Post on 27-Dec-2015
Back to SchoolIdentifying the needs of students following head
injury
Ann Glang, Ph.D. & Bonnie Todis, Ph.D.Principal Investigators
The Teaching Research Institute – EugeneWestern Oregon University
Anne StilwellProject Coordinator
Scope of the Problem: National
• 60,000 children hospitalized annually
• Approximately 30,000 experience persisting disabilities as a result of changes in cognition, behavior, physical abilities
Scope of the Problem: Oregon
• 600 children hospitalized annually
• Approximately 300 experience
persisting disabilities
Under-identification: Nationally
• Annually: 30,000 with persisting disabilities from brain injury
• Annually: 10,000 (1/3) needing special education supports
• Cumulative total (K-12): 130,000
• Total on federal census (2002): 14,844
Education Issues: Under-identification
0
100,000
200,000
300,000
400,000
Expectedcumulativetotal K-12
If 2/3 requireSpecial
Education
Actual total
Under-identification: Oregon
• Annually: 300 Oregon students with persisting disabilities from brain injury
• Annually: approx. 100 (1/3) needing special education supports
• Cumulative total (K-12): 1300
• Total on Oregon census (2004): 310
100
125
150
175
200
225
250
275
300
325
350
1995 1996 1997 1998 1999 2000 2001 2002 2003 2004
Year
Num
ber
of Id
entified S
tudents
Oregon Students (Age 3-21) with Special Education Eligibility in the
Area of TBI (1994-2004)
Arizona Students with Special Education Eligibility in TBI
• 1998-1999 70
• 1999-2000 93
• 2000-2001 307
• 2001-2002 313
• 2002-2003 319
• 2003-2004 374
Effects of Brain Injury
No two brain injuries are exactly the same.
The effects of a brain injury are complex and vary greatly from person to person.
The effects of a brain injury depend on such factors as cause, location and severity.
Long-term effects are influenced by internal and external factors.
Possible Changes after TBI
Physical Changes
• Motor coordination
• Hearing and visual
changes
• Spasticity and tremors
• Fatigue and/or
weakness
• Taste and smell
• Balance
• Mobility
• Speech
• Seizures
• Disinhibition
• Impulsivity
• Socially inappropriate behavior
• Lack of initiation
Possible Changes after TBI Emotions and Behavior
Possible Changes after TBICognition
• Attention/concentration
• Perception
• Processing speed
• Language
• Memory
• Decision making
• Planning
• Judgment
• Problem solving
• Organization
Impact on school performance:
Memory & Learning
• Recent learning usually more affected then long-term memories
• Prospective memory (i.e., ability to carry out intended actions) frequently impaired
• Motor/procedural learning often less impaired
Growing Up
Per
form
ance
Brain Injury
Normal Development
Two critical intervention stages for children after
brain injury
Credit: Sandra Chapman, Dallas Children’s Hospital
Challenge of Pediatric TBI
• School = Rehabilitation setting
• Key to accessing rehabilitation: accessing special education
• Need to identify students who need rehabilitation when they return to school
• For those students who “grow into” disability, need to remember their TBI
Under-identification
Lack of Awareness
Apparent Low Incidence
Lack of Training
Lack of ResearchMoney
Lack of Right Services for Kids
who are ID
Under-identification Cycle
Outcomes
• What happens to students with TBI when they return to school?
• How do these students do in school over time?
• What factors lead to good school outcomes for students with TBI?
PHASE 1: Brief annual parent questionnaire (retrospective & prospective).
All children (birth to 19 yrs) treated for TBI 1990 – 2009.
PHASE 2: Annual in-depth structured parent interviews. Brief annual educator questionnaire. (120 Participants)
Quantitative
QualitativePHASE 3: Parent & educator
interviews & observations.(24 Participants)
Back to School Project Design
Inclusion Criteria
• Child observed/treated at least overnight
• Age 0-19 at injury (not including birth trauma)
• Injury fits CDC list of ICD-9 codes for TBI
Identification at Discharge
• 72 children enrolled in tracking study
– 27 report no problems
– 21 are served under TBI category
– 5 are served under another category
– 19 are experiencing challenges and are not identified for special education
Emerging Themes
• Changes that cause parents concern may be too subtle for schools to pick up
• School personnel often assume recovery from TBI is complete if no physical signs are present
• Problems may not appear until weeks/months/years after injury
• Students maybe viewed as malingering, lazy, disorganized, “just adolescent”
Under-identification:Educators’ knowledge
• Lack of preservice training
• Limited knowledge of the impact of TBI on school performance
• Lack of feelings of competence
• Teacher training in TBI identified as critical need--nationally and in Oregon
David
“The teachers say David is fantastic, such a joy. A little slow. But that’s David now. They don’t know David as any way else.”
-David’s mother
David
“I don’t know if the information about his brain injury got passed along to the 2nd grade teacher. It’s in his cumulative file, but I don’t know if anyone reads those.”
-David’s mother
David
“I had no training in TBI. It was tough…I wanted to push him, but I didn’t want him to get frustrated and shut down.”
-David’s teacher
Appropriate Identification
Increased Awareness
Accurate Incidence
Improved TrainingAppropriate
Funding
Breaking the Cycle
TRACKING
Communication
Information
Improving Identification of Children with TBI
• Improving the link between medical and educational settings
• Helping schools “remember” the brain injury
• Providing information, training, and resources
ResourcesOregon Brain InjuryResource Network
• Comprehensive library (books, videos, journals)
• Statewide database of available resources and services
• Web site with relevant links
• Telephone assistance & individualized information search
800-544-5243 or 503-413-7707www.tr.wou.edu/tbi