Educational Programming Following TBI: Ingredients for Bridging Rehab, Education, and Family Support

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Educational Programming Following TBI
Ingredients for Bridging Rehab, Education, and
Family SupportHeather Atkinson, PT, MS, NCSTami
Konieczny, MS, OTR/L, CBISErika Mountz, MBA,
OTR/L, CBIS
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Learning Objectives

• Understand the basics of brain injury in the
  school-aged child (includes types, causes, brain
  structure / function, etc.)
• Identify educational needs through the
  rehabilitation process
• Identify educational needs after brain injury
• Explain the sequelae of brain injury for the
  student

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Learning Objectives

• Review techniques and strategies for use in the
  classroom
• Review the process of designing the educational
  plan utilizing all available resources, including
  school system resources
• Identify supports in the community and family for
  the educational plan

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The effectiveness of transitioning a child from
inpatient rehabilitation back into the school
setting after sustaining a traumatic brain
injuryAn Interdisciplinary Study byRachel
Karasick, MS, OTR/LLynn Marie Murphy,
MSPTJeanine Stewart, MS, CFSLP
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Purpose

• Examine the process used when transitioning a
  child with TBI from inpatient rehab back to
  school
• Better understand school personnels perception
  of transition services

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Methods

• Developed a questionnaire
• Identified 10 school-aged children in 7
  Philadelphia schools who sustained a TBI
• Identified IEP team members (participants)
• Administered questionnaire to 14 participants
• Analyzed the data

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• How knowledgeable do you feel
• you are about TBI?

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Conclusion

• 75 reported having limited knowledge about TBI

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Clinical Recommendations

• Increase collaboration with schools
• Incorporate school visits into the transition
  process
• Provide a tentative transition plan
• and general information on TBI to schools upon
  admission to hospital
• Provide ongoing and after care consultation to
  schools

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My brain helps me make sense of my world.
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Overview of Brain Injury
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Statistics of BI

• Leading killer and cause of disability
• in children
• More than 2 million brain injuries occur each
  year (more than I million children)
• Estimated rate is 100 per 100,000 persons with
  52,000 annual deaths

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Statistics of BI

• Males are 2 times more likely than females
• TBI is a disorder of major public health
  significance
• Mild TBI is under-diagnosed
• 5.3 million Americans are living with brain injury

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Traumatic Brain Injury(TBI)

• Definition and insult to the brain caused by a
  direct blow to the skull via closed or open head
  injury

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Acquired Brain Injury(ABI)

• Definition An injury to the brain secondary to
  trauma, stroke, post surgical complications, and
  /or certain disease processes (tumors, aneurysms)

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Causes of Traumatic Brain Injury

• Transportation-related injuries
• Bicycle riding
• Scooters

• Sports and recreation
• Falls
• Shaken baby
• Violence

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Causes of Acquired Brain Injury

• Tumor
• Stroke
• Aneurysm
• Infection of the brain
• Near frowning
• Ingestion of toxic substance

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Parts of the Brain

• Brain Stem
• Cerebellum
• Occipital Lobe
• Parietal Lobe
• Temporal Lobe
• Frontal Lobe

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Brain Stem

• Three parts of the Brain Stem
• Midbrain
• Pans
• Medulla
• Functions of the Brain Stem
• Breathing
• Heart rate
• Arousal/consciousness
• Sleep/wake functions
• Attention/concentration

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Cerebellum

• Balance
• Coordination
• Skilled motor activity

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Cortex

• Divided into 4 lobes
• Occipital
• Parietal
• Temporal
• Frontal

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Occipital Lobe

• Vision

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Parietal Lobe

• Sense of touch
• Differentiation size, shape, color
• Spatial perception
• Visual perception

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Temporal Lobe

• Memory
• Hearing
• Understanding language (receptive language,
  Wernickes Area)
• Organization and sequencing

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Frontal Lobe

• Initiation
• Problem Solving
• Judgment
• Inhibition of behavior
• Planning/Anticipation
• Self-Monitoring

• Awareness of abilities/limitations
• Organization
• Attention/Concentration
• Mental flexibility
• Speaking (expressive language, Brocas Area)
• Personality/Emotions
• Motor Planning

