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For more information, questions, and presentation requests, contact Marjorie Pehrson at marjoriepehrson@gmail.com or (801) 361-1813.

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18 Coping Strategies for Children and Teens

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18 Coping Strategies for Children and Teens

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Whether it is a person who uses a wheelchair that you see in the grocery store, a child in their class that has Autism, or a sibling with ADHD your child has someone in their life that has a disability that they might have questions about. Talking openly and honestly about disability with your kids is a critical first step in living in a more inclusive community that celebrates and embraces diversity.

So let kids ask their questions. When your child asks a question about someone with a disability consider it an opportunity to talk about a new and interesting topic rather than turning disability into a topic to be avoided.

2. Be honest and direct. Give direct answers to your child's inquiry. For example, if a child asks, "Why can't she walk?" if you reply with a response like, "Oh, we don't need to talk about that right now" or "It's okay that she doesn't' walk, she has her wheelchair to help her" you are not really answering their question and the child is left wondering. Instead, you could say " Are you curious about how Therese moves? We can go talk to her and ask her to tell us more about herself if you'd like."

With younger kids a simple statement will normally give them what they are looking for. For example, in response to the question "What is that thing in his stomach?" you could reply, "This is Jack's feeding tube. Some people eat through their mouth like you do, and others eat through their stomach like Jack." Simple. Honest. Direct.

As children get older, you may give a more complex response such as "Some kids have medical problems that make it hard for them to get enough nutrition by mouth. A g-tube is a tube that brings food directly to the stomach. It's one of the ways doctors can make sure kids who have trouble eating get the food they need to grow." By elementary age or middle school kids become more aware of less-visible disabilities like those associated with learning or behavior. Again, try to answer your child's questions with facts and be honest. If you don't know much about the person your child is asking about, find a way to respectfully talk with that child's family or teachers to learn more or facilitate a conversation between the children themselves.

3. Avoid making assumptions and interpretations. Whether you know the person your child is asking about or not, avoid adding your interpretation of how a person may feel about their disability or what caused it. You don't know what that person is feeling or experiencing if you haven't taken the time to get to know them.

There are many assumptions and misconceptions about disability that hide under the surface of our interactions such as "people with disabilities are special and should be treated differently" or "people with disabilities lives are hard and challenging." These incorrect assumptions stem from fear, lack of understanding and/or prejudice. You can help your children talk about disability in a more accurate and respectful way by avoiding assumptions and taking the time to get to know someone on an individual level.

4. Keep your explanations positive. Kids are like sponges. If you use positive language with your child, they will continue to use that kind of language on their own. For example, explain that hearing aids help others hear and wheelchairs help others move around, instead of using a negative connotation (he can't hear, she can't walk, etc.) Use the term "disability," and take the following terms out of your vocabulary when talking about or talking to people with disabilities. Don't use the terms "handicapped," "differently-abled," or "special needs" or "retarded" as these terms frame disability as a negative thing and thus further perpetuate the exclusion, isolation and negative stigma of people with disabilities.

6. Prepare for tough questions and avoid shushing their questions. It is not uncommon for kids to ask questions like, "What's wrong with that girl?" When an adult hears this, they often try to shush their kids. They are embarrassed that their child said something rude and potentially hurtful to another person. However, it is key to remember that children are not trying to be rude, they are trying to make sense of what they are seeing. A question like that however can be damaging if not addressed in an appropriate way. Explain to your kids that there is nothing wrong with people with disabilities. Explain that a child may have trouble talking or difficulty in a group situation but that doesn't mean there's something "wrong" with them.

Here are examples of some tough questions we get asked often at the PlayGarden.
How can you prepare yourself to be ready to answer these kinds of questions with your kids or the kids you work with?
Is he really 5?

Why can't she walk?

Can he talk? Will he learn how to talk?

What's that thing? (in reference to... tracheostomy tube, a g-tube, a ventilator, or orthotics).

Why does she make those sounds?

Why does she always do that? (in reference to self-stimulating behaviors)

What is that in her stomach? (in reference to a g-tube)

Why does he eat that way?

Why doesn't ________come to circle time?
7. Talk about human diversity (and neuro-diversity) with your kids.
We are all different in some way and that we all do things every day to adjust to our unique circumstances. For example, someone who wears glass uses them to correct blurry vision, just as someone who is non-verbal may use an assistive device like an ipad to communicate. None of these things are "wrong" they are just different ways of being in the world. Kids use the word "wrong" because they have been socialized by adults and society's attitudes about what is considered "normal" versus "abnormal".

We can expand the notion of "normal" by talking about neurodiversity with kids and talking about how ALL body types, ways of moving, communicating, thinking and behaving are normal and healthy.
8. Emphasize similarities and shared interests.
Avoid focusing solely on differences, doing so sends the message that people with disabilities are inherently different than the other kids. Instead, emphasize similarities. ALL kids are kids first and foremost and everyone wants the same things- to have friends, to play, to be loved, to laugh, feel included and to participate in activities together with their friends and family. We are relational beings at our core and emphasizing similarities helps kids relate to one another. The more we can relate to each other the more understanding, compassion and interest we can develop. This is true in any teaching context across all different ages. What is something that the kids have in common? Are they both learning something new they could share with each other? Are they the same age? Go to the same school? Or like the same activities?
9. Learn about disabilities together.
As kids get older they are able to ask more complex questions and are hoping to get more complex responses. Take your kids questions as opportunities to learn about different disabilities together. What do you know about Downs Syndrome? Autism Spectrum Disorder? Cerebral Palsy? Sensory Processing Disorder? If your child asks about one of these and you don't feel prepared to answer your child's question in the moment you can always say, " I'm not sure. I will think about it and get back to you." or " I don't' know much about Cerebral Palsy, let's learn more about it together."
10. Facilitate conversation.
No matter the age, social interaction with kids and teens stems from having shared experiences together. In school settings taking classes together, participating in an after school club together or sport create these opportunities. Outside of school, kids interact with each other in places like the playground. For some kids, making a friend on the playground is easy. For others, and many children with disabilities this is not as easy. Adults can help kids with and without disabilities talk to each other, to help them find common ground, understand different forms of communication, slow down a conversation if kids need more time to process or to help the kids really hear what the other said.

Have questions, comments or feedback about this blog you'd like to share with us? Send us an email to hannah@seattleplaygarden.org

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10 Strategies for Talking to Kids About Disability - The Seattle PlayGarden

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Whether it is a person who uses a wheelchair that you see in the grocery store, a child in their class that has Autism, or a sibling with ADHD your child has someone in their life that has a disability that they might have questions about.

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The Power of Positive Parenting | Patient and Family Education | UC Davis Children Hospital

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The Power of Positive Parenting with PRIDE Skills: Praise, Reflection, Imitation, Description and Enjoyment.

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Support groups for survivors and caregivers are key to recovering from stroke. Support groups connect you with others who have similar stories. It's where you will find new friends, support, hope and encouragement as you embark on your post-stroke journey.
Find a stroke support group in your area by using our Stroke Group Finder:

1. Enter your zip code.

2. Enter mileage radius.

3. Your search will display registered stroke groups near you.

Once a group or list of groups appears, you may click on any group for more details.

