Traumatic Brain Injury 5 page quick turn around time -- 5:00PM (PST) 3/30
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module_4_lecture_notes.docxModule 4 Overview—
This week, you will learn about low-incidence disabilities. These include severe and multiple disabilities; sensory, physical, and health disabilities; and traumatic brain injury.
Complete the following readings early in the module:
· Human exceptionality: School, community, and family (10th ed.), read the following chapters:
· Severe and multiple disabilities
· Sensory impairments: Hearing and vision loss
· Physical disabilities, health disorders, and traumatic brain injury
· Jantz, P. B., & Coulter, G. A. (2007). Child and adolescent traumatic brain injury: Academic, behavioural, and social consequences in the classroom. Support for Learning, 22(2), 84–89. doi: 10.1111/j.1467-9604.2007.00452.x. (EBSCO AN: 25129744) http://libproxy.edmc.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=pbh&AN=25129744&site=ehost-live
· Smith, L. A., & Williams, J. M. (2005). Developmental differences in understanding the causes, controllability, and chronicity of disabilities. Child: Care, Health, & Development, 31(4), 479–488. doi: 10.1111/j.1365-2214.2005.00532.x. (EBSCO AN: 17246906) http://libproxy.edmc.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=pbh&AN=17246906&site=ehost-live
As our focus for this module is low-incidence disabilities, pay special attention to the assigned readings that deal with the topics listed below. You can even use the search feature in your digital textbook to help pinpoint specific text sections to review.
Keywords to search in your digital textbook and journal articles: dual sensory impairment, augmentative communication, authentic assessment, audition, legal blindness, orthopedic impairment, other health impairment, medically fragile, and traumatic brain injury (TBI).
Module 4 Learning Resources:
Use Module 4 learning resources provided on the pages that follow to enhance your understanding of low-incidence disabilities. Take a moment to check out some of these featured learning resources:
· Exceptional Children: This self-assessment activity presents a scenario of Jeffrey, an exceptional child, and provides you the opportunity of identifying the exceptionalities presented and suggesting an intervention.
· Legal and Ethical Considerations: This self-assessment activity presents a scenario of Tomas, an exceptional child, and provides you the opportunity of identifying the legal and ethical considerations that should be taken in this case.
Learning outcomes:
· Describe and discuss the continuum of exceptional development, including identification of exceptionalities and individual strengths.
· Apply current, peer-reviewed research on environmental, biological, and cognitive influences on development to design systemic support and/or intervention plans for home, school, and transition for children with exceptionalities.
· Evaluate cultural, ethical, and legal considerations in identification and intervention and/or support of children with exceptionalities. Appraise community resources and provide support and resources to parents, children, and families.
Module Topics
· Low-Incidence Disabilities
· Severe and Multiple Disabilities
· Sensory Disorders
· Physical Disabilities
· Health Disabilities
· Traumatic Brain Injury
Module 4 Overview
This module provides an overview of low-incidence exceptionalities in children, including severe and multiple disabilities; sensory, physical, and health disabilities; and traumatic brain injury. You will learn about the prevalence, characteristics, known causes, evaluation, prognosis, and intervention of these exceptionalities with the help of current research.
In the assignments for this module, you will evaluate a video on the deaf culture and explain how you will utilize the information presented to work with children with low-incidence exceptionalities and their families. You will then analyze the case of six-year-old Jefferson, who suffers from cerebral palsy. You will provide a hypothesis of his likely prognosis and evaluate what his future might have been like were he being raised in the U.S. in the 1940s. As you take a closer look at the effect of the specific dynamics of the community and cultural environment on the development of children, remember that every child has an individualized set of community and cultural influences. These influences need to be explored and evaluated further to determine the most appropriate intervention.
Exceptional Children
Jeffrey is a middle school boy who suffers from Hemophilia.
Scenario – The Case of Jeffrey
Jeffrey has to be very careful because, due to his hemophilia, even seemingly minor injuries can cause bleeding (internally or externally), requiring blood transfusions.
Despite his disability, Jeffrey enjoys participating in physical education classes and gets frustrated that he cannot do everything his peers can, such as trying out for the football team.
As Jeffrey’s disability is not obvious, his peers often do not understand his limitations and tease him. However, Jeffrey tries not to let their teasing bother him, opting to try to educate them about hemophilia instead. He sometimes has to do this with teachers as well, particularly when there is a substitute teacher who is not aware of his condition.
Q1. What exceptionalities and individual strengths does Jeffery have?
