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traumatic brain injury By Michelle Kemper
GOALS • IDENTIFY WHAT traumaticbraininjury (TBI) IS • HOW MIGHT TBI DIFFER FROM OTHER DISABILITIES OR BEHAVIORAL ISSUES • SUGGESTED CLASSROOM INTERVENTIONS • WHAT TEACHERS NEED TO KNOW • INFORMATION REFERENCES
What is it? “A bump, blow or jolt to the head or a penetrating head injury that disrupts the normal function of the brain.”(Center for Disease Control and Prevention) • Injury ranges from mild to severe • Majority of injuries are concussions or mild TBIs • Not ALL impacts to the head are TBIs • CDC considers TBI a serious public health problem • TBI Video (Nucleus Medical Media): http://www.youtube.com/watch?v=55u5Ivx31og
Interesting TBI Facts(Center for Disease Control and Prevention) • Leading causes include: • Falls (50% children 0-14 yrs.) • Traffic Accidents • Struck by/Against Events (25% children 0-14 yrs.) • Assaults (2.9% children 0-14 yrs.) • Higher for males than females (in general) • Highest age groups at risk 0-4 yrs. and 15-19 yrs. • 75% Concussions or mild TBI • Individuals who experience TBI have 3X increased risk of re-injury • 1.7 million TBIs each year (MS, Spinal Cord Inj, HIV/AIDs, and Breast Cancer combined)
What happens when a student has a TBI? Immediate changes (may include): • Confusion or disorientation • Loss of consciousness (minutes, hours, days) • Evaluated by doctor/hospital • May or may not be reported to school (depending on severity)
What happens when a student has a TBI? • Physical: • Tired/Sleep Issues • Lack of interest • Headaches • Weakness/Dizziness • Coordination/Motor Function • Slow reactions • Light/Noise Sensitivity • Cognitive: • Forgetfulness/Foggy • Struggles w/new material • Word-finding difficulties • Organization problems • Inattentive • Concentration difficulties • Easily distracted Long-Term (Possible Changes Over Time) • Behavioral: • Irritability • Aggressiveness • Easily Frustrated/Angered • Issues w/unexpected events • Social Withdrawal • Emotional: • Moodiness • Unstable emotions • Depression • Anxiety
HOW TBI DIFFERS FROM LD/ED * Distinguishing Characteristics • Functioning at higher level prior to injury • Marked medical changes (balance, weakness, paralysis, visual,.) • Recovery of some functions (slowly, quickly, unpredictably) • Perform inconsistently • Short-term memory issues • Previous learning intact, may have difficulty learning something new • Full or partial awareness of capabilities and loss (especially in older children) • Agitated, restless, impulsive, • New problems with peers, behavioral difficulties, lack of understanding issues
SIMULATIONS(As time permits) • Visual-Motor Function Apraxia – loss of ability to carry out familiar, purposeful movements without motor or sensory impairment.Examples: Feeding yourself, brushing teeth, writing notes, taking a test • Speed/Processing Function Examples: Cannot keep up, trouble concentrating, frustrated
Classroom Management • Teaching methods and strategies used with learning and emotional disabilities can also be used with traumatic brain injuries. • Accommodations used for students with TBI can likewise benefit all of the students. • There is not one teaching program that applies to every student with a brain injury; therefore, each student’s plan will need to be adapted to their specific needs.
Post TBI Strategies & Interventions I Attention/Concentration Information Processing • Minimize Distractions (eg. Seating) • Technology Options • Peer Notes • Small Groups • Adjust Schedules • Verbal/Non-verbal Cues • Breaks • Slower pace • Extended time (eg. tests, assignments) • Workload adjustment • Repetition • Color-coding • Written assignments • Record instructions • (Examples)
Post TBI Strategies & Interventions II Memory Executive Functioning • Written Instruct/Assign • Recording Information • M/C Test Formats • Highlighted Information • Emphasis on learning mode (visual/auditory) • Organizer • Repetition to comprehend • Memory notebook • Rehearse routines • Organization systems • Break large tasks into smaller steps • Display schedules • Color-coding • Designated locations(eg. for homework) • Practice sequencing material • (Examples)
Personal Stories (Examples, as time permits) • Jessica’s Story Strategy differences may exist for TBI students and students with other disabilities. • Julie’s Story Injuries may not be recognized due to poor transition between hospitals, parents, and schools. • Yvette’s Story A teacher’s willingness to adapt can be critical to success!
