statistics - amazon s3...2012/12/07 · 11/29/2012 3 a child’s brain is not fully developed until...

11/29/2012

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The BrainSTEPS Program

& The Epilepsy Foundation of

Western/Central PA Present

Traumatic Brain Injuries & Epilepsy:

What Schools Need to Know December 3, 2012

Webinar

Brenda Eagan Brown, M.S.Ed., CBIS

BrainSTEPS Program Coordinator Brain Injury Association of PA

724-944-6542 [email protected]

www.brainsteps.net

Andrea Zonneveld

Community Education & Events Coordinator

Epilepsy Foundation Western/Central PA 412-322-5880 ext. 308 [email protected]

Traumatic Brain Injury

Statistics

Brain injury is a leading cause of death and disability in children & young adults.

Children with Traumatic Brain Injury 0-14 years of age

CDC Statistics Average ANNUAL number of Traumatic Brain Injury Emergency Department Visits and Hospitalizations in the United States

• Most children who sustained a TBI (91.5%) were treated and released from the emergency department.

United States. Centers for Disease Control. Traumatic Brain Injury in the United States. 2005. http://www.cdc.gov/ncipc/pub-res/TBI_in_US_04/TBI%20in%20the%20US_Jan_2006.pdf>.

474,000

Each year, approximately

26,000

children in Pennsylvania sustain a traumatic brain injury

(concussion/mild, moderate, or severe)

Source: The Brain Injury Association of Pennsylvania, 2008

How Common is TBI in Children in

Pennsylvania?

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Annually, approx.

4,000 Children & Adolescents in

Pennsylvania are HOSPITALIZED with

TBI

Source: The Pennsylvania Department of Health, 2004 & 2006

DOES NOT INCLUDE EMERGENCY ROOM VISITS.

A Concussion

is a Traumatic

Brain Injury

Concussion: Incidence

Centers for Disease Control:

3.8 million sports and recreation related concussions are estimated to occur in the United States each year.

Concussions in Pennsylvania:

Annually,

approx. 22,000 children

ages 0-21 years

suffer concussions

• Under-developed

• Needs time & experience to mature.

• Not well organized

A Child’s Brain

• Easily injured

• New abilities build on established skills over time

• Does not simply “bounce back” after injury

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A child’s brain is not fully

developed until around

the early to mid 20’s…

Brain Injury & Developmental Stages

• Capacities in process of development, and those not yet developed are those most vulnerable to brain injury.

Acquired

Brain Injuries

Traumatic

&

Non-Traumatic

Types of Brain Injury

Acquired Brain Injury after birth process


external physical force

Non-Traumatic Brain Injury

open head injury

closed head injury

Non-Traumatic Brain Injury Causes

Cerebral Vascular Accidents

Vascular Occlusions

Hemorrhaging

Aneurysms

Ingestion of Toxic Substances

Inhalation of Organic Solvents

Ingestion of Heavy Metal

Alcohol and Drug Abuse

Stroke

Infections of the Brain

Hypoxia – reduced oxygen to the brain

Anoxia – no oxygen to the brain

Brain Abscesses

Meningitis

Encephalitis

Non-Traumatic Brain Injury Causes

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Anoxia/Hypoxia – common causes

• The Choking Game

• Attempted suicide • Electrical shock

• Heart attack

• Brain tumor • Heart arrhythmia

• Extreme low blood pressure • CO2 inhalation

• Poisoning • Choking

• Suffocation • Respiratory conditions that affect breathing

Lightning Near Drowning

Chemotherapy & Radiation

Late-Term Effects

Bleeding in the Brain

Acquired Brain Injury after birth process


external physical force

Non-traumatic Brain Injury Internal process

open head injury

closed head injury

Types of Brain Injury Shaken Baby Syndrome

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Car Accidents

Centre for Neuro Skills

What Happens During a Traumatic Brain Injury?

Skull Protrusions Open Head Injury: Gunshot Wound

Mild/Concussion: • Brief or NO loss of consciousness

• Shows signs of concussion

• vomiting

• lethargy

• dizziness

• headache

Moderate:

• Coma < 24 hours duration

• Neurological signs of brain

trauma

• Skull fractures with contusion

(tissue damage)

• Hemorrhage (bleeding)

• Focal Findings on EEG/CT scan

Severe:

