Traumatic Brain Injury - Brain Injury Alliance of Utah · PDF fileTraumatic brain injury does not apply to brain injuries that are congenital or degenerative, or to brain injuries

Traumatic Brain Injury (TBI)

Children Birth to 4 Years

1

Introduction

Brain injury is the most frequent cause of disability and

death among children in the United States

This training will help early childhood professionals

identify young children who may have had a previous

brain injury and give them tools to support community

early childhood programs in making programmatic

adaptations

The Birth-4 TBI training is based on an in-depth

assessment of needs of Utah early intervention services

providers

2

3

This course is intended for:

Part C Early Intervention providers

Part B Preschool Special Education Teachers

Early Head Start Providers

School Psychologists

Educational Consultants

Social Workers

Guidance Counselors

Program Administrators

Speech and Language Pathologists

Occupational and Physical Therapists

EI and School Nurses

Successful completion of the course

provides Utah Early Childhood providers

with four professional development hours

Course will meet Baby Watch EI

recertification hours, teacher licensure

and PT, OT, SLP recertification licensure

4

Certificate of Completion

Section 1: TBI Overview

Definitions of TBI

Eligibility under IDEA

Incidence of Pediatric TBI

5

What is a TBI?

Insult/Injury to the Brain

External force = cause

Involves diminished/altered consciousness

Results in changes in cognitive, physical,

behavioral functioning

Changes may be temporary or permanent

6

7

“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.”

Def: Individuals with Disabilities Act

(IDEA): Sec. 300.8(c)(12)

Def: Individuals with Disabilities Act

(IDEA): Sec. 300.8(c)(12) cont.

Traumatic brain injury applies to open or closed

head injuries resulting in impairments in one or

more areas, such as cognition; language;

memory; attention; reasoning; abstract thinking;

judgment; problem-solving; sensory, perceptual,

and motor abilities; psychosocial behavior;

physical functions; information processing; and

speech.

Traumatic brain injury does not apply to brain

injuries that are congenital or degenerative, or

to brain injuries induced by birth trauma.”

MCHB TBI Grant 1H21MC01691-01-00 8

Incidence of Pediatric TBI

Approximately 475,000 traumatic brain

injuries (TBIs) occur in children <14 years

old annually

TBI in children is associated with $1 billion

in total hospital charges annually

Gender: Boys twice as likely as girls

Source: Surveillance for Traumatic Brain Injury--Related Deaths --- United States, 1997--2007

9

Age Factor (Donders, 2006)

TBI from child abuse primarily below age

3

Younger children more likely due to falls

Older children more likely due to motor

vehicle accidents

Transportation and falls account for more

than 50% of pediatric TBI

Highest risk 0-4 years, 15-24, and 75

years and older

10

Estimated Average Annual Numbers of Traumatic

Brain Injury-Related Emergency Department

Visits, Hospitalizations, and Deaths by Age Group,

United States, 2002-2006

Age Group

Emergency Dept.

Visits

Hospitalizations Deaths Total

Children (0-14

years)

473,947 35,136 2,174 511,257

Older Adults (>

65 years)

141,998 81,499 14,347 237,844


Quiz, True or False

A mild brain injury (concussion) is mild

and less damaging than other brain

injuries

12

Section 2: Developmental Stages

and TBI in Children

Gain knowledge of TBI specific to early

childhood

Recognize the effects of TBI at each

developmental stage

13

Quiz: True or False

Younger children with TBI heal better

than adults with TBI.


The Child’s Brain

More vulnerable to the effects of a brain injury and takes longer to recover

Undeveloped Unlike heart or kidney, the brain needs time and

experience to mature

The amount of time depends on the activity or function

Not well organized undifferentiated

New abilities build on established skills over time

Easily injured & greater diffuse swelling

15

Effects of Early Childhood TBI

No two are alike

TBI can cause injury all over the brain

Depend on the age of the child when injury occurred: younger shows greater impact

Younger age (<7yrs) = increased risk of long term difficulties



continued…

TBI may not show up on scans

Even a mild brain injury can seriously disrupt higher order thinking, executive functions and social behavior

Previously developed skills may be preserved after brain injury, but new learning may be difficult

Latent effects: may not be apparent until more advanced skills develop



continued…

More extreme discrepancies among

skills

More uneven and unpredictable

progress

The condition could improve to pre-

injury state


Parent Story:

Two days before her first birthday she was

in a head on collision. We didn’t realize

anything was wrong until she started

kindergarten and had a horrible time

concentrating and learning…”

Kansas parent


Video: Recognizing a Child’s early TBI

Later in the Classroom

20

How does TBI impact

development?

