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Back to School Identifying the needs of students following head injury. Ann Glang, Ph.D. & Bonnie Todis, Ph.D. Principal Investigators The Teaching Research Institute – Eugene Western Oregon University Anne Stilwell Project Coordinator. Faces of Brain Injury. - PowerPoint PPT Presentation
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Back to SchoolIdentifying the needs of students following head
injuryAnn Glang, Ph.D. & Bonnie Todis, Ph.D.
Principal InvestigatorsThe Teaching Research Institute – Eugene
Western Oregon University
Anne StilwellProject Coordinator
Faces of Brain Injury
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
Scope of the Problem: Oregon
• 600 children hospitalized annually
• Approximately 300 experience
persisting disabilities
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
Education Issues: Under-identification
0
100,000
200,000
300,000
400,000
Expectedcumulativetotal K-12
If 2/3 requireSpecial
Education
Actual total
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
100
125
150
175
200
225
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275
300
325
350
1995 1996 1997 1998 1999 2000 2001 2002 2003 2004
Year
Num
ber o
f Ide
ntifi
ed S
tude
nts
Oregon Students (Age 3-21) with Special Education Eligibility in the
Area of TBI (1994-2004)
Arizona Students with Special Education Eligibility in TBI
• 1998-1999 70• 1999-2000 93• 2000-2001 307• 2001-2002 313• 2002-2003 319• 2003-2004 374
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. Long-term effects are influenced by internal
and external factors.
Possible Changes after TBIPhysical Changes
• Motor coordination
• Hearing and visual changes
• Spasticity and tremors
• Fatigue and/or weakness
• Taste and smell
• Balance
• Mobility
• Speech
• Seizures
• Disinhibition• Impulsivity • Socially inappropriate behavior• Lack of initiation
Possible Changes after TBI Emotions and Behavior
Possible Changes after TBICognition
• Attention/concentration
• Perception• Processing speed
• Language • Memory
• Decision making• Planning• Judgment• Problem solving
• Organization
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
Growing Up
Perf
orm
ance
Growing Into It
Growing Up
Perf
orm
ance
Brain Injury
Normal Development
Two critical intervention stages for children after
brain injury
Credit: Sandra Chapman, Dallas Children’s Hospital
Challenge of Pediatric TBI
• School = Rehabilitation setting• Key to accessing rehabilitation:
accessing special education• Need to identify students who need
rehabilitation when they return to school
• For those students who “grow into” disability, need to remember their TBI
Under-identification
Lack of Awareness
Apparent Low Incidence
Lack of Training
Lack of ResearchMoney
Lack of Right Services for Kids
who are ID
Under-identification Cycle
Outcomes
• What happens to students with TBI when they return to school?
• How do these students do in school over time?
• What factors lead to good school outcomes for students with TBI?
PHASE 1: Brief annual parent questionnaire (retrospective & prospective).
All children (birth to 19 yrs) treated for TBI 1990 – 2009.
PHASE 2: Annual in-depth structured parent interviews. Brief annual educator questionnaire. (120 Participants)
Quantitative
QualitativePHASE 3: Parent & educator
interviews & observations.(24 Participants)
Back to School Project Design
Inclusion Criteria
• Child observed/treated at least overnight
• Age 0-19 at injury (not including birth trauma)
• Injury fits CDC list of ICD-9 codes for TBI
Recruitment Sources
• Four Oregon hospitals
• Educational and medical professionals
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
Emerging Themes • Changes that cause parents concern
may be too subtle for schools to pick up• School personnel often assume
recovery from TBI is complete if no physical signs are present
• Problems may not appear until weeks/months/years after injury
• Students maybe viewed as malingering, lazy, disorganized, “just adolescent”
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
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
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
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
Appropriate Identification
Increased Awareness
Accurate Incidence
Improved TrainingAppropriate
Funding
Breaking the Cycle
TRACKING
Communication
Information
Improving Identification of Children with TBI
• Improving the link between medical and educational settings
• Helping schools “remember” the brain injury
• Providing information, training, and resources
ResourcesOregon Brain InjuryResource Network
• Comprehensive library (books, videos, journals)
• Statewide database of available resources and services
• Web site with relevant links
• Telephone assistance & individualized information search
800-544-5243 or 503-413-7707www.tr.wou.edu/tbi
ResourcesOregon TBI Consulting Team
• Inservice training & consultation to educators working with students with brain injury
• General or tailored to an individual student
• Multidisciplinary team trained in pediatric brain injury
877-872-7246 or 541-346-0593www.tr.wou.edu/tbi/team/index.html