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Traumatic Brain Injury and School Intervention
 

Traumatic Brain Injury and School Intervention

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A brief overview of school re-entry following a traumatic brain injury

A brief overview of school re-entry following a traumatic brain injury

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    Traumatic Brain Injury and School Intervention Traumatic Brain Injury and School Intervention Presentation Transcript

    • Traumatic Brain Injury and School Intervention Thomas B. King, M. Ed. Hospital Education Program VCU Health Care System
    • Epidemiology of TBI
      • 1 million people are treated and released for TBI
      • 230,000 people are hospitalized and survive
      • 50,000 people die each year
      • Center for Neurological Skills
    • Centers for Disease Control estimates that….
      • Each year more than 80,000 Americans survive a hospitalization for TBI and are discharged with TBI-related disabilities
      • 5.3 million Americans are living today with a TBI-related Injury
    • Types of TBI Impairments
      • Cognitive (such as memory loss, concentration deficit, judgment impairment and mood disorders
      • Movement abilities (such as strength, coordination and balance)
      • Sensation (such as vision impairment and tactile sensation loss)
      • Seizure disorders
    • Overview of TBI – Mild TBI
      • Brief loss of consciousness
      • Loss of memory immediately before or after the injury
      • May seem fine on the surface, but continues to experience on-going functional problems (this is sometimes called post concussion syndrome)
        • This causes change in personality
        • Change in cognitive functioning
    •  
    •  
    • Glasgow Coma Scale
      • Used for initial assessment
      • Scaled scores for observed responses
        • Eye opening
        • Motor responses
        • Verbal responses
    • Range of GCS scores
      • Severe TBI 1 to 8
      • Moderate TBI 9 to 12
      • Mild TBI 13 to 15
    • Definition of TBI
      • Any period of loss of consciousness
      • Any loss of memory for the events just before or after the incident
      • Any alteration in mental state at the time of the accident
      • Focal neurological deficits, which may or may not be transient
      • American Congress of Rehabilitation Medicine
    • Range of sequella
      • Mild TBI can cause “soft” neurological difficulties, change in personality and/or mood. School performance may be affected.
      • Moderate TBI may adversely affect overall IQ and will more than likely have an impact on school performance
      • Severe TBI will adversely affect a range of life activities
    • Coup and contra coup
      • The coup contusions occur at the area of direct initial impact
      • The Contra coup injury occurs at the opposite side of the brain
    • School intervention
      • IDEA has TBI as a separate classification for services
      • Youngsters may also qualify for services in a number of other categories depending on the type and range of injuries
      • Remember – TBI is not the same thing as Specific Learning Disabilities—there may be similarities, but they are not the same, and the diagnostic criteria is different
    • Intervention At the return to school
      • Obtain as much information about the youngster’s condition as possible
      • Changes in motor function
      • Changes in cognitive function
      • Changes in personality or emotional function
    • Understanding Assessments
      • Hospital and Clinical Assessments address the specifics of focal injury
      • School assessments are typically geared toward regulatory mandates
      • Both assessments are important
    • Harvesting needed information
      • The child will qualify for special services if he/she has had a closed head trauma and
      • There is an identified change in performance to the extent that help is needed
    • Neuropsychological or psychoeducational assessment
      • IQ score
      • Visual-motor
      • Visual processing
      • Auditory processing
      • Non-verbal intelligence
      • Processing speed or perceptual speed
      • Language processing
    • Academic achievement assessment
      • Material that was introduced just prior to the time of the injury
      • Material that was assumed to have been previously mastered.
      • Look for “splinter” skills in the assessment data
    • Using the assessment information Once the assessment is completed, it is important to use it correctly
    • Suggested interventions strategies for memory
      • The student may very well remember previously mastered material, but may encounter problems learning new material
      • Get frequent feedback from the student
      • Have the student repeat information
      • Never introduce more than can be mastered in a session
      • “ Spiraling” technique may be needed
    • Memory intervention techniques
      • Mind mapping or semantic mapping techniques may be helpful
      • Mnemonic devices should be considered
      • There are books that catalog mnemonic devices and the teacher(s) should have access to them
      • Keep intervention strategies simple and consistent
    • Processing Speed
      • Allow extra time
      • Allow for fewer examples
      • Allow dictation
      • Be very careful to monitor reading comprehension—your student may appear to read as before, but their comprehension may suffer due to lowered speed of reading
    • Visual-motor
      • Limit and monitor far point copying
      • Limit and monitor “matching” style tests that cross the midline
      • Do not penalize letter formation errors or use of space
      • OT intervention may be important
      • Providing notes or having a note buddy may be important
    • Non-verbal intelligence
      • Changes in this area can be due to an injury to the parietal lobes
      • Math and math abstraction may suffer
      • Use of manipulative materials for math instruction may become important
      • Monitor changes in socialization skills
    • Auditory processing
      • Speech pathology may be important for changes in language processing
      • Use of spell check devices may be important
      • Have the student repeat instructions if necessary
      • Remember auditory processing is not the same thing as auditory acuity
    • Visual processing
      • Map skills may change
      • Use of graphs and charts in instruction may require verbal mediation
      • Copying may be inaccurate
      • Providing notes may be important
      • Remember – visual processing is not the same as visual acuity
    • And finally
      • Changes in your student may be dramatic, but also subtle
      • Subtle changes can, over time, cause serious academic difficulties
      • Do not assume that subtle changes will go away – more than likely –they won’t