Many groups continue to experience difficulties post-pandemic. Some had to suspend meetings or change the format of their meetings. It's important that you use the contact information provided to check for meeting schedule changes before trying to attend any meeting. But the good news is that more groups are forming or restarting, so check back frequently as new groups register regularly.

If you're a group leader and would like to update your information or register your group, visit our Support Group Leaders section.

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American Stroke Association Stroke Support Group Finder

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National Suicide Prevention Lifeline, Call (800) 273-8255, Chat with Lifeline 

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National Suicide Prevention Lifeline, Call (800) 273-8255, Chat with Lifeline 

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Traumatic brain injury affects different people in different degrees, but everyone with TBI experiences similar emotions. Dealing with TBI is challenging for both the patient and his or her family, but sharing your experiences with people who have had similar experiences can help. TBI support groups provide the opportunity to make friends and learn more about... Read More

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Physical Rehabilitation Support Group list

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Physical Rehabilitation Support Group list

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University of Utah Health | University of Utah Health

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Aphasia Group at Rocky Mountain University (Provo, UT) 

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Aphasia Group at Rocky Mountain University (Provo, UT) 

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Contact the Center for Communication Disorders

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Treating Aphasia With Communication Therapy | Rocky Mountain University

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The Center for Communication Disorders (CCD), located on the Rocky Mountain University (RMU) campus in Provo, Utah, is a free clinic that provides exceptional speech-language pathology services to members of the community, particularly the underserved and uninsured. One of the specialties of the clinic is assisting individuals with acquired communication issues like aphasia.

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LAS Young stroke survivors support group

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LAS Young stroke survivors support group

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Join the experts at the Sugar House Health Center of the University of Utah for a free TBI support group. The group meets every 4th Tuesday from 6:15 to 7PM at 1280 East Stringham Avenue, Salt Lake City, UT 84106 in the 3rd Floor Conference Room.

Join the experts at the Sugar House Health Center of the University of Utah for a free TBI support group. The group meets every 4th Tuesday from 6:15 to 7PM at 1280 East Stringham Avenue, Salt Lake City, UT 84106 in the 3rd Floor Conference Room.

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Traumatic Brain Injury Support Group meets 4th Tue of each month

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Join the experts at the Sugar House Health Center of the University of Utah for a free TBI support group. The group meets every 4th Tuesday from 6:15 to 7PM at 1280 East Stringham Avenue, Salt Lake City, UT 84106 in the 3rd Floor Conference Room.

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Helping those with brain injury thrive.

Resources about Brain Injury

Our Goals, Vison & Commitment

Call to Schedule an Appointment

with a Resource Facilitator

Join Us

Create a world where everyone with brain injury thrives.

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Brain Injury Assistance, Education, and Advocacy | Brain Injury Alliance of Utah

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The Brain Injury Alliance of Utah is a non-profit organization that focuses helping those with brain injury. We facilitate resources to help those with brain injury, their family, their friends, and caregivers thrive. We provide education on brain injury and brain injury prevention.

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Care partners have consistently reported needing infor- mational support throughout the rehabilitation process for their loved one. Le Dorze and Signori (2010)

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Angelika Alonso, Academic Editor

Abstract

Stroke in young adults is associated with significant morbidity, and its prevalence is rising in the United States. This is partly attributed to a rise in the prevalence of traditional risk factors including hypertension, hypercholesterolemia, obesity, diabetes mellitus, smoking and heart disease. In addition, there are non-modifiable risk factors comprising migraine, pregnancy and postpartum state, illicit drug use, oral contraceptives and hypercoagulable state. The mechanisms causing stroke in young adults are unique and include cervical dissection, cardioembolic phenomenon, vasculitis and vasculopathy, connective tissue disease, patent foramen ovale and cerebral venous thrombosis. The diagnosis of stroke in the young population can be challenging given its myriad clinical presentations. In this document, we provide an overview of the epidemiology of stroke in young adults, explore mechanisms that may explain increasing rates of stroke in this population, and provide a critical updated overview of the existing literature on the management and prevention of stroke in young adults.

Keywords: stroke, mechanisms, dissection

1. Introduction

Cardiovascular diseases are the leading cause of global mortality and are associated with reduced quality of life [ 1, 2]. Stroke is the second leading cause of death globally, and is recognized as the leading etiology of long-term physical and cognitive disability in adults [ 3, 4]. In the United States (US), stroke is the fifth leading cause of death, and the economic burden of treatment and post-stroke care is substantial [ 5, 6].

Traditionally perceived as a disease of older age, the increasing burden of stroke as a public health issue in younger individuals is alarming, with stroke in individuals <50 years of age accounting for ~10% of all strokes [ 7]. In the US, the average age at stroke onset is decreasing, and stroke incidence and hospitalization rates are rising among young people [ 8]. Although mortality among young patients with stroke is lower than in the elderly, it is significantly higher than in the age-adjusted general population [ 9]. Amongst the survivors, many deal with psychosocial consequences as a substantial proportion cope with sequelae including permanent cognitive deficits, epilepsy, and chronic debilitating fatigue with poor functional outcomes [ 10, 11, 12].

In this review article, we provide a critical updated overview of the existing literature on the epidemiology, risk factors, mechanisms, management and prevention of stroke in young adults.

2. Epidemiology

The prevalence of stroke in young adults, defined as age < 50 years, is estimated to be about 10-14% of all strokes [ 13, 14]. Unlike stroke in older adults, the incidence of ischemic stroke among young adults is rising globally. In the US, the incidence of stroke for adults aged 20-44 has increased from 17 per 100,000 US adults in 1993 to 28 per 100,000 US adults in 2015 [ 15]. In a nationwide cohort of >15,000 patients from Netherlands, the incidence of any stroke in young adults increased from 14.0/100,000 person years in 1998 to 17.2/100,000 person years in 2010 ( p < 0.001), driven by an increase in those aged over 35 years and ischemic stroke incidence (46%) [ 16]. A French study that examined >4500 patients over the course of 27 years concluded that for adults <55 years old, the incidence for ischemic strokes increased from 11.6 per 100,000 adults in 1985-1993 to 20.2 per 100,000 adults in 2003-2011 [ 17]. Alarmingly high trends have been noted in the incidence of stroke in young adults in low- and middle-income countries. A population-based study from India estimated that in the period of 2003-2005, the average annual incidence of stroke was only 4 per 100,000 people in patients <40 years, while it was exceptionally higher, at 41 per 100,000, for the 40-44 age group [ 18].