Capacities in process of development, and those not yet developed, are most vulnerable to brain injury

Abilities not yet developed at time of injury are most likely to be disrupted and may never develop

Child may regain function lost as a result of the TBI but may have difficulty achieving higher level of developmental function

The earlier the TBI, the greater the impact


Birth – 3 yrs

Development Impact of TBI Intervention

Sleep-wake patterns Disruption in regulation Consistent/predictable

routines

No cause-effect Mood lability-irritability Organized environments

Symbiotic relationship

with caregivers

Unpredictable emotional

reactions

Consistent/predictable

care providers

Physical

growth/development

Delay in physical

development

Early Intervention:

Physical therapy

Occupational Therapy


Quiz, True or False

Infants and toddlers diagnosed with

Abusive Head Trauma (Shaken

Baby Syndrome) display clear signs

of physical abuse.

23

Abusive Head Trauma

A

New Mexico's Aging and Long-Term Services Department with funding from the State of NM and the

US Health Resources and Service Administration. Used with permission.

Dr. Nicholas Teodore and Dr. Neera Kapoor

Abusive Head Trauma (AHT)

(Shaken Baby Syndrome)

Cannot be explained by a disease

Cannot be explained by DPT or other

childhood vaccines

Cannot be explained a simple accident

Is not caused by play

Is not caused by resuscitation (CPR)

Is not SIDS (sudden infant death syndrome)

25

Higher Risk for

Abusive Head Trauma (AHT)

Children under the age of five

Premature, special needs, or difficult to soothe

babies

Males more likely than females

26

Common Triggers for AHT :

Crying is the chief “trigger”

Toilet training of children results in many instances

of physical abuse, in addition to SBS

In infants, feeding can become an issue when they

refuse to take the bottle that is offered to them

Interrupting the caregiver

27

Long Term Effects of AHT

Possible death

Those who survive may have brain and vision problems that can last forever These problems can include:

Seizures

Intellectual disability

Blindness or trouble seeing

Physical or emotional growth delays

Learning or behavior problems that may not appear until the child starts school

28

Pre-school: 3 – 6 years

Development Impact of TBI Intervention

Concrete – Black/white Self-regulating functions

impacted

Structure/organization

Caregiver/environment

Egocentric –

Cannot take others into

account

Poor acquisition of

concepts

Visual aids/cues

Beginning – think

before acting

Express feelings

without thinking

Close supervision when

aroused

Do not like change Resistant to direction.

Rigid

Concrete assistance

through transitions

Focus on self-control Anxiety Structured/predicable

routines


Signs and Symptoms of Mild TBI

(concussion) in Preschoolers

Can show up right after the injury, or not appear until days or even weeks after

o Tiredness or listlessness

o Irritability or crankiness (will not stop crying or cannot be consoled)

o Changes in eating (will not eat or nurse)

o Changes in sleep patterns

o Changes in the way the child plays

o Changes in performance at preschool/school

o Lack of interest in favorite toys or activities

o Loss of new skills

o Loss of balance or unsteady walking

o Vomiting


Section 3: TBI Screening and Assessment

for Early Childhood Systems

Why Screen?

SAFE Child Screening Tool

Educational TBI eligibility classification and

medical diagnosis

Criteria to provide Special ED services

Suggested Procedures for Utah Early

Childhood Programs

Evaluation and Assessment of TBI in children

0-4

31

Why Screen?

Child receives appropriate interventions

The TBI should be considered as an underlying cause of the of the developmental delays

Effects of TBI in young children may not be identified until later

Allows family/child to develop self-advocacy skills

Prevents a cycle of failure


Challenges:

TBI is an invisible injury

Parents may not be informed by their

primary care provider about the impact

of a TBI

Parents want to think that there isn’t a

problem..everything is fine with their

child

TBI not familiar to Early Intervention and

Preschool Staff


SAFE Child Screening Tool

Modeled after HELPS Screening Tool

Developed by Nebraska task force members

Asks questions of parents: Symptoms

Accidents

Falls

Emergency Room

Changes

Completed screens left with nurse


Nebraska Screening procedure:

Parents receive “Brain Injury in Young

Children” Brochure with their screen

Brochure includes information on

prevention, signs/symptoms, multiple

injuries and additional resources for

more information

Was screening tool found useful?


