Head and Spinal Cord Injuries

Injuries to the head and spinal cord may occur in automobile accidents, falls, sports and recreation, firearms, or other instances where the head or spine sustains a blow or trauma (National Center for Injury Prevention and Control, n.d.a & n.d.b). Head injuries may be immediately apparent or may become evident weeks, months, or years after the original trauma. For example, a child who sustains a blow to an undeveloped part of the brain may not exhibit symptoms until years later when that part of the brain reaches full development. Spinal cord injuries are usually more obvious, but symptoms may change or go away after bruising or swelling of the cord subsides.

The brain and spinal cord are complex structures and connect to many nerves throughout the body. Symptoms will vary based on the severity and location of the injury. Trauma to the head or spine should receive an immediate medical evaluation and should be noted in the child's or adult's medical records, even if there are no apparent symptoms.

What Should You Do if You Suspect a Concussion or Brain Injury?

The following information is reproduced with permission from the Brain Injury Association of Florida's Mild Traumatic Brain Injury Fact Sheet.

A concussion is an example of a mild brain injury. Following any brain injury/concussion, you should be alert for symptoms that may not show up for days or even weeks after the injury.

A child should return to the emergency department, see his/her physician, or call 911 immediately if any of these occur:

Cannot be awakened (call 911)
Seems increasingly sleepy
Cannot stop vomiting (throwing up)
Has a seizure(s) or a sudden onset of daydreaming or a fixed stare
Has dramatic mood swings; is very irritated, sad, or agitated
Says he/she cannot see clearly or has blurred or double vision
Is not speaking clearly, seems confused, or doesn't know who you are
Has blood or clear fluid from the nose or ears
Has increased headaches or neck stiffness
Has pupils (black center of the eye) that are different sizes
Is stumbling or has other problems with walking
Is experiencing dizziness

An adult should return to the emergency department, see his/her physician, or call 911 immediately if he/she experiences any of the following:

Has trouble answering simple questions (What day is it? What happened to you?)
Has trouble waking up completely
Has a headache that is getting worse even after medication
Changes in behavior or personality or doesn't recognize friends/family
Is still vomiting (throwing up) eight hours after the injury, or vomiting that starts one to two hours after the injury.
Has pupils (black center of the eye) that are different sizes
Is stumbling or has other problems with walking
Has double vision, blurred vision, or visual field cuts
Is slurring speech or repeating questions
Has seizures (convulsions), fixed stares, or "daydreaming"
Is experiencing blood or clear fluid from the nose or ears
Is experiencing dizziness

If you notice that symptoms are getting worse since the injury or if you answer YES to the following questions, you should talk with the doctor about getting help:

Has there been a personality change?
Does the individual get angry for no reason?
Does the individual get lost or easily confused?
Does the individual have more trouble than usual making decisions?
Is there a significant drop in performance (school, work, sports, social, etc.)?
Are there problems in thinking processes (memory, concentration, learning, speaking, understanding)?

For more information, call the Brain Injury Association of Florida, Inc. at (800) 992-3442.

Preventing Head and Spinal Cord Injuries

The primary causes of head and spinal cord injuries are automobile accidents, falls, sports, recreation and firearms, according to the National Center for Injury Prevention and Control (n.d.a & n.d.b). NCIPC's recommendations for preventing head and spinal cord injuries include:

Always use properly installed seat belts and child safety seats in automobiles.
Never drive under the influence of drugs or alcohol.
Never accept a ride from a driver who is under the influence of drugs or alcohol.
Conduct a safety check of your home; remove objects that could cause tripping or falling; and install non-slip mats, grab bars, child safety gates and window guards as needed.
Wear appropriate safety equipment, including helmets, when playing sports.
Never dive into shallow water or water of unknown depth head first.
Store firearms in a locked cabinet or safe; store bullets separately.

Coping with Head and Spinal Cord Injuries

The entire family is affected by head and spinal cord injuries. When the initial period of shock subsides, a number of emotions may follow including confusion, grief, anger, depression and denial. These are normal reactions and need to be recognized as such. A number of organizations provide information and support for individuals and families coping with head and spinal cord injuries including the Brain Injury Association of Florida and the FAAST Spinal Cord Injury Resource Center.

Spinal cord injuries may result in full or partial paralysis that affects bodily functions, dexterity, and mobility. Head and brain injuries may result in physical and cognitive impairments, including comas, depending on the part of the brain that is injured. The recovery and rehabilitation process for both types of injuries may be intensive, long-term, and complex. A number of healthcare professionals--physicians, nurses, therapists (physical, occupational, speech/language, respiratory) and others may be involved in treatment and therapy.

