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Module II ______________________________________________________

Module II ______________________________________________________. Understanding TBI. Module II Goal ______________________________. To present information about the brain and how injury to the brain affects the student and family.

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Module II ______________________________________________________

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  1. Module II______________________________________________________ Understanding TBI

  2. Module II Goal______________________________ • To present information about the brain and how injury to the brain affects the student and family

  3. Module II Learning Outcomes______________________________________________________ • At the end of this module you will understand • Incidence and prevalence of TBI • Mechanisms of brain injury • Wisconsin’s definition of TBI • Basic brain structures and functions • Effects of TBI on student and family

  4. Brain Injury: Why do we need to know about it?_____________________________________________________ • More students are surviving serious brain injury (BI) than ever before • Much of a student’s recovery from BI occurs AFTER returning to school

  5. Brain Injury: Why do we need to know about it?______________________________________________________ • Students with BI often have difficulty with learning and behavior that stems directly from their brain injuries • Educators have many skills we can use once we understand the needs of students with BI

  6. Incidence and Prevalenceof BI_______________________________________________________ • 1 in 500 students sustain an acquired BI each year in the U.S. • 1 in 25 students will sustain an acquired BI before high school graduation • Overall twice as many boys as girls

  7. Brain Injury: Three Students_______________________________________________________ • Mike • Monty • Serena

  8. Primary Causes of BI by Age______________________________________________________ • Infants Abuse; neglect • Toddlers Abuse; falls • Early Elementary Falls; pedestrian-motor vehicle accidents

  9. Primary Causes of BI by Age_______________________________________________________ • Late elementary/Middle school Pedestrian-bicycle accidents Pedestrian-motor vehicle accidents Sports • High school Motor vehicle accidents (Savage & Wolcott, 1994)

  10. Brain Injury Terms: Definitions _______________________________________________________ • Acquired Brain Injury • Congenital and Perinatal Brain Injury • Traumatic Brain Injury • Open Head (brain) Injury • Closed Head (brain) Injury

  11. Acquired Brain Injury_______________________________________________________ • Brain injury incurred after a period of normal development • Internal causes • External causes

  12. Congenital and PerinatalBrain Injury______________________________________________________ • No period of normal development • Congenital: a condition a child is born with (e.g., metabolic disorder, chromosomal abnormality) • Perinatal: a condition that develops around the time of birth (e.g., perinatal stroke)

  13. Traumatic Brain Injury _______________________________________________________ • TBI in Wisconsin Schools: • Occurs after a period of normal development • Not congenital, degenerative, or due to birth trauma • Occurs as a result of external physical force to the brain (e.g., as a result of a bike or car accident or a gunshot wound) • Meets WI PI 11 criteria for TBI

  14. Types of Traumatic Brain Injury_______________________________________________________ • Open Head/Brain Injury: Brain injury in which the skull, meninges, and brain are penetrated by an external object (e.g., gunshot) • Closed Head/Brain Injury: Brain injury in which the skull and meninges are NOT penetrated (e.g., head hits the dashboard)

  15. Open Head/Brain Injuries_______________________________________________________ • Penetrating Injuries • Projectiles such as bullets or nails • Sledding accidents • More likely to experience seizures than closed head injuries

  16. Acceleration/ deceleration Injuries Falls Vehicular accidents Shaken baby syndrome Sports accidents Anoxic Episodes Near-drowning Strangulation Smoke inhalation Focal Injuries non-penetrating blows Closed Head/Brain Injury_______________________________________________________

  17. Closed Head/Brain Injuries_______________________________________________________ • More common than open head/brain injuries • Cause more diffuse damage to the brain than open head/brain injuries • Coup/contracoup mechanism of injury

  18. Mechanism of injury: Coup/Contracoup______________________________________________________ Reprinted with permission from the North Carolina Department of Public Instruction

  19. Primary Effects of Closed Head/Brain Injury______________________________________________________ • Injury to brain tissue at the site of coup and contracoup • Shearing and tearing of neurons throughout the brain

  20. The Neuron______________________________________________________ Graphic courtesy of Marshfield Clinic

  21. The Neuron_____________________________________ • Gray matter: nerve cell bodies • White matter: nerve axons coated with a myelin sheath • Myelinization facilitates rapid transmission of impulses along the axon • Bundles of neurons make up nerves that run from the brain to the spinal cord

  22. Secondary Effects of Closed Head/Brain Injury_______________________________________________________ • Bleeding (contributes to increased intracranial pressure) • Swelling (contributes to increased intracranial pressure) • Lack of oxygen to the brain (results in cell death)

  23. Speed limit 65 Speed limit 25 Before and After BI______________________________________________________

  24. Types of Brain Injury______________________________________________________

  25. Predictors of Outcome after BI______________________________________________________ • Duration of coma • Post-traumatic amnesia (PTA) • Age • Location of injury • Pre-injury functioning • Support systems

