Training Coordinator Brain Injury Association of New York State - - PowerPoint PPT Presentation
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
March 7, 2016 NYS Council of School Superintendents Albany, NY Margo Singer, MPA, CBIS Training Coordinator Brain Injury Association of New York State (BIANYS)
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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
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Top T en Activities Contributing to Pediatric Concussions
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Bicycling
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Football
3.
Baseball/softball
4.
Basketball
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Playground activity
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Powered recreational vehicles
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Soccer
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Skateboard/Scooters
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Winter Sports
10.
Horseback riding
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Acquired Brain Injury - occurs after birth; is not hereditary
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)
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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.
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Frontal Lobe
abilities/limitations
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TEMPORAL
Frontal Lobe
Temporal Lobe Parietal Lobe Occipital Lobe Cerebellum Brain Stem
Temporal Lobe
Brain Stem
Cerebellum
Parietal Lobe Sense of touch Differentiation: size, shape, color Spatial perception Visual perception
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Reason sons s why children have greater disposition to head trauma:
“top-heavy”
heavier structure
Fuchs 2001
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A concussion is just a “bump” on the head A parent should awaken a child who falls asleep after
A concussion is usually diagnosed by neuro-imaging
Loss of consciousness is necessary for a concussion to
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►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
Primary effect
A coup injury is caused by the impact where the blow
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.
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Phys ysic ical al
Headache/ Pressure Blurred vision Dizziness Poor Balance Ringing in ears Vacant stare Nausea Vomiting Sensitivity to light and noise Disorientation Neck Pain
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Emotional ional/Mood /Mood
Irritability Sadness Nervousness/ Anxiety Lack of Motivation
Cogniti itive ve
Feeling in a fog Difficulty remembering Difficulty concentrating Easily confused Slowed speech
Sleep ep Pattern rns
Fatigue Excess sleep T rouble falling asleep Drowsiness Sleeping less than usual
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
pact Syndr drome
high-risk situations (i.e., contact sports) and with a history of closely recurring head injuries. Sympto ptoms ms of Second
pact Syndr drome
Dilated pupils Inability to move eyes Loss of consciousness
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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
T
est results can assist in return-to-play decisions and return-to-learn decisions
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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
functional areas, keep in mind how difficulties or deficits in each area may impede learning
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Common problems often affect following functional areas:
sory y and Motor
itive ve and Exe xecut cutive ive Functio ionin ing
age and Communic icat ation ion
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
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One or more of the following may be noted in varying degrees of severity, depending on each child:
Visual issues such as double vision and impaired coordination
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
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selectively attending (tuning out stimuli) to tasks
projects
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ask completion
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warranted, the way the brain injury manifests may be different
increase
grade may suddenly need additional help in 3rd or 4th grade as the structure of the classroom changes and cognitive demand increases
(puberty) impacts functioning Remember, TBI is a lifelong disability.
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Furnish memory/organizational aids Reduce homework load as needed Provide alternative testing, extend time and reduce questions Initiate tutoring program if needed Arrange an emergency plan Monitor for seizure activity Monitor fatigue/mental exhaustion Provide frequent short breaks during periods of intense concentration Shorten the instructional day if indicated Provide strategies for organizing/sequencing tasks
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ape recorders
attention
Chapter 495 of the Laws of New York 2011
Requires:
Immediate removal from athletic activities of a student believed to have
sustained or who has sustained a mild brain injury.
No return
rn until til student dent is sympt ptom
t 24 hour urs, s, must t be evalua luated ted and receiv ive a w written ten permiss mission ion to retur urn n by a license censed d physici sician. n.
All coaches, physical education teachers, nurses and athletic trainers are
required, biannually, to complete a course of instruction relating to recognition of symptoms of mild brain injury and monitoring and seeking appropriate treatment.
Parents or others in parental relationship must sign permission slip that
contains information relating to concussion.
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Model concussion management
program
Details how school staff, family,
and medical professionals can work together
Return to play and return to
learn process
Reduces strain on school
resources
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REDUC UCE: E: Immediate removal from athletic activity, reduce physical and cognitive demands at school and home ACCOMM MMODATE: E: Allow time for breaks, reduce class work, adjust curriculum, don’t tax the student cognitively at the rate prior to concussion EDUC UCATE: E: Know and monitor symptoms, identify person in the family/school team to oversee cognitive, emotional and physical symptoms and report to the medical team PACE: : Provide graduated return to study and play as symptoms resolve
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Family Advocacy, Counseling and Training Services Funded by the NYS Office for People with
A statewide support program for families and
FACTS Coordinators are employees of the Brain
Located in each region of the State. They are not clinicians or direct service providers
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Family Advocacy, Counseling, and Training Services Program (FACTS)
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Project LEARN is a great resource for teachers Search for solutions by problem or presenting issue. Provides internet access to a “virtual consultant” who
Parent and teacher sections, anyone can access both Mini tutorials on a variety of topics. Can save your
Fits with IDEA RTI “response to intervention”.
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www.youtube.com/watch?v=lBOo2a2BWMI
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http://www.cdc.gov/concussion/pdf/ys_toolkit_flyer.pdf
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CO CONT NTACT ACT INF NFORMA RMATI TION: ON: Brain Injury Association of New York State 10 Colvin Avenue Albany, NY 12206-1242 (518) 459-7911 Family Help Line (1-800) 444-6443 Email: info@bianys.org Website: www.bianys.org
48 The contents of this presentation were produced by the Brain Injury Association of NYS, with funding by project # H21MC026921 from the Department of Human Services, Health Resources & Services Administration & the NYS Department of Health. We would like to acknowledge the following individuals for providing content to this presentation and for their review of this curriculum: Dr. Lois T. Tannenbaum, Dr. Mary R. Hibbard, Rick Knizek, Paul Ripchik, and Dr. Karen McAvoy. This material is in the public domain.