Modified Glasgow Coma Scale for

Infants and Children Measures child’s level of consciousness

Score:

○ 12 suggests a severe head injury

○ 8 suggests need for intubation and ventilation

○ 6 suggests need for intracranial pressure monitoring

If the patient is intubated, unconscious or preverbal, the most important part of this scale is motor response. This section should be carefully evaluated


Glasgow Coma Scale (GCS)

Emergency response personnel use to

rate severity of injury at scene of

accident

Hospitals use to rate:

Progress or decline in status


Glasgow Coma Scale (GCS)

Some formalized testing incorporate

initial score to evaluate progress

Mostly applicable in the initial recovery

state of the TBI, but may continue to

apply for severe TBI’s


Rancho Los Amigos Levels of

Cognitive Functioning

Also Called Rancho Los Amigos

Cognitive Scales

or Rancho level

Used frequently during the recovery

period to describe current cognitive

level.

Used after the Glasgow Scale no longer

applies


Rancho Levels

Example:

A patient who has spontaneous eye

opening, is talking (babbling/producing

sound) and spontaneously moving arms and

legs is the highest GCS score; however,

they may still be at a Ranch level IV:

Confused and agitated.

Physiatrists (Rehab Doctors) are familiar

with the levels, so it is a good way to

communicate function with them.


Rancho Levels

Provides information for family and

friends regarding what they can do for

the patient at each cognitive level

Example:

○ Rancho Level I-III Limit visitors

○ Rancho Level IV Orient frequently, limit

distractions

○ Rancho Level V Repeat things as needed,

don’t assume they will remember

○ Etc.


Rancho levels

Level I- No response to pain

Level II- Generalized reflex response to

pain

Level III- Localized response

Level IV- Confused/agitated

Level V- Confused/non-agitated


Rancho Levels

Level VI- Confused/Appropriate (good

level for formalized cognitive testing).

Level VII- Automatic/Appropriate

Level VIII- Purposeful/Appropriate


Rancho levels

Level IX- Purposeful/Appropriate-Stand-

by assistance on request

Level X: Purposeful/Appropriate-

Modified independent

Please see full explanation for more

specific details at each level


Utah Part C Eligibility Baby Watch Early Intervention Program (BWEIP )does not currently have TBI on

Approved Diagnosis List

Child would have to

meet BWEIP

eligibility criteria

1.5 standard

deviation below the

mean / at or below

the 7th percentile

Determined eligible

through Informed

Clinical Opinion


Educational Classification:

Criteria for Part B Preschool

Eligibility

While there must be prior

documentation by a physician that a

student has an acquired injury to the

brain caused by an external physical

force, a team of qualified

professionals and the student’s

parents determine eligibility


Criteria continued… (1) The traumatic brain injury must adversely affect the student’s educational performance

(2) The student with the traumatic brain injury must require special education and related services

(3) The team must determine that traumatic brain injury is the student’s primary disabling condition

(4) The requirements of Rule II.I must be met


Suggested Procedures for Utah

Early Childhood Programs Step 1: Health Assessment with specific TBI questions

(e.g. Safe Child Screener) medical records

Step 2: Administration of the check list for Children with a reported TBI

Step 3: Developmental Assessment with TBI emphasis OT evaluation for sensory processing

Physical Therapy for muscle tone and balance issues

Speech & Language: social communication and pragmatic speech; information processing/auditory processing

Behavioral assessment

Step 4: IFSP with TBI Emphasis

Step 5: Use intervention strategies recommended for children with TBI Including schedule charts, etc.


Guidelines for Comprehensive

Evaluation

Physical Aspects: Quick recovery of

physical functioning may

mask remaining long

term concerns


Common physical problems: • Hemiplegia • double vision • visual/perceptual difficulties • gait deviations • switched hand dominance • tactile defensiveness

Common health issues: • headaches • fatigue • seizure activity • anxiety • metabolic disorders


Evaluation

Cognitive: a TBI

can significantly affect

and impact the ability

to use cognitive skills

in all aspects of

function and

independence


• Attention: attention problems are extremely pervasive following a traumatic brain injury

• Perception: demonstrate good visual and hearing acuity but have problems interpreting incoming information

• Memory: Memory for new and ongoing events is challenged


Evaluation

Communication: Children with a TBI can

often converse in a

general way and may be

completely intelligible in

terms of speech skills.

