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Medical considerations for students with an ABI fact sheet

Medical considerations for students with an acquired brain injury

Potential Medical Conditions

There may be medical issues that arise following a child’s brain injury. It is important to note that most children make a good physical recovery, and they may have none, one or several of these conditions occurring at the one time. These conditions will be managed by different medical teams and they will be able to provide specific recommendations regarding the treatment of these if the child so requires.

  • Epilepsy/Seizures
  • Hydrocephalus
  • Hormone and growth changes (sexuality)

Hydrocephalus

Following a brain injury, children may develop a condition called hydrocephalus. This condition results in build-up of the fluid around the brain due to a blockage or poor natural absorption of the fluid. This fluid is called cerebrospinal fluid (CSF) and surrounds the brain to protect and nourish it. A build-up causes increased pressure in the brain which can cause further damage or limit function if not treated. Hydrocephalus is usually treated through the insertion of a shunt. A shunt is a one-way valve which has two flexible tubes attached (see picture). This system drains the excess fluid (CSF) from the brain cavities (ventricles) usually into the abdominal cavity where it is absorbed by the body. The shunt regulates the amount, direction and pressure of the CSF flow so that the pressure in the ventricles is as close to normal as possible.

CSF shunt system diagram

Things to consider

Children with shunts can participate in most daily activities. They will have been given medical advice about appropriate precautions with regard to sporting and recreational activities. Although a shunt generally works well, it may stop working if it disconnects, becomes blocked, or is outgrown. If this happens the pressure in the brain will increase and a number of physical symptoms may develop. It is important to get medical attention if any of the following symptoms appear.

Signs that a child may be experiencing shunt dysfunction

  • Headache, Vomiting, Fever, Dizziness
  • Headache, Vomiting, Fever, Dizziness
  • Irritability and personality / behavioural changes
  • Deterioration in performance eg. school work, balance, concentration
  • Lethargy and drowsiness
  • In more severe cases, visual disturbances and seizures
  • Changes in muscle tone or movement patterns

If you note any of the above difficulties, encourage the child’s family to seek a medical review.

Epilepsy/Seizures

Following a brain injury, children may experience post traumatic seizures (also referred to as post traumatic epilepsy). The incidence of post traumatic seizures is low. Seizures fall into two main categories as outlined below:

Partial Seizures

May start with only one part of the body and/or associated with a feeling of confusion. They may or may not effect consciousness and can present as movement of one part of the body, change in sensation or a feeling of confusion (also known as focal seizures). They can evolve into a generalised seizure.

Generalised Seizures

May start as a partial seizure and always effects consciousness. Can affect the whole body, May be associated with loss of bladder function, tongue biting and/or thrashing of limbs (known as tonic-clonic or grand mal seizures)

Absence Seizures

A type of generalised seizure, may only involve a brief lapse in consciousness lasting a few seconds and appear as ‘blanking out’ (known as petit mal seizures)

How to recognise a seizure

Seizures may take the form of:

  • physical jerking or twitching movements
  • physical jerking or twitching movements
  • falling to the ground or slumping in the chair
  • ‘blanking-out’, staring or not responding
  • laboured breathing and facial distortion / jaw clenching.

What to do when a child has a seizure

Always protect the child having a seizure from injury by:

  • placing the child on the floor and rolling onto one side
  • placing the child on the floor and rolling onto one side
  • moving any nearby objects that the child might hit
  • loosening ties and collars
  • providing reassurance.

DO NOT restrain the child’s movements during the seizure or place anything in the child’s mouth. It is impossible for the child to “swallow their tongue”. Placement on the side will ensure a clear airway.

Precautions

It is extremely important that seizure medication is given at specified times as prescribed by the doctor. The child’s family will be aware of any other specific precautions that need to be considered.

Refer to Education Queensland’s and your school’s policies relating to the administration of medication, first aid and emergency actions in the event of a child having a seizure.

