Traumatic Brain Injuries

WHAT IS A TRAUMATIC BRAIN INJURY?Traumatic brain injury means an injury caused by an external force, such as a blow to the head

Important TBI Facts:

•TBI is the leading cause of death AND disability in people ages 1-35

•A “mild” brain injury can seriously disrupt higher order thinking, executive functions, and social behavior. Multiple brain injuries of any severity cause cumulative damage.

•The younger child shows greater impact

•Even very severe TBIs may not show up on scans

•TBI almost always adversely affects behavior

•Even knowledgeable physicians miss the long term effects of TBI

Severity of Brain Injury in Children

Mild: •Concussion •Brief loss of consciousness •Amnesia or AMS w/o the loss of consciousness

Moderate: •Loss of consciousness for 1-24 hours •Subdural hematoma (bleed in the brain)

Severe: •Loss of consciousness for more than 24 hours

A LITTLE DATA:

MV Crash

Motorcy

cleBic

ycle

ATC/RV

Pedest

rian

Gunsho

t

Cuttin

g/Pier

cing

Beati

ngSpo

rtStr

uckAn

imal

Machine

Caug

ht Fall

Other

0.00%

5.00%

10.00%

15.00%

20.00%

25.00%

30.00%27.10%

1.20%

9.70%

1.80%

13.70%

0.80%0.20%

4.40%5.00%4.40%1.50%0.10%0.10%

26.50%

3.60%

Mechanism...

Data Specific to West:

Sports MV Accident Falls Fights0

5

10

15

20

25

30 28

42 2

2013 2014 School Year

Brain Injury in Childhood Almost Always Results in

these Cognitive Symptoms: Sensory Motor Changes

Poor Executive Functioning (organization, processing speed, mental flexibility, self-monitoring)

Unevenness

Fatigue

Deficits in new learning and memory

Social-emotional changes

Developmental Pyramid: Executive Functioning

Our Students

So What Do We Do to Help Our Students at West?

Concussion Management Plan/Team Ensure appropriate accommodations Collaborate between athletic staff, clinic staff, mental

health staff, teaching staff, and parents (wrap around effect)

Educate staff, parents, and students

504 plans and/or IEPs, if necessary

Counseling Through Veronica or Deanna (MHCD therapist)

Concussion Team Members at West High School

DPS Psychologist DPS Trainer Denver Health Nurse Practitioner DPS Nurse

How are students referred to the Concussion Team? Trainer is at the sporting event where

the injury occurs. Student presents to the School Based

Clinic Parent notifies the school Other school staff become aware of the

injury

Evaluation Trainer administers the SCAT 2 at the time of

the injury Results shared with clinic Medical evaluation in the School Based Clinic Information shared with school psychologist,

nurse and trainer Email sent to teachers and other school staff

explaining accommodations needed for the student

EMAIL: Dear Teachers,This email is to inform you that Snoopy sustained a head injury on October 23, 2013.  The student was evaluated by a medical professional and was diagnosed with a concussion.  It is generally recommended that the student rests for two to three weeks after their head injury in order to allow the brain to heal.  Therefore, we ask that during this time, and/or until he is cleared by medical staff, you provide the following accommodations in your classroom: 1.  No physical activity other than walking2.  No tests, quizzes, or major assignments should be given to the student during the healing time.  Allow him to make up this work when he has recovered3.  Allow the student to take breaks when needed.  If he needs to see the nurse or go to the counseling center for rest please allow him to do so.4.  Light classwork.  Provide the student with copies of class notesAlso, if you notice any changes in his behavior (i.e., irritability/fatigue, difficulty with his memory and/or sustaining attention, slower processing speed, sensitivity to light and sounds) please notify me or the nurse immediately.  I will be sure to inform you when the student has been cleared to resume normal activities.  Thank you

Dear Teachers,This email is to inform you that Snoopy has been examined by medical personnel and has been cleared to resume normal activities. Thank you for your cooperation during his healing period in providing him with the appropriate accommodations in the classroom.

Medical Evaluation: History Mechanism of injury? LOC Prior concussions Headache Balance issues Photophobia, phonophobia Vomiting Fatigue Concentration and memory issues

Medical Evaluation: History Sleep Mood changes Dizziness

It is normal for symptoms to last for 2-3 weeks.

Medical Evaluation: Physical

Complete physical exam, vital signs Complete neurological exam

Concussion Handout given Parents contacted to review plan

Referral for complicated concussion Symptoms not resolved after 3 weeks Any time student reports worsening of

symptoms

Challenges Teachers Student gets secondary gain from

accommodations High achiever does not want to abide by

accommodations Student is evaluated in an ED or has an

outside PCP

Restrictions School accommodations Exercise – only walking No reading, video games

Student is re-evaluated in the School Based Clinic weekly until symptoms have resolved.

Trainer administers SCAT 2 weekly if sports-related concussion.

Multiple Head Injuries:

•No law that says a student must stop playing a sport if they sustain multiple head injuries

•Case of Diana and Luis

•The power of unity and education

How Can You Help Students?

TAKE ALL BRAIN INJURIES SERIOUSLY

Bring TBI to the talking table

Collaborate/communicate and form a school TBI team

Recognize the symptoms and ACCOMMODATE

Most of all: BE PATIENT!!!! Just like a broken arm/leg

Presentation Resources: Dise-Lewis, J, Lewis, H. BrainStars: Strategies for

Teams and Re-education for Students. U.S. Dept. of Education, 2002

Dise-Lewis, J. Executive Functions: Developmental Considerations related to Pediatric ABI. 2010

THANK YOU!!!! REMEMBER TO PROTECT YOUR BRAIN:

Wear a helmet Wear your seat belt