Brain Injury
Brain Injury in Children
Brain Injury in Children
According to the Brain Injury Association of America (BIAUSA), unlike adults, a child's brain is still developing; therefore, the cognitive impairments and issues with brain injury in children may not be immediately obvious after the injury. Instead, the cognitive impairment may become apparent as the child gets older, creating lifetime changes in living and learning for the child as well as the child’s family and caregivers. The greatest challenges many children with brain injury face are changes in their abilities to think, learn, and develop socially appropriate behaviors.
According to the Centers for Disease Control and Prevention, the two age groups at greatest risk of brain injury are 0-4 and 15-19. Among the ages of 0-19, an average of 62,000 children sustain brain injuries requiring hospitalizations as a result of motor vehicle crashes, falls, sports injuries, physical abuse and other causes.
In its 2004 Report to Congress, Traumatic Brain Injury in the United States: Emergency Department Visits, Hospitalizations, and Deaths, the Centers for Disease Control and Prevention noted that falls are the leading cause of brain injury for children age 0-4; furthermore, approximately 1,300 children in the U.S. experience severe or fatal brain trauma from child abuse every year.
Symptoms and Recovery
Symptoms and Recovery
Although symptoms of brain injury are similar to those of adults, the functional impact may be different as a child’s brain is still developing. It was once thought that a child may recover quickly from a brain injury due to the “plasticity” in a younger brain; however, recent research has shown that a brain injury actually has more devastating impact on a child than an injury of the same severity on a mature adult.
Common deficits after brain injury include difficulty in processing information, impaired judgment and reasoning. When an adult is injured, these deficits can become apparent in the months following the injury. For a child, it may be years before the deficits from the injury become apparent. With early diagnosis and ongoing therapeutic intervention, the severity of these symptoms may decrease. Symptoms can vary greatly depending on the extent and location of the brain injury.
The following is a table that shows the potential physical, cognitive, and emotional impairments of brain injuries, taken from BIAUSA website:
Physical
- speech
- vision
- hearing
- headaches
- motor coordination
- muscle spasms
- paralysis
- seizure disorder
- balance
- fatigue
Cognitive
- short-term memory deficits
- impaired concentration
- slowness of thinking
- limited attention span
- impairments of perception
- communication skills
- planning
- writing
- reading
- judgement
Emotional
- mood swings
- denial
- self-centeredness
- anxiety
- depression
- lowered self-esteem
- sexual dysfunction
- restlessness
- lack of motivation
- difficulty controlling emotions
Diagnosis
Diagnosis
The treatment team will use the Glasgow Coma Scale (GCS) to evaluate a person’s level of consciousness (LOC) and the severity of brain injury by attempting to elicit body movements (M), opening of the eyes (E), and verbal responses (V). Although there are other scales, this is the most commonly used one.
Motor Response (M)
- follows commands (6)
- localizes to pain (5)
- withdrawal to pain (4)
- decorticate (3)
- decerebrate (2)
- no response (1)
Eye Opening (E)
- natural (4)
- to voice (3)
- to pain (2)
- no response (1)
Verbal Response (V)
- oriented and converses (5)
- disoriented and converses (4)
- inappropriate words (3)
- incomprehensible sounds (2)
- no response (1)
GCS Scoring
- Mild Brain Injury (13-15)
- Moderate Brain Injury (9-12)
- Severe Brain Injury (0-8)
Based on where the patient scores on the scale, the treatment team begins to develop a plan for the patient and gets any relevant therapist or medical personnel on board.
The Glasgow Outcome Scale (GOS) is a brief, one-item descriptive assessment utilized by the treatment team following a brain injury. It is used to determine next steps for treatment but is not helpful in monitoring small, gradual, improvements:
Five possible descriptive measures:
- dead (severe injury or death without recovery of consciousness)
- vegetative (severe damage with prolonged state of unresponsiveness and lack of higher mental functions)
- severely disabled (severe injury with permanent need for help with daily living)
- Moderately Disabled (no need for assistance in everyday life; employment is possible but may require special equipment)
- Good recovery (light damage with minor neurological and psychological deficits.
The following is a list and description of other assessments that may be used to diagnose and monitor:
Treatments and Medications
Treatments and Medications
The following is the typical progression of treatment from intake in the hospital to treatment in and outside of the hospital:
Education
Returning to school can often be difficult for a student, his/her classmates, teachers, and staff members. The adjustmenting to the student’s regular activities and routines can be difficult as well. Many parents may not be aware of the accommodations and supports that schools offer children with brain injuries. There are two important objectives when determining what, if any, accommodations are important for the success of the student. First, the parents should meet with the school’s or district’s administration to discuss the situation. Second, a thorough evaluation of the student’s academic and cognitive abilities may be necessary to determine what accommodations and supports would benefit the student the most. These evaluations can be performed by neuropsychologists, psychologists, or trained school psychologists.It is important to consult with an experienced brain injury professional (such as the child’s doctor or therapist) who can thoroughly document academic strengths, limitations, and recommended accommodations.
Some accommodations may include the following:
- Allowing additional time of assignments and tests
- Allowing for extra or extended breaks
- note-taking support/copy of teacher notes
- preferential seating
- accommodations for class speeches/reading out loud
- shortened assignments (quality of work/understanding over quantity)
Concussions
One of the most common types of brain injuries are concussions. The Centers for Disease Control and Prevention (CDC) defines concussion as a traumatic brain injury (TBI) caused by a bump, blow, or jolt to the head or by a hit to the body that causes the head and brain to move rapidly back and forth. This sudden movement can cause the brain to bounce around or twist in the skull, stretching and damaging brain cells and creating chemical changes in the brain.
There may be signs of injury to the head, such as bruising or cuts, or there may be no visible injury. A person does not necessarily pass out after concussion.
The following link provides you with information of the symptoms, treatment, education considerations, and other follow-up care if you are diagnosed with or suspect a concussion:
