Traumatic Brain Injury Statistics

The BrainSTEPS Program & The Epilepsy Foundation of Western/Central PA Present Traumatic Brain Injuries & Epilepsy: What Schools Need to Know December 3, 2012 Webinar Brenda Eagan Brown, M.S.Ed., CBIS BrainSTEPS Program Coordinator Brain Injury Association of PA 724-944-6542 eaganbrown@biapa.org www.brainsteps.net Andrea Zonneveld Community Education & Events Coordinator Epilepsy Foundation Western/Central PA 412-322-5880 ext. 308 azonneveld@efwp.org Traumatic Brain Injury Statistics Brain injury is a leading cause of death and disability in children & young adults. CDC Statistics Average ANNUAL number of Traumatic Brain Injury Emergency Department Visits and Hospitalizations in the United States 474,000 Children with Traumatic Brain Injury 0-14 years of age Most children who sustained a TBI (91.5%) were treated and released from the emergency department. How Common is TBI in Children in Pennsylvania? Each year, approximately 26,000 children in Pennsylvania sustain a traumatic brain injury (concussion/mild, moderate, or severe) Source: The Brain Injury Association of Pennsylvania, 2008 United States. Centers for Disease Control. Traumatic Brain Injury in the United States. 2005. http://www.cdc.gov/ncipc/pub-res/tbi_in_us_04/tbi%20in%20the%20us_jan_2006.pdf>. 1

Annually, approx. 4,000 Children & Adolescents in Pennsylvania are HOSPITALIZED with TBI Source: The Pennsylvania Department of Health, 2004 & 2006 DOES NOT INCLUDE EMERGENCY ROOM VISITS. A Concussion is a Traumatic Brain Injury Concussion: Incidence Centers for Disease Control: 3.8 million sports and recreation related concussions are estimated to occur in the United States each year. Concussions in Pennsylvania: Annually, approx. 22,000 children ages 0-21 years suffer concussions A Child s Brain Under-developed Needs time & experience to mature. Not well organized Easily injured New abilities build on established skills over time Does not simply bounce back after injury 2

Brain Injury & Developmental Stages A child s brain is not fully developed until around the early to mid 20 s Capacities in process of development, and those not yet developed are those most vulnerable to brain injury. Acquired Brain Injuries Types of Brain Injury Acquired Brain Injury after birth process Traumatic & Non-Traumatic Traumatic Brain Injury external physical force open head injury closed head injury Non-Traumatic Brain Injury Non-Traumatic Brain Injury Causes Cerebral Vascular Accidents Vascular Occlusions Hemorrhaging Aneurysms Ingestion of Toxic Substances Inhalation of Organic Solvents Ingestion of Heavy Metal Alcohol and Drug Abuse Non-Traumatic Brain Injury Causes Stroke Infections of the Brain Brain Abscesses Meningitis Encephalitis Hypoxia reduced oxygen to the brain Anoxia no oxygen to the brain 3

Anoxia/Hypoxia common causes The Choking Game Attempted suicide Electrical shock Heart attack Brain tumor Heart arrhythmia Extreme low blood pressure CO2 inhalation Poisoning Choking Suffocation Respiratory conditions that affect breathing Lightning Near Drowning Chemotherapy & Radiation Late-Term Effects Bleeding in the Brain Types of Brain Injury Shaken Baby Syndrome Acquired Brain Injury after birth process Traumatic Brain Injury external physical force Non-traumatic Brain Injury Internal process open head injury closed head injury 4

Car Accidents What Happens During a Traumatic Brain Injury? Centre for Neuro Skills Skull Protrusions Open Head Injury: Gunshot Wound Levels of TBI Severity Mild/Concussion: Brief or NO loss of consciousness Shows signs of concussion vomiting lethargy dizziness headache Severe: Moderate: Coma > 24 hours duration Coma < 24 hours duration Neurological signs of brain trauma Skull fractures with contusion (tissue damage) Hemorrhage (bleeding) Focal Findings on EEG/CT scan Brain Injury Effects 1. Physical 2. Cognitive 3. Social 4. Emotional 5. Behavioral 6. Sensory 5

