Traumatic Brain Injuries

1. Traumatic Brain Injuries

2. WHAT IS A TRAUMATIC BRAIN INJURY?Traumatic brain injury means an injury caused by an external force, such as a blow to the head

3. Important TBI Facts: •TBI is the leading cause of death AND disability in people ages 1-35 •A “mild” brain injury can seriously disrupt higher order thinking, executive functions, and social behavior. Multiple brain injuries of any severity cause cumulative damage. •The younger child shows greater impact •Even very severe TBIs may not show up on scans •TBI almost always adversely affects behavior •Even knowledgeable physicians miss the long term effects of TBI

4. Severity of Brain Injury in Children Mild: •Concussion •Brief loss of consciousness •Amnesia or AMS w/o the loss of consciousnessModerate: •Loss of consciousness for 1-24 hours •Subdural hematoma (bleed in the brain) Severe:•Loss of consciousness for more than 24 hours

5. A LITTLE DATA:

6. Data Specific to West:

7. Brain Injury in Childhood Almost Always Results in these Cognitive Symptoms: • Sensory Motor Changes • Poor Executive Functioning (organization, processing speed, mental flexibility, self-monitoring) • Unevenness • Fatigue • Deficits in new learning and memory • Social-emotional changes

8. Developmental Pyramid: Executive Functioning Our Students

9. So What Do We Do to Help Our Students at West? • Concussion Management Plan/Team • Ensure appropriate accommodations • Collaborate between athletic staff, clinic staff, mental health staff, teaching staff, and parents (wrap around effect) • Educate staff, parents, and students • 504 plans and/or IEPs, if necessary • Counseling • Through Veronica or Deanna (MHCD therapist)

10. Concussion Team Members at West High School • DPS Psychologist • DPS Trainer • Denver Health Nurse Practitioner • DPS Nurse

11. How are students referred to the Concussion Team? • Trainer is at the sporting event where the injury occurs. • Student presents to the School Based Clinic • Parent notifies the school • Other school staff become aware of the injury

12. Evaluation • Trainer administers the SCAT 2 at the time of the injury • Results shared with clinic • Medical evaluation in the School Based Clinic • Information shared with school psychologist, nurse and trainer • Email sent to teachers and other school staff explaining accommodations needed for the student

13. EMAIL: • Dear Teachers, This email is to inform you that Snoopy sustained a head injury on October 23, 2013.  The student was evaluated by a medical professional and was diagnosed with a concussion.  It is generally recommended that the student rests for two to three weeks after their head injury in order to allow the brain to heal.  Therefore, we ask that during this time, and/or until he is cleared by medical staff, you provide the following accommodations in your classroom: 1.  No physical activity other than walking 2.  No tests, quizzes, or major assignments should be given to the student during the healing time.  Allow him to make up this work when he has recovered 3.  Allow the student to take breaks when needed.  If he needs to see the nurse or go to the counseling center for rest please allow him to do so. 4.  Light classwork.  Provide the student with copies of class notes Also, if you notice any changes in his behavior (i.e., irritability/fatigue, difficulty with his memory and/or sustaining attention, slower processing speed, sensitivity to light and sounds) please notify me or the nurse immediately.  I will be sure to inform you when the student has been cleared to resume normal activities.  Thank you • Dear Teachers, This email is to inform you that Snoopy has been examined by medical personnel and has been cleared to resume normal activities. Thank you for your cooperation during his healing period in providing him with the appropriate accommodations in the classroom.

14. Medical Evaluation: History • Mechanism of injury? LOC • Prior concussions • Headache • Balance issues • Photophobia, phonophobia • Vomiting • Fatigue • Concentration and memory issues

15. Medical Evaluation: History • Sleep • Mood changes • Dizziness • It is normal for symptoms to last for 2-3 weeks.

16. Medical Evaluation: Physical • Complete physical exam, vital signs • Complete neurological exam • Concussion Handout given • Parents contacted to review plan

17. Referral for complicated concussion • Symptoms not resolved after 3 weeks • Any time student reports worsening of symptoms

18. Challenges • Teachers • Student gets secondary gain from accommodations • High achiever does not want to abide by accommodations • Student is evaluated in an ED or has an outside PCP

19. Restrictions • School accommodations • Exercise – only walking • No reading, video games • Student is re-evaluated in the School Based Clinic weekly until symptoms have resolved. • Trainer administers SCAT 2 weekly if sports-related concussion.

20. Multiple Head Injuries: •No law that says a student must stop playing a sport if they sustain multiple head injuries •Case of Diana and Luis •The power of unity and education

21. How Can You Help Students? • TAKE ALL BRAIN INJURIES SERIOUSLY • Bring TBI to the talking table • Collaborate/communicate and form a school TBI team • Recognize the symptoms and ACCOMMODATE • Most of all: BE PATIENT!!!! Just like a broken arm/leg

22. Presentation Resources: • Dise-Lewis, J, Lewis, H. BrainStars: Strategies for Teams and Re-education for Students. U.S. Dept. of Education, 2002 • Dise-Lewis, J. Executive Functions: Developmental Considerations related to Pediatric ABI. 2010

23. THANK YOU!!!! • REMEMBER TO PROTECT YOUR BRAIN: • Wear a helmet • Wear your seat belt