Teaching Students with Epilepsy

1. Teaching Students with Epilepsy Hannah Anderson Dr. Vanessa Tucker

2. What is epilepsy? • Epilepsy is a general term used for a group of disorders that cause disturbances in electrical signaling in the brain. • An epileptic seizure happens when the energy pulses in the brain come too fast – up to 500 pulses per second – for a short time. • Seizures can be caused by anything: • Flickering lights • Stopping anti-epileptic medicine • High fever • Sometimes there are no causes at all *http://www.ehealthmd.com/library/epilepsy/epi_whatis.html*

3. Types of Seizures • There are 40 different types of seizures – some produced by the whole brain and some produced by only a portion of the brain • Children may have more than one type of seizure in their lifetime • Epilepsy is diagnosed when a child or person has two or more seizures that are provoked by causes such as low blood sugar or a high fever http://www.epilepsy.com/info/family_kids_diagnosis

4. Whole Brain Seizures • Tonic Clonic (Grand Mal) • Unconsciousness, muscle rigidity, convulsions • Most severe type of seizure • Student may foam at mouth and lose control of bladder during seizure, as well as go into a deep sleep called the postictal stage after seizure is finished • Tonic = Muscle stiffness and rigidity • Clonic = Repetitive, jerking movements • Absence • Brief period of unconsciousness, student may appear to be “spacing off” but actually may be seizing • Myoclonic • Sporadic jerking movements; may cause student to inadvertently throw or drop objects • Atonic (Drop Seizures) • Sudden loss of muscle tone, primarily in arms and legs, which causes student to fall http://www.webmd.com/epilepsy/guide/types-of-seizures-their-symptoms

5. Partial Brain Seizures • Simple • Jerking movements, muscle rigidity, sensations interfering with seeing, hearing, speaking, etc. • Emotional and memory disturbance • Complex • Involuntary yet coordinated movements such as lip-smacking, chewing, or fidgeting • Partial Seizure with Secondary Generalization • Seizure begins with conscious activity and then turns into unconsciousness later in the seizure • http://www.webmd.com/epilepsy/guide/types-of-seizures-their-symptoms

6. Pros of Inclusion • Many times seizures will affect the language ability of a child so social interaction is imperative • As the child gets older he/she may become embarrassed of their seizures so it is important that they have early positive interactions with their peers • General education students have the chance to work with the epileptic student, giving them a broader idea of their world • Epileptic student may start copying other students’ behaviors and may learn new skills throughout the year • Teaches student with seizures how to advocate for themselves and deal with issues such as post-seizure behavior, incontinence, etc.

7. Cons of Inclusion • Seizures can be scary for other students to see • There are a lot of para-educators and para-nurses that come with a student with a severe seizure disorder so it can, at times, become distracting in the classroom • If the epileptic student has a dog, this can be a major adjustment to some students who might be nervous around dogs • The dog can be quite distracting if it is not trained correctly • There are not as many seizure safe areas in a general education classroom

8. What does the research say? • Prevalence • In the US, an estimated 300,000 children under the age of 14 have epilepsy. • http://www.efwp.org/programs/epilepsy_learning.shtml • Implications on learning • No single aspect of epilepsy can accurately predict how a child’s learning will be affected • Many children that have had tonic-clonic seizures have some form learning disability • http://www.efwp.org/programs/epilepsy_learning.shtml • Is there anything to help with seizures’ implications on learning? • “In some individuals, suppression of discharges by antiepileptic drugs has demonstrably improved psychological function, but further work is required to determine the indications for such treatment.” • Binnie, C.D., Channon, S., & Marston, D. (2007). Learning disabilities in epilepsy: neurophysiological aspects . Epilepsia, 31, S2 - S8.

9. Can Seizures Actually Affect Learning? Article Review #1 Binnie, C.D., Channon, S., & Marston, D. (2007). Learning disabilities in epilepsy: neurophysiological aspects . Epilepsia, 31, S2 - S8. • In the article, Learning Disabilities in Epilepsy: Neurophysiological Aspects, the authors of this article found that when a seizure lasts more than 3 seconds, there is some cognitive impairment • They also found some specificity in the types of learning difficulties as to where the seizures were spiking • When a seizure spiked on the left, quite often that person had verbal difficulties • When a seizure spiked on the right, that person often had difficulty handling non-verbal materials • Overall, the authors found that the seizure activity and discharges on the brain do actually cause an impairment on a child’s educational learning abilities • Some research has also been done on the effects of antiepileptic drugs, and the researchers mentioned that these drugs to help a child to focus and retain information more steadily, but they admitted that more research needed to be done on this topic.

