Outline Chapter 26
Traumatic Brain Injury

It is nongenerative, noncongenital insult to brain resulting from mechanical force

1.7 million Americans sustain TBI each year

275,000 are hospitalized; 52,000 die

511,000 TBIs occur in children under age 14

Male to female ratio 1.4:1

Occurs most commonly during spring and summer and weekends

Causes of Traumatic Brain Injury

 Motor vehicle accidents, falls, sports and recreational injuries, and assault.

Young Children less than 1 year: physical abuse

Toddlers (falls)

School-age (bicycle crashes)

Adolescents (motor vehicle accidents, sports and recreational activities)

Types of Injury

Primary (occurs at the moment of impact):

  • Brain contusions
  • Vascular injuries causing hemorrhage or hematomas
  • Scalp injuries and skull fractures
  • Cranial nerve injuries

Secondary (within 24 hours)

  • Brain swelling/edema
  • Elevated intracranial pressure
  • Seizures
  • Electrolyte disturbances (changes in sodium)
  • Hydrocephalus (increased fluid in brain)

Concussions:closed-head brain injury occurring when head strikes an object or when moving object strikes head. Can be caused during motor vehicle accidents, falls, sport injuries

Symptoms of Concussions:

confusion,

headache,

nausea,

vomiting,

dizziness,

hypersensitivity to lights or sounds,

loss of balance,

blurry vision/ double vision/ loss of vision,

loss of consciousness,

seizures,

personality changes,

slurred speech,

body/facial weakness or numbness

Evaluations and Assessment of Brain Injury may include:

  • Neurological exam
  • Neurological imaging (CT scan or MRI)

Severity of TBI can be determined by measuring motor response, verbal response, ability of opening the eyes, length of time in coma, time it takes after coma to remember events and store new memories

Mild TBI—reactions return in less than one hour

Moderate TBI—reactions return between one hour and one day

Severe TBI—reactions take longer than one day

Treatment

Assessment of breathing and circulation,

Assessment of head and spinal exam and imaging

Monitoring of blood pressure, oxygen levels and brain pressure

Surgery depending of intensity of injury and complications

Use of ventilator assistance

Medications for brain swelling

Treatment for Motor impairments—prognosis is related to duration of coma; medications and/or surgery may be used to treat motor impairments related to movement patterns and tone

Sensory impairments—traumatic injury to optic nerve can cause blindness; or sensorineural hearing loss generally unilateral

Feeding disorders—difficulty in swallowing, hydration, aspiration; may need feeding tube

Communication skills impairments—can be expressive or receptive; less appropriate use of language, and lack of conversation ability

Cognition impairments—affecting attention, memory, executive function, and speed of process; long-term outcome depends on severity of injury and environmental factors

Behavioral and social impairments—adjustment difficulties, psychiatric disorders, impulsivity, social withdrawal, inappropriate social behavior

Recovery Outcomes

Mild TBI—generally complete recovery

Moderate to severe TBI—depends on severity of injury, family factors, age, and developmental stage at time of injury. Rehabilitation needed by multidisciplinary team

  • School Outcomes: child is at risk for long-term academic difficulties in reading, math, attention, concentration, and memory
  • Traumatic Birth Injury is one of the special education eligibility categories under IDEA
  • Student needs transition support, education of school staff, and long-term monitoring

Prevention:

Falls: Use window guards and gates at stairways and avoid using infant walkers

Motor vehicle accidents: proper use of Car and booster seats, seat belts. Limited nighttime driving, limited teen passengers

Pedestrian injuries: caution while crossing streets

Bicycle, sport, and other recreation-related injuries: use of Helmets and protective gear