Introduction to Traumatic Brain Injury TBI for Educators

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Introduction to Traumatic Brain Injury (TBI) for
Educators

• Funded by an IDEA Discretionary Grant
  2007-9911-22
• Wisconsin Department of Public Instruction
• (http//www.dpi.wi.gov)

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Outline__________________________________________
____________

• Brain injury definition
• Brain Function
• Common Problems
• Steps to evaluation and programming success
• Resources

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WHAT IS A BRAIN INJURY?
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What is a brain injury?__________________________
____________________________

• An injury to the brain caused by a blow to the
  head penetration of the skull caused by an
  accident.
• The injury may disrupt functioning in a single
  area of the brain (focal damage) or impact
  multiple areas of brain functioning (diffuse
  damage).
• Adverse effects could be short term or life-long.

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Types of Brain Injury ____________________________
__________________________
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Wisconsin TBI Definition _________________________
_____________________________

• Traumatic brain injury
• an acquired injury to the brain
• caused by an external physical force
• resulting in total or partial functional
  disability or psychosocial impairment, or both
• adversely affects a childs educational
  performance

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Prevalence_______________________________________
_______________

• Every 23 seconds 1 person in the U.S. sustains an
  acquired brain injury
• 1 in 500 students sustain an acquired BI each
  year in the U.S.
• 1 in 25 students will sustain an acquired BI
  before high school graduation
• Overall twice as many boys as girls
• Highest risk 0-4 year olds and 15-19 year olds

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Primary Causes of BI by Age______________________
________________________________

• Infants
• Abuse neglect
• Toddlers
• Abuse falls
• Early Elementary
• Falls pedestrian-motor vehicle accidents
• Late elementary/Middle school
• Pedestrian-bicycle accidents
• Pedestrian-motor vehicle accidents
• Sports
• High school
• Motor vehicle accidents
• (Savage Wolcott, 1994)

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What Happens When the Brain is Injured?__________
____________________________________________

• Brain injuries are either
• Closed head Skull not penetrated (car
  accident, falls)
• Open Head Skull and meninges are penetrated
  (gunshot, nail)
• Both of these result in
• A disruption of communication within the
  brain due to torn or stretched neurons
• Lack of oxygen to the brain resulting in cell
  death.

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Primary Effects of Brain Injury__________________
____________________________________

• Injury to brain tissue at the initial site of
  impact and at the second injury site (Coup
  Contracoup)
• Shearing and tearing of neurons throughout the
  brain disrupts communication

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Mechanism of injury Coup/Contracoup_____________
_________________________________________
Reprinted with permission from the North Carolina
Department of Public Instruction
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Shearing Tearing of Neurons

• When an injury occurs the neurons stretch, twist
  or tear.

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Secondary Effects of Brain Injury________________
_______________________________________

• Bleeding (contributes to increased intracranial
  pressure)
• Swelling (contributes to increased intracranial
  pressure)
• Lack of oxygen to the brain (results in cell
  death)

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Mild, Moderate, Severe___________________________
___________________________

• Injuries can range from mild (a brief change in
  mental functioning) to severe (extended period
  of unconsciousness)
• Significant long-term disability.
• Full effects of brain injury may not be apparent
  until later when the child is expected to perform
  more advanced skills and to self-regulate
  behavior.

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Severity of Brain Injury Mild___________________
___________________________________

• Brief or no loss of consciousness
• Signs of concussion
• Nausea and vomiting
• Headache
• Fatigue
• Dizziness
• Poor recent memory
• Unable to form new memories following the injury
  (less than 1 hour)

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Severity of Brain Injury Moderate_______________
_______________________________________

• Coma less than 24 hours
• Unable to form new memories following the injury
  (less than 24 hours)

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Severity of Brain Injury Severe_________________
______________________________________

• Coma more than 24 hours
• Unable to form new memories following the injury
  (longer than 24 hours)

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Proportion of Mild, Moderate, and Severe Brain
Injuries_________________________________________
______________

• The vast majority of students with brain injuries
  returning to school have mild injuries.

