From Lash and Associates Website www.lapublishing.com

 

This list may be copied and distributed to help families find information and resources. _________________________________________________________ PUBLICATIONS

Emergency Information Forms (EIF) for Children with Special Health Care Needs

American Academy of Pediatrics & American College of Emergency Physicians (1999) The Emergency Information Form (EIF) for parents of children with special health care needs places pertinent medical information in one accessible place. The tool helps physicians, parents, EMS professionals, and nurses provide prompt and appropriate care. To download a free copy as well as for Q&A and other information on its history and intended use, go to www.aap.org/advocacy/emergprep.htm

Facts About Concussion and Brain Injury: Where to Get Help

National Center for Injury Prevention and Control at the Centers for Disease Control and Prevention (1999) This booklet explains common symptoms following brain injuries, describes danger signs, and provides tips for better recovery and resources for help. It is intended for people who are treated for less severe brain injuries, either in hospital emergency departments or with brief hospital admission. This booklet was developed with advice from persons with brain injury, health care professionals, neuroscientists, and the Brain Injury Association. To download a free copy, go to www.cdc.gov/ncipc/tbi

A Guide to the Individualized Education Program

Office of Special Education and Rehabilitative Services, U.S. Department of Education (July 2000) This guide helps teachers and parents of children with disabilities design and implement an Individualized Education Program based on what is required by the Individuals with Disabilities Education Act (IDEA).To download a free copy, go to www.ed.gov/offices/OSERS/OSEP/IEP_Guide

Helping Parents and Professionals Communicate After a Child Has Been Injured (set of 5 tip cards)

Research and Training Center in Rehabilitation and Childhood Trauma of the New England Medical Center (1997) Four tip cards provide parents with suggestions on communicating with health care professionals in the emergency/intensive care unit, the hospital, the rehabilitation center, and the community. The fifth tip card is written for health care professionals who work in all of these settings.To download a free copy, go to www.tbigrants.com/tip_card.htm

Key Transition Issues for Youth with Disabilities and Chronic Health Conditions

Rhonda Schulzinger, Esq. (September 1998) One of the Maternal and Child Health Bureau’s Institute for Child Health Policy’s Healthy & Ready to Work publications. This policy paper describes recent changes in the Supplemental Security Income (SSI) Program that affect adolescents; SSI work incentives for adolescents; how adolescents can maintain access to quality health care and benefits during their transition years; and key issues to consider during transition planning. It is the first in a series of papers aimed at assisting service providers and families to ensure successful transitions to work and independence for youth with disabilities and chronic illness.To download a free copy, go to www.mchbhrtw.org/materials/default.htm

A Parent’s Guide: Accessing Programs for Infants, Toddlers, and Preschoolers with Disabilities

National Information Center For Children and Youth with Disabilities (August 1994) This guide is intended to help parents get help for their children with special needs. It answers common questions about early intervention services for children ages birth to 2 years; special education and related services for children ages 3 to 5 years; services for underserved populations, including rural, Native American, adoptive/foster, and military; and information about the Individuals with Disabilities Education Act (IDEA). It also includes a glossary and a bibliography of references. This publication is available as a downloadable text or .pdf document in both English and Spanish www.nichcy.org/pubs/parent/pa2.htm

A Parent’s Guide: Special Education and Related Services: Communicating Through Letter Writing

National Information Center for Children and Youth with Disabilities (September 1991) This publication identifies when and to whom it is necessary or useful to write a letter as part of the special education process of initially identifying a disability through the eventual development of an Individualized Educational Program (IEP). Sample letters are included. This publication is available as a downloadable text or .pdf document in both English and Spanish at www.nichcy.org/pubs/parent/pa9.htm

Paying the Bills: Tips for Families on Financing Health Care for Children with Special Needs, 2nd edition

New England SERVE Regional Task Force on Health Care Financing (1999) This was written in collaboration by parents who have children with special needs and the New England SERVE Regional Task Force on Health Care Financing. This work encourages families to ask questions, be persistent and learn about the health care financing system. It gives tips in getting started; making a child’s health insurance work for the family; making public programs work for the family; tackling medical bills; influencing decision-makers; documenting a child’s special needs; changing decisions; cost savings; finding other sources of funding; and connecting with other families. It includes a 9-page glossary. To order a free from the Maternal and Child Health Clearinghouse, go to www.nmchc.org/html/order.htm or call 1-888-434-4624 (toll-free) and ask for Inventory Code L-094.

