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 Back To Module ListModule Main | Module Description | Instructional Outcomes | Instructional Proficiencies | Instructional Events | Instructional EvaluationReturning to School After a Traumatic Brain Injury (TBI) Author Kathleen Munroe, MS CCC-SLP, Riley Hospital for Children-Pediatric TBI Program & Angela Tomlin, PH.D., Riley Hospital for Children- Child Development CenterModule Description Schools are the largest provider of services for individuals with brain injury and returning to school is one of the primary goals for children and adolescents following brain injury (Savage & Wolcott, 1995). This module is designed to provide interested individuals with the essential information to develop an appropriate individualized educational plan (IEP) to meet the diverse needs of students with a traumatic brain injury. The interdisciplinary evaluation unique to the TBI population will be explored including commonly used tests, their purpose, and interpretation of findings. The individual will be offered options for programming considerations and an IEP checklist tailored specifically to the distinctive educational needs of the student with a TBI. Teaching strategies found to be effective to support the student in the classroom and options for compensatory systems for memory and organizational challenges are identified. Since changes in behavior are common after a TBI, individuals will learn how to recognize these changes and what strategies can be employed to alter inappropriate behavior. Instructional OutcomesAfter completing the module, the individual will be able to:
Identify behavior needs and create a repertoire of successful strategies to manage the behavior of a student with a TBI. Standard 3: Performances #3, #6, #7, #8 This site has a narrative text for you to peruse. Specific web sites and texts references are provided to assist you in completing the "Instructional Events" for which you will be evaluated.
TASK #1:
Identify a student with a traumatic brain injury. Obtain permission to review his or her file. Critique the appropriateness and comprehensiveness of the following components of the student's IEP using the information and references presented within this module to support your comments. Please offer suggestions to improve the comprehensiveness of the student's IEP as appropriate using references to support your comments.
Please critique the following components of the student's IEP:
Assessment Rubric
TASK #2:
Traumatic Brain Injury Case Study. You are to read through the information provided to you by the school psychologist and answer the questions. Please use text or web-based resources to support your answers.
Tiffany-Case #1
Background Information: '
Tiffany was involved in a car accident two weeks before her 16th birthday. She was a restrained passenger riding in the back seat of the car. Tiffany sustained a severe closed head injury that included right frontal and right temporal lobe contusions with central and peripheral diffuse axonal injury. She was admitted to a local emergency room and then transferred immediately to a tertiary care hospital. Two weeks later, Tiffany was transferred to a rehabilitation center in another city, where she received inpatient therapies for another two weeks before being released home.
Tiffany's mother reported that she had been an average student prior to the injury. She was attending a large suburban high school and was in the 10th grade. School records indicated that Tiffany had passed all classes during her freshman year. Teachers reported that Tiffany was passing all classes thus far, with one D in a science class due to late assignments.
Prior to the head injury, Tiffany was described as a social, popular, "typical" teenager. She had a history of two truant episodes from the previous school year. The hospital psychologist interviewed Tiffany's mother after the head injury during the inpatient hospitalization using the Vineland Adaptive Behavior Scale, Interview Edition, Survey Form. Tiffany's mother rated her pre-injury daily living skills within the average range (Adaptive Behavior Composite) for a teenager. She had a history of two truant episodes from the previous school year. The hospital psychologist interviewed Tiffany's mother after the head injury during the inpatient hospitalization using the Vineland Adaptive Behavior Scale, Interview Edition, Survey Form. Tiffany's mother rated her pre-injury daily living skills within the average range (Adaptive Behavior Composite = 98). Immediately after the accident, Tiffany's mother reported that she was sleeping more than usual and seemed tired. She was described to laugh inappropriately and her cooperation with therapies had been inconsistent. Her mother rated her current, post-injury, adaptive skills within the deficient range (Adaptive Behavior Composite = 70). Communication skills appeared to be most compromised and Tiffany's social activities were also severely curtailed.
Baseline Test Results:
The Wechsler Adult Intelligence Scale, Third Edition was administered to assess functioning immediately after the brain injury. Tiffany obtained a Full Scale IQ score of 69, which was within the deficient range. No significant differences were obtained between the verbal (74) and nonverbal (69) subscales. No significant differences were found among the verbal subtests. The performance subtests demonstrated one score within the average range and all others in the deficient range. Tiffany had the most difficulty with tasks that were timed and those that required fine motor skill.
