brain injury.ppt

8/14/2019 brain injury.ppt

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Brain Injury 101Supporting Students

with Brain Injury

In the Classroom


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OBJECTIVES

Review federal and state definitions oftraumatic brain injury (TBI)

Learn about the discrepancy between:

Incidence rates of TBI among

children and youthvs.

Number of students counted in the TBI

category of Special Education


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OBJECTIVES

Developan understanding of thecauses and effects of TBI on children,

their families, and communities

Learn about normal brain

development and the effects of braininjury on a developing brain


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OBJECTIVES

Develop an awareness of the

potential physical, cognitive,

behavioral, and psychosocial effectsof a TBI

An overview of successful strategiesand resources for supporting

students with TBI in the classroom


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WH TIS THE DEFINITION OF ATR UM TIC BRAININJURY(TBI)?


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BRAIN INJURY

Congenital brain injury

Pre-birth During birth

Acquired Brain Injury

After birth process

Traumatic Brain Injury

(external physical force)

Closed

Head

Injury

Open Head

Injury

Non-traumatic

Brain Injury

Savage, 1991


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IDEA Definition of TBI:

an acqu ired in jury to the brain

caused by an external phys ical

force resu l t ing in total or part ialfunc t ional d isabi l ity or

psychosoc ial impai rment o r bo th

that adversely affects a childseducat ional perfo rmance.


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TBI Definition (IDEA)

The term appl ies to open or c losed head in jur ies

resul t ing in impairments in one or m ore areas,

such as:

cogni t ion

language

memory

attent ion reasoning

abstract th inking

judgement

problem-solv ing

senso ry, perceptual and

motor abi l i t ies

psy chos ocia l behavior

phy sica l funct ions

in format ion processing

speech


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TBI Definition (IDEA)

The term does not apply to brain

injur ies that are congeni tal ordegenerat ive, or brain inju r ies

induced by b ir th trauma.

Federal Public Law 101-476


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StrokeBrain Infection

Tumor

Anoxia

Exposure to Toxic Substances

Neither definition includesacquired brain injuries caused

by internal conditions, such as:


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Important note:

Brain injuries

that result from either an

external

or internal force

may have similar effects.


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WHO

SUSTAINSABRAIN

INJURY?


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National prevalence rates ofvarious disabilities

400,000 with Spinal Cord Injuries

500,000 with Cerebral Palsy

2.3 million with Epilepsy

3.0 million with Stroke-related Disabilities

4.0 million with Alzheimers Disease

5.3 mil lion w ith Traumatic B rain Injury

5.4 million with persistent Mental Illness

7.2 million with Mental Retardation


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IN TENNESSEE

Since 1996, the TBI registry hasrecorded over 7,000 persons, ages3 to 21, who have been hospitalizedfor treatment of a brain injury

0

200

400

600

800

1000

1200

1400

1600

TBI

Registry

DOE

Report

The number of people,ages 3 to 21, who wererecorded in the TBIRegistry for the 2003 -2004 school year: 1547

Number of studentsclassified as having aTBI according to theDOE report of the 2003 -2004 school year : 306

What is happening with the 1,241students?


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Reasons for the

discrepancy Not all children who

sustain a brain injuryexperience lasting

effects

The etiology of a

students disability may

be unidentified or

misunderstood

The student may be

served under a 504 plan

The effects of the brain

injury in children can be

latent, surfacing as more

advanced skills are

required of the student at

school

When the effects of theinjury do surface, they may

resemble other disabilities,

such as a learning

disability or emotional

disorder


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HOWAND

WHEREDOES TBI HAPPEN?


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WHY

TBI is so devastating MYTH: Younger

children are more

resilient and can

therefore bounce

back easier and

more quickly from a

brain injury.

REALITY: It may just

take longer for the

effects of a brain

injury to show up in

a growing and

developing brain.


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WhyTBI is so devastating

Myth: Visible,

physical

recovery is a

sign that the

brain is healed.

Reality:The

cognitive and

behavioral effects

of a brain injury

can last long after

the person heals

on the outside.


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The

Growing Brainand

Injury

Surface View


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Geographyof the Brain

Midline View

Surface View

Hippocampus


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TBI in children

can be especially devastating,

as a childs brain is in an almost

constant state of development.