Traumatic Brain Injury in Children and Teens: A National Guide for Families

New Hampshire EMS for Children Grant Project (1999) This guide is intended to help parents of children who have sustained brain injuries understand and cope with their child's injury and treatment, locate the appropriate health care services, and find ways to pay for short- and long-term care. Divided into seven progressive chapters, the guide takes parents through each step of their child's recovery from the hospital to the home. Real life examples, charts, and questionnaires personalize the text. To download a free copy, go to www.ems-c.org/downloads/pdf/NatlTBIbook.pdf . The reader for the Adobe Acrobat (.pdf) file is available free at www.adobe.com/products/acrobat/readstep.html

When Your Child’s Head Has Been Hurt

Arizona Governor’s Council on Spinal & Head Injuries (1999) This two-page fact sheet is designed to help families identify post-concussive (mild brain) disorders after discharge from the emergency department or hospital. It addresses four common signs that may indicate a more serious problem: problems with health, changes in behavior and feelings, trouble thinking, and difficulty in communicating. To download a free copy, go to www.tbigrants.com/arizonaproduct.htm     WEB SITES

20 Questions with an Emergency Room Doctor

Karen Frush, emergency department physician at Duke University Medical Center, answers questions regarding a child's visit to the emergency room. Go to www.sparky.org/cool/cool-Erdoctor.htm

Families USA Home Page

Serving as a national voice for and aid to consumers, Families USA provides information and resources related to health care public policy. The organization conducts grassroots campaigns and tracks the progress of legislation affecting managed care and Medicaid. Go to http://www.familiesusa.org/

Institute for Family-Centered Care Home Page

This web site contains a discussion forum for families who have experienced emergency care as well as resources and tools that providers and families can use to improve the quality of health care delivery. Go to www.familycenteredcare.org

National Center of Medical Home Initiatives for Children with Special Needs Home Page

The National Center of Medical Home Initiatives for Children with Special Needs provides support to pediatricians, families, and other medical and non-medical providers who care for children with special needs. Many educational resources, including fact sheets and slide presentations, are available on their web site. Go to www.aap.org/advocacy/medhome/aap.htm

 

Copyright © 1999-2000 Lash and Associates Publishing/Training
708 Young Forest Drive, Wake Forest, NC 27587-9040

 

 

LEARNING ABOUT SPECIAL EDUCATION

By Marilyn Lash

 Where do I start? This is the question often asked by parents of recently injured children as they enter the complex system known as special education. Educating a student with a brain injury is a complex and challenging process that constantly changes over time. As one parent commented, "The only constant is change." 

 

The informed consumer

Parents can only be effective advocates if they are knowledgeable. The federal law on education, the Individuals with Disabilities Education Act (IDEA), has a specific category for traumatic brain injury under special education. The federal definition is limited to traumatic injuries to the brain that are caused by an external physical force (such as a blow to the head). But many states have broadened this definition to include acquired brain injuries (strokes, tumors, encephalitis, meningitis, near drowning). Readers can find out how their state defines brain injury by contacting the state Department of Education or their local special education director. 

 The diagnosis of a traumatic or acquired brain injury does not automatically qualify a student for special education. The diagnosis is just a beginning. Once a referral for special education has been made, the school conducts a multidisciplinary evaluation. This evaluation determines how the brain injury has affected the student’s ability to learn and function in school. Federal and state laws provide very specific procedures and timelines for this process.

 The education law guarantees parents certain rights and responsibilities. It is important for parents to know their rights under this law and to be involved. This article identifies four important resources for parents, advocates and educators injury.