• Coma > 24 hours duration

Levels of TBI Severity Brain Injury Effects

1. Physical

2. Cognitive

3. Social

4. Emotional

5. Behavioral

6. Sensory

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Post Traumatic

Seizures

3 Types of Seizures after TBI

1. Immediate: within 24 hrs of TBI

2. Early onset: less than 1 week after TBI – Not considered epilepsy

– Risk factor for later epilepsy, but typically pass

uneventfully

– Approx. 25% will have another seizure in future

3. Late onset: Up to 20 years after TBI – Considered epilepsy

– Approx. 80% will have another seizure in future

-www.internationalbrainassociation.org

-www.neurology.stanford.edu/divisions/e_12.html

-www.brainline.com

-

Seizures after TBI

• Epilepsy: Having more than one seizure is called

epilepsy. More than half the people with epilepsy will

have this problem for their whole lives. www.brainline.org

• 5% of epilepsy is caused by a traumatic brain injury

www.neurology.stanford.edu/divisions/e_12.html

Seizures after TBI

• Seizures are reported in up to 50% of all TBI survivors

International Brain Injury Association

• Severe TBI leads to epilepsy in approx. 15% of adults and 30% of children.

www.neurology.stanford.edu/divisions/e_12.html

• Seizures can also occur after concussions

Seizures after TBI

• 20% of people with ‘closed brain injuries’ that cause

bleeding between the brain and the skull experience seizures

• Over 35% of people who need 2 or more brain surgeries

after a brain injury experience late onset seizures

www.brainline.org

Seizures after TBI

• Injuries with actual penetration of the brain are likely to

cause epilepsy, about 25 to 50% of the time

ww.neurology.stanford.edu/divisions/e_12.html

• 65% of people with brain injuries caused by bullet

wounds have seizures

www.brainline.org

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Seizures after TBI

• 5-10% of children will experience seizures as a

result of their TBI -UAB TBI Model System website

• Common medications – Phenobarbital, Dilantin, or Tegretol

Watch for medication side effects that may impact school work

Absence Seizures after TBI - Common

• Absence Seizures commonly referred to as:

– Petit mal seizure

– Absence Attacks

– Primary Generalized Seizures - Absence Type

• Abrupt & brief interruption of consciousness without

convulsion

• Typically lasts several seconds

• Can occur 100’s of times per day

• During seizure, interaction is not possible

• Observed almost exclusively in children

At School: Seizures after TBI

Can impact a students ability to: – acquire new knowledge

– process new information

– remember new information

– keep pace

– organize

– plan and follow through on tasks

– attend to important classroom instruction

What teacher’s may see or report if they

don’t understand Absence Seizures

Student is:

– Daydreaming

– Spacy

– Lazy

– Inattentive

– Always off task

– Looking at neighbors paper

Reviewing the Basics, First Aid, and Treatment Options for Dif ferent Kinds of Seizures

AN OVERVIEW OF

EPILEPSY

Andrea Zonneveld Community Education &

Events Coordinator

SOME FUNDAMENTAL BASICS

What is epilepsy?

A neurological disorder characterized by recurring seizures

May also be referred to as a “seizure disorder”

What is a seizure?

A seizure is a temporary disruption of the electrical system of the

brain that results in the release of excessive energy in synchronized

form

Can affect the entire brain and impair consciousness and memory

or can affect only part of the brain, which may or may not disrupt

awareness

Produce changes in consciousness, behavior, and/or movement

Introduction Seizure Types

& First Aid Treatment Social Impact The EFWCP

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EPILEPSY IS NOT…

Contagious/disease

Mental illness

Intellectual disability

The result of a single seizure

A condition you can tell someone has based on their

appearance



WHO DOES EPILEPSY AFFECT?

Nearly 3 million Americans

326,000 children (through age 15)

1 in 26 individuals will develop epilepsy at some point in their

lifetime

-Epi lepsy Across the Spectru m, IO M

1 in 10 individuals will have a seizure during their lifetime



WHAT CAUSES SEIZURES?

70% of cases are idiopathic (of unknown cause)

Symptomatic epilepsy (the other 30%) can be caused by:



• Birth trauma

• Head injury

• Brain tumors

• Strokes

• Lead poisoning

• Infection of the brain

• Heredity

• Lack of oxygen to the

brain

• Chronic usage of

drugs/alcohol

• Metabolic abnormalities

TBI at any age can lead to development of post -traumatic

epilepsy

Ex: TBI is the most common injury for returning servicemen from

Operation Enduring Freedom and Operation Iraqi Freedom

TBI is associated with up to 53% risk for post -traumatic

epilepsy, depending on the severity of the injury


Epileptogenesis after TBI is not well understood, so attempts

to prevent epilepsy after TBI have not been successful


TBI AND EPILEPSY



Tonic clonic seizures, also known as grand mal seizure are the

most common and best known of generalized seizures

During the seizure:

May let out a sudden cry or gasp for air

Consciousness is lost

Breathing may become shallow/irregular

Begins with stiffening of muscles ( tonic phase), followed by jerking of

limbs and face (clonic phase)

Drooling or vomiting, bluing of skin, and loss of bladder or bowel

control may occur

After the seizure:

Will often be confused and fatigued

WHAT DOES A SEIZURE LOOK LIKE?



