BRAIN INJURY 101 Definition Causes Incidence Judy L

BRAIN INJURY 101 Definition Causes Incidence Judy L. Dettmer

Definitions of Brain Injury Traumatic Brain Injury (TBI): a physical force applied to the brain that results in a traumatic injury U. S. Department of Education, Federal Register, 1992 Acquired Brain Injury (ABI): an injury to the brain that occurs following birth, and can be classified as traumatic or non-traumatic Educational Dimensions of Acquired Brain Injury, Savage, Wolcott, 1994

Common Causes of TBI Infants: Physical abuse Toddlers: Falls Young Children: Passengers in vehicles School-aged Children: Bicycle and pedestrian collisions with vehicles Adolescents: Drivers and passengers in motor vehicle accidents

Sports & TBI Amateur Boxing Injuries consistent with acute TBI Post-concussive syndrome Football 20% high school players Soccer 5% Horseback Riding 17% of all equestrian injuries are brain injuries (Brain Injury Association of America)

Open v. Closed Brain Injury Open Brain Injury Skull is fractured Blood & swelling have a place to go Closed Brain Injury Concussion Swelling results in further (secondary) injury ○ May go unidentified if no loss of consciousness ○ Damage great or greater than open brain injury

Common Causes of Non-Traumatic Brain Injuries Illness (e. g. high fever) Infections (e. g. meningitis, encephalitis) Anoxic injuries Strokes, vascular accidents Brain tumors Poisoning (e. g. ingestion, inhalation) Metabolic disorders (e. g. insulin shock)

LEVELS OF SEVERITY Does not always predict outcome

Mild TBI (an oxymoron) Also called post-concussive syndrome Brief or no loss of consciousness 90% of concussions resolve in a few weeks 10% have symptoms that last a lifetime Symptoms are not “mild”

Moderate TBI Loss of consciousness for < 24 hrs Skull fracture, contusions, hemorrhage, or focal damage In children may result in ○ Physical weakness ○ Cognitive-communication impairments ○ Difficulty learning new information ○ Psycho-social problems

Severe TBI Loss of consciousness > 24 hours Multiple cognitive, communicative, physical, social, emotional & behavioral problems 20% return with minimal changes Approx 80% have life long changes

INCIDENCE OF BRAIN INJURY Is it a “low incidence” disability?

Breast Cancer 176, 300 Spinal Cord HIV/AIDS Injuries 43, 681 11, 000 Multiple Sclerosis 10, 400 Traumatic Brain Injuries 1, 500, 000 Comparison of Annual Incidence Data compiled by the Brain Injury Association of America based of data from the Centers for Disease Control and Prevention, American Cancer Society and National Multiple Sclerosis Society

Gender, Age and TBI After infancy boys are injured twice as frequently Young adults age 16 - 24 are most at risk

TBI in Children 1. 4 million children injured annually About 1/2 are between 16 -21 Highest risk groups ages 0 -4 and 15 -19 More likely to survive than adults Less likely to be unconscious

National Data Brain injury is the leading cause of death and disability of children in the U. S. (Pediatric Registry) CDC reports annual incidence of TBI for Children 0 -14: - 2, 685 deaths - 37, 000 hospitalizations - 435, 000 ED visits These numbers do not include children who sustained a TBI and did not seek medical care or were treated and released without mention of potential TBI

National Data Each year an average of 475, 000 TBIs occurred among children. Most children who sustained a TBI (91. 5%) were treated and released from the emergency department without further treatment. CDC 2005

CHARACTERISTICS AND AFFECTS OF BRAIN INJURY IN CHILDREN

Simplified Brain Behavior Relationships Frontal Lobe • Initiation • Problem solving • Judgment • Inhibition of behavior • Planning/anticipation • Self-monitoring • Motor planning • Personality/emotions • Awareness of abilities/limitations • Organization • Attention/concentration • Mental flexibility • Speaking (expressive language) Temporal Lobe • Memory • Hearing • Understanding language (receptive language) • Organization and sequencing Parietal Lobe • Sense of touch • Differentiation: size, shape, color • Spatial perception • Visual perception Occipital Lobe • Vision Cerebellum • Balance • Coordination • Skilled motor activity Brain Stem • Breathing • Heart rate • Arousal/consciousness • Sleep/wake functions • Attention/concentration

