At the end of this chapter, you should be able to: Traumatic Brain Injury Chapter 13 Objectives At the end of this chapter, you should be able to: Describe how traumatic brain injury can affect a student’s social, academic, and emotional abilities. Recall effective teaching practices for working with students with traumatic brain injury. Understand how they can encourage participation. Describe strategies that would be helpful to the transition of students with TBI. These are the instructional goals presented in the Student Study Guide and the Instructor’s Manual - don’t forget that you can introduce the chapter by accessing the audio clips of the authors on the companion website. These audio clips provide an overview and focus the student to understand the importance of the information they are preparing to learn. Chapter Objectives

Who Is Jarris Garner? Traumatic Brain Injury Chapter 13 Jarris is a 10-year-old girl who was involved in a serious car accident when she was only seven months old. Jarris spent much of her recovery at her grandmother’s home, so she could be in quiet surroundings. Her mother had her enrolled in the Language Acquisition Program in order to focus on her use of language and communication, even learning sign language (ASL). Her entire family learned ASL in order to communicate with her, and Jarris learned how to be part of a social community. She is currently in a general education classroom; she enjoys sports, but has to avoid contact sports so as not to reinjure herself. To encourage students to discuss Jarris, use the “What Do You Think?” questions on p. 373. Ask students why Jarris’ story focuses so much on the acquisition of language skills.

How Do You Recognize Students with Traumatic Brain Injury? Defining and Identifying Traumatic Brain Injury Traumatic brain injury (TBI) is an acquired injury caused by external physical force. Most common term for the effects of external physical force is concussion Two types of brain injury not covered: Anoxia: loss of oxygen from illness or accident Congenital brain injury: injury present at birth Two types of TBI: Closed head injury Post-concussional syndrome Open head injury There is an online book available on TBI entitled “Traumatic Brain Injury Survival Guide.” You can access it at http://www.tbiguide.com/ Introduce Figure 13.1 so that students understand the types of brain injury that can and do occur. Be attentive to the key portions of the definition above - explaining the nature of head injuries. Spend time discussing the differences with class participants and how this might impact needs instruction in the classroom. Take a few minutes and explore with them the National Resource Center for TBI at http://www.neuro.pmr.vcu.edu/. This resource offers an understanding of the differences between a closed and open head injury. Introduce Figure 13.2 and explore closed head injury accident for further illustration. http://pediatrics.about.com/gi/dynamic/offsite.htm?zi=1/XJ&sdn=pediatrics&zu=http%3A%2F%2Fwww.tbiguide.com%2F Describe traumatic brain injury

How Do You Recognize Students with Traumatic Brain Injury? Describing the Characteristics Characteristics will vary according to: Site and extent of injury Length of time student was in a coma Student’s maturational stage at the time of injury Possible changes due to TBI: Physical Cognitive Linguistic Social, behavioral, and personality Direct students to Figure 13-4 on p. 377 to illustrate the portions of the brain that control different functions. A good online tour of the brain and its functions is available at http://www.neuroskills.com/index.html?main=tbi/brain.html Main Points - Physical - changes can range from non-existent to severe. More common than spasticity or paralysis are coordination problems, physical weakness, and fatigue. Main Points - Cognitive - The changes associated with TBUI can be obvious to subtle. Remember, just because the student doesn’t appear to have lasting physical changes to them it does not mean there have not been significant cognitive changes as a result of the injury. Main Points - Linguistic - Most students with brain injuries regain most of their speech and language facility, especially their expressive language. However, learning new concepts may continue to be a challenge. Main Points - Social, Behavioral, and Personality - some of the behaviors may include temper outbursts, euphoria, restlessness, irritability, anxiety, and fatigue. These behaviors may interfere with their self-esteem, school performance, friendships, community functioning, and family interactions http://kidshealth.org/parent/general/body_basics/brain_nervous_system.html http://www.pbs.org/wnet/brain/3d/index.html Describe traumatic brain injury

How Do You Recognize Students with Traumatic Brain Injury? Identifying the Causes Major causes: Accidents 28% of all accidents result in head injuries Falls Violence-related incidents Are the leading cause of TBI-related death Child abuse Shaken-impact syndrome Sports and recreational injuries Introduce Figure 13.6 and facilitate a discussion on the causes of the traumatic brain injury. The notes above focus on three major causes but the fourth which continues to grow is sport related. Increasingly, sport related concussions amongst professional and school-age athletes are being discovered and reported in the media. The link in the slide will direct you to information on “shaken baby syndrome”, most common in infants and toddlers who are abused. Questions for discussion: Should protections be mandated to protect children from potential sport related head injuries? In a society that prides itself in individual freedoms, are the consequences of head injuries due to lack of restrictive helmet laws and the like worth the individual freedom? Describe traumatic brain injury

