March 7, 2016 NYS Council of School Superintendents Albany, NY Margo Singer, MPA, CBIS Training Coordinator Brain Injury Association of New York State (BIANYS)
Ques uestion: tion: An in An indiv ividua idual l sus ustains tains a bra rain in in injur ury y ev ever ery y ho how w ma many ny se second onds? s? 2
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New York Statistics Each year in New York State, TBIs result in: 2,100 deaths 18,500 hospitalizations 82,000 emergency department visits $860 million in hospital charges Falls, motor vehicle crashes, and assaults are the leading causes of TBI, in in chil ildren dren & y youth. www.health.ny.gov/publications/0660.pdf 4
The Pediatric “Top Ten” Top T en Activities Contributing to Pediatric Concussions Bicycling 1. Football 2. Baseball/softball 3. Basketball 4. Playground activity 5. Powered recreational vehicles 6. Soccer 7. Skateboard/Scooters 8. Winter Sports 9. Horseback riding 10. 5
Enough statistics Already!!!!! Ok, Ok, Ok! Let’s talk about brain injury …….
Two Types of Brain Injuries Acquired Brain Injury - occurs after birth; is not hereditary or degenerative, and may include damage resulting from: Anoxia, stroke, aneurysms Infections such as encephalitis or meningitis Toxic exposure (CO, lead paint, neurotoxins) Traumatic Brain Injury - results when the head: Hits a stationary object (ground, wall, car windshield) Is hit (sports collisions, domestic violence) Is penetrated (gunshot wound) Is jolted or shaken (whiplash, Shaken Baby Syndrome) Is exposed to blasts (bombing) 7
How Brain Damage Occurs The brain is a very complicated organ, with millions of cells and connections. While specific areas of the brain may be related to specific functions, each function (walking, lifting an arm, thinking, speaking, etc.) involves many areas of the brain communicating and interacting with each other. 8
Our Brain Controls… Breathing Walking T alking Thinking Feeling Behaving Vision Hearing 9
… Everything about us Parietal Lobe Sense of touch Differentiation: size, shape, color Frontal Lobe • Initiation Spatial perception • Problem solving Visual perception • Judgment • Inhibition of behavior Frontal • Planning/anticipation Parietal Lobe • Self -monitoring Lobe • Motor planning • Personality/emotions Occipital Lobe • Vision • Awareness of abilities/limitations Temporal • Organization Lobe • Attention/concentration TEMPORAL • Mental flexibility • Naming Cerebellum Temporal Lobe Brain Stem Brain Stem • Memory Cerebellum • Breathing • Hearing • Balance • Heart rate • Language • Coordination • Arousal/consciousness • Organization and sequencing • Skilled motor activity • Sleep/wake functions • Attention/concentration 10
Age Matters Beca cause use th the ch child's ild's bra rain in is is sti till ll developing; veloping; injur in ury y ma may y alte ter r th the co cours rse e of of development elopment of of the bra th rain in and d it its funct ctions ions Ch Childre ildren/Y n/Youth outh re reco cover ery y ti time me is is usually ally lon onger er and d ca can ta take mo months ths 11
Children vs. Adults Reason sons s why children have greater disposition to head trauma: Greater head mass relative to their body weight makes them “ top-heavy ” Neck musculature has not been developed to handle relatively heavier structure Increased head weight results in increased momentum during falls or injuries Brain area has more fluid: more susceptible to wave-like forces Thinner cranial bones more easily shattered Fuchs 2001 12
TRUE or FALSE??? A concussion is just a “bump” on the head A parent should awaken a child who falls asleep after a brain injury A concussion is usually diagnosed by neuro-imaging tests (ie. CT Scan or MRI) Loss of consciousness is necessary for a concussion to be diagnosed 13
What happens in a concussion? ► A concussion occurs when a blow to the head causes the brain to slam against the skull beyond the ability of the cerebrospinal fluid to cushion the impact. ► The impact can cause bruising of the brain, tearing of blood vessels and nerve damage. ► Studies show that prior concussions put a person at greater risk of having another concussion(s) and with more severity especially if the prior one(s) have not healed 14