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General Patterns of Dysfunction

• RIGHT SIDE OF BRAIN
• Visual-spatial impairments
• Left-neglect
• Decreased awareness of deficits
• Altered creativity and music perception
• Loss of Gestalt
• Visual Memory deficits
• Decreased control of left side of the body

• LEFT SIDE OF BRAIN
• Receptive language
• Expressive language
• Depression, Anxiety
• Verbal Memory deficits
• Decreased control of right side of the body
• Impaired Logic
• Sequencing Difficulties

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General Patterns of Dysfunction

• Diffuse Injury
• Reduced Thinking Speed
• Increased Confusion
• Reduced Attention and Concentration
• Increased Fatigue
• Impaired Functions Across All Lobes

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Mild Brain Injury

• -Loss of Consciousness (LOC) is brief, usually a
  few seconds or minutes
• LOC does not have to occur- may be dazed or
  confused
• Scans may appear normal
• Concussion

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Concussions

• Most common head injury in sports
• Fewer than 10 result in LOC
• Symptoms include dizziness, headache, difficulty
  in concentrating, disturbances of vision or
  equilibrium, post traumatic amnesia, and LOC

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Symptoms of Concussion

• Early (24 hours)
• Headache
• Dizziness
• Confusion
• Ringing in the ears
• Nausea
• Vomiting
• Vision changes

• Late (days/weeks)
• Memory disturbances
• Poor concentration
• Irritability
• Sleep disturbances
• Personality changes
• Fatigue

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Current Practice and Future Directions

• UPMC Sports Medicine
• Contracts with professional sports teams to
  perform computerized neuropsych testing
• ImPACT
• Before the season (baseline) and after any
  concussive events
• Athlete cannot return to sports until testing is
  at baseline

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Current Practice and Future Directions

• UPMC Sports Medicine
• Branching into college and some high school
  athletics
• Cumulative effects and second impact syndrome
• http//sportsmedicine.upmc.com/ConcussionProgram.h
  tm

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Moderate Brain Injury

• LOC lasts from a few minutes to a few hours
• Confusion lasts from days to weeks
• Physical, cognitive, and/behavioral impairments
  last for months or may be permanent

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Severe Brain Injury

• Coma
• Persistent Vegetative State (minimally
  responsive)
• Physical, cognitive, and behavioral impairments
  last for months or may be permanent

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Remember.

• A person with brain injury is a person first
• No 2 injuries are the same
• Effects of brain injury are complex and can vary
  greatly
• Prevention is key

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Identifying Educational Needs through the
Rehabilitation Process
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Identifying Educational Needs

• Process of Assessment
• Communication with the School
• Intervention Strategies
• Planning for the IEP

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What are the different types of assessments?

• Assessment by therapies
• Intellectual assessment
• Achievement assessment
• Behavioral assessment
• Neuropsychological assessment
• Integrated neurofunctional assessment

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Traditional Neuropsych Assessment

• Based on battery of tests
• Usually includes measures of
• Attention/concentration
• Sensory/perceptual/motor functioning
• Memory for novel information
• Higher order reasoning, planning, problem
  solving, executive functioning

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Traditional Neuropsych Assessment

• Is at best a sampling of behavior
• Used to predict everyday functioning
• Forces prediction of how the child will perform
  in school, at home, in relationships

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What you really want to know about the child

• how is the child going to be able to learn?
• will they be able to apply new learning in novel
  situations?
• what kinds of supports do they need for their
  learning?
• are these supports realistically available in
  their world?