Young women are at a disproportionately increased risk of ischemic strokes compared with their male counterparts. A recent meta-analysis of 19 studies that reported on sex-specific stroke incidence among young adults found that there were 44% more women ≤35 years old with ischemic strokes than men (incidence rate ratio, 1.44 [1.18-1.76], I2 = 82%) [ 19]. This gap seemed to narrow in young adults 35 to 45 years old, as there was no significant difference in stroke incidence noted in this age group (incidence rate ratio, 1.08 [0.85-1.38], I2 = 95%) [ 19]. The prevalence of atherosclerotic disease is lower in premenopausal women and rises in postmenopausal women, and therefore the role of nonatherosclerotic and nontraditional risk factors in young women may be more important in ischemic stroke [ 20]. A better understanding of these sex differences is important to be able to implement strategies to prevent and treat strokes in this age group more effectively.

The incidence of ischemic strokes in young adults has been reported to be higher among Black and Hispanic individuals compared with white individuals. A population-based incidence study that examined all cases of first stroke in Northern Manhattan from 1993 to 1997 found that stroke in the young was greatest for Black (relative risk, RR 2.4; 95% CI, 0.8-6.7) and Hispanic people (RR 2.5; 95% CI, 1.1 to 5.8) compared with white people [ 21]. A Baltimore-based study showed that Black people had higher rates of both ischemic and hemorrhagic (intracerebral hemorrhage) strokes than white people [ 22]. The cerebral infarction rates per 100,000 were 22.8 for Black males, 10.3 for white males, 20.7 for Black females and 10.8 for white females. The intracerebral hemorrhage rates per 100,000 were 14.2 for Black males, 4.6 for white males, 4.8 for Black females and 1.5 for white females. While studies have shown no racial disparity in access to care as demonstrated by the equal administration of tPA and mechanical thrombectomy and non-significant differences in length of stay, the early poststroke functional outcomes remained worse in Black and Hispanic patients [ 23]. Black patients also have the highest 30-day poststroke mortality [ 24, 25].

3. Risk Factors

The risk factors for stroke in young adults are largely similar to those for stroke in the general population, which are traditional factors including hypertension, hypercholesterolemia, obesity, diabetes mellitus, smoking and heart disease. However, there are additional factors that are unique to the young population and further potentiate stroke risk, including migraine, oral contraceptive use, pregnancy and post-partum state, patent foramen ovale and recreational drug use ( Figure 1 ).

3.1. Traditional Modifiable Risk Factors

The rise in the incidence of stroke in young adults has been accompanied by an increase in modifiable vascular risk factors. In fact, the prevalence of having multiple traditional stroke risk factors among young adults with ischemic stroke has doubled over the decade from 2003-2004 through 2011-2012 [ 26]. Atherosclerotic disease accounts for about one third of ischemic strokes in young adults aged 15 to 45 years [ 26, 27]. Notably, both small- and large-vessel disease have been identified as an increasing cause of ischemic stroke beginning at age 30 years [ 28]. Similarly, hypertension, hypercholesterolemia, obesity, diabetes mellitus and smoking are on the rise, contributing to increased stroke risk.

3.2. Migraine

Migraine has been associated with both ischemic and hemorrhagic strokes in young adults [ 29]. In a meta-analysis that investigated the association between migraine and cardiovascular disease including stroke, migraine was associated with a twofold increased risk of ischemic stroke (RR 1.73; 95% CI, 1.31 to 2.29), and the risk was significantly higher among people who had migraine with aura (2.16, 1.53 to 3.03) compared with people who had migraine without aura (1.23, 0.90 to 1.69; p= 0.02) [ 29]. The relative risk for women was increased (RR 2.08, 95% CI 1.13 to 3.84) but not for men (RR 1.37, 95% CI 0.89 to 2.11), and the risk was further magnified by age < 45 (RR 3.95, 95% CI 2.21 to 6.04), smoking (RR 9.09, 95% CI 4.22 to 19.34) and oral contraceptive use (RR 7.02, 95% CI 1.51 to 32.68). Migraine predisposes patients to endothelial dysfunction and increased platelet activation and aggregation, thereby triggering key pathogenetic mechanisms of atherosclerosis and potentiating cerebral ischemia.

3.3. Pregnancy and Post-Partum

Pregnancy and the postpartum period are associated with an increased risk of ischemic stroke and cerebral hemorrhage. The risk of stroke among pregnant and postpartum women is 3 times increased when compared with nonpregnant women of similar age [ 30]. Preeclampsia and stroke have numerous risk factors in common, including metabolic syndrome, obesity, hypercoagulable states, endothelial dysfunction and accentuated inflammatory response [ 31].

3.4. Illicit Drug Use

The use of illicit and recreational drugs is on the rise among young adults [ 32]. Illicit drug users have an increased risk of both hemorrhagic and ischemic stroke. In the Baltimore-Washington Cooperative Young Stroke Study that included 428 patients 18 to 44 years old with first stroke, the use of illicit drugs was found to be the fifth most common risk factor for ischemic stroke (9.4% of the study population) [ 33]. Cerebral vasospasm is an important mechanism of cocaine-induced stroke. The most frequent mechanism of stroke in heroin addicts is cardioembolism due to infective endocarditis.

3.5. Oral Contraceptives

The role of oral contraceptive pills (OCPs) in stroke in young adults is controversial. The earliest meta-analysis of 16 studies from 1960 to 1999 found an elevated risk of stroke in young women who used high-dose estrogen-containing OCPs (RR 2.75, 95% CI 2.24-3.38), while progestin-only OCPs did not increase stroke risk [ 34]. A Danish study comprising 1,626,158 women showed that while the absolute risk of thrombosis with the use of hormonal contraception was low, the risk was increased by a factor of 0.9 to 1.7 with oral contraceptives that included ethinyl estradiol at a dose of 20 μg and by a factor of 1.3 to 2.3 with those that included ethinyl estradiol at a dose of 30-40 μg [ 35]. OCPs are associated with increased procoagulant factors, including fibrinogen, prothrombin and factors VII and VIII, and a decrease in the levels of antithrombin and tissue factor pathway inhibitor. In addition, OCPs, through the induction of hypertension, can increase the risk of hemorrhagic strokes [ 36].

3.6. Hypercoagulable States

Hypercoagulable states are common in young patients with ischemic stroke. Antiphospholipid syndrome, an autoimmune disease that occurs 5 times more often in young women, is present in 10% of stroke patients <50 years of age [ 37]. In a large multicenter population-based case-control study, a significantly increased risk of ischemic stroke was found in association with this condition in women under 50 years of age (OR 43.1, 95% CI 12.2-152.0) [ 38]. Antiphospholipid syndrome occurs frequently among individuals with systemic lupus erythematosus, and several studies have shown that stroke risk is ~2 times higher among those with systemic lupus erythematosus, particularly at younger ages [ 39]. Sickle cell disease is another hypercoagulable condition, and about one quarter of patients with sickle cell disease have had a stroke by age 45 [ 40]. In addition, protein C and S deficiency (~6%), factor V Leiden (~6), antithrombin III deficiency (~7%) and prothrombin mutation (~4%) are other common prothrombotic states that increase the risk of stroke [ 37].

