March Is TBI Awareness Month

March is TBI awareness month, which is something that is very near and dear to me.  In January of 1998, I suffered a TBI, and the repercussions have been trying, to say the least.  But that is a post for later this week.  This post is for awareness, resources, and advocacy.  Enough said.

What is a TBI?

TBI (traumatic brain injury), as defined by the Centers for Disease Control and Prevention (2015), is caused by a bump, blow, or jolt to the head or a penetrating head injury that disrupts the normal function of the brain.  While not all bumps or blows to the head result in a TBI, it is estimated that approximately 2.5 million hospital visits are associated with a TBI which contribute to more than 50,000 deaths per year.

Diagnosis a TBI

TBIs are diagnosed using one of two main systems: The Glasgow Coma Scale or the Ranchos Los Amigos Scale.   The Glasgow Coma Scale is based on a 15-point scale and describes the level of consciousness of a person after a TBI and used to describe the severity of the injury.  It measures the functions of eye opening, verbal response, and motor response.  (To see a more detailed breakdown of these functions, please click here.)  The Ranchos Los Amigos Scale measures the levels of awareness, cognition, behavior, and interaction with the environment.  It uses eight different levels ranging from Level 1: No Response to Level VIII: Purposeful-appropriate.  (To see a more detailed breakdown of these levels, please click here.) 

For simplicity purposes, I am choosing to elaborate using the Glasgow Coma Scale.  Using this scale, the severity can be described as mild, moderate, or severe.

Mild TBI 

• brief loss of consciousness ranging from a usually few second to a few minutes OR no loss of consciousness but some confusion
• post-traumatic anmesia (PTA) for less than 1 hour of the TBI
• normal brain imaging results 

Moderate TBI 

• loss of consciousness for a few minutes to a few hours
• confusion lasts from days to weeks
• PTA for 1-24 hours
• abnormal brain imaging results
• physical, cognitive, and/or behavioral impairments last for months or weeks

Severe TBI

• loss of consciousness for more than 24 hours
• PTA for more than 24 hours
• abnormal brain imaging results
• may affect short or long-term cognition, sensation, language, and emotional impairments 

Causes of TBIs

According to the CDC, TBIs between 2006-2010 were results of the following:

Long-Term Effects

Long-term effects of TBIs are variable and depend on the severity.  Individuals with a mild TBI will most often have no long-term effects.  For those that do, the symptoms may be longer lasting or even permanent including irritability, anxiety, and depression.  Other challenges may also include balance, movement, attention, concentration, judgement, and reaction time.  For many individuals with a moderate to severe TBI, the long-term effects can lead to life-long challenges.  Physical changes can include sleep disorders, changes in appetite, paralysis, seizures, difficulty regulating body temperature, and hormonal challenges.  Cognitive changes can include difficulty with attention, concentration, memory, processing speed, perseveration, confusion, impulsivity, and executive functions.  Speech-language challenges may include understanding spoken words or generating words, slurred speech, reading and writing problems.  Social-emotional challenges may include fluctuating emotions, lack of motivation, irritability, aggression, depression, and and lack of inhibition.  Additional challenges may include sensory, perception, vision, hearing, smell, and taste.  The list is even more extensive, however, these highlight the most common.

Resources

CEMM (Center of Excellence for Medical Multimedia) has great resources for TBI.  Please visit their website to find an interactive brain, videos, and information on caregiver and personal journeys.

The CDC has a four-minute podcast about The Dangers of Brain Injuries that is also a great resource.  You can check it out here. 

References:

BrainLine.org (2015).  Retrieved from http://www.brainline.org/content/2010/10/what-is-the-glasgow-coma-scale.html

Northern University: Traumatic Brain Injury Resource for Survivors and Caregivers (2010).  Retrieved from http://www.northeastern.edu/nutraumaticbraininjury/what-is-tbi/severity-of-tbi/

Brain Injury Alliance (nd.) Retrieved from http://biau.org/types-and-levels-of-brain-injury/

Center for Disease Control and Prevention (2015).  Retrieved from http://www.cdc.gov/traumaticbraininjury/get_the_facts.html

Center of Excellence for Medical Multimedia (nd.) Retrieved from http://www.traumaticbraininjuryatoz.org

Executive Function

A year ago I purchased the e-version of the book “Smart but Scattered” written by Dr. Peg Dawson and Dr. Richard Guare. Over the past few days I had the chance to sit down with this book again. If anyone gets the chance to read it this summer it has many practical ideas to help with students with executive function weaknesses. It is a great read if you get the chance. It also inspired me to look up more information about executive function and how it ties to language functioning. I thought I would share what I found. 