10. Teachers’ Attitudes About Epilepsy Article Review #2 Bishop, M., & Boag, E. (2006). Teachers’ knowledge about epilepsy and attitudes toward students with epilepsy: results of a national survey. Epilepsy & Behavior, 8, 397 - 405. • In this article, Bishop and Boag had 512 elementary and middle school teachers fill out a questionnaire about their beliefs and attitudes towards epileptic students, as well as their overall knowledge about epilepsy. • The results found that teachers generally had a very positive attitude about epileptic students, but there were significant deficits in the knowledge that teachers had about epilepsy • The results also found that there were many teachers who did not have regular contact with epileptic students, but were open to the situation when it arose. • This lack of overall knowledge about epilepsy left teachers searching for ideas as to how to effectively reach out to epileptic students, and the academic program they should be on. • The researchers found that a teacher’s attitude and willingness to learn has a direct impact on their comfort level of teaching students with epilepsy.

11. Epilepsy and Learning Article Review #3 Epilepsy and Learning. (2009). Retrieved November 09, 2010, from http://www.efwp.org/programs/epilepsy_learning.shtml • This website contains many valuable pieces of information on epilepsy and how it affects a child’s learning. • This site reports that every child’s learning difficulties are different due to the vast variability of the types of seizures. • Some contributing factors as to how much the seizures will affect learning are how long the seizures have been occurring, the severity of the seizures, and the age of the child. • Some seizures, though, are not as severe, such as absencia seizures, where the student looks like he/she is dozing off, but these seizures can cause a student to lose out on the instruction being given. • Anti-epileptic drugs • The drugs that students with seizures take can also have an effect on learning, because quite often these drugs will make the student drowsy or so hyperactive that they struggle to concentrate • Overall, this site explains that each child is different in their learning strengths and difficulties, but understanding these struggles will help a teacher be much more effective. • The drugs that students with seizures take can also have an effect on learning, because quite often these drugs will make the student drowsy or so hyperactive that they struggle to concentrate

12. Modifications *These modifications are primarily for students who are with a para-nurse to take care of their seizures or can predict their seizures coming* • Sound specific instruction • Gives the student the opportunity to verbally express his/her knowledge about the sounds • Guided coloring activities • Coloring can be a great fine-motor activity for students • Stamps for name to help with fine motor issues • Allows students to feel independent about showing their name • Larger pictures for coloring • Because many epileptic students have issues with fine motor skills, larger print and larger pictures to color are effective

13. More Modifications… • Puzzles and electronic games to help with letter name retention • Anything with pushing buttons instead of only writing can help a student display their knowledge • Signing to help with language deficits • Due to language deficits, using sign in the classroom can help to ease communication issues • Set clear expectations of parameters around learning • Students respond well to boundaries and consistent schedule • http://www.uscupstate.edu/uploadedFiles/library/about/faculty_staff/Vol1_Issue2.pdf

14. Accommodations • Always have a visual schedule for student • Have a specific spot that the student will sit to enable a routine to be made • Openly communicate about seizure protocol with all staff involved • Allow student to point to numbers and letters to show learning if language skills are affected • Allow student more time for activities for them to feel like they have to time to complete it to their full ability

15. Seizures • Remain calm • Do not restrain individual • Follow school and parent approved protocol • If convulsing, lower student to the floor away from hard objects • Loosen ties and shirts • Have a plan as to how to take class out of room if child is having a seizure (dependent on age of class) • Child may lose consciousness • In this case, stay with child and if he/she regains consciousness, reassure them • If the child loses consciousness, there is usually a bladder/bowel issue that comes as well • For a non-convulsive seizure stay with the child until the seizure has passed and then document seizure length • All information taken from http://www.as.wvu.edu/~scidis/epilepsy.html