Jeffrey suffers from hemophilia, a potentially life-threatening disorder in which it is very difficult for blood to clot.
Jeffrey seems to understand his diability and the limitaitons it can cause. Rather than becoming discouraged by his peers’ lack of understanding and teasing, he has chosen to educate them on his disability. He is able to advocate for himself when necessary.
Q2. What interventions would be appropriate for Jeffrey?
Jeffrey might benefit from being given a leadership position, perhaps by asking him to give a presentation on hemophilia to peers and staff since he appears comfortable with discussing his condition. Adults who work with Jeffrey also need to be educated about the treatment protocol in case of an injury and the activities that are restricted and allowed. Jeffrey might also be a good role model for other children at his school with disabilities.
Severe and Multiple Disabilities
Consider the following example.
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Matthew, an eleven-year-old boy in fifth grade, was born premature at twenty-six weeks and has since struggled with his health. He obtains nutrition from a feeding tube through a “button” placed in his abdomen. He has difficulty walking, and alternates between using a walker and a wheelchair. Matthew’s intellectual development is significantly delayed, and he is functioning at the level of a four-year old. He knows basic concepts, such as letters and numbers, but his speech and motor delays make it difficult for him to convey what he knows. Despite his challenges, Matthew is a happy boy and loves to be around other students. His teachers marvel at his persistence in trying new things despite his difficulty with motor movements. His somewhat awkward, but constant, smile is contagious. |
Matthew receives special-education services as a student with multiple disabilities. He has physical, health, and cognitive impairment and requires assistance to function at his potential. There is no IDEA category for severe disabilities and these are subsumed under other categories. Although Matthew’s challenges are severe, there are a wide range of challenges and abilities within this category.
TASH
Formerly, TASH stood for The Association for the Severely Handicapped, but the organization has since abandoned that title in favor of using only TASH.
This is because their mission is the full inclusion of people with disabilities, and they felt the title put too much emphasis on disabilities, rather than the person. Visit TASH website at the following: TASH. (2011). http://tash.org/
Deaf-Blindness
The multiple disabilities eligibility category under IDEA includes deaf-blindness. The most well-known figure with deaf-blindness is Helen Keller, who became deaf and blind at the age of nineteen months due to an illness. Interestingly, Alexander Graham Bell (inventor of the telephone) worked with her family and steered her toward a school for the blind, rather than for the deaf, because he did not believe in signing; rather, he believed lip reading and oral speech should be emphasized as he felt signing was too primitive a means of communication.
Keller was inspirational because she did not see herself as a disabled person; she saw herself as having some difficulties, rather than being an oppressed minority (Nielsen, 2004). She felt that the focus should not be on only overcoming her challenges but embracing them. People assumed that because she could not see or hear, she was unintelligent and incapable of functioning “normally,” which could not be further from the truth. She wrote that the “…truly disabled were those who had ‘eyes of ignorance’” (Keller, 1903, as cited in Nielsen, 2004, p. 69).
Keller’s story is important to understand because it shows that we do not always know one’s potential. Even those with multiple or severe disabilities have strengths that should be embraced and fostered. Keller not only learned to finger-spell and use Braille, by the age of nine, she also learned to speak and read lips using touch.
Nielsen, K. E. (2004). Radical lives of Helen Keller. New York, NY: New York University Press.
Assessing Severe and Multiple Disabilities
Evaluating children with multiple and severe disabilities can be difficult due to the nature of their challenges, particularly when one has physical impairments. Traditional standardized assessment tools (such as intelligence tests) often cannot be used due to motor or communication deficits. Another downside of these tools is that they tend to focus on limitations rather than strengths. This can sometimes result in misidentifying a child as having intellectual impairment or, at a minimum, not recognizing his or her potential. Therefore, alternative assessments are required for severe and multiple disabilities (Narayan, Bruce, Bhandari, & Kolli, 2010).
Examples of alternative assessments include the following:
· Communication-based assessment: This should include observation of movements, gestures, sounds, and words to communicate (DeVeney, Hoffman, & Cress, 2012).
· Observations in the home, community, and school: Observing a child in his or her natural environment tells us what he or she can do, which might not be observable in a test setting.
· Personal profile: This is a holistic summary of the child, which includes likes and dislikes, strengths, challenges, interests, requirements of learning and other environments, and a description of the family (Kelly, Siegel, & Allinder, 2001).
· Interviews with parents and teachers: Parents and teachers know the child better than anyone else and observe the child for much more time than an evaluator could.
