Traumatic Brain Injury in Children and Adolescents

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Traumatic Brain Injury in Children and Adolescents Katherine C. Nordal, Ph.D. The Nordal Clinic Vicksburg, MS 39183 Knordal@vicksburg.com

Traumatic Brain Injury to cerebrum External compel Total or fractional incapacity or psychosocial weakness at least 1 ranges Cognition, dialect, memory, consideration, thinking, unique considering, judgment, critical thinking, sensor, perceptual, or engine capacities, psychosocial conduct, physical capacities, data preparing, discourse

TBI does exclude strokes, vascular mishaps anoxic wounds, contaminations tumors, metabolic clutters introduction to dangerous substances

Types of Brain Injuries Open mind wounds Closed mind wounds 1. Diffuse 2. Central

Severity of Brain Injury Mild: brief or no LOC, sickness, indications of blackout, GCS 13-15, PTA < 1 hr, half 75% Moderate: trance like state < 6 hrs, skull break or dying, GCS 9-12, PTA 1-24 hrs Severe: unconsciousness > 6 hrs, PTA > 1 day, GCS 3-8

Glasgow Coma Scale (GCS) Eye Opening Spontaneous 4 To speech 3 To pain 2 None 1 Best Motor Response Obeys command 6 Localizes pain 5 Withdraws from pain 4 Abnormal flexion to pain 3 Extension to pain 2 None 1 Verbal Response Oriented conversation 5 Confused conversation 4 Inappropriate words 3 Incomprehensible sounds 2 None 1

GCS Facts 8 is the basic score 90% with scores not exactly or equivalent to 8 are in a trance like state half with scores not exactly or equivalent to 8 at 6 hours will kick the bucket

Post Traumatic Amnesia (PTA) Time after trance state when individual is still not able to frame new recollections Measured by COAT or GOAT

Rancho Los Amigos Scale Level I No Response Level II Generalized Response Level III Localized Response Level IV Confused/Agitated Level V Confused/Inappropriate Nonagitated Level VI Confused Appropriate Level VII Automatic, Appropriate Level VIII Purposeful, Appropriate

Epidemiology Who gets harmed? TBI not haphazardly circulated Predominately male Lower SES High family or life stretch Behavioral penchant toward hazard making and high move levels

Epidemiology Who gets harmed? 3-8 year olds 15-29-year olds Kid's at most serious hazard: HA/candidly irritated/reprobate Under 5, w/earlier modification issues, of low SES, guardians w/issues

Risk Factors for TBI Prior behavioral issues Family stretch Family flimsiness Crowded living conditions Prior TBI

Major Causes of Brain Injuries Infants : unintentional dropping, physical manhandle, "shaken infant disorder" Toddlers and Preschoolers : falls, auto collisions, physical mishandle Elementary school youngsters : auto and bicycle mishaps, play area and recreational mischances Adolescents : auto crashes, sports wounds, strike

TBI: Some Statistics 7,000 passings of kids >500,000 hospitalizations Hospital mind costing over $1 billion 30,000 kids turning out to be for all time crippled

TBI: Some Statistics The NHIF gauges that < 10% of all who survive TBI get sufficient recovery to return them to independence TBI survivors requires amongst $4 and $9 M for a lifetime of administer to around 16% of all pediatric doctor's facility confirmations for kids between the periods of birth and 14 half of battered kids who survive a TBI endure changeless neurological, scholarly, and mental debilitation

What Happens After the Injury? Physical Cognitive Psychosocial Behavioral/Emotional

Physical Effects Reduced stamina and perseverance Regulation of physical capacities Motor shortages, ataxia Seizures as well as cerebral pains Skeletal distortions Hormonal and body temperature changes Dysarthria

Cognitive Effects Short and long haul memory issues Intellectual capacities frustrated Attention and fixation lessened Language troubles Academic working decreased

Psychosocial Effects Depression and nervousness Social withdrawal Feelings of uselessness Guilt Loss of enthusiasm for school and family exercises

Behavioral Effects Acting socially inappropriate..loss of companions Being ignorant of one's effect on others...may look for more youthful associates Irritable Impulsive as well as forceful More passionate Unmotivated

Emotional Effects Poorer resistance, more unbending Greater reliance, lack of care Flat effect, oppositional, reprimanding More requesting More labile, juvenile adapting

