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The Impact of Brain Injury on the Developing Brain
In part I of this series (Understanding TBI), we discussed how the brain grows and matures in children. In this section we will discuss the effects of an injury to a child's brain - a brain that is still growing and developing. We will also discuss why brain injuries sustained by children at different points of time in their lives may have varying effects.
Parents have long known what experts are just finding out about the long term effects of brain injury on children. Scientists and other experts today are discovering that after a brain injury "the younger you are, the better you'll do" motto is generally not true. The old idea that children have plastic-like brains and they can just "bounce back" after a brain injury is much more complicated. While many children are certainly able to survive even severe trauma to their brains, they are just as vulnerable as adults to the long term effects of trauma. It just takes longer for the effects of the injury to their brains to be seen.
The idea that children's brains are protected because they are more "plastic" is based on research from the 1930's by psychologist Dr. Margaret Kennard. Kennard studied young monkeys and older monkeys. She had made small cuts in the area of their brains that control movement. Compared to older more mature monkeys, Dr. Kennard found that the younger monkeys walked sooner that the older monkeys. The so-called Kennard Principle on "neuroplasticity" was born.
Yet, as every mother and father knows, a simple cut in the motor area is not the same as the massive damage their child may have received from a severe head trauma. Also, as many pediatric physical therapists have observed, children generally tend to walk sooner than adults after brain injury. However, this tells us little about how well the child can think, or speak, or behave.
New research has been using advanced scanning technology (CAT scans, MRI) and analyzing EEGs to better study how a child's brain matures from birth through adolescence. That is, how does the brain grow and help us to get smarter, learn better, move faster? Scientists have found five peak maturation periods that children go through as their brains grow and develop. The five peak maturation points are:
Interestingly, the greatest percent of brain maturation occurs in the early years, birth through age 5. As every parent knows, this is a time of great learning and activity for children. Thus, it may be that injury to a child's brain before age 5 may be the worst time to get an injury since it is the greatest brain growth period. This may be why infants and toddlers who have suffered severe head trauma from being "shaken and impacted" often do not do very well and that those children who sustain frontal lobe injuries early in life tend to develop long term psychosocial and behavioral problems. Our frontal lobes have much to do with our personalities and how we act and behave.
Many parents have long known that their children seem to grow in "leaps and spurts" both physically and mentally. In fact, many parents have learned how children go through these different developmental stages as they get older. These stages of development have long been emphasized by schools to help children learn better. Now scientists are finding out that different regions of the brain may even have their own special growth periods. These four regions are the:
For example, a period of rapid development occurs in the fronto-temporal region of the brain between the ages of 1 to 5 and 7 to 10 with much more development between the ages of 17 to 21. Does this mean that children who sustain serious injury to their frontal lobes at age 3 may have forever damaged the continued development of their frontal lobes? Does this mean that our preschool-age children who fall and bang the front of their heads may be in danger of more serious problems as they get older because those areas of the brain that help us control how we behave might have been damaged? Of course by the time the 3 year old reaches the teenage years, everyone will have forgotten about his/her injury at age 3 or even if we do recall that bang to the head, how many of us would connect an adolescent's present behavioral or emotional problems with a head injury from 10 years ago? Scientists are just discovering the answers to these questions. Yet, many parents will tell you that their child has "never been the same" since the brain injury and that few professionals even know what they are talking about.
For those of us interested in the long term recovery of children after brain injury, we have long suspected that injury at an early age can have long term consequences. The developing brain is a brain in motion. As we better understand how the brain develops, we may be better able to see into the future of our children. The brain injury may be a moment in time, but brain injury is a life time experience. The more we know, the better we can gather the resources our children need to have happy and productive lives.
Site Note: Here's a link to our 'Brain Map' that you can locate the specific areas that Dr. Savage is talking about.
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