 

NICHCY

This is the National Information Center on Children and Youth with Disabilities. It is an excellent place to begin to understand how special education works. This federally funded national clearinghouse provides information on disabilities in children and youth (birth to age 22). It specializes in fact sheets and guides that are written just for parents. Many materials are free or have a minimal charge. Their Publications Catalog lists their many products and is a gateway to information. You can even find a list of Resources in your state.

 

You can check it out on the web at www.nichcy.org or call 1-800-695-0285 or 202-884-8200. NICHCY’s address is PO Box 1492, Washington, DC 20013-1492.

 

Fact Sheet on Traumatic Brain Injury

NICHCY also has a four-page fact sheet on TBI that provides an excellent overview of the consequences of brain injury and it effects upon a student’s learning. Sections include What is TBI? How Common is TBI? and Signs of TBI. The section on school describes how a brain injury can affect a student and provides tips for teachers and parents. Resources direct readers to books and manuals about students with brain injuries. It can be ordered at the above numbers through NICHCY.

 

Special Education IEP Checklist for a Student with a Brain Injury

Once a student has been found eligible for special education, the educational team develops an individualized educational program (IEP) to meet the student’s special needs. This is the blueprint for the student’s education. Parents are an integral part of this plan. The IEP is not just a pile of paperwork that sits in the student’s folder. It is a flexible and critical tool that should change, as the student’s needs change.

 

Because a brain injury affects each student differently, there is no standard content for this IEP. This IEP checklist identifies common changes after a brain injury. It lists student accommodations or assistance that may be needed for thinking and communication, developing social skills, and adjusting to physical changes. Teaching strategies, methods for giving instructions and assignments, and types of adaptive aids are listed for use is the classroom.

 

This tip card is available for free by contacting Lash and Associates Publishing/Training at 708 Young Forest Drive, Wake Forest, NC 27587 (919)562-0015 email at mlash@lapublishing.com or visit their web site at www.lapublishing.com

 

Parent Centers

Children with birth related conditions, mental retardation, chronic illness and cancer have wide informational networks and advocacy systems. This includes Parent Training and Information Centers in each state.

 

Parents of children with brain injury often overlook these centers. However, they are valuable resources because they "know the special needs system" in their state, especially the laws and regulations for special education. Parent Centers are excellent resources for gathering information, asking questions and meeting professionals and parents. Many even provide advocacy workshops for families, training programs, conferences, newsletters, and support groups.

 

The name and address of the Parent Center in your state is available from the family help line of the national Brain Injury Association (800-444-6443). The Federation for Children with Special Needs lists all the centers by state on their web site at www.fcsn.org

 

Broaden your network

Look beyond the diagnosis. Parents of children with other disabilities can be valuable mentors and sources of information. They may have years of experience negotiating special education services, finding funding for uninsured expenses, locating recreation programs, and maneuvering through the red tape of bureaucracy. Their savvy can help parents of recently injured children understand how the system works and what to do when it gets stuck or breaks down. Learn from each other.

 

Permission to copy or reprint this article is provided by Lash and Associates Publishing/Training.

Feel free to print out a copy of this article or copy & paste it to your computer...

 

THE FOLLOWING IS FROM healthanswers.com:

CONCUSSION RESOURCES

 

Definition
A concussion is a result of a blow or sudden, uncontrolled, rapid movement to the head. It can cause memory loss, problems with thinking or temporary unconsciousness.

What are the signs and symptoms of the injury?
The signs and symptoms of a concussion are: loss of awareness after a blow or major injury to the head memory loss of the events surrounding the injury

Signs of a serious injury requiring emergency care include: persistent unconsciousness or coma. altered level of consciousness. This can mean that the person is hard to wake or not his or her usual self. confusion. convulsions </MedEnc/view.asp?filename=434.htm>(the sudden, uncontrollable spasm of muscles). vomiting. difficulty walking. weakness on one or both sides of the body.

