Traumatic Brain Injury

DEFINITION

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 §300.8(c)(12)]

OTHER DEFINITIONS

Traumatic brain injury (TBI), a form of acquired brain 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. This injury can change how the person acts, moves, and thinks. The term TBI is not used for a person who is born with a brain injury. It is also not used for brain injuries that happen during birth.

The term TBI is used for head injuries that can cause changes 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.

(National Institute for Neurological Disorders and Strokes, NINDS, 2019)
(Center for Parent Information and Resources, CPIR, 2015)

TYPES

Symptoms of a TBI can be mild, moderate, or severe, depending on the extent of the damage to the brain. 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.

(NINDS, 2019)

FACTS and STATS

From 2006 to 2014, the number of TBI-related emergency department visits, hospitalizations, and deaths increased by 53%. The Centers for Disease Control and Prevention have data of TBI-related emergency room visits, hospitalizations, and deaths as recent as 2014. TBI-related Emergency Department visits are approximately 2.53 million, with over 812,000 occurring among children. Approximately 288,000 TBI-related hospitalizations (over 23,000 children) and 56,800 TBI-related deaths (over 2,500 in children).

(Centers for Disease Control and Prevention, CDC, 2019)

CAUSES

An estimated 283,000 children seek care in U.S. emergency rooms each year for sports- or recreation-related traumatic brain injury (SRR-TBI) according to a 2016 report. Contact sports contributed to nearly half (45%) of the SRR-TBI visits examined. Activities with the highest number of SRR-TBI visits included football, bicycling, basketball, playground activities, and soccer.

Falls are the leading cause of TBI, accounting for almost half (48%) of all TBI-related emergency room visits with younger children and adults over the age of 65 years being at a high incidence of falls. Being struck by or against an object and motor vehicle crashes are the first and second (respectively) causes of TBI-related hospitalizations. Intentional self-harm was the first leading cause of TBI-related deaths at 33%.

(CDC, 2019)

PREVENTION

Prevention tips for TBI include wearing a seatbelt every time one drives or rides in a motor vehicle, never driving under the influence of alcohol or drugs, wearing a helmet or appropriate headgear during sports or high-risk activities, preventing falls, and making living and play areas safer for children.

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 their website. To further communication among injury prevention practitioners, BIAA 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.

(Brain Injury Association of America, BIAA, 2019)
(CDC, 2019)

CHARACTERISTICS

The signs of brain injury can be very different depending on where the brain is injured and how severely. Symptoms usually fall into four categories:

Thinking and Remembering

Physical

Emotional/Mood

Sleep

Seek emergency help immediately if any of the following symptoms appear in adults or children, as a rare blood clot could have developed and is crowding the brain against the skull:

It is 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.

(CPIR, 2015)
(CDC, 2019)

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.

(NINDS, 2019)

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.

(NINDS, 2019)

EDUCATIONAL IMPLICATIONS

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 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 school. This information is usually available from the school's principal or special education services at the school. The school will need to evaluate the child thoroughly.

Tips for Teachers

(CPIR, 2015)

ORGANIZATIONS & RESOURCES

Acoustic Neuroma Association
https://www.anausa.org
600 Peachtree Parkway, Suite 108
Cumming, GA 30041
Tel: 770-205-8211
info@anausa.org

This is 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.

Brain Injury Association of America, Inc.
https://www.biausa.org
1608 Spring Hill Rd., Suite 110
Vienna, VA 22182

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.

Brain Trauma Foundation (BTF)
braintrauma.org
228 Hamilton Ave, 3rd Floor
Palo Alto, CA. 94301

The Brain Trauma Foundation works to improve the outcomes of patients with traumatic brain injuries. They do this through the development of our best-in-class, evidence-based guidelines, groundbreaking research partnerships, and educational outreach. They provide guidelines for the treatment of concussion and coma.

Child Neurology Foundation (CNF)
childneurologyfoundation.org
201 Chicago Avenue #200
Minneapolis, MN 55415
info@childneurologyfoundation.org
612.928.6325

The Child Neurology Foundation is a collaborative center of education and support for caregivers and their children with neurologic conditions. It serves pediatric patients through advocacy, education, research, and support initiatives.

International Brain Injury Association (IBIA)
https://www.internationalbrain.org
MCC Association Management
5909 Ashby Manor Place
Alexandria, VA 22310
congress@internationalbrain.org

The IBIA was founded by George A. Zitnay, PhD and Martin B. Foil, Jr in 1993 following an international meeting on brain injury held in Oxford, United Kingdom at Oxford University. IBIA was established to encourage international exchange of information, to support research, to provide training especially in developing countries, and to advocate for brain injury. IBIA has created the “World Congress on Brain Injury” as well as member states and organizations. IBIA has encouraged the development of country wide associations created by families and professionals joining together to support brain injury research and service development.

ThinkFirst For Kids
thinkfirst.org
1801 N. Mill Street, Suite F
Naperville, IL 60563
630.961.1400
800.THINK.56
thinkfirst@thinkfirst.org

The ThinkFirst For Kids program was developed by the ThinkFirst Foundation through the National Injury Prevention Foundation. Its mission is 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.

Last modified January 2020