TBI and adolescent Flashcards
highest risk of TBI
Ages
0-4: Falls, Susceptible to Abusive Head, Trauma/Shaken Baby Syndrome (AHT/SBS)
Ages 15-19: Struck by something, Falls
leading cause of death / disability in children/ adolescents in the US
Traumatic brain injury is the leading cause of death and acquired disability in children and adolescents in the United States
age effect of TBI
While children may look fine after the trauma, they’re just as vulnerable to injury as adults
The prognosis for functional recovery of previously learned skills is better the younger the child is when the injury is acquired; but prognosis for acquiring new skills is worse the younger the child is at time of injury
Effects of trauma may not immediately be apparent, as the child’s brain is still developing
As the child gets older, that part of the brain previously damaged may not work as well as it should
maturation age 3-5
Period of overall rapid brain growth in all regions of the brain
Perfecting ability to form images, use words, and place things in serial order; beginning to develop tactics for problem solving
maturation age 8-10
Sensory and motor systems continue to mature in tandem
Frontal executive system begins accelerated development
Maturation of sensory motor regions of the brain peak
Begin to perform simple operational functions (e.g. determining weight and mathematical reasoning)
maturation age 14-15
Maturation of visuospatial, visuo-auditory and somatic systems
Able to review formal operations, find flaws and create new ones
maturation age 17-19
Maturation of frontal executive functions
Questions information, reconsiders and forms new hypotheses
brain injury immediate impact on development
immediate result is serious disruption to normal development
recovery period of brain injury
right after initial brain injury recovery period, which includes aspects of both spontaneous recovery and rehabilitative efforts
For children who may experience this developmental stall, continued rehabilitative efforts may serve to mitigate the stalled post-injury development
latent stage of brain injury
stage of development post injury
may have DECLINE post recovery period or with proper interventions may maintain gains and continue to learn new skill
ongoing intervention for adolescent TBI
When brain injury has been properly identified, medical and school professionals are collaborating, and ongoing services and supports are made available we see best results
non traumatic injury and adolescent
Brain tumors Anoxia or hypoxia Infections CVA (from AVM or Sickle Cell Disease) Exposure to toxic substances
often misinterpreted as developmental d/o
abusive head trauma
aka shaken baby syndrome
Most common in infants and young children 0 to 5 years old
More common for boys to be the victim
Often committed by frustrated care giver in response to crying baby, temper tantrums or issues due to toilet training
Male caregivers more often commit the abuse
AHT/SBS Prevention Strategies
education!
25-50% of teenagers do not know that shaking baby is bad
teach ways to cope with crying babies
crisis hotlines
AHT/ SBS diagnostic criteria
Bleeding of the brain (subdural hemorrhage or hematoma)
Brain Swelling (cerebral edema)
Bleeding in eyes (retinal hemorrhage)
AHT/SBS outcomes
75-80% long term disability
40% severe deficits
15-30% die as a result of injury
15% other result
concussion for student athletes
need training for coaches / staff
must be evaluated and cleared for return to play
post concussive syndrome in the student athlete
10% of athlete with persistent symptoms (lasts longer than 2-3 weeks)
symptoms:
fatigue, attention, memory, fatigue, sleep, headache, dizziness, irritability or change in mood
post concussive evidence
some research shows measurable changes on functional imaging
second impact syndrome
SIS can occur when an athlete sustains an initial concussion and then sustains a second head injury before symptoms from the first have fully resolved
The second concussion could occur minutes, days, or weeks after the initial event and can be fatal or result in severe disability
SIS may occur due to diffuse cerebral swelling or secondary to a subdural hematoma
return to school - importance of collaboration between medical and rehab systems
referral systems are key to support long term needs - both medical and educational
hospitals / medical settings need to develop discharge policies to aid communication and discharge planning
504 education plan
formal plan implemented to aid general education
Provides reasonable accommodations so they can benefit from education Can include: Preferential seating Extended time on assignments or tests Tests in quiet setting Rest breaks built into schedule Shortened assignments Books on CD or the use of text to speech software
IEP - individualized education plan
special education needs - specially designed and individualized
supported under IDEA
Support and related services recommended by IEP can include: Adapted technology Speech language pathology & Audiology Psychological Services Occupational & Physical Therapy Parent Counseling and training Medical services
3 major clusters of needs for kids with BI
cognitive
psychosocial
sensorimotor
motor impairments for kids with BI
gross / fine motor coordination speed spastic ataxic apraxic
physical effects for kids with BI
less common but significant disruption in growth eating D/o diabetes thermoregulation difficulties
feeding/ sensory d/o for kids with BI
dysphagia
vision loss / hearing loss
memory problems for the student look like …
difficulty with new learning
cannot remember 2-3 step directions
unable to grasp new concepts easily
difficulty recalling schedule / assignments
attention/ concentration problems for students look like
distracted by normal classroom activity
delayed in responding to questions
difficulty staying on topic
unable to complete task without prompting
higher level problem solving issues look like ..
difficulty organizing and completing long term projects
lacks ability to sequence
difficulty drawing conclusions
difficulty evaluating information
language problems look like …
difficulty taking turns in conversation
unable to summarize / articulate thoughts, talks around subjects/ indefinite words
does not understand complex conversation
visuospatial problems look like .. .
difficulty completed math worksheets
field cut
disoriented in hallways / route finding
behavior/ emotional problems look like ..
says / does socially inappropriate things
difficulty fitting in with peers
easily misled by peers into making poor choices
easily frustrated
This is the most common and most misunderstood experience - not due to choice but due to memory / disinhibition / exec. func issues
scatter skill
kids with BI can have extreme discrepancies in abilities
some things done really well
other things very challenging
send to neuropsych for eval
Child Find
component of IDEA which requires schools to locate, identify, and evaluate all students from birth to 21 whom they suspect to have a disability
assessment of child with BI
This should begin in the hospital - hospital and school connect for educators to begin evaluation process and plan for IEP needs
comparing 504 plan vs. IEP
504- can be in place while waiting for IEP.
quickly establish eligibility with brain injury documents
can be useful if child does not meet IEP requirements
IEP- contract btw the school system and student’s family designating kinds of services - describes the help student is given
developing an IEP for brain injury
goals are required to be reviewed every 12 months - but should be reviewed every 2-4 months
traditional IEP evaluates every 3 years, but with early stage of brain injury recommend evaluate 6-12 months
charter school
follows same IDEA rules as public school - services provided
private school
school district where kid lives provides the assessment
if kid stays in private, the school district can offer limited services to child
students with medical needs
IHCP
school nurse can help establish individual health care plan and set up things like
g tube, oxygen, seizure, headaches
school transitions for kids with BI
these can be challenging - set up transition planning early
provide specifics early - to student and to teachers
post secondary accomodations
IDEA does not apply to college
504 accommodations can be made - each college varies in types and amount of accommodations
provide assistance as to what schools will be appropriate for the student
vocational planning for post secondary
educate students on options and potential resources for post high school
linkage to services is key