· Functional assessment: This includes reports from teachers and parents identifying what the child can do in each setting. Performance across time and in a natural setting should be emphasized. The focus is on teaching skills in deficit areas (Narayan et al., 2010).
DeVeney, S. L., Hoffman, L., & Cress, C. J. (2012). Communication-based assessment of developmental age for young children with developmental disabilities. Journal of Speech, Language, and Hearing Research, 55(3), 695–709.
Kelly, K. M., Siegel, E. B., & Allinder, R. M. (2001). Personal profile assessment summary: Creating windows into the worlds of children with special needs. Intervention in School and Clinic, 36(4), 202–210.
Narayan, J., Bruce, S. M., Bhandari, R., & Kolli, P. (2010). Cognitive functioning of children with severe intellectual disabilities and children with deafblindness: A study of the perceptions of teachers and parents in the USA and India. Journal of Applied Research in Intellectual Disabilities, 23, 263–278.
Interventions for Severe and Multiple Disabilities
As severe and multiple disabilities vary by diagnosis, presentation, and individual differences, so do the interventions. A multidisciplinary evaluation helps determine what interventions and supports are needed for each child.
A major contribution of technological advancement has been to evaluate and support the capabilities of people with severe and multiple disabilities. When Helen Keller was a child, Braille was a technological advancement. Today, the possibilities seem endless. Technology helps people navigate the world physically and cognitively. Advances enable communication, mobility, and self-care.
Jackson (2012) reports the results of an exciting study of patients who were paralyzed. With an electrode inserted very close to the primary motor cortex (area responsible for movement) in the brain, the patients were able to control the movement of a robotic arm to drink from a bottle. This was a huge accomplishment. The study also shows that even though the relevant neurons had not been used since the paralysis, they were able to respond to the patients’ thoughts once the gap was bridged with a computer.
Advancements like these give hope that one day, we will be able to fully understand the capabilities of individuals with multiple and severe disabilities, and intervene to help them live to their fullest potential.
Web Quest
Search videos, articles, and other resources using the Argosy University online library and the internet for stories about individuals with severe and multiple disabilities.
Jackson, A. (2012). Brain-controlled robot grabs attention. Nature, 485, 317–318.
Sensory Disorders
Sensory disorders include deafness, hardness-of-hearing, blindness, and partial sight. As discussed previously, some people experience both deafness and blindness.
The NAD
The National Association of the Deaf (NAD) advocates the right to learn American Sign Language (ASL) from an early age, as well as the civil rights of the deaf and hard-of-hearing. Visit the NAD Web site at the following: National Association of the Deaf. (n.d.). http://www.nad.org/
Hearing Loss
Hearing loss may be congenital (present at birth) or acquired. The location in the ear in which impairment occurs determines the type of loss experienced, as well as the potential for intervention.
There are many causes of hearing loss, including genetics, prenatal or postnatal disease or illness, and environmental factors. Although academic performance may vary, studies show that children with hearing loss show the same normal distribution of intelligence as those whose hearing is intact.
Food for Thought
Think about hearing loss in terms of support and intervention. If intellectual capability is assumed to be similar in a typically developing child, with deficits tending to be in language-based areas, how might teachers and parents design supports and interventions?
Deaf Culture
The deaf culture has long been controversial. Alexander Graham Bell advocated keeping the deaf away from each other to discourage the deaf culture. He believed that American Sign Language (ASL) was a primitive form of communication and should be discouraged. Those supporting this viewpoint assert that by emphasizing ASL, learning the English language is deemphasized, relegating those who are deaf to communicate only with those in the deaf community. Additionally, Bell believed that by allowing a deaf community to form and intermarry, deafness would never be eliminated (Osborne, 1943).
Contrary to this belief, the National Association of the Deaf (NAD), formed in 1880, embraces the right to use ASL and champions the rights of the deaf community. This is more of a bilingual approach, treating ASL as the primary language, with English being second.
By reviewing this debate throughout history, it is easier to understand why there can be a divide between those for and against promoting the deaf culture.
Osborne, H. S. (1943). Biographical memoir of Alexander Graham Bell 1847–1922: Vol. 23. Biographical memoirs. United States: National Academy of Sciences.
Deaf-Blindness
The American Association of the Deaf-Blind emphasizes the need for independence and integration into the community for individuals with deaf-blindness. Visit their website at the following: American Association of the Deaf-Blind. (2011). http://www.aadb.org/
Consider the following example:
Zach Thibodeaux, an eight-year-old boy, was featured in a series in The Dallas Morning News (Ramirez, 2011). Zach was diagnosed with cone-rod dystrophy, which causes rapid deterioration of vision. Knowing that complete loss of vision was approaching quickly, Zach was taught how to function using a cane while blindfolded and to use Braille. He has also made adjustments, such as reading enlarged text, using big screens for watching television, playing videogames, and using audio books as his vision fades.