4. Mechanisms

There are several mechanisms of stroke in young adults, including arterial, cardiac and venous ( Figure 2 ). Extracranial arterial dissection is a significant contributor to the stroke burden in young adults, accounting for 10-25% of strokes in patients <45 years old, but only for 2% of all ischemic strokes [ 41]. The highest incidence of dissections lies in the fifth decade, and men and women are about equally affected [ 42]. While most arterial dissections occur spontaneously, some are associated with trauma and several genetic and connective tissue disorders such as fibromuscular dysplasia, Ehlers-Danlos syndrome and Marfan syndrome. Cervical artery dissections, in general, have a favorable prognosis because of the young age of the patients.

Arterial thrombosis is the predominant mechanism of stroke in young patients with an underlying prothrombotic state. There are several other rare but well-known vasculopathic conditions that can lead to ischemic and/or hemorrhagic strokes, including Fabry disease, Moyamoya disease, reversible cerebral vasoconstriction syndrome, giant cell arteritis, Takayasu arteritis, primary cerebral arteritis and radiation-induced arteritis. Large artery atherosclerosis and small-vessel diseases are a more common cause of stroke after the age of 35 years. In addition, celiac disease has recently been described as a hypercoagulable condition that might be associated with increased risk for stroke via several mechanisms, one including embolism and another due to cerebral sinovenous thrombosis [ 43].

With regard to cardiac causes, cardioembolism is an important mechanism of stroke in young adults. Atrial fibrillation/flutter detected on electrocardiogram and/or thrombus detected in any cardiac chamber would point towards this mechanism in a patient presenting with stroke. However, approximately 20% to 40% of these young patients with stroke are classified as having embolic strokes of undetermined source, because the underlying stroke etiology cannot be reliably identified despite recommended diagnostic workup. Patent foramen ovale is present in up to 45% of young patients with cryptogenic stroke, and has been independently associated with cryptogenic stroke in young adults (OR 3.70; 95% CI, 1.42 to 9.65; p = 0.008) [ 44].

In addition, human immunodeficiency virus infection has also been described as one of the mechanisms of stroke [ 45].

With regard to venous etiology, cerebral venous thrombosis accounts for 0.5-1.0% of unselected stroke admissions and is about three times more common in women than in men,, partly due to its association with pregnancy and postpartum as well as with the use of OCPs.

5. Clinical Suspicion and Management

The timely diagnosis of stroke is important to ensure prompt treatment and reduce morbidity and mortality. Although the typical presentation of ischemic stroke in young adults is similar to that in older adults, it is the atypical symptoms that can pose challenges for diagnosis [ 46]. Atypical symptoms such as neuropsychiatric symptoms, acute confusional state, chorea and dizziness can be difficult to diagnose as they are non-localizing. Other atypical symptoms include severe nausea, vomiting, cranial neuropathies, visual symptoms, pure sensory loss and monoparesis [ 47].

Clinical clues can help identify the etiology of stroke. Persistent headache or neckache after recent minor trauma or sudden neck movements, including chiropractic neck manipulation or vigorous exercise, are associated with cervical arterial dissection. Similarly, a painful Horner syndrome, or coexisting cranial neuropathies, should always raise suspicion for dissection, since all cranial nerves except the olfactory nerve may be affected by dissection. Computed tomographic or magnetic resonance angiography is the diagnostic modality of choice. The treatment is antiplatelet therapy.

Persistent headache, particularly thunderclap headache, with or without focal neurological findings in young adults with hypercoagulable condition, pregnancy, puerperium or OCP use could point towards cerebral venous thrombosis. A history of arterial or venous thrombosis and history of pregnancy complications (e.g., three or more miscarriages, intrauterine death, premature birth due to high blood pressure, pre-eclampsia, HELLP syndrome or placenta failure) should lead to suspicion for antiphospholipid antibody syndrome. The treatment is antithrombotics.

The presence of atypical symptoms including earache, behavioral and cognitive symptoms, encephalopathy, seizures, fever, weight loss, rash, visual problems and other organ involvement (e.g., lungs, skin, joints) should raise suspicion for vasculitis as the underlying etiology for stroke. Laboratory workup including raised erythrocyte sedimentation rate or C-reactive protein and positive autoimmune/inflammatory workup is suggestive. CT with contrast and/or MRI often reveals multiple bilateral infarctions, at various stages, usually affecting different vascular territories and meningeal enhancement. Angiography shows focal or multifocal segmental narrowing of branches of cerebral arteries or occlusions.

Recurrent thunderclap headaches lasting 1-3 h with or without focal neurological symptoms or seizures in a patient with uncontrolled hypertension should raise suspicion for reversible cerebral vasoconstriction syndrome. Angiography is the gold standard for diagnosis, revealing segmental narrowing of branches of cerebral arteries (string of beads). The treatment is blood pressure control.

For embolic stroke, electrocardiography, cardiac telemetry and transthoracic echocardiogram with bubble study are commonly performed to investigate abnormal heart rhythms, cardiac sources of emboli and patent foramen ovale. The treatment is anticoagulation for atrial fibrillation to mitigate the risk of thromboembolism.

In addition, polysubstance abuse is more prevalent in young adults, and hence comprehensive drug screening is crucial for a young patient presenting with stroke.

6. Prevention

Ischemic stroke is a condition associated with up to four times higher mortality in young adults compared to healthy individuals. The socioeconomic and emotional burdens of stroke cannot be ignored, as up to one third of ischemic stroke patients remain unemployed for up to eight years following the episode [ 6]. Therefore, a comprehensive multidisciplinary approach is necessary to reduce the risks of primary and secondary events. Intensive blood pressure control, lifestyle modification, dietary changes and better glycemic control may be beneficial for young adults. Particular attention should be given to discouraging drug use and promoting smoking cessation.

Active smoking is associated with a dose-dependent increase in the risk of strokes, and this risk remains high in young stroke survivors due to lower rates of quitting smoking compared to older adults [ 48]. A comprehensive program consisting of evidence-based individualized smoking cessation strategies, including effective pharmacotherapy, motivational counseling, cost-effective intervention provision and effective surveillance strategies, may benefit in terms of achieving higher rates of smoking cessation and abstinence.

Hypertension is one of the leading modifiable risk factors for stroke. A reduction in blood pressure provides the greatest benefit in reducing the risk of stroke compared to other clinical outcomes such as coronary events [ 49]. Studies have shown that individuals with blood pressure significantly higher than the goal may benefit most from blood pressure reduction [ 50]. Moreover, reducing either isolated systolic or diastolic blood pressure has also been found to provide benefits in terms of reducing the risk of stroke. Clinical guidelines recommend targeting blood pressure levels of ≤140/≤90 mmHg in non-diabetic patients and ≤130/≤80 mmHg in patients with diabetes mellitus or those who can tolerate it without severe adverse effects [ 51].

Diabetes mellitus is another modifiable risk factor that significantly increases the risk of stroke in young adults. Recent studies have found that young adult stroke patients with a history of diabetes mellitus are at higher risk of in-hospital mortality and long-term care facility admissions compared to their counterparts without diabetes [ 31]. We believe that glycemic control should be individualized and that young adults with a longer life expectancy and minimal cardiovascular disease burden may benefit from more stringent glycemic control if it can be achieved without recurrent hypoglycemia.

