A traumatic brain injury (TBI) occurs approximately once every 16 seconds and annually effects over 700,000 individuals in North America. By definition, a TBI is any injury caused by a blunt blow to the head, upon which the head was accelerating and suddenly stopped. Most commonly occurring in motor vehicle accidents, this injury rarely produces any specific sites of damage to the brain. Instead, the damage is spread over the surface of the brain due to the acceleration, rotation, compression and expansion of the brain within the skull after impact. As a result, many parts of the brain are affected.

Closed head injuries are not always caused by something as serious as a motor vehicle accident. In many cases they can be caused by every day activities like falling off roller blades, jungle gyms, or even street corner curbs. Regardless of the cause of head injury, an array of unique changes can take place in movement, behavior, language, and speech.

How do I know if my child has a head injury?

The most common symptom of head injury is loss of consciousness after a blow to the head for even a brief period of time. Confusion regarding the time, date, or location of the accident are also indications of brain trauma. Other salient factors are presence of a coma, or difficulty remembering new information after waking up from a coma.

The length of unconsciousness experienced by an individual has been used to characterize the severity of head injury. If the unconsciousness lasts less than twenty minutes, and post-traumatic amnesia less than an hour, the injury is considered mild. If a person is unconscious for at least a day and post-traumatic amnesia lasts more than twenty-four hours, it is considered severe. Other symptoms include tremors, spastic muscle movements, difficulty swallowing and slurred speech.

How might a head injury affect my child’s body?

Changes after a head injury may be physical, cognitive and/or behavioral. Physically, a child may experience seizures or a decrease in speed and coordination of muscle movements. Muscles may also move with excessive or inadequate tension, causing tremors or spasticity. Behaviorally, a child may become impulsive, acting without thought of consequence. Agitation, irritability and egocentrism may also be noticed, as well as depression to the point of threats of suicide.

Cognitively, a child may experience changes in the following six areas:

• Attention, or the ability to hold thoughts and events in consciousness. The child may become easily distracted. The ability to concentrate and focus on one thing at a time lessens noticeably. Language skills suffer due to decreased ability to understand what is heard and read. Expressive language is often inappropriate and confused, and ability to maintain topic is minimal.
• Perception, or the ability to recognize features and relationships among those features. Errors in perception may yield weakness in judgment based on what is seen or heard, causing spatial organization to be difficult. Impaired perception may cause a child to focus on one part of an object, or to neglect a portion of his visual field. Evidence of this may be seen at dinner when a child has an entire plate of food but only eats the food on the left half until the plate is rotated.
• Memory and Learning, which involves the storage and retrieval of information. Impairments in memory and learning will splinter to all aspects of communication, but specifically, a decrease in ability to follow multi-step directions is seen. Reading comprehension and spelling are challenged, and children have difficulty retrieving words to express feelings. When these words are found, language is typically fragmented and non-specific. Arranging sequential facts creates obstacles, and there is little or no ability to express thoughts in a timely manner.
• Organization or the analyzing, classifying, integrating and comparing of information. If stricken with a head injury, a child may display poor problem solving, social judgment, or goal maintenance. Self-direction and confidence may be poor, as may be the ability to manage tasks and time. Conversational skills suffer and the ability to discern main ideas into themes becomes difficult.
• Reasoning, or the ability to draw conclusions from past experience, may be one of the more obvious effects of a TBI. Actions and thoughts become concrete, causing impulsive and reactionary behavior. Children may be swayed easily, unable to understand consequences of their behavior, or demonstrate poor social judgment. Communication is impaired by socially inappropriate comments, and the understanding or expression of abstract concepts becomes difficult. Poor reasoning may affect the ability to persuade people through language, understand humor, or follow complex conversation.
• Problem solving and judgment which involves identification of goals, relevance of information, exploration of solutions, and the ability to select appropriate options. A poor skill set in this area causes inflexible thinking and difficulty using compensatory strategies. Behavior is often impulsive and decisions are made in a “trial and error” format.

Although the physical and behavioral effects of a head injury are serious, cognitive deficits seem to challenge family and friends more than the children themselves. Especially in cases of mild to moderate head injury where physical symptoms may be minimal if present at all, individuals often appear “normal.” Victims of head injury may speak clearly, walk without assistance, and ride a bike. With cognitive impairments practically invisible to strangers, family members become extremely concerned for their loved ones’ safety.

How can occupational therapy help?

Occupational therapy addresses affected issues of fine and gross motors skills, including activities of daily living and self-care skills. Providing children with ways to regain affected motor functions helps contribute to increased confidence, independent, and feelings of self-worth. By orienting individuals to their recent changes in function, comprehensive therapy programs create strategies and coping mechanisms for children and their families.

What can I do to help?

Participating in your child’s occupational therapy sessions can be beneficial for both you and your child. In sessions, you can learn strategies that can be beneficial to support your child’s motor needs in other settings. Additionally, your child’s OT may suggest and teach you specific treatment methods that can be administered frequently throughout the week when not in therapy sessions to help your child make the most gains.