Children with Traumatic Brain Injury - Term Paper Example

Children with Traumatic Brain Injury 1. Learning Characteristics of Student Who have TBI Each year America records a high prevalence of traumatic brain injury (TBI) in children, approximately one million. This attributes to 20% of deaths in children and about 165,000 hospitalization cases wherein approximately 20,000 get minor injuries. These brain injuries are mostly caused by falls, sports related injuries that occur on the head, abuse and motor vehicle accidents. TBI refers to brain injuries that are caused by external physical forces and not brain injuries that result during child birth or those that are congenital and degenerative (Ponsford, Draper &Schonberger, 2008). In actual fact, TBI may occur in several ways for instance when the head hits an object, when the head comes into contact with force or when there is movement inside the skull. This results into development of two types of TBI first being the closed head injury (CHI) which refers to brain damage that is not caused by exterior force and the damages are not visible. The other is open head injury (OHI) which is caused by the impact of external force resulting to development of visible head injuries for instance swelling. Unfortunately, a child that sustains a brain injury may look fine at the moment but later in life especially in the adolescent stage exhibit intense behavioral and cognitive problems. This implies that TBI causes children to have lifelong disabilities including cognitive, perceptual, memory, abstract thinking, psychosocial behavior, speech, language, attention, judgment, information processing, sensory, physical functions and problem solving impairments (Saatman, Duhaime & Workshop Scientific Team and Advisory Panel Members, 2008). These disabilities are manifested in an array of characteristics depending on the location and extent of brain injury. They may also be permanent or temporary in nature where they can either cause total or partial psychosocial adjustment or functional disabilities. For instance, students with cognitive impairments suffer from long or short-term memory deficits thus remembering things and facts become quite difficult. Such students also suffer from impaired concentration and limited attention span. Therefore, they cannot engage in any activity for a long period of time even concentrating in class becomes difficult. Moreover, these students suffer from impaired perception where sequencing, judgment and planning pose serious problem. In addition, such children gravely suffer from communication problems which inhibit both their writing and reading skills. This is as a result of damage that occurs on the frontal lobes of the brain (Aimaretti & Ghigo, 2007). TBI also manifests behavioral and emotional characteristics which include mood swings, lowered self-esteem, self-centeredness, fatigue, anxiety, depression, restlessness and nosedived motivation. They are also unable to control their emotions as at times they may excessively cry or laugh. As a result, they can neither self monitor nor relate well with others. This arises because of damage that occurs on the limbic system in the brain. On the other hand, the physical impairment characteristics include sensory impairments as well as vision, speech and hearing problems. Conversely, the students may suffer from constant headaches, paralysis or paresis of either or both sides, lack of proper balance, gait impairments, spasticity of muscles and seizure disorders. They also lack effective coordination especially the fine motor coordination. These physical characteristics arise due to imbalance that affects the brain equilibrium. This is because of the development of the midline shift syndrome which further affects the weight, posture and drift posture of patients with TBI. As a result, the patients do not see a straight horizon or wall they see them as tilted (Parikh, Koch & Narayan, 2007). 2 (a) Classroom Behavioral Management Strategies and Instructional Strategies However, in spite of the high toll of TBI incidents most education and health care practitioners are usually unaware of the TBI characteristics and often confuse them with development of mental disorders, emotional disturbance and learning difficulties. This fact hugely inhibits efforts geared towards the provision of services and special education programs that will appropriately suit and meet the needs of students with TBI. Also the funds required to oversee the neuropsychological operation that is used to detect language, speech and emotional impairments among others are not appropriately disbursed. As a result, the required resources for establishment of effective Individualized Education Programs (IEP) are not available. This is partly because as mentioned earlier detecting TBI immediately after a child suffers from head injuries is difficult. Therefore, the education collaborators if not told cannot deduce that the affected student suffered from head injuries when small hence manifest TBI symptoms and characteristics. In addition, students with TBI show similar conditions as the other children with congenital disabilities. However, patients with TBI can perfectly remember their previous condition before falling ill which is in contrast to patients with congenital disabilities (Ponsford, Draper &Schonberger, 2008). Therefore, to curb this misunderstanding a good linkage between the schools, the special education department and trauma centre hospitals should be established. This will enable the school practitioners to effectively identify students with TBI thus give them the required attention. For instance, constant supervision is needed for the students’ orientation. This is because due to the short memory capacity what was learnt in the morning may be forgotten as the day goes by. Also the reentry category for the school should be evaluated to allow the students who have to relearn previous education programs to do so (Blissitt, 2006). This can be achieved by including all the education practitioners like the general and special education teachers and the other service personnel in the effort of constructively relating with students with TBI. The teachers should devise mechanisms or strategies that will help them to determine if each of the students can perfectly accomplish a one-step instruction before engaging him/her in a