Back to SchoolIdentifying the needs of students following head

injuryAnn Glang, Ph.D. & Bonnie Todis, Ph.D.

Principal InvestigatorsThe Teaching Research Institute – Eugene

Western Oregon University

Anne StilwellProject Coordinator

Faces of Brain Injury

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 o

f Ide

ntifi

ed S

tude

nts

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 TBIPhysical 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

Perf

orm

ance

Growing Into It

Growing Up

Perf

orm

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

Recruitment Sources

• Four Oregon hospitals

• Educational and medical professionals

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

ResourcesOregon TBI Consulting Team

• Inservice training & consultation to educators working with students with brain injury

• General or tailored to an individual student

• Multidisciplinary team trained in pediatric brain injury

877-872-7246 or 541-346-0593www.tr.wou.edu/tbi/team/index.html