Intervention Frameworks For Children With A Traumatic Brain Injury

A traumatic brain injury is separated into two categories: primary and secondary. A primary brain injury is a direct and immediate result of a traumatic event. Examples of a primary brain injury include direct trauma to the brain, subarachnoid hemorrhage (type of stroke), epidural hematoma (bleeding between dura mater and skull), subdural hematoma (bleeding outside the brain), contusion (bruise), and axonal shear injury. A secondary brain injury is the physiologic response following the initial injury. Some possible secondary effects are high/low blood pressure, hypoxia (lack of oxygen in tissues), anemia, edema (swelling), infection, and seizure. Chances of surviving a severe TBI are dependent on avoiding or minimizing the secondary effects.

Research-based interventions for children with a TBI are often recommended based on the severity of the injury and the specific needs of the child. Most interventions for TBI emphasize improvement in emotional behavior, cognitive skills, speech and language, and learning. Behavioral interventions are used to regulate unwanted behaviors and replace them with alternative actions. This is taught through different strategies such as modeling, prompting, fading, and reinforcement of desired behaviors. Different behavioral programs such as proactive positive behavior, contingency management, and metacognitive skills training may also focus on improving certain aspects of behavior. A cognitive intervention that research studies have declared a “beneficial task-specific training option for children with cerebral palsy and brain injury” and is recommended by many medical professionals is the Cognitive Orientation to daily Occupational Performance approach, or CO-OP for short. Stated on the CO-OP website, the program is “designed to be a task-oriented, problem-solving approach that enables children to be actively engaged in solving their performance problems and experience success.”. CO-OP has helped both children and adults with TBI develop cognitive strategies and learn new and old skills used throughout daily living. Speech and language interventions are suggested based on the child’s current level of development and which areas of development require attention. According to ASHA.org, interventions for younger children typically focus on following instructions, speech sounds, expansion of vocabulary, and word fluency. Patients are commonly referred to a speech-language pathologist. Lastly, the area of development that tends to be a main concern is the child’s learning. Under the Individuals with Disabilities Education Act (IDEA), it is the law to provide eligible children with disabilities access to a free and appropriate public education, plus special education and other related services. Students can qualify for education services through an Individualized Family Service Plan (IFSP), Individualized Education Program (IEP), or Section 504 Plans. Furthermore, the arrangement of a well-organized transition back to class is beneficial to the child’s academic and social success.

As indicated earlier, a child who sustains a traumatic brain injury can suffer from the temporary or life-long effects of the injury. At the same time, the roles and responsibilities of the child’s family dramatically shifts. Parents begin to feel helpless because they have little to no knowledge of their child’s condition. Moreover, they grow overwhelmed and frustrated because their values are sometimes not respected, and their needs are not fulfilled. When families do not feel empowered, they believe they are unable to participate in decision-making and meet the needs of their child and themselves. In a 2011 study, 42 parents of children diagnosed with a moderate to severe TBI were interviewed to discuss their experiences post-injury. During these interviews, parents expressed four common themes: grateful to still have my child; grieving for the child I knew; running on nerves; and grappling to get what your child and family need. Parents spoke about taking on multiple roles and feeling alone because they were not receiving adequate assistance from those they believed were caring and supportive. As parents try to tackle these new challenges, siblings are also affected. For example, siblings might stop receiving the same amount of attention from their parents as they did prior to the traumatic event. Since the family is greatly involved in providing proper care, their needs are often overlooked.

If I were a service provider for a child who has sustained a traumatic brain injury, my primary focus would be to provide medical care services, if needed. One of the first intervention frameworks I would use is the traditional, or medical, model. During this process, I would consult with the child’s doctor and analyze the diagnosis to see which areas of development require attention. From there, I can compile a list of appropriate therapy programs I would refer the child to; examples may include physical therapy, occupational therapy, cognitive training, and speech/language rehabilitation. Other types of therapy programs that also improve delayed developmental skills and that the children might find more appealing are music and art-based therapies. The therapist will then evaluate the child’s condition and determine whether he or she needs to move further with therapy services. Once the child has shown progress in his or her development, I would implement a universal intervention strategy such as opportunity. For children with disabilities to learn how to effectively practice certain skills, they must be given opportunities where they can perform these. Moments of opportunity include getting dressed, walking around their community, holding a conversation with others, and learning how to solve a math problem in the classroom. In summary, traumatic brain injury is mild to severe damage in the brain that can lead to a variation of physical, cognitive, and emotional problems. Effects can severely impact the lives of both the child and their family. With the appropriate resources and services, plus quality care from medical professionals and childcare service providers, a child with TBI can properly develop the skills they need to move, think, and live independently as a person.