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Children with acquired brain injury (insult to the brain resulting in disruption of neurological function) may be at risk for long-term physical, emotional/behavioral and cognitive impairments in function at home, school, and in the community. Traumatic brain injury (TBI) is the most common cause of acquired brain injury in children and can be classified as mild, moderate or severe. Regardless of the severity of the brain injury, families should be met by providers with an individualized and multidisciplinary plan for the child’s transition back to school, play, sports and daily living.
Children with a mild traumatic brain injury (concussion) should be evaluated every two weeks until clinical recovery. Academic, athletic and recreational activity management plans should be modified and adjusted at each visit to reflect the child’s current status. Research indicates that because concussive symptoms in children can persist for up to 2 months, it is not feasible to wait for complete symptom resolution before a child’s return to school. With appropriate accommodations in place, children can transition back to school after 1-2 days of reduced activity levels. It is important that educators and school personnel are equipped with knowledge on common school adjustments and academic accommodations that support children in their recovery and return to school. A gradual increase in academic activity (cognitive exertion) is recommended. Providers can access supports to help develop an individualized plan through the American Academy of Pediatrics (AAP) “Return to Learning” guide as well as a baseline for common academic accommodations through the CDC’s Acute Concussion Evaluation (ACE) care plan. These resources have been developed in an effort educate schools on the creation of plans/instructions to help children diagnosed with concussions transition back to school.
Children diagnosed with moderate to severe traumatic brain injuries typically experience limitations in language, executive function, working memory, and speed of information processing. Although it is possible for a child’s preinjury academic skills to remain intact, moderate to severe TBI’s can make it difficult for a child to learn new information. Reading/math abilities, attention, concentration and memory are often compromised. In order to understand a child’s current cognitive ability and create the most helpful plan for accommodations upon returning to school, educational and neuropsychological testing is recommended. For children with TBI’s who qualify, special education support is available through the 2004 Individuals with Disabilities Education Improvement Act (IDEA). To assist educators in recognizing impairments and needs of a student with a TBI, individualized education programs (IEPs) or Section 504 plans can be created for qualifying students. IEPs and Section 504 plans allow for communication across all settings. In the creation of an IEP, parents and representatives from a child’s school and/or school district meet to outline direct services and accommodations that will help a child be successful in the school environment (therapy services, classroom structure/environment, focused instruction, increased time to complete work). A Section 504 plan can be used when a child requires accommodations and supports but not direct services. Supports include extended time for assignments/tests, reduced work, check-ins for assignments and deadlines, etc). Having an individualized plan for school reentry and the education of parents and school staff are critical elements in helping a child successfully transition back to school.