BrainSTEPS: Assists students, schools and families in Pennsylvania following acquired - PowerPoint Presentation

1.    BrainSTEPS: Assists students, schools and families in Pennsylvania following acquired brain injury

2. The BrainSTEPS ProgramCreated by: PA Department of Health in 2007Unique partnership for funding: PA Department of HealthPA Department of Education, Bureau of Special Education via the PaTTAN networkImplemented by: Brain Injury Association of Pennsylvania

3. Monica VaccaroProgram ManagerBrain Injury Association of PennsylvaniaMary Lou BusbyBoard of Directors, Brain Injury Association of PennsylvaniaBrenda Eagan BrownBrainSTEPS Program CoordinatorBrain Injury Association of PennsylvaniaProgram Steering Committee

4. What We Will CoverIncidence and causes of brain injury in childrenMechanisms of injuryCommon EffectsPatterns of recoveryBrainSTEPS School Re-Entry ProgramConcussion Management Team Program

5. Traumatic Brain Injury STATISTICS

6. Brain injury is a leading cause of death and disability in children & young adults.

7. Children with Traumatic Brain Injury 0-14 years of ageCDC StatisticsAverage ANNUAL number of Traumatic Brain Injury Emergency Department Visits and Hospitalizations in the United States Most children who sustained a TBI (91.5%) were treated and released from the emergency department.United States. Centers for Disease Control.  Traumatic Brain Injury in the United States. 2005. http://www.cdc.gov/ncipc/pub-res/TBI_in_US_04/TBI%20in%20the%20US_Jan_2006.pdf>.509,000

8. Each year, approximately26,000 children in Pennsylvania sustain a traumatic brain injury (mild, moderate, or severe) Source: The Brain Injury Association of Pennsylvania, 2008How Common is TBI in Children in Pennsylvania?

9. Mild: Brief or no loss of consciousness Shows signs of concussion vomiting lethargy dizziness lack of recall of injuryModerate: Coma < 24 hours duration Neurological signs of brain trauma Skull fractures with contusion (tissue damage) Hemorrhage (bleeding) Focal Findings on EEG or CT scanSevere: Coma > 24 hours durationLevels of Medical Severity of TBI

10. In 2006approx. 4,000Children & Adolescents in Pennsylvania were HOSPITALIZED with TBI Source: The Pennsylvania Department of Health, 2006DOES NOT INCLUDE EMERGENCY ROOM VISITS.Focus:

11. Why the Discrepancy?Not all children who sustain a brain injury experience lasting effectsNot all parents want to have their child classified – they want the child back to “normal”The effects of a brain injury can be latent.Effects of TBI may mimic other disabilities leading to misdiagnosis and inappropriate placementUnder-identification and Misidentification within the educational system.

12. Acquired Brain Injuries :Traumatic &Non-Traumatic

13. Types of Brain InjuryAcquired Brain Injuryafter birth processTraumatic Brain Injuryexternal physical forceNon-traumatic Brain Injuryopen head injuryclosed head injury

14. Definition of Acquired Brain InjuryAn injury to the brain that has occurred after birth. The injury commonly results in a change in neuronal activity, which effects the physical integrity, the metabolic activity, or the functional ability of the cell. An acquired brain injury may result in mild, moderate, or severe impairments in one or more areas, including:CognitionSpeech-language communicationMemoryAttention/concentrationReasoningAbstract thinkingPhysical functionsPsychosocial behaviorInformation processing

15. Types of Brain InjuryAcquired Brain Injuryafter birth processTraumatic Brain Injuryexternal physical forceNon-Traumatic Brain Injuryopen head injuryclosed head injury

16. Non-Traumatic Brain Injury CausesCerebral Vascular Accidents Vascular Occlusions Hemorrhaging AneurysmsIngestion of Toxic Substances Inhalation of Organic Solvents Ingestion of Heavy Metal Alcohol and Drug Abuse

