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Traumatic Brain Injury
"the silent epidemic"

IDEA Def:  An acquired brain injury caused by an external physical force, resulting in total or partial functional disability or psychosocial impairments
*Definition excludes anoxia and disease, as well as congenital conditions


Types of TBI

closed head injury
•     results when the brain whips back and forth during an accident

postconcussional syndrome (mild traumatic brain injury) - a mild closed head injury that may not show damage on medical tests but results in changes in personality or cognitive functioning.

  May result in problems with:  memory, learning new information, attention and concentration, information processing speed and capacity, executive functions such as planning and establishing priorities, and disruptions to emotional centers of the brain.  

  Other characteristics include the following:

•     Becomes restless or fussy
•     Doesn't pay attention
•     Forgets things
•     Gets mixed up about time and places
•     Takes longer to get things done
•     Doesn't act the same
•     Acts without thinking
•     Becomes easily upset
•     Loses his or her temper a lot
•     Tires easily or needs extra sleep
•     Doesn't see or hear as well
•     Drops things or trips a lot
•     Develops problems with words or sentences
•     Has a harder time learning


open head injury
•     results when a specific area or focal point of the brain is injured
•     generally only affects those functions controlled by the injured part of the         brain


Characteristics
*Characteristics are dependent on the site and extent of the injury, length of time in coma, and the student's maturation.

Physical Changes
*Most changes are temporary or compensated for through rehabilitation
•     experience seizures (20% of traumatic brain injuries)
•     spasticity or paralysis
•     growth related problems
•     sleep disorders
•     photosensitivity
•     coordination problems
•     physical weakness
•     fatigue
•     headaches
•     vision or hearing impairments
•     changes in senses of taste, touch and smell



Cognitive Changes
•     attention and concentration deficits
•     long- or short-term memory limitations
•     difficulty with reasoning and problem solving
•     slowed processing
•     problems with academic skills that were previously satisfactory
•     poor judgement
•     lack of foresight
•     planning and sequencing is difficult



Linguistic Changes
•     problems with receptive and written language communication are often         long-term
•     learning new concepts and vocabulary may be challenging
•     aphasia: problems with speaking or total loss of speech, often caused by TBI,     lack of oxygen, stroke, or an illness that causes brain swelling
•     problems understanding language
•     socialization is difficult due to inability to perceive voice inflections and         nonverbal clues



Social, Behavioral, and Personality Changes
•     euphoria, temper outbursts, restlessness, irritability, anxiety, fatigue
•     depression (15-20% of brain injury survivors)
•     inability to initiate tasks
•     disinhibition:  an inability to inhibit inappropriate behavioral responses
•     poor self-monitoring skills
•     poor coping and social skills

Prognosis:
•     at least 50% survive
•     those with mild head injuries may have negligible effects and little change         over a 3-year period
•     those with most severe injuries show the highest initial deficits and highest         improvements at one year
•     lifetimes effects are present for 10% of those with mild head injuries, 33-50% of     those with moderate injuries (coma less than 24 hrs), and 80% of those with     severe injuries (coma more than 24 hrs)


Causes

Brain injury includes both congenital and acquired brain injuries

Causes of traumatic brain injuries (2000):
motor vehicle crashes (51%)
falls (21%)
assaults and violence (12%)
sports and recreation (10%)
other (6%)

•     shaken-impact syndrome:  caretaker becomes frustrated and loses control, shakes the child violently to make the child stop crying (in 10-25% of cases, the child dies)


Teaching Students with Traumatic Brain Injury

Curriculum

Goals aim to…
recover lost abilities, skills, and knowledge
compensate for nonrecoverable skills
accept and adjust to the new person they are becoming

Cognitive retraining - helps students regain perceptual processing, communication, behavioral, and social skills that were lost as a result of traumatic brain injury

Component training - a form of cognitive retraining that provides students who have TBI with intensive and systematic training of specific cognitive skills such as memory, attention, organization, and perceptual processing

Compensatory strategy training - a form of cognitive retraining that helps students who have TBI to clarify, remember, organize, and express information

Functional retraining - a form of cognitive retraining that uses everyday curriculum and activities of a student with TBI to teach cognitive skills

Computer Use and simulation software


Methods - Instructional

•     instructional times should be kept short with frequent repetition
•     memory notebook (an electronic or paper organizer)
•     errorless learning:  Involves memorization - Gives student the correct answer,     tell him to say it and write the answer on the paper)
•     emphasize major points and use a variety of modalities (auditory, visual,         kinesthetic, tactile)


Methods to Improve Behavior
•     minimize common distractors such as background noise, movement, clutter,     and harsh colors
•     increasing predictability in daily routines
•     decreasing demands that stress the student's current coping skills
•     matching educational expectations to the student's cognitive functioning     skills
•     Personal Intervention Plan:  includes information on what triggers inappropriate behavior, the typical behaviors displayed by the student, the desired behaviors, goals for achieving the behaviors, and supports the student needs to achieve the goals
•     Self-modeling: the teacher videotapes the student exhibiting appropriate or     exemplary behaviors
•     Sit the student near compliant students
•     Describe the desired behavior specifically
•     Preplan negative consequences for noncompliance with the student
•     Follow compliance with immediate praise
•     Differential reinforcement of other behavior:  encourages appropriate         behavior by reinforcing a positive behavior that is incompatible with the         undesired behavior.  The focus is on praising good behavior rather than         punishing inappropriate behavior.