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Integrated neurofunctional approach

• If you want to know real life performance
• Must do an assessment of their ability to perform
  on specific task
• Task analysis
• skills are the smallest fundamental units of real
  life functions
• groups of skills linked together by a common goal
  comprise a functional routine
• clusters of routines that fill the childs day
  and week constitute an activity pattern

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Integrated neurofunctional approach

• Task analysis
• What are the cognitive requirements?
• What are the other requirements (physical)?
• What are the situational variables?
• Asks entire team to work in a transdisciplinary
  style

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Integrated neurofunctional approach leads to
intervention

• combine neuropsychological assessment,
  neurofunctional assessment, and cognitive task
  analysis
• learn how to put all this data together to come
  up with meaningful interventions
• first at the skill level
• then to build routines

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Integrated neurofunctional approach leads to
intervention

• visual cueing systems
• written instructions
• providing constant feedback
• paraphrase and rehearse information
• organizing systems, checklists,
• restructuring the task environment to decrease
  distraction
• watches, electronic alarms, gizmos, computers,
• procedural training
• diary, memory book

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Communication with the school is KEY

• Can best do this by having evaluator work with
  the student in an actual or simulated classroom
  setting, using real classroom materials
• Determine the childs learning style, and the
  nature of errors being committed

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Utilizing this information in developing the IEP

• Requires communication with the school at the
  beginning of the admission regarding the
  possibilities the school can offer
• Requires frequent interactive communication
  between team, parents, and school during the
  rehabilitation admission
• Requires transdisciplinary thinking about the
  discharge recommendations and the school plan
• Requires a process of many meetings with school
  principal and the actual teachers of the
  classes to fashion accommodations

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Break!
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Brain Injury vs. Other Disabilities
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Similarities Between BI and Other Disabilities

• Poor attention
• Diminished impulse control
• Deficits in abstract reasoning
• Disorganization
• Limited skill integration
• Poor problem solving/and or social judgment

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BI Can Be Confused With

• Mental Impairments
• Mild to Severe
• Physical and Other Health Impairments
• Learning Disabilities
• Hearing and Visual Impairments
• Speech and Language Impairments
• Developmental Delays
• Behavioral/Emotional Problems

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Differences Between BI and Learning Disabilities

• An acquired disability
• Abrupt change in academic and social performance
• Normal self-identity prior to injury
• Inconsistent performance across skill levels
• Islands of preserved higher-level skills and
  gaps in more rudimentary skill areas.

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Differences Between BI and Learning Disabilities

• The performance of students with BI will
• change for years after their injury.
• Students with TBI may experience severe deficits
  in new learning integration and generalization of
  skills despite their retaining most basic
  competencies

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Differences between BI and Learning Disabilities

• BIs often involve complex combinations of
  difficulties across motor, sensory, cognitive,
  social and emotional realms.
• Students often require a variety of compensatory
  and adaptive strategies.
• Students with BI are less likely to benefit from
  traditional approaches to behavior modification
  management.

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CHANGES IN ACADEMIC DEVELOPMENT

• Difficulty in finding appropriate school
  environment due to varying needs
• Unrealistic academic expectations
• Disparity between IQ and
• performance
• Perception of child as unmotivated

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CHANGES IN ACADEMIC DEVELOPMENT

• Difficult to understand childs new learning,
  medical, and behavioral needs
• Incorrect labeling of new behavior and learning
  needs
• Labeling as ADD, ADHD, LD, etc..

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Educational Needs After Brain Injury
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Physical Fatigue / ?d Physical Endurance

• With basic everyday tasks
• Getting ready in morning
• Walking to/from class or bus
• Sitting with good posture in class
• Sports activities
• From seizures
• From side effects of some pharmacological
  interventions

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?d Balance

• Walking through the hallways
• Playing on uneven surfaces on the playground
• Going up/down the stairs
• Transferring on/off chairs or toilets
• Navigating around obstacles in the classroom.

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?d Range of Motion/ ?d Strength

• Hemiparesis Weakness of one side of the body
• -Possibility of legs more then arms or vice
  versa
• Difficulties
• Reaching up and out
• Carrying things
• Using both sides of the body
• If need for change in hand dominance

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?d Gross Fine Motor Coordination and Dexterity

• Slowed and uncoordinated bilateral hand use,
  manipulation skills, and grasp patterns
• Impacts
• writing - walking
• typing - running
• cutting - playing sports
• talking - managing clothing
• self-feeding fasteners

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Ataxia / Spasticity

• Ataxia constant tremors - appear when student
  exerts effort
• Spasticity extreme tightness in the muscles of
  the body or sudden jerks in arms or legs
• May require splints or casts for management