Impact on communication

is dependent on sight of

injury.


• Impaired Discourse: The organization of language (both spoken & written)

• discourse plays a central role in everyday communication

• Fluency: The smoothness or flow of sounds, syllables, words and phrases

• Decreased flow of speech contributes to awkward and incomplete expression of ideas.


Evaluation


Problem-solving: impact of attention,

memory and language

deficits

Reasoning: requires

the integration of

information

Executive functions: generally exhibited in a

frontal lobe injury

Problem solving: e.g. inability to generate

more than one possible solution, inability

to draw from previous experiences in

choosing the best alternative

Reasoning: requires the integration of

information with rules of logic and the

experience base

Executive functions: unable to organize,

plan and execute activities and benefit

from feedback from self-monitoring and

self-regulation


Evaluation

Emotional &

Behavioral: A TBI

(especially a frontal

lobe injury) are likely

to exhibit behavioral

difficulties

○ May not demonstrate

social/emotional &/or

behavioral concerns

for years


• Disinhibited, socially inappropriate and possible aggressive behavior

• Impaired initiation • Inefficient learning from

consequences • Perseverative behavior • Impaired social perception

and interpretation

Observation Checklists


Standardized Tests

Majority of standardized measures are

appropriate for children 5 years and older

Behavior Rating Inventory of Executive Function- Preschool Version (2.0 years- 5.11 years)

The BRIEF-P is a single form used by parents, teachers, and day care providers to rate a child's executive functions within the context of his or her everyday environments--both home and preschool. Completed in just 10 to 15 minutes

Woodcock-Johnson III (2.0 years- 90+ years)

general intellectual ability, specific cognitive abilities, oral language, and academic achievement


Section 4: Strategies

Working as a team

ISFP


Working as a Team

Professionals and parents monitor:

Growth and nutrition

Evaluation of oral-motor skills (drooling) and

aspiration

Speech pathologist, physical and

occupational therapists and a nurse may be

needed on team

Monitor vision and hearing


After a TBI Diagnosis: Transition

Responsibilities

Family Collect all medical

records

Provide contact

names for EI /

school (if

previously

enrolled)

Participate in

discharge team

meeting with EI

/school team


Medical Identify EI/School

transition contact

Support for on-site

services from EI

/preschool (if

previously

enrolled)

Develop discharge

plan

Request a

discharge team

meeting with EI

/school team

EI / School Identify primary

medical contact

Provide on-site

services to child in

medical setting (if

previously enrolled)

Participate in

discharge team

meeting with medical

team

Collaborate with

medical facility to

determine services

needed


Increase communication

Guided IFSP http://www.cbirt.org/media/dynamic/medialibrary/2010/09/IFSP_Guide_for_Children_with_TBI.pdf


Service Coordination

Case Management

• At least 1 team member with

knowledge/ training about

TBI and impact to learning

• Coordinate service with

medical and private service

providers

• Ongoing communication

across service agencies

• Decrease confusion to

parents & child due to

multiple approaches by

different service providers &

agency requirements

Consider & Modify • Temperature

• Lighting- Highly reflective

surfaces, bright or dim

lighting

• Time of day

• Loud noises

• Period of calm allow for best

learning, over-stimulations

decrease learning

opportunities

• Significant behavior

problems need to be

addressed by behavior

specialists, Functional

Behavior Analysis

• Vision difficulties: visual

field cuts, visual tracking,

light sensitivity

http://www.cbirt.org/media/dynamic/medialibrary/2010/09/IFSP_Guide_for_Children_with_TBI.pdf

http://www.cbirt.org/media/dynamic/medialibrary/2010/09/IFSP_Guide_for_Children_with_TBI.pdf


IFSP/IEP Considerations

Frequency of Services

Due to fatigue, chronic pain,

medication side effects or

sensory sensitivities

IFSP IEP

• Co-visits

• Shorter &

more frequent

visits

• Adapt

classroom

schedule to

allow for

breaks

• Shorten or

lengthen-

minutes per

days / days

per week

• ESY –

regression

recoupment

Location of Services

Over-stimulation

Under-stimulation

IFSP IEP

• Quiet

environment

• Stimulating

environment

• Sensory

equipment

• 1-1 teaching

• Small group

• Quiet

environment

• Stimulating

activities

IFSP / IEP

Describe how the child has changed due to a TBI: Communication

Remember/ use reasoning

Process information

Tolerate change / behavior

Attention

Perceptual motor sills

Abstract thinking

Use of touch, vision, hearing, smell, & taste


Levels of

Development

Treatment – IFSP / IEP

Outcomes/ Goals

63 MCHB TBI Grant 1H21MC01691-01-00

• Keep goals functionally oriented and outcome‐based

• Base goals on the strengths paired need

• Dynamic document- rewritten to meet changing needs

The goals were modified from examples in the website to reflect learning levels for younger children in setting other than school. Center on Brain Injury Research and Training http://www.tbied.org/tbi‐support/iep‐main/sample‐iep‐goals/

