TBI - from the Hospital to the Community

Admission to the Hospital

Admission is determined by medical team or physician.
Once a patient has been settled, Hospital School Program staff (teacher) makes contact with the family.
Teacher explains his or her role as related to the student while in the hospital which includes: contact with school for records, and current school work and materials, instruction as appropriate, and assist with district assessments as necessary.

During the Hospital Stay

All educational interventions and or services take place only after medical needs are addressed and child has been cleared by physician for education.
Teachers may complete screening assessments as feasible to determine educational level of functioning.
At times, more in depth assessment may be requested to assist with educational programming.

Transition from Hospital

As medical status improves, processes begin to assist the student return to school

Teacher will communicate with school about a 504 or IEP
504 or IEP needs are determined by either previous history or current needs as identified by testing.
Testing is completed once the teacher initiates process for eligibility determination.

Eligibility Determination in the Hospital

Teacher completes the educational components
School Psychologist completes the psychological component
Support staff is pulled as appropriate for additional components such as: speech, occupational therapy, physical therapy, and social work.

Assessment: Strengths & Weaknesses

Early Intervention is Key

Knowledge of strengths and weaknesses

where is the injury?
temporal lobe, frontal lobe, cerebellum?
specific or diffuse?

Cont.

☐ Remember that impairment may be present in one or more areas such as in:
- cognition; language; memory; attention; reasoning;
- abstract thinking; judgment; problem-solving;
- sensory, perceptual and motor abilities;
- psychosocial behavior; physical functions;
- information processing; and/or speech.

Brain Axes and Functions

Executive Functions
Motor Output

Left Hemisphere

Routinized/Detailed/Local
Convergent/Concordant
Crystallized Abilities

Adapted xom Fiorello, C. A. (2011) Advanced Cross-Battery Assessment: Usimplithe Theory & Neruropsychological Medication

Partnership for People with Disabilities

Posterior

Sensory Input
Comprehension

Right Hemisphere

Novel/Global/Coarse
Divergent/Discordant
Fluid Abilities

Possible Assessment Tools

CAS Cognitive Assessment System Riverside
CTOPP Comprehensive Test of Phonological Processing Pro Ed
DAS-II Differential Abilities Scales Second Edition PsychCorp/Pearson
D-KEFS Delis-Kaplan Executive Function System PsychCorp/Pearson
KABC-II Kaufman Assessment Battery for Children Second Edition Pearson Assessments
NEPSY-II PsychCorp/Pearson
WISC-IV Integrated PsychCorp/Pearson

Discharge and Follow Up

 Discharge to home
- Homebound, therapies
 Follow up in the out-patient clinic
- Recommendations from physician

School Contact and Initial Meeting

 Contact with school
 Initial meeting
- Review of medical history
- Current status
  -  Medical
  -  Academic
  -  Emotional

Injury Types and Plans

 mBI/concussion
- Usually 504 plan
 Moderate to Severe Injuries
- Usually IEP

Assessments and Considerations

 Assessments
- Completed
- Needed
 Considerations
- Still regaining previous knowledge
- Medications
- Stamina
- Environment

Definitions

 TBI definition
- …”by an external physical force, resulting in total or partial functional disability or psychosocial impairment, or both, that adversely affects a child's educational performance. The term applies to open or closed head injuries resulting in impairments in one or more areas”…
 ABI
- May not meet the TBI definition
- Brain tumor
- Anoxic event
- Stroke etc.

Symptoms and Similarities

 Physical symptoms.
 Cognitive symptoms.
 Behavioral symptoms.
 Brain injury can resemble other disabilities: Know the differences!
 Instructional strategies.

