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Traumatic Brain Injury (TBI) can be defined as a forceful bump, blow, or jolt to the head and body, or an object that pierces the skull and enters the brain.

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Traumatic Brain Injury (TBI) can be defined as a forceful bump, blow, or jolt to the head and body, or an object that pierces the skull and enters the brain.

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TBI often occurs (but is not limited to) as a result of either a sports injury or a car accident. 80% of all TBI's are considered mild, with 1.7 million adolescents in the United States (ages 15 - 19 years old) suffering with a traumatic brain injury.

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Concussion: It results from acceleration/deceleration forces occurring to a direct blow to the head. It causes a negative change in cognitive function, which can range from confusion to loss of consciousness.

Extra-axial Hematoma: Includes both epidural hematomas (EDH) and subdural hematomas (SDH).

EDH usually results from bleeding from the middle meningeal artery and SDH can result from the bleeding of a bridging vein. Both EDH and SDH can be either acute or chronic.

Contusion: known as bruising of the brain

Traumatic Subarachnoid Hemorrhage (SAH): results from the tearing of small capillaries with blood entering into the subarachnoid space

Diffuse Axonal Injury (DAI): results from any shearing, stretching, or twisting injuries to the neuronal axons

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Physical Symptoms:

Headache

Nausea or vomiting

Fatigue

Problems with speech

Dizziness or loss of balance

Sensory Symptoms:

Blurred vision

Ears ringing

Sensitivity to light and/or sound

Cognitive/Mental Symptoms:

Loss of consciousness (few seconds to a few minutes)

State of being disoriented or confused

Memory or concentration problems

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Physical Symptoms:

Loss of consciousness from several minutes to hours

Persistent headache

Repeated vomiting or nausea

Seizures

Dilation of one or both pupils

Weakness or numbness in fingers and toes

Cognitive/Mental Symptoms:

Profound confusion

Agitation, or unusual behavior

Slurred speech

Coma

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A computerized tomography (CT) scan is usually the first tested used in an emergency room if a patient is suspected of having a TBI. A CT scan uses a series of X-rays to create a detailed view of the brain, and can be used to quickly visualize evidence of bleeding in the brain (also known as a hemorrhage), blood clots (also known as hematomas), bruised brain tissue (contusions), and brain tissue swelling.

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Magnetic resonance imaging (MRI) uses powerful radio waves and magnets to help create a detailed view of the brain. This test is usually used after the patient's condition stabilizes, or if symptoms don't improve after the injury

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Some accommodations that may help students with problems related to concentration, organization, and memory (caused my a TBI) are:

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Some accommodations that may help students with problems related to concentration, organization, and memory (caused my a TBI) are:

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try and reduce distractions in the classroom

break down assignments into smaller tasks

repeat and review assignments and have students write them down

create a checklist of tasks for the student to complete each day

provide extra time for assignments and tests

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It is important to give the child more time to process what is being said and also give them extra time to answer. It is best to not overwhelm them with information since it can be harder for kids with a TBI to process that information.

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National Level: This website is a great resource to use that provides a quick fact sheet all about Traumatic Brain Injuries for specifically for teachers to use. It is broken down into two sections, what teachers should know and what teachers can do.

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What Teachers Should Know

A severe traumatic brain injury (TBI) is damage to the brain caused by an injury that changes the way the brain normally works. Concussions are sometimes called mild TBIs, and most have a temporary effect on brain function. Severe TBIs usually have longer-lasting effects.

Severe TBIs can cause temporary or permanent impairments in:

memory and attention

coordination, balance, and mobility

language and communication skills

hearing, vision, touch, smell, and taste

emotions, resulting in depression, anxiety, aggression, poor impulse control, and personality changes

Severe TBIs can affect all aspects of students' lives, including:

relationships with family, friends, classmates, and teachers

how they learn and participate in classroom and extracurricular activities

Students with TBI may:

have short- and long-term memory loss

need frequent breaks due to inability to concentrate for long periods of time

require seating accommodations or assistive devices in the classroom

need help and/or extra time getting to other classes

struggle with writing, reading, and other academic tasks they used to be able to do

have seizures or other neurological changes

seem depressed, anxious, or show aggressive or inappropriate behaviors

miss classroom time for medical appointments and to visit the school nurse for medicine

benefit from individualized education programs (IEPs) or 504 education plans

need extra time to complete homework and assignments

What Teachers Can Do

The effects of a TBI vary from person to person. Speak with your student's parents or guardians, the school counselor or psychologist, and special education staff to find ways to customize your instruction.

