The Long Term Impact of Brain Injury on Children & Families

1. The Long Term Impact of Brain Injury on Children & Families Martine Simons & Suzanne Benson Senior Social Worker Senior Clinical Psychologist and Clinical Neuropsychologist Brain Injury Service, Department of Rehabilitation

2. Rehabilitation at CHW • Brain Injury Service is part of the Rehabilitation Department • State wide service providing inpatient and outpatient rehabilitation services to approximately 600 children. • The team consists of medical, nursing & allied health professionals.

3. Overview • Impact of Brain Injury on children • Long term issues for children & families

4. Factors impacting on families • Immediate: • Injury & hospitalisation • Medical • Legal • Highly charged emotional situation • Disruption to family life • Being away from community and supports

5. Factors impacting on families • Emerging picture of long term consequences • Process of change and adaptation for the family

6. NAI/SBS • Mostly injured under 12 months • Often show good physical recovery in early stages after injury • Problems emerge as neurodevelopment does not proceed in typical pattern

7. Early NAI Research Kriel, Kruch & Panser (1989) Bonnier (1995) Duhaime et al (1996) Haviland J, Ross, Russell RI (1997) Ewing-Cobbs et al (1998;1999) Kyriagis, Waugh & Epps (2003) Barlow (2005)

8. Summary “…inflicted TBI has a very poor outcome.” “…deficits in preschoolers are often underestimated.” Barlow, KM et al, (2005)

9. Changes in child • Physical and medical problems • post trauma epilepsy • hemiplegia • coordination problems • headaches • physical and cognitive fatigue • sensory deficits (vision, hearing, smell)

10. Cognition • Cognitive deficits • Learning and memory • Speed of processing • Language • Attention • Executive functions • Intellectual impairment

11. Cognitive problems • Executive problems • working out solutions • planning and organisation • inhibition • perseveration • lack of flexibility • concrete reasoning

12. Behavioural Problems • Non-compliance • Overactivity • Lack of persistence • Physical aggression • Verbal aggression • Sleep & bedtime problems

13. Social Issues • Social problems • poor communicator • lack of friends • rejected by others • Bullying / teasing

14. Emotional problems • Anger • low frustration tolerance • overly sensitive • impulsive • Depression • feeling helpless • feeling different • Anxiety • ability to complete work • future • dependence on others

15. Behaviour & Emotions • Difficult behaviour is the result of the interaction of many factors • No particular behaviour is “all brain injury” or “not brain injury”

16. Behaviour & School • Emotional and behavioural issues may not be present at school • Environment will impact on manifestation of problems • Family coping will depend on many factors

17. Families & Coping • Stress on families tends to increase, not decrease • Supports in community and school tend to decrease • Unfavourable family circumstances exacerbate problems from TBI

18. Role changes who has paid work? (at home, community) therapy needs Carers Family structure losses/absences location Nature/cause of TBI Financial burdens Family Stressors

19. A multidisciplinary team approach • Case managers • Allied health • Nursing and medical response

20. Interventions • Support • Therapeutic needs • behavioural interventions • emotional support • individual therapy • family therapy

21. Schooling • All children return to school • Crucial part of child’s reintegration and ongoing development • Engagement and connectedness

22. Implications • Non accidental brain injury is a serious form of child abuse • Long term costs to individuals, families and communities • Prevention programmes are essential