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)