What are the causes and risks of injury?
A concussion is caused by a blow or sudden, uncontrolled, rapid movement to the head. Examples are being hit on the head with a baseball or being thrown forward in a car accident. The brain is pushed against the wall of the skull. This can cause bruising, swelling, or bleeding that damages the brain cells. This damage usually goes away with time, but occasionally has lasting effects. The more serious a concussion, the longer a person may have symptoms. Many people have little or no memory of the events surrounding the injury. This memory loss is called amnesia.

What can be done to prevent the injury?
Individuals should wear helmets when playing football, rollerblading, skateboarding, skiing and snowboarding. Helmets also should be worn when riding bicycles and motorcycles. People should wear seat belts or be in age-appropriate car seats at all times when riding in all vehicles. In high-risk construction areas, individual should wear hard hats. People participating in activities in which head injuries can occur should wear mouth and teeth guards.

How is the injury diagnosed?
A concussion can be diagnosed by a doctor or healthcare professional with a standard neurologic exam and complete history. Neurologists may use an EEG </MedEnc/view.asp?filename=1205.htm> or electroencephalogram to diagnose concussion by checking brain waves.

Tests such as head CT scan </MedEnc/view.asp?filename=1175.htm>, or computed tomography (special three-dimensional x-ray), x-ray , and MRI , or magnetic resonance imaging (special three-dimensional image using magnets), may also be used to rule out bleeding, bruises, or fractures by checking tissue structures. Often, all tests will be normal because the injury is not severe enough to detect. A diagnosis may be made by how a person feels and behaves.

What are the treatments for the injury?
An individual should keep the injured person quiet.

Activities may be limited based on: the amount of time the person was unconscious. the number of prior injuries. how closely spaced these head injuries were.

Sports participation may be restricted. Repeated head injuries, especially if the injuries occur closely together, can lead to serious brain injury and even death.

Complicated concussions that bleed are treated in a hospital and usually require surgery.

If symptoms persist that interfere with thinking and behavior, specialized therapy may be given by people with training in brain injury rehabilitation.

What are the side effects of the treatments?
There are few side effects with the treatment of an uncomplicated concussion. If medications have been given, side effects may occur. There are no side effects from the tests. Most people fully recover from concussions.

What happens after treatment?
After a certain amount of time, as determined by a doctor or healthcare professional, a person can usually participate in regular activities. If, however, at any time the person becomes confused, a doctor or healthcare professional should be consulted immediately.

Author: James Broomfield, MD  Date Written: 08/07/99 Reviewer: Karen Preston, PHN, MS, CRRN Date Reviewed: 05/11/00

 

 

THE FOLLOWING IS FROM www.tbi.org:

 

            Copyright held since 1991 by The Perspectives Network, Inc. , 770/844-6898

 

What is an Acquired Brain Injury?

 

It is the impairment of normal brain function due to a neurological insult, such as: open or closed head injury (traumatic brain injury or TBI), select cerebral vascular lesions (i.e., aneurysm, hemorrhage, brain stem stroke), hypoxic event (loss of oxygen .. i.e., near drowning), intracranial tumor, and select neurological diseases (i.e., encephalopathy). Well, that is a technical definition. Not very satisfying, is it? It's very impersonal and doesn't really even begin to answer the question. For something as complex as brain injury, there are no easy definitions or answers.**

 

**Most often, brain damage from congenital or genetic origins or birth trauma is not included within the standard definition of TBI. Neither are degenerative neurological diseases or disabilities stemming from mental illness. However, the definition of ABI and TBI will vary from organization to organization.

 

Is it only an ABI if there has been coma?

 

NO! ABI has many levels of intensity. It is possible that someone can acquire a brain injury without loss of consciousness or external bruising or tangible confirmation (i.e., CAT Scans, Skull X-rays, EEGs, etc.)

 

Individuals who have even a mild brain injury may continue to experience a wide variety of symptoms that can have life-changing implications. However, each injury is different and unique for each person.

 

What are the symptoms of an ABI?

 

Symptoms and related deficits fall into four major groups: Cognitive, Perceptual, Physical and Behavioral/Emotional. Keep in mind that because of the uniqueness of each injury, some survivors may or may not face or exhibit some or all of the symptoms. The number of symptoms doesn't reflect on the impact that the injury will have on the survivors. Much of that depends on where the injury is located. The following is, by no means, a complete or comprehensive listing.