17. Infections of the BrainHypoxia – reduced oxygen to the brainAnoxia – no oxygen to the brain Brain Abscesses Meningitis EncephalitisNon-Traumatic Brain Injury Causes

18. Anoxia – common causesRespiratory arrestElectrical shockHeart attackBrain tumorHeart arrhythmiaExtreme low blood pressureCO2 inhalationPoisoningChokingSuffocationRespiratory conditions that affect breathing

19. Lightning

20. Near Drowning

21. Brain Tumors & Cancer Chemotherapy/Radiation Effects

22. Bleeding in the brain

23. Acquired Brain Injuryafter birth processTraumatic Brain Injuryexternal physical forceNon-traumatic Brain Injuryopen head injuryclosed head injuryTypes of Brain Injury

24. Definition of traumatic brain injuryor both, that adversely affects a person’s performance”“an acquired injury to the brain caused by an external physical force, resulting in total or partial functional disability or psychosocial impairment, Brain Injury Association of America

25. Open Head Injury: Gunshot Wound

26. Centre for Neuro SkillsWhat Happens During a Closed Head Injury?

27. Skull Anatomy Dr. Mary Pepping of the University of Idaho’s presentation The Human Brain: Anatomy,Functions, and Injury Bony RidgesThe skull is a rounded layer of bone designed to protect the brain from penetrating injuries.The base of the skull is rough, with many bony protuberances.These ridges can result in injury to the temporal and frontal lobes of the brain during rapid acceleration.

28. Skull Protrusions

29. Shaken Baby Syndrome

30. Car Accidents

31. EACH YEAR – Hundreds of Thousands of Student Athletes Sustain ConcussionsDefined as a trauma-induced alteration in mental status (dazed, disoriented, confused)May or may not involve loss of consciousnessCan result in loss of memory for events immediately before or after traumaCan result in local neurological deficits that may or may not be transient

32. If concussion occurs as a sports or recreational injuryClearing for return to play Challenges students faceTreatment & compensatory strategiesFacilitating a successful school re-entry

33. Signs and Symptoms of Concussion

34. Decreased Processing SpeedShort-Term Memory ImpairmentConcentration DeficitIrritability/DepressionFatigue/Sleep DisturbanceGeneral Feeling of “Fogginess”Academic DifficultiesPost-Concussion Syndrome(persistent symtoms)

35. A Child’s Brain

36. A Child’s BrainUnderdeveloped – the younger the child, the less developed is their brainEasily Injured – infant’s neck is weakUnlike the heart or kidney, the brain needs time & experience to mature Undifferentiated – as learning occurs, specialization develops in the brain

37. A Child’s BrainNew abilities build on ESTABLISHED skills over timeBrain injury interrupts skill development, and can prevent new skills from developingChild’s brain was thought to have “plasticity,” yet does not “bounce back” after injury

38. Rates of Development:5 Peak Maturation PeriodsPeak Maturation PeriodsFIVE distinct stages between the ages of 1 and 21 yrs.% of maturation incrementsage increments 1 3 5 7 9 11 13 15 17 19 216420Frontal lobes still developing

39. Brain Injury & Developmental StagesIn the normal brain, cognitive, emotional, & social abilities emerged developmentally. Abilities developed at one stage of life form the foundation for more complex abilities later on.

40. Brain Injury & Developmental Stages Capacities in the process of development, and those not yet developed are those most vulnerable to brain injury.The earlier the injury, the more pervasive the impact on thinking, emotional regulation, and behavior.

