Children with Traumatic Brain Injury

Children with Traumatic Brain Injury

Successful completion of this training meets one hour of the four hour annual training requirement for Personal Attendant Services direct care staff

as provided through the WV TBI Waiver Program

Disclaimer

Information included in this presentation was current at the time it was developed

Presentation materials are reviewed on an annual basis

22015 West Virginia TBI Waiver Program direct care staff annual training

Author

MELODEE A HURSEY, MSW, LSW, CBISTAPS HEALTHCARE, INC.TBI WAIVER PROGRAM PROVIDER EDUCATOR

Ms Hursey is a Certified Brain Injury Specialist Trainer through the Academy of Certified Brain Injury Specialists and a West Virginia Licensed Social Worker. She has more than 17 years of brain injury experience in a variety of areas including rehabilitation, waiver, support group facilitation, training, and program development.

CONTACT INFORMATION:[email protected]

32015 West Virginia TBI Waiver Program direct care staff annual training

Learning Objectives

• Identify common symptoms that a child may experience after a TBI

• Describe emotions and challenges children may struggle with after a TBI

• Understand and use interventions as a direct care staff to help a child adjust following a TBI

42015 West Virginia TBI Waiver Program direct care staff annual training

Overview of Traumatic Brain InjuryTraumatic Brain Injury (TBI) is

an insult to the brain not of a degenerative or congenital nature caused by an external physical force,

that may produce a diminished or altered state of consciousness resulting in an impairment of cognitive

abilities or physical functioning. It can also result in the disturbance of behavioral or emotional

functioning, may be temporary or permanent and cause partial or total functional disability or

psychosocial maladjustment.

National Head Injury Foundation(now the Brain Injury Association of America)

52015 West Virginia TBI Waiver Program direct care staff annual training

Medicaid TBI Waiver Definition

A non-degenerative, non-congenital insult to the brain caused by an external physical force resulting in total or partial functional disability and/or psychosocial impairment or an injury caused by anoxia due to near drowning

Chapter 512 Traumatic Brain Injury Waiver Services

62015 West Virginia TBI Waiver Program direct care staff annual training

Overview of Traumatic Brain Injury

In 2010, about 2.5 million emergency department visits, hospitalizations, or deaths were associated with TBI—either alone or in combination with other injuries—in the United States

Centers for Disease Control and Prevention

72015 West Virginia TBI Waiver Program direct care staff annual training

Overview of Traumatic Brain Injury• Children 0-4 years, older adolescents 15-19 and

adults 65 and older are the most likely to sustain a TBI

• Almost half a million emergency department visits each year for a TBI occur among children 0-14

Centers for Disease Control and Prevention

82015 West Virginia TBI Waiver Program direct care staff annual training

Symptoms of Traumatic Brain InjuryPhysical

Impairments Cognitive

Impairments Emotional

Impairments speech short term memory deficits mood swings

vision impaired concentration denial

hearing slowness of thinking self-centeredness

headaches limited attention span anxiety

motor coordination impairments of perception depression

spasticity of muscles communication skills lowered self-esteem

paresis or paralysis planning sexual dysfunction

seizure disorders writing restlessness

balance reading lack of motivation

fatigue judgment difficulty controlling emotions

92015 West Virginia TBI Waiver Program direct care staff annual training

Brain Injury Association of America

Symptoms of Traumatic Brain Injury• The child(ren) you are working with may experience any or all of

the impairments listed on the previous slide• The nature of the injury and its consequences can range from

mild to severe, and the course of recovery is difficult to predict for any given child

• With early diagnosis and ongoing therapeutic intervention, the severity of these symptoms may decrease in varying degrees

• Symptoms can vary greatly depending on the extent and location of the brain injury

• It is common for the child to have impairments in one or more areas such as cognitive functioning, physical abilities, communication, or social/behavioral disruption

Brain Injury Association of America

102015 West Virginia TBI Waiver Program direct care staff annual training

Why is Brain Injury in Children Different?