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Rates of Development for theFour Regions of the Brain

% of maturation increments

age increments

1 3 5 7 9 11 13 15 17 19 21

5 DistinctPeriods of

MaturationP-O parietal/

occipital

C central(limbic

& brainstem)

T temporal

F-T frontal/

temporal0

2

4

6

P-O

C

T

F-T

P-O

C

F-T

P-O

T

C

F-T


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The Anatomy

ofa Brain Injury


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Two types of TBI

OPEN-HEADINJURY (penetrating)

Example:

Skull fracture that

penetrates the

brain

Gunshot wound

CLOSED-HEAD

INJURY

Example:

Coup-ContraCoup

Diffuse axonal injury


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Two Classes ofBrain Injury

PRIMARYTHE INJURY IS MORE OR

LESS COMPLETE ATTHE TIME OF IMPACT

SKULL FRACTURE

CONTUSION/BRUISING OF THEBRAIN

HEMATOMA/BLOODCLOT ON THE BRAIN

DIFFUSE AXONAL

INJURY

SECONDARYTHE INJURY EVOLVES OVER APERIOD OF HOURS TO DAYSAFTER THE INITIAL TRAUMA

BRAIN SWELLING/EDEMA

INCREASED INTRACRANIAL

PRESSURE

INTRACRANIAL INFECTION

EPILEPSY

HYPOXEMIA (LOW BLOODOXYGEN)

HIGH OR LOW BLOOD

PRESSURE

ANOXIA/HYPOXIA (LACK OF

OXYGEN TO THE BRAIN)


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PRIMARY INJURIES

Coup-Contra Coup


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PRIMARY INJURIES

Axon

Rotational forces on

the brain cause thestretching and snapping

of axons

Diffuse Axonal Injury


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PRIMARY / SECONDARYINJURIES

Epidural

Hematoma

Subdural

Hematoma

Intracerebral

Hemmorhage


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SECONDARY INJURIES

Enlarged

Ventricles

Brain withHydrocephalus

Brain with Edema

Edema

(swollen

brain

tissue)


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ConsequencesChallenges

After

Traumatic Brain Injury


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TBI ENORMOUS

VARIABILITY

TYPE OF

INJURY&

SEVERITY

AGE

AT THE TIME

OF INJURY

PRE-EXISTING

DISABILITIES

OR BEHAVIORS

RECOVERY

AVAILABLE

KNOWLEDGE,

RESOURCES,

&

SUPPORT


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TBI Can Affect

Physical skillsCognitive skills

Behavioral /Psychosocial Skills


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Possible Physical Effects

Impairment of:

Speech

Vision

Hearing

Difficulty with:

Balance

Spasticity Paralysis

Paresis

Less obvious physical effects:headachesfatigue


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Possible Cognitive Effects

Impairments in:attention or

concentration

ability to initiate,organize, orcomplete tasks

ability to sequence,generalize, or plan

flexibility ofthinking, reasoning,or problem-solving

abstract thinking

judgment or perception

long-term or short-termmemory

confabulation

ability to acquire orretain new information

ability to processinformation- slowed

speed


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Possible Behavioral /Social Effects

VERBAL / PHYSICAL

AGGRESSION

LOW

FRUSTRATION

TOLERANCE

MOOD SWINGS

OR

EMOTIONAL LABILITY

IMPAIRED

ABILITY TO COPEWITH

OVER-STIMULATING

ENVIRONMENTS

IMPAIRED

ABILITY TO PERCEIVE,

EVALUATE,

OR USE

SOCIAL CUES/

CONTEXT

LACK OF

AWARENESS

OF DEFICITS

IMPULSIVITY

PRE-EXISTING

MALADAPTIVE

BEHAVIORS

OR

DISABILITIES

INTENSIFIED


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What the Future HoldsSupporting Students

with

TBI

at School


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Be creative in designing

services...Use the too ls you haveto work with these

students, but keep the following in mind:

Progress can be inconsistent and unpredictable

Student may experience reduced stamina and

fatigue for some time after the injury

Student may process information slower aftertheir injury

Impairment of memory may hinder new learning


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Plan for transitions

Hospital to school

Grade to Grade

School to School


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Consider Ongoing

Supports... Establishing effective means of communication

between school and home

Establishing primary contacts for the family both

at the school level and at the administrative level

Developing peer supports for the student

Updating evaluations as needed


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Initial School Re-entry

Eligibility

A physicians letter should be obtained

documenting the Traumatic Brain Injury

Interview the family of the injured student toobtain pre-injury academic and socialhistory, as well as changes they have seensince the injury

