Reintegration of Children with Aquired Brain Injury into the Educational Process Hermina Damjan Svetlana Logar Tanja Babnik Sabina Andlovic Metka Teržan University Rehabilitation Institute Hospital school Ljubljana, Slovenia

Aquired brain injury (ABI) in children Represents the leading cause of mortality and life long sequels in paediatric trauma and illness Modern medicine - better survival rate Broad scope of long-term problems

Long term outcome depends on Severity of injury Interaction of normal development and injury Pre-injury abilities and personal characteristics Quality of acute injury management Family and peer support Education – school Child´s cappacity to adapt to changed abilities Age at time of injury Possibility and quality of early and continuous rehabilitation

Functional impairments after ABI Mobility Daily activities – self care Deficit of sensory and perceptive functions Communication – speech Cognitive functions and learning Behaviour Social interaction

Rehabilitation Institute, Slovenia Children after TBI  Period 1987 – 2006: N=237 children  67,9 % boys  mean age at time of injury: 8,3 y (+/- 4,1y)  80,5% admitted to hospital for comprehensive rehabilitation program  mean duration of hospitalization: 50 days

Children after TBI GCS frequency - 139

Rehabilitation outcome MobilityDaily activities

Rehabilitation outcome CommunicationSpeech

Rehabilitation outcome MemoryAttention

Education – school after TBI

Children after ABI

Type of ABI

Glasgow coma scale

Movement disability

Daily activities

Educational program

Psychological Consequences Short and long – term deficits in many domains - Orientation to person, place, and time - Intelectual functioning - Academic skills - Language skills (expressive an receptive) - Nonverbal skills (visuoperceptual / visuoconstructional) - Information processing speed - Problem solving - Attention - -Memory / learning (difficulty retrieving newly learned information) - Executive functions (inability to plan, organize, initiate a task, inhibit responses, and self- monitor behaviors ) - Capacities for control, regulation, and adaptation of complex behaviors - Personality changes - Social skills (competence)

Psychological Assesment and rehabilitation plan Identify extent of cognitive deficits Develope rehabilitation plan regarding cognitive and learning abilities Explaine cognitive strenghts and weaknessess to parents and teachers Plan of interventions (learning strategies and behaviour management) Support to educational programme integration

School (re)entry after ABI Resembles life before the accident Motivation for child and family Social rehabilitation – peer collaboration Transition to more independent life Programme for (re)integration into educational programmes has to be a part of holistic rehabilitation programme

Problems influencing reintegration -Normal physical appearance can mask underlying cognitive deficits -Uneven performance -Fatigue -Poor emotional control -Behavioral problems -Not recognising and denying their disabilities -Poor peer relationships

School re-integration -part of long-term recovery process -Interventions in child’s environment (parents, school) are the most important and represent cognitive rehabilitation in a broader sense

The Process of school work Assessment of pupils' abilities in the educational field. Guidelines for educational work. Preparation of an individualized program:  the timing of lessons with the objectives,  standards of knowledge,  learning strategies,  adjustments,  materials and gadgets at work,  the timetable and the methods for knowledge assessment,  activity days enabling the pupils to develop specific knowledge and social skills and gain experience in the wider social environment. Adapting school work to other therapeutic programmes and individual psychophysical abilities of each pupil.

Reintegration in the mainstream school The experts of rehabilitation team and school areas need to enable the following :  proper understanding of the child's abilities  educational and social support to the pupil  special needs of the professional school staff,  ongoing monitoring and possible adjustments of an individualized program Team meetings URI Soča and mainstream school.

Monitoring the pupil when reintegrated in the mainstream school The mainstream school needs to develop an individualized program New meetings:  to assess the performance and potential problems the school is facing while implementing the educational program,  URI Soča team and hospital school visits at the pupil‘s school,  a brief presentation about the pupil‘s locomotor disabilities and difficulties for his/her classmates Continuous monitoring of the pupil throughout schooling.

Professional orientation strengthens youth in their personal independence and sovereignty and contributes to widening their perspectives in working world that is changing for youth with disabilities special offers need to be developed

Vocational Rehabilitation Centre of the University Rehabilitation Institute Soča team of professionals (medical doctor - specialist of vocational medicine, psychologist, occupational therapist, social worker and rehabilitation technologist) assessment of health factors, educational, vocational and work experience factors, social and environmental factors, cognitive and learning abilities, personality and behaviour, acceptance of disability, interests and goals. to help youth with disabilities and their families defining a potential field of education to direct the attention of youth with disabilities towards future jobs not only education

Thank you!