Traumatic Brain Injury
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)]
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 and object, or when an object pierces the skull and enters brain tissue. (NINDS, 2011)
Approximately 1.4 million people receive traumatic brain injuries every year. There are approximately 5.3 million Americans living with a long-term disability as a result of TBI. Males are more likely than females to sustain a TBI at any age. 75% of traumatic brain injuries are classified as mild. Of children 0-14 years old, TBI results in 435,000 trips to the emergency room annually and 37,000 hospitalizations. (Brain Injury Association of America, 2011; NICHCY, 2010).
Causes of TBI include: falls, motor vehicle accident, struck by/against an object, and assault. (Brain Injury Association of America, 2011).
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. (Brain Injury Association of America, 2011)
The signs 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 (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. They may also have trouble with their long-term memory. 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 (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.
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. (NICHCY, 2010)
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, 2011)
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, 2011)
Although TBI is very common, many medical and education professional may not realize that some difficulties can be caused by a childhood brain injury. Often, students with TBI are though to have a learning disability, emotional distrubance, 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.
Tips for Teachers
Acoustic Neuroma Association
600 Peachtree Parkway
Cumming, GA 30041
Tel: 770-205-8211 877-202-0239
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)
4200 Forbes Boulevard
Lanham, MD 20706-4829
Tel: 301-459-5900/301-459-5984 (TTY) 800-346-2742
[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.
8201 Greensboro Drive
McLean, VA 22102
Tel: 703-761-0750 800-444-6443
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.
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)
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.