1. 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

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

3. 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
% may have symptoms that last longer!
Child may look fine but may really be struggling internally

4. 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

5. 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

6. 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

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

8. 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

9. 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

10. 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?

11. 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

12. 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…

13. 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
(BIA of New York State)
Kimberly C. Davis, PhD