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Traumatic Brain InjuryDISABILITY CATEGORY: Traumatic Brain Injury TYPES: Mild, Moderate, Severe DEFINITION(S): Our nation’s special education law, the Individuals with Disabilities Education Act (IDEA) defines traumatic brain injury as... “...an acquired injury to the brain caused by an external physical force, resulting in total or partial functional disability or psychosocial impairment, or both, that adversely affects a child’s educational performance. The term applies to open or closed head injuries resulting in impairments in one or more areas, such as cognition; language; memory; attention; reasoning; abstract thinking; judgment; problem-solving; sensory, perceptual, and motor abilities; psycho-social behavior; physical functions; information processing; and speech. The term does not apply to brain injuries that are congenital or degenerative, or to brain injuries induced by birth trauma.” [34 Code of Federal Regulations §300.7(c)(12)] Other definitions: Traumatic brain injury (TBI), also called acquired brain injury or simply head injury, occurs when a sudden trauma causes damage to the brain. TBI can result when the head suddenly and violently hits an object, or when an object pierces the skull and enters brain tissue. Symptoms of a TBI can be mild, moderate, or severe, depending on the extent of the damage to the brain. (Source: National Institution of Neurological Disorders and Stroke, NINDS) FACTS AND STATS: Each year, at least 1.5 million Americans sustain a traumatic brain injury (TBI) resulting in more than 4,000 individuals sustaining a TBI on a daily basis. One million people are treated and released annually from hospital emergency rooms after sustaining a brain injury. Brain injury claims more than 50,000 lives and leaves more than 80,000 individuals with lifelong disabilities each year. With traumatic brain injury occurring every 21 seconds, this public health concern ranks as the leading cause of death and disability in children and young adults. For those who survive and their families, brain injury is life altering. Serious physical impairments are a frequent result, as are a variety of cognitive, behavioral and emotional complications. In addition, the costs related to brain injury are staggering. Individuals with severe brain injury typically face five to 10 years of intensive rehabilitation with cumulative costs exceeding $35 billion annually. (Source: Brain Injury Association of America, 2006) CAUSES: Injuries are the leading cause of death in the United States for people ages 1-34. Of all injuries, those to the brain are most likely to result in death or permanent disability. Most of these brain injuries are preventable. (Source: Centers for Disease Control and Prevention, CDC) PREVENTION: The Brain Injury Association of America offers fact sheets, which include up-to-date statistics on topics such as bike safety, falls, sports and recreation, violence, and transportation safety, and recommendations on how to prevent injuries from occurring. The Association also represents its interest in brain injury prevention through participation in national coalitions, including SafeUSA, the National Highway and Transportation Safety Administration’s (NHTSA) National Bicycle Safety Network, and the National Organizations for Youth Safety (NOYS). Links to these organizations and others are available from our website. To further communication among injury prevention practitioners, we also provide free online access to Prevention Matters. This newsletter focuses on current brain injury prevention issues and offers guidance on conducting effective prevention initiatives. (Source: Brain Injury Association of America) CHARACTERISTICS: A person with a mild TBI may remain conscious or may experience a loss of consciousness for a few seconds or minutes. Other symptoms of mild TBI include headache, confusion, lightheadedness, dizziness, blurred vision or tired eyes, ringing in the ears, bad taste in the mouth, fatigue or lethargy, a change in sleep patterns, behavioral or mood changes, and trouble with memory, concentration, attention, or thinking. A person with a moderate or severe TBI may show these same symptoms, but may also have a headache that gets worse or does not go away, repeated vomiting or nausea, convulsions or seizures, an inability to awaken from sleep, dilation of one or both pupils of the eyes, slurred speech, weakness or numbness in the extremities, loss of coordination, and increased confusion, restlessness, or agitation. The signs and symptoms of a TBI can be subtle. Symptoms of a TBI may not appear until days or weeks following the injury or may even be missed as people may look fine, even though they may act or feel differently. The following are some common signs and symptoms of a TBI: Behavioral: Irritability; Depression; Anxiety; Sleep disturbances; Problems with emotional control; Loss of initiative;Problems related to employment, marriage, relationships, and home or school management Physical: Headaches; Dizziness; Insomnia; Fatigue; Uneven gait; Nausea; Blurred Vision Cognitive: Attention difficulties; Concentration problems; Memory problems; Orientation problems (Source: NINDS; CDC) MEDICAL TREATMENT: Anyone with signs of moderate or severe TBI should receive medical attention as soon as possible. Because little can be done to reverse the initial brain damage caused by trauma, medical personnel try to stabilize an individual with TBI and focus on preventing further injury. Primary concerns include insuring proper oxygen supply to the brain and the rest of the body, maintaining adequate blood flow, and controlling blood pressure. Imaging tests help in determining the diagnosis and prognosis of a TBI patient. Patients with mild to moderate injuries may receive skull and neck X-rays to check for bone fractures or spinal instability. For moderate to severe cases, the imaging test is a computed tomography (CT) scan. Moderately to severely injured patients receive rehabilitation that