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You might be wondering why you as an educator or school staff member should be interested in brain injury. Many people do not realize how common it is for children to suffer a brain injury. Traumatic Brain Injury (TBI) is a leading cause of death and disability among children ages 1 to 19 years in the United States (Faul, Xu, Wald, & Coronado, 2010). Each year, approximately 40 percent of TBIs in the United States occur in the pediatric population (ages 0–19 years) (Faul et al., 2010). The Centers for Disease Control (CDC) estimates that more than 60,000 children and adolescents are hospitalized annually in the United States after sustaining moderate to severe brain injuries from motor vehicle crashes, falls, sports and physical abuse; an additional 631,146 children are seen in hospital emergency rooms and released (Faul et al., 2010). In all, nearly 145,000 children aged 0–19 years are currently living with long-lasting, significant alterations in social, behavioral, physical and cognitive functioning following a TBI (Zaloshnja, Miller, Langlois, & Selassie, 2008). The Colorado Department of Public Health and Environment (CDPHE) reported that from 2007 through 2009, there were 307 TBI-related deaths and 2,392 Colorado children and youth who were hospitalized and discharged with a TBI. TBI was twice as high for Colorado boys and young males ages 0-20 years who were hospitalized (71.7 TBIs per 100,000 population), compared to the rate for Colorado girls and young females (36.0 per 100,000). The leading causes of non-fatal TBI among Colorado children and youth were motor vehicle-related events in traffic or on public roads and falls. Two additional causes more common among children and youth than adults are those involving other transportation (including motor vehicles not in use on public roads, off-road vehicles, trains, airplanes and water transport), and being struck by/against a person or object (such as in recreational and sporting events). Although TBI is a high-incidence medical event, from the point of view of the U.S. Department of Education and most state departments of education, TBI is a “low-incidence” educational disability. A significant discrepancy between the incidence of TBI and the identification of children with TBI for special education services continues to exist. Although approximately 145,000 children live with persistent disability following TBI (Zaloshnja et al., 2008), the total number of students receiving special education services under the TBI category is only 24,602 (U.S. Department of Education, 2007]). Furthermore, given that 60,000 children are hospitalized each year for TBI (Faul et al., 2010), a subset of these children who need services are likely not receiving them. Rates of special education identification are higher for some students with TBI, including those with severe TBI, problem behavior, poor academic performance, and socio-economic disadvantage (Donders, 1994; Ewing-Cobbs, Fletcher, Levin, Iovino, & Miner, 1998; Max et al., 1998; Miller & Donders, 2003; Taylor et al., 2003). This discrepancy exists across all states, including Colorado. As of December, 2012, the Colorado Department of Education reported 497 students identified with brain injury as their primary disability category for special education. Comparing this to the data from the CDPHE which states that approximately 2,392 youth ages 0-20 years are discharged from the hospital with TBI each year, it could be suggested that there may be a significant number of students who are either not receiving special education services at all, or who are receiving services under an inappropriate disability category. While it is difficult to determine how many youth who sustain TBI will experience any long-term educational impact requiring special education support, the Pediatric Registry suggests approximately 19 percent of moderate to severe brain injury will result in on-going, life-long impairment. This data would suggest that we are grossly under-identifying students with brain injury that may benefit from special education services. Additionally, this data only reflects injuries that were of a significant enough medical nature to require hospitalization. Therefore, those with medically “mild” TBI (concussion) who were treated and released from the hospital or who perhaps never sought medical care are not included in these numbers. Schools and districts specifically wanting more information on concussion identification and management and state concussion legislation (Senate Bill 11-040) should refer to http://www.cde.state. co.us/HealthAndWellness/BrainInjury.htm