Obesity is also associated with a higher risk of stroke, and its prevalence is higher in diabetic patients [ 52]. Lifestyle modifications such as physical exercise for at least three to four sessions per week of moderate to vigorous intensity with each session lasting 40 min, salt restriction to <1.5 g/d and DASH and Mediterranean-type diets are recommended to reduce weight and achieve better glycemic control. Certain antidiabetics, including metformin, pioglitazone and semaglutide, have been shown to reduce the risk of stroke [ 53]. In conclusion, an individualized strategy that includes lifestyle modifications and pharmacotherapy can be adopted to achieve the best clinical outcomes for young adults at risk of stroke due to diabetes mellitus and obesity.

Treatment with statin therapy is recommended for primary prevention in patients estimated to have a high 10-year risk of cardiovascular events. A consensus is yet to be reached on targeting the low-density lipoprotein (LDL) levels in preventing stroke recurrence of atherosclerotic origin. Statins are the recommended first-line therapy, and these can be combined with ezetimibe for better lipid control and the achievement of LDL goals. Statins have the advantage of pleotropic effects in terms of stabilizing atherosclerotic plaques in addition to lowering the LDL levels [ 54]. While a detailed discussion of the mechanisms of different pharmacotherapies is beyond the scope of this review, we recommend a more aggressive strategy for controlling dyslipidemia in young stroke survivors to prevent the risk of future recurrent strokes.

Non-pregnant females of reproductive age who experience migraines with aura are at a higher risk for stroke, which is further elevated when these individuals use estrogen-based oral contraceptive pills (OCPs) and smoke [ 34]. It is crucial to develop an effective strategy that involves counseling on smoking cessation, alternative methods of birth control and effective management of migraine headaches in this population. Furthermore, ergots and triptans are not recommended for the treatment of migraines in individuals who have suffered an ischemic stroke.

7. Prognosis

Older patients are at a higher risk for short-, intermediate- and long-term morbidity and mortality from stroke compared with younger patients <50 years old [ 55]. However, studies have also shown that older patients are less likely to be treated with guideline-recommended stroke therapies than younger patients [ 56]. Older patients also demonstrate more severe stroke deficits at presentation and have a higher in-hospital case mortality than younger patients [ 57, 58]. Potential contributing factors for the excess mortality evident in older patients in these data include increased stroke severity, greater frequency of atrial fibrillation and higher prevalence of medical comorbidities [ 59].

8. Conclusions

The incidence of stroke in young adults is on the rise globally. While this could be attributed to increases in the traditional modifiable risk factors including hypertension, diabetes mellitus, obesity and hypercholesterolemia, other nontraditional factors also account for this. There are different stroke mimickers that can potentially delay the diagnosis of stroke. Timely diagnosis and prompt treatment are important. Prevention, both pharmacological and nonpharmacological, as well as primary and secondary, is the key.

Funding Statement

This research received no external funding.

Author Contributions

Conceptualization, S.B. and Z.B.; methodology, S.B.; software, S.B.; validation, S.B., S.Y. and Z.B.; formal analysis, S.B.; investigation, S.B.; resources, S.B. and Z.B.; data curation, S.B. and Z.B.; writing-original draft preparation, S.B.; writing-review and editing, S.B., S.Y. and Z.B.; visualization, S.B.; supervision, S.B. All authors have read and agreed to the published version of the manuscript.

Institutional Review Board Statement

Not applicable.

Informed Consent Statement

Not applicable.

Data Availability Statement

Not applicable.

Conflicts of Interest

The authors declare no conflict of interest.

Footnotes

Disclaimer/Publisher's Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content.

References

1. GBD 2017 Causes of Death Collaborators. Roth G.A., Abate D., Abate K.H., Abay S.M., Abbafati C., Abbasi N., Abbastabar H., Abd-Allah F., Abdela J., et al. Global, regional, and national age-sex-specific mortality for 282 causes of death in 195 countries and territories, 1980-2017: A systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2018;392:1736-1788. [[ PMC free article] [ PubMed] Google Scholar]

4. Virani S.S., Alonso A., Benjamin E.J., Bittencourt M.S., Callaway C.W., Carson A.P., Chamberlain A.M., Chang A.R., Cheng S., Delling F.N., et al. Heart disease and stroke statistics-2020 update: A report from the American Heart Association. Circulation. 2020;141:e139-e596. [[ PubMed] Google Scholar]

5. Murphy S.L., Xu J., Kochanek K.D., Arias E. mortality in the United States. NCHS Data Brief. 2017;2018:1-8. [[ PubMed] Google Scholar]

22. Kittner S.J., McCarter R.J., Sherwin R.W., Sloan M.A., Stern B.J., Johnson C.J., Buchholz D., Seipp M.J., Price T.R. Black-white differences in stroke risk among young adults. Stroke. 1993;24((Suppl. S12)):l13-l15. [[ PubMed] Google Scholar]

Articles from Journal of Clinical Medicine are provided here courtesy of Multidisciplinary Digital Publishing Institute (MDPI)

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Stroke in young adults is associated with significant morbidity, and its prevalence is rising in the United States. This is partly attributed to a rise in the prevalence of traditional risk factors including hypertension, hypercholesterolemia, obesity, ...

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Traumatic brain injury (TBI) has been called a “signature injury” of Iraq and Afghanistan Conflicts.1 The Defense and Veterans Brain Injury Center (DVBIC) report nearly 350,000 incident diagnoses of TBI in the U.S. military since 2000.2 

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Traumatic brain injury (TBI) has been called a “signature injury” of Iraq and Afghanistan Conflicts.1 The Defense and Veterans Brain Injury Center (DVBIC) report nearly 350,000 incident diagnoses of TBI in the U.S. military since 2000.2 

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YoungStroke: YoungStroke is a global community dedicated to young stroke survivors and their families. They offer online support groups, educational resources, and advocacy initiatives. You can find their website at https://www.youngstroke.org/.

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YoungStroke: YoungStroke is a global community dedicated to young stroke survivors and their families. They offer online support groups, educational resources, and advocacy initiatives. You can find their website at https://www.youngstroke.org/.

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American Stroke Association (ASA): The ASA provides online resources and support for stroke survivors of all ages. While not exclusively for young stroke survivors, their online community forums and resources can still offer valuable support and information. Visit their website at https://www.stroke.org/.

Reddit: Reddit hosts various online communities (subreddits) where individuals can connect and discuss topics related to stroke. Subreddits like r/stroke may have threads or discussions specifically for young stroke survivors. Make sure to explore and engage with these communities respectfully.

Facebook Groups: Facebook hosts numerous support groups for stroke survivors, caregivers, and advocates. You can search for groups using keywords like "young stroke survivors," "young stroke support," or "young stroke warriors" to find communities specifically tailored to younger individuals.