How Do You Recognize Students with Traumatic Brain Injury? Identifying the Causes Emotional Stages of Recovery Confusion and agitation Denial Anger and depression Testing phase Uneasy acceptance Emotional adjustment Introduce Figure 13.6 and facilitate a discussion on the causes of the traumatic brain injury. The notes above focus on three major causes but the fourth which continues to grow is sport related. Increasingly, sport related concussions amongst professional and school-age athletes are being discovered and reported in the media. The link in the slide will direct you to information on “shaken baby syndrome”, most common in infants and toddlers who are abused. Questions for discussion: Should protections be mandated to protect children from potential sport related head injuries? In a society that prides itself in individual freedoms, are the consequences of head injuries due to lack of restrictive helmet laws and the like worth the individual freedom? Describe traumatic brain injury

How Do You Evaluate Students with Traumatic Brain Injury? Determining the Presence Figure 13-7 Point out how the steps of observation, screening, prereferral, referral, and nondiscriminatory evaluation take place in the evaluation of students who have an emotional or behavioral disturbance.

How Do You Evaluate Students with Traumatic Brain Injury? Determining the Nature and Extent of Services Personal intervention plan Team should ask: What can the student do now? What does the student need to do next? Who will be responsible for the student’s educational program? How will the team determine if the educational program is working for the student? The team will: Obtain as much knowledge as possible Know the student’s specific deficits Not equate the student’s physical recovery with overall recovery Be clear about expectations Not give the student major responsibility for making decisions if his disability interferes with decision-making abilities Identify the purposes of inclusion and the expectations for schools and teachers regarding the inclusion of students with disabilities. Discuss the previsions for setting aside the presumption of inclusion. Direct students to the inclusion tips in Box 13-2 on p. 386 in the text. How might the personal intervention plan help implement these tips in the classroom? Recall effective teaching practices for working with students with traumatic brain injury.

How Do You Recognize Students with Traumatic Brain Injury? Recommendations School re-entry establish linkage between the trauma center/rehabilitation hospital and the special education team at the school determine whether the child needs to relearn material previously known supervision may be needed (i.e. between the classroom and restroom) as the child may have difficulty with orientation because the child's short-term memory may be impaired, what appears to have been learned may be forgotten later in the day Demonstrate new tasks, state instructions, and provide examples to illustrate ideas and concepts Be prepared for students' reduced stamina and increased fatigue and provide rest breaks as needed Keep the environment as distraction-free as possible. Introduce Figure 13.6 and facilitate a discussion on the causes of the traumatic brain injury. The notes above focus on three major causes but the fourth which continues to grow is sport related. Increasingly, sport related concussions amongst professional and school-age athletes are being discovered and reported in the media. The link in the slide will direct you to information on “shaken baby syndrome”, most common in infants and toddlers who are abused. Questions for discussion: Should protections be mandated to protect children from potential sport related head injuries? In a society that prides itself in individual freedoms, are the consequences of head injuries due to lack of restrictive helmet laws and the like worth the individual freedom? Recall effective teaching practices for working with students with traumatic brain injury.

