Transcript Document 7158264

Traumatic Brain Injury:
Eligibility, Special Education
and Classroom Practices
Josh Zola MA, Ed.S, CBIS
Sarah Powell M.Ed, CCC-SLP, CBIS
Disguised as a Low Incident
Disability…
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Each year, an estimated 1.7 million people
sustain a TBI annually. Of them:
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52,000 die
275,000 are hospitalized,
1.365 million, nearly 80%, are treated and
released from an emergency department.
The number of people with TBI who are not
seen in an emergency department or who
receive no care is unknown. Only 200 of every
100,000 cases go to the hospital.
SC Special Education Law
(Definition)
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Traumatic Brain Injury means an acquired injury to the
brain caused by an external physical force, resulting in
total or partial functional disability or psychosocial
impairment, or both, that adversely affects a student’s
educational performance. The term applies to open or
closed head injuries resulting in impairments in one or
more areas, such as cognition; language; memory;
attention; reasoning; abstract thinking; judgment;
problem-solving; sensory, perceptual, and motor
abilities; psychosocial behavior; physical functions;
information processing; and speech. The term does
not apply to brain injuries that are congenital or
degenerative, or to brain injuries induced by birth
trauma.
Types of Brain Injury
Brain Injury
Congenital and Perinatal
Acquired
(no period of normal development)
(following a period of normal development)
Perinatal
Congenital
Non-traumatic
Traumatic
(e.g., birth stroke)
(e.g., PKU)
(internal occurrence
e.g., tumor)
(external physical force)
Open
Closed
(e.g., gunshot)
(e.g., fall)
Short term effects of Brain Injury
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Injury to brain tissues at the site of
damage
Shearing and tearing of neurons
throughout the brain
Bleeding, swelling, and lack of oxygen to
the brain
Possible coma, loss of consciousness
Described as mild, moderate and severe
Long Term Consequences
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A student’s decreased functioning may be
noted immediately upon return to school
OR it may be several years after the
injury!
If not aware, teachers may see changes
but do not know why they have suddenly
emerged.
Typical Medical Course for a Student
with a Moderate/Severe TBI
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Emergency room
Regional trauma center if necessary
Surgery if necessary
Acute care setting (hospital)
Rehabilitation unit or center
School
(So there should be tons of paperwork)
A student with a TBI has landed in
your school…
Meeting the Challenge of TBI
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To address the educational needs of
students who have experienced a TBI,
educators need to clear 4 hurdles…
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Identification
Assessment
Qualifying for Services
Classroom Accommodations
4 Facts about Identification
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Each student will vary greatly, no 2 will be alike
Changes are unlikely to disappear fully over time
Negative consequences may not be seen
immediately but emerge when developmental
demands reveal problems
An injured brain is less likely to meet the
increasingly complex tasks all children face as
they get older
Common Problems Teachers look
for:
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Physical/Medical Problems
Motor Problems
Sensory/Perceptual Problems
Cognitive-Communication Problems
Emotional and Behavioral Problems
Physical/Medical Problems
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Problems
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Seizures
Fatigue
Headaches
Swallowing/Eating
Self-care activities
Medication issues
Motor Problems
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Apraxia
Ataxia
Coordination
problems
Paresis or paralysis
Orthopedic problems
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Spasticity
Balance problems
Impaired speed of
movement
Sensory/Perceptual Problems
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Visual deficits
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field cuts
tracking (moving and stationary objects)
spatial relationships
double vision (diplopia)
Neglect / Inattention
Auditory sensory changes
Tactile sensory changes
Cognitive-Communication Problems
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Executive functions
Memory
Attention
Concentration
Information
processing
Sequencing
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Problem solving
Comprehension of
abstract language
Word retrieval
Expressive language
organization
Pragmatics
Emotional & Behavioral Problems
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Irritability
Impulsivity
Disinhibition
Perseveration
Emotional Lability
Insensitivity to social
cues
Low frustration
tolerance
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Anxiety
Withdrawal
Egocentricity
Denial of deficit/lack
of insight
Depression
Peer conflict
Sexuality concerns
High risk behavior
So you begin to think about
assessment and will this
student qualify for
services…and qualify for what
services???
Assessment…
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Traditional
Assessment
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Focuses on
intellectual, emotional
and academic
functioning
Example: an IQ score
that declines over time
Cognitive
Assessment
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Focuses on
the underlying
reasons for
academic
failure such as
problems with
attention,
memory, and
executive
skills
Cognitive Assessment…is the student?