WHAT DOES A SEIZURE LOOK LIKE? (CONT’D)

Generalized Seizures

Tonic-Clonic seizure: convulsive seizure

Absence seizure : often confused for daydreaming

Atonic seizure : sudden loss of muscle tone (AKA ‘drop seizure’)

Myoclonic seizure : sudden brief, massive muscle jerk

Partial Seizures

Simple Partial and Complex Partial seizures : depends on the

individual, but can involve anything your brain can do/control;

automatisms (repeated automatic gestures) are common as part of a

complex partial seizure



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WHAT SHOULD I DO?

Tonic-Clonic seizure:

Lay the person on the ground and turn them onto their side

Support the head

Loosen tight clothing that could restrict breathing

Keep track of time – call EMS if seizure >5 minutes

Check for medical alert ID

Stay with person until the seizure has ended

NEVER place anything in person’s mouth

NEVER forcefully restrain person

NEVER try to administer food, drink, or oral medication until full

awareness has returned and seizure has ended



WHAT SHOULD I DO? (CONT’D)

Complex Partial seizure:

Remove hazards from person’s path

Speak in a gentle voice

Do not forcefully restrain

Stay with person until the seizure ends and consciousness has fully

returned

If the person appears angry or agitated, observe from a distance, but

stay near them

Keep track of time

Help reorient the person after the seizure has ended and explain

what has occurred to bystanders



If the person has no known history of epilepsy/seizures

If the seizure lasted longer than 5 minutes (convulsive

seizures)

If the person is injured

If the person is pregnant or has diabetes

If the seizure occurs within water ( i.e. swimming pool)

If seizures occur in back -to-back clusters without the person

regaining consciousness

Seizures often have typical patterns that dif fer from person to

person, so if possible develop a seizure action plan if you

work with someone who has been diagnosed with epilepsy

WHEN TO CALL EMS



Seizure

Action

Plan

Missed medication or a change in medication

Lack of sleep or fatigue

Dehydration

Flashing lights (photosensitivity )

Hormonal changes (esp. in women)

Alcohol or drug abuse

Fever (febrile seizures – usually happen in young children)

SEIZURE TRIGGERS



Anti-epileptic drugs (AEDs)

Medications control or substantially reduce seizure frequency for

70% of epilepsy patients

Vagus Nerve Stimulation (VNS)

Implanted device that sends extra electrical signals to the brain

through the vagus nerve

Ketogenic diet

High fat diet typically used for seizure control in young children

Surgery

TREATMENT OPTIONS



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Both children and adults with epilepsy can experience social

isolation as a result of ignorance and stigmas that surround

their medical condition

Children with epilepsy are at an increased risk of developing:

Learning disabilities

Depression

SOCIAL ISSUES AND EPILEPSY



Establish effective communications between parents, teachers, students and other school personnel involved with the child

Develop a seizure action plan and talk about it in the student’s IEP

Keep a log documenting date, time and symptoms of seizure activity observed

Note changes in behavior, both academic and social

Keep updated records of any changes to the child’s medication (dosage and type)

Avoid overprotection of the child

Address teasing behaviors and educate other students about epilepsy

MANAGING SEIZURES IN THE SCHOOL



Founded in 1972

Mission Statement:

The Epilepsy Foundation

Western/Central Pennsylvania

leads the fight to stop

seizures, find a cure and

overcome the challenges

created by epilepsy.

EPILEPSY FOUNDATION

WESTERN/CENTRAL PA



Family Services

Family assistance: One-on-one

counseling

Family outings: Annual Picnic,

Holiday Party

Support Groups

Teen Getaway

Camp Frog (Erie and Wernersville, PA)

EPILEPSY FOUNDATION

PROGRAMS AND SERVICES



Created for children and teens ages 8-17 years old that have seizures

One week of camp in Erie and Wernersville, PA

Fully -integrated camp program with extra supportive and medical services

All camp counselors are given seizure recognition and first aid training

Pediatric neurologist and nurse on-site for the duration of camp

Financial assistance is available to help families pay for the camp fees

CAMP FROG



Adult Services

Information and Referral Services

Employment Education/ Advocacy Services

I.D Cards

Emergency Medication Assistance

Adult Socialization/Support Group Events

Scholarship Recipients

EPILEPSY FOUNDATION

PROGRAMS AND SERVICES



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Community Education

School Alert Presentations

Individual Education/Advocacy Cases

Community Educational/Training Presentations

Annual Conference

EPILEPSY FOUNDATION

PROGRAMS AND SERVICES (CONT’D)