Students with Head and Spinal Cord Injuries

Students with head and spinal cord injuries exhibit emotional, psychological, and behavioral problems in school as they struggle to adapt to their new 'normal'; counseling, psychotherapy and specialized treatment for the student may be necessary (BEESS, 2005). Students with head injuries may also have significant cognitive impairments that affect their ability to learn, read, concentrate, comprehend, and behave (BEESS, 2005, p. 8). It is important for family members and school personnel to work together to develop learning plans and share information so that appropriate services and classroom strategies can be implemented.

Selzer (n.d.) summarized the physical, cognitive, and psychosocial effects of traumatic brain injuries in an article addressing educational perspectives of Traumatic Brain Injury (TBI). He conducted focus groups on educator perceptions of their abilities to support students with TBI and identified the following 'critical success factors' for students with TBI who were returning to school:

Establish a system of communication early between school, family and rehabilitation centers prior to the student's discharge from the rehabilitation facility.
Obtain information about the injury along with successful interventions or strategies used in the rehabilitation setting.
Establish a schedule that allows a shortened school day to accommodate the student's need for physical recuperation.
Appoint a staff member to be the liaison between rehab and school staff.
Take the family's needs into consideration and empower them by getting them involved in the planning and monitoring.
Structure the physical environment to accommodate the student's needs and be prepared to make changes according to the student's results (Selzer, n.d., "Defining Success" section).

Best practices for managing the classroom, addressing psychological issues, and accommodating students with Traumatic Brain Injuries, as well as other helpful information, have been excerpted from Understanding and teaching students with traumatic brain injury: What families and teachers need to know (2005).

Resources

Brain Injury Association of Florida, Inc. (BIAF)
BIAF's mission is to improve the quality of life for persons with brain injury and their families by providing information and resources, education and training, support services, a toll-free helpline, awareness and prevention programs, and legislative advocacy.

The Brain Injury Recovery Network
This website provides information and support on traumatic brain injuries as well as chronicling the recovery of Ashleigh, who suffered a severe TBI in 1999. Supports include a hotline, newsletter and web news and links.

Brainline.org
This is a resource for "preventing, treating, and living with traumatic brain injury" with sections on TBI basics for people with TBI, for families and friends, and for professionals. Resources include "ask the expert," research updates, personal stories and webcasts.

ByYourSide.org
The Traumatic Brain Injury Resource & Support Center, a service of Brain Injury Association of Florida (BIAF), provides one-stop access to TBI information, resources and support services, and a toll-free Helpline: (800) 992-3442.

Florida Department of Education Traumatic Brain Injury (TBI)
This page includes contact information, state laws and regulations, and Florida and national resources.

Florida Spinal Cord Injury Resource Center
This resource center is a statewide clearinghouse of information for spinal cord injury survivors, their families and friends, healthcare professionals, support groups, the media and the general public.

National Center for Injury Prevention and Control
This Center is part of the Centers for Disease Control and Prevention (CDC) and has the mission of preventing injuries and violence and reducing their consequences. Its resources include data and statistics, research and funding, publications and resources, information on state programs and more on a variety of topics including head and spinal cord injuries.

References

Bureau of Exceptional Education and Student Services. (2005). Understanding and teaching students with traumatic brain injury: What families and teachers need to know. Tallahassee, FL: Florida Department of Education.

Adapted from National Association of State Head Injury Administrators (https://www.nashia.org/Default.asp). (2001, March). Traumatic brain injury facts: Emergency medical services. Tallahassee, FL: Florida Department of Health Brain and Spinal Cord Injury Program (http://www.floridahealth.gov/%5C/diseases-and-conditions/brain-and-spinal-cord-injuries/index.html).

National Center for Injury Prevention and Control. (n.d.a). Heads up: Preventing brain injuries. Atlanta, GA: Centers for Disease Control and Prevention. Available at https://www.cdc.gov/headsup/index.html and https://www.cdc.gov/headsup/basics/concussion_prevention.html.

National Center for Injury Prevention and Control. (n.d.b). Spinal Cord Injury (SCI): Prevention tips. Atlanta, GA: Centers for Disease Control and Prevention. Available at http://www.cdc.gov/NCIPC/factsheets/sciprevention.htm.

Selzer, M.E. (n.d.). Traumatic brain injury: Perspectives from educational professionals. Columbus, OH: Ohio Valley Center for Brain Injury and Rehabilitation. Available at http://brainline.org/content/2008/10/traumatic-brain-injury-perspectives-educational-professionals.html.