THE ESSENTIAL BRAIN INJURY GUIDE Special Populations Section 7 - PDF document

8/29/2017 THE ESSENTIAL BRAIN INJURY GUIDE Special Populations Section 7 Education & Brain Injury Presented by: Rene Carfi, LCSW, CBIST Outreach Alliance of Manager Connecticut Certified Brain Injury Specialist Training – October 26 & 27, 2017 This training is being offered Presented by Brain Injury Alliance of Connecticut staff: as part of the Brain Injury Rene Carfi, LCSW, CBIST, Education & Outreach Manager Alliance of Connecticut’s & ongoing commitment to Bonnie Meyers, CRC, CBIST, Director of Programs & Services provide education and outreach about brain injury in an effort to improve services and supports for those affected by brain injury. Contributors Jerrod Brown, MS Carol Gan, RN, MScN, AAMFT Philip Girard, MS Emilie E. Godwin, PhD, LPC, MFT Sharon Grandinette, MSEd, CBIST Kim Kang Jeffrey S. Kreutzer, PhD, ABPP Herman Lukow, PhD, NBCC Kimberly Meyer, ARNP, CRRN Drew A. Nagele, PsyD Ronald Savage, EdD Jillian C. Schneider, PhD, ABPP Tina Trudel, PhD Janet Tyler, PhD, CBIST Kathryn Wilder Schaaf, PhD, LCP 1

8/29/2017 Pediatric and Adolescents Learning Be able to discuss the Be able to identify the disruption in trajectory of diagnostic criteria child development for Shaken Baby Objectives interrupted by brain Syndrome/Abusive injury Head Trauma Be able to explain the Be able to describe the types of educational process of gaining accommodations access to special available under a education supports and Section 504 plan services Be familiar with options for special education for children in private or parochial schools Be able to articulate why the traditional Be able to distinguish between a 504 3-year or triennial re-assessment cycle Plan and an IEP utilized in special education may not be appropriate for students with brain injury Be able to give an example of an Individual Health Care Plan DEVELOPMENT AND DEVELOPMENTAL DISRUPTION 2

8/29/2017 Peak Maturation Mileposts Most brain maturation occurs from birth to 5 years. Injury in that time frame may be the most devastating time for injury to occur. Brain Maturation by Lobe Development Disruption Performance Age 3

8/29/2017 ABUSIVE HEAD TRAUMA/SHAKEN BABY SYNDROME (AHT/SBS) AHT/SBS Biological Father 56% Girls 42% Boyfriend of Mother 16% Boys 58% Biological Mother 15% Babysitter 5% Other 8% AHT/SBS Outcomes Long Term Disability Severe Deficits Die as a Result of Injury Other 4

8/29/2017 mTBI IN CHILDREN AND ADOLESCENTS Concussion and mTBI • Second Impact Syndrome Persistent symptoms • Return to Play or School  State concussion legislation  Strategies for recovery  Evaluation for return 5

8/29/2017 EDUCATION AFTER BRAIN INJURY Coordinating Medical and Rehabilitation Systems with School Reintegration Educational Needs Motor impairments Cognitive impairments Gross and fine motor, strength, coordination, Attention, memory, executive   speed; may also include rigidity, tremors, functioning, speed of processing, spasticity, ataxia, or apraxia splinter skills Physical effects Academic or learning difficulties Disruption in growth, eating disorders, Fatigue  development of diabetes, or thermoregulation Physical and cognitive  difficulties Medical issues Feeding disorders Seizures, headache, pain, orthopedic  Dysphagia  issues Sensory impairments Social-emotional or behavioral difficulties Vision, hearing  Family difficulties Communication impairments Post-school or vocational issues Expressive and receptive language  Pragmatics  6