41. Important Developmental StagesChild’s stage of development when injury happened Child’s stage of development NOW

42. Growing UpPerformanceNormal DevelopmentDevelopment Without Brain InjuryDiagram by Dr. Sandra Chapman,University of Texas

43. Growing UpPerformanceBrain InjuryNormal DevelopmentTraumatic Brain Injury Without InterventionDiagram by Dr. Sandra Chapman,University of Texas

44. Growing UpPerformanceBenefit of Intervention in Multiple Time FramesTraumatic Brain Injury with SupportDiagram by Dr. Sandra Chapman,University of Texas

45. Pre-Existing Conditions & TBIChildren with pre-existing behavioral weaknesses are much more likely to have a TBI.Effects of TBI will compound and add to pre-existing learning, behavioral or psychological problems, such as:DyslexiaADHDParanoiaDepression

46. Visible, physical recovery is a sign that the brain is healed...REALITY: Cognitive & behavioral effects of a brain injury can last long after the person heals “on the outside”Younger kids are more resilient & can “bounce back” easier and more quickly after a brain injury...REALITY: It may just take longer for the effects of a brain injury to show up in a developing brainM Y T H :M Y T H :Tennessee’s Project Brain, 2008

47. Effects of Brain Injuryon Children

48. Physical EffectsSeizures HeadachesChanges in speech & languageSensory changes Taste Smell Hearing Vision

49. Physical EffectsReduced StaminaWeakness - Navigating between classes quickly - Carrying books - Physical Education class impactDifficulty with balance, paralysis, paresis, spasticity

50. Cognitive EffectsAttention or concentrationAbility to initiate, organize, or complete tasksAbility to sequence, generalize, or planFlexibility of thinking, reasoning, or problem solving

51. Cognitive EffectsAbstract thinkingInformation processing (slowed speed)Judgment or perceptionLong-term or short-term memory

52. Cognitive Effects ConfabulationAbility to acquire or retain new informationInconsistent and unpredictable learning rate

53. Psychosocial Adjustment Family’s Ability to Cope Denial of Illness Affective Problems

54. Psychosocial Adjustmentis Influenced by: Behavioral Problems Cause of Behavior Problems Pre-Injury Personality Traits

55. Social, Emotional,Behavioral Issues Distractibility Impulsivity Irritability Aggression Motivation & Initiation Depression Lack of Social Judgment Denial/Lack of Self-Awareness Rigidity/Inflexibility Low Frustration Tolerance

56. Brain Injury VS. Other Disabilities

57. Similarities Between Students with TBI & Students with Other Neurologic Disabilities Skill Integration Generalization Abstract Reasoning Social JudgmentProblems with: Attention Memory Impulse Control Organization

58. What is Different AboutBrain Injury? Prior normal development Sudden onset of disability Require hospital to school transition planning Ongoing medical needs Cognitive, physical, and psychological impact

59. What is Different about Students with Brain Injury? TBI results in disruption of normal brain development Reconciliation of “old” self with “new” self Loss of peer relationships & change in family dynamics

60. What is Different About Students with Brain Injury? Exacerbation of prior difficulties Having to learn HOW to learn again More extreme discrepancies among abilities More uneven and unpredictable progress

61. What is Different About Students with Brain Injury? Relearning of old material - may learn faster at first Problems are not developmentalReliance on previous learning strategies – might not be effective now

62. Psychological TestingTEST SCORES on typical school psychological & IQ tests are NOT indicative of future learning capabilities for a TBI student. Many tests measure only previously learned skills, which tend to remain intact after a brain injury.Usually perform fairly well during ONE-on-ONE testing that has no generalization or carry-overEvaluation MUST be ongoing.

63.    BrainSTEPS: Assists students, schools and families in Pennsylvania following acquired brain injury

64. BrainSTEPS Assists Students with All Acquired Brain InjuriesTraumatic Brain Injury (includes Concussions)Non-Traumatic Brain Injury * Any child who has a brain injury that occurs AFTER the birth process can be referred to BrainSTEPS

65. The BrainSTEPS ProgramBrain injury consulting teams available to families and schools throughout Pennsylvania.Teams are extensively trained in the educational needs of students returning to school following brain injury.Teams consult with & train local school staff to develop educational programs.