Hormone and growth changes

Hormones are chemical messages that the body uses to help regulate growth and sexual development. Following brain injury, there may be changes to the way these hormones are produced, which may have effects on development. Specifically, the timing of puberty and growth rate. Some students may require medication to assist them grow at a rate similar to their peers.

Puberty

Occasionally after a severe brain injury, puberty may begin early. This is known as precocious puberty. A growth spurt and development of sexual interest, as with normal puberty, usually accompanies precocious puberty. Problems, such as management of the physical and emotional changes, can result when puberty occurs much sooner than the child’s peers eg. under nine or ten years.

Sexuality

Brain injury does not automatically affect a young person’s sexuality. Some young people will experience no impact on their sexual development or behaviour. Others may be affected in a number of ways and have different needs in relation to sex education and socialisation. It is important to remember that a degree of inappropriate behaviour is not uncommon in adolescence.

Psychological considerations

Physical and cognitive impairment may result in some young people feeling less attractive and capable, impacting on feelings of self worth. Lowered self-esteem and self-confidence can affect the ability to develop relationships. Impaired memory and intellectual skills may affect the ability to learn about sexuality and appropriate behaviours. Decreased social skills can affect the young person’s ability to mix with, and be accepted by others. Strategies to assist with psychological considerations include:

  • Look for ways to enhance self-esteem in all situations.
  • Look for ways to enhance self-esteem in all situations.
  • Focus on strengths, not on what the young person can’t do.
  • Sex education may need to be specifically tailored for the needs of a young person with impaired memory e.g. small chunks of information given a number of times.
  • Social skills training covering basic areas like meeting and greeting, forming friendships, anger management, saying “no” and “stranger danger” can be beneficial.

Behavioural Considerations

Sexually inappropriate or disinhibited behaviour may be observed in some young people following a brain injury. While this can manifest at any time following a brain injury, it would most commonly be seen during the early stages of recovery. Inappropriate behaviour, sexual comments or innuendoes by the young person who has been discharged home or has returned to school may lead to rejection, ridicule or even threats by other members of the community. A child’s disinhibited behaviour, impaired social skills and poor awareness may leave him or her particularly vulnerable to sexual abuse or exploitation. Strategies to assist with behavioural considerations include:

  • Discuss behaviour with parents and try to get a clear picture of the context in which the behaviour occurs e.g. what, when, why, consequences.
  • Discuss behaviour with parents and try to get a clear picture of the context in which the behaviour occurs e.g. what, when, why, consequences.
  • Teachers and parents need to reach agreement about what approach will be taken to modify the behaviour and how progress will be reviewed. Aim for consistency through home and school management.
  • Give clear explanations to the child or adolescent about what is and is not acceptable and the consequences or unacceptable behaviour.
  • Ensure the child has received appropriate sex education and has been taught protective behaviours.
  • In consultation with the parents, seek assistance from the child’s Rehabilitation Team to determine appropriate intervention for the individual child.

Sexuality is a topic that many parents and teachers find difficult to discuss. It is important that teachers alert parents if they have concerns that children may be exhibiting inappropriate sexual behaviour. If you have concerns about particular behaviours you may wish to discuss these with a member of the  child’s Rehabilitation Team.

Contact us

Queensland Paediatric Rehabilitation Service
Lady Cilento Children’s Hospital
Level 6, 501 Stanley Street, South Brisbane 4101
t: 07 3068 2950
t: 07 3068 1111 (general enquiries)
f: 07 3068 3909
e: qprs@health.qld.gov.au

In an emergency, always call 000.

If it’s not an emergency but you have any concerns, contact 13 Health (13 43 2584). Qualified staff will give you advice on who to talk to and how quickly you should do it. You can phone 24 hours a day, seven days a week.

Developed by the Queensland Paediatric Rehabilitation Service, Children’s Health Queensland. Updated: October 2017. All information contained in this sheet has been supplied by qualified professionals as a guideline for care only. Seek medical advice, as appropriate, for concerns regarding your child’s health.

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