Inspired Living with a Disability (ILWD): ILWD is an online community that offers support and resources for individuals living with disabilities, including those resulting from stroke. They provide a platform for connecting with others, sharing stories, and accessing informative content. Visit their website at https://www.inspiredlwd.org/ to learn more.

StrokeNet: StrokeNet is an online platform that provides support and resources for stroke survivors and their caregivers. While not exclusively for young stroke survivors, they offer a supportive environment for sharing experiences and seeking advice. Visit their website at https://www.strokenet.org/ for more information.

Local Healthcare Providers and Organizations: Local hospitals, rehabilitation centers, and healthcare providers may offer online support groups or virtual events for stroke survivors. Reach out to healthcare professionals in your area to inquire about available resources and support options.

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The National Child Traumatic Stress Network

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Even in the closest of families, it is sometimes hard to remember that family members may have different reactions to the same traumatic event.

The following resources on Families and Trauma were developed by the NCTSN.

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All families experience trauma differently. Some factors such as a child's age or the family's culture or ethnicity may influence how the family copes and recovers from a traumatic event. Trauma changes families as they work to survive and adapt to their circumstances and environment.

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“What has been helpful to you to parent your child since your stroke?” Onesurvivor responded:“The support that I've received from family and friends really helped a lot. I hada great support system along the way that helped me get through everything and justbeing there. My mom was up here for, she stayed for two weeks. And then my motherin-law came, and she stayed for two weeks. So just being here with me and then justkind of emotional support” (Mother, age 29 at time of stroke). 

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“What has been helpful to you to parent your child since your stroke?” Onesurvivor responded:“The support that I've received from family and friends really helped a lot. I hada great support system along the way that helped me get through everything and justbeing there. My mom was up here for, she stayed for two weeks. And then my motherin-law came, and she stayed for two weeks. So just being here with me and then justkind of emotional support” (Mother, age 29 at time of stroke). 

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1.     Harris Walker, G., Oyesanya, T. O., Hurley, A., Sandhu, S., Liu, C., Mulla, M., & Prvu Bettger, J. (2021). Recovery experiences of younger stroke survivors who are parents: A qualitative content analysis. Journal of Clinical Nursing, 30(1–2), 126–135. https://doi-org.rmuohp.proxy.liblynxgateway.com/10.1111/jocn.15529

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Centers for Disease Control and Prevention

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Find facts and statistics about stroke in the United States.

Stroke statistics

In 2021, 1 in 6 deaths from cardiovascular disease was due to stroke.¹

Every 40 seconds, someone in the United States has a stroke.² Every 3 minutes and 14 seconds, someone dies of stroke.¹

Every year, more than 795,000 people in the United States have a stroke. About 610,000 of these are first or new strokes.²

About 185,000 strokes-nearly 1 in 4-are in people who have had a previous stroke.²

About 87% of all strokes are ischemic strokes, in which blood flow to the brain is blocked.²

Stroke-related costs in the United States came to nearly $56.5 billion between 2018 and 2019.² This total includes the cost of health care services, medicines to treat stroke, and missed days of work.

Stroke is a leading cause of serious long-term disability.² Stroke reduces mobility in more than half of stroke survivors age 65 and older.²

Stroke statistics by race and ethnicity

Stroke is a leading cause of death for Americans, but the risk of having a stroke varies with race and ethnicity.

Risk of having a first stroke is nearly twice as high for non-Hispanic Black adults as for White adults,2 and non-Hispanic Black adults and Pacific Islander adults have the highest rates of death due to stroke.¹

The death rate for stroke increased from 38.8 per 100,000 in 2020 to 41.1 per 100,000 in 2021.¹

Stroke risk varies by age

Stroke risk increases with age, but strokes can-and do-occur at any age.

In 2014, 38% of people hospitalized for stroke were less than 65 years old.³

Early action is important for stroke

Know the warning signs and symptoms of stroke so that you can act fast if you or someone you know might be having a stroke. The chances of survival are greater when emergency treatment begins quickly.

In one survey, most respondents-93%-recognized sudden numbness on one side as a symptom of stroke. Only 38% were aware of all major symptoms and knew to call 9-1-1 when someone was having a stroke.⁴

Patients who arrive at the emergency room within 3 hours of their first symptoms often have less disability 3 months after a stroke than those who received delayed care.⁴

Americans at risk for stroke

High blood pressure, high cholesterol, smoking, obesity, and diabetes are leading causes of stroke. One in 3 U.S. adults has at least one of these conditions or habits. 2

Learn how to take steps to prevent stroke.

What is CDC doing about stroke?

CDC and its partners are leading national initiatives and programs to reduce rates of death and disability caused by stroke and to help women live longer, healthier lives.

CDC's Division for Heart Disease and Stroke Prevention (DHDSP) provides resources to all 50 states to address heart disease and stroke, as well as helping lead or support the following:

The WISEWOMAN program provides low-income, underinsured, or uninsured women with chronic disease risk factor screening, lifestyle programs, and referral services in an effort to prevent heart disease and strokes.

The Paul Coverdell National Acute Stroke Program funds states to measure, track, and improve the quality of care for stroke patients. The program works to reduce death and disabilities from stroke.

The Million Hearts® initiative, which is co-led by CDC and the Centers for Medicare & Medicaid Services, works with other federal agencies and private-sector partners to raise awareness about heart disease and stroke and prevent attacks and strokes.

More information

CDC

Other organizations

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Read statistics about how race, ethnicity, age, and other risk factors can contribute to a stroke. Get the facts from CDC.

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Introduction

Being a parent can be one of the most rewarding experiences in a person's life. It can also be one of the most challenging experiences. Parenting requires many skills, such as good communication, patience, attention to detail, and a good memory. Parents also need to be flexible and able to handle complex emotions. Juggling the responsibilities of being a parent with other life demands can be hard for anyone. But having a traumatic brain injury (TBI) can make it especially difficult. This factsheet includes information about how being a parent with a TBI can be difficult and offers suggestions for overcoming parenting challenges.

Keeping Everyone Safe and Healthy

Keeping your family safe and healthy is one of your top priorities as a parent. A parent's biggest fear is that they are not keeping their kids safe. Sometimes after a TBI, a parent may lose confidence in their ability to keep their kids safe. But in most cases, they are still very capable. Many books and websites provide tips on how to make a home safe, how to protect your child from danger, and what children need to be healthy. The following tips can help you care for your child, in spite of coping with TBI-related changes:

Do things a little different. Know yourself and what you can and cannot do. If your body moves differently than it did before the TBI, you may need to change how you carry your infant or hold your child's hand when you cross the street. If your vision has changed, you will need to do some childcare tasks differently. Talk to an occupational or physical therapist about alternate ways to do some tasks and devices that can help you. For example, you may use a stroller in your home or have your child hold onto a rope or strap that is attached to your belt when you cross the street.

Get input from others. It is a good idea to talk to another adult you trust about how to childproof your home and come up with rules for safety. This can help you think of ideas; it can also boost your confidence.

Set up a healthy routine. Children of all ages need a good sleep schedule, healthy food, and regular checkups with their doctors. To help you keep track of these, use daily or weekly schedules and checklists.