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Processing Speed
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Memory
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Retaining new info from day to day?
Benefiting from context?
Benefiting from repetition?
Executive Function
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Accurate but slow?
Prioritizing? Following through? Staying organized?
Using problem solving strategies?
Shifting from 1 task to another?
Attention
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Able to concentrate? Hold onto information?
Attending to more than 1 thing at a time?
Accurate when carrying out complex tasks?
How is TBI different from LD?
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TBI is not “just a learning disability”
Students with TBI cannot be dealt with as
if they have something similar
Although similar, the differences are
important
The impairments are different, as are the
implications for educators
TBI: How is it Different?
TBI
LD
ED
Onset and
Cause
Sudden with blow to head
and loss of consciousness
Early/ unclear
Slow/ unclear
Functional
Change
Marked contrast between
pre and post onset
No before-after
contrasts
Changes
emerge slowly
Physical
Disabilities
Loss of balance, weakness,
paralysis
Poor
coordination
Unlikely
Behavior
Agitation, impulsive,
restlessness, disinhibited
Restlessness,
impulsive
Variable
Emotions
Labile, depression, anxious
Prone to
outbursts
Reactions due to
distortions of
reality
Academic
Deficits
Based on disrupted
cognition
Based on type of Not based on
learning disability impaired cognition
Difficulties
with
Learning
Old info easier to recall than New learning can
be linked with old
new info
learning
New learning can
be linked with old
learning
Misclassified or Missed Altogether
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Poor transitional services
between hospitals and schools
Mild TBI slip thru the cracks
Traditional approaches to
assessment fail to provide
necessary insight into how
cognitive deficits impact school
Special Ed for TBI vs. LD vs. ED
looks different
Deficits are not always
immediately apparent
So, now the assessment as been
done…
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What services are out there?
Qualifying for Special Ed
Traumatic Brain Injury (TBI)
Title of Regulation:
Regulation No.: R43-243.1
CRITERIA FOR ENTRY INTO
PROGRAMS OF SPECIAL EDUCATION
FOR STUDENTS WITH DISABILITIES
Vs.
Medical Definition of TBI
SC TBI Eligibility Criteria
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A multidisciplinary evaluation team shall include a
certified school psychologist, a licensed school
psychologist, or a licensed psycho-educational specialist
in addition to a speech-language therapist
knowledgeable in the education of students with
traumatic brain injury.
The existence of traumatic brain injury has been
diagnosed by a licensed physician. Or, in the absence of
an existing medical diagnosis or a prior diagnosis of a
traumatic brain injury, both of the following are
furnished:
 a documented history that evidences trauma to the
head resulting in impairments according to the
definition of the term “traumatic brain injury” and
 a cognitive profile that is consistent with the head
injury.
SC TBI Eligibility Criteria
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The injury has resulted in partial or total
functional disability and/or psychosocial
impairments.
The student’s traumatic brain injury
adversely affects his or her educational
performance.
SC Special Education Law
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The following evaluation components are
required:
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Medical records, if available.
Documentation of vision, hearing, and speechlanguage screening conducted after the injury and
within the past twelve months.
Review of the developmental history or education
records of the student to determine effect on his or
her educational performance and psychosocial
functioning. Particular attention should be paid to
the student’s progress prior to and following the
suspected injury.
SC Special Education Law
d.
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Observations in three environments by an observer, other than
classroom teacher, that record the nature and severity of the
student’s learning and/or behavior difficulties. These may include
anecdotal records from previous caregivers; a certified school
psychologist, a licensed school psychologist, or a licensed psychoeducational specialist; or the parent(s).
Assessment of the student’s language processing and use (not
receptive or expressive vocabulary tests), memory, attention,
reasoning, abstract thinking, judgment, problem-solving skills,
auditory perception and visual perception shall be completed by
two professionals—a speech-language therapist and either a
certified school psychologist, a licensed school psychologist, or a
licensed psycho-educational specialist who are knowledgeable of
traumatic brain injury.
Documentation of the student’s physical functioning that includes
motor abilities, sensory functions, and the status of seizure activity,
medication, and health.
SC Special Education Law
g.
h.
A behavior assessment shall include psychosocial, pre-injury
functioning and adjustments to impairments.
Documentation of the evidence that the student’s traumatic brain
injury adversely affects his or her educational performance.
