The Long Term Impact of Brain Injury on

Children & Families

Martine Simons & Suzanne BensonSenior Social Worker Senior Clinical Psychologist

and Clinical Neuropsychologist

Brain Injury Service, Department of Rehabilitation

Rehabilitation at CHW• Brain Injury Service is part of

the Rehabilitation Department

• State wide service providing inpatient and outpatient rehabilitation services to approximately 600 children.

• The team consists of medical, nursing & allied health professionals.

Overview

• Impact of Brain Injury on children

• Long term issues for children & families

Factors impacting on families

• Immediate:– Injury & hospitalisation– Medical– Legal– Highly charged emotional situation– Disruption to family life– Being away from community and supports

Factors impacting on families

• Emerging picture of long term consequences

• Process of change and adaptation for the family

NAI/SBS

• Mostly injured under 12 months

• Often show good physical recovery in early stages after injury

• Problems emerge as neurodevelopment does not proceed in typical pattern

Early NAI Research

• Kriel, Kruch & Panser (1989)• Bonnier (1995)• Duhaime et al (1996)• Haviland J, Ross, Russell RI (1997)• Ewing-Cobbs et al (1998;1999)• Kyriagis, Waugh & Epps (2003)• Barlow (2005)

Summary

“…inflicted TBI has a very poor outcome.”

“…deficits in preschoolers are often underestimated.”

Barlow, KM et al, (2005)

Changes in child

• Physical and medical problems– post trauma epilepsy– hemiplegia– coordination problems– headaches– physical and cognitive fatigue– sensory deficits (vision, hearing, smell)

Cognition

• Cognitive deficits– Learning and memory– Speed of processing– Language– Attention– Executive functions– Intellectual impairment

Cognitive problems

• Executive problems – working out solutions– planning and

organisation– inhibition– perseveration – lack of flexibility– concrete reasoning

Behavioural Problems

• Non-compliance

• Overactivity

• Lack of persistence

• Physical aggression

• Verbal aggression

• Sleep & bedtime problems

Social Issues

• Social problems– poor communicator– lack of friends– rejected by others– Bullying / teasing

Emotional problems• Anger

– low frustration tolerance

– overly sensitive

– impulsive

• Depression

– feeling helpless

– feeling different

• Anxiety

– ability to complete work

– future

– dependence on others

Behaviour & Emotions

• Difficult behaviour is the result of the interaction of many factors

• No particular behaviour is “all brain injury” or “not brain injury”

Behaviour & School

• Emotional and behavioural issues may not be present at school

• Environment will impact on manifestation of problems

• Family coping will depend on many factors

Families & Coping

• Stress on families tends to increase, not decrease

• Supports in community and school tend to decrease

• Unfavourable family circumstances exacerbate problems from TBI

Family Stressors

• Role changes– who has paid

work? (at home, community)

– therapy needs

• Carers

• Family structure– losses/absences– location

• Nature/cause of TBI

• Financial burdens

A multidisciplinary team approach

• Case managers

• Allied health

• Nursing and medical response

Interventions

• Support

• Therapeutic needs– behavioural interventions– emotional support– individual therapy– family therapy

Schooling

• All children return to school– Crucial part of child’s reintegration and

ongoing development– Engagement and connectedness

Implications

• Non accidental brain injury is a serious form of child abuse

• Long term costs to individuals, families and communities

• Prevention programmes are essential