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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. - PowerPoint PPT Presentation

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Traumatic Brain Injury:

Recovering Brains:Understanding Traumatic Brain Injury and the Supports Needed for Student Success

Kim Leaf M.A. CCC- SLP

1Whats 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.

2AgendaDemographics1.4 million a year in USIncidence doubles for children 5-14 and 15-24. Children are more likely to survive than adultsPeaks for children and adolescence and early adulthood250 per 100,000: 80-90,000 sustain lifelong disability50,000 die annuallyCurrently 5.3 Americans are living with a TBI (2% of US pop.)

4Types of TBIs2 type of Brain Injuries

1) Closed Head Injury- no break in the skull

2) Penetrating brain injury- a break in the skull

6Causes of TBIMost Common cause is Motor Vehicle Accidents (MVAs). Falls in Children (bicycles) and Elderly Sporting Activity-post concussive syndrome (PCS)Violence- Gunshots, Shaken Baby Syndrome, Domestic Violence

7TBIs and ChildrenAge 15-24 most likely to have TBIChildrens brains are not little adult brainsTBIs in childhood is the leading cause of death and long term disabilityRapid recovery may be misleading- recovery continues over yearsTwo phases immediate and latent recoveryPresent both cognitive and psychiatric symptoms

8Causes of ABI (Acquired Brain Injury)Occurance during/after birth- lack of oxygenAlcohol or drugs- slow onsetCVAs, brain attacks/strokes aneurysmsBrain diseases: Tumors, AIDS, Alzheimers, MSLack of oxygen: Heart Attack 9Severity of TBIMildBrief or no loss of consciousnessShow signs of concussionModerateComa 24 hours

10KIM Mild An estimated 15% of persons who sustain a mild brain injury continue to experience negative consequences one year after the injury.BriefShow signs of concussion which include vomiting, lethargy, dizziness, lack of recall of injury.

Moderate ComaNeurological signs Focal findings evidence of trauma like skull fractures with contusion (tissue damage) and hemorrhage (bleeding).

Severe ComaYou can see obvious damage on the CT Scan

Medical diagnosis of mild, moderate, or severe brain injury doesnt always correlate with the individuals outcome. For example an individual diagnosed with mild or moderate TBI may have significant impairments.Post Concussive Syndrome (PSC)Evaluation of Child Brain InjuryPrimary injury: force of the injury, bruising, location and bleeding.Secondary injury: hypoxia, ICP, seizures, cerebral swelling, axonal injurySoft signs: less efficient thinking, problems getting along, executive function changes, moodinessSeverity: any LOC, duration Morbidity increases with repetitive injury12Diffuse 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 13The BrainThe 3 pound universe, 2% of the bodies weightSoft, jelly-like organ with billions of neural cross connections2 halves and 4 lobes and cerebellumFloating in cerebrospinal fluidBrain stem connects with rest of the body

14Complications from TBIChanges in Skill Areas:CognitivePhysicalSensory/PerceptualCommunicationSocial Emotional/Behavioral

Post Concussive Syndrome-PCS

15ComaComa- an altered state of consciousnessRanges from brief to deep, level of responsivenessDepth and time depend on many factorsSeverity and length can reflect outcomeGlasgow coma scale: 3-15Eye opening, verbal response, motor response16Rancho Scale Standard Scale that reflects the patient response and ability to function. (Hagen et.al)

Originally 8 level now 10, 2 higher levels added.Functional activity levels17Consequences: Cognitive ChangesConfusionDecreased attention/concentrationMemory problems Problem solving deficitsJudgment/ insight problemsInability to understand abstract conceptsDecreased awareness of self/ othersLoss of sense of time/spaceTrouble Multi-taskingDifficulty with processing information

18Physical consequencesParalysis or weaknessSpasticityDecreased balance, enduranceDelays in initiation, tremorsSwallowing problemsPoor coordinationHeadachesFatigue

19Perceptual/Sensory changesChanges in vision, hearing, taste, smell, touchLoss of sensation, heightened sensationLeft/right neglectDifficulty understanding limbs in relation to bodyVisual problems-double vision, acuity Sensitivity to Light

20Communication/ languageDifficulty speaking/ understanding (aphasia)Difficulty choosing and saying words (anomia, apraxia, dysarthria)Problems with speech articulationProblems identifying objects, functionsProblems with reading, writing, math

21Social DifficultiesImpaired social capacity-appears self centeredDifficulties in making and keeping friendsDifficulties in understanding social rules and subtle nuances in social interactionsSocially inappropriateacts and remarks

22Regulatory ChangesFatigueChanges in sleep patterns, eatingDizzinessHeadachesBowel and bladder problemsBody temperature

23Personality changesApathyDecreased motivationEmotional labilityIrritabilityAnxiety and depressionDisinhibition

24Challenges: Outcome FactorsAge at the time of injurySeverity and location of injuryLength of comaPre-injury personality, intelligenceMotivation to recoverQuickness and quality of hospital careFamily involvement and support network25RehabilitationAcute 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

26The Recovery Process: Mild TBIMild 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 need27Key Points for Return to School: Mild TBICognitive changes may impact learning stylesTBI interrupts normal developmentNeeds may change rapidlyEffects may be delayedHeadache and fatigue commonSubtle changes may result in adjustment problems

Recovery: Moderate TBIsLOC 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 TBIWhole Person changes: Cognitive, Emotional, PhysicalTBI interrupts normal developmentSlower processing/thinking speedSlower recovery rate than with mild TBIBut should improve more rapidly than student with Specific LDEffects may be delayedAdjustment issues are pronounced

Recovery: Severe TBIsLOC 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 TBIWhole Person changes: Cognitive, Emotional, PhysicalTBI interrupts normal developmentSlower recovery rate Effects may be delayedDeficits more significant and long lastingAdjustment 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 33School Based Treatment TeamSchool Psych Social WorkerSLPClassroom TeacherSpecial Education TeacherDistrict TBI LiaisonOTPT

NurseAdministrationStudentFamilyParaeducatorAdaptive PE/CoachAT FacilitatorOutside 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.35Return to School after TBI:Close Communication with Medical Team if possible (Medical Records request)Have plan in place prior to student return to school if possible.Careful assessment of student when they return in light of the cognitive, physical, emotional/behavioral changes.Frequent re-assessment and communication among the school team to modify the program based on recovery or other changes in the student performance.

36Return to School after TBI:School staff who understand TBI and provide appropriate support are crucial to student successBehavioral support is often a key piece of successful return to schoolDont discount the impact of fatigue (physical and cognitive)Headache and other physical issues can impact progressNot all Students with TBIs are the same

37Programming 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 abilitiesTeaching may need to focus on compensatory strategies as well as re-teaching of specific skillsThe goal is to meet the needs of the whole person

Remember!Treat a man as he appears a