involves individually tailored treatment programs in the areas of physical therapy, occupational therapy, speech/language therapy, physiatry (physical medicine), psychology/psychiatry, and social support. (Source: NINDS) PROGNOSIS: Approximately half of severely head-injured patients will need surgery to remove or repair hematomas (ruptured blood vessels) or contusions (bruised brain tissue). Disabilities resulting from a TBI depend upon the severity of the injury, the location of the injury, and the age and general health of the individual. Some common disabilities include problems with cognition (thinking, memory, and reasoning), sensory processing (sight, hearing, touch, taste, and smell), communication (expression and understanding), and behavior or mental health (depression, anxiety, personality changes, aggression, acting out, and social inappropriateness). More serious head injuries may result in stupor, an unresponsive state, but one in which an individual can be aroused briefly by a strong stimulus, such as sharp pain; coma, a state in which an individual is totally unconscious, unresponsive, unaware, and unarousable; vegetative state, in which an individual is unconscious and unaware of his or her surroundings, but continues to have a sleep-wake cycle and periods of alertness; and a persistent vegetative state (PVS), in which an individual stays in a vegetative state for more than a month. (Source: NINDS) EDUCATIONAL IMPLICATIONS: Early and ongoing help is essential to the child’s improvement. Based on the level of severity, and the specific type of injury, the child’s Individualized Education Program (IEP) might address motor, sensory, communication, and cognitive impairments as well as areas concerning the child’s social and emotional well-being. The brain of the younger child may have greater plasticity although this advantage may be offset by the fact that TBI affects new learning more than retention of information learned prior to the injury. As the child grows, new problems may arise. It is hard to predict how a child will respond from some types of injuries. Some studies suggest that cognitive impairments following an injury are can be related more to social and personal factors than the injury itself. Even after less severe TBI, psychosocial problems may develop and entire families may need ongoing consultation and services. (The following from the Council for Exceptional Children Information Center on Disabilities and Giftedness; http://ericec.org/faq/tbi.html, April 2000). 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. The following tips may assist teachers in working with these students:
ORGANIZATIONS: Acoustic Neuroma Association We are a patient member organization, providing information and support to persons diagnosed with or treated for acoustic neuroma and other benign tumors of the cranial nerves. The Acoustic Neuroma Association creates and publishes a quarterly newsletter, distributes patient information booklets, presents a biennial national symposium, provides access to a network of local support groups, and maintains this website for patient information and discussion. National Rehabilitation Information Center (NARIC) [Offers] an abundance of disability- and rehabilitation-oriented information organized in a variety of formats designed to make it easy for users to find and use. For the past 25 years NARIC staff members have been dedicated to providing direct, personal, and high-quality information services to anyone throughout the country. As a leader in providing interactive information to the disability and rehabilitation community, NARIC's Web site continues this tradition by putting the information into the hands of the users through online publications, searchable databases, and timely reference and referral data. Brain Injury Association of America, Inc. The Brain Injury Association of America was founded in 1980 by a group of individuals who wanted to improve the quality of life for their family members who had sustained brain injuries. Despite phenomenal growth over the past two decades, the Association remains committed to its grassroots. The Brain Injury Association of America encompasses a national network of more than 40 chartered state affiliates across the country, as well as hundreds of local chapters and support groups.
RESOURCES: Web sites: http://www.thinkfirst.org/kids/ The ThinkFirst For Kids Program was developed by the ThinkFirst Foundation to increase awareness and knowledge among children 6-8 years of age (grades 1-3) about the risks traumatic injury and the use of good safety habits. It is anticipated that increasing knowledge while modifying attitudes and behaviors of children in this age group will help decrease traumatic injuries during their lifetime. (National Injury Prevention Foundation) http://www.waiting.com/glossary.html Useful information for family members of a person who is in a coma. In addition to this glossary there is much more information on coma and coming out of a coma. Publications: Tramatic Brain Injury: Hope Through Research. A booklet about traumatic brain injury, or head injury, prepared by the National Institute of Neurological Disorders and Stroke (NINDS) Shaken Baby Syndrome Information Page (compiled by the National Institute of Neurological Disorders and Stroke (NINDS) Lash and Associates Publishing/Training, Inc. specializes in information on the treatment and rehabilitation of brain injury and concussion in children and adults. Educational materials and customized training programs on brain injury are designed for clinicians, educators, families and advocates. Our books, rehabilitation manuals, tip cards, CD-ROMs and Videos and attention process training on brain injury can be used in hospitals, rehabilitation programs, schools, vocational settings, and in the community. Forums on brain injury for families and survivors give support and strategies for adjustment and coping. Materials for children and adolescents on safety.
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