As he learns to navigate his ever-changing visual world, Zach continues to participate in activities typical of eight-year-old boys, such as playing soccer and video games, even though participating in these activities is becoming more challenging.
Food for Thought
Think of Zach’s case, particularly the following questions:
· Why is it beneficial to teach Zach how to navigate his environment as someone with vision loss before his eyesight is completely gone?
· What interventions or supports can help Zach continue participating in the activities he loves as much as possible once he is completely blind?
What support might his family need?
Ramirez, M. (2011, June 19). Eight-year-old Lewisville boy destined for blindness learns some new tricks. The Dallas Morning News. Retrieved from http://www.dallasnews.com/health/family-health/headlines/20110619-eight-year-old-lewisville-boy-destined-for-blindness-learns-some-new-tricks.ece
Physical Disorders
Physical disorders in childhood include, but are not limited to, cerebral palsy, spina bifida, muscular dystrophy, juvenile rheumatoid arthritis, and spinal cord injury.
Research has shown that children with chronic physical disabilities show significantly higher rates of psychiatric disorders compared to those without physical disabilities (Wallander & Varni, 1998).
In addition, their mothers may be more likely to develop problems with psychosocial adjustment. The severity of the impairment and the timing of the diagnosis (congenital versus postnatal) might make a difference in the level of risk.
Supports such as family cohesiveness, perceived control, friendships, education on coping skills, and a stress management program can help increase resilience for both families and the child with the physical disorder.
Wallander, J. L., & Varni, J. W. (1998). Effects of pediatric chronic physical disorders on child and family adjustment. Journal of Child Psychology and Psychiatry, 39(1), 29–46.
Health Disorders
A wide range of health problems can occur in childhood, including asthma, diabetes, seizure disorders, cystic fibrosis, sickle-cell anemia, cancer, and congenital heart conditions. A wide range of interventions and supports are required for these varied conditions. Similar to the exceptionalities reviewed thus far, children with medical disabilities vary with respect to the severity of their condition, comorbidity with other exceptionalities, individual strengths, and needs. A multifaceted and multidisciplinary approach to evaluation and support is important. Although some children’s health conditions might be severe enough to significantly interfere with daily functioning and require special education support, others might experience minimal interference.
Consider the following example:
Alex, a ten-year-old boy, has asthma and requires daily medication to minimize his symptoms. Despite strict adherence to his medication regimen, he sometimes requires trips to the school nurse for breathing treatments, which can interfere with classroom lessons and time with friends. Many times, he has had to sit out during recess or physical education class due to difficulty in breathing.
Lucas, on the other hand, only rarely has an asthma attack. His symptoms seem to ebb and flow with the allergy season, with him going months at a time without requiring treatment.
Given their different levels of symptoms, the levels of support needed for Alex and Lucas differ. Alex might require academic intervention and social support due to the level of interference his asthma has in his daily functioning, while Lucas might experience minimal impact.
In addition to the health disorder itself, side effects from medication might require support. For example, side effects such as lethargy, difficulty concentrating, nervousness, and dry mouth might require adjustments to accommodate the child at home, at school, or in the community.
Sickle-cell anemia
Some health disorders vary by race. For example, sickle-cell anemia is more prevalent in those who are Black or Hispanic (National Heart, Lung, and Blood Institute, 2011). National Heart, Lung, and Blood Institute. (2011). What is sickle-cell anemia? Retrieved from: http://www.nhlbi.nih.gov/health/health-topics/topics/sca/
Traumatic Brain Injury
The last exceptionality we will review in this module is traumatic brain injury or TBI. TBI has gained more attention in the past decade, particularly in regard to concussions acquired in athletic activities.
TBI occurs when the head is impacted by some force, which causes the brain to shift in the skull, damaging vital nerve fibers or bruising the brain. This can be caused by falls, car accidents, sports injuries, or being hit on the head by an object.
Think about riding in a car and hitting the brakes quickly. What happens to your body? As the car stops suddenly, your body lurches forward. This jolting can also cause your brain to move, hitting your skull with force, even if your head does not hit an object. This is what happens when an infant or toddler is shaken.
