Children with TBI
In the fight to prevent traumatic brain injuries — and the speech, language, hearing, and swallowing disorders that may result — the ammunition of choice may include a melon, a swim cap, and brain-shaped chocolates.
Prevention of communication disorders is one of the primary responsibilities of the communication sciences and disorders (CSD) profession (ASHA, 1988, 1991). However, this responsibility probably is not stressed enough—clinicians spend the majority of the day assessing and treating patients who have already acquired a communication or swallowing disorder, and faculty train future professionals to do the same. ASHA offers a tutorial on preventing communication disorders (1991) that provides many suggestions on how CSD professionals can be involved in prevention and educational outreach throughout the lifespan: increasing awareness of the relationship of alcohol and tobacco use to oral and laryngeal cancer, improving diet to reduce the risk of strokes, and providing a language-rich environment to prevent language delay are just a few.
Prevention of traumatic brain injury (TBI), which can cause speech, language, hearing, and swallowing disorders, is another area prime for targeting, especially because TBI risk factors are numerous and vary according to age.
It was my 7-year-old son who led me to take a stronger role in prevention of communication disorders. He volunteered me to speak about the brain to his first-grade class a little more than a year ago. What started as a one-time effort has grown into something much larger.
I may be "Dr. Meredith" to my college students, but to younger students I am "The Brain Lady." Earlier this year, from mid-May through July, I spoke to hundreds of school-aged children in their classrooms, at a skate park, and in summer youth programs; participated in a community safety fair; did an interview at a local radio station; and consulted with the local bicycle shop on spreading the word on bike safety.
Teaching the basics about the brain and brain safety can be fun, especially when you have engaging teaching tools. Depending on the audience, my props may include a variety of brains (models, real specimens, and made of chocolate), gloves, a model skeleton, white swim caps, permanent magic markers, melons, a helmet, a large colorful brain atlas, and pictures with stories about real people who wore helmets and those who did not.
Primary Grades
In the elementary-school classroom, I begin by discussing the brain, spinal cord, and nerves with a basic picture book about the nervous system. Next, I have an eager volunteer don a swim cap, and I tell the children I can see the volunteer's brain through his or her head with my "special glasses." I illustrate the different lobes of the brain and discuss the various functions of each location as I draw them on the volunteer's swim cap. For example, on the occipital lobe, I draw eyes representing vision; on the temporal lobe, I draw an ear to depict listening.
When we get to the frontal lobe we discuss its role in good decision-making as well as in other cognitive functions. This explanation leads into a discussion about good choices for a healthy brain and poor choices that would hurt the brain. The lesson also includes the role of the cerebellum (taught to them as "Sarah Bellum"), as they practice standing on one leg, touching their fingers to their nose, and walking a straight line from heel to toe. Depending on the age of my audience, I discuss other details, such as the role of the neurons.
After this brief neuroanatomy lesson, I introduce the children to Mr. Bones, my plastic skeleton who is dressed with his own brain swim cap, a helmet worn incorrectly, pink feather boa, bike jacket, bike shorts, and flip flops. We engage in an energetic dialogue about what Mr. Bones has done correctly and incorrectly. Children love to point out what is wrong. The fact that the helmet is not covering his frontal lobe and that he is wearing a pink boa are often noted first.
The conversation provides many teaching opportunities. The lesson ends with true stories available through Trauma Nurses Talk Tough. The first story is about a boy on a bike who did not have a helmet and collided with a car. The boy was in a coma for three months and in rehabilitation for six months; pictures depict the boy trying to learn to walk and eat again. The second story is of a boy in a similar accident, but because he was wearing a helmet, he escapes with minor scratches on his face. The students are asked to think about which child they would rather be. I then share a parallel story about two adults, emphasizing the point that even adults need to wear helmets.
After the large group lesson, children are invited to put on gloves and get a closer look at the real brains in small groups. This activity provides an excellent opportunity to fuel their interest in neuroscience, as well as in brain protection.
Safety Fair
My involvement in the schools led to my membership on the planning committee for an annual safety fair. The committee comprised a wide variety of citizens concerned with health and safety, including law enforcement officers, an insurance business owner, parents, bike shop employees, parks and recreation employees, advocates for safe routes to school, and psychology and early education professors. It is encouraging that there are so many others in our communities with whom we can work to address the prevention of injuries that can lead to communication disorders. About 600 people visited the safety fair and its more than 20 organizational booths. Some booths represented safety advocates for guns, water, bikes, ATVs, automobiles, and pedestrians; others offered free bike helmets, car seats, car seat checks, gun locks, DNA kits, and brochures on myriad topics.
My booth was popular — I had real brains and the booth was adjacent to the free helmet giveaway. I distributed safety literature, fun pages, reflectors provided by the Idaho transportation department, and chocolate brains that I had made and individually packaged with a label that included a list of bike safety facts (with parents, I refer to this list as "nag facts"). I also told the children that they could use these facts to get their parents to wear helmets as well.
To receive a chocolate brain, each person had to listen to the stories about the outcomes of people in accidents who did and did not wear a helmet. One child convinced her friends to come over to listen to the stories again. As others packed up their booths at the end of the day, mine had a steady stream of people wanting to listen to the stories, touch the brain, and perhaps get a chocolate. Surveys completed by attendees indicated that using correctly fitting helmets was one of the most effective messages they learned at the fair. Correct use of child safety seats also received high scores. This result is good news, as research has shown that bike helmet use has been estimated to reduce head injury risk by 85% (Bicycle Helmet Safety Institute) and correct child safety car seat use can reduce the risk of head injury by more than 75% (Muszynski, Yoganandan, Pintar, & Gennarelli, 2005).
