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Understanding Acquired Brain Injury

The brain is the body’s control centre.  It controls our thoughts, movements, feelings, sense and how we communicate.  Each part of the brain has a specific job or function.  When the brain is damaged, parts of the brain may have difficulty doing their job.

Understanding Acquired Brain Injury Acquired brain injury (ABI) refers to any type of damage to the brain that occurs after birth.  Acquired brain injury is NOT a disease that is present from birth such as Fetal Alcohol Spectrum Disorder and prenatal illness or diseases that progressively impact the function of body organs and tissues such as Alzheimer’s disease or Parkinson’s disease.

There are two types of acquired brain injuries: traumatic and non-traumatic:

A traumatic brain injury is the result of a physical force from the outside of the head that impacts the brain (eg. a fall, assault, motor vehicle or bike accidents, sports injury, Abusive Head Trauma/Shaken Baby Syndrome, etc.).

A non-traumatic brain injury  is the result of a medical need that results in an impact on the brain (eg. the brain not getting enough oxygen, a stroke, an infection, etc.).

How Brain Damage Happens

Damage to the brain, whether traumatic and non-traumatic can happen in many ways.  Acquired brain damage occurs because one of the following has occurred internally:

  • Bruising
  • Bleeding
  • Brain Swelling
  • Fever
  • Lack of blood or oxygen to the brain
  • Shearing or tearing of brain cells when the brain is rapidly moved back and forth/twisted around
  • Pressure inside the skull
  • Objects taking up space in the brain (such as a tumour)

Symptoms

It is important to note that no two acquired brain injuries are alike.  While there is a standard list of acquired brain injury symptoms, which symptoms and the way it impacts a child varies.  For example, a child with an injury in the front of the brain may experience difficulties in social settings but may not have difficulties with balance as it is controlled by a different part of the brain.  The characteristics and symptoms following an acquired brain injury depend on which part of the brain is damaged and the severity of that damage.  The most common acquired brain injury symptoms are listed below:

Physical:

  • Difficulties with walking, sitting, bathing, etc. 
  • Slurred speech 
  • Chronic pain such as headaches 
  • Fatigue or sleeping difficulties (such as trouble staying asleep, having to sleep for longer periods of time) 
  • Difficulties with balance 
  • Seizures

Intellectual/Thinking:

  • Difficulty starting, planning or organizing tasks 
  • Visual disturbances such as blurred vision 
  • Easily distracted and difficulty concentrating 
  • Memory needs (such as long term, short term, memory capacity) 
  • Difficulty making decisions and judging situations 
  • Moments of/general confusion 
  • Impulsiveness (such as  acting before thinking or difficulty with social boundaries) 
  • Shortened attention span 

Emotional:

  • Irritability
  • Intense emotional or behavioural periods 
  • Mood disorders such as depression, anxiety and difficulties managing anger 
  • Difficulty controlling emotions (such as laughing or crying for no apparent reason) 
  • Feelings of sadness, anger, loss of sense of self 
  • Denial of injury and limitations 
  • Lack of motivation 
  • Fear of acquiring a second brain injury that effects daily life

Social:

  • Difficulty reading social cues which can manifest in awkwardness or inappropriate behaviour 
  • Isolation due to feeling different 
  • Limited coping skills 
  • Trouble maintaining work and social relationships 
  • Changes in daily roles (such as roles in the family, at work, in social life) 
  • Loss of independence 
  • Changing/altering of goals for the future

Managing an Acquired Brain Injury

The recovery process from a brain injury can be difficult to manage because it is hard to predict outcomes or time range with any certainty. Since a child’s body and brain is still developing, each developmental stage can be affected by the acquired brain injury. New challenges can emerge within each developmental stage and into adulthood. For example, when the child reaches their teenage years, they may experience acquired brain injury symptoms they had not previously.  Recovery depends upon the individual child, the type of injury and the amount of damage to the brain. It’s important to remember that positive outcomes are possible; many people with acquired brain injuries are able to hold jobs, attend university or college and live independently

A child with an acquired brain injury may require a range of services. The types of services required depend on the needs of the child and their symptoms following the acquired brain injury. Common acquired brain injury services include:

Child Life Services:

Helps the child understand their injury and limitations.

Modified School Programs:

The child may require supports and accommodations at school.

Neuropsychological Services:

Following an acquired brain injury, a child should have a neuropsychological assessment completed by a neuropsychologist.  A neuropsychological assessment is used to assess functioning following an acquired brain injury.  It will show which thinking tasks the child has difficulties with and can be useful in determining which accommodations and supports are required at school and at home.