SC Special Education Law
Evaluation Results:
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The school based team (which includes the parent) must determine
if the student meets criteria to receive special education as a TBI (or
other classification) student.
IEP v. Section 504 Plan
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Section 504 Plan = Accommodations needed to access the general
curriculum.
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IEP = Special Education = needs for modified curriculum and direct
or indirect services (Resource, Self-Contained, Speech, OT, PT, etc.)
So now, what are your
interventions?
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What are your IEP goals?
504 accommodations
What can you do in your classroom?
Who can you ask for help?
Helpful Hint!
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Accommodations useful to a child with a
TBI often benefit most or all the other
students in the classroom!!
Consistency!!!
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Agree on a strategy and apply it throughout
the day and week
Classroom Environment
Cognitive
Challenge
Accommodations
Attention/
Concentration
Seat
Information
Processing
Speed
Reduce
Memory
Provide
Reasoning
Designate
the student near the teacher, Minimize
distractions, use earplugs, Low stimulation
environment
Distractions, Small Group Instruction,
Position student for optimal learning
written materials, consistent routines,
schedules, visual aids, create an environment that
doesn’t rely on memory
a specific location to return homework,
Display classroom schedule and activities, Reduce
unnecessary frustrations/problems
Classroom Instructions/Materials
Cognitive
Challenge
Accommodations
Attention/
Concentration
Use
Information
Processing
Speed
Give
Memory
Use
Reasoning
Use
peer note taker and tape recorders, Provide
assignments in writing, match the student’s ability
to attend, break tasks into smaller parts, alternate
instructions with activities
the student “time to get it”, Review notes to
identify missed information, smaller segments of
info, emphasize key points
tape recorders and highlighters, Use external
memory management system, Test using multiple
choice, chunk work into manageable pieces, written
instruction, mnemonics, identify learning style
binders to keep materials and notes organized,
Develop systems/use maps, use clear instructions,
provide samples, keep routines
Educating Students with TBI
and Peers
Cognitive
Challenge
Accommodations
Attention/
Concentration
Educate
Information
Processing
Speed
Monitor
Memory
Buddy
Reasoning
“Stop
on attention types, clarify information,
complete a predetermined amount of work, take
rest breaks BEFORE becoming tired, limit
interruptions and distractions
their own comprehension, ask questions,
signal if not understanding, educate others on
strengths and limitations, extra time to respond
system, peer note taker, external memory
systems, routines, generate their own memory cues
and Think,” seek adult assistance, know your
strengths and limitations, use a problem solving
model, listen
Modify your Expectations and
Values
The teacher’s shift in his/hers expectations
of what compromises competence
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For example:
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A teacher may feel the only test of “true”
learning is to ask the student under timelimited conditions to recall ideas and facts.
Try testing their learning through recognition
tests
Other things to keep in mind…
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Physical and Cognitive Endurance/Fatigue
Low Frustration Tolerance
Poor Awareness
Rapid Classroom Pacing
Lack of Predictability
Negative Social Input
Pragmatic Deficits
What happens as a result of
these deficits and behaviors?
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Friends leave
Families mourn
Teachers are frustrated
The student is at increased risk for
isolation from peers, academic failure,
depression, substance abuse, sexual
behavior, delinquency, further TBI
Provide…
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An ear to listen
A safe environment
Clear structure and routine
Consistency
Immediate feedback and praise
Reinforcement
Cueing and modeling
Advocacy
Accessible Resources
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The Family
School Psychologist
Resource Teacher
Guidance Counselor
Speech Therapist
Neuropsychologist
Hospital Case Manager
Peers and Friends
Traumatic Brain Injury Information &
Suggestions
A TBI tool kit for school staff can be downloaded at :
http://www.aasa.dshs.wa.gov/Library/tbitoolkitpro.pdf
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A TBI tool kit for families can be downloaded at:
http://www.aasa.dshs.wa.gov/Library/tbitoolkit.pdf
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Additional Resources
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www.brainline.org
www.binav.org
www.abieducation.com
www.neuroskills.com
www.projectlearnet.org
www.dpi.wi.gov/sped/tbi-trg-pres.html
In Summary
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Students must be identified, appropriately
assessed, and then taught in ways that
address both their strengths and
weaknesses. Disguised as a low incidence
disability, brain injury is occurring and
students need our help at being successful
in SC classrooms!