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Brain Function _________________________________
_____________________

• The adult brain weighs about 3 pounds.
• The brain is a complex organ made up of billions
  of neurons that all relate to each other.
• Each area of the brain has primary
  responsibilities that contribute to our ability
  to function.

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Brain Surface____________________________________
__________________
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The Brainstem____________________________________
___________________

• At the base of the brain above the spinal cord
• Comprised of the medulla, pons, and midbrain
• Responsible for basic life functions
• Severe injury causes death

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The Cerebellum___________________________________
___________________

• Primarily helps modulate motor responses
• Regulates direction, rate, force, and steadiness
• Injury disrupts coordination and muscle tone

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The Cerebral Cortex______________________________
________________________

• Center of conscious brain activity
• Divided into two hemispheres connected by the
  corpus collosum
• The right side of the brain controls the left
  side of the body and vice versa
• Dominant hemisphere represents language (usually
  left hemisphere)

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The Lobes of the Cerebral Cortex_________________
_____________________________________

• Each hemisphere of the brain is divided into four
  lobes
• Frontal
• Temporal
• Parietal
• Occipital

Reprinted with permission from the North Carolina
Department of Public Instruction
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The Frontal Lobe Functions_______________________
_______________________________

• Control executive functions
• Area of motor cortex
• Deficits may become apparent over time

If Injured you may see impaired -memory -motor
planning and performance -behavior
control -higher level thinking skills
(summarizing, inferencing) -deficits may become
more apparent as child is expected to perform
higher level skills.
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The Parietal Lobe Functions______________________
________________________________

• Receives, analyzes, and integrates sensory and
  motor stimuli

If injured you may see impaired -body awareness
(poor judgment about space and
distance) -sensations (hypo/hypersensitivity) -v
isual neglect (not attend to stimuli on
affected side)
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The Temporal Lobes_______________________________
_______________________

• Receives, analyzes, and integrates auditory
  information
• Center for language

If Injured you may see impaired -ability to
listen, understand and generalize auditory
input -expressive and receptive
language -memory formation
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The Occipital Lobes______________________________
________________________

• Receives, analyzes. integrates visual
  information

If Injured you may see impaired -ability to
understand and integrate visual
information -visual functions (restricted
vision) -ability to track moving objects (ex
catching a ball) -ability to track stationary
objects (ex reading a line of print
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Common Problems__________________________________
____________________

• Difficulties with memory, attention,
  concentration fatigue are common.
• Anticipating planning for these deficits
  increases the likelihood of student success.
• May have problems with motor, sensory/perceptual,
  cognitive/communication, social/emotional,
  behavioral functioning.

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Common Problems__________________________________
____________________

• Certain types of difficulties are common in
  students with TBI
• Anticipating these difficulties can facilitate
  success in school
• Problems can be physical/medical, cognitive,
  sensory, motor, social, emotional, and behavioral

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Common Motor Problems____________________________
__________________________

• Apraxia
• Ataxia
• Coordination problems
• Paresis or paralysis
• Orthopedic problems

• Spasticity
• Balance problems
• Impaired speed of movement
• Fatigue

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Sensory/Perceptual Problems______________________
________________________________

• Visual deficits
• field cuts
• tracking (moving and stationary objects)
• spatial relationships
• double vision (diplopia)
• Neglect
• Auditory deficits
• Tactile deficits

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Cognitive/Communication Problems_________________
______________________________________

• Executive functions
• Memory
• Attention
• Concentration
• Information processing
• Sequencing

• Problem solving
• Comprehension of abstract language
• Word retrieval
• Expressive language organization
• Pragmatics

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Social/Emotional Problems________________________
_______________________________

• Irritability
• Impulsivity
• Disinhibition
• Perseveration
• Emotional lability
• Insensitivity to social cues
• Low frustration tolerance