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?d Visual Motor Skills

• Difficulty copying
• drawings
• shapes
• letters
• Difficulty following visual directions in gym
  class

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Vision and Hearing Impairments

• Vision
• Double vision
• Field cuts
• visual neglect
• visual inattention of one side

• Hearing
• Conductive hearing loss from outer or middle ear
  damage (wax, ear infection)
• Sensorineural hearing loss from inner ear or
  auditory nerve damage (permanent)

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Headaches

• Due to
• prolonged concentration
• bright lights
• loud noises
• no apparent precipitating event

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Cognitive Changes

• Executive Functions
• Reduced initiation (inability to start tasks)
• Lack of self-monitoring
• Poor task persistence or follow through
• Difficulty with planning and sequencing
• Decreased insight into current limitations and
  need to use compensatory strategies

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Cognitive Changes

• Memory/ New Learning (immediate, short-term,
  long-term memory)
• Recalling assignments
• Information that was taught in class
• Class schedules, teachers, and classmates
• Current tasks
• Routine locations

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Other Cognitive Changes

• Impaired problem solving/reasoning techniques
• Cognitive fatigue/decreased cognitive endurance
• Difficulty with following simple directions
• Limited attention (focused, sustained, selective,
  divided)

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Cognitive Profile

• Poor organizational skills
• Slow rate of mental processing
• Inconsistent learning and performance
• Uneven cognitive skill profile
• Developmental disruptions

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Speech-Language ChangesReceptive Language

• Difficulty with comprehension of
• directions (verbal or written)
• questions
• reading material
• concepts and structures

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Speech-Language ChangesExpressive Language

• Word retrieval difficulties
• Paraphasic errors
• Poor sentence and/or narrative organization

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Speech-Language Changes

• Aphasia Loss of the ability to express oneself
  and/or understand language. Caused by damage to
  brain cells rather than deficits in speech or
  hearing organs.

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Speech-Language ChangesSpeech Production

• Dysarthria - difficulty speaking clearly
  secondary to weakness of muscles used in
  speaking
• Apraxia - difficulty planning movements required
  for speaking

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Social Changes

• Decreased judgement/ safety awareness
• Difficulties understanding social cues
• Lack of inhibition/ increased verbal and physical
  impulsivity
• Insensitivity towards others
• Withdrawal

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Emotional Changes

• Irritability or lability
• Heightened anxiety
• Decreased frustration tolerance
• Low confidence/self-esteem/feeling of belonging
• Self-centered
• Flat affect
• Depression

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Behavioral Changes

• Extreme behavioral dyscontrol
• Acting out
• Defiance/ oppositional behavior
• Unusual behaviors (i.e., staring spells,
  echolalic speech, self-stimulation)

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Recommendations for the Academic Setting
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Recommendations Physical Fatigue/ ?d Physical
Endurance

• Give frequent rest breaks
• Flexible schedule
• ½ day of school
• Challenging classes in the morning
• Adjust classroom proximity

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Recommendations ?d Balance

• Leave class early to avoid crowded halls
• Buddy/aide when walking to class/ bathroom
• Use assistive devices (walker, wheelchair)
• Use safety devices (helmet, gait belt)
• Classrooms free of clutter

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Recommendations ?d Range of Motion/Strength

• Backpack or buddy to carry books from class to
  class
• Second set of books at home
• Adapt desks, computers, work environments for
  better access for functional side of body

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Recommendations ?d Gross Fine Motor
Coordination

• Modify gym class as needed
• Increased time for writing/ typing tasks
• Provide pre-written class notes
• Allow classmate to share copy of notes
• Assistive Devices/ Strategies for writing
• Built up pencil grips
• Write every other line
• Type (vs. write)

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Recommendations Ataxia/Spasticity

• Use recommendations re Gross Fine Motor
  coordination
• Allow student to wear weights
• Wrist
• Ankle
• Vest
• Place desk along perimeter of classroom (vs. in
  center)

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Recommendations ?d Visual Motor Skills

• Hand-over-hand assistance
• Modeling
• Consistent verbal cues
• Near point vs. far point copying

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Recommendations Vision Impairments