A school staff person should be designatedto visit the student before he or shereturns to school to make anecdotalobservations


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Information to obtain:

Medical

Documentation of the injury, site(s) of injury or lesion,duration of coma, services received post-injury,medications, contact information for doctors

Medical Release

Specifies the students ability to participate in physicalactivities at school

Rehabilitation Records

Initial evaluations & discharge summaries from alltherapies administered

Specific recommendations for adaptations to the schoolenvironment

Therapy recommendations

Instructions related to use of adaptive equipment


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Information to obtain:

Psychosocial

History of student pre-injury from an educational andsocial perspective

Relevant information on siblings, including ideas abouthow to address their reaction to the injury

Educate support team about possible suicidal ideationpost-injury (especially with adolescents)

Educational

Contact person for family Initial and subsequent IEPs

Records from support personnel

Attendance records

Records from other schools attended, if applicable

Specific information related to sensory issues


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Considerations forFormal Assessment

The nature of formalized testing may compensate for

cognitive weaknesses (e.g., attention, initiation,

flexibility, information processing, executive

functioning).

New learning is often not assessed.

The students scatter in abilities is often not

revealed (i.e., gaps below basals and strengths

above ceilings).Scores may not reveal the extent of reduced

functioning in the classroom. Alternatively, some

students may perform better in the real world with

natural cues present than testing would predict.


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Considerations forInformal Assessment

Real-life classroom performance is represented.

New learning can be assessed.

Hypotheses about breakdowns and possibleinterventions can be tested.

Current functioning can be compared with pre-

injury performance.

Environmental variables affecting performance can

be evaluated.

Work samples and classroom evaluation can

provide a direct link to intervention strategies.

Sample Strategies to


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Sample Strategies toConsider:

Scheduling Modifications Attend school part-time initially

Schedule several in-school breaks

Provide study halls with resource teacher

Schedule most difficult subjects early in the day

Keep number of classroom changes to a minimum, or

assign a buddy to assist the student in changing

classes

Begin with one-on-one/small group instruction, adding

additional students with improvement of concentration

Consider ESY, homebound services or tutoring for

summer months

Will child be supervised at all times?

From: TBI Inservice Training Module, Janet Siantz Tyler, PhD.,

Kansas Dept. of Education, TBI Project

Sample Strategies to


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Sample Strategies toConsider:

Instructional Strategies

Classroom rules & expectations should be well structuredand explicitly taught

Instruction should contain repetition & feedback

Avoid multi-step instructions if possible

Supplement verbal instructions with writing / modeling

Provide amply time to process, complete tasks, andrespond

Assist the student in keeping his/her materials andschedule organized

Teach compensatory strategies for test-taking, note-

taking, reading materials, etc. Try external aids such as lists, diaries, computers,

calculators

Videotape the students progress in class to providefeedback and show progress

From: TBI Inservice Training Module, Janet Siantz Tyler, PhD.,Kansas Dept. of Education, TBI Project


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IEP Development

TO INCLUDE: Obtain eligibility

documents, including

information aboutcurrent levels of

functioning

Include individuals in

IEP meetings who can

help to identify theadverse effects of the

brain injury on the

students performance

TO ADDRESS: Students current and past

strengths/ areas of need

Medical needs

General modifications /

accommodations

Involvement of student in

general curriculum

Extended school year

options


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Developing IEP Goals

Focus on 2 or 3 priority issues

Identify metacognitive & organizational

strategies

Write measurable goals that incorporate

the strategies

Include specific information about how the

strategy should be taught andimplemented across settings

Write short-term goals that are truly short-

term


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For More Information:

Paula Denslow, Coordinator &

Project BRAIN Resource Specialist

Tennessee Disability Coalition

480 Craighead Street, Suite 200

Nashville, TN 37204

Office: 615383.9442 x 56

Fax: 615383.1176

Cell: 615585.2998

TTY: 615292.7790

[email protected]

Jennifer Jones, M.S., C.R.C.

Project BRAIN Resource Specialist

Tennessee Disability Coalition

5641 Merchants Center Blvd.

Suite A102

Knoxville, TN 37912

Office: 865/689-1797 x 12

Fax: 865-689-8518

Cell: 865-803-5995

[email protected]

www.tndisability.org/brain

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