The Wide Range Assessment of Memory and Learning was administered. Tiffany's General Memory Index was in the deficient range (45) and considerably lower than her intellectual skills would predict. Verbal (55) and Visual Memory (51) were not significantly different. The Learning Scale (53) also reflected deficient performance. Tiffany needs extra time to process information. She performed better with recognition memory tasks than with recall tasks. Tiffany had difficulty with following verbal instructions.
Questions:
Six-Month Follow-Up:
At this appointment, a screening of memory revealed continued problems with no appreciable change. Tiffany was now aware of her memory deficits. Some improvement in adaptive skills was present. Tiffany reported that school is difficult and she is considering dropping out and getting a job. She would like to take cosmetology classes. Tiffany's mother noticed that she is more impulsive and easily angered than in the past. Tiffany feels that her mother unnecessarily curtails her social activities. However, Tiffany's mother reported that she does have a steady boyfriend, who had visited frequently during the hospitalization. Tiffany stated that she and the boyfriend spend a great deal of time together after school and before parents arrive home from work.
Questions:
One-Year Follow-Up:
Tiffany, now age 17 years and a junior in high school, returned for a one-year follow-up appointment. The appointment was delayed due to the birth of Tiffany's child, who was placed in an adoptive home. Repeat testing demonstrated improved cognitive skills to the borderline range. (Full Scale IQ was 80, Verbal IQ 83, and Performance IQ 80.) Memory skills are improved but continue to be a serious problem for Tiffany (Verbal Memory= 72;Visual Memory = 68; Learning Index = 66; General Memory Index= 61).
Questions:
Assessment Rubric
TASK #3:
Traumatic Brain Injury Case Study. You are to read through the information provided to you by the school psychologist and answer the questions. Please use text or web-based resources to support your answers.
Lance - Case #2
Background Information:
Lance is an almost 5-year-old boy who sustained a traumatic brain injury when he fell from his bike and then was run over by the bike. A CT scan showed massive right brain swelling and right subdural hematoma; a later MRI demonstrated peripheral diffuse axonal injury. Lance's treatment included surgery and induced coma to help with swelling. A shunt was inserted. Lance was transferred from the hospital to a long-term rehabilitation facility about one month after the injury.
Lance's parents reported that his adaptive skills were in the low average range prior to the injury (Vineland Adaptive Behavior Scales, Interview Edition, Survey Form - Adaptive Behavior Composite = 86). Their concerns upon bringing him home from the hospital were extremely high activity level, serious lack of inhibition, and regression of toilet training. Lance had no prior preschool experience. He goes to a baby sitter while his parents work. Parents reported that Lance is having difficulty with transition to and from the sitter's home.
Test Results and Interpretation:
Lance was difficult to assess. His mother accompanied him to testing and stayed with him in the testing room as he refused to separate. He was highly active, easily distracted, had little ability to maintain sustained attention, and cried when redirected. During parent interviews, Lance ran out of the room and was found in another's office. His verbal responses included 1-2 word comments and he was often difficult to understand.
Lance completed verbal, visual, and memory tasks of the Stanford-Binet Intelligence Scale, Fourth Edition. He attained a partial test composite of 58, which is mildly deficient. All areas assessed were evenly affected. The evaluator noticed a hand tremor. Occupational therapy had also identified problems with fine motor and adaptive skills.
Lance's mother rated his adaptive skills within the very low borderline to mildly deficient range. On a behavior rating scale, Lance was rated as having significantly more problems with attention than other boys his age.
Questions:
Follow-up:
Lance failed the 6-month follow-up appointment. When contacted regarding a 1-year follow-up appointment, the family agreed to come for the evaluation. Medical assessment revealed that Lance was improving and that the shunt was functioning well. The family had been referred to psychiatry for assistance with behavior and possible medication for short attention span. However, the family did not follow through with the appointment.
Lance was enrolled in the early childhood program at his local public school. He received speech therapy and occupational therapy in addition to developmental preschool services. Repeat testing revealed continued performance within the mildly deficient range. Lance's teacher reported that it is difficult to have him in class because of his extremely short attention span and impulsive behavior. He frequently runs out of the room and that is sometimes aggressive with peers. Lance has had some problems with these behaviors when riding the bus. The driver has been extremely upset several times and two other parents complained that their children were afraid of Lance.
Lance will be attending kindergarten during the upcoming school year. His parents have stated that they would be interested in Lance having some inclusion experiences. They would also like to have Lance participate in after school-care at the school as he continues to have a hard time with transition.
Questions:
Assessment Rubric
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