Students with TBIs often face a long-term healing process. To help students with problems related to concentration, organization, and memory, you can:

reduce distractions in the classroom

break assignments into smaller tasks

repeat and review assignments and have students write them down

provide a checklist of tasks to complete each day

give extra time for tests and assignments

Date reviewed: November 2019

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Severe Traumatic Brain Injury Factsheet (for Schools)

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A severe traumatic brain injury (TBI) is damage to the brain caused by an injury that changes the way the brain normally works. Concussions are sometimes called mild TBIs, and most have a temporary effect on brain function. Severe TBIs usually have longer-lasting effects.

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State Level: This website was published by the North Carolina Department of Public Instruction and provides quick links to help teachers learn more about TBIs, and find a provider in their specific area.

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Secure websites use HTTPS certificates. A lock icon or https:// means you've safely connected to the official website.

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National Level: This website is published by the Brain Injury Association of America. It provides many great resources for parents to use all about brain injuries, diagnosis and treatments. It also has additional resources for parents to find support groups and have a safe space to share their own stories.

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BIAA is the nation's oldest and largest brain injury advocacy organization. Our mission is to advance awareness, research, treatment, and education and to improve the quality of life for all people affected by brain injury.

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State Level: This website is published by the North Carolina Division of Health and Human Services, and provides a lot of resources for people living in North Carolina with a TBI. It also includes resources for training for what to do if someone experiences a TBI, and a list of state legislation for people with TBIs.

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A traumatic brain injury (TBI) is an injury to the brain that is caused by an external physical force such as hitting your head or other types of blunt force trauma. The most common causes of TBI include slips and falls, motor vehicle accidents and struck by or against events. The injury can cause physical and mental challenges. Every injury to the brain has different effects or consequences.

Federal TBI Grant

The North Carolina TBI Program was awarded a 5 year grant from the federal Administration for Community Living (ACL). The main grant objectives include:

A TBI grant has been approved and funded by the federal Administration for Community Living (ACL).

NC TBI Grant is for $200,179 per year for a total of $1,000,895 over the five-year grant period. .

DHHS contracts with BIANC to implement most grant objectives and deliverables.

Grant Goal- To facilitate the continued development and expansion of a comprehensive, multi-disciplinary, and easily accessible system of care for individuals with lived experience and their families.

Main Grant Objectives

Contribute to infrastructure development of the whole care system to ensure individuals with Traumatic Brain Injury (TBI) are receiving culturally responsive, quality care in the new managed care system;

100% of individuals in NC who seek behavioral health services through a Local Management Entity-Managed Care Organization (LME-MCO) will be screened for a potential TBI;

Increased provider knowledge, skill and ability across all service programs;

Develop new partnerships with emphasis on the criminal justice system and domestic violence programs;

Expanded options for online support groups; 6) increase education to individuals with TBI to promote person-centeredness, empowerment, skill building and other topics.

TBI Grant Products

The following are products that will be developed during the five-year grant cycle.

A new Symptoms Questionnaire (SQ) database for professionals and others

TBI screening and referral

The addition of at least one active online support group

Implementation of Employment and SUD training modules

Updated Salesforce database

Feasibility review of potential Peer Support pilot program

Training curriculum for individuals with TBI

Updated TBI Needs Assessment
(Bi-annually)

Training plan for behavioral health providers with emphasis on TBI Waiver, SUD Waiver and MCOs

Updated TBI state plan (Annually)

TBI State Funded Programming

Based upon legislative appropriation, the State funded TBI program operates on approximately $3.9 million dollars for the purposes of services, supports, education and awareness. Out of this appropriation, each Local Management Entity-Managed Care Organization (LME-MCO) is allocated funding to provide TBI specific services and supports to individuals living with TBI in their respective catchment area. The Brain Injury Association of NC (BIANC) also receives funding out of the same legislative appropriation.

$3,413,868 for the LME-MCO's

$559,218 for the Brain Injury Association of NC (BIANC)

Click on the link below for the name and contact information of the LME-MCO that serves your county.
Local Management Entity/Manage Care Organization Directory Map

TBI Waiver

The TBI Waiver has been operational for three years. The program is currently available to eligible individuals living in the Alliance Health (LME-MCO) catchment area (Wake, Durham, Johnston and Cumberland counties). It offers a variety of services and supports to eligible individuals.