What happens in a Brain Injury Primary effect A coup injury is caused by the impact where the blow occurs or the head strikes. A contrecoup injury occurs as the brain rebounds and collides with the side of the skull that is opposite the initial site of impact (the coup). Acceleration/deceleration are the rapid movements of the brain forward and backward. Shearing/rotation occurs as the twisting and rotation of the brain damages blood vessels and nerve fibers. 15
Know the symptoms! Phys ysic ical al Cogniti itive ve Headache/ Feeling in a fog Pressure Difficulty Sleep ep Pattern rns Blurred vision remembering Fatigue Emotional ional/Mood /Mood Dizziness Difficulty Excess sleep Irritability Poor Balance concentrating T rouble falling Sadness Ringing in ears Easily confused Nervousness/ asleep Vacant stare Slowed speech Anxiety Drowsiness Nausea Lack of Motivation Sleeping less Vomiting Sensitivity to light and than usual noise Disorientation Neck Pain 16
Post Concussive Disorder & Second Impact Syndrome When symptoms of concussion last longer then 3 months Headache, dizziness, irritability, anxiety, insomnia, loss of memory Often caused by re-injury before complete recovery Affects cognitive processes such as behaviors and thinking as well as emotion Second ond Impact pact Syndr drome ome should be suspected in all children involved in high-risk situations (i.e., contact sports) and with a history of closely recurring head injuries. Sympto ptoms ms of Second ond Impact pact Syndr drome ome Dilated pupils Inability to move eyes Loss of consciousness 17
Neurocognitive Evaluation A tool that can be used to evaluate what to accommodate for the student. A Neuropsychological evaluation is a comprehensive assessment of the child’s thinking skills (cognition), behavior, and emotional status May be covered by health insurance plans when it is part of the medical diagnosis T est results can assist in return-to-play decisions and return-to-learn decisions 18
Results of Brain Injury Following are lists of common problems that MAY occur. Not all childr dren en with h Brain Injury y will have all p problems ms and each child d may have differ erent nt combinations inations of problems ms and deficits cits As we discuss these functional areas, keep in mind how difficulties or deficits in each area may impede learning 19
Common Problems after Brain Injury Common problems often affect following functional areas: Sensor sory y and Motor Cogniti itive ve and Exe xecut cutive ive Functio ionin ing Language age and Communic icat ation ion Social, ial, Behav avior ioral al and Emotio ional nal Students may experience difficulty with some or several of these functions. Not all children will experience all/any of these problems. 20
Common Physical Changes One or more of the following may be noted in varying degrees of severity, depending on each child: Loss of smell or taste Tinnitus (ringing in ears) Visual difficulties Photophobia (sensitivity to light) Balance difficulties Speech production Coordination/motor difficulty Fatigue Headaches Sleep disturbances Seizures 21
Common Sensory Effects Visual issues such as double vision and impaired coordination of both eyes can occur, making reading even walking, difficult Hearing loss is also a common outcome Careful assessment and monitoring of potential hearing and visual problems should be provided especially for young children as they are not adept at identifying these sensory losses Difficulties with balance, gait, coordination, strength, range of motion, fatigue and lack of endurance Headaches commonly occur; frequency and severity should be monitored Difficulty adjusting and maintaining body temperature A small percentage of students may develop seizures 22
Language and Communication Speech problems and word retrieval are common There can be a sharp deterioration in communication depending upon the amount of information to be expressed “Social communication” can be greatly negatively affected following a brain injury May take things “literally”
Cognitive Effects D ifficulty staying on topic during a class discussion Distracted by normal classroom activity Difficulty focusing attention vigilantly AND selectively attending (tuning out stimuli) to tasks Difficulty organizing and completing long-term projects Difficulty drawing conclusions from facts presented Difficulty taking turns in conversation Unable to summarize and articulating thoughts 24
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