  26. Outcome Predictors: Coma______________________________________________________ • Coma is a state of unconsciousness in which the person cannot be aroused or does not respond, even to painful stimuli • Coma is measured along a continuum of levels of responsiveness • No or brief coma is generally a more positive predictor than longer coma

  27. Coma Scales ______________________________________________________ • Assess responsiveness to environmental stimuli • Examples • Glasgow Coma Scale • Rancho Los Amigos Scale of Cognitive Levels

  28. Outcome Predictors:Post-Traumatic Amnesia (PTA)______________________________________________________ • Retrograde: Failure to remember events leading up to injury • Anterograde: Failure to accumulate new memories after injury

  29. Outcome Predictors: Age______________________________________ • Young children are especially vulnerable to the effects of brain injury • Previously developed skills may be preserved after brain injury, but new learning may be difficult • Effects of brain injury may not be apparent until more advanced skills are expected to develop

  30. Other Outcome Predictors ______________________________________ • Location of injury • Pre-injury functioning • Support systems

  31. Severity of BI: Mild______________________________________________________ • Brief or no loss of consciousness • Signs of concussion • Nausea and vomiting • Headache • Fatigue • Dizziness • Poor recent memory • Post traumatic amnesia less than 1 hour • GCS of 13-15

  32. Severity of BI: Moderate_______________________________________________________ • Coma less than 24 hours • Post-traumatic amnesia 1- 24 hours • GCS of 9-12

  33. Severity of BI: Severe_______________________________________________________ • Coma more than 24 hours • Post-traumatic amnesia more than 1 day • GCS 3-8

  34. Student examples_______________________________________________________ • Mike • Monty • Serena

  35. How does a student with BI qualify for special education services?______________________________________________________ • To be identified as a student with TBI, the student must meet the Wisconsin definition of TBI • Not all students with BI meet the Wisconsin criteria for TBI

  36. Traumatic Brain Injury:What is it? __________________________________________ • TBI became a special education handicapping condition in IDEA in 1990 • TBI was added to Wisconsin’s special education law (Chapter 115) and rules (PI 11) in 1995. • TBI is one of 11 areas of impairment listed in Wisconsin Chapter 115

  37. Wisconsin Definition of TBI_______________________________________________________ • The Wisconsin TBI definition has four parts • The entire definition from Wisconsin PI ll is printed on the next page of your manual

  38. Wisconsin TBI Definition: Part 1_______________________________________________________ • Traumatic brain injury • an acquired injury to the brain • caused by an external physical force • resulting in total or partial functional disability or psychosocial impairment, or both • adversely affects a child’s educational performance

  39. TBI Definition (part 1 cont.)_______________________________________________________ • open or closed head injuries • impairments in one or more • cognition; speech and language; memory; attention; reasoning; abstract thinking; communication; judgment; problem solving; sensory, perceptual and motor abilities; psychosocial behavior; physical functions; information processing; and executive functions

  40. TBI Definition (part 1 cont.)________________________________________________ • Executive functions are “planning, prioritizing, sequencing, self-monitoring, self-correcting, inhibiting, initiating, controlling or altering behavior. ” (Savage & Wolcott, 1995, p. 150).

  41. TBI Definition (part 1 cont.)_______________________________________________________ • The term does NOT apply to brain injuries that are congenital or degenerative, or brain injuries induced by birth trauma

  42. TBI Definition: Part 2_______________________________________________________ • Acquired injuries to the brain caused by INTERNAL occurrences are NOT TBI • Injuries due to INTERNAL causes MAY meet criteria for other areas of impairment

  43. TBI Definition: Part 3_______________________________________________________ • Standardized and norm-referenced instruments may not be reliable or valid • Alternative means of evaluation shall be considered

  44. TBI Definition: Part 4_______________________________________________________ • Before a child may be identified with TBI available medical information from a licensed physician shall be considered.

  45. Incidence of TBI in Wisconsin Schools______________________________________________________ • 431 students identified with TBI per PI 11 criteria (as of December 1, 2005)

  46. The Brain______________________________________________________ • Weighs about three pounds and is the consistency of jello • Contains billions of neurons • Videotape (optional)

  47. Components of the Brain_______________________________________________________ 1. Brainstem 2. Cerebellum 3. Basal Ganglia 4. Diencephalon 5. Limbic System 6. Cerebral Cortex *See Brain Surface map on next page

  48. At the base of the brain above the spinal cord Comprised of the medulla, pons, and midbrain Responsible for basic life functions Severe injury causes death The Brainstem_______________________________________________________

  49. The Cerebellum______________________________________________________ • Primarily helps modulate motor responses • Regulates direction, rate, force, and steadiness • Injury disrupts coordination and muscle tone

  50. Basal Ganglia______________________________________________________ • Nerve cell clusters involved with regulation of physical movement • Injury results in involuntary movements, slowness or tremor

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