Although some use the term mild traumatic brain injury, while others use the term concussion, Halstead and Walter (2010) assert they are the same thing. In the U.S., there are approximately 300,000 to 3.8 million recreation-related concussions every year. This estimation range is wide due to underreporting and different definitions of concussion. Football has been reported to have the highest rates of concussion among high-school athletes, with girls’ soccer coming in second. There is a dearth of studies in younger athletes. Girls tend to have higher rates of TBI than boys playing similar sports due to weaker neck muscles and smaller head mass (Halstead & Walter, 2010).
Aside from the seemingly obvious risks of physical symptoms, such as headaches, concussions can result in symptoms related to depression, anxiety, and ADHD. These might include irritability, sadness, nervousness, difficulty concentrating, trouble remembering information, and sleep disturbances.
Halstead, M. E., & Walter, K. D. (2010). Clinical report—sport-related concussions in children and adolescents. American Academy of Pediatrics, 126(3), 597–615.
TBI: An Example
Consider the following example of Tristan, a twelve-year-old student in seventh grade:
Tristan began playing full-contact football last fall, excelling at the sport. His parents could not have been prouder when they saw their son in his full football uniform, pads and all.
About halfway through the season, Tristan’s team played a considerably tougher team. During the first quarter, Tristan was tackled particularly hard and did not get up for about half a minute, even though he had not lost consciousness. After being urged by his coach, Tristan stood up and was helped back to the bench for a drink of water. Although he seemed a bit confused, his coach encouraged him to get back in the game.
Despite hesitation on his parents’ part, Tristan returned to the game. Later, Tristan collapsed, and this time he did not get up. When his parents ran over to him, they could see blood coming out of his mouth, and he was unconscious. Tristan was flown by helicopter to a hospital, where doctors were horrified to find that he had sustained a head injury and had been allowed to continue playing.
Tristan’s story speaks of the importance of educating not only coaches at schools, but coaches and parents involved in recreational nonschool activities. Although injuries as extreme as Tristan’s are relatively rare, they do occur, and can result in lasting harm to a developing body or even death.
TBI: Legal Considerations and Treatment
Legal Considerations
In 2009, Washington State passed the Zackery Lystedt law, becoming the first state to pass a concussion-management law for youth athletes. This law applies to school boards and the state interscholastic activity associations. It mandates education and guidelines for parents, athletes, and coaches.
According to this law, parents must demonstrate an understanding of the dangers of concussions by signing a consent form. Mandatory removal from the game is required if an athlete is suspected of having a concussion. Children and adolescents can take up to ten days or longer to fully recover from this injury.
The alarming fact is that, although the risk of concussions can be minimized by using equipment such as helmets and mouth guards and educating people about the risks, there is no way to fully guard against concussions in sports.
Training of Coaches
Similar to Washington, the University Interscholastic League (UIL) in Texas now requires all public school coaches to be trained in concussion prevention and treatment.
What are the requirements, if any, in your state?
Treatment of TBI
As noted by Halstead and Walter (2010), a youth’s brain is still developing, which makes treating concussions more challenging. As concussions are “functional rather than structural” injuries of the brain (p. 603), cognitive rest is prescribed for those with concussions. This means that activities such as schoolwork, using a computer, or even watching television should be avoided during recovery.
Although physical and cognitive rest helps most children with TBI, some require more intensive intervention, such as cognitive rehabilitation. Often implemented by neuropsychologists, cognitive rehabilitation aims to pinpoint deficits in cognition (such as memory, planning, or organization) through neuropsychological assessment. It also introduces activities aimed at repairing or compensating for those specific deficits so that the person can function in his or her environment.
Halstead, M. E., & Walter, K. D. (2010). Clinical report—sport-related concussions in children and adolescents. American Academy of Pediatrics, 126(3), 597–615.
Legal and Ethical Considerations
Sometimes professionals can become stuck with an attitude of “this is the way it’s always been done.” However, the needs of each child must be carefully considered, regardless of exceptionality.
Tomas’ Case
Twelve-year-old Tomas has mild cerebral palsy. He walks with a limp and needs some academic accommodations due to motor difficulties and challenges in processing information. Tomas suffers socially and emotionally and wishes he could be like the other students and have more friends.
Tomas does well in math and history, but struggles in reading, writing, and science. His parents wish to minimize stigma toward Tomas and insist that he be educated completely in the general education classroom with a teacher’s aide by his side. His teachers feel that the aid is more restrictive.
They also believe Tomas would be more successful by attending the general education classroom for subject in which he is successful and a pull-out classroom for subject in which he struggles. The school follows this strategy for other kids with similar disabilities.
Q1. What considerations should be taken in Tomas’ case?