multiple step instruction. This is because among the goals of the program is to reestablish the self-esteem of the students with TBI. It is thus only right to focus on the strengths of the students as well as providing them with opportunities that focuses on their success. In addition, the teachers should ensure the TBI education program provides room for consistency and repetition (Aimaretti & Ghigo, 2007). To further enable the students grasp what they are being taught the teachers should use new tasks, easy to understand instructions, illustrations and examples. Conversely, they should curb the use of figurative speech as it will confuse the students. To lure the concentration of the students the attention period should be lengthened by use of appealing tasks as well as use of compensatory strategies that play a vital role of increasing the memory. Moreover, the teachers should be able to embrace the fact that the students will demonstrate high levels of fatigue and nosedived stamina. Therefore, they should ensure the learning environment is completely free from any source of distraction. Furthermore, the learning environment should be flexible in that it effectively caters for the needs of each student for instance a student may require more attention and supervision, support to engage in organizational strategies or formulation of a behavioral plan (Moppett, 2007). 2 (b) Parents collaborating with teachers, related services personnel, administrators and school Parents have a huge responsibility when it comes to preparing their children for school. Those whose children suffer from traumatic brain injuries have even a harder task of making sure that their children not only attend school but also are able to cope with the various challenges that their condition poses. In order for this to be efficient there is need for all stakeholders especially school administrators, teachers and related services personnel to be involved. It is important to appreciate that going back to school after such a traumatizing accident can be a mountainous challenge for the children or teenagers (Blissitt, 2006). As mentioned above these children exhibit changes both in behavior and how they grasp educational instructions. Although all other relevant stakeholders are important in ensuring a successful transition, parents take the most important responsibility. Before any step is taken, parents need to develop a clear plan on how they are to reintroduce school to their children who have undergone a TBI. They need to do ample research on what available schools have to offer in respect to special education needs. It is at this point that they meet the educators mostly those working in the administration department. Parents need to present their children for the teachers and administrators to evaluate them. This is an important stage which is meant to uncover the child’s specific special education needs (Parikh, Koch & Narayan, 2007). Special services personnel e.g. school psychologists are also involved so as to assist in identifying the best way forward in regards to the needs identified. The whole team then is supposed to develop a concise program i.e. Individualized Education Program (IEP) that takes care of all the special educational needs pinpointed earlier. IEP in essence proves vital for a successful educational process of all TBI children. Its main contents include specific learning objects and the services that that particular school has to offer to meet the special needs. Most IEP are developed within the first month of the child’s recovery so as to capture all the necessary information as to the extent of special educational needs (Saatman, Duhaime & Workshop Scientific Team and Advisory Panel Members, 2008). They are also conducted that fast in order to facilitate fast reentry into the education system for the TBI children. As much as the team is involved in developing the IEP it is also involved in evaluating (mostly on annual basis) its effectiveness in delivering desired results. Such evaluations also consider the progress that the child has made and in case variances are discovered, corrective measures are taken for example revising the child’s educational goals to be achieved. As much as teachers, administrators and special services personnel are involved in tracking progressive changes in a child’s condition in respect to the set IEP, parents need to put in mind some issues to facilitate success of the program. They are supposed to ensure that at home these children are not exposed to highly stressful activities. In the morning such children are not to be rushed to wake up or to prepare for school. Instead, they can be woken up early enough so that even if they drag there will be enough time to get to school. Since these children’s brains become fatigued quite easily, many breaks need to be introduced while attending to chores (Parikh, Koch & Narayan, 2007). Parents also need to be extremely patient with the child’s progress and as such needed to adjust their expectations. This also avoids or reduces stress on their part. Under the same consideration TBI can affect a child way into their adulthood. Parents should also establish fixed daily routines that need to be followed as changing them poses undue disruption. Therefore, parent’s role is pivotal in achieving desired progress in a TBI child. 2 (c) Administrators collaboration with special and general educators, related services personnel and parents It is not long ago when it was believed that a TBI can seldom cause lasting negative effects on a child’s development and learning processes owing to the brain plasticity witnessed in early years. It has however been seen through research that children with special needs derived from a TBI tend to demand more from educators and the society in general as they grow older. Earlier in the paper characteristics of these children were elaborated. From them it is easy to find that dealing with such a child within a school community may be quite hard. It is at this point that school administrators need to come in and save the situation through collaboration, family support and transition planning among others. In doing these they need to work together with special and general educators, related services personnel and parents of students who have TBI. The first people to make aware of the delicateness of these children are