Supporting ‘Return to Learn’ After TBI After a child has a traumatic brain injury, it takes ongoing coordination between the hospital and school to get them back to learning again. School Matters
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School Matters  |   June 01, 2018
Supporting ‘Return to Learn’ After TBI
Author Notes
  • Angela Hein Ciccia, PhD, CCC-SLP, is an associate professor in the Department of Psychological Sciences at Case Western Reserve University in Cleveland. She is also the adviser for the university’s National Student Speech Language Hearing Association chapter and an affiliate of ASHA Special Interest Group 2, Neurogenic Communication Disorders. angela.ciccia@case.edu
    Angela Hein Ciccia, PhD, CCC-SLP, is an associate professor in the Department of Psychological Sciences at Case Western Reserve University in Cleveland. She is also the adviser for the university’s National Student Speech Language Hearing Association chapter and an affiliate of ASHA Special Interest Group 2, Neurogenic Communication Disorders. angela.ciccia@case.edu×
Article Information
School Matters
School Matters   |   June 01, 2018
Supporting ‘Return to Learn’ After TBI
The ASHA Leader, June 2018, Vol. 23, 36-37. doi:10.1044/leader.SCM.23062018.36
The ASHA Leader, June 2018, Vol. 23, 36-37. doi:10.1044/leader.SCM.23062018.36
Traumatic brain injury (TBI) is a leading cause of disability during childhood. Breaking down this alarming statistic even more, we learn children ages birth to 4 and adolescents ages 15 to 19 experience the highest rates of TBI-related emergency department visits annually, as compared to other age groups.
Unfortunately, despite the high rates, children with TBI tend to get underidentified. Even the available incidence data don’t give a full representation of the scope of the problem.
Current data also can’t provide a true representation of the likelihood a child with TBI will appear on a speech-language pathologist’s caseload.
In best-case scenarios, children experiencing TBI receive appropriate medical care, including referral to the medically based rehabilitation team—which can include physical therapy, speech-language pathology and a rehabilitation or sports medicine physician. When the child is ready, the rehab team coordinates a smooth transition process between hospital and return to school.
In support of this transition, the school-based SLP is a critical component of the “return to learn” process. SLPs also help implement related IEPs, as well as 504 or response-to-intervention plans.
Many children, however, return to school without formal coordination between the medical team, the family and the school. Too frequently, schools aren’t even alerted if a child experiences a concussion or other TBI.
In February, the Centers for Disease Control and Prevention (CDC) released a report to Congress, “Management of Traumatic Brain Injury in Children.” This report generates a useful opportunity for SLPs to consider opportunities to bridge the gap between hospital and school services.

When a child with a TBI returns to school, the hospital-based SLP and the school-based SLP ideally remain in contact.

Chances to connect
The approaches listed below can build interprofessional practice and aid students in their recovery from TBI.
Identify the protocol. School-based SLPs can reach out to the SLPs at their local hospitals to find out their return-to-school protocols for children with TBI. SLPs in medical settings can contact SLPs at local schools to talk about the best options for coordinating services and continuing care.
Stay in contact. When a child with a TBI returns to school, the hospital-based SLP and the school-based SLP ideally remain in contact by email, phone or video conferencing to discuss the child’s ongoing needs. Contact is typically frequent at first, and then as needed. The child with TBI may have complex physical, cognitive, behavioral and psychosocial needs, such as interventions for attention, memory or new learning. Understanding all contributing factors to successful transition to school and successful classroom performance is critical.
Gather the team. The school SLP can communicate with the school nurse, classroom teachers and/or the school psychologist to discuss a team approach that supports return to learn for a child with a TBI. The CDC provides resources, including training videos and customizable education handouts, to help the conversation.
Monitor symptoms. Because children with TBI often experience latent presentation of issues, such as memory loss, dizziness or sensitivity to light and noise, school-based SLPs and other personnel are advised to monitor students over time, not just during the initial return to school. The Center on Brain Injury Research and Training offers extensive resources on coordinating the hospital-to-school transition.
Monitor progress. When the child returns to school and receives supports designated by the IEP team, the SLP should monitor the student’s cognitive-communication skill development, and watch for any effects of ongoing cognitive-communication challenges on academic performance.
Provide education and training. The school-based and hospital-based SLPs together can offer education and training to school faculty and staff and the child’s family on long-term effects of TBI. They can also explain how each person connected to the child with TBI can make modifications in home and classroom environments to support the child. For example, preferential classroom seating, frequent breaks in a quiet room and a predictable homework routine can help the child be successful in returning to school and throughout their recovery and management.

The child with TBI may have complex physical, cognitive, behavioral and psychosocial needs. Understanding all contributing factors to successful transition to school and successful classroom performance is critical.

Special considerations
Children with a history of language disorder, learning disability and other neurodevelopmental diagnoses might experience a more complicated and prolonged recovery from TBI. School-based SLPs are in a unique position to help these children: You probably already worked with them prior to their injury and can act as an advocate for their changing needs.
Managing recovery and return to school after TBI takes time and requires multiple steps and various levels of interaction with many people. We know coordinated care between hospital and school is a critical factor for successful outcomes. Let’s do what we can to provide the needed support that can make a difference for each student.
Learn More About Serving Students With TBI at Schools Connect in July

To find out more about coordinating transitions back to school and treating students with TBI, look for Angela Hein Ciccia’s presentation at ASHA Schools Connect, July 20–22, at the Baltimore Convention Center in Baltimore, Maryland.

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June 2018
Volume 23, Issue 6