Presentation on theme: "Students with TBI: Who and Where are They?"— Presentation transcript:
1 Students with TBI: Who and Where are They? What are the Effects of TBI?What Do They Need?
2 Traumatic Brain Injury (9-27-07) The BrainAbout 3.5 poundsConsistency of 3 day-old JelloBony, bumpy case surrounded by less than ¼ cup of spinal fluid10 billion neuronsEach neuron connects with othersaverage of 10,000 synapsesPass around Jello brain
3 Brain Injury Closed Head Injury Open Head Injury Congenital Brain InjuryPre-birth or during birthAcquired Brain InjuryAfter birth processTraumatic Brain Injury(TBI)Closed Head InjuryConcussionSwelling results in further(secondary) injuryNo loss of consciousnessDamage great or greater thanopen brain injuryOpen Head InjurySkull is fracturedBlood & swelling have aplace to go
4 Traumatic Brain Injury (9-27-07) Shearing strainsthroughout thebrainSubdural veinstorn as brainrotates forwardSwelling ofbrain stemDamage totemporal lobesfrom roughbones at skull baseCompressionfractureTypes of Damage in a Closed Head Injury
8 What’s Different about TBI? No two brain injuries are exactly the same.Brain injury is complex and varies greatly from person to person.Cause, location and severity of injury determine the effects.Long-term effects are not always apparent and may present as cognitive and environmental demands increase.Attainment of developmental milestones may be effected by a past injury.Commonly results in functional deficits that may be identified in another disability category(ies)
9 Causes of TBI in Children Traumatic Brain Injury ( )Causes of TBI in ChildrenMotor Vehicle CrashesHigh Risk SportsATVs, rodeo, skiing, snow boardingMotorcycle incidentsPedestrian vehicle incidentsViolenceFallsAbuseShaking
10 Traumatic Brain Injury (9-27-07) TBI in Children1.4 million children injured annuallyHighest risk groups ages 0-4 and 15-19More likely to survive than adultsLess likely to lose consciousness1/50 kids have had a concussion
11 Scope of the Problem: Oregon Approximately 1000 children hospitalized annually in OregonMore than 1/3 experience persisting functional limitationsExpected yield = approx 3,000-4,000 identifiedJust over 300 identified for SPED under TBI in OregonJust 50 in NWRESD service area
12 Why Don’t We Find Them? Lack of medical training and referral Lack of educational training and awarenessLack of parental recognitionMany “look good” physicallyDevelopmental bias that they will be OK
13 Under–Identification Cycle Apparent Low IncidenceEligible Under Different CategoryLack of AwarenessLack of Research MoneyLack of TrainingLack of Services for those IdentifiedLack of research money but also support services
14 Special Educational Definition of TBI …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 child’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.
15 Sequence of Skill Recovery Traumatic Brain Injury ( )Sequence of Skill RecoveryMotorGross motor functioning (1 to 2 months)SensoryImproves relatively rapidly in children (1 to 2 months)Speech Communication skillsExpressive speech may resolve within a few months,Subtle language problems may persist indefinitelyMeasured IQMay be small changesNot as rapid as motor, sensory and speech functionsMemory, Attention, Processing speedMay lag for many months or be forever reducedHigher Level CognitionInformation processingLearning under new, complex or difficult situationsAbility to adapt to new problems or situations.Children negatively affected by stress more easily than before.May be impacted for years or permanently
16 Traumatic Brain Injury (9-27-07) 2 Years After Injury….Memory problems (74%)Fatigue (72%)Word-Finding difficulties (67%)Irritability (67%)Impaired Speed of Thinking (64%)Impaired Concentration (62%)(Ponsford, 1995)Depressed Mood40-50% of people with TBI(Glenn, 2001)
17 Pet Scans – New Learning Everything lights up with new learningPathways rewirePathways are created through repetitionEventually, learning results in more efficiencyTend to encode Irrelevant InformationPET scans show that when learning new information, many areas in the brain light up. This continues in TBI students which shows us that proper storage and encoding is not being obtained.In TBI-Injured students pathways are created that are irrelevent, there is difficulty figuring out what is important.Because a typically functioning brain becomes efficient by repetition, this disrupts TBI students’ ability to create meaninful pathways.
18 Residual Cognitive Deficits Disorders of Attention – easily fatigued, impaired shifting, impaired maintenance, impaired selectionDisorders of Memory – poor rote, short term difficulties, storage and retrieval difficulties, prospective memory problems (remembering to remember)Disorders of Planning – slowed initiation, disinhibition, poor at abstraction, poor sequencing, doesn’t learn from mistakes, doesn’t ask for help, can’t get started
19 Residual Cognitive Deficits Disorders of Judgment – misinterprets actions of others, can’t handle multiple bits of information at once, socially unacceptable physical and verbal behaviors, little self awareness of strengths and weaknessesDisorders of Information Processing Speed – extreme slowness in reaction time, slowed psychomotor activities – writing, talking, etc.Disorders of Communication – anomia, inefficient word retrieval, hyperverbal, peculiar use of words and phrases, uninhibited word choiceRoberta DePompei, 2009
21 Observed Behaviors Underlying Problems Can’t learn new games, decision rules, changes in targeted taskTemper tantrums, sticks with one solution, won’t change mindPoor social interactions, foul language, hot temperLack of awareness, poor task completion, trouble with changeInflexibility, poor working and short term memory, poor “shifting” (multitask)Ineffective problem solving and judgment, Limbic dysregulationPoor judgment, lack of self-awareness, language deficitsImpaired “executive”skills
