Traumatic Brain Injury

Jeff KuratnickKathryn WalterKera Volk

Michelle Staab

Hands-on activity

    TERMINOLOGY -Open Head Injury- Brain injury where there is an open wound or penetration of the head by an

object which results with damage to brain tissue -Closed Head Injury-Damage to brain that happens without penetration of skull could be caused

by blow to head or violent shaking by an adult. -Behavior Modification-Systematic control of environmental events, especially of consequences to

make specific changes in observable responses. Can include reinforcement, punishment, modeling, self-instruction, desensitization, guided practice or any other technique for strengthening or eliminating a particular response.

-Behavior Management-Strategies and techniques used to increase desirable behavior and decrease undesirable behavior. Can be used in classroom, home, or other setting.

-Concussion-Shock from an impact that causes brain injury. Ex. A blow to the head -Contusion-Bruise.

TERMINOLOGY CONT.-Acquired Brain Injury (ABI)-Damage to brain acquired after birth, not external force ex. Stroke, meningitis, and anoxia -Non-Traumatic Brain Injury-Stroke, brain tumors, infection, poisoning, hypoxia, ischemia or substance abuse. -Mild Traumatic Brain Injury (MTBI)-A brief loss of consciousness, loss of memory immediately before or after the injury, any

alteration in mental state at the time of the accident, or focal neurological deficits.

-Neuropsychological-Aims to understand how structure and function of brain relate to specific psychological process and overt behavior.

-Brain Stem-Plays a vital role in attention, arousal and consciousness. All information going to and from our body passes through the brain stem to or from the brain.

-Frontal Lobe- Controls motor function, problem solving, spontaneity, memory, language, initiation, judgment, impulse control,

and social and sexual behavior.Two parts: Left-Controls language related movement.

Right-Controls nonverbal abilities. -Temporal Lobe-controls sensory information as well as language so damage to the left side makes it hard to understand words

and damage to the right side can affect the ability to talk.

 DEFINITION

IDEA Definition · Traumatic Brain Injury-acquired injury to brain caused by

external physical force, resulting in total or partial functional disability or psychosocial impairment, or both, that adversely affects a child's educational performance. This term applies to open or closed head injuries resulting in impairments in on or more areas: cognition, language, memory, attention, reasoning, abstract thinking, judgment, problem-solving, sensory, perceptual, and motor skills, psychosocial behavior, physical function, information processing, and speech. This term doesn't apply to injuries that are congenital or degenerative or brain injuries induced by birth trauma. [34CF4, Sec.300.7(6)(12)]

Classification – of injury

Primary Injury  - (2 causes)1. contact – object hits the head/ brain hits inside of skull -- results in injury to scalp/ fractures/ surface contusion

2. acceleration/deceleration – unrestricted movement of the head - Causes intracranial hematomas - the most common cause of death and clinical deterioration after

TBI- Common features attributed to I.H. include blood clots, lesions, and overall pressure on the brain

tissue.

Secondary injury - may occur hours or even days after the inciting traumatic event (2 causes)

1.    Impairment-

2.   declines in cerebral blood flow – result of hemorrhage/ intracranial pressure

Classification – Effects after injury

Mild TBI • loss of consciousness for a few seconds/ minutes immediately following injury• lightheadedness, headache, ringing in ears, memory trouble, and thinking affected

Moderate TBI • may show same symptoms as mild TBI• worsening/ persistent headache, vomiting or nausea, convulsions or seizures, and agitation.• seek medical attention IMMEDIATELY

Severe TBI • hematomas (ruptured blood vessels) or contusions (bruised brain tissue) prevalent• posttraumatic seizures • coma/vegetative state common in severe TBI• seek medical attention IMMEDIATELY

Video – Living with Traumatic Brain Injury

http://youtube.com/watch?v=FgtHvBF4t-E&feature=related

Prevalence:- The exact prevalence of TBI is difficult to determine because many head injuries

are not reported and many cases of TBI are mistaken for other disabilities.

Statistics: - About 50% of school-aged children acquire a brain injury each year - Nearly 4% of students may have TBI by the time they graduate high school - An estimated 3,000 children and youth die from TBI each year- 29,000 children and youth are hospitalized due to TBI each year- Youths between the ages of 15 and 19 are the most likely to sustain a TBI because

of: 1. sporting accidents2. firearm accidents3. auto accidents

- By age 16, about 4 out of 100 boys and 2.5 out of every 100 girls have sustained a TBI

Causes

• Open head injuries • Closed head injuries • Chemical/ toxic • Hypoxia – Lack of oxygen • Tumors • Infections • Stroke

Identification and Assessment

Identification (common disabilities include….)· problems with cognition (thinking, memory, and reasoning) · sensory processing (sight, hearing, touch, taste, and smell)· communication (expression and understanding) · behavior or mental health (depression, anxiety, personality changes, aggression, acting out, and

social inappropriateness)  Assessment· Medical assessment used in making accommodations at school· Functional Independence Measure (FIM) - One of the most widely used measures of function in rehabilitation- 18 item scale used to evaluate level of independence in areas such as; mobility, self care and cognition· Glaslow Coma Scale· Glaslow Outcome Scale· IEP (REMEMBER!!!)- must be frequently reassessed due to the progress of the injury- As students progress; frequent review/ placement changes essential

Psychological and Behavioral Characteristics:

-  Physical changes-fatigue-headaches-difficulty balancing-sensory impairments

-  Change in mood and behavior -depression-anxiety-irritability-inappropriate mannerisms

-   Changes that affect academic performance-memory loss-struggle to retain new information-difficulty sequencing things -trouble staying focused-difficulty planning and following through with tasks

Simulation

EDUCATIONAL CONSIDERATIONS

-Transition                        

-IEP

-Co Teaching

-Team Approach

Service Delivery

• Mainstreaming into the general education classroom • Working one on one with a specialist a few times a week • Focus on behavioral patterns – not behavior • Give IQ tests to find the level of the student

• *Depends on the severity of each individual’s situation*

Issues of Early Intervention

· variability, flexibility, coordination of services to meet needs of student· wide variety of interventions available

· Environmental intervention - structure - minimize unnecessary stimuli (noisy rooms)- transitional classrooms – pre- school return, ability to function evaluated

· Behavioral Intervention - positive reinforcement – successful for chronic problems- provide verbal feedback – promotes regulation

· Cognitive Intervention- task analysis – steps within capabilities- self management techniques – re-teach the basics- breakdown of tasks – students more effective

Issues of transitioning to adult life

· Preparing for everyday things · Finding a job · Living with assistance or on their own · Safety · Nutrition/ grocery shopping · Handling money · Education · Social interactions

Video - Nick’s Story

http://youtube.com/watch?v=KTpw_HIW-EY