Recovery Factors

 Pre-morbid self
- May or may not look different [ which is worse?]
 Therapies
 Stamina
 Tolerance of:
- Sounds, light, other students

Unique Recovery

 Each child’s recovery process, outcome, and social situation are unique
 Growing into the brain injury

Medical Input and Predictors

 Medical input
 Specific information about outcome is impossible for medical/rehab professionals to provide because there are no indicators they can rely on to predict this information
 Family
 Non-linear nature of the condition
 Pre-morbid functioning and memories

Appendix

CAS Cognitive Assessment System Riverside
CTOPP Comprehensive Test of Phonological Processing Pro Ed
DAS-II Differential Abilities Scales Second Edition PsychCorp/Pearson
D-KEFS Delis-Kaplan Executive Function System PsychCorp/Pearson
KABC-II Kaufman Assessment Battery for Children Second Edition Pearson Assessments
NEPSY-II PsychCorp/Pearson
WISC-IV Integrated PsychCorp/Pearson

CAS

Planning

Planned Codes: Sustained attention, psychomotor speed, strategy use
Matching Numbers: Sustained attention, visual scanning, psychomotor speed, strategy use
Planned Connections: Sustained attention, visual scanning, psychomotor speed, strategy use

Simultaneous

NV Matrices: Inductive reasoning, multiple choice
Verbal/Spatial Relations: Receptive language, working memory, grammatical relationships, visual scanning/discrimination
Figural Memory: Visual perception, spatial relationships, visual memory, graphomotor reproduction, constructional skills, figure-ground relationships

Adapted from Fiorello, C. A. (2011)

CAS, cont.

Attention

Expressive Attention: Inhibition of automatic response
Number Detection: Cancellation task, sustained attention, visual scanning, visual discrimination, inhibition, psychomotor speed
Receptive Attention: Sustained attention, visual scanning, attend to perceptual, then shift set to meaning

Successive

Word Series: Word span, rote auditory memory
Sentence Repetition: Rote recall of meaningless sentences, grammatical structure important
Sentence Questions: Language comprehension based on grammatical structure with meaningless content
Speech Rate: Oral praxis

Adapted from Fiorello, C. A. (2011)

CTOPP

Phonological Awareness

Elision: Phonological perception, segmentation
Blending Words: Phonological assembly
Sound Matching: Phonological perception, segmentation
Phoneme Reversal: Phonological perception, segmentation, working memory
Blending Nonwords: Phonological assembly
Segmenting Nonwords: Phonological perception, segmentation

Phonological Memory

Memory for Digits: Short-term memory, sequencing
Nonword Repetition: Phonemic analysis, assembly, working memory

Adapted from Fiorello, C. A. (2011)

CTOPP, cont.

Rapid Naming

Rapid Digit Naming: Number automaticity, processing speed, verbal fluency
Rapid Letter Naming: Letter automaticity, processing speed, verbal fluency
Rapid Color Naming: Color name knowledge, naming automaticity, processing speed, verbal fluency
Rapid Object Naming: Object recognition, naming automaticity, processing speed, verbal fluency

Adapted from Fiorello, C. A. (2011)

DAS-II, cont.

Recall Digits— Backward: Working memory for auditory material
Recall Objects— Immediate: Memory for verbal and pictorial stimuli
Recall Objects— Delayed: Longer-term memory, verbal and pictures
Recall Sequential Order: Short-term memory for verbal and pictorial stimuli, sequencing
Recog. of Pictures: Nonverbal visual memory, recognition
Seq. & Quant. Reasoning: Fluid reasoning, sequential reasoning, figural and numeric
Verbal Similarities: Verbal knowledge, verbal reasoning
Speed of Info Processing: Processing speed, graphomotor
Verbal Comp.: Receptive language, basic language concepts
Word Definitions: Verbal knowledge, oral expression

Adapted from Fiorello, C. A. (2011)

