Every year hundreds of thousands of American children die from head wounds that they have received in car accidents and falls, or from gun shots or being shaken, struck or thrown. No fewer than 1,000,000 are head-injured each year. Traumatic Brain Injury is called The Silent Epidemic because so many cases go undetected.
That is part of the bad news. There is some good news, as you will see.

Every year hundreds of thousands of American children die from head wounds that they have received in car accidents and falls, or from gun shots or being shaken, struck or thrown. Traumatic Brain Injury [TBI] is the leading cause of death for children and adolescents. No fewer than 1,000,000 are head-injured each year. 165,000 are hospitalized and evidence shows others should be. Effects may be mild, but they are more often devastating. Abilities that may suffer include cognition, speech, comprehension, memory, judgement, socialization and emotional stability. [Physical disabilities are discussed below.]

The good news is, therapy usually helps. IF it starts right away and lessons are frequent. Children recover better and faster than adults because their brains are still developing. If the damage is confined to one side of the brain, the other side begins compensating. This has been known to increase creativity.

“The silent epidemic,” the Brain Injury Association calls TBI. Sadly, a lot of brain damage goes undetected. Symptoms can be subtle and complex. Severity depends on the amount of damage and which part or parts of the brain are affected. Disabilities can be permanent, especially if left untreated. Emotional problems pile on and families and friends can’t understand what is wrong. The child has been proclaimed healthy. Behavior problems are put down to willfulness. Many children begin to hear that they are “stupid,” “stubborn,” “lazy,” or worse.

Physical signs may include trouble speaking, seeing, hearing and identifying objects by touch. Headaches are common. Coordination usually suffers, and stiffness [spasticity] may occur. One or both sides of the body may be weak or paralyzed. Sensation and tone may be under par. Seizures sometimes occur and balance and-or gait suffer. Memory deficits may interfere with learning and adjustment. The child may have trouble concentrating. Thoughts come slowly and attention wanders.. Communication problems run the gamut from muteness to talkativeness. Deficits are common in reading, writing, planning, remembering or explaining the order in which things happen. Also, counting, naming or identifying objects. As if these aren’t enough, the child tires easily and has mood swings. Self-centeredness, anxiety and depression may rear. Sexual dysfunction, restlessness and passiveness plague some victims. Some can’t monitor their behavior. Agitation and excessive laughter or crying may interfere with peace of mind and relationships. Any or all of these can attack, and severity varies. Although many ‘experts’ predict success or failure (usually the latter), they are often proven wrong. People are too different, their brains too complex.

Educational Issues:

Many professionals do not recognize TBI. Sufferers are labeled learning-disabled, emotionally disturbed, mentally retarded, or “all of above” and assigned to programs that thwart progress. They can hardly be blamed if they become frustrated, anxious, angry or fearful. TBI requires specific types of treatment and education on a one-by-one basis. Speech and language therapy, PT, OT, psychological counseling or kinesthetic therapy may be needed. Or some combination of them. We need to lean hard on legislators to fund programs to treat and educate children who have been injured in this way. Insist on quality education for each and every child, regardless. Many IEPs [Individualized Education Programs] are jokes. This hurts us all. We are already paying a terrible price for neglecting these kinds of things. Violence is only one of the costs.

While most brain-injured children are able to return to school, their needs are are drastically different than they were. Some appear to function normally. Most are lumped with children who were born with handicaps. Sudden injury creates important differences! For one thing, many victims remember how they were. So do their families and friends. Everyone has to readjust expectations, and that is not an easy thing to do.

Before a child re-enters school, careful planning and a lot of coordination need to take place. It is essential that educators, medical personnel and family members work together. Will the child need to be retaught? Need physical assistance? Supervision? What equipment and materials should be ordered? Might orientation be a problem? Teachers should be fully informed about the state of the child’s memory and other school-related abilities. Emotional state! He or she may need extra repetition and consistency. New tasks will have to be introduced in particular ways. Examples simplified and special illustrations provided.

Teaching Hints:

>Use concrete language (as indicated).
>Reward the tiniest increase in attention.
>Re-assess often, and with respected measures.
>Repeat as necessary, maintaining a pleasant
demeanor.
>Help the child find ways to remember and compensate for forgetting.
>Watch for low stamina and provide plenty of rest.
>Keep distractions down [or create one to increase interest or make a point]
>Determine the number of steps the child needs to learn. If is is one, break it
into fractions to insure success.
>Simplify directions and sequences as needed.
>Reward each and every success, no matter how small!!
>Focus on the things the child c a n do.
>Cater to the child’s interests to build self-esteem and motivation.
>L i s t e n to the child.
>L i s t e n to the family.
>L i s t e n to professionals who have worked with the child or assisted with diagnosis.
>L i s t e n to your instincts.
>L i s t e n to the child. [This repetition is not an accident.]
>Read, study, question, research – in other words, do your homework. College libraries are
good sources for information about brain injury and the latest teaching techniques,
as is the Internet.
>Be patient.
>Remember what they say about honey and vinegar.
>Hope, Believe, Go the Extra Mile and Then Another and Another.
>And always remember to be good to yourself. . .too!

I have done therapy with many individuals with severe TBI. Most got better. Children, especially. Many were eventually able to work and some entered college. The most important key is two-sided: on top is loving support, especially from family. On the other side is early diagnosis followed by timely and intensive therapy. Like all keys, there are times when it is hard to operate. But when you get it to work, the door opens to happier and healthier future.

(c) Phyllis Jean D[awson] Green, M. Ed./ASHLA/CCC/SPL/ret.

Author’s Note: The statistics are from the Brain Institute of America { http://www.biausa.org }. The other information is based on decades of research and experience as a teacher, therapist and clinic owner [Greenhouse Speech & Language Pathology Center, Burlington and Graham, NC]. I have been fortunate enough to work in hospitals, nursing homes, adult rehabilitation and child development centers as well as for Project Head Start, a sheltered workshop and a home-visitation program geared to help infants and their families. Working with people of all ages and from all walks of life has been a great blessing. They have taught me more than I could hope to teach them!
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