Traumatic Brain Injury and School Intervention Thomas B. King, M. Ed. Hospital Education Program VCU 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 Control estimates 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 personality  Change in cognitive functioning

Glasgow Coma Scale Used for initial assessment Scaled scores for observed responses  Eye opening  Motor responses  Verbal 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 transient American 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

Intervention At 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