1. Definition Causes Incidence Judy L. Dettmer
Brain Injury 101
Definition
Causes
Incidence
Judy L. Dettmer

2. Definitions of Brain Injury
Traumatic Brain Injury (TBI): a physical force applied to the brain that results in a traumatic injury U.S. Department of Education, Federal Register, 1992
Acquired Brain Injury (ABI): an injury to the brain that occurs following birth, and can be classified as traumatic or non-traumatic
Educational Dimensions of Acquired Brain Injury, Savage, Wolcott, 1994

3. Common Causes of TBI
Infants: Physical abuse Toddlers: Falls Young Children: Passengers in vehicles School-aged Children: Bicycle and pedestrian collisions with vehicles Adolescents: Drivers and passengers in motor vehicle accidents

4. Sports & TBI Amateur Boxing Football Soccer Horseback Riding
Injuries consistent with acute TBI
Post-concussive syndrome
Football
20% high school players
Soccer 5%
Horseback Riding
17% of all equestrian injuries are brain injuries
(Brain Injury Association of America)

5. Open v. Closed Brain Injury
Open Brain Injury
Skull is fractured
Blood & swelling have a place to go
Closed Brain Injury
Concussion
Swelling results in further (secondary) injury
May go unidentified if no loss of consciousness
Damage great or greater than open brain injury

6. Common Causes of Non-Traumatic Brain Injuries
Illness (e.g. high fever)
Infections (e.g. meningitis, encephalitis)
Anoxic injuries
Strokes, vascular accidents
Brain tumors
Poisoning (e.g. ingestion, inhalation)
Metabolic disorders (e.g. insulin shock)

7. Does not always predict outcome
Levels of Severity
Does not always predict outcome

8. Mild TBI (an oxymoron) Also called post-concussive syndrome
Brief or no loss of consciousness
90% of concussions resolve in a few weeks
10% have symptoms that last a lifetime
Symptoms are not “mild”

9. Moderate TBI Loss of consciousness for < 24hrs
Skull fracture, contusions, hemorrhage, or focal damage
In children may result in
Physical weakness
Cognitive-communication impairments
Difficulty learning new information
Psycho-social problems

10. Severe TBI Loss of consciousness > 24 hours
Multiple cognitive, communicative, physical, social, emotional &
behavioral problems
20% return with minimal changes
Approx 80% have life long changes

11. Incidence of Brain Injury
Is it a “low incidence” disability?

12. Traumatic Brain Injuries Comparison of Annual Incidence
Spinal Cord Injuries
11,000
HIV/AIDS
43,681
Multiple Sclerosis
10,400
Breast Cancer
176,300
Traumatic Brain Injuries
1,500,000
Comparison of Annual Incidence
Data compiled by the Brain Injury Association of America based of data from the Centers for Disease Control and Prevention, American Cancer Society and National Multiple Sclerosis Society

13. Gender, Age and TBI After infancy boys are injured twice as frequently
Young adults age are most at risk

14. TBI in Children 1.4 million children injured annually
About 1/2 are between 16-21
Highest risk groups ages 0-4 and 15-19
More likely to survive than adults
Less likely to be unconscious

15. National Data
Brain injury is the leading cause of death and disability of children in the U.S. (Pediatric Registry)
CDC reports annual incidence of TBI for
Children 0-14: - 2,685 deaths
- 37,000 hospitalizations
- 435,000 ED visits These numbers do not include children who sustained a TBI and did not seek medical care or were treated and released without mention of potential TBI 15

16. National Data
Each year an average of 475,000 TBIs occurred among children.
Most children who sustained a TBI (91.5%) were treated and released from the emergency department without further treatment.
CDC 16

17. Characteristics and Affects of Brain Injury in Children

18. Simplified Brain Behavior Relationships
Frontal Lobe • Initiation • Problem solving • Judgment • Inhibition of behavior • Planning/anticipation • Self-monitoring • Motor planning • Personality/emotions • Awareness of abilities/limitations • Organization • Attention/concentration • Mental flexibility • Speaking (expressive language)
Parietal Lobe • Sense of touch • Differentiation: size, shape, color • Spatial perception • Visual perception
Occipital Lobe • Vision
Cerebellum • Balance • Coordination • Skilled motor activity
Temporal Lobe • Memory • Hearing • Understanding language (receptive language) • Organization and sequencing
Brain Stem • Breathing • Heart rate • Arousal/consciousness • Sleep/wake functions • Attention/concentration