the teachers and other personnel involved in the daily learning and other activities for example co-curricular instructors and drivers among others. If not well educated these staff members can easily misconstrue a TBI child as an emotionally disoriented child. They need to understand that these children find it difficult to cope with normal life hustles like normal children do (Blissitt, 2006). Therefore, their main role is to assist these children get on with their daily activities with as little ease as possible. Through collaboration with special and general educators, related services personnel and parents of students, an administrator is able to ensure that the child’s school life is both enjoyable and successful in terms of assimilation of classroom instructions. Parents and family in general as stated earlier come in handy as they have more intimate time to study the TBI children’s behaviors. The administrator needs to keep close contact with the parent for them to get timely changes in behavior or attitude e.g. increased levels of frustration or emotional outbursts all of which can aid in developing changes in the instructional process. Speech pathologists are other special services personnel who offer assistance in cognitive recovery. This will help administrators to develop instructional techniques that will effectively match the children’s cognitive level in order to reduce chances of frustration and to effectively meet special education needs goals. It is not uncommon for family members and friends to constantly compare the injured child with how they were before. This usually leads to disappointment, feeling of guilt and anger. Other appropriate support needs to be given e.g. notebooks that have information on all events of the day. Psychologists need to play part here where they teach the TBI child on its various aspects (Saatman, Duhaime & Workshop Scientific Team and Advisory Panel Members, 2008). The notebook can incorporate teachers and their pictures and a school map well marked to identify all necessary facilities. In the transition period where students switch grades emphasis needs to be put in assisting them adapt to changes. Transitions come with new teachers, new classes, new classmates and much more all of which increase confusion and difficulty in adapting to the school environment. It is the work of the administrators to ensure that these difficulties are reduced as much as possible through collaboration with all relevant parties. 3 Implications of the information read Through the above information and much more that has not been captured by the scope of the study, various issues come in mind as to how this will affect me in future. It can be deduced that parents actually have a big role to play in preparing the TBI child to cope with the daily life challenges especially those experienced in school. As such parents need to be involved as much as possible in every stage of development or change in aspects to do with the child’s wellbeing. The school on the other hand spends a great deal of time with the student and should impart the required knowledge regardless of their challenges. This is definitely a daunting task for school administrators, teachers and other support staff. It is also a challenge to other related service personnel like school psychologists. It is important to mention at this point that children recover from TBI but for this to happen, intense collaboration and input from all stakeholders needs to be felt in all stages of the rehabilitation process. In future it is my realization that if faced by this issue all those that will deal with TBI children need to have sufficient information regarding how they can assist in making TBI children’s lives better. Due to behavior change some aspects of a student’s personality also change which may result in loss of friends and as such their fellow students should be made aware of the reasons behind the changes and how they can assist rather than being part of the bigger problem. In a nutshell, successful rehabilitation and achievement of set educational goals in IEP can only be a reality when parents, administrators, special and general educators and related services personnel collaborate. 4 Conclusion From the above, it is quite clear that TBI is among the major and most common ailments that cause development of long-term or short-term disabilities in the world. Children face a higher risk than adults because their skulls are still quite delicate and undergoing growth thus there is a high probability for occurrence of brain damage. The increase in TBI prevalence is also shocking and drastic measures should be taken to enlighten individuals on measures of preventing its occurrence or how to seek immediate intervention once a head injury occurs. Early detection of TBI is quite helpful in the administration of treatment options to curb future manifestation of TBI characteristics such as memory and perception loss and thus decrease the number of TBI cases. TBI patients and their families should also be appropriately informed about it, the changes that will occur and the measures they will need to take. This will help them to effectively cope with the situation. Currently, the available information contains a high percentage of medical jargon. Therefore, it is complicated for a layman to understand it. Future plans for writing the same in a simpler language should be in force. Moreover, the government together with the private sector should work to ensure the appropriate resources of establishing TBI learning centers are availed. They should further ensure that the centers contain appropriate equipments and a good learning environment. Teachers who specialize in TBI cases should be employed to ensure that students get the appropriate care, supervision and attention. In addition, the government should play a key role in the formulation of a new education curriculum that will meet all the needs and demands of students with TBI. References Aimaretti, G. & Ghigo, E. (2007). Should every patient with traumatic brain injury be referred to an endocrinologist? Nature Clinical Practice of Endocrinology and Metabolism, 3(4), 318–319. Blissitt, P. A. (2006). Care of the critically ill patient with penetrating head injury. Critical Care Nursing Clinics of North America, 18(3), 321–332. 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