Pediatric Traumatic Brain Injury Roberta DePompei, The ASHA Leader Page 1 of 4

Multimedia

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  Children who sustain a TBI early in childhood often grow into their injury; their problems sometimes don't surface until they are in elementary school.

  See all videos interviews with Dr. Ann Glang.

  
  Transcript of this video.
  
• Recognizing a Child's Early TBI Later in the Classroom
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  It's crucial to find a balance between keeping your child safe and allowing her to explore her world.
• Keeping Kids Safe ... and Stimulated
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  Working in collaboration with your child's school and communicating clearly and calmly with teachers and administrators are two crucial strategies. Produced by Victoria Tilney McDonough and Brian King.

  See all videos interviews with Dr. Ann Glang.

  Transcript of this video.
  
• Learn How to Be a Proactive Advocate for Your Child
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  Learn about the tools out there — from traumatic brain injury 101-type information to specifics on how to develop a student's individualized education plan.

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  Transcript of this video.
  
• Tools and Resources for Educators Working with Kids with TBI
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  Lots of rest, sleep, and reduced stress are crucial for a child recovering from a mild TBI. The more parents know about the symptoms, the better. Produced by Vicky Youcha and Brian King. Transcript of this video.
  
• The Emotional Consequences of Concussion
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  Studies show that a child's brain is more vulnerable to the effects of a brain injury and takes longer to recover. Learn more. Produced by Vicky Youcha and Brian King.   Transcript of this video.
  
• Child Brain Versus Adult Brain with Traumatic Brain Injury
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  When can a young athlete return to play after a concussion? Learn about the ins and outs of this complex question -- from the use of baseline testing to the philosophy of  "one and done." Produced by Vicky Youcha and Brian King.
  Transcript of this video.
  
• Identifying a Concussion and Its Long-and Short-Term Effects

Where Do We Go From Here?

These quotes — from real families and individuals dealing with traumatic brain injury (TBI) — illustrate the spectrum of traumatic brain injuries and the resulting complexities. The families' words also convey frustrations that can result from a lack of awareness about TBI and its implications for children, adolescents, and young adults, as brain development continues into their 20s.

Some common factors in these experiences are relevant to speech-language pathologists who may be called upon to treat communication difficulties in children and adolescents with TBI:

• The effects of a TBI in childhood are not fully realized right away and, in fact, new challenges can emerge after the individual has become an adult.
• The full scope of cognitive-communicative issues that results from a TBI often are not recognized in school and community environments, and sometimes, not even at home.
• There is a lack of recognition of the full scope of cognitive and communication issues and their impact on lifelong learning and living; as a result, there are significant gaps in the available research, especially with respect to evidence-based methods that are likely to improve outcomes for this population.
• Considerable information exists based on expert opinion about how practitioners and caregivers can support cognition and communication throughout development, but this information is not widely disseminated.

Although professionals often discuss and present on these concerns, positive strides have been made in the past decade and sufficient information exists to guide young TBI patients, their families, and the clinicians who treat them. These advances include increased information about cognitive communication after TBI, research on post-TBI developmental issues, and resources for best practice.

Immediate Effects 

Cognitive communication is the ability to use language and underlying skills such as attention, memory, self-awareness, organization, and problem-solving skills to communicate effectively. Cognitive communication combines thinking skills with language. Language skills may appear to have returned after brain injury, particularly in nonstressful situations. However, when the child most needs to communicate at home, in school, and in the community, the spontaneous and unpredictable nature of communication demands can result in decreased language performance. Changes are most likely to be seen at school under the pressures of time, grades, assignments, the struggle to keep up with curricular requirements, and social pragmatic interactions (DePompei & Blosser, 2003).

The entire spectrum of TBI — from mild through severe injuries—can have an effect on cognitive-communication issues and the complex academic learning and social interactions that can be involved.

A history of a mild brain injury is considered a significant factor that may preclude an athlete from returning to play and may necessitate academic accommodations. The effects of moderate injuries typically are better understood as causing academic struggles as well as an inability to develop adequate social skills. Individuals with severe injuries uniformly receive specialized accommodations in school and community environments within the special education category of TBI.

Strategic learning is essential for success at all educational and social levels and often does not develop properly in students with TBI. Strategic learning, an important function that underlies the brain's capacity to learn, is the ability to extract important information while inhibiting the unimportant features of that information. When a student is presented with a new learning task, the student's ability to identify meaningful information, generalize or abstract this information, and store it for future use may be impaired. Thus, this student may store details related to less important information and be unable to recall the gist of the new learning task efficiently or successfully. Language and cognitive communicative difficulties are often at the root of these problems and treatment is usually indicated (Blosser & DePompei, 2003; Chapman et al., 1999).

Reprinted with permission from "Pediatric Traumatic Brain Injury" by Roberta DePompei. The ASHA Leader, 13, November 2, 2010, pp. 16-20. Copyright 2010. All rights reserved.

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