Factors Influencing Outcome Type of harm Medical confusions Severity of damage: conveys most weight re: forecast for recuperation Premorbid working Gender and SES don't influence result Pre-harm psychiatric d/o prescient of later issues w/serious TBI

Factors Influencing Outcome General standards: Not only the harm the cerebrum supports, yet the mind that maintains the damage Understand the person who has the mishap, the setting in which he/she lives, and will keep on living Multifactorial impacts on result at time make "dosage and reaction" appear to be miserably out of extent

Factors Influencing Outcome Age @ damage: @ > 5 y.o., age inconsequential to seriousness of neurocognitive shortfalls or rate of recuperation @ < 5 y.o., more extreme long haul neurocognitive deficiencies May be hard to decide seriousness of harm w/nonappearance of pattern information - examination w/kin, guardians

Factors Influencing Outcome Pre-existing disarranges Injury may cooperate w/earlier learning handicap, low scholarly limit, psychiatric d/o and so forth. Expansion of even a minor affront to premorbidly bargained individual may deliver an evident lopsided addition in inability

Factors Influencing Outcome Neurological harm more extreme than at first acknowledged Overlooked because of other systemic wounds requiring crisis consideration, surgery, long healing, and so forth which put couple of psychological requests on patient But, different wounds can likewise create PCS manifestations with no neurologic substrate

Factors Influencing Outcome Co-existing propensity designs Alcohol and substance Abuse Previous head wounds Produce challenges in life working and , now and again, make singular more vulnerable to negative result

Factors Influencing Outcome Family skill Well-working versus scarcely bearable circumstance which is inadequately overseen Injured kid may build strain in as of now barely adapting family- - deliver more negative results than neurological occasion itself

Factors Influencing Outcome Recovery Rates Dependent upon seriousness - milder wounds have quicker recuperation More quickly a capacity returns, better the anticipation for that capacity Major part of recuperation inside first year Note: there are diverse fields of contemplated TBI recuperation rates

Factors Influencing Outcome Summary Neurocognitive and psychiatric residuals for children with mellow or even direct wounds appear to be less clear and when wounds at this seriousness level do create deficiencies, recuperation appears to happen over a short (a while) timeframe Pediatric TBI research is in its early stages - great longitudinal studies are required

Factors Influencing Outcome Management of case Appropriate administration of gentle to direct wounds for the most part results in effective re-combination to class Inappropriate attribution of example of neurocognitive changeability to cerebrum harm may produce self-satisfying negative desires, misattributions, tension

Neuropsychological Assessment: Conceptual Approach Presenting issue Significant others as sources Child's presentation shaded by restrictions in reasonable limit and mindfulness Consistency and disagreements in reports Pervasiveness/span of manifestations character etiologic variables

Neuropsychological Assessment: Conceptual Approach Collection of foundation data Records of damage/hospitalization Neurodiagnostics Length of unconsciousness Approximate length of PTA Current Medications Anticonvulsants can antagonistically influence test comes about if blood levels are high

Neuropsychological Assessment: Conceptual Approach Collection of foundation data Premorbid history Medical earlier TBI History of seizures Birth records Psychiatric history Comprehensive formative history Family history- - patterns re: ADD, LD School history- - participation, testing, sped, and so on

Neuropsychological Assessment: Conceptual Approach Appraisal of displaying issues and accumulation of foundation data gives a gauge of premorbid working, assurance of momentum components which may impact the evaluation procedure, and theory improvement about example/seriousness of expected neuropsychological shortfalls

Neuropsychological Assessment: Conceptual Approach Neuropsychological Examination Selection of appraisal systems dictated by nature of referral question, tyke's age, tyke's physical and mental limits, and therapist's own inclinations Measures a full scope of capacities essential for accomplishment in youth's surroundings

Neuropsychological Assessment: Conceptual Approach Assessment Domains General Intelligence Academic Achievement Motor Skills Sensory, Perceptual, Constructional Language/Speech Auditory Attention/Information Processing Visual Attention/Information Processing

Neuropsychological Assessment: Conceptual Approach Assessment Domains Executive Functions/Problem Solving Memory Personality/Behavioral/Adaptive Skills

Assessment Instruments Neuropsychological Test Batteries Halstead-Reitan Neuropsychological Test Battery for Older Children, 9-14 yrs. Reitan-Indiana Neuropsychological Test Battery for Children, 5-8 yrs Luria-Nebraska Neuropsychological Test Battery for Children, 8-12 yrs NEPSY

Assessment Domains General