Traumatic Brain Injury and School InterventionThomas 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 Controlestimates 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 personalityChange in cognitive functioning
Glasgow Coma Scale
Used for initial assessment Scaled scores for observed responses
Eye openingMotor responsesVerbal 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 transientAmerican 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
InterventionAt 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
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