8/29/2017 Common Long Term Effects Problem Area The Student... Memory Is unable to recall previously-learned information that serves as the foundation for new  learning Cannot remember a series of two-to-three step directions  Is unable to grasp new concepts without repeated exposures  Has difficulty recalling the day’s schedule, what was assigned for homework, or what  materials to bring to class Attention and Is distracted by normal classroom activity  Concentration Is delayed in responding to questions  Has difficulty staying on topic during a class discussion  Is unable to complete a task without prompting  Blurts out answers in the middle of a class session  Becomes fatigued by mid-afternoon and appears uninterested in activities  Higher-Level Has difficulty organizing and completing long-term projects  Problem Lacks ability to sequence steps necessary to plan an activity  Solving Is unable to come up with solutions to problem situations (e.g., lost lunch money)  Has difficulty drawing conclusions from facts presented  Has difficulty evaluating and altering performance  Common Long Term Effects Problem The Student... Area Language Has difficulty taking turns in a conversation Is unable to take notes while listening to the   Skills Is unable to summarize and articulate class lecture  thoughts Has difficulty copying information from the  Does not understand the meaning of a board or projection unit  conversation when figures of speech or Talks around a subject or uses indefinite  metaphors are used words Visual- Has difficulty completing simple math Becomes disoriented in the hallway and has   Spatial Skills problems when presented with a worksheet difficulty finding the classroom of problems Takes an inordinate amount of time to  Completes only problems on one-half of the produce written material  paper because of difficulty seeing objects in part of the visual field Behavioral Says or does socially inappropriate things Is unaware of and denies any impairments   Is easily misled by peers into making poor resulting from the injury and  choices Lacks self-confidence Emotional  Is unable to start or stop an activity without Appears unmotivated   Effects assistance Does not hand in assignments  Impulsively leaves the seat or classroom Becomes withdrawn and depressed.   Becomes easily frustrated Has difficulty fitting in with peers   Changes in Behavior  Difficulty with short-term memory  Reduced behavior control due  Limited executive functioning  Limited awareness of others’ expectations of them  Misperception of interaction  Limited awareness of social cues  Communication deficits  Inattention  Impulsivity  Disinhibition  Inflexibility  Emotional lability 7

8/29/2017 Section 504 of the Rehabilitation Act of 1973  Requires schools receiving federal funding to provide reasonable accommodations to allow an individual with a disability to participate  Students qualify for a 504 Plan if they have a presumed disability  The term disability means that an individual has a physical or mental impairment that substantially limits one or more major activities; has a record of the impairment; or is regarded as having an impairment  Can range from basic classroom interventions to a formal plan Individuals with  Federal education mandate to provide public education through Disabilities Education special education and support Act (IDEA) services to children with eligible disabilities  Special education is defined as Specialized Academic Instruction (SAI) and services and are delivered at no cost to meet the need of a child with a disability  An Individualized Education Plan (IEP) starts with the assessment process to determine if child meets criteria to receive special education support Developing the IEP Document • Assessments Present Level of Academic • Achievement and Functional Performance (PLAAFP) Goals (review more often than • required) Determination of Specialized • Academic Instruction (SAI) 8

8/29/2017 Services for Children in Charter and Private Schools Transitions Multiple transitions over the years – grade to grade, elementary to middle to high school, to graduation – can be difficult at times for any student and particularly troublesome for students with brain injury Military Populations 9

8/29/2017 Learning Be able to distinguish Be able to explain the between the causes of four types of blast injuries brain injury in combat Objectives and in peacetime Be able to discuss the Be able to describe the diagnostic challenges interaction and presented when a cascading effects of person with brain injury mTBI symptoms also has PTSD symptoms Be familiar with the VA Polytrauma System of Care Be able to give an example of neuropsychological Be able to summarize elements of a assessment tools frequently utilized by the military to Community Integrated Rehabilitation identify the areas of function which may have been program affected after brain injury BACKGROUND Incidence Servic vice Members Re Returning from Operation Iraqi Freedom  Combat Related Injuries  Peacetime Related Injuries TBI and Persistent  Anywhere: falls, motor vehicle accidents Concussion Symptoms 10