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BrainSTEPS Child & Adolescent Brain Injury School Re-Entry Program. S trategies T eaching E ducators P arents S tudents. BrainSTEPS. What is BrainSTEPS?. Brain injury consulting teams available to families and schools throughout Pennsylvania.

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what is brainsteps
What is BrainSTEPS?
  • Brain injury consulting teams available to families and schools throughout Pennsylvania.
  • Teams are extensively trained in the educational needs of students returning to school following brain injury.
  • Teams will work with local school staff to develop educational programs, academic interventions, strategy implementation, and monitoring of students.
what brainsteps can do
What BrainSTEPS Can Do:
  • Conduct observations of the student
  • Communicate with the district and medical professionals to ensure a smooth re-entry
  • Review medical, rehabilitation, & educational reports to assist in making educational recommendations.
what brainsteps can do1
What BrainSTEPS Can Do:

4. Create & provide a training for the school on the educational impact of the student’s specific brain injury. Educate and support district staff & family.

5. Provide Peer Trainings, so peers understand how brain injury has impacted their classmate.


What BrainSTEPS Can Do:

6. Consult on all aspects of the student’s educational plan & make recommendations to the district team.

  • Assist in transitioning a student from grade to grade or school to school by training new teachers

Who should be referred to BrainSTEPS?

  • A student who continues to have CONCUSSION symptoms 2 WEEKS after injury, should be referred to BrainSTEPS.
  • A student who sustains a more moderate to severe brain injury should be referred prior to the student’s return to school.
  • A student who has an older injury, but begins to experience educational impacts as their brain matures/develops can be referred at any time through graduation.

CDC Statistics

AverageANNUAL number of Traumatic Brain Injury Emergency Department Visits and Hospitalizations in the United States


Children with Traumatic Brain Injury 0-14 years of age

  • Most children who sustained a TBI (91.5%) were treated and released from the emergency department.

United States. Centers for Disease Control.  Traumatic Brain Injury in the United States. 2005.>.


How Common is TBI in Children in Pennsylvania?

Each year, approximately


children in Pennsylvania sustain a traumatic brain injury

(mild, moderate, or severe)

Source: The Brain Injury Association of Pennsylvania, 2008



Accidental Dropping

Physical Abuse



Vehicular Accidents



Vehicular Accidents

Physical Abuse

Elementary School Children

Vehicular Accidents

Bicycle Accidents


Recreational Injuries


Vehicular Accidents

Sports Injuries


Causes of Traumatic Brain Injury


Causes of Acquired Brain Injury

  • Post Cancer Treatment
  • Toxic Substances
  • Infections
  • Aneurysms
  • Stroke
  • Anoxia (i.e. choking, respiratory / heart conditions)
a concussion

A Concussion

is a Traumatic

Brain Injury!

Concussions in Pennsylvania:


approx. 22,000children

ages 0-21 years

suffer concussions

a child s brain
A Child’s Brain
  • Underdeveloped – the younger the child, the less developed is their brain
  • Easily Injured – infant’s neck is weak
  • New skills build on ESTABLISHED skills over time
  • Brain injury interrupts skill development, and can prevent new skills from developing
important developmental stages
Important Developmental Stages
  • Child’s stage of development when injury happened
  • Child’s stage of development NOW
pre existing conditions tbi
Pre-Existing Conditions & TBI
  • Children with pre-existing behavioral weaknesses are much more likely to have a TBI.
  • Effects of TBI will compound and add to pre-existing learning, behavioral or psychological problems, such as:
          • Dyslexia
          • ADHD
          • Paranoia
          • Depression
examples of physical effects
Examples of Physical Effects
  • Headaches
  • Changes in speech & language
  • Stamina/weakness
  • Difficulty with balance
  • Seizures
  • Sensory changes





cognitive effects
Cognitive Effects

Executive Function Challenges:

