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Posted 1/16/98
In the time it takes to read this sentence, someone in the United States will suffer a traumatic brain injury. For young children and adolescents, brain injuries are one of the leading causes of death, and for survivors, these injuries can produce life-altering consequences.
"The most handicapping of those consequences relates to social and cognitive functions," says Lyn Turkstra, the new assistant professor of communication sciences in the College of Arts and Sciences at Case Western Reserve University.
Turkstra has a five-year, $350,000 Mentored Clinical Scientist Development Award from the National Institute on Deafness and Communication Disorders to study 200 uninjured adolescents and 60 brain-injured youths between the ages of 13 and 21.
The study focuses on aspects of social communication that are essential for brain-injured youths to function in peer, work, school, or family settings. The injured youths in the study will have sustained a closed head injury resulting in unconsciousness for at least one hour.
Another $1,000 gift from the Flora Stone Mather Alumnae Association will help renovate laboratory space in the communication sciences office in the Cleveland Hearing and Speech Center on Euclid Avenue so that CWRU students may participate in the testing and observations of brain-injured youths.
According to Turkstra, the human brain can withstand a blow she likens to running into a tree at three miles per hour. Anything greater can cause damage to the brain and impair the ability to learn, recall information, pay attention, and sustain an adequate threshold for handling stress and irritability.
Young men outnumber adolescent females two to one with these injuries. In middle school grades the injuries come primarily from sports. Once teens get their driver's license at 16, auto accidents produce the highest number of these injuries.
While most youths will recover from the jostles of sports injuries, car accidents, or falls, others do not.
Even if head injuries are properly treated, long-term problems can still exist. The problems may not appear until many months later, after the individual has left rehabilitation or healthcare services. By this time the injured youths, as well as their family and friends, notice changes but are frustrated about what to do.
"If someone has a brain injury, they will have physical problems at first, but these problems will not be the long-term limiting factor in terms of going back to school or work or having a family or friends," Turkstra says. Rather, the cognitive and social handicaps have disabling consequences. The social repercussions are particularly important for adolescents.
Youths may exhibit a wide range of handicapping social behaviors -- monopolizing conversations with a focus on themselves, forgetting how to greet others, telling jokes at the wrong time, or failing to follow through after making plans. Turkstra says all of these behaviors can alienate the youths from their peers.
"If you don't address the long-term behavioral consequences of brain injury, everyone is frustrated. The child or adolescent knows they are different, but can't explain it very well. The family knows they are different, but may not know how to cope with the changes," says Turkstra.
Negative behaviors snowball into social isolation and low self esteem, according to Turkstra, as the individuals begins to realize they no longer are the same person they were before the injury.
Unlike students with learning disabilities, who have a lifetime of experience with strategies and coping mechanisms, students with brain injuries may no longer be able to use strategies that worked only weeks before the trauma. They may develop negative attitudes toward school and adopt coping behaviors that lead to more problems.
By the time neuropsychological and speech-language pathology tests reveal the cognitive and communication problems related to the head injury, the maladaptive behaviors may be entrenched.
While cognitive problems surface following the injury, the ability to remember habits and procedures usually is not impaired, Turkstra says. This ability to remember procedures is one of the skills that can be used to help youths over their social communication hurdles.
For example, some youths with brain injuries have difficulty initiating a social conversation, but social communication skills groups can help them learn conversational routines to help them stay involved with their peer group.
Turkstra plans to initiate such a group for six youths in the spring. She will gather examples of adolescent social communication skills from students in Cleveland-area schools.
Her study also will reflect the current trauma data in its representation of diverse racial and ethnic groups. According to data gathered by MetroHealth Hospital, the population of individuals who sustain a traumatic brain injury is 77 percent white, 16 percent African American, 5 percent Hispanic and 1 percent Asian/Pacific Island.
Turkstra joins other at the University who study trauma in children. These include Joanne Youngblut from the nursing school, whose research focuses on newborns through age six and Gerry Taylor, professor of pediatric at the school of medicine, studying children from 6 to 12 years old.
Adolescent communication skills is sorely understudied, says Turkstra. She became interested in the topic as a post-doctoral fellow at the National Center for Neurogenic Communication Disorders at the University of Arizona and continued to pursue it there while a research assistant professor in the Department of Neurology and Surgery and Speech and Hearing Sciences.
Turkstra's NIDCD is a mentoring grant. She will work closely with Danielle Ripich, the associate dean of the College of Arts and Sciences, and Maureen Dennis, a well-known pediatric neuropsychologist at the University of Toronto.
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