This presentation is to be paired with the TBI Learning Module: Children with Traumatic Brain Injury apart of the West Virginia State Traumatic Brain Injury Program.

1. Children with Traumatic Brain
Injury
Successful completion of this training meets one hour of the four hour annual
training requirement for Personal Attendant Services direct care staff as
provided through the WV TBI Waiver Program

2. Disclaimer
Information included in this presentation was
current at the time it was developed
Presentation materials are reviewed on an
annual basis
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2015 West Virginia TBI Waiver Program direct care staff annual training

3. Author
MELODEE A HURSEY, MSW, LSW, CBIST
APS HEALTHCARE, INC.
TBI WAIVER PROGRAM PROVIDER EDUCATOR
Ms Hursey is a Certified Brain Injury Specialist Trainer through the Academy of Certified Brain Injury
Specialists and a West Virginia Licensed Social Worker. She has more than 17 years of brain injury
experience in a variety of areas including rehabilitation, waiver, support group facilitation, training,
and program development.
CONTACT INFORMATION:
mhursey@apshealthcare.com
304-964-9007
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4. Learning Objectives
• Identify common symptoms that a child may
experience after a TBI
• Describe emotions and challenges children may
struggle with after a TBI
• Understand and use interventions as a direct care
staff to help a child adjust following a TBI
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5. Overview of Traumatic Brain Injury
Traumatic Brain Injury (TBI) is
an insult to the brain not of a degenerative or
congenital nature caused by an external physical force,
that may produce a diminished or altered state of
consciousness resulting in an impairment of cognitive
abilities or physical functioning. It can also result in
the disturbance of behavioral or emotional
functioning, may be temporary or permanent and
cause partial or total functional disability or
psychosocial maladjustment.
National Head Injury Foundation
(now the Brain Injury Association of America)
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6. Medicaid TBI Waiver Definition
A non-degenerative, non-congenital insult to the brain
caused by an external physical force resulting in total or
partial functional disability and/or psychosocial
impairment or an injury caused by anoxia due to near
drowning
Chapter 512 Traumatic Brain Injury Waiver Services
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7. Overview of Traumatic Brain Injury
In 2010, about 2.5 million emergency department visits,
hospitalizations, or deaths were associated with TBI—
either alone or in combination with other injuries—in
the United States
Centers for Disease Control and Prevention
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8. Overview of Traumatic Brain Injury
• Children 0-4 years, older adolescents 15-19 and
adults 65 and older are the most likely to sustain a
TBI
• Almost half a million emergency department visits
each year for a TBI occur among children 0-14
Centers for Disease Control and Prevention
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9. Symptoms of Traumatic Brain Injury
Physical
Impairments
Cognitive
Impairments
Emotional
Impairments
speech short term memory deficits mood swings
vision impaired concentration denial
hearing slowness of thinking self-centeredness
headaches limited attention span anxiety
motor coordination impairments of perception depression
spasticity of muscles communication skills lowered self-esteem
paresis or paralysis planning sexual dysfunction
seizure disorders writing restlessness
balance reading lack of motivation
fatigue judgment difficulty controlling
emotions
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Brain Injury Association of America