19. Executive Functions: Initiate Inhibit Shift Plan Organize Self-Monitor
Emotional Control
Working Memory

20. Executive Functions: Attention Planning Judgment Organization
Problem-solving
Emotion Regulation (lability)
Social Skills

21. Some are more academically based:
memory – “making new learning stick”
processing speed
abstract concepts
money and time concepts
sequencing learning
simultaneous learning
shifting/changing sets
perseveration
handwriting
inconsistent learning curve
learning plateau

22. Some are more organizationally based:
initiation - completion
time on task
visual over-stimulation
auditory over-stimulation
planning
under-arousal
emotional load

23. Typical effects of mild to moderate BI
Mental fatigue
Slowed processing speed
Difficulty transferring “new learning” into memory – affects sequential thinking
Problems with Executive Function
Social Skill problems

24. Typical effects of moderate to severe BI:
Tend to see:
Mental Fatigue
Motor problems
Feeding problems
Cognitive problems – concrete thinking
Emotional and Behavior regulation
Seizures

25. How BI issues “manifest” in the classroom
Mental fatigue
Slowed processing speed
Difficulty transferring “new learning” into memory – affects sequential thinking
Problems with Executive Function
Social Skill problems
Head down, tired, “lazy”
Dragging work out
Inconsistent learning – “you had it yesterday and not today, faking”
Behavior problems, ADHD, messy,
Can’t get along with others

26. Identification and Eligibility

27. U.S. Department of Education Data Students (ages 6-21)
During the school year there were a total of 4,499,824 students receiving special education services of that total only 245 were served under the TBI disability category
During the school year there were a total of 5,683,707 students receiving special education services of that total there were 13,874 served under the TBI disability category
U.S. Department of Education, Office of Special Education Services: Annual Report to Congress, 2000 27

28. U.S. Department of Education Data Students (ages 6-21)
2005 data shows there were a total of 6,021,462 students receiving special education services of that total there were 23,449 served under the TBI disability category
Interesting fact, Autism became a disability category in 1991 also; in 1992, 15,302 students were identified, in 2000, 79,085 were identified and in ,643 students were identified under the autism disability category 28

29. Let’s Recap: You do the Math…
Each year an average of 475,000 TBIs occurred among children (0-14)
The National Pediatric Registry reports that it is estimated that 19% of youth who sustained a brain injury will have long term disabilities
Reviewing data from USDOE in 2004 there were 23,204 students with TBI receiving special education services. In 2005 there were 23,449 served under the TBI disability category (0-21). Totaling an increase of 245 students. 29

30. Let’s Recap: You do the Math…
Conservatively, using the 19% guideline, we could estimate roughly 90,250 with long term disabilities resulting from brain injury annually.
Get your calculators out……………
19% of 475,000 = 90,250, USDOE increased by 245 in one year…………
Are we missing 90,005 students with brain injury? 30

31. Colorado Picture 31

32. Where Does Colorado Stand?
According to data from the Colorado Department of Public Health and Environment, on average during annually there were 693 children (5-21) discharged from an acute care hospital with TBI diagnosis.
There are an estimated 3,000 youth living with brain injury in Colorado. 32

33. Where Does Colorado Stand?
In 2007 Colorado reported 413 students identified with brain injury as their primary disability category for special education. In 2008 Colorado reported 419, an increase of 6 students.
Calculators please………
693 new injuries, CDE increase of 6 students…..
Are we missing 687 students annually? 33

34. Why Are We Missing These Kids?
Transition support from medical setting is rare or poorly coordinated
From hospital fewer than 2% are recommended for special education (though 19% have cognitive limitations) (National Pediatric Registry)
Treat and Release from the EDs 34

35. Why Are We Missing These Kids?
Brain injury often goes undiagnosed
The effects of brain injury can be very subtle
Families and school personnel have limited knowledge about brain injury 35

36. The Importance Of Accurate Identification
Student receives appropriate interventions
Prevent a cycle of failure
Allows the student to begin developing self advocacy skills
Accurate identification ensures more appropriate funding and subsequent service provision 36

37. TNT Website