3 Types of Seizures after TBI Post Traumatic Seizures 1. Immediate: within 24 hrs of TBI 2. Early onset: less than 1 week after TBI Not considered epilepsy Risk factor for later epilepsy, but typically pass uneventfully Approx. 25% will have another seizure in future 3. Late onset: Up to 20 years after TBI Considered epilepsy Approx. 80% will have another seizure in future -www.internationalbrainassociation.org -www.neurology.stanford.edu/divisions/e_12.html -www.brainline.com Seizures after TBI Epilepsy: Having more than one seizure is called epilepsy. More than half the people with epilepsy will have this problem for their whole lives. www.brainline.org 5% of epilepsy is caused by a traumatic brain injury www.neurology.stanford.edu/divisions/e_12.html Seizures after TBI Seizures are reported in up to 50% of all TBI survivors International Brain Injury Association Severe TBI leads to epilepsy in approx. 15% of adults and 30% of children. www.neurology.stanford.edu/divisions/e_12.html Seizures can also occur after concussions Seizures after TBI Seizures after TBI 20% of people with closed brain injuries that cause bleeding between the brain and the skull experience seizures Over 35% of people who need 2 or more brain surgeries after a brain injury experience late onset seizures www.brainline.org Injuries with actual penetration of the brain are likely to cause epilepsy, about 25 to 50% of the time ww.neurology.stanford.edu/divisions/e_12.html 65% of people with brain injuries caused by bullet wounds have seizures www.brainline.org 6

Seizures after TBI 5-10% of children will experience seizures as a result of their TBI -UAB TBI Model System website Common medications Phenobarbital, Dilantin, or Tegretol Watch for medication side effects that may impact school work Absence Seizures after TBI - Common Absence Seizures commonly referred to as: Petit mal seizure Absence Attacks Primary Generalized Seizures - Absence Type Abrupt & brief interruption of consciousness without convulsion Typically lasts several seconds Can occur 100 s of times per day During seizure, interaction is not possible Observed almost exclusively in children At School: Seizures after TBI Can impact a students ability to: acquire new knowledge process new information remember new information keep pace organize plan and follow through on tasks attend to important classroom instruction What teacher s may see or report if they don t understand Absence Seizures Student is: Daydreaming Spacy Lazy Inattentive Always off task Looking at neighbors paper SOME FUNDAMENTAL BASICS AN OVERVIEW OF EPILEPSY Andrea Zonneveld Community Education & Events Coordinator Reviewing the Basics, First Aid, and Treatment Options for Different Kinds of Seizures What is epilepsy? A neurological disorder characterized by recurring seizures May also be referred to as a seizure disorder What is a seizure? A seizure is a temporary disruption of the electrical system of the brain that results in the release of excessive energy in synchronized form Can affect the entire brain and impair consciousness and memory or can affect only part of the brain, which may or may not disrupt awareness Produce changes in consciousness, behavior, and/or movement 7

EPILEPSY IS NOT WHO DOES EPILEPSY AFFECT? Contagious/disease Mental illness Nearly 3 million Americans 326,000 children (through age 15) Intellectual disability The result of a single seizure A condition you can tell someone has based on their appearance 1 in 26 individuals will develop epilepsy at some point in their lifetime -Epilepsy Across the Spectru m, IO M 1 in 10 individuals will have a seizure during their lifetime WHAT CAUSES SEIZURES? TBI AND EPILEPSY 70% of cases are idiopathic (of unknown cause) Symptomatic epilepsy (the other 30%) can be caused by: Birth trauma Head injury Brain tumors Strokes Lead poisoning Infection of the brain Heredity Lack of oxygen to the brain Chronic usage of drugs/alcohol Metabolic abnormalities TBI at any age can lead to development of post -traumatic epilepsy Ex: TBI is the most common injury for returning servicemen from Operation Enduring Freedom and Operation Iraqi Freedom TBI is associated with up to 53% risk for post -traumatic epilepsy, depending on the severity of the injury -Epilepsy Across the Spectru m, IO M Epileptogenesis after TBI is not well understood, so attempts to prevent epilepsy after TBI have not been successful -Epilepsy Across the Spectru m, IO M WHAT DOES A SEIZURE LOOK LIKE? WHAT DOES A SEIZURE LOOK LIKE? (CONT D) Tonic clonic seizures, also known as grand mal seizure are the most common and best known of generalized seizures During the seizure: May let out a sudden cry or gasp for air Consciousness is lost Breathing may become shallow/irregular Begins with stiffening of muscles (tonic phase), followed by jerking of limbs and face (clonic phase) Drooling or vomiting, bluing of skin, and loss of bladder or bowel control may occur After the seizure: Will often be confused and fatigued Generalized Seizures Tonic-Clonic seizure: convulsive seizure Absence seizure: often confused for daydreaming Atonic seizure: sudden loss of muscle tone (AKA drop seizure ) Myoclonic seizure: sudden brief, massive muscle jerk Partial Seizures Simple Partial and Complex Partial seizures: depends on the individual, but can involve anything your brain can do/control; automatisms (repeated automatic gestures) are common as part of a complex partial seizure 8

