES:Neuropsychological Assessment:
Neuropsychological evaluation is a measure of brain-behavior relationships
Assessment of the following brain-behavior functions: arousal, attention and concentration memory, orientation, language
visuospatial functions executive functioning psychological/ personality functions
SCHOOL BASED TREATMENT TEAM School Psych
Social Worker SLP Classroom
Teacher Special
Education Teacher
District TBI Liaison
OT PT
Nurse Administration Student Family Paraeducator Adaptive
PE/Coach AT Facilitator
OUTSIDE RESOURCES: Behavioral Optometry: Assesses how
eyes work together and changes after an injury.
Counseling Services: Individual and family counseling to address adjustment issues.
Behavior Specialist: Address behavior management concerns.
RETURN TO SCHOOL AFTER TBI:1. Close Communication with Medical Team
if possible (Medical Records request)2. Have plan in place prior to student return
to school if possible.3. Careful assessment of student when they
return in light of the cognitive, physical, emotional/behavioral changes.
4. Frequent re-assessment and communication among the school team to modify the program based on recovery or other changes in the student performance.
RETURN TO SCHOOL AFTER TBI: School staff who understand TBI and
provide appropriate support are crucial to student success
Behavioral support is often a key piece of successful return to school
Don’t discount the impact of fatigue (physical and cognitive)
Headache and other physical issues can impact progress
Not all Students with TBI’s are the same
PROGRAMMING FOR RETURN TO SCHOOL:Students with TBI May look like students
with LD or ID but with important differences:
Students with TBI do not stay the same- need frequent re-assessment and program adjustment as they recover
Recovery can take weeks, months or years
PROGRAMMING FOR RETURN TO SCHOOL: Differences between students with TBI
and LD continued:
Students with TBI usually recall having normal abilities
Teaching may need to focus on compensatory strategies as well as re-teaching of specific skills
The goal is to meet the needs of the “whole person”