What is Executive Function and What happens when there are Weaknesses?

According to the National Center for By: National Center for Learning Disabilities (NCLD 2014), ”Executive Function is a term used to describe a set of mental processes that helps us connect past experience with present action. We use executive function when we perform such activities as planning, organizing, strategizing and paying attention to and remembering details.” Also according to the NCLD website, individuals with executive function problems have difficulty with planning, organizing and managing time/space. Because these skills play a large role in all aspects of life a deficit in executive function skills can restrict a child both socially and academically. For some students there is a difference in executive functioning noted from an early age and for many deficits in executive function does not become apparent until middle school when there is a shift to more independence in work completion and organizing oneself.

How does Language impact Executive Function?

After reading more I learned that language and executive function are often intertwined with individuals needing strong skills in both to complete tasks in every day life. Some examples of how individuals use language for executive function tasks are through recognition of symbols (such as in reading), storing and retrieving information (such as expressive retelling events) and with meta-cognition (self reflection and self-monitoring). Remine et al. in their 2004 study discussed, "That when using language in self-questioning, individuals are in fact communicating with themselves about how to approach and solve a problem and ultimately learning and monitoring one’s own behavior.”

I also learned that when Individuals struggle with language they can also struggle with executive functioning skills. Two studies I looked at that discussed Children with specific language impairment (SLI) and executive functioning noted that children with SLI may also struggle with attention, narrative language skills, and auditory working memory (Hoffman & Gillam, 2004; Marton & Schwartz, 2003).  According to Remine et al., “Given that increasingly sophisticated language is required for effective executive functioning as an individual matures, it is likely that students with poor language abilities will have difficulties performing complex problem-solving tasks.”  

If you would like more information about Executive Function and Language Skills please check out these helpful resources:

Executive Function and ADHD

The Source for Executive Function

Ways to Help Students with Executive Function Skills

Defining Executive Function Visual for Parents

Smart But Scattered Book Link

Cited Sources:

Dawson, Peg, and Richard Guare. Smart but Scattered: The Revolutionary "executive Skills" Approach to Helping Kids Reach Their Potential. New York: Guilford, 2009. Print.

"What Is Executive Function? | Executive Functioning." National Center for Learning Disabilities. N.p., n.d. Web. 30 June 2014.

Remine, M. D., E. Care, and P. M. Brown. "Language Ability and Verbal and Nonverbal Executive Functioning in Deaf Students Communicating in Spoken English." Journal of Deaf Studies and Deaf Education 13.4 (2008): 531-45. Web.

Hoffman, L. M., and R. Gilliam. "Verbal and Spatial Information Processing Constraints in Children With Specific Language Impairment." Journal of Speech, Language, and Hearing Research 47.1 (2004): 114-25. Web.

Marton, K., and R. G. Schwartz. "Working Memory Capacity and Language Processes in Children With Specific Language Impairment." Journal of Speech, Language, and Hearing Research 46.5 (2003): 1138-153. Web.

Crazy for Camping!

We just bundled a group of camping-themed activities just in time for Memorial Day and summer!   Crazy for Camping is a bundle of six different activities which targets the following skills:

Object Descriptions: Camping Supplies!

Students play a game describing supplies used for camping.  Descriptions target what an object looks like, what it is made of, what it is used for, and what parts it has.

Auditory Memory: Pack Your Bag! 

Students “pack” a camping bag by listening carefully to verbally stated objects and putting matching picture icons “in” the bag.  

Word Order: S’more Sentence Combos!

Students use s’more ingredients to organize words in sentences. 

Sequencing: Building A Campfire! 

Students are presented with five steps of a sequence that are printed on a log.  Students build a campfire by putting the logs on top of each other in sequential order.  

Inferencing: Whose Footprint?

Students are presented with 10 different animal footprint cards and make a smart guess about which animal they belong to.  Then they are given a series of three clues to further inference which forest animal the tracks belong to.  

Main Idea/Details, Summarize, and Vocabulary: Let’s Go Camping!

Students practice vocabulary using the “I have…who has…”vocabulary game prior to reading two informative texts.  A graphic organizer is included for students to identify the main idea, details, and write a brief summary about each text.

All activities are aligned to the Common Core.  Check it out and let us know what you think!