WHAT SHOULD I DO? WHAT SHOULD I DO? (CONT D) Tonic-Clonic seizure: Lay the person on the ground and turn them onto their side Support the head Loosen tight clothing that could restrict breathing Keep track of time call EMS if seizure >5 minutes Check for medical alert ID Stay with person until the seizure has ended NEVER place anything in person s mouth NEVER forcefully restrain person NEVER try to administer food, drink, or oral medication until full awareness has returned and seizure has ended Complex Partial seizure: Remove hazards from person s path Speak in a gentle voice Do not forcefully restrain Stay with person until the seizure ends and consciousness has fully returned If the person appears angry or agitated, observe from a distance, but stay near them Keep track of time Help reorient the person after the seizure has ended and explain what has occurred to bystanders WHEN TO CALL EMS If the person has no known history of epilepsy/seizures If the seizure lasted longer than 5 minutes (convulsive seizures) If the person is injured If the person is pregnant or has diabetes If the seizure occurs within water (i.e. swimming pool) If seizures occur in back-to-back clusters without the person regaining consciousness Seizure Action Plan Seizures often have typical patterns that differ from person to person, so if possible develop a seizure action plan if you work with someone who has been diagnosed with epilepsy SEIZURE TRIGGERS TREATMENT OPTIONS Missed medication or a change in medication Lack of sleep or fatigue Dehydration Flashing lights (photosensitivity) Hormonal changes (esp. in women) Alcohol or drug abuse Fever (febrile seizures usually happen in young children) Anti-epileptic drugs (AEDs) Medications control or substantially reduce seizure frequency for 70% of epilepsy patients Vagus Nerve Stimulation (VNS) Implanted device that sends extra electrical signals to the brain through the vagus nerve Ketogenic diet High fat diet typically used for seizure control in young children Surgery 9

SOCIAL ISSUES AND EPILEPSY MANAGING SEIZURES IN THE SCHOOL Both children and adults with epilepsy can experience social isolation as a result of ignorance and stigmas that surround their medical condition Children with epilepsy are at an increased risk of developing: Learning disabilities Depression Establish effective communications between parents, teachers, students and other school personnel involved with the child Develop a seizure action plan and talk about it in the student s IEP Keep a log documenting date, time and symptoms of seizure activity observed Note changes in behavior, both academic and social Keep updated records of any changes to the child s medication (dosage and type) Avoid overprotection of the child Address teasing behaviors and educate other students about epilepsy Founded in 1972 Mission Statement: EPILEPSY FOUNDATION WESTERN/CENTRAL PA The Epilepsy Foundation Western/Central Pennsylvania leads the fight to stop seizures, find a cure and overcome the challenges created by epilepsy. Family Services Family assistance: One-on-one counseling Family outings: Annual Picnic, Holiday Party Support Groups Teen Getaway EPILEPSY FOUNDATION PROGRAMS AND SERVICES Camp Frog (Erie and Wernersville, PA) CAMP FROG Created for children and teens ages 8-17 years old that have seizures One week of camp in Erie and Wernersville, PA Fully-integrated camp program with extra supportive and medical services All camp counselors are given seizure recognition and first aid training Pediatric neurologist and nurse on-site for the duration of camp Financial assistance is available to help families pay for the camp fees Adult Services Information and Referral Services Employment Education/ Advocacy Services I.D Cards EPILEPSY FOUNDATION PROGRAMS AND SERVICES Emergency Medication Assistance Adult Socialization/Support Group Events Scholarship Recipients 10