Division of Health Benefits (DHB) has submitted the TBI Waiver renewal application to the Centers for Medicare and Medicaid Services (CMS). The renewal will include:

Expansion of the Waiver into the two additional counties that are transitioning into the Alliance catchment area (Mecklenburg and Orange);

Increase federal poverty level to 300%

Lower age of date of Traumatic Brain Injury down from 22 to 18;

Add supported living as a service;

Other changes as identified in the renewal application.

The draft TBI Waiver renewal application can be found here. This draft Waiver application is currently being reviewed by the Center for Medicare and Medicaid Services (CMS). The Waiver renewal is anticipated to start in Spring 2022. Until the new application is approved, the current TBI Waiver remains in place.
The original TBI Waiver application to the Centers for Medicare and Medicaid Services (CMS) can be found here.
More information about the TBI Waiver can be found at Alliance Health here.

Data

The CDC estimates that 2% of the population will have a TBI, which equates to approximately 208,000 people in NC.

Overall 365,719 individuals received Behavioral Health Services during SFY 2018.

Of the 365,719 individuals receiving Behavioral Health Services during SFY 2018, 36,068 (10%) indicated a TBI Dx on NC Tracks records. These 36,068 clients are unduplicated across both systems, Medicaid and DMH.

During 2019, there were 29,081 Traumatic Brain Injuries sustained by North Carolinians (NC DHHS-DPH, TBI Special Emphasis Report, 2019).

Data Initiatives

The TBI Program is engaged in several data initiatives to assist in determining the number of individuals living with TBI throughout North Carolina. Data initiatives include:

TBI Screenings at six LME-MCO's and a Domestic/Intimate Partner Violence (D/IPV) Pilot program;

Youth Sport initiative: TBI screening with all twenty-four teams in the Carolina Champions Soccer League;

Claims Data Reviews - The TBI Program is working with the Quality Management Section at the Division of Mental Health, Developmental Disabilities and Substance Use Services (DMH/DD/SUS) to determine the number of individuals that have accessed publicly funded services such as physical health, mental health and substance use service systems.

Collaborations on data collection with state partners such as Division of Health Benefits (DHB) and Division of Public Health (DPH).

There are 113,852 consumers who had a TBI diagnosis in at least one of seven diagnosis code positions using applicable ICD-9 codes, based on paid claims for any Medicaid-funded service or non-Medicaid-funded (DMH/DD/SAS) mental health service paid through the NCTracks system after July 1, 2013 for services beginning on or before Sep. 30, 2015. July 1, 2013 is when NCTracks began and 10/1/2015 is when use of ICD-10 codes was required.
Please note that there are likely many more people with TBI in NC than this number. This is one of many indicators. For example, it does not include people that have private insurance who have never accessed publicly funded services.

Training and Outreach

The TBI program provides some direct training opportunities:

The TBI Program also contracts with the Brain Injury Association of North Carolina (BIANC) to provide a variety of education, outreach and training activities. Some of the training opportunities available include Brain Injury Basics, TBI and Co-Occurring Mental Health and Substance Use Disorders, TBI and Aging, TBI and Post-Traumatic Stress Disorder (PTSD) in the Military and Crisis Intervention Training. Many of these trainings are offered in-person (as permitted) and/or in webinar format.
The online training modules include topics such as Identification of TBI among Medical Professionals and the Primary Care Workforce as well as TBI and Public Services in NC.
Online training opportunities can be found here.

TBI Legislation

Educational Resources

Additional Resources

Brain Injury Advisory Council

The purpose of the Brain Injury Advisory Council (BIAC) is to review the nature and cause of traumatic and other acquired brain injuries in North Carolina. The Council also makes recommendations to the Governor, the General Assembly, and the Secretary of Health and Human Services regarding the planning, development, funding, and implementation of a comprehensive statewide service delivery system to address the needs of brain injury survivors.

BIAC Meeting Notice

This is formal notice of upcoming BIAC meetings.

BIAC Meeting Minutes

Brain Injury Association of North Carolina (BIANC) Family Help Lines

Toll-Free Statewide: 800-377-1464
Raleigh: 919-833-9634

TBI Program Contact

Phone: 984-236-5040
Email: TBIContact@dhhs.nc.gov

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A traumatic brain injury (TBI) is an injury to the brain that is caused by an external physical force such as hitting your head or other types of blunt force trauma. The most common causes of TBI include slips and falls, motor vehicle accidents and struck by or against events.