What You Might Be Tempted Ways to Include Peers in the Process How Do You Assure Progress in the General Curriculum? Including Students What You Might See What You Might Be Tempted to Do Alternate Responses Ways to Include Peers in the Process Behavior The student may show behavior and personality changes, such as temper, outbursts, anxiety, fatigue, or depression. Respond with strong disapproval and discipline her new behavior. Reward her positive behaviors. Provide predictable routines that encourage normal behavior patterns while teaching her new ways to respond within the school environment. Give her time to work in natural settings with peers who will encourage appropriate behavior yet show acceptance during the relearning stage. Social interactions She may have forgotten social skills and experience social misunderstandings because of her new identity struggles. Ignore her social difficulties and hope they go away. Work with both the speech pathologist and the school counselor to plan the best ways to use language and social skills in successful situations. Allow friends with whom she feels secure to role-play social activities. Structure new opportunities for successful inter- actions. Use videotapes for self- evaluation. Educational performance Learning new information may be difficult for her, or it may take her much longer to process information. Require extra work in areas of difficulty rather than focus on holding skills and what she can accomplish. Capitalize on what is familiar to retrieve and develop memory, organization, and cognitive processes. Prioritize the academic skills she needs to learn. Have her brainstorm and work with her peers/friends to practice skills as well as to plan future projects and educational aspirations. Classroom attitudes She may appear easily distracted, have headaches, or show a lack of motivation during instruction. Reprimand her apparent lack of participation. Discipline her or excuse her from class activities. Allow her to take rest periods. Modify the amount and intensity of her assignments. Pair her with a partner and friend who can help her focus and participate meaningfully during instruction. Discuss the continuum of services that schools must provide including: resource rooms, special classes, special schools, homebound services, and hospitals or institutions. Question for discussion on the continuum of services: Why would schools need to provide resource rooms if they are including students in the regular education environment? Nonacademic inclusion: Discuss students’ participation in extracurricular activities and other nonacademic normal school routines (such as lunch, recess, clubs, sporting events, etc.) Question for discussion on nonacademic inclusion: How should schools plan for and facilitate to nonacademic inclusion of students with special needs? Recall effective teaching practices for working with students with traumatic brain injury.

How Do You Recognize Students with Traumatic Brain Injury? Characteristics Learning and behavioral difficulties Difficulty with logic, thinking and reasoning Slower to respond, react and complete activities and tasks Difficulty focusing attention Physical limitations Inappropriate social behaviors Difficulty remembering Frequently puzzled or challenged by grade level work Difficulty learning It is believe that TBI has a profound effect on new learning even though previous learning may remain in tact Never underestimate the potential for growth and development Some TBI children will have speech and language deficits Introduce Figure 13.6 and facilitate a discussion on the causes of the traumatic brain injury. The notes above focus on three major causes but the fourth which continues to grow is sport related. Increasingly, sport related concussions amongst professional and school-age athletes are being discovered and reported in the media. The link in the slide will direct you to information on “shaken baby syndrome”, most common in infants and toddlers who are abused. Questions for discussion: Should protections be mandated to protect children from potential sport related head injuries? In a society that prides itself in individual freedoms, are the consequences of head injuries due to lack of restrictive helmet laws and the like worth the individual freedom? Recall effective teaching practices for working with students with traumatic brain injury.

How Do You Recognize Students with Traumatic Brain Injury? Recommendations Best Practices Become informed, work with the parents to understand as much as you can about the child Exercise patience and alter your expectations, Set the student up for success Repeat instructions, directions as needed and provide one direction at a time Allow the student more time to complete tasks and reduce the workload if needed Activities/tasks requiring the student to concentrate for long periods of time should be avoided It's important to remember that the student takes a longer amount of time to process information Be sure to have consistent routines and rules Keep distractions to a minimum Remember to assess this student with an approach that will meet his/her needs - i.e., additional time, more observation etc. Make sure the IEP is in place and that it is flexible - a working document. Each child with TBI is unique in needs. The child may require a modified schedule and or a behavioral plan The child may need direct support in organizational strategies Introduce Figure 13.6 and facilitate a discussion on the causes of the traumatic brain injury. The notes above focus on three major causes but the fourth which continues to grow is sport related. Increasingly, sport related concussions amongst professional and school-age athletes are being discovered and reported in the media. The link in the slide will direct you to information on “shaken baby syndrome”, most common in infants and toddlers who are abused. Questions for discussion: Should protections be mandated to protect children from potential sport related head injuries? In a society that prides itself in individual freedoms, are the consequences of head injuries due to lack of restrictive helmet laws and the like worth the individual freedom? Recall effective teaching practices for working with students with traumatic brain injury.

How Do You Assure Progress in the General Curriculum? Planning Universally Designed Learning Altering curriculum and instruction Mnemonics Keyword method Pegword method Letter strategies Acronyms Acrostics Augmenting curriculum and instruction Review background knowledge Modifications and accommodations Alter how students practice and demonstrate what they are learning Direct the discussion towards instruction by discussing the two strategies listed above. Discuss the details of each strategy and inquire from the students the types of memory techniques they have employed to remember something in school or related to work. Questions for discussion: How useful do you think memory strategies would be in the classroom? in the work-based environment? How would accommodations and modification enhance access to the general education classroom for the child with TBI? Where should general education teachers draw the line concerning the accommodation or modification they provide in their classroom? How would you respond to a teacher who says an accommodation or modification is simply “watering down” my curriculum? Recall effective teaching practices for working with students with traumatic brain injury.

