Traumatic Brain Injury Resource
What is Traumatic Brain Injury?
Traumatic brain injury (TBI) occurs when an external bump or blow to the head leads to brain dysfunction. Penetrating objects such as bullets or shattered pieces of glass, violent shaking and sudden jolts can also cause TBI. The severity of the condition ranges from mild, temporary amnesia to permanent disability. It can impact the victims' actions, movements, cognition and memory. It can also affect their ability to learn and socialize at school.
TBI is the leading cause of death in children and young adults. Emergency rooms across the United States treat and release more than 560,000 children with TBI each year, according to the Brain Injury Association of America. Another 62,000 children require hospitalization. The Centers for Disease Control and Prevention (CDC) states that the rate of TBI-related emergency room visits has increased by 6.8 percent from the years 1995-2001 to the years 2002-2006, especially in children between 0 to 14 years of age. In fact, children between 0 to 4 years of age and young adults between 15 to 24 years age are at a greater risk for TBI. Many of these children suffer from lifelong disabilities that can impact their ability to lead normal lives and succeed at school.
Symptoms of TBI can vary significantly. Some children may go into coma or a vegetative state. Others may experience blood vessel or nerve damage and fluid build-up in the brain.
Young victims often suffer from physical, cognitive and psychological disabilities. However, you may not see all the symptoms in one victim. The manifestations fluctuate from very mild to seriously debilitating. It is important to remember that TBI does not include brain injuries that occur before or during birth.
Physical symptoms may include:
- Inability to speak, see, hear or sense surroundings effectively
- Persistent ringing in the ears
- Blind spots, poor vision or double vision
- Persistent bad smell or bitter taste in the mouth
- Headaches and fatigue
- Seizures and spastic or sudden contraction of muscles
- Poor fine motor skills such as writing or drawing
- Restricted gross motor skills such as walking, balance and hand-eye coordination
- Partial or complete paralysis on one or both sides of the body
- Tingling sensation in the skin, itching or constant pain
Cognitive problems may include:
- Inability to think and process information
- Poor short-term or long-term memory
- Difficulty focusing, listening and comprehending new information
- Slow thought process that causes children to lag behind their contemporaries in academics, sports and other activities
- Difficulty in sequencing, judging and understanding the order of events
- Inability to organize thoughts
- Inability to use muscles for forming words
- Inability to begin or discontinue talking
- Difficulty reading cues from others
- Limited organization and multitasking skills
- Poor decision-making ability
Psychological changes may include:
- Anxiety and depression due to sudden disability
- Difficulty socializing with friends
- Poor self-image
- Risky behavior and violent outbursts
- Lack of self-control and self-awareness
- Lack of empathy toward others
- Mood swings
Doctors may prescribe medications to treat seizures and reduce fluid build-up in the brain. Surgical interventions can help remove blood clots and fix skull fractures. Occupational therapists and physical therapists help affected children relearn or improve basic life skills required for everyday activities. Speech pathologists, psychologists and rehabilitation nurses work together to help children with TBI develop coping strategies. Many school districts allocate a dedicated social worker or case manager for children with TBI, and parents and teachers collaborate with that case manager while planning treatment and care.
Early diagnosis and prompt treatment are crucial. Prognosis will also depend on the severity of the condition and the kind of support the children receive at home and school.
Life at School
Parents, caregivers and teachers can take several steps to deal with TBI. In many children, the condition is not diagnosed immediately. Parents may notice symptoms after several months or years. They may also notice new issues as the child grows and uses his or her brain in new ways. The doctors may also take time to establish a connection between the symptoms and the injury, especially if the accident occurred a long time ago. TBIs are often misdiagnosed as learning disabilities, emotional disturbances, and mental retardation. Hence, the students may not receive the treatment and support required to deal with the condition.
When children with a brain injury get back to school, their educational and emotional needs are very different. The sudden trauma and the associated disability can introduce emotional changes. Children may develop phobias or become overly sensitive. Parents and educators may find it difficult to adjust to the new demands. They often compare the child's current abilities to his or her skills before the accident, which can pose additional challenges to the child.
Parents should plan the return to school carefully. Learn more about special education classes at the school. The school website, its principal and the special education teacher can guide you through the process. Educators and the school psychologist will evaluate your child and develop an individualized education program (IEP) that focuses on specific needs your child. IEPs should be flexible and modified according to the needs of the child as well as the vision of the parents and the teachers.
Tips for Parents
Parents should represent their children's needs at every stage and help them cope with the changes.
- Learn all you can about TBI, and understand the kind of impact it can have on your child's life. You will find helpful resources and a list of important support organizations at the end of this publication.
- Work closely with your child's doctors and therapists. Discuss your concerns with them and understand their points of view. Develop a comprehensive treatment plan that will address all aspects of your child's health.
- Track your child's progress at every step. File all the paperwork, and write every important detail in a notebook. You can go back and refer to the information before making important decisions.
- Connect with other parents who have children with similar issues. You will find parent groups all across the United States.
- Collaborate with your child's teacher, and discuss the progress regularly. Understand your child's behavior in the school setting, and compare it with his or her behavior at home. Inform the teacher immediately if you notice something out of the norm.
Tips for Teachers
Teachers also play an important role in helping children adjust and succeed at school after a brain injury.
- Teachers should also find out more about TBI and the specific needs of the child. You will also find useful resources at the end of this publication. Information can empower you and help you make a difference in the child's life.
- Help the child feel comfortable in the class by giving him or her more time to finish the work. Give directions slowly. Explain one step at a time, or write down all the instructions on paper.
- Demonstrate new tasks and ideas, and give good examples. Allow the child to practice a new skill several times, and make sure he or she actually learns it.
- Have a consistent routine and let the child know what to expect. Inform the child about changes ahead of time. A written schedule can also help children with TBI to plan their day and prepare for it.
- Be flexible and patient about the child's success. Remember that the student may get tired very quickly.
- Keep distractions to minimum.
- Give the child more time during tests and assessments. Do not overwhelm the student, as it may undermine his or her confidence and contribute to thoughts of quitting.
MayoClinic; Traumatic Brain Injury; http://www.mayoclinic.org/diseases-conditions/traumatic-brain-injury/basics/definition/con-20029302; October 2012. Center for Disease Control and Prevention; Traumatic Brain Injury in the U.S.; http://www.cdc.gov/Features/dsTBI_Braininjury/, March 2012; Brain Injury Association of America; Brain Injury in Children; http://www.biausa.org/brain-injury-children.htm; 2014.