EPILEPSY FOUNDATION PROGRAMS AND SERVICES (CONT D) EPILEPSY FOUNDATION WESTERN/CENTRAL PENNSYLVANIA Community Education School Alert Presentations Individual Education/Advocacy Cases Community Educational/Training Presentations Annual Conference For up to date information on all EFWCP Programs, Services and Special Events, visit our website! www.efwp.org RESOURCES Epilepsy Foundation Western/Central Pennsylvania: www.efwp.org Epilepsy Foundation of America: www.epilepsyfoundation.org England, Mary J. et al. (2012) Epilepsy Across the Spectrum: Promoting Health and Understanding. Institute of Medicine of the National Academies. Andrea Zonneveld Community Education & Events Coordinator Epilepsy Foundation Western/Central PA 1501 Reedsdale Street Suite 3002 Pittsburgh, PA 15233 www.efwp.org 412-322-5880 BrainSTEPS Strategies Teaching Educators Parents Students What is BrainSTEPS? Brain injury consulting teams available to families and schools throughout Pennsylvania. Teams are extensively trained in the educational needs of students returning to school following brain injury. Teams will work with local school staff to develop educational programs, academic interventions, strategy implementation, and monitoring of students. 11

The BrainSTEPS Program Funded by: 1. PA Department of Health 2. PA Department of Education Implemented by: 1. Brain Injury Association of Pennsylvania - Beginning our 5 th academic year BrainSTEPS Encompasses Acquired Brain Injuries Traumatic Brain Injury (includes Concussions) Non-Traumatic Brain Injury (Any child who has a brain injury that occurs AFTER the birth process can be referred!) 30 BrainSTEPS Teams 27 Intermediate Unit teams & 3 large school district teams 300+ Active Team Members All Colored Areas = Trained BrainSTEPS Teams White = Regions without BrainSTEPS teams Non-School Based Team Members Include: Hospital & Rehabilitation based: 1. Acadia Rehabilitation, Inc. 2. Children s Hospital of Philadelphia 3. The Children s Institute of Pittsburgh 4. Geisinger Medical Center 5. Good Shepherd Rehabilitation 6. Lehigh Valley Hospital 7. Hershey Medical Center 8. Mainline Rehabilitation 9. Nemours/A.I. dupont Hospital for Children 10. Reading Hospital 11. Schuylkill Health Systems 12. St. Christopher s Hospital for Children 13. St. Vincent s Medical Center 14. ReMED 15.The Barber Institute What BrainSTEPS Can Do: 1. Conduct observations 2. Communicate with the district and medical professionals 3. Gather medical, rehabilitation, & educational reports to assist in making educational recommendations. 5. Provide training for the school & family 6. Consult on all aspects of the student s educational plan & make recommendations to the district team. 7. Assist in transitioning a student from grade to grade or school to school by training new teachers 4. Provide Peer Trainings 12

BrainSTEPS Teams monitor all referred students annually until graduation. Who should be referred to BrainSTEPS? A student who: 1. Has an acquired brain injury At any point in the student s life 2. Is having difficulty at school as a result of the acquired brain injury How to make a referral to BrainSTEPS 1. Student with an acquired brain injury is identified by a parent, physician, school, etc. 2. That person locates the BrainSTEPS team leader by county (www.brainsteps.net) and calls to make a referral 3. The Team Leader will: get parent permission signed ask intake questions contact the school district work with their team members, school, & family to create a plan of action Contact: For More Information on the BrainSTEPS Program Brenda Eagan Brown, M.S.Ed., CBIS Program Coordinator BrainSTEPS Brain Injury School Re-Entry Program Brain Injury Association of Pennsylvania Phone: 724-944-6542 Email: eaganbrown@biapa.org www.brainsteps.net References: Giza, C. C., & Hovda, D. A. (2001). The neurometabolic cascade of concussion. Journal of Athletic Training, 36(3), 228 235. QUESTIONS? Langlois, J. A., Rutland-Brown, W., & Wald, M. M. (2006). The epidemiology and impact of traumatic brain injury: A brief overview. Journal of Head Trauma and Rehabilitation, 21(5), 375 378. Information retrieved from: www.neurology.stanford.edu/divisions/e_12.html www.internationalbrainassociation.org www.brainline.org 13