• Eye patch
• Position student in room according to field cut
• L side if R field cut
• Frequent verbal cues for attention
• Visual cues for inattention
• Bright red line down side of page that is being
  neglected
• Frequent proofreading

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Recommendations Hearing Impairments

• Seat close to the speaker
• FM system
• Tape record class
• Get copy of class notes to check for missed
  information
• Encourage asking for clarification

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Recommendations Headaches

• Reduce amount of extraneous light/ noise
• Take breaks as needed
• Walk to water fountain
• Put head down

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Recommendations Cognitive-Linguistic

• Use catch phrases to prompt initiation and
  attention
• Provide periodic praise for sustained attention
  to tasks
• Provide frequent breaks or chunk / shorten tasks

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Recommendations Cognitive-Linguistic

• Use memory aids routinely (calendars, planners,
  journals, photos, assignment books, memory book)
• Provide repetition (visual auditory structures
  routines, checklists, outlines)
• Use cueing hierarchies

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Recommendations Receptive Language

• Preview new vocabulary
• Provide information in small chunks with keywords
• Provide visual and auditory information
• Have comprehension checks regularly (by
  paraphrasing information)
• Encourage students to relate new information to
  personal experiences

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Recommendations Expressive Language

• Provide keyword lists for new vocabulary
• Encourage circumlocution (description)
• Praise proximity and effort
• Provide semantic and or phonemic cues
• Provide visual aids for organization

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RecommendationsSpeech Production

• Positioning upright, feet flat on the floor,
  chairs with arms, eye contact with communication
  partner
• Breath support belly breath
• Phonation relaxation, easy onsets
• Overarticulation
• Pacing to reduce rate of speech

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Recommendations Social/Pragmatic

• Establish clearly defined social rules
• Use social scripts
• Prompt social awareness via catch phrases or
  probe questions
• Establish and rehearse self-esteem statements

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Recommendations Emotional

• Schedule emotion checkpoints throughout the day
• Encourage journaling or alternate expression
• Remain calm and acknowledge students emotional
  state
• Offer alternative activity

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Recommendations Behavior

• Positive vs. negative reinforement
• Reward System
• praise
• token economy
• Ignore behaviors
• Redirect

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Recommendations To Consider For School Re-Entry

• Requires communication with the school at the
  beginning of the rehab admission regarding the
  possibilities the school can offer
• Requires frequent interactive communication
  between team, parents, and school during the
  rehabilitation admission
• Requires transdisciplinary thinking about the
  discharge recommendations and the school plan
• Requires a process of several meetings with
  school principal and the actual teachers of the
  classes to fashion accommodations

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Strategies to help students and staff prepare

• School re-entry meeting
• Inservice for staff students
• Have parent or family member come in to speak to
  teachers and / or students
• Identify a Buddy (empower the students)

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Questions
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LUNCH
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Techniques and Strategies for Use in the Classroom
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Adaptations

• Adapting time
• Provide extra time for assignments, projects,
  tests, and answering questions

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Adaptations

• Adapting Content
• Excuse student from items that he already knows
• Reduce the length of required assignments and
  tests
• Reduce the number of items per task (vocabulary,
  math problems, etc.)

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Adaptations

• Adapting level of difficulty
• Simplify directions chunk language, read them
  aloud, or use visual aids
• Lower reading level
• Provide 2nd chance grading

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Adaptations

• Adapting input (delivery of instruction)
• Use cooperative learning technique
• Utilize visual aids
• Create a student centered atmosphere
• Simplify task directions

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Adaptations

• Adapting output (response to instruction)
• Non-electronic assistance
• Adapted pens and pencils
• Change required spacing of writing
• Laminated or magnet word strips and velcro
  surfaces
• Alternative reporting of mastery oral reporting,
  portfolios, storyboards, interviews, and models.

