When a Child has
a Brain InjuryBy Marilyn Lash,
Bob CluettTwo million brain injuries
occur each year. Half of these involve children. Why have they gotten so little
attention? In the silent epidemic of brain injury, children have become the invisible
survivors. How have we allowed this to happen if our children are the promise
for the future? The most common causes of brain injury among children are falls
and motor vehicle collisions with children as passengers, pedestrians or bicyclists.
Tragically, physical abuse is the most frequent cause among infants. Sports injuries
become more common as children mature and play on teams and outside the home.
Violence is an increasing cause of injuries among adolescents. What is a Brain InjuryA traumatic brain injury
is caused by an external force or blow to the head, such as the head hitting
the windshield during a car crash or the head hitting the ground after a fall.
Acquired brain injury is the other major type; this results from an internal
change, such as a brain tumor, stroke, lack of oxygen, or disease such as encephalitis.
The distinguishing feature that traumatic and acquired brain injuries share
is that ongoing brain development is interrupted. It is this interruption in
previously "normal" development that is different from the child who
is born with a condition such as cerebral palsy or mental retardation. Growth of RehabThe number of in-patient rehabilitation
programs grew rapidly in the 1970s and 80s as the number of survivors of brain
injuries increased due to advances in emergency medicine and trauma care. There
was no parallel growth of brain injury programs for pediatric rehabilitation.
Ten to twenty years ago, there was only a handful of rehabilitation programs for
children with brain injury in the US. Even today, the number of programs remains
small. The discrepancy in the number of brain injury rehabilitation programs for
children compared to adults has contributed to the perception that brain injury
primarily affects young adults. After all, if children don't need rehabilitation,
then it can't be that serious, right? Wrong. Rehabilitation for childrenThe dramatic "before and
after" of physical, cognitive, and behavioral changes so often seen in an
adult with a brain injury is a visible sign that, "This person is different
now." For many years, it was believed that children recovered better than
adults, because they "looked good". A child's physical recovery, even
after a period of coma, is often so rapid that it is described as "miraculous"
by parents. This faster recovery of motor skills in children has affected their
access to in-patient rehabilitation services. Many children do not meet the criteria
for admission to in-patient rehabilitation for multidisciplinary services once
they are "walking and talking". Even when in-patient rehabilitation
is recommended, parents usually have few choices. The closest rehabilitation program
may still be many miles from home. The prospect of the child's extended separation
from parents and siblings adds to the family's emotional stress. As discharge
from the hospital nears, many families opt to care for the child at home. The
lighter weight and smaller size of a child makes home care possible; a choice
that is more difficult for families of adult survivors. Time RevealsTime reveals We are just beginning
to appreciate that it takes longer for the effects of a brain injury to show up
in children. Physical recovery is not the same as cognitive recovery. Unlike the
comfort often found in the phrase, "Time heals..." it is the opposite
for children with brain injuries. Time reveals the consequences of a brain injury
as a child grows. Unlike the adult, an injury interrupts a developing brain in
a child. This development continues right up through adolescence. It can take
months, and even years, for the effects of the injury to appear. It is in school
that the long-term consequences show up. Yet parents and educators usually are
not trained to track the cognitive and behavioral development of a child with
a brain injury. Early referrals to special education are too often not even made
by hospital staff before the child goes home. As a result, many students with
brain injuries return to school with no special services or supports and can face
years of struggle and confusion. As an adult survivor of a three-story fall at
age four described, "I had all the typical problems through school, but nobody
understood why. I was always the kid at the bottom of the class, no matter how
hard I tried. I couldn't read the blackboard, was always getting into fights,
and had trouble with any subjects like history that required lots of memorization.
Teachers thought I was a daydreamer, but I just couldn't pay attention for long
in class. They couldn't understand why I did well in some subjects like music
and math, but was terrible in other subjects like English and Spanish. They couldn't
decide if I was just stubborn or lazy. No one remembered that I had a brain injury
when I was a kid, because I looked fine. My mother didn't want to admit that I
was different from my brothers and sisters and the teachers thought I was just
slow. All I remember about school was how hard it was and how bad it made me feel.
