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Definition Causes Incidence Judy L. Dettmer. Definitions of Brain Injury Traumatic Brain Injury (TBI): a physical force applied to the brain that results.

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Presentation on theme: "Definition Causes Incidence Judy L. Dettmer. Definitions of Brain Injury Traumatic Brain Injury (TBI): a physical force applied to the brain that results."— Presentation transcript:

1 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 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 Common Causes of TBI

4 Sports & TBI Amateur Boxing 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

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 Is it a low incidence disability?

12 Traumatic Brain Injuries 1,500,000 Multiple Sclerosis 10,400 Spinal Cord Injuries 11,000 HIV/AIDS 43,681 Breast Cancer 176,300 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 Highest risk groups ages 0-4 and 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

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 2005

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18 Simplified Brain Behavior Relationships Parietal Lobe Sense of touch Differentiation: size, shape, color Spatial perception Visual perception Occipital Lobe Vision Cerebellum Balance Coordination Skilled motor activity 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) Brain Stem Breathing Heart rate Arousal/consciousness Sleep/wake functions Attention/concentration Temporal Lobe Memory Hearing Understanding language (receptive language) Organization and sequencing

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, Cant get along with others

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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 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 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

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 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 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

29 Lets 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.

30 Lets 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?

31 Colorado Picture

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.

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?

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

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

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

37 TNT Website


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