 

Cognitive Symptoms

 

·        Difficulty in processing information (decreased speed, accuracy and consistency)

·        Shortened attention span

·        Inability to understand abstract concepts

·        Impaired decision-making ability

·        Inability to shift mental tasks or to follow multi-step directions

·        Memory loss or impairment

·        Language deficits (difficulty expressing thoughts and understanding others, inappropriate word selection)

 

Perceptual Symptoms

 

·        Change in vision, hearing or sense of touch

·        Loss of sense of time and space and spatial disorientation

·        Disorders of smell and taste

·        Altered sense of balance

·        Increased pain sensitivity

 

Physical Symptoms

 

·        Persistent headache

·        Extreme mental and/or physical fatigue

·        Disorders of movement - gaiting, ataxia, spasticity and tremors

·        Seizure activity (traumatic epilepsy)Impaired small motor control

·        Photosensitivity (sensitivity to light)

·        Sleep disorders

·        Paralysis

·        Speech that is not clear due to poor control of the muscles in the lips, tongue and jaw and/or poor breathing patterns

 

Behavioral/Emotional Symptoms

 

·        Irritability and impatience

·        Reduced tolerance for stress

·        Lack of initiative, apathy

·        Dependence (failure to assume responsibility for one's actions

·        Denial of disability

·        Lack of inhibition (may result in aggression, cursing and inappropriate sexual behavior

·        Inflexibility

·        Flattened or heightened emotional responses/reactions

 

How long does a brain injury last?

 

Each injury is different and unique to the survivor just as all survivors have different capacities for recognizing and compensating for the symptoms they exhibit. Much depends on getting the correct diagnosis and treatment and ensuring that good support systems are in place for the ENTIRE family. Changes and improvement continue although sometimes they are so slight they are hard to notice. It doesn't happen overnight. Some of the deficits may remain for a lifetime while others may improve to the point that they are not a major factor in day-to-day living.

 

Is a Mild Brain Injury unimportant?

 

NO! A mild brain injury can have the same devastating effects that a moderate or severe injury can have. The key point is location. Most survivors of mild brain injury don't lose consciousness and may only be in the emergency room for a short time before being sent home without ever knowing that they've been injured. For many of them, the survivor and their family/friends will begin noticing changes in them .. sometimes very subtle, sometimes very obvious. Since they weren't diagnosed with a brain injury in the emergency room and since they didn't ever lose consciousness, far too many of them will never receive the help that they need. Only now are the impacts of mild brain injury being understood, identified and treated. Most typically, mild brain injuries are received in car accidents where the brain is 'sloshed' around in the skull by the collision.

 

Does everyone who hits their head get a brain injury?

 

In the most mild of cases, the brain still gets bruised in much the same way your leg might get bruised if you bump into a coffee table. However, the head and the brain is pretty resilient and it can usually handle that injury without much effort. Some times people can get a really tremendous blow on the head and it not have any external effect. Again, much depends of the location of the injury and the brain's ability to compensate.

 

Am I alone with this injury?

 

NO! Estimates place the annual occurrence of Acquired Brain Injury at 2 million. Tasks shared are tasks light. PLEASE take advantage of the people and organizations waiting to help you. You will find resource listing in this site.

 

Brain injury is traumatic .. physically, mentally and emotionally. It is hard on the person who has sustained the injury and it is hard on the family and friends of that person. It usually occurs quickly and without warning and finds everyone scared, confused, overwhelmed and in a state of shock.

 

Just as the definition of ABI varies so does the information that is passed onto the survivor and their family. I can either be too much or too little. It can be only the good or only the bad. There might be times when you're so tired you don't think you can go another step. You'll find yourself caught up in many different emotions. You might feel that all hope is gone .. but never give up!

 

Brain injury requires that someone without prior knowledge quickly become informed and aware of what is happening now and what might happen in the future. It requires that lines of communication be put into place and then used to their maximum, advocating for the survivor until he/she is able to assist with that responsibility or take it over completely.