66. 31 BrainSTEPS teams cover PA29 are based out of the educational Intermediate Units and 2 school districts300+ active, trained BrainSTEPS team membersEducational professionalsMedical professionalsRehabilitation professionalsStaff from community facilities Staff from government agenciesUniversity facultyFamily membersBrainSTEPS Teams

67. Hospital & Rehabilitation Team MembersChildren’s Hospital of PhiladelphiaThe Children’s Institute of PittsburghAcadia Rehabilitation, Inc. Lehigh Valley HospitalGood Shepherd RehabilitationNemours/A.I. duPont Hospital for Children (Delaware)Beechwood NeuroRehabMainline RehabilitationThe Barber InstituteMagee Rehab HospitalGeisinger Medical CenterSchuylkill RehabilitationReading HospitalSt. Vincent’s Medical Center

68. What BrainSTEPS Teams Can Do: Prepare the student for return to schoolCommunicate with the district & medical, & rehab professionalsGather medical, rehab, & educational reports/evaluations to assist in making educational recommendationsConduct student observations

69. Provide peer, parent and school trainingIndividual to student needs for school teamsGeneral for district wide in-service trainingsConsult on all aspects of the student’s educational plan & make recommendations to the district teamAssist in transitioning a student from grade to grade or school to school by training new teachersWhat BrainSTEPS Teams Can Do:

70. What BrainSTEPS Teams Can Do: Serve as a consistent point of contact for studentsOffer families support, education and connections to community resources Continually update their brain injury expertise by attending mandatory BrainSTEPS trainings, obtaining CBIS certification, and participate in other brain injury training opportunities

71. 11. It is a goal of the BrainSTEPS Teams to monitor all referred students annually until graduation.

72. Communication with familyCommunication with schoolConsultation with studentRecords reviewConsultation: strategiesConsultation w/ medical professionalsConsultation educational planTraining of educators and support staffClassroom and peer educationInformation sharing among teamDemonstration of interventionsObservations/evaluations of studentParticipation in IEP and 504 meetingsBrainSTEPS Consultation Activities

73. Who is referred to BrainSTEPS?A student who:Has an acquired brain injury At any point in the student’s lifeIs having difficulty at school as a result of the acquired brain injuryConcussions – referrals taken at 4wks. post unless there are “concussion modifiers” presentAll other brain injury severities – referrals taken at any point in time. The sooner the better

74. How to make a student referral to BrainSTEPS

75. BrainSTEPS referralswww.brainsteps.net

76. Students Served by BrainSTEPS:Students 2,387

77. Female: 45%Male: 55%Most prevalent AGE AT INJURY for referrals continues to be:14 yrs & 15 yrs

78. Students referrals from:65 out of 67 countiesand620 School Entities (public, private, charter)

79.

80. Injury Type and Severity

81.    BrainSTEPS Concussion Support2013 - Statewide Return to School Concussion Management Team Project

82. Schools should ensure that cognitive demands (school work) placed on a student are below the student’s individual symptom threshold

83. Return to School BrainSTEPS Concussion Management Team Project (CMT) 20132 CMT monitorsAcademic Monitor (School Psych, Guidance Counselor)Symptom Monitor (School Nurse)700+ CMTs formed & trained by BrainSTEPS across the state of PA since January 2013 (as of 8/2013) CMTs follow BrainSTEPS Return to School Concussion Protocol

84. School Work After ConcussionInitial 4 WeeksBeyond 4 WeeksBeyond6 months

85. PA’s Unique Layered Statewide Infrastructure for Concussion Return to School1stlayer2ndlayer

86. Resources

87. Available fordownload at: www.brainsteps.netAvailable to orderIn bulk at: www.pattan.net

88. Available fordownload at: www.brainsteps.netAvailable to orderIn bulk at: www.pattan.net

89. Available fordownload at: www.brainsteps.netAvailable to orderin bulk at: www.pattan.net

90. Available fordownload at: www.brainsteps.netAvailable to orderin bulk at: www.pattan.net