TRAUMATIC BRAIN INJURY Fact Sheet Number 4 (FS4), 1997 ________________________ NICHCY National Information Center for Children and Youth with Disabilities P.O. Box 1492 Washington, DC 20013 E-Mail: nichcy@aed,org URL: http://www.nichcy.org 1-800-695-0285 (Voice/TT) _________________________ DEFINITION The 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)] INCIDENCE TBI 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. CHARACTERISTICS The 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 IMPLICATIONS Despite 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. RESOURCES DeBoskey, D.S. (Ed.). (1996). Coming home: A discharge manual for families of persons with a brain injury. Houston, TX: HDI Publishers. (Telephone: (713) 682-8700.) Gerring, J.P., & Carney, J.M. (1992). Head trauma: Strategies for educational reintegration. San Diego, CA: Singular Publishing Group, Inc. (Telephone: 1-800-521-8545.) Hughes, B.K. (1990). Parenting a child with traumatic brain injury. Springfield, IL: Charles C. Thomas. (Telephone: 1-800-258-8980.) National Rehabilitation Information Center. (1994). Traumatic brain injury: A NARIC resource guide for people with TBI and their families. Silver Spring, MD: Author. (Telephone: 1-800-227-0216.) Orto, A.D., & Power, P. (1994). Head injury and the family: A life and living perspective. Delray Beach, FL: St. Lucie Press. (Telephone: 407-274-9906.) Savage, R. (1995). An educator's manual: What educators need to know about students with TBI. Washington, DC: Brain Injury Association. (See address below.) Tucker, B.F., & Colson, S.E. (1992). Traumatic brain injury: An overview of school re-entry. Intervention in School and Clinic, 27(4), 198-206. ORGANIZATIONS Brain Injury Association (formerly the National Head Injury Foundation) 1776 Massachusetts Avenue, NW Suite 1000 Washington, DC 20036 800-444-6443 (Family Helpline) 202-296-6443 Web Address: http://www.biausa.org Epilepsy Foundation of America 4351 Garden City Drive, Suite 406 Landover, MD 20785 301-459-3700 (800)332-1000; (800) 332-2070 (TTY) E-Mail: postmaster@efa.org Web Address: http://www.efa.org THINK FIRST Foundation 22 South Washington Street Park Ridge, IL 60068 708/692-2740 _______________________________ Update June 1997 This fact sheet is made possible through Cooperative Agreement #H030A30003 between the Academy for Educational Development and the Office of Special Education Programs. The contents of this publication do not necessarily reflect the views or policies of the Department of Education, nor does mention of trade names, commercial products or organizations imply endorsement by the U. S. Government. This information is in the public domain unless otherwise indicated. Readers are encouraged to copy and share it, but please credit the National Information Center for Children and Youth with Disabilities (NICHCY). ------------------------------------------------------------------------ Back To Special Education Articles Page