 

If you are the survivor, there will be times when you are so frustrated, so angry, so depressed, so confused that you will want to give up .. don't! Reach out and find a peer groups of survivors and let them help you. You will find out that you ''are not going crazy' inspite of what it sometimes seems like.

 

Recovery will vary and changes will occur long after you were told they would stop. A great deal will depend on the desire of the survivor to improve but 'desire' alone won't do it. Never feel that this injury will go away if the survivor really wanted it to. It will take work and lot's of it on everyone's part.

 

The material below is from the Brain Injury Association of America website www.biausa.org

The Anatomy of a Brain Injury

The most widely accepted concept of brain injury divides the process into primary and secondary events. Primary brain injury is considered to be more or less complete at the time of impact, while secondary injury evolves over a period of hours to days after trauma.

Primary Injury

·        Skull fracture: Breaking of the bony skull; in a depressed skull fracture, these bone fragments exert pressure on the brain.

·        Contusions, or bruises, will often occur under the location of a particular impact. They are also common in the tips of the frontal temporal lobes, where the force of the injury can drive the brain against the bony ridges on the inside of the skull.

·        Hematomas, or blood clots, result when small blood vessels are broken by the injury. They can occur between the skull and the brain (epidural or subdural hematoma), or inside the substance of the brain itself (intracerebral hematoma). In either case, if they are sufficiently large they will compress or shift the brain, damaging sensitive structures in the brain stem. They can also raise the pressure inside the skull and eventually shut off blood supply to the brain. Prompt surgical removal of such large blood clots is often lifesaving. However, certain smaller hematomas can be safely allowed to resolve themselves without surgery.

·        Lacerations: Tearing of frontal and temporal lobes or blood vessels caused by brain rotating across ridges inside skull.

·       Diffuse Axonal Injury: After a closed brain injury, the shifting and rotation of the brain inside the skull will result in shearing injury to the brain's long connecting nerve fibers or axons. This can be microscopic and potentially reversible in mild brain injury, but following more severe brain injury it can be devastating and result in permanent disability or even prolonged coma. At present, there is no special treatment for diffuse axonal injury. However, recent studies have shown that some of the damage to axons progresses over the first 12 to 24 hours after the injury. For this reason, there is hope that it may be possible to prevent this progression in the future with specific treatments. Because of these recent findings, diffuse axonal injury is now thought of as a combination of primary and secondary damage.

Secondary Injuries

Delayed secondary injury at the cellular level has come to be recognized as a major contributor to the ultimate tissue loss that occurs after brain injury. A cascade of physiologic, vascular, and biochemical events is set in motion in injured tissue. This process involves a multitude of systems, including possible changes in neuropeptides, electrolytes such as calcium and magnesium, excitatory amino acids, arachidonic acid metabolites such as the prostaglandins and the leukotrienes, and the formation of oxygen-free radicals. This secondary tissue damage is at the root of most of the severe, long-term deficits a person with brain injury may experience. Procedures that minimize this damage can be the difference between recovery to a normal or near-normal condition or permanent disability.

Diffuse blood vessel damage has been increasingly implicated as a major component of brain injury. The vascular response appears to be biphasic. Depending on the severity of the trauma, early changes include an initial rise in blood pressure, an early loss of the automatic regulation of cerebral blood vessels, and a transient breakdown of the blood-brain barrier. Vascular changes peak at approximately 6 hours postinjury but can persist for as long as 6 days. The clinical significance of these blood vessel changes is still unclear, but may relate to delayed brain swelling that is often seen, especially in younger people. Oxygen-free radical scavenger drugs prevent or reverse these changes experimentally, suggesting that such drugs may come to play an important role in the management of brain injury in the near future.