Examples: Communication

• Given a topic, Steven will take 4 turns in a conversation before changing the topic 3 out of 4 trials across 3 settings: in speech therapy, in the classroom and in the hallway. • Sam will choose an activity and show a picture of that activity to another child as an invitation to play. Anna (Jenny’s mom) will identify Jenny’s body cues to increase response for feeding, comfort.

Behavior • Jenny will (with prompt) leave a confrontation with a classmate by going to her quiet time area and choosing an activity from her cool down box: 2 out of 3 occasions. • Jenny will learn 5 games to play at home, park, neighbor’s house.

Center on Brain Injury Research and Training http://www.tbied.org/tbi‐support/iep‐main/sample‐iep‐goals/

The following goals were modified from examples in the website to reflect

learning levels for younger children in setting other than school.

Problem Solving

• Sandy will be presented with simple

games requiring problem solving (simple

to increasingly difficult puzzles, playful

obstruction activities). She will be able to

resolve the problem or ask for help in an

appropriate manner.

Reasoning

• Bentley will be presented with an activity

without all the needed items for play (e.g.

bubbles without the wand, train track

without trains) he will independently

determine what is missing and request the

missing item.

Information Processing

• Given a prompt or cue, Kyle will say his

name in less than 30 seconds

•While participating in circle time, Sandy

will say the next word of the song when

the teacher pauses in less than 30

seconds, 3 times.

Sensory

• Suzy will stop crying and comfort herself while

being rocked, swung, or swaddled.

• Brandon will tolerate increasing levels of noise in

various environments.

Cognition

• Sarah will take breaks during playtime (every 30

minutes) to help keep her alert.

Memory

• Jim will successfully play increasing difficult

games requiring memory recall (items hidden while

watching, hidden while not watching, looking for

item in known place etc.)

Attention

• Sandy will attend for increasing lengths of time

during home and church activities.

Abstract Thinking

• Given a toy or items with connecting parts, Suzy

will connect the pieces (Legos, paper chains, train

tracks).

• After listening to a story Harold will tell parts of the

story.


Center on Brain Injury Research and Training http://www.tbied.org/tbi‐support/iep‐main/sample‐iep‐goals/

The following goals were modified from examples in the website to reflect

learning levels for younger children in setting other than school.

65 MCHB TBI Grant 1H21MC01691-01-00

Judgment • With decreasing levels of guidance Mary will make choices beginning with 2 items increasing to 5 items. • Mary will identify safe and unsafe household/ community items (scissors, knifes, hammers, unfamiliar dogs)

Perceptual Motor

• Taylor will use visual cues to transition from activities independently 4 out of 5 opportunities

Physical Abilities

• Given a tangible cue, Dakota will navigate his home, yard and friend’s yard independently using his walker to the destination indicated by the cue. • Karla will spend 30 minutes each day in her stander

TBI service considerations

IFSP / IEP

Often requires 1:1 assistance or small group experience of 1-2 children

Special equipment often including sensory motor experience

Frequent experiences with children with typical development

Placement with typical developing peers as much as possible for modeling and appropriate social development

Offer services in an environment that is neither over nor under stimulating

Plan for a continuum of possible placements


Treatment-

IFSP

IEP

Instructional Strategies for Preschoolers

See handout

Reading: Sound Boxes

Learning Facts: Incremental Rehearsal

Teaching Planning


Suggestions for Family Support

Family education regarding TBI

Strategies to organize critical paperwork

and records

Community resources:

Developmental disability services

SSI resources

Counseling services

State & National TBI websites, networks,

parent support groups


Looking to the Future…


What does this mean for families

and schools?

“The challenge of addressing the latent developmental effects of childhood brain injuries is compounded by the fact that families often must assume the primary caregiving role and schools often become the sole providers of rehabilitation services. Neither families nor educators have been systematically prepared or trained for this role”.