DAS-II

Copying: Visual-motor integration, graphomotor skills
Early Number Concepts: Receptive language, spatial and numerical concepts
Matching Letter-Like Forms: Visual perception, orientation, attention to details
Matrices: Inductive reasoning, multiple choice
Naming Vocabulary: Expressive naming
Pattern Construction: Visual-spatial processing, constructional praxis, planning, bimanual coordination
Phonological Processing: Phonological awareness, segmentation, assembly
Picture Similarities: Fluid reasoning, visual perception
Rapid Naming: Fluent retrieval from LTM; automaticity of visual-auditory associations
Recall of Designs: Visual and spatial memory
Recall Digits-Forward: Rote auditory memory, sequencing

Adapted from Fiorello, C. A. (2011)

D-KEFS

Sorting: Problem-solving, verbal and spatial concept formation, categorical thinking, flexibility of thinking
Trail Making: Mental flexibility, sequential processing on visual-motor task, set shifting
Verbal Fluency: Verbal fluency
Design Fluency: Visual fluency
Color-Word Interference: Attention and response inhibition
Tower: Planning, flexibility, organization, spatial reasoning, inhibition
20 Questions: Hypothesis testing, verbal and spatial abstract thinking, inhibition
Word Context: Deductive reasoning, verbal abstract thinking
Proverb: Metaphorical thinking, generating versus comprehending abstract thoughts

Adapted from Fiorello, C. A. (2011)

KABC-II

Simultaneous
Triangles: Visual-spatial processing, constructional praxis, planning, bimanual coordination
Face Recognition: Visual facial memory (ventral stream)
Pattern Reasoning (5-6): Inductive reasoning, visual processing, figural
Block Counting: Visual-spatial processing, quantitative knowledge
Story Completion (5-6): Reasoning, sequencing, attention to visual details
Conceptual Thinking: Inductive reasoning, visual processing, pictorial
Rover: Planning, inhibition, spatial processing
Gestalt Closure: Visual processing, holistic perception
Sequential
Word Order: Short-term auditory memory for unrelated words, nonverbal response, later items interference task
Number Recall: Short-term auditory memory
Hand Movements: Short-term visual memory, sequencing, praxis

Adapted from Fiorello, C. A. (2011)

KABC-II, cont.

Planning

Pattern Reasoning (7-18): Inductive reasoning, visual processing, figural
Story Completion (7-18): Reasoning, sequencing, attention to visual details

Learning

Atlantis +Delayed: Associative memory, meaningless symbols and names, syllable length cues
Rebus +Delayed: Associative memory, rebus clues to meaningful sentences

Knowledge

Riddles: Receptive language, reasoning, long-term memory retrieval
Expressive Vocabulary: Word knowledge, oral expression
Verbal Knowledge: General knowledge, multiple choice, pictorial representations

Adapted from Fiorello, C. A. (2011)

NEPSY-II

Executive Functions/Attention

Animal Sorting: Problem-solving, verbal and spatial concept formation, categorical thinking, flexibility of thinking
Auditory Atten & Response Set: Sustained auditory atten., vigilance, inhibition, set maintenance, flexibility
Clocks: Telling time, reading analogue clocks, visual-spatial processing, graphomotor
Design Fluency: Visual-motor fluency, flexibility, divergent thinking, graphomotor
Inhibition: Naming fluency, inhibition, shifting set
Knock and Tap: Self-regulation, inhibition, maintaining set
Statue: Resistance to distraction, inhibition, motor persistence

Adapted from Fiorello, C. A. (2011)

NEPSY-II Memory and Learning

List Learning (Delay): Verbal memory
Memory for Designs (Delay): Visual memory, spatial recall and visual details
Memory for Faces (Delay): Facial memory (ventral stream)
Memory for Names (Delay): Associative memory, names and faces
Narrative Memory: Meaningful memory
Sentence Repetition: Auditory short-term memory, content and grammatical structure important
Word List Interference: Auditory memory, short term and working memory (with interference)

Adapted from Fiorello, C. A. (2011)

