Brain Injury:A Guide forSchool NursesBrain Injury Association of New Jersey, Inc.Brain Injury:A Guide forSchool NursesThis publication is a project of the Education System Advisory Group of theBrain Injury Association of New Jersey (BIANJ).Within BIANJ, TBI Outreach Specialists Wendy Berk and Joanna Boyd were thecoordinators for this publication with additional assistance provided by specialistsSusan Quick, Rita Steindlberger, and Judi Weinberger.Lead writers:Susan Cohen, M.S.N., R.N., C.S., Edison School DistrictMarilyn Kent, M.S.N., R.N., NJ Department of EducationMary Lotze, P.N.P., M.S., Robert Wood Johnson Medical School, UMDNJJudith Woop, M.Ed., R.N., NJ State School Nurses AssociationOther group contributors included:Jill Brooks, Ph.D., Robert Wood Johnson Medical School, UMDNJJill Harris, Ph.D., Children’s Specialized HospitalBonnie Merkel, M.A., NJ Department of EducationLois Mishkin, M.A., C.C.C./L.D.T.C., Lois Mishkin Associates, Inc.Susan Paradise, M.Ed., JFK Rehabilitation InstituteBrad Ross, Ph.D., Children’s Specialized HospitalRon Savage, Ed.D., Bancroft NeuroHealthSue Stephens, M.S.W., Children’s Specialized HospitalEdited by:Marilyn Lash, M.S.W.This publication is not copyrighted and may be reproduced and distributed in anyform. For further information about this publication, or to obtain additional copies,please contact:Brain Injury Association of New Jersey, Inc. (BIANJ)1090 King George Post Rd., Suite 708, Edison, NJ 08837Phone: 732-738-1002 Fax: 732-738-1132 Email: [email protected] Web: www.bianj.orgFAMILY HELPLINE: (800) 669-4323Executive Director: Barbara Geiger-ParkerTBI Demonstration Project Director: Jane M. LowensteinPublished 2001Table of ContentsIntroduction.....................................................................................1Brain Injury Association of New Jersey..........................................................2Chapter 1 What is Brain Injury?.................................................3The silent epidemic.........................................................................................6Mild brain injury.............................................................................................6Chapter 2 Statistics........................................................................9Some national figures......................................................................................9Some NJ statistics...........................................................................................9Chapter 3 Brain Structure and Function...................................11Brain stem.....................................................................................................11Cerebellum....................................................................................................11Cerebral hemispheres....................................................................................11Lobes............................................................................................................12Corpus callosum...........................................................................................12Chapter 4 What Happens to the Brain when it is Injured?.......14Primary effects..............................................................................................14Secondary effects..........................................................................................15Defining the severity of traumatic brain injury..............................................15Rating Scales................................................................................................15Chapter 5 Common Changes Following a Brain Injury...........17Physical changes...........................................................................................17Cognitive changes.........................................................................................18Psychosocial changes....................................................................................19Neuropsychological evaluation.....................................................................20Chapter 6 Pharmacological Intervention...................................22Antidepressants.............................................................................................22Anticonvulsants/mood stabilizers..................................................................23Psychostimulants...........................................................................................23Chapter 7 School Re-entry..........................................................25Academic and cognitive considerations........................................................25Home instruction...........................................................................................25Cognitive rehabilitation.................................................................................26Educational placement..................................................................................26Chapter 8 Transitional Planning................................................29Preparing school staff....................................................................................30Preparing peers.............................................................................................31Preparing the family......................................................................................32Preparing the student with a brain injury.......................................................33Special considerations for adolescents and older students.............................33Chapter 9 Role of the School Nurse............................................35Advocate.......................................................................................................35Prevention.....................................................................................................35Coordinate....................................................................................................36Educate.........................................................................................................37Chapter 10 Personal Stories ........................................................39Katie’s mild brain injury................................................................................39Kevin’s moderate brain injury.......................................................................42Eric’s severe brain