Nursing services:

Nursing services include assistance in day-to-day personal care, help with communication skills, assistance with day-to-day activities, mobility assistance, companionship and ensuring safety.

Occupational therapy:

Occupational therapy can assist in the retraining of motor control and cognitive/thinking functions that were impacted by the acquired brain injury. Occupational therapists provide assessments in the areas of home and school safety, the impacts of the acquired brain injury on daily activities and determining a child’s needs for care.

Physiotherapy:

Physiotherapy assesses a child’s movement patterns following an acquired brain injury. This includes balance, weakness and coordination. Based on the assessment, a physiotherapist will develop a therapeutic exercise and movement retraining program to improve a child’s physical needs following the acquired brain injury.

Social Work:  

A social worker provides support and education for individuals and the families of those with an acquired brain injury. The social worker can refer and connect individuals and families to acquired brain injury resources in the community.

Speech Language Pathology:

A speech therapists can assist with communication skills related to speech and language. A speech and language therapist can assess and assist with swallowing and chewing abilities, general speech and language skills, oral motor skills, reading and writing skills, communication skills, organization and attention, and strategies for memory.

An acquired brain injury may change the way in which a child thinks and learns but a child is indeed still able to do so.  The child’s school and teacher should be made aware of the acquired brain injury as the child will likely require supports and accommodations to be put in place.  For example, more time for assignments and breaks built into their school day.  It’s also important for the school and teacher to be aware as an acquired brain injury is invisible and symptoms can easily be mislabeled by a teacher.  The family and school should work together with medical and rehabilitation professionals to ensure the child’s experience at school is positive and to enable a child to reach their full potential.

An acquired brain injury is best managed in a supportive environment that provides routine and predictability for the child.  Following an acquired brain injury, the brain tires much easier than it did prior to the injury.  Some strategies to reduce how much the brain tires include avoiding high-stress activities several hours for bed, allowing for a gradual wake up in the morning and building rest into daily activities.

Once a child has acquired one brain injury, they are more susceptible to another.  For this reason, it’s especially important to make efforts to prevent a secondary acquired brain injury.  Preventing a secondary acquired brain injury can be done by keeping stairs free of clutter, securing rugs, using mats in the shower and bath, avoiding high risk sports and trampolines, and helping the child be more aware of their surroundings as to avoid an accident (such as being aware of slippery floors, traffic, stairs, etc.).

Parenting a Child with an Acquired Brain Injury 

Parenting a child with an acquired brain injury can be a challenging but rewarding experience. Parents should have information about the effects of the acquired brain injury and the difficulties that may be encountered. Having a journal can be helpful for keeping track of changes you notice in your child and questions you may have for professionals. This will be helpful for updating your child’s doctor or other medical professionals and remembering questions you want to ask. This journal can also be helpful for writing down the information provided at appointments.

When parenting a child with an acquired brain injury, it’s helpful to talk to children in short and clear sentences. Children with acquired brain injuries do best when there are clear and consistent guidelines for behaviour, when parents communicate with them regularly and a safety net is present for the child. This safety net means the child feels supported by their family and knows that their family loves them. There are many things you can do to support your child such as showing your child pictures of friends and family, keeping a guest book of visitors and using a calendar to record what happens day-to-day. This can help with the child’s memory needs as it allows them to visually process their day.

There are also things that adoptive parents can do to help their child.  Adoption can be overwhelming for any child.  The child is meeting and developing relationships with new family members, attending a new school and may be adjusting to a new city.  A child with an acquired brain injury may have trouble remembering the new people they are meeting and the new schedules at home and at school.  A memory book with photos, significant dates and events can help a child with an acquired brain injury remember the new people and places in their life.  In addition, a memory book can also be for information required for day-to-day life such as addresses, names and new schedules.

Parents play a key role in helping a child understand their acquired brain injury. Children need to be able to speak openly about their feelings around having an acquired brain injury. They need to know that it is okay to talk about the injury and how they feel. Children often experience denial of their injury, grief over the loss of function or skills, changes in how they relate to others and limited awareness of the differences they experience. Parents should provide support and encouragement without trying to talk the child out of their feelings. If your child needs more support than your family can offer, do not hesitate to ask the child’s medical team.

Parents often have to assist others in understanding their child’s acquired brain injury. Decisions about sharing information are best made as a family. Family and peers may have misconceptions about acquired brain injury, as many myths exist. Constantly repeating information can be emotionally exhausting for parents.  Directing family and friends to resources on acquired brain injury can be helpful. Allowing family and friends to ask questions about your child will help them better understand how acquired brain injury impacts your child. This allows your child to learn ways they can talk about their acquired brain injury. It is important to be aware of how you speak about the acquired brain injury. If the acquired brain injury is spoken about negatively, a child may view their acquired brain injury and themselves as “bad”. Educating and informing others about your child’s acquired brain injury is a way to keep your child safe. If others are aware, they are better able to help your child safely navigate their day when you are not present.