• Anxiety
• Withdrawal
• Egocentricity
• Denial of deficit/ lack of insight
• Depression
• Peer conflict
• Sexuality concerns
• High risk behavior

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Behavioral Problems______________________________
________________________

• Deficits (all types) may lead to challenging
  behaviors
• non-compliance
• aggression
• confrontational behavior
• lack of initiative
• withdrawal

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Impact on Learning_______________________________
_______________________

• Sequential Processing
• Problem-Solving, Reasoning, and Generalization
• Organization and Planning Skills
• Impulse or Self-Control
• Social Adjustment and Awareness
• Emotional Adjustment
• Sensorimotor Skills

• Orientation and Attention to Activity
• Starting, Changing, and Maintaining Activities
• Taking in and Retaining Information
• Language Comprehension and Expression
• Visual-Perceptual Processing
• Visual-Motor Skills

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Identifying Educational Concerns_________________
_____________________________________

• The educational team needs to consider the
  multifaceted implications of the brain injury.
• It is helpful to use checklists and other tools
  to assist in identifying child specific concerns.
• Traumatic Brain Injury checklist may be used as
  an evaluation tool to identify specific student
  concerns.

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• Traumatic Brain Injury Checklist
• Please rate the students behavior (in comparison
  to same-age classmates) using the following
  rating scale
• Not at all
• Occasionally
• Often
• Very Severe Frequent Problem

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Waaland and Bohannon (1992)
Reprinted from Guidelines for Educational
Services for Students with Traumatic Brain Injury
(Virginia Department of Education, 1992)
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WHAT ARE THE NEXT STEPS TO SUCCESSFUL EVALUATION
AND PROGRAM PLANNING?
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What are the next steps? _________________________
_____________________________

• Once a student suspected of having a disability
  is referred for a special education evaluation,
  the next step is to gather information.
• You will need two types of information
• Brain Injury information
• (type of injury, location of injury, length
• of coma, etc.)
• 2. Information on current functioning
• (physical/medical, social/emotional, academic,
  cognition and memory, speech/language and
  communication, sensory/perceptual

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Whats Next? (continued)_________________________
_____________________________

• How will you gather the information?
• Review medical reports
• Observe student
• Interview the student and knowledgeable others
  (therapists, medical personnel, parents, etc.)
• Use curriculum based measures and work samples

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Whats Next? (continued)_________________________
_____________________________

• Identify appropriate team members
• (If student has fine and gross motor
  difficulties, should an OT, PT or APE person be
  part of the IEP Team?)
• Conduct a thorough educational evaluation of the
  student to
• 1. Determine eligibility and need for special
  education and related services
• 2. Identify disability-related educational needs

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Whats Next? (continued)_________________________
_____________________________

• If the student has a disability, identify major
  issues to address in the IEP such as
• Student health and safety issues (wheelchair
  transportation, medication management, etc.)
• Schedule (need for a shortened day, more frequent
  breaks during the day, etc.)
• Classroom instruction (enlarged print,
  preferential seating, other modifications)
• Staff training (TBI, medical procedures)

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What can be done if the IEP Team determines that
the student does not have a disability?

• To support the student in regular education,
  the team could recommend short term
  accommodations such as
• adjust schedule
• delay high stakes tests
• prioritize homework
• educate parents, teachers, peers
• assign case manager to monitor progress
• refer to a building team

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Resources________________________________________
______________

• Dept. of Public Instruction (DPI)
  http//dpi.wi.gov/sped/tbi.html
• Level I TBI Training http//dpi.wi.gov/sped/tb
  i-trg-pres.html
• CESA-based TBI consultants http//dpi.wi.gov/sped
  /pdf/tbi-contacts.pdf
• TBI Kit (available at each CESA)
• Teacher tools, charts, and checklists
• Level I trainings
• Memory training and resources
• Links and resources
• Additional TBI materials (on DPI website)
• Mild brain injury informational brochure
• Parent Information packet
• Teacher Information packet
• Administrators information packet
• Informational brochure for hospitals and clinics