Traumatic Brain Injury and School Intervention

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Traumatic Brain Injury and School Intervention

• Thomas B. King, M. Ed.
• Hospital Education Program
• VCU Health Care System

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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

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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

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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

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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

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Glasgow Coma Scale

• Used for initial assessment
• Scaled scores for observed responses
• Eye opening
• Motor responses
• Verbal responses

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Range of GCS scores

• Severe TBI 1 to 8
• Moderate TBI 9 to 12
• Mild TBI 13 to 15

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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

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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

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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

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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 Disabilitiesthere may be similarities,
  but they are not the same, and the diagnostic
  criteria is different

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InterventionAt the return to school

• Obtain as much information about the youngsters
  condition as possible
• Changes in motor function
• Changes in cognitive function
• Changes in personality or emotional function

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Understanding Assessments

• Hospital and Clinical Assessments address the
  specifics of focal injury
• School assessments are typically geared toward
  regulatory mandates
• Both assessments are important

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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

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Neuropsychological or psychoeducational assessment

• IQ score
• Visual-motor
• Visual processing
• Auditory processing
• Non-verbal intelligence
• Processing speed or perceptual speed
• Language processing

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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

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Using the assessment information

• Once the assessment is completed, it is important
  to use it correctly

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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

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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

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Processing Speed

• Allow extra time
• Allow for fewer examples
• Allow dictation
• Be very careful to monitor reading
  comprehensionyour student may appear to read as
  before, but their comprehension may suffer due to
  lowered speed of reading

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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

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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

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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

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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

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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 wont