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Adaptations

• Adapting Output
• Computer Hardware
• Special keyboards (ABC, enlarged, or mini)
• Key guards or guides
• Joy sticks or switches (mouse, jelly bean, track
  ball)

• Touch screens
• Eye gaze mouse
• Head Mouse
• Magnifer for monitor
• Enhanced speakers

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Adaptations

• Adapting Output
• Computer Software
• Voice output to accompany written text
• Voice recognition programs
• Word prediction programs
• Talking and pictorial word processing programs
• Multimedia programs

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Adaptations

• Degree of participation
• (The extent to which the learner is actively
  involved in the task)
• Plan physically interactive tasks
• Allow planned peer assistance on oral
  presentations
• For group projects, adjust requirements for each
  student as needed

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Adaptations

• Reading
• Use highlighter to emphasize key points prior to
  having student read material
• Review key vocabulary words prior to reading
• Highlight key words with a colored marker
• Use lower level text as alternative reading
  material in subject areas

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Adaptations

• Reading
• Use a line marker (strip of paper or ruler) to
  keep place while reading
• Use books on tape access tape during class with
  headphones
• Have the student orally summarize content after
  reading small segments

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Adaptations

• Demonstrate mathematical concepts using
  concrete/manipulative items
• Create functional activities for practicing
  mathematical concepts (e.g. purchasing items from
  an in-school store).
• Use a calculator to aid solving multiple step
  problems, including word problems.

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Adaptations

• Math
• Reduce the number of items on the assignment.
• Practice word problems with pictures or stories
  that relate personally to the student.
• Cover multiple math problems with a piece of
  paper with a window to display problems one at a
  time.

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Adaptations

• Writing
• Use oral responses as an alternate to writing
• Darken lines on paper to facilitate writing
  within the given space
• Highlight lines on the paper for student to use
  as a prompt
• Allow for alternatives to traditional writing
  (chalkboard, computer, dry erase board)
• Provide alphabet/number strip on the desk as a
  reference for the correct formation of numbers
  and letters

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Adapting Written Tests

• Multiple choice
• Present choices vertically versus horizontally
• Present fewer possible answers to each question
  or use a highlighter to limit choices
• Eliminate combination choices (such as all of
  the above or none of the above, or a and d)

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Adapting Written Tests

• Matching
• Give the same amount of questions as answers
• Highlight or underline clue words
• Organize the test
• Group questions/answers into manageable amounts
• Facilitate scanning (list definitions on left and
  single word answers on the right)
• Match letters with numbers

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Adapting Written Tests

• True/false
• Highlight, underline or bold key words
• Avoid using negative words
• Use yes/no rather than true/false

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Adapting Written Tests

• Completion
• Provide pattern clues for answers
• Give initial letters of answers
• Organize the test into smaller segments of
  questions with analogous word banks
• Allow for open book tests with page numbers

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Adapting Written Tests

• Essay
• Give a choice of essay questions for students to
  pick from (2 of 5)
• Ask students to list key points as answers
• Give introductory sentence or phrase as a prompt
• Provide an idea bank of phrases for students to
  include in their essay

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Adapting Written Tests

• Essay
• Give possible essay questions in advance
• Allow students to draw pictures, followed by
  short descriptive narrative
• During open book test, provide page numbers where
  essential information can be located easily

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Adapting Written Tests

• Providing alternatives to written tests
• Projects construct models, displays or pictures
  to demonstrate knowledge
• Portfolio collection of students work and
  assessments
• Oral tests the test is read orally or recorded
  for the student to listen to.

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Designing Educational Plans Utilizing All
Available Resourcesincluding School System
Resources for TBI
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Resources for transition back to school

• Use medical services for collaboration
• Transition with supports already in place
• Provide training for all teachers / individuals
  working with student

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Services within the 1st Year

• In the 1st year, students with TBI change
  continually
• Baseline Evaluations
• IEPs / 504 plans

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Examples of 504 Accommodations

• Extended time on test / assignments
• Alternate formats for exams (oral vs. written, a
  scribe for writing answers)
• Note-takers for lectures
• Preferential seating
• Assistance with project planning
• Provisions of audio-taped books

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Services within the 1st Year continued

• IEP Development
• Document should be both Measurable and dynamic
• Re-evaluate / make changes every 2-4 months after
  a student returns to school

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Utilization of Available Resources

• Special Educators
• Guidance Counselors
• Neuropsychology
• Speech and Language Pathology
• Occupational Therapy
• Physical Therapy
• Nursing Services
• Psychologist / Counselor / Social Worker

