16 Traumatic Brain Injury

The following section is adapted from: Center for Parent Information and Resources, (2015), Traumatic Brain Injury. Retrieved 4.1.19 from https://www.parentcenterhub.org/tbi/ public domain

SUSAN’S STORY

Susan was 7 years old when she was hit by a car while riding her bike. She broke her arm and leg. She also hit her head very hard. The doctors say she sustained a traumatic brain injury. When she came home from the hospital, she needed lots of help, but now she looks fine.

In fact, that’s part of the problem, especially at school. Her friends and teachers think her brain has healed because her broken bones have. But there are changes in Susan that are hard to understand. It takes Susan longer to do things. She has trouble remembering things. She can’t always find the words she wants to use. Reading is hard for her now. It’s going to take time before people really understand the changes they see in her.

WHAT IS TRAUMATIC BRAIN INJURY?

A traumatic brain injury (TBI) is an injury to the brain caused by the head being hit by something or shaken violently. (The exact definition of TBI, according to special education law, is given below.) This injury can change how the person acts, moves, and thinks. A traumatic brain injury can also change how a student learns and acts in school. The term TBI is used for head injuries that can cause changes (impact learning) in one or more areas, such as:

• thinking and reasoning,
• understanding words,
• remembering things,
• paying attention,
• solving problems,
• thinking abstractly,
• talking,
• behaving,
• walking and other physical activities,
• seeing and/or hearing, and
• learning.

The term TBI is not used for a person who is born with a brain injury. It also is not used for brain injuries that happen during birth.

WHAT ARE THE SIGNS OF TRAUMATIC BRAIN INJURY?

The signs  (characteristics) of brain injury can be very different depending on where the brain is injured and how severely. Children with TBI may have one or more difficulties, including:

Physical disabilities: Individuals with TBI may have problems speaking, seeing, hearing, and using their other senses. They may have headaches and feel tired a lot. They may also have trouble with skills such as writing or drawing. Their muscles may suddenly contract or tighten (this is called spasticity). They may also have seizures. Their balance and walking may also be affected. They may be partly or completely paralyzed on one side of the body, or both sides.

Difficulties with thinking: Because the brain has been injured, it is common that the person’s ability to use the brain changes. For example, children with TBI may have trouble with short-term memory (being able to remember something from one minute to the next, like what the teacher just said). They may also have trouble with their long-term memory (being able to remember information from a while ago, like facts learned last month). People with TBI may have trouble concentrating and only be able to focus their attention for a short time. They may think slowly. They may have trouble talking and listening to others. They may also have difficulty with reading and writing, planning, understanding the order in which events happen (called sequencing), and judgment.

Social, behavioral, or emotional problems: These difficulties may include sudden changes in mood, anxiety, and depression. Children with TBI may have trouble relating to others. They may be restless and may laugh or cry a lot. They may not have much motivation or much control over their emotions.

A child with TBI may not have all of the above difficulties. Brain injuries can range from mild to severe, and so can the changes that result from the injury. This means that it’s hard to predict how an individual will recover from the injury. Early and ongoing help can make a big difference in how the child recovers. This help can include physical or occupational therapy, counseling, and special education.

It’s also important to know that, as the child grows and develops, parents and teachers may notice new problems. This is because, as students grow, they are expected to use their brain in new and different ways. The damage to the brain from the earlier injury can make it hard for the student to learn new skills that come with getting older. Sometimes parents and educators may not even realize that the student’s difficulty comes from the earlier injury.

Although TBI is very common, many medical and education professionals may not realize that some difficulties can be caused by a childhood brain injury. Often, students with TBI are thought to have a learning disability, emotional disturbance, or an intellectual disability. As a result, they don’t receive the type of educational help and support they really need.

When children with TBI return to school, their educational and emotional needs are often very different than before the injury. Their disability has happened suddenly and traumatically. They can often remember how they were before the brain injury. This can bring on many emotional and social changes. The child’s family, friends, and teachers also recall what the child was like before the injury. These other people in the child’s life may have trouble changing or adjusting their expectations of the child.

Therefore, it is extremely important to plan carefully for the child’s return to school. Parents will want to find out ahead of time about special education services at the school. This information is usually available from the school’s principal or special education teacher. The school will need to evaluate the child thoroughly. This evaluation will let the school and parents know what the student’s educational needs are. The school and parents will then develop an Individualized Education Program (IEP) that addresses those educational needs.

It’s important to remember that the IEP is a flexible plan. It can be changed as the parents, the school, and the student learns more about what the student needs at school.

(Center for Parent Information and Resources, 2015)

The following text is an excerpt from:

DeMatteo CA, Randall S, Lin C-YA and Claridge EA (2019) What Comes First: Return to School or Return to Activity for Youth After Concussion? Maybe We Don’t Have to Choose. Front. Neurol. 10:792. doi: 10.3389/fneur.2019.00792 This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY).

Concussion

Concussion has become an epidemic in children and youth. The number of reported head injuries in Emergency Departments among youth playing sport has increased in the past decade by over 40% . The symptoms of concussions can often interfere with participation and performance in home, school, and community activities. The current consensus for standard concussion management is the six-stage Berlin Return to Play recommendations. This statement and much of the literature now suggest a more conservative approach to the management of children/youth with concussion. It is, however, still unclear as to what “more conservative” entails. When they are symptomatic, children and youth are advised to rest for 48 hours, then gradually resume regular activity with incremental increases in physical and cognitive activity within symptom tolerance. Depression and anxiety may result as a secondary sequelae if youth are socially isolated and removed from normal activity and participation for prolonged periods of time. Prolonged rest can lengthen recovery time and contribute to deconditioning, therefore protocols for children must contain a balance of activity and rest to promote physical, emotional and cognitive recovery.

Both Return to School (RTS) and Return to Activity/Play  (RTA) protocols for pediatric concussion management should be conservative and individualized. A number of protocols guiding families and youth through progressive recovery steps for safe Return to School (RTS) and Return to Activity/Play (RTA) have now been developed, are widely-accepted and are important aspects of pediatric concussion management.

Download Return to School Guidelines https://www.frontiersin.org/articles/10.3389/fneur.2019.00792/full#supplementary-material

Youth return to school faster than they return to play in spite of the self-reported, school-related symptoms they experience while moving through the protocols. Youth can progress simultaneously through the RTS and RTA protocols during the early stages 1–3. Considering the numbers of youth having school difficulties post-concussion, full contact sport, stage 6, of RTA, should be delayed until full and successful reintegration back to school has been achieved. In light of the huge variability in recovery, determining how to resume participation in activities despite ongoing symptoms is still the challenge for each individual child. There is much to be learned with further research needed in this area

*Research sample mean age of the research is “46% male, 13 yrs. of age.

(DeMatteo, Randall, and Lin, 2019)

The Full article and references can be accessed at: https://www.frontiersin.org/articles/10.3389/fneur.2019.00792/full#h14

Optional Extended Learning / Teacher Recources

• From the Wisconsin Department of Public Instruction Mild Brain Injury Brochure for Educators
• Colorado Dept. of Education, (2012). Brain Injury in Children and Youth A Manual for Educators. Retrieved from  http://www.cde.state.co.us/cdesped/tbi_manual_braininjury
• Brain Injury Association of VA, (2013) Brain Injury and the Schools: A Guide for Educators, Ch. B & C, Educational Implications. Retrieved from http://www.doe.virginia.gov/special_ed/disabilities/traumatic_brain_injury/brain_injury_schools.pd

updated 9.26.22