16. Safety Plans • For students with seizures or any medical condition, the staff may be asked to provide medicine, call 911, or perform other seizure related duties • Children with potentially life threatening conditions must have a safety plan that is written by the school nurse. The school nurse should be in collaboration with the child’s doctor or designated nurse. • Staff needs to be trained by medical professionals and not just parents – staff need to operate under the legal boundaries that are given to them • All staff must be aware of the key aspects of the safety plan, such as when to call 911, medicines he/she might need, and the line of communication when the seizure occurs – these plans should be review at least once a quarter. • ALL medical questions and orders must go through the school nurse • When a child is having a tonic clonic seizure, the immediacy of their care is critical – therefore these safety plans and orders are of utmost importance *Tucker, V. (personal communication, November 23, 2010*

17. After the seizure…. • Students are often embarrassed about their seizures and other children’s reactions to them • Give the student a quiet place where he/she can relax after a seizure, as well as a place to change if there was a bladder or bowel movement accident during the seizure • The nurse may provide specific instructions as to how to help someone that is just coming out of a seizure • Reassure the student as these seizures can be very scary • Document length of seizure, protocol taken, and be very communicative with parents

18. Dealing with Dogs • If seizures are severe enough, some students may have a seizure dog • These dogs will have a special harness on them that will signify when they are working • Talk to the parents about how strict they want to be about the “no-touch” rule when the dog is working • Be aware that seizure dogs are often very protective of their charges • Survey classroom quickly at the beginning of the year to ask if any child is afraid of dogs, as classroom switches may need to be made • Be communicative up front with parents of general education students to assure them that the dog will not affect their child’s learning

19. Recommendations for the Dog • Have a rest mat ready for the dog in the classroom • Set up a “petting party” every once in a while so students have the opportunity to pet the dog • Make dog seem like part of the class, and stress his importance to all students in the class • Talk to parents about the dog’s signals he/she will give when student is about to seize • Create a bond with dog when he is off work so a trust can be built • Have some treats ready for students to give the dog if they are uncomfortable at first

20. Recommendations for the Classroom • Set up special jobs for epileptic students to help you with – whether it is delivering mail, sorting papers, or leading the line • Have parents come in and explain epilepsy so students have some knowledge about it • Praise the student often about his/her successes in school because often they feel very self-conscious about their seizures • Never let ‘em see you sweat – know the protocol so well that the epileptic student can trust that you will know what to do when he/she does seize

21. Food For Thought.. • Your attitude matters – if the students see that you are bothered by the extra work or are unsure around the epileptic student, it can affect their emotional mindset towards school • Bishop, M., & Boag, E. (2006). Teachers’ knowledge about epilepsy and attitudes toward students with epilepsy: results of a national survey. Epilepsy & Behavior, 8, 397 - 405. • Depending on the severity of the seizure disorder, life expectancy is never guaranteed, so enjoy your student and all of the amazing things they will teach you!

22. References • Binnie, C.D., Channon, S., & Marston, D. (2007). Learning disabilities in epilepsy: neurophysiological aspects . Epilepsia, 31, S2 - S8. • Bishop, M., & Boag, E. (2006). Teachers’ knowledge about epilepsy and attitudes toward students with epilepsy: results of a national survey. Epilepsy & Behavior, 8, 397 - 405. • Epilepsy and Learning. (2009). Retrieved November 09, 2010, from http://www.efwp.org/programs/epilepsy_learning.shtml • Glass, J. (2009). Types of Seizures and Seizure Symptoms - WebMD. Retrieved November 22, 2010, from http://www.webmd.com/epilepsy/guide/types-of-seizures-their-symptoms • Strategies for Teaching Students with Epilepsy. (2009). Retrieved November 09, 2010, from http://www.as.wvu.edu/~scidis/epilepsy.html • Tucker, V. (personal communication, November 23, 2010 • What Is Epilepsy? (n.d.). Retrieved November 09, 2010, from http://www.ehealthmd.com/library/epilepsy/epi_whatis.html • Whessler, J. (2006). Diagnosing Epilepsy In Children. Retrieved November 28, 2010, from http://www.epilepsy.com/info/family_kids_diagnosis