10. Symptoms of Traumatic Brain Injury
• The child(ren) you are working with may experience any or all
of the impairments listed on the previous slide
• The nature of the injury and its consequences can range from
mild to severe, and the course of recovery is difficult to predict
for any given child
• With early diagnosis and ongoing therapeutic intervention, the
severity of these symptoms may decrease in varying degrees
• Symptoms can vary greatly depending on the extent and
location of the brain injury
• It is common for the child to have impairments in one or more
areas such as cognitive functioning, physical abilities,
communication, or social/behavioral disruption
Brain Injury Association of America
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11. Why is Brain Injury in Children Different?
The symptoms of a brain injury in children are similar to the
symptoms experienced by adults, but the functional impact can be
very different
Children are not little adults
The brain of a child is continuing to develop
It is wrong to assume that a child with a brain injury will recover
better than an adult because there is more “plasticity*” in a
younger brain
* ability of the brain to change—physically, functionally, and chemically—throughout life
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12. Why is Brain Injury in Children Different?
• Brain injury actually has a more devastating impact on a child
than an injury of the same severity has on a mature adult
• Cognitive impairments of children may not be immediately
obvious after the injury
• May become apparent as the child gets older and
faces increased cognitive and social expectations for new
learning and more complex, socially appropriate behavior
• Delayed effects can create lifetime challenges for living and
learning for children, their families, schools and
communities
• Some children may have lifelong physical challenges but the
biggest challenges many children with brain injury face are
changes in their abilities to think and learn and to develop
socially appropriate behaviors
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13. Emotions and Challenges after TBI
Although no two children or their brain injuries are alike, you may see
similar emotions and challenges after the TBI.
These include:
• Denial
• that the injury will have a long-term impact
• Grief
• over their loss of function and skill
• Changes
• in how they relate to others
• Frustration
• with the recovery process, and
• Limited awareness
• of the differences in themselves
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14. Guidelines to Help a Child Adjust after TBI
1. Encourage and praise progress
 When the child brushes his/her teeth with less assistance or
supervision let him/her know. The child may not recognize
that s/he has made progress because they only know they
aren’t doing it on their own.
2. Listen and provide support
 Acknowledge the child’s frustration. Let him/her know that
you are there.
3. Serve as a role model for social behavior
 Children model what they see and hear. You are a role model
whether you know it or not. Be a GOOD role model.
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15. Guidelines to Help a Child Adjust after TBI
4. Encourage the child to have relationships with friends
 With parental approval, help the child interact with his/her
friends.
5. Encourage the child to focus on one day at a time by setting
small goals as steps toward accomplishing larger ones
 The service planning team will provide the guidance for this
but as the direct care staff you will need to provide the
encouragement as the child works to achieve their goals.
6. Encourage independence with supervision. Be creative with
this!
 Does the child have a pet they love? Help him/her take care
of the pet by walking or feeding the pet.
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16. Guidelines to Help a Child Adjust after TBI
7. Communicate! (with the child, family members, neighbors,
friends, professionals, and the school)
 A communication log is a tool that can provide information
about how the child is doing in your care. Remember that
whatever you write is NOT A SECRET from the child.
8. Help the child understand his/her injury and recovery, that the
brain needs time to heal like other body parts
 Direct care staff should get direction from the service
planning team for specific recovery information.
9. Instill confidence in creative ways--draw on previous skills and
interests, applied in new ways
 What was the child interested in before the brain injury? Did
s/he like to sing? Have him/her sing the steps to the task or
sing the words s/he is trying to memorize.
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17. Guidelines to Help a Child Adjust after TBI
10. Create a Memory Book
 Memory difficulties are often frustrating. Help the child use
the memory book.
 This may also help to document events and reinforce
progress.
11. Encourage a normal lifestyle, predictability, and routine as
much as possible
 Keep to regular schedules and routines
12. Above all, remember that this is challenging and a lifelong
process!
 Recovery takes time. Don’t give up on the child when it
seems like s/he is not making progress.
Excerpted from Children with a Traumatic Brain Injury: A Parents’ Guide
Brainline.org
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18. Traumatic Brain Injury: Susan’s Story
Click on this link to read the article called Pediatric Traumatic Brain
Injury
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19. Accommodations and Interventions
ACCOMMODATIONS AND INTERVENTIONS SHOULD:
• Build on the child’s strengths
• Provide support with areas of weakness
• Be consistently implemented
• Be solution focused, not deficit focused
• Emphasize structure
Joshua Cantor, Ph.D., ABPP
Department of Rehabilitation Medicine
Mount Sinai Brain Injury Research Center
The next few slides will provide examples of specific
accommodations & interventions YOU can use as a Personal
Attendant Professional
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20. Accommodations and Interventions – Examples
ATTENTION/CONCENTRATION:
• Reduce distractions in the environment such as television or
radio, bright lights, or toys
• Divide task into smaller sections
• For example, if the child is supposed to clean his/her room,
break the task into sections such as make bed, dust furniture,
put toys away
• Ask the child to repeat back what has just been presented or
said to them to make sure s/he understands
• Use cue words to alert the child to pay attention (e.g., “listen,”
“look,” “name”)
• Schedule breaks and rest periods
• Provide positive feedback when the child is attending well
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21. Accommodations and Interventions – Examples
MEMORY DIFFICULTIES:
• Frequently repeat information and summarize it
• Help the child use his/her devices such as post-it notes,
calendars and assignment books as self-reminders
• Teach the child to categorize or chunk information to aid
retention. For example, a grocery list will be easier to
remember and follow if it is chunked by location in the store or
by type of item: fruit, vegetable, dairy, etc. A spelling list may
be easier for the child to remember if the list is chunked by
what the word represents: toy, animal, family, etc.
• Demonstrate techniques such as mental rehearsal and use of
special words or examples as reminders
• Link new information to the child’s relevant prior knowledge
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22. Accommodations and Interventions – Examples
PROCESSING SPEED:
• Slow down pace when possible
• Allow rest periods
• Repeat material
• Don’t rush or challenge the child
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23. Accommodations and Interventions – Examples
PROBLEM SOLVING, JUDGMENT, AND REASONING:
• Engage the child in everyday problem-solving tasks
• Use structured questions to help guide the problem-solving
• Help the child create and initiate a plan
• Engage the child in real-life activities where problems and
possible solutions are discussed
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24. Accommodations and Interventions – Examples
BEHAVIOR:
Try to prevent behaviors BEFORE they develop
• Maintain consistent and reasonable expectations
• Limit the number of people interacting with the child at one
time
• Avoid over-stimulating or overloading the child
• Develop and review “rules of behavior” before beginning an
activity
• Refer to these as needed during the activity
• Help the child use compensatory strategies to reduce
inappropriate behavior
• Provide explicit feedback to help develop more appropriate
behavior and increased self-awareness
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25. Teens Talking to Teens about TBI
PLEASE CLICK ON THIS LINK TO WATCH A VIDEO CALLED
KEEP MOVING FORWARD: CHILDREN WITH BRAIN INJURIES
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26. Additional Resources and Readings
YOU MAY WANT TO EXPLORE ADDITIONAL RESOURCES
TO EXPAND YOUR KNOWLEDGE BASE AND JOB SKILLS*
Here are just a few:
• brainline.org
• Brain Injury Association of America
• Centers for Disease Control and Prevention: TBI
• Children with Acquired Brain Injuries
• Think First National Injury Prevention Foundation
• National Resource Center for Traumatic Brain Injury
• TBI Services at Center for Excellence in Disabilities
1-877-724-8244 TBI@hsc.wvu.edu
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*If you are seeking formal training please check with your employer to make sure the internet training
provider has been approved by APS Healthcare before you take the training

27. Next Steps
• To receive your certificate of successful completion
you must first pass the test and complete an online
evaluation
• A score of 70% or higher is required
• Once you have successfully completed this training
module you will receive an email with your certificate
of completion
• Click this link to go to the test
• http://tbi.cedwvu.org/trainings/children-with-tbi.php
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28. Thank You for Your Thoughts
• Please click this link to go to the online evaluation
• http://tbi.cedwvu.org/trainings/children-with-tbi.php
• Your thoughts and comments are very important to
us
THANK YOU!
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