22 INTERVENTIONS – What do they need? 0-21INTERVENTIONS – What do they need?
23 Physical ChallengesIndividuals with TBIs have many things at work sapping their energy……pain, mood problems, disrupted sleep patterns. Each of the processes build upon each other to reach the higher level functioning. You must pay attention to the energy the student has available to work on learning.
24 Executive Functions Planning Inhibition Rigidity/Inflexibility Self RegulationInhibitionRigidity/InflexibilitySustained EnergyPoor monitoring and awareness of behaviorFrequent distractionsPlanningDifficulty with multi-Step tasksEngaging in independent tasksOrganizational difficultiesMemoryDifficulty holding instructions/InformationNew learning is most difficultDifficulty with multiple cognitive demands (writing)Strategic LearningMetacognitionGoal-Directed activityProblem solving for attainment of future goalInability to form Mental representations & interpretations
25 Memory Interventions Repeat often and summarize Have child paraphrase, doodle, condense for encodingCarry assignment sheet for each classClosed-ended tasks (fill-in vs. essay)Categorize or “chunk” informationUse visualizationLink new information to prior knowledgeGive examples with instructionDiscrete task objectives (Vocabulary)Rehearsal (often doesn’t work real well)Visual interventions such “Inspiration” SoftwareAuditory interventions such as tape recorder, books on tape
26 Self Regulation Reduce distractions in work area Make tasks shorter Behavior contractDivide work into smaller segmentsUse cues (words, sounds, tactile) to alert person to pay attentionBuild in choiceIncrease joyfulness, high interest and relationshipIgnore dis-inhibited responseIncentive SystemsKeep tools and materials availableKeep it structuredAllow for frequent breaks
28 Processing Speed Strategies The Wright Family Story!Give more time to complete requested tasksSlow pace of InstructionNote takerCondense tasksMusicUse Scaffolding and Modeling
29 Strategic Learning Strategies Prompts and remindersProvide scoring rubricHave child provide a written planBreak down tasks and timelines (note cards)CoachingStructured teachingRe-teach affect and social cluesFlexible performance optionsVisual and written instructionsHigh degree of tactile reinforcersTeach Note MethodsSQ3R (Survey, question, read, write, review)
30 Concrete ThinkingDifficulty with abstraction, synthesis, inference etc.
31 Planning Interventions Draw maps, use lists, timelines, visual schedulesGoal SettingColor-code materials, information (definition vs. main ideaElectronic organizersPreview completed assignmentAnswer – “How will I know when I am done?”Establish RoutinesUse paraphrasing, re-teaching, reciprocal coachingMeet at beginning and end of dayPost-activity reflection
32 Self-Regulation and Behavior GoalObstaclePlanPredictDoReviewTask completion templateWork on internalizationStrive for consistency across all support people including parents – everybody needs to be using the same language
33 Template Prompts Plan-Do-Review Goal “What do you need to do?” “What are we here for?” “What will it look like when it’s finished?”Obstacle “What stands or might stand in the way of accomplishing the goal?”Plan “What will you do first, second, third, etc?”Student makes prediction about success of plan “Will it be hard or easy?” Is it scary or not scary?”“Will it take an hour or take 6 hours?” “Is it a choice or not a choice?”Do “Let me know if you need any help.”Review “How did that work out?” “What would you do differently?” “Do you think you met your goal?”
34 Behavioral Interventions (Very Common) Conduct a FBAGive very clear written and verbal guidelinesBig 5When to startWhat to doHow much to doWhat finished looks likeWhat to do nextCoach to assist with misperceptionsImplement Positive Behavior Supports
35 SelfRegulationExecutiveFunctioningCommunication SkillsWe must teach and support the underlying processes to get to self-regulationR. DePompei 2009
36 What Can You Do? Remember that TBI is vastly under identified When you see unexplained behaviors or learning characteristics….suspect!Ask! “Has your child ever had a blow to the head or a concussion?”Add the question to medical cardsVisit some of the great websites available
37 NWRESD TBI Educational Consulting Team Laura BekkenCindy HodgesKristy Young
38 Oregon Brain Injury Resources Resource librarian (Laura Beck) is available to find specific information for your particular request regarding TBITBI Educator website from Teaching Research Institute is very dense with information, resources, forms, training opportunities
39 Websites of Interest- LearnNet – excellent resource for educators and parentsespecially for parents-Username=wear your Password=helmet-Enter “TBI manual” in search for excellent educator’s manual on TBI