Executive Functions: Initiate Inhibit Shift Plan Organize Self-Monitor Emotional Control Working Memory

Executive Functions: Attention Planning Judgment Organization Problem-solving Emotion Regulation (lability) Social Skills

Some are more academically based: memory – “making new learning stick” processing speed abstract concepts money and time concepts sequencing learning simultaneous learning shifting/changing sets perseveration handwriting inconsistent learning curve learning plateau

Some are more organizationally based: initiation - completion time on task visual over-stimulation auditory over-stimulation planning under-arousal emotional load

Typical effects of mild to moderate BI Mental fatigue Slowed processing speed Difficulty transferring “new learning” into memory – affects sequential thinking Problems with Executive Function Social Skill problems

Typical effects of moderate to severe BI: Tend to see: Mental Fatigue Motor problems Feeding problems Cognitive problems – concrete thinking Emotional and Behavior regulation Seizures

How BI issues “manifest” in the classroom Mental fatigue Slowed processing speed Difficulty transferring “new learning” into memory – affects sequential thinking Problems with Executive Function Social Skill problems Head down, tired, “lazy” Dragging work out Inconsistent learning – “you had it yesterday and not today, faking” Behavior problems, ADHD, messy, Can’t get along with others

IDENTIFICATION AND ELIGIBILITY

U. S. Department of Education Data Students (ages 6 -21) During the 1991 -92 school year there were a total of 4, 499, 824 students receiving special education services of that total only 245 were served under the TBI disability category During the 1999 -2000 school year there were a total of 5, 683, 707 students receiving special education services of that total there were 13, 874 served under the TBI disability category U. S. Department of Education, Office of Special Education Services: Annual Report to Congress, 2000

U. S. Department of Education Data Students (ages 6 -21) 2005 data shows there were a total of 6, 021, 462 students receiving special education services of that total there were 23, 449 served under the TBI disability category Interesting fact, Autism became a disability category in 1991 also; in 1992, 15, 302 students were identified, in 2000, 79, 085 were identified and in 2005 192, 643 students were identified under the autism disability category

Let’s Recap: You do the Math… Each year an average of 475, 000 TBIs occurred among children (0 -14) The National Pediatric Registry reports that it is estimated that 19% of youth who sustained a brain injury will have long term disabilities Reviewing data from USDOE in 2004 there were 23, 204 students with TBI receiving special education services. In 2005 there were 23, 449 served under the TBI disability category (0 -21). Totaling an increase of 245 students.

Let’s Recap: You do the Math… Conservatively, using the 19% guideline, we could estimate roughly 90, 250 with long term disabilities resulting from brain injury annually. Get your calculators out…………… 19% of 475, 000 = 90, 250, USDOE increased by 245 in one year………… Are we missing 90, 005 students with brain injury?

Colorado Picture

Where Does Colorado Stand? According to data from the Colorado Department of Public Health and Environment, on average during 2004 -2006 annually there were 693 children (5 -21) discharged from an acute care hospital with TBI diagnosis. There an estimated 3, 000 youth living with brain injury in Colorado.

Where Does Colorado Stand? In 2007 Colorado reported 413 students identified with brain injury as their primary disability category for special education. In 2008 Colorado reported 419, an increase of 6 students. Calculators please……… 693 new injuries, CDE increase of 6 students…. . Are we missing 687 students annually?

Why Are We Missing These Kids? Transition support from medical setting is rare or poorly coordinated From hospital fewer than 2% are recommended for special education (though 19% have cognitive limitations) (National Pediatric Registry) Treat and Release from the EDs

Why Are We Missing These Kids? Brain injury often goes undiagnosed The effects of brain injury can be very subtle Families and school personnel have limited knowledge about brain injury

The Importance Of Accurate Identification Student receives appropriate interventions Prevent a cycle of failure Allows the student to begin developing self advocacy skills Accurate identification ensures more appropriate funding and subsequent service provision

TNT Website www. cokidswithbraininjury. com