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Returning to School After Experiencing a TBI

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Returning to School After Experiencing a TBI

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Parents become the biggest advocate for their child once they return to school after experiencing a TBI. Parent's often have the most knowledge about their children are able to ensure that all supports are in place to help their student be successful when they return back to school.

The effects of TBI can differ vastly from student-to-student. Some common changes are tiredness, headaches, and heightened sensitivity to light or noise. A TBI can also impact a student where they have a hard time learning new material and are more forgetful.

Not all students with a TBI will require special programs, but in some states a brain injury educational consultant is available through the state's Office of Special Education. This consultant helps special education educators in local schools to provide services to students with brain injurys.

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Local level: This website is published by Psychological Services in NC Public Schools, and divides the state up (has an Eastern North Carolina section) in order to find providers in your specific area.

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Psychological Services in NC Public Schools

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Local Level: This website helps discuss how ECU's hospital helps with children's emergencies. It is a great resource for local families to know about in case if an emergency happens.

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Providing dedicated emergency care for your child.

We know that children are not little adults, but instead have unique health care needs. You'll find clinical expertise for your child's medical emergency at the Children's Emergency Department located next to the main Emergency Department. Physicians and nurses who are highly and specially trained in pediatric emergencies staff our children's emergency services 24 hours a day, 7 days a week.

From traumatic injuries to medical illnesses, the children's emergency medicine team cares for your child with equipment and technology designed for children of all ages. Our treatment rooms are large enough to accommodate and support the family as well. We offer comprehensive laboratory and radiology services, developmentally appropriate treatment, and appropriate sedation for potentially painful procedures.

Phone Number: 252-847-1517
Hours: Open 24 Hours
Address: 2100 Stantonsburg Road, Greenville, NC 27834 (within ECU Health Medical Center)

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We know that children are not little adults, but instead have unique health care needs. You'll find clinical expertise for your child's medical emergency at the Children's Emergency Department located next to the main Emergency Department. Physicians and nurses who are highly and specially trained in pediatric emergencies staff our children's emergency services 24 hours a day, 7 days a week.

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Abrahamson, E. (2023, September 13). Common characteristics of Traumatic Brain Injury - Abrahamson & Uiterwyk. Abrahamson & Uiterwyk Car Accident and Personal Injury Lawyers. https://www.theinjurylawyers.com/common-characteristics-traumatic-brain-injury/#What_Are_the_Common_Characteristics_of_Mild_TBI

Children’s emergency care. ECU Health. (2023, July 6). https://www.ecuhealth.org/pediatric-services/childrens-emergency-care/

Gavin, M. L. (Ed.). (2019, November). Severe traumatic brain injury factsheet (for Schools) (for parents) | nemours kidshealth. KidsHealth. https://kidshealth.org/en/parents/tbi-factsheet.html

Georges, A. (2023, January 2). Traumatic brain injury. StatPearls [Internet]. https://www.ncbi.nlm.nih.gov/books/NBK459300/

Mayo Foundation for Medical Education and Research. (n.d.). Traumatic brain injury. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/traumatic-brain-injury/symptoms-causes/syc-20378557

Psychological services in NC public schools. (n.d.-a). https://ncschoolpsychology.med.unc.edu/index.php/nctbi/approvedproviders/

Psychological services in NC public schools. (n.d.-b). https://ncschoolpsychology.med.unc.edu/index.php/nctbi/

Returning to school after traumatic brain injury. MSKTC. (n.d.). https://msktc.org/tbi/factsheets/returning-school-after-traumatic-brain-injury#:~:text=On%20the%20other%20hand%2C%20not,to%20students%20with%20brain%20injuries.

Traumatic Brain Injury. NC DPI. (n.d.). https://www.dpi.nc.gov/districts-schools/classroom-resources/exceptional-children/educational-resources/traumatic-brain-injury

Traumatic brain injury. NCDHHS. (n.d.-a). https://www.ncdhhs.gov/divisions/mental-health-developmental-disabilities-and-substance-use-services/traumatic-brain-injury

Traumatic brain injury. NCDHHS. (n.d.-b). https://www.ncdhhs.gov/divisions/mental-health-developmental-disabilities-and-substance-use-services/traumatic-brain-injury

U.S. Department of Health and Human Services. (n.d.). Traumatic brain injury (TBI). National Institute of Neurological Disorders and Stroke. https://www.ninds.nih.gov/health-information/disorders/traumatic-brain-injury-tbi