The process by which brain contusions produce brain necrosis is equally complex and is also prolonged over a period of hours. Toxic processes include the release of free oxygen radicals, damage to cell membranes, opening of ion channels to influx of calcium, release of cytokines and metabolism of free fatty acids into highly reactive substances that may cause vascular spasm and ischaemia. Such processes may also be interruptable by therapeutic agents such as lipid antioxidants, calcium channel blockers, and glutamate antagonists. The search for secure evidence that new classes of drug based on these mechanisms reduce the morbidity and mortality of brain injury will be one of the most important efforts of the nineties.

Free radicals are formed at some point in almost every mechanism of secondary injury. Their primary targets are the fatty acids of the cell-membrane. A process known as lipid peroxidation damages neuronal, glial and vascular cell membranes in a geometrically progressing fashion. If unchecked, lipid peroxidation spreads over the surface of the cell membrane and eventually leads to cell death. Thus free radicals damage endothelial cells, disrupt the blood-brain barrier, and directly injure brain cells, causing edema and structural changes in neurons and glia. Disruption of the blood-brain barrier is responsible for brain edema and exposure of brain cells to damaging blood-borne products.

Free iron, as found in contusions and hematomas, is particularly toxic, probably by catalyzing the formation of hydroxyl radical (one of the most destructive of all the free radicals). Hall and Traystman report that these products may result in progressive secondary injury to otherwise viable brain tissue through several mechanisms, for example, by producing further ischemia or altering vascular reactivity, by producing brain swelling (edema or hyperemia), by injuring neurons and glia directly, or activating macrophages that result in such injury, or in the case of penetrating brain injury, by establishing conditions favorable to secondary infection. In other words, much of the ultimate brain loss may be caused not by the injury itself, but by an uncontrolled vicious cycle of biochemical events set in motion by the trauma. The control of this complex cascade of cellular events remains one of the most important challenges in the acute management of brain injury. As with diffuse axonal injury, it offers a potential therapeutic window of opportunity during which brain swelling and nerve cell death may be prevented during the first few hours after an injury has been sustained.

Secondary Intracranial Insults

.In the minutes and hours after a brain injury, a variety of other damage may occur.

·        Hematoma (epidural, subdural and/or intracerebral)

·        Brain swelling/edema

·        Increased intracranial pressure

·        Cerebral vasospasm

·        Intracranial infection

·        Epilepsy

In one recent survey of 100 individuals with severe, moderate and minor brain injury associated with other injuries by Andrews, 92% were found to have one or more type of intracranial insult occurring for periods of 5 minutes or longer while being managed in a well staffed and well equipped intensive care unit.

Secondary Systemic Insults

Secondary systemic insults (outside the brain) that may lead to further damage to the brain are extremely common after brain injuries of all grades of severity, particularly if they are associated with multiple injuries. Thus people with brain injury may have combinations of low blood oxygen, blood pressure, heart, and lung changes, fever, blood coagulation disorders, and other adverse changes at recurrent intervals in the days following brain injury. These occur at a time when the normal regulatory mechanism by which the cerebrovascular vessels can relax to maintain an adequate supply of oxygen and blood during such adverse events is impaired as a result of the original trauma.

Some of the more common forms of secondary systemic insults are listed below:

·        Hypoxemia (Low blood oxygen)

·        Arterial hypotension (high or low blood pressure)

·        Hypercarbia (carbon dioxide accumulation)

·        Severe hypocarbia

·        Pyrexia (fever)

·        Hyponatremia (low sodium)

·        Anemia

·        Abnormal blood coagulation

·        Lung changes

·        Cardiac (heart) changes

·        nutritional (metabolic) changes

Resources

On the biausa Links page you will find hundreds of brain injury related web site links.

 

From National Resource Center for TBI Website:
www neuro.pmr.vcu.edu

 

Working with Children and Their Families

 

Many children with TBI carry no visible scars following injury; however, they may continue to suffer disorders of learning and behavior. Ideally, an interdisciplinary approach utilizing a team of professionals is used to address an individual child’s needs. Guidelines for Educational Services for Students with Traumatic Brain Injury provides an excellent step-by-step recipe for success. For Kids Only: A Guide to Brain Injury is a superb booklet geared for siblings and close friends of a child who incurs a brain injury. We believe professionals and family members alike will benefit from these two special offerings. In addition, videotape developed by Dr. Pamela Waaland offers school personnel insights and guidelines for addressing the unique educational needs of children returning to school after sustaining a brain injury.