Summer Camp
Participating in the safety fair connected me with the local parks and recreation department, which invited me to talk to children enrolled in its summer program near the local skate park. The skate park is used mostly by non-helmet-wearing boys ages 10–14 on BMX bikes and skateboards. Not surprisingly, this population is at the highest risk of bike accidents that result in severe brain injury or death (Trauma Nurses Talk Tough), so a skate park is the perfect location for a melon-drop demonstration. After the campers heard the accident stories, made chocolate brains, had pictures taken with Mr. Bones, and witnessed pretend neurosurgery on a child wearing a brain swim cap, they went out to the skate park. They watched as a head-sized, helmeted melon was dropped from the top of the highest ramp — and how it survived intact. They then watched as an un-helmeted melon, dropped from the same point, split in two upon contact with the ground. Let's hope that these children will think of this melon demonstration when they make a helmet-wearing decision.
Educating children is the method I have chosen to prevent brain injuries. Once a child understands how something as wonderful as the brain works, he or she can be a wonderful ally in spreading the information. Many parents reported to me that their child was eager to share the information I had taught them. This had two effects; one, the parents were relieved to see their child be more helmet compliant and two, the parents re-evaluated their own safety habits.
Idaho has a seatbelt law but it does not have helmet laws. This situation is unfortunate, as laws that mandate helmets for bike, ATV, and motorcycle use have shown to reduce significantly the rates of death and severe brain injuries (Yankee & Benincasa, 2008).
Spreading the Word
I have found wonderful safety allies at the local bike shop. I made posters with bike-riding safety tips, stories of how helmets saved lives, and statistics of death and head injury in helmeted vs. non-helmeted riders. These colorful educational displays are posted by the helmets, with Mr. Bones handing out pamphlets on fitting a helmet and the "A to Z by Bike" guide to safe bicycling for kids and adults. The store owner invited me to do a radio talk show with him and to train him to teach youngsters about the brain and safe cycling. It is rewarding to see the spread of excitement generated by brain safety with all ages.
Working with the community has prompted me to share this experience with my university students. Their neuroanatomy and senior seminar coursework now includes disseminating brain-injury prevention information to various populations. Working in pairs, the students address an audience of their choice, such as parents and children at daycare centers and after-school programs; participants at senior centers; high school health classes; and college students in dorms, fraternities and sororities, and the student union. The students tailor their presentations to their audiences. They talk about peer pressure and good decision-making with high school and college students and encourage them to avoid high-risk activities such as drug and alcohol abuse, as well as driving while distracted (e.g., texting), as motor vehicle accidents are a significant concern for this age group (Brain Injury Association of America). The message to senior citizens includes issues that would impact balance and obstacles in their homes, as falls are the leading cause of brain injury in the elderly (Thompson, Wayne, McCormick, & Kagan, 2006).
There are many ways to help prevent brain injury. Team up with law enforcement agents, sports trainers, trauma specialists, allied health professionals, and school representatives. If you are a university instructor, get your students involved and have them work with related student organizations in nursing, psychology, physical therapy, and neuroscience. Take advantage of the free online resources (see sidebar on p. 34). With all of these wonderful resources you could make your own "brain campaign"!
About the Author
Amy Skinder-Meredith, PhD, CCC-SLP, is an assistant professor in the Department of Speech and Hearing Sciences at Washington State University. Her primary clinical and research interest is in children with motor speech disorders, and she has published and presented on childhood apraxia of speech at national and international conferences. Contact her at mereditha@wsu.edu.
cite as: Skinder-Meredith, A. (2010, November 02). Creative Community Involvement to Prevent TBI. The ASHA Leader.
Resources
Bicycle Helmet Safety Institute
Centers for Disease Control and Prevention
Bike Safety Facts
(from the Bicycle Helmet Safety Institute website)
88% of all head or brain injuries could be avoided if cyclists wore a bicycle helmet.
85% of all accidents occur within five blocks of home.
47% of all bicycle accidents occur off-road, in driveways and on sidewalks.
References
American Speech-Language-Hearing Association. (1991). Prevention of Communication Disorders Tutorial [Relevant Paper]. Available from www.asha.org/policy.
American Speech-Language-Hearing Association. (1988). Prevention of Communication Disorders [Position Statement]. Available from www.asha.org/policy.
Bicycle Helmet Safety Institute. (n.d.) www.helmets.org/stats.htm [retrieved Sept. 30, 2010].
Brain Injury Association of America. (n.d.) Brain Injury: The teenage years — Understanding and preventing teenage brain injury. www.biausa.org/publications/Teenage.Years%20_Edited_.pdf [retrieved Oct. 1, 2010].
Muszynski, C., Yoganandan, N., Pintar, F., & Gennarelli, T. (2005). Risk of pediatric head injury after motor vehicle accidents. Journal of Neurosurgery: Pediatrics, 102(4), 374–379.
Thompson, H., Wayne, C., McCormick, W., & Kagan, S. (2006). Traumatic brain injury in older adults: Epidemiology, outcomes, and future implications.Journal of American Geriatric Society, 54(10), 1590–1595.
Yaukey, J., & Benincasa, R. (2008) Motorcyclist deaths spike as helmet laws loosen. USAToday. www.usatoday.com/news/nation/2008-03-26-bikehelmets_N.htm [retrieved Sept. 30, 2010].
Reprinted with permission from "Creative Community Involvement to Prevent TBI" by Amy Skinder-Meredith. The ASHA Leader, 13, November 2, 2010, pp. 34-35, 37. Copyright 2010. All rights reserved.