Chapter 13 Technology Tips How Do You Assure Progress in the General Curriculum? Planning Universally Designed Learning Collaborating to meet students’ needs Collaboration is crucial in facilitating a reentry to school from a hospital or rehabilitation center A core team can be used to develop plans and foster communication between family and professionals The diverse perspectives of team members allow for more active problem solving The discussion for TBI could have two separate components. One focus could examine the relationship between rehabilitation facilities and the school and home environment. How can all those involved in the transition from the rehabilitation facility back to home and school work together to ensure success? Another focus could consider the essence of the Core Team approach and how regular interaction can prove to be the determining success for students like Jarris. Have students look at the tips in Box 13-4 on p. 389 in the text for further details. What time and costs are involved for such an approach? Chapter 13 Technology Tips http://wps.prenhall.com/chet_turnbull_exceptional_4/0,8158,952953-,00.html http://en.wikipedia.org/wiki/Personal_digital_assistant Chapter Objectives

The Early Childhood Years What Can You Learn from Others Who Teach Students with Traumatic Brain Injury? Early Childhood What Can You Learn from Others Who Teach Students with Traumatic Brain Injury? The Early Childhood Years The Children’s Place, Kansas City, Missouri A non-specific program dedicated to serving the needs of preschool children with challenges caused by their environment The program often serves as a transitional program after a rehabilitation center. Team members work closely with the child’s primary caregiver, and the program is continued in the home. The program works to also transition students into a traditional preschool program. At The Children’s Place, professionals may often be working with parents who need support in proper parenting techniques. What challenges do your students see in working with children who may have been abused, as well as with parents who may not use appropriate parenting methods? Chapter Objectives

Centennial Elementary School, Lawrence, Kansas What Can You Learn from Others Who Teach Students with Traumatic Brain Injury? Elementary The Elementary Years Centennial Elementary School, Lawrence, Kansas Jarris attended Centennial Elementary in the general education program. Her teachers had to learn about TBI as she progressed. A supportive collaborative team developed a program that would accelerate Jarris’ learning while meeting her immediate needs. Her general education classroom teacher advocated for less pull out services, and made numerous accommodations. A special education teacher now conducts ASL workshops for any student who expresses an interest so that they may communicate with Jarris. In reading the story of Jarris and her elementary school, ask students to identify how school staff implemented different ideas and techniques discussed in the chapter. How did the actions of the school contribute to Jarris’ success? Chapter Objectives

The Middle and Secondary Years What Can You Learn from Others Who Teach Students with Traumatic Brain Injury? Middle and Secondary The Middle and Secondary Years Shawnee Mission West, Shawnee Mission, Kansas Middle and secondary students with TBI often need interventions that refine self-management, learning, thinking, and problem-solving abilities. Sometimes students may exhibit significant behavioral problems that require specific instruction. Teachers work to do functional behavioral analyses and develop plans to prevent problem behaviors and develop better social interactions. Ask students to imagine Jarris in the future. How could a teacher like Katie Williamson benefit Jarris? In “Traumatic Brain Injury Survival Guide,” there is a section entitled “Returning to School” which has good information for both college and high school students. (http://www.tbiguide.com/returnschool.html) You can use this material in discussing this slide and the next. Chapter Objectives

The Transitional and Post-Secondary Years What Can You Learn from Others Who Teach Students with Traumatic Brain Injury? Transitional and Post Secondary The Transitional and Post-Secondary Years Pepperdine University, Malibu, California Students need to identify post-secondary institutions that are consistent with their strengths and needs. It is important to work with professors to let them understand the disability and the student’s needs. One challenge may be the ability to be independent and attend to basic daily needs. Study skills will also be a crucial need. Bindependent is a website created by brain injury survivors and family members (http://www.bindependent.com/). It provides materials and suggestions to allow TBI survivors lead independent lives. Chapter Objectives

A Vision for Jarris’ Future Jarris has mastered ASL and can communicate effectively with her family, teachers, and schoolmates. Jarris’ parents want her to be able to choose and pursue whatever dreams she has. They believe she has the potential to succeed, and believe this developed from her early involvement with the LAP. Use the “What Would You Recommend?” questions on page 396 to wrap up the chapter and return to Jarris. Using these questions at the end of each chapter are a good method of tying the chapter information together. You can use the story of the student introduced at the beginning of the chapter as a way to put the information into a practical application.