Definition of Traumatic Brain Injury
DEFINITIONThe regulations for Public
Law 101-476, the Individuals with Disabilities Education Act (IDEA), formerly
the Education of the Handicapped Act, now include Traumatic Brain Injury (TBI)
as a separate disability category. While children with TBI have always been eligible
for special education and related services, it should be easier for them under
this new category to receive the services to which they are entitled. Traumatic Brain Injury (TBI)
is defined within the IDEA as an acquired injury to the brain caused by an external
physical force, resulting in total or partial functional disability or psychosocial
impairment, or both, that adversely affects a child's educational performance.
The term applies to open and closed head injuries resulting in impairments in
one or more areas, such as cognition; language; memory; attention; reasoning;
abstract thinking; judgement; problem-solving; sensory, perceptual, and motor
abilities; psychosocial behavior; physical functions; information processing;
and speech. The term does not apply to brain injuries that are congenital or
degenerative, or brain injuries induced by birth trauma. [(Code of Federal Regulations,
Title 34, Section 300.7(b)(12)] INCIDENCETBI is the leading cause of
death and disability in children and adolescents in the United States. The most
frequent causes of TBI are related to motor vehicle crashes, falls, sports, and
abuse/assault. More than one million children sustain head injuries annually;
approximately 165,000 require hospitalization. However, many students with mild
brain injury may never see a health care professional at the time of the accident.
CHARACTERISTICSThe Brain Injury Association
(formerly the National Head Injury Foundation) calls TBI "the silent epidemic,"
because many children have no visible impairments after a head injury. Symptoms
can vary greatly depending upon the extent and location of the brain injury. However,
impairments in one or more areas (such as cognitive functioning, physical abilities,
communication, or social/behavioral disruption) are common. These impairments
may be either temporary or permanent in nature and may cause partial or total
functional disability as well as psychosocial maladjustment. Children who sustain TBI
may experience a complex array of problems, including the following: Physical impairments: speech,
vision, hearing and other sensory impairment, headaches, lack of fine motor
coordination, spasticity of muscles, paresis or paralysis of one or both sides
and seizure disorders, balance, and other gait impairments. Cognitive impairments: short-
and long-term memory deficits, impaired concentration, slowness of thinking,
and limited attention span, as well as impairments of perception, communication,
reading and writing skills, planning, sequencing, and judgement. Psychosocial, behavioral,
or emotional impairments: fatigue, mood swings, denial, self-centeredness, anxiety,
depression, lowered self-esteem, sexual dysfunction, restlessness, lack of motivation,
inability to self-monitor, difficulty with emotional control, inability to cope,
agitation, excessive laughing or crying, and difficulty relating to others.
Any or all of the above
impairments may occur to different degrees. The nature of the injury and its
attendant problems can range from mild to severe, and the course of recovery
is very difficult to predict for any given student. It is important to note
that, with early and ongoing therapeutic intervention, the severity of these
symptoms may decrease, but in varying degrees. EDUCATIONAL IMPLICATIONSDespite its high incidence,
many medical and education professionals are unaware of the consequences of childhood
head injury. Students with TBI are too often inappropriately classified as having
learning disabilities, emotional disturbance, or mental retardation. As a result,
the needed educational and related services may not be provided within the special
education program. The designation of TBI as a separate category of disability
signals that schools should provide children and youth with access to and funding
for neuropsychological, speech and language, educational, and other evaluations
necessary to provide the information needed for the development of an appropriate
individualized educational program (IEP). While the majority of children
with TBI return to school, their educational and emotional needs are likely
to be very different from they were prior to the injury. Although children with
TBI may seem to function much like children born with other handicapping conditions,
it is important to recognize that the sudden onset of a severe disability resulting
from trauma is very different. Children with brain injuries can often remember
how they were before the trauma, which can result in a constellation of emotional
and psychosocial problems not usually present in children with congenital disabilities.
Further, the trauma impacts family, friends, and professionals who recall what
the child was like prior to injury and who have difficulty in shifting and adjusting
goals and expectations. Therefore, careful planning
for school re-entry (including establishing linkages between the trauma center/rehabilitation
hospital and the special education team at the school) is extremely important
in meeting the needs of the child. It will be important to determine whether
the child needs to relearn material previously known. Supervision may be needed
(i.e. between the classroom and restroom) as the child may have difficulty with
orientation. Teachers should also be aware that, because the child's short-term
memory may be impaired, what appears to have been learned may be forgotten later
in the day. To work constructively with students with TBI, educators may need
to: - Provide repetition and
consistency;
- Demonstrate new tasks,
state instructions, and provide examples to illustrate ideas and concepts;
- Avoid figurative language;
- Reinforce lengthening
periods of attention to appropriate tasks;
- Probe skill acquisition
frequently and provide repeated practice;
- Teach compensatory strategies
for increasing memory;
- Be prepared for students'
reduced stamina and increased fatigue and provide rest breaks as needed; and
- Keep the environment
as distraction-free as possible.
Initially, it may be important
for teachers to gauge whether the child can follow one-step instructions well
before challenging the child with a sequence of two or more directions. Often
attention is focused on the child's disabilities after the injury, which reduces
self-esteem; therefore, it is important to build opportunities for success and
to maximize the child's strengths. |
