Special Education Resource Guide Disability Fact Sheet

Traumatic Brain Injury

1. Define traumatic brain injury

Traumatic brain injury, also known as TBI or intracranial injury, is generally the result of a
sudden, violent blow or jolt to the head. The brain is launched into a collision course with the
inside of the skull, resulting in possible bruising of the brain, tearing of nerve fibers and
bleeding.

2. Describe characteristics of the students who are identified with traumatic brain injury
Physical disabilities: Individuals with TBI may have problems speaking, seeing,
hearing, and using their other senses. They may have headaches and feel tired a lot.
They may also have trouble with skills such as writing or drawing. Their muscles may
suddenly contract or tighten (this is called spasticity). They may also have seizures.
Their balance and walking may also be affected. They may be partly or completely
paralyzed on one side of the body, or both sides.
Difficulties with thinking: Because the brain has been injured, it is common that the
persons ability to use the brain changes. For example, children with TBI may have
trouble with short-term memory (being able to remember something from one minute to
the next, like what the teacher just said). They may also have trouble with their long-term
memory (being able to remember information from a while ago, like facts learned last
month). People with TBI may have trouble concentrating and only be able to focus their
attention for a short time. They may think slowly. They may have trouble talking and
listening to others. They may also have difficulty with reading and writing, planning,
understanding the order in which events happen (called sequencing), and judgment.
Social, behavioral, or emotional problems: These difficulties may include sudden
changes in mood, anxiety, and depression. Children with TBI may have trouble relating
to others. They may be restless and may laugh or cry a lot. They may not have much
motivation or much control over their emotions.

3. List and describe classifications/types of traumatic brain injury.

Primary Injury- Occurs at the moment of initial trauma. They can be caused by either a
penetrating (open-head) injury or a non-penetrating (close-head) injury.
o Skull fracture (breaking of the bony skull)
o Contusions (bruise/bleed on the brain) that can lead to hematomas (blood
clots in the meningeal layers or in the cortical/subcortical structures as a
result of the trauma)
o Concussions (low velocity injury resulting in functional deficits without
pathological injury)
o Lacerations (tears in brain tissue or blood vessels of the brain)
o Diffuse axonal injury (traumatic shearing forces leading to tearing of nerve
fibers in the white matter tracts)
Secondary Injury- Secondary injury occurs as an indirect result of the insult. It results
from processes initiated by the initial trauma and typically evolves over time.
o Ischemia (insufficient blood flow)
o Hypoxia (insufficient oxygen in the brain)
 o Hypo/hypertension (low/high blood pressure)
o Cerebral edema (swelling of the brain)
o Raised intracranial pressure (increased pressure within the skull), which can lead
to herniation (parts of the brain are displaced)
o Hypercapnia (excessive carbon dioxide levels in the blood)
o Meningitis (infection of the meningeal layers) and brain abscess
o Biochemical changes (changes in levels of neurotransmitters, sodium,
potassium, etc.)
o Epilepsy

4. Describe Federal (IDEA) or state criteria for identification of traumatic brain injury Note:
MUST cite source of information.

Our nations special education law, the Individuals with Disabilities Education Act (IDEA) defines
traumatic brain injury as

an acquired injury to the brain caused by an external physical force, resulting in total or
partial functional disability or psychosocial impairment, or both, that adversely affects a childs
educational performance. The term applies to open or closed head injuries resulting in
impairments in one or more areas, such as cognition; language; memory; attention; reasoning;
abstract thinking; judgment; problem-solving; sensory, perceptual, and motor abilities; psycho-
social behavior; physical functions; information processing; and speech. The term does not
apply to brain injuries that are congenital or degenerative, or to brain injuries induced by birth
trauma.

5. Discuss factors contributing to traumatic brain injury.

The top three causes are: car accidents, firearms, and falls.
Open Head Injury
o Results from bullet wounds, etc.
o Largely focal damage
o Penetration of the skull
o Effects can be just as serious as closed brain injury
Closed Head Injury
o Resulting from a slip or fall, motor vehicle crashes, etc.
o Focal damage and diffuse damage to axons
o Effects tend to be broad (diffuse)
o No penetration to the skull
Deceleration Injuries (Diffuse Axonal Injury)
o Diffuse axonal shearing: when the brain is slammed back and forth inside the
skull it is alternately compressed and stretched because of the gelatinous
consistency. The long, fragile axons of the neurons (single nerve cells in the
brain and spinal cord) are also compressed and stretched. If the impact is strong
enough, axons can be stretched until they are torn. This is called axonal
shearing. When this happens, the neuron dies. After a severe brain injury, there
is massive axonal shearing and neuron death.
Chemical/Toxic
o Also known as metabolic disorders
o This occurs when harmful chemicals damage the neurons
 o Chemicals and toxins can include insecticides, solvents, carbon monoxide
poisoning, lead poisoning, etc.
Hypoxia (Lack of Oxygen)
o If the blood flow is depleted of oxygen, then irreversible brain injury can occur
from anoxia (no oxygen) or hypoxia (reduced oxygen)
o It may take only a few minutes for this to occur
o This condition may be cause by heart attacks, respiratory failure, drops in blood
pressure and a low oxygen environment
o This type of brain injury can result in severe cognitive and memory deficits
Tumors
o Tumors caused by cancer can grow on or over the brain
o Tumors can cause brain injury by invading the spaces of the brain and causing
direct damage
o Damage can also result from pressure effects around an enlarged tumor
o Surgical procedures to remove the tumor may also contribute to brain injury
Infections
o The brain and surrounding membranes are very prone to infections if the special
blood brain protective system is breached
o Viruses and bacteria can cause serious and life-threatening diseases of the brain
(encephalitis) and meninges (meningitis)
Stroke
o If blood flow is blocked through a cerebral vascular accident (stroke), cell death
in the area deprived of blood will result
o If there is bleeding in or over the brain (hemorrhage or hematoma) because of a
tear in a n artery or vein, loss of blood flow and injury to the brain tissue by the
blood will also result in brain damage.