4.2 - TBI in Children and Adolescents (Roberta DePompei) Flashcards
What 3 life arenas can be affected in children with TBI?
Classroom learning
Behavior
Community participation
What are the two types of brain injury?
Congenital
Acquired
What are the two types of acquired brain injuries?
Traumatic
Non-traumatic
What are the two types of traumatic brain injuries?
Closed head
Open head
What are the four major part of the brain’s nerve cells?
Axons
Dendrites
Receptor sites
Neurotransmitters
Why would language be believed to be neutral association?
It is the result of global linkages between nerve cell circuits
What happens to neural pathways when we learn something new?
They rewire
What is strategic learning?
2
Efficiently extracting important information
Efficiently inhibiting unimportant information (to not use up vital storage capacity)
What kind of learning is the brain most effective at?
2
Abstracting meaning
Not storing detail
How is strategic learning affected after TBI?
It impaired
The individual might have trouble summarizing, finding main idea, and interpreting statements
What is the theory behind the learning of high capacity and low capacity individuals?
High capacity individuals are more efficient at learning only relevant information
Low capacity individuals inefficiently encode and learn irrelevant informations
When does strategic learning begin?
What does this mean for children after TBI?
Early years
They should be provided with specific interventions early
What 4 things drive the Under-Identification Cycles of children suffering from the effects of TBI?
Apparent Low Incidence Rate (probably not true)
Lack of Awareness of TBI-specific issues
Lack of Research Money
Lack of training
What 5 things may prevent a child from being referred for SLP services post-TBI?
Lack of medical referral
Lack of parental recognition
Developmental bias that they will be OK
Many “look good” physically
Lack of public awareness
What often happens to children who do not receive intervention after TBI?
They can end up in…
– Mental health systems
– Penal institutions
– Welfare rolls
– Social service agencies
What Attention Disorders can be found in children post-TBI?
4
Sustaining attention
Easily fatigued
Impaired selective attention
Poor shifting of attention (gets lost in group conversations)
What Memory Disorders can be found in children post-TBI?
4
Poor rote learning
Short term memory difficulties
Difficulty organizing information to store
Can’t recognize what is “important” to store
What Planning Disorders can be found in children post-TBI?
7
Impaired ability to abstract
Can’t inhibit action resulting in impulsive or perseverative responses
Slowed initiation time
Can’t start to solve a problem
Can’t sequence information
Doesn’t learn from mistakes
Doesn’t know when, where or how to ask for help
What Judgement Disorders can be found in children post-TBI?
4
Misinterprets actions of others
Can’t handle multiple bits of information at one time
Socially unacceptable verbal and physical behaviors
Unrealistic appraisal of self and residual strengths and weaknesses
What Processing Disorders can be found in children post-TBI?
(4)
Extreme slowness in reaction time
Slowed in psychomotor activities (talking, writing etc)
What Communication Disorders can be found in children post-TBI?
(5)
Anomia
Inefficient word retrieval
Hyperverbal
Use of peculiar words or phrases
Uninhibited choice of words
What 10 problems can occur after TBI in children?
DISORIENTATION (not appropriate to the prevailing stimuli—unable to discuss where he is)
DISORGANIZATION (fragmented and incomplete thoughts—unable to complete sentence)
CONFUSION
CONFABULATIONS (story telling; filling in information that can be partially true and partially untrue)
CIRCUMLOCUTIONS (talking around the word without saying it)
TANGENTS (getting further and further from the topic)
HYPERVERBALNESS (talking long past the point where others are interested)
STIMULUS BOUND (sticks on one part of the topic but cannot convey the intent of the entire message)
REDUCED INITIATION (can’t start the conversation but can respond if someone else begins)
REDUCED INHIBITION (once started can’t stop)
What may be seen in a child post-TBI due to impaired attention, perception, and/or memory?
(3)
Daydreaming
Bothering another student
Playing with materials from desk
What may be seen in a child post-TBI due to inflexibility, impulsivity, and/or disorganized thinking, or acting?
(2)
Speaking out
Interrupting with non relevant topic
What may be seen in a child post-TBI due to inefficient processing of information (rate, amount, & complexity)?
