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Services for Students with Traumatic Brain Injury

Services for Students with Traumatic Brain Injury. Jay Gense and Steve Woodcock Oregon Department of Education Ann Glang Teaching Research Institute. Faces of Brain Injury. Scope of the Problem.

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Services for Students with Traumatic Brain Injury

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  1. Services for Students with Traumatic Brain Injury Jay Gense and Steve Woodcock Oregon Department of Education Ann Glang Teaching Research Institute

  2. Faces of Brain Injury

  3. Scope of the Problem • 5.3 million Americans – about 2 % of the population - currently live with disabilities resulting from TBI. • 1.5-2 million people sustain a TBI every year – 1 every 15 seconds. • Males 2:1, majority 18-25 years old. • Far exceeds HIV/AIDS, breast cancer, spinal chord injury in annual incidence rates

  4. Mechanisms of injury • Motor vehicle crash • Bicycle/motor vehicle collision • Pedestrian/motor vehicle collision • Sports injuries • Falls • Firearms • Abuse

  5. Scope of the Problem: National • 60,000 children hospitalized annually • Approximately 30,000 experience persisting disabilities as a result of changes in cognition, behavior, physical abilities

  6. Scope of the Problem: Oregon • 600 children hospitalized annually • Approximately 300 experience persisting disabilities

  7. Effects of Brain Injury • No two brain injuries are exactly the same. • The effects of a brain injury are complex and vary greatly from person to person. • The effects of a brain injury depend on such factors as cause, location and severity.

  8. Motor coordination Hearing and visual changes Spasticity and tremors Fatigue and/or weakness Taste and smell Balance Mobility Speech Seizures Possible Changes after a Brain InjuryPhysical Changes

  9. Possible Changes after TBIEmotions and Behavior • Disinhibition • Impulsivity • Socially inappropriate behavior • Lack of initiation

  10. Attention/concentration Perception Processing speed Language Memory Decision making Planning Judgment Problem solving Organization Possible Changes after a Brain InjuryCognition

  11. Impact on school performance:Memory & Learning • Recent learning usually more affected then long-term memories • Prospective memory (i.e., ability to carry out intended actions) frequently impaired • Motor/procedural learning often less impaired

  12. Traumatic Brain Injury (TBI) vs. Learning Disabilities (LD) • What these students have in common: • poor organization and planning • poor problem solving • some difficulty with social interaction

  13. Traumatic Brain Injury (TBI) vs. Learning Disabilities (LD)What’s different? • Students with traumatic brain injury tend to:  • be more impulsive and distractible  • have more significant discrepancies in ability levels (the "Swiss cheese" phenomenon) • learn more rapidly (particularly during the first several years following the injury)

  14. Traumatic Brain Injury (TBI) vs. Learning Disabilities (LD)What’s different? • Demonstrate more uneven and variable learning rates • Have less awareness of deficits • Have more difficulty controlling emotional reactions

  15. Delayed impact of TBI • Children injured at a young age often seem to do fine initially • Many “grow into” their brain injury • Injury recovery superimposed on normal course of recovery

  16. Developmentwithout Brain Injury Normal Development Performance Growing Up

  17. Puzzling Paradox ofPediatric Brain Recovery 1. Prognosis for functional recovery of oldskills is better in early brain injury 2. Prognosis for acquiring new skills after injury is worse after early brain injury

  18. Growing Into It • Immediately after the injury, previous knowledge base aids in testing within normal limits. • If developmental milestones are not achieved-no-one equates this lack of development to injury years earlier.

  19. Growing Into It Performance Growing Up

  20. Outcomes • How do students with TBI do in school? • What happens to students when they leave school?

  21. Under-identification: Nationally • Annually: 30,000 with persisting disabilities from brain injury • Annually: 10,000 (1/3) needing special education supports • Cumulative total (K-12): 130,000 • Total on federal census (2002): 14,844

  22. Under-identification: Oregon • Annually: 300 Oregon students with persisting disabilities from brain injury • Annually: approx. 100 (1/3) needing special education supports • Cumulative total (K-12): 1300 • Total on Oregon census (2004): 310

  23. Oregon Students (Age 3-21) with Special Education Eligibility in the Area of TBI (1994-2004)

  24. Tracking Oregon students from hospital to school (Back to School Project) Most students with severe injuries are referred for special education A surprising number of students are experiencing difficulty in school, yet receive no supports

  25. Identification at discharge • 72 children enrolled in tracking study • 27 report no problems • 21 are served under TBI category • 5 are served under another category • 19 are experiencing challenges and are not identified for special education

  26. Under-identification • Often physical effects resolve quickly • Lack of educator awareness • Brain injury is “forgotten”

  27. Under-identification:Educators’ knowledge • Lack of preservice training • Limited knowledge of the impact of TBI on school performance • Lack of feelings of competence • Teacher training in TBI identified as critical need--nationally and in Oregon

  28. David “The teachers say David is fantastic, such a joy. A little slow. But that’s David now. They don’t know David as any way else.” -David’s mother

  29. David “I don’t know if the information about his brain injury got passed along to the 2nd grade teacher. It’s in his cumulative file, but I don’t know if anyone reads those.” -David’s mother

  30. David “I had no training in TBI. It was tough…I wanted to push him, but I didn’t want him to get frustrated and shut down.” -David’s teacher

  31. Long-term Effects of TBI Academic Functioning Ewing-Cobbs, et al (1992) N = 62 Severe TBI (coma > 24 hrs): Showed significant decrements in academic achievements at 6, 12, and 24 months.

  32. Long-term Effects of TBI Academic Functioning Donders (1993) N = 69 Children with traumatic brain injury, ages 6 - 16. Evaluated one year post injury. 30 (43%) in regular academic programs. 39 (56%) receiving special education.

  33. Post-School Outcomes • Longitudinal study of students in Oregon and Washington

  34. PSO Sample:Gender 94 Total

  35. PSO Sample:Age at Injury

  36. Had IEP During Last Six Months of High School

  37. Number enrolled inschool or training

  38. Number employed

  39. What are your son/daughter’s3 major activities in a typical day? • Sleeping • Eating • Watching TV • Hanging out at the mall or with friends • Video games • Chores • Playing pool • Reading

  40. Improving Outcomes for Students with TBI • State level awareness of population • Increase awareness of all educators • Provide training for all educators in effective practices • Consultation and support available for challenging cases

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