Traumatic Brain Injury

In 1998, the National Institutes of Health (NIH) released a Consensus Statement that broadly defines traumatic brain injury (TBI) as a brain injury from an externally inflicted trauma (i.e., car accident, physical abuse) that may result in significant impairment of an individual's physical, cognitive, and psychosocial functioning. The NIH Consensus Statement noted that while TBI could result in physical impairment, generally the more significant and/or problematic sequelae involved the person's cognition, emotional functioning, and behavior.

Reid and colleagues (2001) noted that approximately 75 to 200 of every 100,000 children will sustain a TBI in the United States each year, with a male-to-female ratio of nearly 2:1. The incidence of TBI also increases significantly in people who are 15 to 24 years of age, particularly for males. These figures, coupled with the fact that approximately 75% to 80% of all head injuries are mild in nature and thus may go unreported, suggest that TBI in school-age children and adolescents is a major educational problem. Even with the high potential underestimation of occurrence, TBIs represent the most frequent neurological conditions that result in hospitalization of children and adolescents under 19 years of age, and they are the leading cause of death or permanent disability in children and adolescents.

Until legislative changes were initiated in the early 1990s, these children were not typically identified as [Page 573]needing special education and related services (e.g., detailed assessment, intervention); however, some school systems accommodated students who sustained moderate or severe head injuries under exceptional children classifications (e.g., learning disabled, mental retardation, multiply handicapped). Even with current legislative mandates acknowledging TBI as a special education classification, the range of outcomes following a TBI will vary, in large part secondary to the severity of the injury.