Brain Injury among Children and Youth: Myths and Facts

• Marilyn Lash, M.S.W.

• Lash and Associates Publishing/Training

• www.lapublishing.com

Defining Brain Injury

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

Severity of Injuries

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

Myths and Facts

about Brain Injury

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: Time heals.

Fact: Time reveals.

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.

Incidence and Identification

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

Consequences of Brain Injury in the Classroom

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