TRAUMATIC BRAIN INJURY: A BRIEF OVERVIEW
Low Incidence Special Education Services in
Minnesota Schools
DEFINITION OF TBI: MN RULE 3525.1348
‘Caused by ‘External Physical Force’
Total or partial functional disability and/or psycho-social impairment
Adversely affects educational performance
Medical documentation
Consistent with Federal Definition
TBI CHILD COUNT: December 2013
129,646 students (birth to age 21) received special education services
454 students identified under TBI Category = 0.4% (<1%)
340
390
440
490
540
590
640
690
740
790
2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
399430
446 450461 470 461 469
457431
4394540.3%
0.4%
0.4% 0.4%0.4% 0.4% 0.4% 0.4%
0.4%
0.3%0.3%
0.4%
TB
I C
hild
Co
un
t -
% o
f To
tal
Ch
ild C
ou
nt
Year
Minnesota Child Count: Age 0-21Traumatic Brain Injury
December 2002 to December 2013
LA 2-9-11
Autism Spectrum Disorders 12%
Blind-Visually Impaired 0.3%
Deaf and Hard of Hearing 1%
Deaf-Blind .05%
Developmental Cognitive Disabilities: Mild-Moderate,
5%
Developmental Cognitive Disabilities: Severe-Profound,
1.6%
Developmental Delay 11.7%
Emotional or Behavioral Disorders, 11.6%
Other Health Disabilities, 13.3%
Physically Impaired 1.3%
Severely Multiply Impaired 1.1%
Specific Learning Disabilities, 23%
Speech or Language Impairments 16%
Traumatic Brain Injury (454) 0.4%
Minnesota Child Count Age 0-21Disability Distribution
December 1, 2013
Total number of students receiving special education services as of December 2013:
129,646 (an increase of 834 students from previous year)
Traumatic vs. Non-traumatic
Falls
Physical abuse/SBS
Motor vehicle accidents
Recreational & sports injuries
Concussion
Surgical resection/tumor removal
Assault
Infections of the brain
Cerebral vascular accidents
Tumor
Anoxic injury
Stroke
Toxins
Metabolic disorders
Fever
MN Services & Support at the Local School Level
Service Providers
TBI Specialist (Educator with expertise in TBI)
Physical/Health Disabilities (P/HD) Teacher
Services and Support at the Local School Level
Monitoring/General Accommodations
504 Plan
Special Education Services/IEP under TBI Category
Services and Support at the Local School Level
Referral
Evaluation process
Qualification
Educational Evaluation
EDUCATORS ARE ENCOURAGED TO...
Use what is available, current, & applicable
Go beyond ‘traditional testing’
Accurately define deficits
Potential Educational Challenges...
Intellectual/Cognitive Changes
Physical Changes
Behavioral Changes
Student Profile: Intellectual/Cognitive
School teams are aware there may be problems with:
Memory/New Information Processing speed Organization/Executive Functioning Distractibility/Inattention
EXAMPLE: Memory Problems
Questions educators should ask:
Can student retain info from one day to the next?
Does providing a context improve learning?
Are verbal and visual memory skills equally proficient?
EXAMPLE: Memory Problems
Questions educators should ask:
Does repetition increase learning?
Does student attempt to ‘chunk’ or organize info to aid recall?
What works better: recognition or spontaneous recall?
Accommodations for Memory Problems
May need to hear information multiple times AND using different modes of input (visual, auditory)
Repetition often needed
Recognition v. Recall (multiple choice v. open answer worksheets), fact cards/cue sheets for studying
Accommodations for Memory Problems continued
Memory aids- PDAs/smart phones with schedules & alarms, digital video and/or audio recorders
Peer note takers, electronic pens, extra copies of notes, extra texts for home
visual organizers, highlighters
Just one example…
In addition to memory and retention deficits, accommodations, strategies & supports may also be needed for…
Processing speed Organization/executive functioning Distractibility/inattention Starting/changing/maintaining activities Problem solving & reasoning Impulse control, judgment, decision making Impaired motor skills
For more information, see the TBI Resource Manual for MN Educators
Physical Changes
Motor coordination
Hearing and visual changes
Spasticity and tremors
Fatigue and weakness
HeadachesSlowed reactionsHeightened
sensitivity to light and/or noise
Taste and smell
BalanceMobilitySpeechSeizures
Student Profile: Emotional
DepressionAnxietyPoor self-esteemAppears to be
unmotivatedMoody
Student Profile: Behavioral
IrritabilityLow frustration
toleranceSense of apathy AggressionInflexibility
Factors That Can Influence Behavior
neurological damage
SS
CC
HH
OO
OO
LL
HOME
Family
pre-existing conditions/traits
CHALLENGES
+FRUSTRATION =
ACTING OUT
SUSPENSI
ON
YELLING
FIGHTS
DETENTION
The Next Step: Implementing Pro-Active Behavioral Strategies
Goal: Minimize the TRIGGERS
Identify AntecedentsProvide
accommodations
Classroom/Environmental Considerations
StimulationPacingTeaching styleClassroom culture
...All of these have a very real impact on student success!
Focus on Prevention: In the Home, School & Community
Develop
alternatives
Consistent structure
Predictable routinesEducate Peers
The BIG Picture: Considerations for Schools
Return to School practices (hospital to school re-entry) for moderate and severe TBI
Increased awareness & Identification of Mild TBI/concussion
Professional development with a focus on TBI and available resources
The BIG Picture: Considerations for Schools continued
Traditional approaches to psycho-educational assessment often do not work with TBI population
Placement & Instruction: Mistaken assumption that TBI is like other learning/behavioral disabilities
Qualification for school services when there is no medical diagnosis
TBI Resources Found on Website
• Technical Training Materials
• Professional Development Opportunities
• Service Delivery Considerations
• Information & Resources for Families
RESOURCES
MN Low Incidence Projects Website: www.mnlowincidenceprojects.org
(click on TBI)
MN Dept. of Education website: www.education.state.mn.us
ADDITIONAL ELECTRONIC
RESOURCES
CBIRT Online Learning Modules for Educators http://intheclassroom.cbirt.org/
Project Learnet www.projectlearnet.org/
Concussion Resources/CDCwww.cdc.gov/features/
Concussion/
Lash & Associates www.lapublishing.com/
Created by Deb Williamson, Statewide TBI SpecialistMN Low Incidence Projects (Revised 2014)