  • Attend or concentrate
  • Initiate, organize, or complete tasks
  • Sequence, generalize, or plan
  • Flexibility of thinking, reasoning, or problem solving
  • Working memory
cognitive effects1
Cognitive Effects

Metacognitive Challenges:

  • Abstract thinking
  • Information processing (slowed speed)
  • Judgment or perception
  • Long-term or short-term memory
cognitive effects2
Cognitive Effects

Related Challenges:

  • Confabulation
  • Ability to acquire or retain new information
  • Inconsistent and unpredictable learning rate
social emotional behavioral issues
Social, Emotional,Behavioral Issues
  • Distractibility
  • Impulsivity
  • Irritability
  • Aggression
  • Motivation & Initiation
  • Depression
  • Lack of Social Judgment
  • Denial/Lack of Self-Awareness
  • Rigidity/Inflexibility
  • Low Frustration Tolerance
instructional strategies to consider
Instructional Strategies to Consider
  • Classroom rules & expectations should be well structured and explicitly taught
  • Instruction should contain repetition & feedback
  • Avoid multi-step instructions if possible

From: TBI Inservice Training Module, Janet Siantz Tyler, PhD., Kansas Dept. of Education, TBI Project

instructional strategies to consider1
Instructional Strategies to Consider
  • Supplement verbal instructions with writing and modeling
  • Provide ample time to process, complete tasks, and respond
  • Assist the student in keeping his/her materials and schedule organized

From: TBI Inservice Training Module, Janet Siantz Tyler, PhD., Kansas Dept. of Education, TBI Project

instructional strategies to consider2
Instructional Strategies to Consider
  • Teach compensatory strategies for test-taking, note-taking, reading materials, etc.
  • Try external aids such as lists, diaries, computers, calculators
  • Videotape the student’s progress in class to provide feedback and show progress

From: TBI Inservice Training Module, Janet Siantz Tyler, PhD., Kansas Dept. of Education, TBI Project

modifications to consider
Modifications to Consider
  • Consider scheduling adjustments, i.e. breaks, study hall, eliminating non-core classes, etc.
  • Assist the student in changing classes
  • Introduce student gradually, i.e. small group
  • Need for supervision
  • Consider ESY, homebound services, instruction in the home, or tutoring for summer months

From: TBI Inservice Training Module, Janet Siantz Tyler, PhD., Kansas Dept. of Education, TBI Project

brainsteps partnerships in our region
BrainSTEPS Partnerships in our Region
  • Discharge Info from:
    • Children’s Hospital Pittsburgh
    • Children’s Institute Pittsburgh
pennsylvania s brainsteps program is considered a national model for brain injury school re entry
Pennsylvania’s BrainSTEPS Programis Considered a National Model for Brain Injury School Re-Entry!

BrainSTEPS received the

Award of Excellence for Programs & Services December 2008,

from the national Brain Injury Association of America

for more information on the brainsteps program
For More Information on the BrainSTEPS Program


Jamie Moder, MHPE, CHES

Adapted Recreational Education Consultant

Allegheny Intermediate Unit


Brenda Eagan Brown, M.S.Ed., CBIS

BrainSTEPS Program Coordinator

Brain Injury School Re-Entry Program

Brain Injury Association of Pennsylvania



Chapman SB. Neurocognitive stall: a paradox in long term recovery from pediatric brain injury. Brain Injury Professional, 3(4): 10-13, 2007.

Kennedy, M. & Krause, M., University of Minnesota, Symposium on Disability Studies & Inclusive Education, July 23, 2010 ppt presentation

Savage RC. The Child’s Brain – Injury and Development, Lash and Associates Publishing, Wake Forest, NC, 1999.

Savage, Ronald C. “The utilization of allostatic load theory to predict long term deficits in children/adolescents with TBI” presented at North American Brain Injury Society conference. October, 2007.

Todis B. & Glang, A. (2008).  Redefining success: Results of a qualitative study of post-secondary transition outcomes for youth with traumatic brain injury. Journal of Head Trauma Rehabilitation, 23(4), 252-263.