 

Guidelines for Educational Services for Students with Traumatic Brain Injury. Virginia Department of Education (1993). Rehabilitation Research and Training Center on Severe Traumatic Brain Injury, MCV/VCU, Richmond. (110 pages)

This manual helps readers develop effective school-family partnerships to mediate successful educational programming. Common problems/deficits to learning following traumatic brain injury and recommended "action steps" for successful educational programming are identified. In addition, TBI screening measures, functional/vocational assessments, suggested evaluation tools, information on services under Section 504 and IDEA, and a comprehensive listing of resources are included.

Item: #247 Cost $12.50

 

For kids only: A guide to brain injury. Waaland, P. & Raines, S. (1992). Rehabilitation Research and Training Center on Severe Traumatic Brain Injury, MCV/VCU, Richmond.

This heartwarming guide was compiled by experienced child psychologists who offer age-appropriate explanations of what happens when a child sustains a traumatic brain injury. Frequently asked questions and quotes from siblings of injured children are incorporated into the text. Other highlights include information on coma; physical, cognitive, and behavioral changes; sibling relationship issues; and the role of family and friends in the recovery process. Factual information on brain injury is conveyed in a simplified style that is reassuring to young readers who face the tragedy of brain injury in their own lives.

Item #244 Cost $6.50

Returning to School following Traumatic Brain Injury: A Guide for School Personnel.  Pamela K. Waaland, Ph.D.

This video will help family members, counselors, and teachers more effectively advocate for students with brain injury. This insightful three-part, 60 minute videotape addresses the causes and consequences of TBI, eligibility requirements and curriculum considerations, and classroom strategies for promoting academic success following traumatic brain injury. Professionals, survivors of TBI, their family members, and students help educators understand the need for family-educator-professional partnerships in preparing the student with TBI for his/her return to the school setting. Topics highlighted include: effective educational programming and individual educational plans; common obstacles to learning and recommended action steps; environmental adaptations and special education services; and placement options. (60 minutes)

Item: VT #11 Cost $57.50

 

The Neuropsychological Assessment Kit, 2^nd Edition

The second edition of this popular kit contains even more useful clinical and research materials. Materials are intended to enhance the practice of neuropsychological and neurobehavioral assessment for persons with brain injury. Included are questionnaires, structured interviews, descriptions of the assessment process, tools for report writing, normative data, a sample report, and information on developing referral sources. Information is also provided regarding the use of neuropsychological tests in litigation.

The kit contains the following clinical materials:

 

·         Tests and Corresponding Neuropsychological Functions - a comprehensive list of neuropsychological tests and the corresponding areas of measurement expressed in functional terms

·         Neuropsychological Profile - a checklist for reporting neuropsychological levels of test performance, competencies, and qualitative aspects of examination

·         Referral Form – a form for your referral sources to use intended to aid in determining their referral questions

·         General Health and History Questionnaire - a comprehensive assessment instrument used to obtain pre- and post-injury patient information from family members and patients including: (1) demographic information; (2) severity of injury; (3) alcohol and drug use; and (4) employment history

·         The Headache Inventory – a extensive questionnaire used to identify: location, type, length, and severity of headaches

·         Structured Interview Form – this 1 page, double-sided form can be used to collect all pertinent information during the interview with the patient and family

·         Guide to Neuropsychological Report Writing and Recommendations List - a comprehensive listing of recommendations based on patient strengths and areas of cognitive and behavioral dysfunction; the list provides an illustration of the direct link between assessment and treatment

·         Sample Reports – these 2 extensive, comprehensive neuropsychological report is an example of how to incorporate the information gathered during the assessment into a product which is useful to the patient, the family, and the professional

·         Billing Form – this form serves as a model for invoicing 3^rd party payors, illustrating a way to substantiate evaluation charges while maintaining patient confidentiality