Set rules in your home that encourage good habits. For example, you might not allow cell phones in the bedroom at bedtime. Use your pediatrician as a resource and support in how to care for your child.

If you have complications from the TBI, such as seizures, create a plan for what to do if a crisis occurs. For example, you may need a medical alert button. You may also need to teach your child to dial 911 in case of crisis.

Learn to recognize when you need help. Sometimes being a good parent means knowing when you can't keep your child safe on your own. When this happens, ask another trusted adult to help look after your child.

Supporting Your Child's Education

During childhood and adolescence, school is a central focus of life for children and their parents. School educates children for the future and teaches them social skills. As a parent, you want to support them as they learn to be independent and help them succeed. It can be hard to keep track of the schoolwork, due dates, and meetings. You are expected to communicate with teachers and other parents. Sometimes you have to manage conflicts between your child and other children or teachers. Your child will have times when they feel proud and times when they feel frustrated.

Here are some tips to help you interact with the school and support your child:

You may wonder if you should disclose your TBI. You don't need to share this information with everyone. But it is important to let the teacher or other main contact at school know if you need them to communicate differently with you. For example, tell them if you need them to highlight the most important information, or if you need to get requests through email and not in your child's backpack.

There are many forms to complete. If this is hard for you, set up a way to complete forms with your family and friends or with the school. (Maybe they can be done verbally or carried over from year to year.)

Checklists can be helpful for you and your child. Teachers often provide these for students when they start school. As children get older, they encourage kids to make their own checklists. Help your child make a checklist of assignments and tests, with dates. Post this where you can both see it and review it with your child each day. You can also list any materials that your child needs for projects. As they get older, put your child in charge of making the checklists.

Children will reach a point where they are studying things that their parents don't understand. Don't worry if you don't fully understand what they are studying. You can still help them study. First, be supportive and encourage them to meet the deadlines on their assignment checklist. Second, make sure they have the tools they need. This may include books, teacher resources, and a quiet place to study and do homework. This may include monitoring time spent on the Internet that is not related to schoolwork.

Is your child struggling academically? Are they frustrated or are their grades poor? Sometimes they just need you to listen to their frustrations. However, if your child can't manage an assignment, guide them to ask their teachers for help. As they get older, their schools may also have resource centers and tutors. Remember that you have a community of support for your child, including your social supports and the school.

For young children, reading together is important. If your TBI makes it hard for you to read, ask your child to read to you. You can also share books with pictures, while encouraging your child to create their own story from the pictures.

Managing Your Child's Activities

As a parent, you must coordinate many activities for your child. These include doctors' appointments, social activities with family and friends, and leisure activities, such as team sports, piano lessons, and scouts. TBI can make it hard for you to manage your child's activities. For example, fatigue may make it hard to start or continue a leisure activity. You may also have a hard time planning, organizing, and remembering activities. This can make it hard to keep track of activities, set up transportation, and help with events. Here are some tips:

Use a calendar or agenda to track appointments. Include when sign-ups are due, when and where practices and events are, and when you need to call for appointments. Take advantage of reminder calls offered by doctors' offices.

You will likely feel tired before your child does. Know your limits. Pace yourself. You will need to decide what you can help with and when to say no. Your child can do some activities without you.

Use checklists with your child to make sure you bring everything they need to the appointment/event.

Work with other parents. Working together can help you overcome expected and unexpected challenges. If there are things that you can't do, see if you can coordinate with other parents so that they do those tasks, and you do others. For example, if the other parent can drive, you can offer to bring sliced oranges to sports practice. For some, hiring help is an option.

Take note of changes in your child's interests after your injury or a change in your health. They may need encouragement or support to stay with activities that they enjoy.

Emotional Support for Your Child

You may think that forming an emotional bond with your child occurs naturally, but it takes work. As children go through different developmental stages, their interests change, along with how they interact with others. Over time, they grow into independent people with their own needs and likes. In addition to keeping up with their emotional changes, children need discipline and rules to keep them safe. Changes in thinking and emotions caused by TBI can make it hard to give them the structure and support they need. For some, TBI can make it hard to recognize their child's emotions, especially when they rely on facial expressions and body language. TBI can also affect your ability to recognize your own emotions and to monitor how you express them. Forming an emotional bond with others also requires your attention and mental energy. TBI can cause rapid mental fatigue and make it difficult to pay attention. So, after a long day, your ability to respond to your child's emotional needs may not be the same as before your TBI.

Here are some tips to help provide emotional support to your child:

Take time to listen. Set aside a regular time for check-ins. Check in with your children about how they are feeling. Ask "How has your day been?" If they respond with one-word answers, such as "good," gently probe for more detail with something like, "Can you tell me something that made you happy?"

If you have a young child who is learning new tasks, watch them and say aloud what they are doing. For example, if your child is playing with Legos, say, "You are putting the blue Legos together to make a train," or "You decided to build a tree." This lets your child know that you notice what they do and supports them.

Make a few simple rules. Writing them down can make them clearer to you and to your child. Written rules can help you communicate the rules consistently when you are under stress. Teach these rules by example. Children are more likely to follow what you do than what you tell them. Show them what you want them to do.

If you have trouble recognizing good behavior, work with another adult to identify what "good" looks like. Look for that behavior in your child and praise them for it.

If you find yourself losing your temper with your child, give yourself a time-out. If you make a mistake or hurt someone, apologize. Explain to them what you are doing. This is good way to be a role model for your child. Make notes about things that your child seems to take an interest in. When you are feeling alert, ask them to share a favorite song with you or ask them about their favorite sports team. Schedule an activity around their interests (e.g., a concert, shopping, or watching an online video). Let them know you care about what is important to them.

Talk to them about the consequences of their actions. Use language they can understand. For example, point out to a toddler that their friend is sad. Ask a teenager how an action affects a friendship and whether they want to keep the friendship.

When children are upset, it helps them and you to name the emotion. You can give them choices so they can pick the emotions that fit. For example, ask, "Are you feeling sad or are you feeling jealous?" Also share your emotions honestly when you can.

If you feel that your child is more distant since your TBI, talk to them about this. Let them know that you understand that your injury may be scary to them, and that it may have changed some things about you. Invite your child to share their feelings about this. Share your feelings about the TBI, too. You may also involve other family members to this discussion.

If your child is acting out, work with another adult who cares about your child to set rules. Also work with them to problem-solve difficult behavior issues.

If you think your child is struggling emotionally, get help. Are they withdrawn? Are they acting out a lot? Do their mood swings seem severe? Did their grades drop suddenly? Your pediatrician or your school can help direct you to get help from therapists, counselors, psychologists, etc.

Co-Parenting When Your Partner Has TBI

Co-parents may be together, separated, or no longer in a relationship. No matter what their status is, they may share responsibility for raising a child. Co-parents may have a mutual commitment to promote and support their child's healthy development from infancy through adulthood. Like parenting, co-parenting is hard work and can be stressful. It requires a lot of time, communication, and problem-solving, which is challenging for all parents and becomes even more so for a co-parent with a TBI.