Glang & Lash, 2006


Importance of Research &

Training

“Advances in trauma care have directly

contributed to the higher survival rates

of children with traumatic brain injury.

However, more attention and resources

need to be directed toward school

systems and community programs to

address the long term challenges for

neuro-recovery”. Child’s Recovery After Traumatic Brain Injury Takes

Time Blog on Brain Injury By Marilyn Lash, M.S.W.


State Programs • Brain STEPS Program:

• http://www.caiu.org/resources/schools/brain-steps.aspx

• BrainSTARS, Brain Injury: Strategies for Teams and Re-education for Students. Jeanne E. Dise-Lewis, Ph.D.; Margaret Lohr Calvery, Ph.D; Hal C. Lewis, Ph.D.

• http://orthopedics.childrenscolorado.org/what-we-do/rehab--physical-therapy/brainstars

• Center on Brain Injury Research and Training

• www.cbirt.org

• LEARNet: A resource for Teachers, Clinicians, Parents, and Students by the BIA of New York State

• http://www.projectlearnet.org/

• REAP Concussion Management Program

• http://www.rockymountainhospitalforchildren.com/sports-medicine/concussion-management/reap-guidelines.htm

• School Transition & re-Entry Program (STEP)

• http://www.tr.wou.edu/STEP/

• Early Childhood TBI

• http://www.cbirt.org/tbi-education/early-childhood-tbi/

• Traumatic Brain Injury Networking Team Resource Network:

• http://cokidswithbraininjury.com


Publications:

The ASHA Leader http://www.asha.org/Publications/leader/2010/101102/Pediatric-

Traumatic-Brain-Injury/

Colorado Department of Education. Brain Injury: A Manual for Educators http://www.cde.state.co.us/cdesped/SD-TBI.asp

Florida Department of Education, Bureau of Exceptional Education and Student Services, 2005; Understanding and Teaching Students with Traumatic Brain Injury: What Families and Teachers Need to Know https://www.ocps.net/cs/ese/programs/tbi/Pages/default.aspx

Returning to School after Traumatic Brain Injury and other fact sheets: http://uwmsktc.washington.edu/TBIfactsheets.html


National Resources

BrainLine www.brainline.org

BrainLine Kids http://www.brainline.org/landing_pages/features/blkids.html

Centers for Disease Control and Prevention (CDC), TBI: http://www.cdc.gov/ncipc/tbi/TBI.htm

National Dissemination Center for Children with Disabilities (NICHCY), Traumatic brain injury: http://nichcy.org/disability/specific/tbi

TBI Focus www.tbifocus.org


Publications

Centers for Disease Control and Prevention. “Traumatic Brain Injury: Incidence and Distribution.” Publication 2003. June 2004. www.cdc.gov

Hibbard, Mary, et al. “Students with Traumatic Brain Injury: Identification, Assessment and Classroom Accommodations.” Research and Training Center on community Integration of Individuals with Traumatic Brain Injury. November 2001.

Mount Sinai School of Medicine. “RTCTBI FAQ’s About TBI.” June 2004. www.mssm.edu/tbinet/alt/faq.html.

National Dissemination Center for Children With Disabilities. “Traumatic Brain Injury: Fact Sheet 18.” June 2004. www.nichcy.org/pubs/factshe/fs18txt.htm.

Wisconsin Department of Public Instruction. “Wisconsin DPI Traumatic Brain Injury Training Presentation.” June 2004. http://www.dpi.state.wi.us/dpi/dlsea/een/tbihomepg.html


Utah Resources:

Brain Injury Alliance of Utah www.biau.org

Medical Home Portal http://www.medicalhomeportal.org/

Phoenix Services http://www.phoenixservices.org/

Primary Children’s Medical Center

https://intermountainhealthcare.org/hospitals/primarychildrens

Utah Brain Injury Council http://www.utahbraininjurycouncil.net/

Utah Department of Health Violence and Injury Prevention

http://health.utah.gov/vipp/traumaticBrainInjury/overview.html

Utah State Office of Education

http://www.schools.utah.gov/sars/Disability-Information/Disability-

Categories/Traumatic-Brain-Injury.aspx


http://www.medicalhomeportal.org/

http://www.phoenixservices.org/

http://www.utahbraininjurycouncil.net/

Traumatic Brain Injury - Brain Injury Alliance of Utah · PDF fileTraumatic brain injury does not apply to brain injuries that are congenital or degenerative, or to brain injuries

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