For up to date information on all EFWCP Programs, Services

and Special Events, visit our website!

www.efwp.org

EPILEPSY FOUNDATION

WESTERN/CENTRAL PENNSYLVANIA



Epilepsy Foundation Western/Central Pennsylvania:

www.efwp.org

Epilepsy Foundation of America: www.epilepsyfoundation.org

England, Mary J. et al . (2012) Epilepsy Across the Spectrum:

Promoting Health and Understanding. Institute of Medicine of

the National Academies .

RESOURCES

Andrea Zonneveld Community Education &

Events Coordinator

Epilepsy Foundation Western/Central PA

1501 Reedsdale Street

Suite 3002

Pittsburgh, PA 15233

www.efwp.org ● 412-322-5880

• Strategies • Teaching • Educators • Parents • Students

BrainSTEPS What is BrainSTEPS? • Brain injury consulting teams available to

families and schools throughout Pennsylvania.

• Teams are extensively trained in the educational needs of students returning to school following brain injury.

• Teams will work with local school staff to develop educational programs, academic interventions, strategy implementation, and monitoring of students.

http://www.efwp.org/

http://www.epilepsyfoundation.org/

http://www.efwp.org/

11/29/2012

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The BrainSTEPS Program

Funded by:

1. PA Department of Health

2. PA Department of Education

Implemented by:

1. Brain Injury Association of Pennsylvania -

Beginning our 5th academic year

BrainSTEPS Encompasses

Acquired Brain Injuries

• Traumatic Brain Injury (includes Concussions)

• Non-Traumatic Brain Injury

(Any child who has a brain injury that occurs

AFTER the birth process can be referred!)

30 BrainSTEPS Teams 27 Intermediate Unit teams & 3 large school district teams

300+ Active Team Members

All Colored Areas = Trained BrainSTEPS Teams

White = Regions without BrainSTEPS teams

Hospital & Rehabilitation based: 1. Acadia Rehabilitation, Inc.

2. Children’s Hospital of Philadelphia

3. The Children’s Institute of Pittsburgh 4. Geisinger Medical Center

5. Good Shepherd Rehabilitation 6. Lehigh Valley Hospital

7. Hershey Medical Center

8. Mainline Rehabilitation 9. Nemours/A.I. duPont Hospital for Children

10. Reading Hospital 11. Schuylkill Health Systems

12. St. Christopher’s Hospital for Children

13. St. Vincent’s Medical Center 14. ReMED

15.The Barber Institute

Non-School Based Team Members Include:

What BrainSTEPS Can Do:

1. Conduct observations

2. Communicate with the district and medical

professionals

3. Gather medical, rehabilitation, & educational reports to assist in making educational

recommendations.

4. Provide Peer Trainings

5. Provide training for the school & family

6. Consult on all aspects of the student’s educational plan & make recommendations

to the district team.

7. Assist in transitioning a student from grade to

grade or school to school by training new teachers

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BrainSTEPS Teams monitor all referred students annually until graduation.

Who should be referred to BrainSTEPS?

A student who:

1. Has an acquired brain injury • At any point in the student’s life

2. Is having difficulty at school as a

result of the acquired brain injury

How to make a referral to

BrainSTEPS 1. Student with an acquired brain injury is identified

by a parent, physician, school, etc.

2. That person locates the BrainSTEPS team leader by county (www.brainsteps.net) and calls to

make a referral

3. The Team Leader will: • get parent permission signed

• ask intake questions • contact the school district

• work with their team members, school,

& family to create a plan of action

For More Information on the

BrainSTEPS Program

Contact:

Brenda Eagan Brown, M.S.Ed., CBIS

Program Coordinator

BrainSTEPS Brain Injury School Re-Entry Program

Brain Injury Association of Pennsylvania

Phone: 724-944-6542

Email: [email protected] www.brainsteps.net

QUESTIONS?

References:

Giza, C. C., & Hovda, D. A. (2001). The neurometabolic cascade of concussion.

Journal of Athletic Training, 36(3), 228–235.

Langlois, J. A., Rutland-Brown, W., & Wald, M. M. (2006). The epidemiology and impact of traumatic brain injury: A brief overview. Journal of Head Trauma and

Rehabilitation, 21(5), 375–378.

Information retrieved from: www.neurology.stanford.edu/divisions/e_12.html

www.internationalbrainassociation.org

www.brainline.org

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