Kids make up largest group with traumatic brain injuries

Article By Meredith Cohn, The Baltimore Sun

November 8, 2010 | 9:27 p.m.

Austin Story doesn't remember the late-summer outing at a friend's lakefront home in New Jersey, or the rocks he climbed near a waterfall. Or how he lost his footing and, as his horrified mother looked on, fell about 50 feet.

The 14-year-old lay motionless with a traumatic brain injury as his father tried to get him off the rocks and find help.

Two months later, Austin is still being treated at the Kennedy Krieger Institute
in Baltimore, though he has learned again to walk and talk. And his
family is coming to grips with a grim statistic: Kids are the largest
group among the 1.7 million Americans who suffer serious brain injuries
each year.

Such injuries are receiving more attention lately, as the National Football League seeks to prevent concussions and the U.S. military
struggles to cope with those wounded on the battlefield. Government
officials say further efforts are underway to raise awareness on playing
fields.

Austin's family hopes this accident furthers that cause — by promoting
recognition, prevention and treatment — especially for the youngest
victims.

"I have long feared that something like this could happen [to his
child], even while I trusted it would not, or tried to prevent it, or
tried not to worry about it, or struggled to let go at the same time,"
said Shane Story, Austin's father. "That's the challenge we live with."

Story, a lieutenant colonel in the Army
Reserve stationed in Alexandria, Va., has served two tours in Iraq and
has known fellow soldiers to suffer traumatic brain injuries. He
believes injured service members, as well as pro athletes, are helping
raise awareness. But Austin is a reminder that accidents can happen
anywhere to anyone, he said.

Indeed, the U.S. Centers for Disease Control and Prevention
say kids up to age 4 have the highest rate of emergency room visits for
traumatic brain injuries — 1,256 per 100,000 people — and together with
kids up to 14 make up about a third of the sufferers.

The number of cases seen annually from 2002 to 2006 in the nation's
emergency rooms rose about 62 percent from the five previous years,
according to data recently released. That pushed total annual cases to
1.7 million from 1.4 million.

Dr. Mark Faul, a behavioral scientist with the CDC, said officials there
attribute the rise to awareness, not a spike in cases. And he agreed
attention to the wars in Iraq and Afghanistan, as well as on playing fields, is helping.

Traumatic brain injury "is the signature injury associated with the wars
and we suspect more people are going and getting themselves looked at,"
he said. "We believe there is more awareness. ... We don't know enough
to say for sure."

Falls on and off the playing fields, he said, are the major causes of head injuries,
ahead of car accidents. Faul and Kelly Sarmiento, director of
communications in the CDC's division of injury response, said many
states are starting to ban school kids from returning to games after
they've been hit in the head. The CDC has helped "craft the thinking"
and encourage lawmakers to take head injures seriously, from mild
concussions to major blows such as Austin's.

They say long-term consequences for sufferers include problems with
thinking, perception, language and emotions. Officials at the CDC and
elsewhere are working on better science and educational outreach.

Austin is lucky, his doctors and therapists at Kennedy Krieger say. He
was taken to the specialty hospital for children with brain and spinal
disorders about two weeks after the accident.

The Prince William County, Va., teen had been airlifted to a hospital in
New Jersey after his accident. He was diagnosed with an epidural
hematoma, or a buildup of blood between the inside of the skull and the
outer covering of the brain. Emergency surgery was necessary to stop the
bleeding, and he could barely open an eye 24 hours later.

Today, it's hard for casual observers to tell that anything is wrong
with him, though his parents say he is a slimmer 127 pounds, down from
144, and has a slight tremor in his hand. He doesn't remember the
accident, or much of September for that matter. His short-term memory
hasn't fully returned and words don't always come to him, though his
parents are mindful that 14-year-olds aren't always the chattiest. He
declares many things a simple "awesome."

Austin relearned to walk, talk and do everyday things at Kennedy
Krieger. He's already completing sentences, texting friends and playing
some of his favorite sport, lacrosse. He now holds a hospital record on
the Wii video game in soccer's performance, a better performance than the one given by his beloved Dallas Cowboys' Tony Romo in a late October game. Austin called the quarterback's possibly season-ending collarbone break "depressing."

But not all kids do as well as Austin, who will soon transfer to an
outpatient facility, where he'll continue therapy to improve his
cognitive abilities. His parents hope he can return, probably next year,
to his regular school, where he'd be a ninth-grader. He still may have
some short-term memory issues and other problems, though his parents say
they expect him, like his two older sisters, to go to college.

The family credits the fast action of rescue workers and the team at
Kennedy Krieger with his recovery — and Shane Story hopes other families
will take all head injuries seriously and seek immediate treatment.

Dr. Stacy Suskauer, director of Kennedy Krieger Brain Injury Program, said it becomes clearer in the first few weeks how well the children
there will fare. She said it's apparent, however, that immediate care
and early intervention and therapy benefit all of the injured children.

Researchers are working on improving treatment and ways to use magnetic
resonance imaging (MRIs) to better evaluate the extent of damage and the
length of time recovery might take, she said. "Those are always the
first questions."

In the meantime, she said, use of helmets by kids on bikes and better
protection for student athletes is crucial. She supports efforts in many
schools to teach athletic trainers to identify symptoms of mild
traumatic brain injury, or concussions, such as dizziness, blurred
vision, confusion, ringing in the ears and mood changes.

Suskauer supports the many schools, including the University of Maryland
and Howard County public schools, that are doing baseline testing of
kids before an injury happens so they can tell when something is wrong.

"Our goal is to maximize the potential of these kids," she said of
Kennedy Krieger patients, who include more than 13,000 children with
neurologic injury or illness, as well as those with spinal cord
injuries, behavior problems related to autism, feeding disorders and
other maladies.

But she argues that not getting hurt in the first place is the ultimate
goal. "Traumatic brain injury is the No. 1 cause of acquired disability
among kids," she said. "Recovery is long and hard and not everyone does
as well as Austin. ... Preventing injury would be huge."

In addition to the physical damage, the costs are high, about $56
billion a year, according to the National Institute of Neurological
Disorders and Stroke
.Those who survive may need physical, occupational and speech-language
therapy, as well as psychiatric care and social support and care for the
rest of their lives.

Shane Story says the family is thankful for church and friends, who are
taking care of the family's house and dogs. And he's grateful for
support at work, where he returned this week, and his health insurance.
He still frets about the freedom Austin will soon crave.

"I survived my teens and early 20s and realized later in life how
foolish young men can be," he said. "This is a reminder life can turn
bad very quickly. ... We need to overcome the idea that there's
something cool about getting back in the game after a blow to the head.
We need more attention, more research and more seriousness."