What Teachers Should KnowBe aware of possible TBI. • Importance of Assessment: While interventions for other disabilities may be the same for TBIs, it will not focus and identify the cognitive impairments. Identification is essential to their success. • Annually follow-up: Students that have had a TBI need to be tracked for additional problems or progress. • TBI Classified as ED: Many times students labeled as ED have been found to have had a TBI (20% in one study); behavior is misunderstood and cognitive deficits are missed.
What Teachers Should KnowHow can you support these students? • Analyze and work with the student • Do not rush or challenge • Consistency in strategies • Understand the emotional challenges, talk to the student. • Older students may appear to “not care” but it is a common problem with memory deficits. • Watch for social issues, peers may need to be educated
What Teachers Should KnowRemember! • Many students with TBIs may fail in school due to unrecognized injury, or due to “mild” mis-diagnosis. (15% have significant injury) • Early TBI may be academically normal but experience significant issues with new demands of middle or high school. • With older students, previously learned material may remain intact, while learning new information may be compromised.
The End ED584 - November 2013
References Bowen, J. (2004). Classroom Interventions for Students with Traumatic Brain Injuries. Retrieved November 2013, from Brainline.org (brainline kids): http://www.brainline.org/content/2008/07/classroom-interventions-students-traumatic-brain-injuries_pageall.html Dawson, P., Devine, A., Gioia, G. A., Jones, V., Dohrn, E., Dunn, C., et al. (n.d.). TBI Compared to ED,LD,ADHD& Autism. Retrieved November 2013, from CBIRT: http://media.cbirt.org/uploads/medialibrary/2010/10/TBI_Compared_to_ED_ADHD_LD_ASD_FINAL.pdf DePompei, R., & Blosser, J. (2003). TBI Compared to Other Disabilities. Retrieved November 2013, from CBIRT: http://media.cbirt.org/uploads/medialibrary/2010/10/TBI_vs_Autism_LD_ED_ADHD.pdf Hibbard, M., Gordon, W. A., Martin, T., Raskin, B., & Brown, M. (2001). Students With Traumatic Brain Injury: Identification, Assessment and Classroom Accommodations. Research and Training Center on Community Integration of Individuals with Traumatic Brain Injury, Department of Rehabilitation Medicine. New York: Mount Sinai School of Medicine. Injury Prevention & Control: Traumatic Brain Injury; What are the Leading Causes of TBI? (n.d.). Retrieved November 2013, from Centers for Disease Control and Prevention: http://www.cdc.gov/TraumaticBrainInjury/ Lash, M. (2000). Teaching Strategies for Students with Brain Injuries. Retrieved November 2013, from Brain Injury Association of America: http:// www.biausa.org Learning Difficulties and Strategies to Assist Students with Traumatic Brain Injury. (2011, November). Retrieved November 2013, from Duke Health Organization: http://www.dukehealth.org/services/speech_and_audiology/care_guides/speech_pathology_resources/traumatic-brain- injury/pediatric-traumatic-brain-injury-resources/learning-difficulties-and-strategies-to-assist-students-with-traumatic-brain-injury
References(Continued) New Start Program: Center for Community Participation . (2004, September). Learning About Brain Injury: An Activity Manual For Elementary School Students. Retrieved November 2013, from Colorado State University: http://www.colostate.edu/Dept/CCP/Programsfolder/ Disability%20Awareness%20Curriculum%20final%209-04.pdf Nucleus Medical Media. (2012, March 14). Concussion, Traumatic Brain Injury (TBI). Retrieved November 2013, from YouTube: http:// www.youtube.com/watch?v=55u5Ivx31og Resources: Traumatic Brain Injury. (n.d.). Retrieved November 2013, from National Association of Special Education Teachers (NASET): http:// www.naset.org/traumaticbraininj2.0.html#c9611 Traumatic Brain Injury Basics. (n.d.). Retrieved November 2013, from brainline.org: http://www.brainline.org/landing_pages/Basics.html University of Oregon. (n.d.). Service Providers. (I. a. Office of Research, Producer) Retrieved November 2013, from The Center on Brain Injury Research and Training (CBIRT): http://cbirt.org/resources/service-providers/