An acquired brain injury affects the entire family, not just the child. It is important for parents to take care of themselves. This could be achieved through formal counselling or establishing strong support networks with family, friends, neighbours, community/religious institutions, school personnel, professionals and the brain injury community (online and in your area). Self-care looks different for everyone but is very important for parents of children with an acquired brain injury.  Part of taking care of oneself is taking a break when needed. This means that if people offer help or assistance, accept it.

A child with an acquired brain injury may experience barriers in the community, in school and in the medical field in accessing services. You will be your child’s advocate at home and at school. Do not be afraid to speak up if you have questions or if you think your child is not being accommodated, supported or being provided with the proper services. With the proper support, a child with an acquired brain injury can prosper and have positive outcomes in all aspects of their life. An acquired brain injury can be frustrating and exhausting at times but it can also be a rewarding experience for the entire family.

Helpful links and resources for Acquired Brain Injuries

Brain Injury Association of Canada - http://biac-aclc.ca/

Brain Injury Guide for Youth - http://teenmentalhealth.org/toolbox/brain-injury-guide-youth/

McMaster Children’s Hospital: A guide for families of children with an acquired brain injury - http://www.hamiltonhealthsciences.ca/documents/Patient%20Education/ChildrensPediatricBrainInjuryHandbook-lw.pdf

Ontario Brain Injury Association - http://obia.ca/

The Survival Guide: Living with Acquired Brain Injury in the Community - [Download]

Tips for Caregivers - http://www.projectlearnet.org/pdfs/Caregivers-TipCard.pdf

Content resources: 

A Guide for Families of Children with an Acquired Brain Injury. (2011). McMaster Children’s Hospital. Retrieved February 1, 2015, from http://www.hamiltonhealthsciences.ca/documents/Patient Education/ChildrensPediatricBrainInjuryHandbook-lw.pdf

Acquired brain injury - Better Health Channel. (n.d.). Retrieved February 1, 2015, from https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/acquired-brain-injury

Bonner, C. (n.d.). Children with Traumatic Brain Injury: A Parents' Guide. Retrieved February 10, 2015, from http://www.brainline.org/content/2009/06/children-with-traumatic-brain-injury-a-parents-guide-_pageall.html from Children with Traumatic Brain Injury: A Parents' Guide edited by Lisa Schoenbrodt, EdD, published by Woodbine House. Copyright © 2001. 

Brain Injury in Children. (n.d.). Brain Injury Association of America. Retrieved February 24, 2015, from http://www.biausa.org/brain-injury-children.htm

Brain Injury Definitions. (n.d.).  Brain Injury Association of Niagara. Retrieved January 23, 2015, from http://www.bianiagara.org/site/definitions

Brain Injury Family Resources TBI. (1998).  Brain Injury Resource Center. Retrieved February 24, 2015, from http://www.headinjury.com/families.htm

Brain Injuries happen to Families. (n.d.). Retrieved February 24, 2015, from http://obia.ca/brain-injuries-happen-to-families/

Brain Injuries Happen to Families. (n.d.). Retrieved February 24, 2015, from http://www.projectlearnet.org/pdfs/Tips_Caregivers_brochure.pdf

Brain Injury | TeenMentalHealth.org. (n.d.). Retrieved February 24, 2015, from http://teenmentalhealth.org/learn/brain-injury/

Children and Brain Injury. (2010, June 16). Retrieved February 2, 2015, from http://biac-aclc.ca/2010/06/16/children-and-brain-injury/

DePompei, R. (2002, November 2). Pediatric Traumatic Brain Injury: Where do we go from here? Retrieved February 4, 2015

Rumney, P. (n.d.). Ask the Expert - Children and Brain Injury. Brain Injury Society of Toronto. Retrieved February 24, 2015, from http://www.bist.ca/ask-the-expert-children-and-brain-injury/

Traumatic brain injury. (2014, May 15). Mayo Clinic.  Retrieved February 24, 2015, from http://www.mayoclinic.org/diseases-conditions/traumatic-brain-injury/basics/coping-support/con-20029302

What is Acquired Brain Injury - ABI. (n.d.).  Powell River Brain Injury Society. Retrieved February 1, 2015, from http://braininjurysociety.com/information/acquired-brain-injury/what-is-abi/

Dr. Dawn Good. Brock University: Department of Psychology, personal communication.