The symptoms of a brain injury in children are similar to the symptoms experienced by adults, but the functional impact can be very different

Children are not little adults

The brain of a child is continuing to develop

It is wrong to assume that a child with a brain injury will recover better than an adult because there is more “plasticity*” in a younger brain

* ability of the brain to change—physically, functionally, and chemically—throughout life

112015 West Virginia TBI Waiver Program direct care staff annual training

Why is Brain Injury in Children Different?• Brain injury actually has a more devastating impact on a child

than an injury of the same severity has on a mature adult• Cognitive impairments of children may not be immediately

obvious after the injury • May become apparent as the child gets older and

faces increased cognitive and social expectations for new learning and more complex, socially appropriate behavior

• Delayed effects can create lifetime challenges for living and learning for children, their families, schools and communities

• Some children may have lifelong physical challenges but the biggest challenges many children with brain injury face are changes in their abilities to think and learn and to develop socially appropriate behaviors

122015 West Virginia TBI Waiver Program direct care staff annual training

Emotions and Challenges after TBIAlthough no two children or their brain injuries are alike, you may see similar emotions and challenges after the TBI.

These include:• Denial

• that the injury will have a long-term impact• Grief

• over their loss of function and skill• Changes

• in how they relate to others• Frustration

• with the recovery process, and• Limited awareness

• of the differences in themselves

132015 West Virginia TBI Waiver Program direct care staff annual training

Guidelines to Help a Child Adjust after TBI1. Encourage and praise progress

When the child brushes his/her teeth with less assistance or supervision let him/her know. The child may not recognize that s/he has made progress because they only know they aren’t doing it on their own.

2. Listen and provide support Acknowledge the child’s frustration. Let him/her know that

you are there. 3. Serve as a role model for social behavior

Children model what they see and hear. You are a role model whether you know it or not. Be a GOOD role model.

142015 West Virginia TBI Waiver Program direct care staff annual training

Guidelines to Help a Child Adjust after TBI4. Encourage the child to have relationships with friends

With parental approval, help the child interact with his/her friends.

5. Encourage the child to focus on one day at a time by setting small goals as steps toward accomplishing larger ones

The service planning team will provide the guidance for this but as the direct care staff you will need to provide the encouragement as the child works to achieve their goals.

6. Encourage independence with supervision. Be creative with this!

Does the child have a pet they love? Help him/her take care of the pet by walking or feeding the pet.

152015 West Virginia TBI Waiver Program direct care staff annual training

Guidelines to Help a Child Adjust after TBI7. Communicate! (with the child, family members, neighbors,

friends, professionals, and the school) A communication log is a tool that can provide information

about how the child is doing in your care. Remember that whatever you write is NOT A SECRET from the child.

8. Help the child understand his/her injury and recovery, that the brain needs time to heal like other body parts

Direct care staff should get direction from the service planning team for specific recovery information.

9. Instill confidence in creative ways--draw on previous skills and interests, applied in new ways

What was the child interested in before the brain injury? Did s/he like to sing? Have him/her sing the steps to the task or sing the words s/he is trying to memorize.

162015 West Virginia TBI Waiver Program direct care staff annual training

Guidelines to Help a Child Adjust after TBI10. Create a Memory Book

Memory difficulties are often frustrating. Help the child use the memory book.

This may also help to document events and reinforce progress.11. Encourage a normal lifestyle, predictability, and routine as much

as possible Keep to regular schedules and routines

12. Above all, remember that this is challenging and a lifelong process!

Recovery takes time. Don’t give up on the child when it seems like s/he is not making progress.

Excerpted from Children with a Traumatic Brain Injury: A Parents’ GuideBrainline.org

172015 West Virginia TBI Waiver Program direct care staff annual training

Traumatic Brain Injury: Susan’s StoryClick on this link to read the article called Pediatric Traumatic Brain Injury

182015 West Virginia TBI Waiver Program direct care staff annual training

Accommodations and InterventionsACCOMMODATIONS AND INTERVENTIONS SHOULD:• Build on the child’s strengths• Provide support with areas of weakness• Be consistently implemented• Be solution focused, not deficit focused• Emphasize structure

Joshua Cantor, Ph.D., ABPPDepartment of Rehabilitation Medicine

Mount Sinai Brain Injury Research Center

The next few slides will provide examples of specific accommodations & interventions YOU can use as a Personal