There are many ways that you can help your co-parent with a TBI. Here are some tips:

Learn about TBI and its effects so that you can understand the mental, physical, and social challenges your co-parent faces. Understand that the journey after TBI has many ups and downs, which affect the whole family. TBI is an invisible disability and can be easy to forget in the moment, yet remembering and using these strategies and resources can lead to greater success for all.

The parenting responsibilities that your partner had before the TBI may be too much now. Talk to your partner about a weekly schedule or calendar that spells out the responsibilities that you both feel are realistic and that each of you will take on. Post the schedule and review it each week.

Your partner may not be aware of the impact of their actions-or their lack of action-in any given situation. Understand that what they do or don't do may not be on purpose.

To nurture your relationship, schedule time for just the two of you to be together. This should be separate from your time with your children.

Learning how to deal with the effects of your partner's TBI can be hard for you on many levels. Get the outside support that you need so that you remain supportive of your partner and your children.

Realize that every happy family looks a little different-there is no one way to be a happy family. Love, attention, good communication and understanding how your TBI is part of the family are keys to success.

Resources for Parenting With a TBI

Living with Traumatic Brain Injury (TBI): https://msktc.org/tbi

Parenting After Brain Injury: https://www.headway.org.uk/media/3998/parenting-after-brain-injury-e-booklet.pdf

Positive Parenting Tips: https://www.cdc.gov/ncbddd/childdevelopment/positiveparenting/index.html

Ultimate List of Resources for Co-Parents: https://talkingparents.com/blog/ultimate-list-of-resources-for-co-parents

Traumatic Brain Injury Factsheets: https://msktc.org/tbi/factsheets

Authorship

Being a Parent With a Traumatic Brain Injury was developed by Judy Wilson, MA, OTR; Angelle M. Sander, PhD; Therese O'Neil-Pirozzi, PhD; Kirk Lercher, MD; Chad Swank, PT, PhD; Jeffrey Kreutzer, PhD; Tamara Bushnik, PhD; and Kan Ding, MD, in collaboration with the Model Systems Knowledge Translation Center.

Source: The content in this factsheet is based on research and/or professional consensus. This content has been reviewed and approved by experts from the Traumatic Brain Injury Model Systems (TBIMS), funded by the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR), as well as experts from the Polytrauma Rehabilitation Centers (PRCs), with funding from the U.S. Department of Veterans Affairs.

Disclaimer: This information is not meant to replace the advice of a medical professional. You should consult your health care provider about specific medical concerns or treatment. The contents of this factsheet were developed under grants (grant numbers H133A110004 (principal investigator (PI): Bushnik), 90DPTB0016 (PIs: Sherer, Sander), 90DPTB0009 (PI: Lercher), 90DPTB0005 (PI: Kreutzer), 90DPTB0011 (PIs Giacino & Zafonte), 90DPTB0013 (PI: Driver), 90DP0082, and 90DPKT0009) from NIDILRR. NIDILRR is a Center within the Administration for Community Living (ACL), U.S. Department of Health and Human Services (HHS). The contents of this factsheet do not necessarily represent the policy of NIDILRR, ACL, or HHS, and you should not assume endorsement by the federal government.

Recommended citation: Wilson, J., Sander, A. M., O'Neil-Pirozzi, T., Lercher, K., Swank, C., Kreutzer, J., Bushnik, T., & Ding, K. (2022). Model Systems Knowledge Translation Center (MSKTC). https://msktc.org/tbi/factsheets/being-parent-traumatic-brain-injury

Copyright © 2022 Model Systems Knowledge Translation Center (MSKTC). May be reproduced and distributed freely with appropriate attribution. Prior permission must be obtained for inclusion in fee-based materials.

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Being a Parent With Traumatic Brain Injury

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Introduction Being a parent can be one of the most rewarding experiences in a person's life. It can also be one of the most challenging experiences. Parenting requires many skills, such as good communication, patience, attention to detail, and a good memory. Parents also need to be flexible and able to handle complex emotions.

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CDC collects and reports TBI data to understand:

How many people are affected by this injury

Who is most at risk

The leading ways a person may get a TBI

Whether programs to prevent TBI are working

Based on the most recent data:

There were approximately 223,135 TBI-related hospitalizations in 2019* and 64,362 TBI-related deaths in 2020.¹

This represents more than 611 TBI-related hospitalizations and 176 TBI-related deaths per day.

These estimates do not include the many TBIs that are only treated in the emergency department, primary care, urgent care, or those that go untreated.²

People age 75 years and older had the highest numbers and rates of TBI-related hospitalizations* and deaths.¹ This age group accounts for about 32% of TBI-related hospitalizations and 28% of TBI-related deaths.

Males were nearly two times more likely to be hospitalized (79.9 age-adjusted rate versus 43.7) * and three times more likely to die¹ from a TBI than females (28.3 versus 8.4).

Children (birth to 17 years old) had 16,070 TBI-related hospitalizations* in 2019 and 2,774 TBI-related deaths¹ in 2020.

* This rate was calculated using the weighted number of hospitalizations with a primary diagnosis of injury (ICD-10-CM diagnosis codes S00-S99; T07-T34; T36-T50 with a 6th character of 1, 2, 3, or 4; T36.9, T37.9, T39.9, T41.4, T42.7, T43.9, T45.9, T47.9, or T49.9 with a 5th character of 1, 2, 3, or 4; T51-T76; T79; O9A.2-O9A.5; T84.04; or M97) and an ICD-10-CM diagnosis code for an initial medical encounter of TBI (S02.0. S02.1-, S02.80-S02.82, S02.91, S04.02, S04.03-, S04.04-, S06-, S07.1, T74.4) in any diagnosis field and dividing it by the corresponding civilian non-institutionalized population per 100,000.Data source: Healthcare Cost and Utilization Project's National Inpatient Sample. 2019.

Please see the following CDC reports for more information on the leading causes of TBI and the groups of people at increased risk for TBI:

Surveillance and research to support data-driven solutions

CDC conducts research on preventing TBI before they happen and reducing the chance for disability and other potential effects of these injuries.

Read TBI research published by CDC.

Learn more about the National Concussion Surveillance System, a state-of-the-art data collection effort designed to learn how many Americans (children and adults) get a concussion each year and the leading causes of this injury.

1. Centers for Disease Control and Prevention. National Center for Health Statistics: Mortality Data on CDC WONDER. Accessed 2022, https://wonder.cdc.gov/mcd.html.

2. Bell JM, Breiding MJ, DePadilla L. CDC's efforts to improve traumatic brain injury surveillance. J Safety Res. 2017;62:253 -256.

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CDC collects and reports TBI data to understand: How many people are affected by this injury Who is most at risk The leading ways a person may get a TBI Whether programs to prevent TBI are working Based on the most recent data: There were approximately 223,135 TBI-related hospitalizations in 2019* and 64,362 TBI-related deaths in 2020.1 This represents more than 611 TBI-related hospitalizations and 176 TBI-related deaths per day.