Supporting Students with Traumatic Brain Injury/Concussions: A Medical Perspective Kimberly C. Davis, Ph.D. Pediatric Neuropsychologist, Texas Children’s Hospital Assistant Professor, Baylor College of Medicine

Outline Mild TBI Severe TBI Broad Recommendations for Consideration Mild TBI Specific Recommendations Severe TBI Specific Recommendations Resources

Mild Traumatic Brain Injury Typical plan is for child to return immediately or after a couple days rest with a plan for environmental adjustments Physical and cognitive symptoms expected to improve over 1-to-2 weeks 15 - 25% may have symptoms that last longer! Child may look fine but may really be struggling internally

Mild Traumatic Brain Injury Medical team to provide recommendations to school and family GOAL: Minimize the occurrence, amplification, or exacerbation of symptoms Shortened school day frequent rest breaks Allowing missed assignments to remain incomplete (without penalty) Complete tests in quite setting Temporary decrease of homework load Extended time homework/tests Postponement of academic tests or 1 test/day

Severe Traumatic Brain Injury Typically the child is hospitalized for an extended period of time. Sometimes return to full in-school can happen quickly after discharge sometimes not Long-term impairments are anticipated

Severe Traumatic Brain Injury Physical Impairments Cognitive Impairments Emotional Impairments Speech difficulty Short term memory deficits Mood swings Vision changes Impaired concentration Denial Hearing impairments Slowness of thinking Self-centeredness Headaches Limited attention span Anxiety Motor dyscoordination Impairments of communication skills Depression Spasticity of muscles Poor Planning Lowered self-esteem Paresis or paralysis Impaired Writing Restlessness Seizure disorders Impaired Reading Lack of motivation Balance difficulty Poor judgment Difficulty controlling emotions Fatigue Perceptual changes Poor awareness

Severe Traumatic Brain Injury Neurocognitive Stall after Brain Injury Level of Functioning Return to school X (Birth) Time Chapman, 2007

Broad Recommendations to Support Re-entry Resource Document Develop a plan in advance Designated Point of Contact When an injury occurs Reach out to family to provide point of contact information/have ROI forms signed Provide medical team with academic information as quickly as possible, if requested When child returns Flexibility! Work with child/family/school team to appoint a child advocate Child appointed? If informal or 504 supports provided, ensure all academic instructors are onboard Close Monitoring Communication with family Frequent and timely modifications to the student’s academic plan/supports

Specific Recommendations: Mild Injuries Please.. Consider the medical team’s recommendations Believe the child’s reports of current physical or cognitive difficulties If… Cognitive, physical, or behavioral symptoms persist longer than 1-to-2 weeks or worsen Child’s academic performance declines Child demonstrates emotional change (sadness, irritability, anxiety, distress, avoidance) Then… Consider bumping up level of supports either formally or informally (RTI/504) Consider the support of psychology/counseling involvement Encourage family to return to the child’s Primary Care Provider

Specific Recommendations: Severe Injuries Immediate needs for consideration: Home bound Instruction (what will this look like?) Transportation needs to and from school Academic accommodations/modifications – cognitive, fine motor, gross motor, ADLs SLP, OT, PT, Adaptive Technology evals Plan for missed coursework/assignments/tests due to medical appointments/therapy Transportation needs within the school Medication/Feeding/Toileting needs Safety and/or Behavioral Plan Timeline for provision/implementation of supports? What is the child doing in the meantime?

Severe Traumatic Brain Injury Please consider IEP as a first line of support Anosognosia Close monitoring by child advocate: academic, mood, home, and social functioning Benefit from being taught self-advocacy skills Provide a high level of support initially and remove supports gradually

Other Types of Brain Injury…? Acquired Brain Injuries (those that are not traumatic) Near drowning Brain Tumors/Surgery Cancers requiring chemotherapy and/or brain radiation Cardiac arrest/surgery Prolonged Seizure Respiratory Arrest Central Nervous System Infection/Encephalitis Stroke Organ Transplant Uncontrolled diabetes…

Additional Resources Kimberly C. Davis, PhD kcdavis@texaschildrens.org Brain Injury Association of America (BIAA) Brain Injury Association of Texas (Texas BIA) Hope 4 Minds National Association of Special Education Teachers (NASET) Brainline.org http://www.projectlearnet.org/ (BIA of New York State) Kimberly C. Davis, PhD kcdavis@texaschildrens.org