Attendant Professional19

2015 West Virginia TBI Waiver Program direct care staff annual training

Accommodations and Interventions – Examples

ATTENTION/CONCENTRATION:• Reduce distractions in the environment such as television or

radio, bright lights, or toys• Divide task into smaller sections

• For example, if the child is supposed to clean his/her room, break the task into sections such as make bed, dust furniture, put toys away

• Ask the child to repeat back what has just been presented or said to them to make sure s/he understands

• Use cue words to alert the child to pay attention (e.g., “listen,” “look,” “name”)

• Schedule breaks and rest periods• Provide positive feedback when the child is attending well

202015 West Virginia TBI Waiver Program direct care staff annual training

Accommodations and Interventions – Examples

MEMORY DIFFICULTIES:• Frequently repeat information and summarize it• Help the child use his/her devices such as post-it notes,

calendars and assignment books as self-reminders• Teach the child to categorize or chunk information to aid

retention. For example, a grocery list will be easier to remember and follow if it is chunked by location in the store or by type of item: fruit, vegetable, dairy, etc. A spelling list may be easier for the child to remember if the list is chunked by what the word represents: toy, animal, family, etc.

• Demonstrate techniques such as mental rehearsal and use of special words or examples as reminders

• Link new information to the child’s relevant prior knowledge

212015 West Virginia TBI Waiver Program direct care staff annual training

Accommodations and Interventions – Examples

PROCESSING SPEED:• Slow down pace when possible• Allow rest periods• Repeat material• Don’t rush or challenge the child

222015 West Virginia TBI Waiver Program direct care staff annual training

Accommodations and Interventions – Examples

PROBLEM SOLVING, JUDGMENT, AND REASONING:• Engage the child in everyday problem-solving tasks• Use structured questions to help guide the problem-solving• Help the child create and initiate a plan• Engage the child in real-life activities where problems and

possible solutions are discussed

232015 West Virginia TBI Waiver Program direct care staff annual training

Accommodations and Interventions – Examples

BEHAVIOR:Try to prevent behaviors BEFORE they develop

• Maintain consistent and reasonable expectations• Limit the number of people interacting with the child at one time• Avoid over-stimulating or overloading the child• Develop and review “rules of behavior” before beginning an

activity• Refer to these as needed during the activity

• Help the child use compensatory strategies to reduce inappropriate behavior

• Provide explicit feedback to help develop more appropriate behavior and increased self-awareness

242015 West Virginia TBI Waiver Program direct care staff annual training

Teens Talking to Teens about TBI

PLEASE CLICK ON THIS LINK TO WATCH A VIDEO CALLED KEEP MOVING FORWARD: CHILDREN WITH BRAIN INJURIES

252015 West Virginia TBI Waiver Program direct care staff annual training

Additional Resources and ReadingsYOU MAY WANT TO EXPLORE ADDITIONAL RESOURCES TO EXPAND YOUR KNOWLEDGE BASE AND JOB SKILLS*

Here are just a few:• brainline.org• Brain Injury Association of America• Centers for Disease Control and Prevention: TBI• Children with Acquired Brain Injuries• Think First National Injury Prevention Foundation• National Resource Center for Traumatic Brain Injury• TBI Services at Center for Excellence in Disabilities

1-877-724-8244 [email protected]

262015 West Virginia TBI Waiver Program direct care staff annual training

*If you are seeking formal training please check with your employer to make sure the internet training provider has been approved by APS Healthcare before you take the training

Next Steps

• To receive your certificate of successful completion you must first pass the test and complete an online evaluation

• A score of 70% or higher is required

• Once you have successfully completed this training module you will receive an email with your certificate of completion

• Click this link to go to the test • http://tbi.cedwvu.org/trainings/children-with-tbi.php

272015 West Virginia TBI Waiver Program direct care staff annual training

Thank You for Your Thoughts

• Please click this link to go to the online evaluation• http://tbi.cedwvu.org/trainings/children-with-tbi.php

• Your thoughts and comments are very important to us

THANK YOU!

282015 West Virginia TBI Waiver Program direct care staff annual training