NEPSY-II Visuospatial Processing

Arrows: Spatial processing, visualization, line orientation, inhibition, no motor
Block Construction: Visual-spatial processing, constructional praxis, planning, bimanual coordination
Design Copying: Visual-motor integration, graphomotor skills, local and global processing
Geometric Puzzles: Visual-spatial processing; figural, mental rotation, no motor demands
Picture Puzzles: Visual-spatial processing, pictorial, visual discrimination, local detail processing, figure ground
Route Finding: Visual-spatial processing, orientation

Adapted from Fiorello, C. A. (2011)

NEPSY-II Sensorimotor Functioning

Fingertip Tapping: Simple motor speed, perseverance
Imitating Hand Positions: Visual perception, praxis, kinesthesis
Manual Motor Series: Imitate a series of rhythmic movements
Visuomotor Precision: Visual-motor integration, graphomotor w/o construction

Social Perception

Affect Recognition: Facial processing (ventral stream), matching emotions
Theory of Mind: Perspective taking for knowledge and emotions

Adapted from Fiorello, C. A. (2011)

NEPSY-II Language

Body Part Naming: Knowledge of body parts, receptive and expressive
Comprehension of Instructions: Receptive language, sequencing, grammar
Oromotor Sequences: Oral praxis, sequencing, memory span
Phonological Processing: Auditory attention, phonological awareness, segmentation, assembly
Recognition of Reversals: Visual perception of orientation, orthographic knowledge
Repetition of Nonsense Words: Phonemic awareness, auditory memory span, sequencing
Speeded Naming: Naming automaticity, processing speed
Word Generation: Verbal fluency, integrated RH/LH functioning, compare category with letter responses

Adapted from Fiorello, C. A. (2011)

WISC-IV Integrated

Verbal Comprehension

Verbal Subtests Multiple Choice: Long-term memory retrieval; compares free-recall and recognition memory

Working Memory

Visual Digit Span (Forward): Compare visual to auditory memory span
Spatial Span (Forward and Backward): Compare visual to auditory working memory
Letter Span (Forward): Compare numbers to letters (familiarity)
L-N Seq Process Approach
Arithmetic Process Approach: Compare working memory effects
Written Arithmetic: Compare arithmetic knowledge

Adapted from Fiorello, C. A. (2011)

WISC-IV Integrated, cont.

Perceptual Reasoning

Block Design Multiple Choice: Visual discrimination and spatial perception; removes v-m integration and speed demands
Block Design Process Approach: Comparison of orientation (LH) versus configuration (RH) errors
Elithorn Mazes: Executive functions—planning, organization, monitoring, inhibition; graphomotor skills

Processing Speed

Coding Copy: Visual-motor integration, graphomotor skills, processing speed
Coding Recall: Paired-associate symbol and digit recall, free recall

Adapted from Fiorello, C. A. (2011)

TBI - from the Hospital to the Community

Admission to the Hospital

During the Hospital Stay

Transition from Hospital

Eligibility Determination in the Hospital

Assessment: Strengths & Weaknesses

Cont.

Brain Axes and Functions

Anterior

Left Hemisphere

Posterior

Right Hemisphere

Possible Assessment Tools

Discharge and Follow Up

School Contact and Initial Meeting

Injury Types and Plans

Assessments and Considerations

Definitions

Symptoms and Similarities

Recovery Factors

Unique Recovery

Medical Input and Predictors

Appendix

CAS

Planning

Simultaneous

CAS, cont.

Attention

Successive

CTOPP

Phonological Awareness

Phonological Memory

CTOPP, cont.

Rapid Naming

DAS-II, cont.

DAS-II

D-KEFS

KABC-II

KABC-II, cont.

Planning

Learning

Knowledge

NEPSY-II

Executive Functions/Attention

NEPSY-II Memory and Learning

NEPSY-II Visuospatial Processing

NEPSY-II Sensorimotor Functioning

Social Perception

NEPSY-II Language

WISC-IV Integrated

Verbal Comprehension

Working Memory

WISC-IV Integrated, cont.

Perceptual Reasoning

Processing Speed