(4)
Asking for repeats of information
Acting rude
Doodling on paper
Bolting the classroom/work station
What may be seen in a child post-TBI due to difficulty processing abstract information?
Does not get double meanings of words, humor, puns
What may be seen in a child post-TBI due to difficulty learning new information, rules and procedures?
(2)
Can’t learn a new game.
Only sorts by shape, can’t convert to color
What may be seen in a child post-TBI due to inefficient retrieval of old or stored information?
(2)
Poor test taker
Inconsistent memory for information (recalls facts one day and not the next)
What may be seen in a child post-TBI due to ineffective problem solving and judgment?
(2)
May have temper tantrums like much younger aged person
Sticks to only one solution and will not change mind
What may be seen in a child post-TBI due to inappropriate or unconventional social behavior?
(3)
Quick to lose temper
Uses foul language at the wrong times
Poor social interactions
What may be seen in a child post-TBI due to impaired “Executive” Functions?
(2)
Self-awareness of strengths and weaknesses
Goal-setting, planning, self-initiating, inhibiting, monitoring & evaluating either do not develop as they should or are ineffectively used
What can happen the the trajectory of a child’s development when they are not assessed as they age?
They may appear to have returned to “normal” levels
They may experience a decline in function as they age
This may be due to their reliance on information learned pre-injury and inability to efficently learn new information
In what 2 environments should we assess a child post-TBI?
Where he/she communicates (context specific environments)
One-on-one evaluation versus evaluation within environment
What 7 normed assessments measures can be use to assess cognitive function in children post-TBI?
Peabody Picture Vocabulary
Woodcock Johnson: Picture Vocabulary and Sentence Memory Subtests
Wisconsin Card Sort
Boston Naming
Test of Word Finding
CELF: Concepts and Directions
California Test of Verbal Learning
What are 3 informal measures that can be used to assess language in children post-TBI?
The Giant Story
The Cookie Theft: Verbal and written
Conversation about his interests and activities
What 6 things should we be aware of in a child’s environment?
Organizational System
Location in Work Area
Distractions
Work Materials and Equipment
Performance Options
Transitions
What 13 things should we be aware of in Communication Manner and Style when dealing with children post-TBI?
Average rate
Organization
Attentiveness
Word choice
Use of sarcasm, humor, puns
Typical length and complexity
Gestures
Body Language
Objects
Responsiveness
Ability to Provide Directions
Ability to understand
Patience
What 3 cognitive measures can we intervene in with children post-TBI?
Attention
Memory
Organization and Planning
In what 2 specific ways can we intervene in Attention with children post-TBI?
Task analysis
Task completion
In what 2 specific ways can we intervene in Memory with children post-TBI?
Internal aids
External aids
What are 5 Attention and Concentration Strategies that can be used with children post-TBI?
Reduce distractions in work area
Divide work into smaller sections
Have person summarize new information
Use cue words to alert person to pay attention
Develop a nonverbal cueing sys
What are 7 Memory Strategies that can be used with children post-TBI?
Repeat information often and summarize it
Carry an assignment sheet for each class
Use devices as self-reminders
Categorize or chunk information
Use special words as reminders
Link new information to prior knowledge
Give examples with instructions
What are 16 Organizational and Concentration Strategies that can be used with children post-TBI?
Extra time for review
Written checklist of steps for complex tasks
Instruction for checking each step when done
Written schedule of daily routine
Person to meet with at start and end of school/ work day
Written cues to organize activities
Practice sequencing material
Outline to match lectures with note taking sections
Color coded materials for each class
Practice organizing activities
Oral and written directions
Have person repeat instructions
Highlight important part of written directions
Break directions down into simple steps
After client does task, check work and give feedback
Slow pace of instruction
How can we target Strategic Learning Skills in children post-TBI?
(1+5)
Identify main idea
Increasing problem solving skills
Building language skills
Developing self-advocacy
How should we intervene with young children post-TBI?
Play
Introduce social interactions with other children and family
Stimulate receptive and expressive language
Start vocation transitions (turn taking, responsibilities)
Why should we involve families when treating children post-TBI?
Families are the one constant
Families are the real experts
