Traumatic Brain Injury and School InterventionThomas B. King, M. Ed.Hospital Education ProgramVCU 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 Controlestimates 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 personalityChange in cognitive functioning

Glasgow Coma Scale

Used for initial assessment Scaled scores for observed responses

Eye openingMotor responsesVerbal 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 transientAmerican 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

InterventionAt 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