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Utilization of Available Resources

• Behavioral Psychology
• 11 Aides
• Job Coaches / Vocational Training
• Increased Teacher Student Ratios (Specialized
  Classrooms)
• Peers (Buddy/s)
• Modified Environments / Expectations
• Other Teachers within your school system who have
  experience in working with a student(s) with TBI
• Principals

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Utilization of Available Resources

• Outside Health Care Providers
• Psychiatry
• Primary Care Physician
• Outpatient Therapies, Counselors, Vocational
  Rehabilitation, etc.
• Nutritionists
• Anyone consulting with aspects of the medical,
  emotional, behavioral, therapeutic, overall
  wellness of the student with TBI, as well as
  state / local community transition services as
  appropriate

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Utilization of Available Resources Additional
years

• Continuous involvement all resources for
  continual assessment of needs over the school
  career and into adulthood.
• Information from follow up medical,
  rehabilitation and neuropsychology evaluations
  provide valuable information to help the school
  determine the childs functioning as they develop
  and progress

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School-Based Therapies

• Direct vs. Consultative Therapy Services
• Integration of therapeutic strategies with
  education plan, home and community
• Striving for Generalization

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Designing the IEP to prepare for within school
transitions

• Recognize the need for transition planning
• Begin transition planning early
• Assess new environment and determine needs
• Prepare receiving teachers
• Provide specific information about the student
• Involve ancillary personnel involved in the
  students care (medical, psych, rehab)
• Continually monitor progress around transition

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Supports in the Community and Family for the
Educational Plan
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Family Supports for the Educational Plan

• Key component of the Team serving student with
  brain injury
• Make sure family is asked what long term and
  short term goals are for their child

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Family Supports for the Educational Plan

• Families of newly injured children will have
  resources for the education plan
• Hospital reports
• Specific training by therapists

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Community Supports for the Educational Plan

• Changes in Activity Level
• Changes in Peer Relationships
• Prepare for Transition
• Post secondary education
• Employment
• Community living

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Community Supports for the Educational Plan

• Encourage the student and / or family to
  reference local, state or national brain injury
  associations
• Network with other families
• Support groups

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Case Study
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QUESTIONS?
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REFERENCES

• DePompei, R., Blosser, J., Savage, R., Lash, M.,
  (1998). Special education IEP checklistfor a
  student with a brain injury. (Tipcard) LA
  Publishing/Training, Wake Forest, NC
• Keating, D.J., Page, T.J., Boyer, C.L., Boudreau,
  C. (October/November 2000). Postacute Brain
  injury rehabilitation. Rehabilitation
  Management The Interdisciplinary Journal of
  Rehabilitation. Http//www.rehabpub.com/features/
  10112000/3.as
• Lash, M., McMorrow, D.B., Tyler, J., Antoinette,
  T. (2004). Training manual for certified brain
  injury specialists level 1 core competencies.
  American Academy for the Certification of Brain
  Injury Specialists. Brain Injury Association of
  America. McLean, VA.
• Marsick, MJ., Watkins, K.E., (Spring 2001).
  Informal and incidental learning. New Directions
  for Adult and Continuing Education, Jossey-Bass,
  A Publishing Unit of John Wiley Sons Inc. Ch.
  3, no. 89.
• Rossi, E.L., Fleming, P., Pompeo, L., Savage, R.,
  (1999). Therapies in school for student with
  brain injuries. (Tipcard) LA Publishing/Training
  , Wake Forest, NC.
• Savage, R.C., McDonald, H., Arons, M., Marchese,
  N., Potoczny-Gray, A., Reilly, E., Rossi, E.
  (Summer 1999). Managing challenging behaviors in
  the classroom. Brain Injury Source, Vol. 3,
  Issue 3. P 26 - 32.

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REFERENCES

• References
• www.biausa.org/states.htm
• www.bipa.org
• Contact Information
• Heather Atkinson (PT) Atkinsonh_at_email.chop.edu
• Tami Konieczny (OT) Konieczny_at_email.chop.edu
• Erika Mountz (OT)
• Mountz_at_email.chop.edu