" When it is serious?Any brain injury can have serious
consequences for a child. The classification of brain injuries into categories
of mild, moderate and severe gives the false impression that only the latter results
in disabilities. The assumptions that a minor brain injury has no consequences
and that a severe brain injury means a child will always be very disabled are
not valid. Each brain injury is different. Recovery depends upon the extent and
location of the damage to the brain. The consequences are different for each child
and each brain injury. Children are constantly changing. This makes it much more
complicated to figure out what changes are due to "normal" development
vs. recovery from the brain injury. Parents periodically think about "what
could have been" if their child had not had a brain injury. As changes in
behavior, communication or learning appear over time, parents struggle with the
question of "Is this related to the brain injury or would this have happened
anyway?" Adolescence, which is known for its stormy difficulty, brings special
challenges to answering this question. Unlike adults who have a lifetime of experience
to draw upon after a brain injury, children are still developing new life skills
and learning how to adapt and compensate for their injury. Information is the answerParents and educators need
accurate information to correct the misunderstandings and stereotypes associated
with brain injury. They also need practical information to design educational
programs, manage difficult behaviors, develop communication strategies, and above
all, to prepare for the future. Fortunately, the federal law for special education,
the Individuals with Disabilities Education Act, added an amendment in 1991 that
created a specific category of traumatic brain injury. All states must use this
category. However, the law did not include a mechanism for educators to receive
the necessary training and information in order to identify these students and
how to meet their special educational needs. L&A Publishing was founded to address
this gap in information.
MEET YOUR PALSLash and Associates Publishing/Training
Practical and understandable
information about brain injury and disabilities is hard to find. It is even
harder to find materials written just for families, therapists, educators and
community caregivers. L&A Publishing does this. Our materials summarize clinical
experience, research findings, and educational programs into practical and affordable
information that can be readily used in health care programs, home, school and
the community. Tip cards, booklets and manuals are written by national experts
in a user friendly style to: - understand the needs
of children and adolescents with disabilities
- help families cope
- develop effective educational
programs
- prepare for the future.
Check out our web site at
www.lapublishing.com
or write or call for a free catalog to L&A Publishing, 708 Young Forest Drive,
Wake Forest, NC 27587 or tel 919-562-0015 or e-mail lapublishing@earthlink.net Visitors to our web site
can order a free tip card and take advantage of monthly specials on books. Meet Our National Experts Ron Savage, Ed.D.,
is Executive Vice President at Bancroft NeuroHealth in Haddonfield, New Jersey.
He specializes in the impact of brain injury on behavior and learning in children
and adolescents. His international recognition as author and presenter is based
on practical experience as a rehabilitation clinician, educator and school administrator.
A leader in advocacy for
children with brain injuries, Ron founded the Pediatric Task Force of the Brain
Injury Association. He is a national leader in developing model programs and
has given special attention to recognizing the effects of concussion among children,
the consequences of brain injury upon behavior, and designing educational programs
for students with brain injuries in the community. Marilyn Lash, M.S.W.,
uses her social work experience and research in pediatric rehabilitation to
develop sensitive and practical guides for families, educators, and professionals.
Marilyn's specialty is helping families cope with the emotional impact of brain
injury and developing strategies for negotiating the complex service system.
Now Director and Senior Editor of Lash and Associates Publishing and Training,
she focuses on developing user friendly publications for families, educators,
and clinicians. As co-chair of the Special
Interest Group on Children and Adolescents for the national Brain Injury Association,
Marilyn advocates for greater recognition of youths with brain injuries and
the development of statewide systems across the nation to address their needs.
Bob Cluett; As the
survivor of a childhood brain injury, Bob brings a special perspective as President
of Lash and Associates Publishing/Training. The skills that he developed during
his corporate career of over 20 years in communication, marketing, direct mail
advertising and sales now focus on publishing information about the consequences
of brain injury among children , adolescents, and young adults. Bob presents at national
and regional conferences on effective methods of communication and advocacy
by families, survivors, and professionals. He also consults with non-profit
organizations to build community awareness of brain injury and for more effective
methods of fundraising. Roberta DePompei, Phd.
is a Professor and Clinical Supervisor at the Speech and Hearing Center at the
University of Akron in Ohio. An advocate of the needs of youths with brain injuries
and their families, she is on numerous national task forces and committees,
as well as co-chair of the Special Interest Group on Children and Adolescents
with Brain Injuires for the Brain Injury Association. Widely published and a national
and international presenter, Roberta's specialty is the impact of brain injury
upon speech, language and communication. She is especially interested in developing
transitional opportunities for youth as they progress through school and prepare
for adulthood. |
