Special Populations

Question 1

leading cause of death and acquired disability in children/adolescents in the US

Answer 1

TBI
age groups at highest risk: 0-4 (falls and abuse/ shaken baby syndrome), 15-19 (struck by something, falls, motor vehicles)

Question 2

T/F: prognosis for functional recovery of previously learned skills is worse the younger the child is when brain injury is acquired, but prognosis for acquiring new skills is better the younger the child is

Answer 2

FALSE: prognosis for functional recovery of previously learned skills is better the younger the child is, but prognosis of acquiring new skills is worse the younger the child is at time of injury

Question 3

peak maturation mileposts of ages 3-5

Answer 3

overall rapid brain growth
developing ability to form images, use words, place things in serial order
developing tactics for problem solving

Question 4

peak maturation mileposts of ages 8-10

Answer 4

sensory and motor systems mature
frontal executive system quickly develops
perform simple operational functions (mathematical reasoning)

Question 5

most devastating time for brain injury to occur

Answer 5

0-5 years, during which most brain maturation occurs

Question 6

peak maturation mileposts ages 14-15

Answer 6

visuospatial, visuo-auditory, somatic systems mature

able to review formal operations, find flaws, and create new ones

Question 7

peak maturation mileposts ages 17-19

Answer 7

maturation of frontal executive functions

ability to form hypothesis

Question 8

AHT/SBS

Answer 8

abusive head trauma (AHT)/ shaken baby syndrome (SBS)
most common 0-5 years old, more common in boys
most lead to long-term disability

Question 9

AHT/SBS diagnostic indicators (3)

Answer 9

subdural hemorrhage or hematoma
cerebral edema
retinal hemorrhage (bleeding in eyes)

Question 10

second impact syndrome (SIS)

Answer 10

child sustains initial concussion and then sustains second head injury before symptoms have fully resolved
can be fatal or result in severe disability
may occur due to diffuse cerebral swelling or secondary to subdural hematoma

Question 11

T/F: assessment of the student’s present level of academic and functional performance following a head injury (like concussion) is a requirement under IDEA

Answer 11

TRUE:
steps for accessing special education and support services through IDEA:
- hospital/ rehab staff must immediately inform school they are caring for the student
-family and/or attending physician should request that the school begin evaluation process, and release medical records to school
-school-based educators can visit the student in the health care facility
-assessment of the student’s present academic/functional performance to determine if child meets criteria for special education that leads to an IEP (Individual Education Plan)

Question 12

Section 504 of the Rehabilitation Act of 1973

Answer 12

requires schools receiving federal funding to provide reasonable accommodations to allow individual with disability to participate
can range from basic classroom interventions to formal plan
from preschool through post-secondary education and employment
“disability” = physical or mental impairment that substantially limits activities

Question 13

what are some “reasonable accommodations” that may be provided under Section 504 of the Rehab Act of 1973?

Answer 13

preferential seating, extended time, tests in quiet settings, rest breaks built into schedule, shortened assignments, books on CD or use of text to speech software

Question 14

IDEA

Answer 14

Individuals with Disabilities Education Act (IDEA) - federal education mandate to provide public education through special education and support services to children with eligible disabilities
“special education” = specialized academic instruction (SAI), services delivered at no cost to meet needs
IEP (individualized education plan) begins with assessment process

Question 15

what are some support and related services recommended by IEP under IDEA?

Answer 15

adapted technology, speech language pathology and audiology, psychological services, OT/PT, parent counseling and training, medical services

Question 16

504 Plan vs IEP

Answer 16

504 Plan - can establish eligibility before IEP is established, can be used in place while more intensive IEP is established, can be used student does not meet IEP eligibility after assessment
IEP - contract between student’s family and school system, describes what services and support student will get, identifies skills/strategies/behaviors the student needs to learn to function at school

Question 17

how often should IEP goals be reviewed

Answer 17

required to be reviewed annually (12 months), but should be more often (2-4 months)

Question 18

T/F: IDEA does not apply to charter schools because they are not considered public schools

Answer 18

FALSE: charter schools ARE considered public schools so IDEA applies

Question 19

Individual Health Care Plan (IHCP) in schools

Answer 19

allows schools to address medical needs of students with disabilities through school nurse collaboration with the student’s physician
Guides medical concerns and emergencies

Question 20

Individual Transition Plan (ITP)

Answer 20

for when students turn 16
IEP team addresses post-secondary education, vocational training, employment, adult services, living arrangements, community participation

Question 21

T/F: IDEA provides funding for special education in college

Answer 21

FALSE: IDEA does not apply to college
individuals with brain injuries can receive services under Section 504 of Rehab Act
types of accommodation determined by individual institutions
high school responsible for helping student choose appropriate post-secondary settings

Question 22

unpaid individual who provides care services to those who cannot adequately care for themselves

Answer 22

caregiver

Question 23

name an example of care burden stressors that begins in acute phase of injury, rehab phase, and post discharge phase

Answer 23

acute phase - taking on responsibilities formerly managed by the injured person
rehab phase - lack of familiarity with rehab protocol and language, how to measure progress, uncertainty of role
post discharge phase - social isolation, depression, anxiety

Question 24

Family Systems Theory (FST) vs Family Centered Service (FCS) theoretical frameworks for caregivers and relieving burden

Answer 24

Family Systems Theory (FST) - whole is greater than sum, families have shared beliefs and way of communicating that affects the way they understand rehab goals/outcomes, assumes families have strength and capacity to solve problems

Family Centered Service (FCS) - about mutual respect/ information sharing collaboration, emphasizes that the survivor and family and provider are partners in health care, healthcare should be comprehensive and tailored

Question 25

Cognitive Behavioral Theory & Cognitive Behavioral Family Theory (CBT/CBFT)

Answer 25

CBT - talk therapy, helps individual become aware of inaccurate or negative thinking, encourage perspective taking
change in belief can result in changes in feelings and outcomes: activating event (families do not have control) –> belief (families have control) –> consequence of belief (families do have control)

Question 26

Resilience Theory of family theoretical frameworks

Answer 26

based on notion that there are always individuals that beat the odds/ rise about expected negative outcomes
emphasizes skill sets that can be taught, including belief systems, family organization, communication strategies

Question 27

letting families know that their concerns and experiences are both valid and typical given their situation (for working with families after brain injury)

Answer 27

normalizing

Question 28

describe 4 levels of blast related injuries

Answer 28

primary - direct impact from pressure wave, compresses air filled organs, catapults body
secondary - energized debris or fragments (shrapnel) impacts body or head
tertiary - body impacts wall, ground, object
quaternary - inhalation of toxic gases or substances, exacerbation or complications

Question 29

MACE

Answer 29

Military Acute Concussion Evaluation, used by first responders, providers gross measures of cognitive domains (orientation, immediate memory, concentration, memory recall)

Question 30

Neurobehavioral Symptom Inventory (NSI)

Answer 30

neuropsychological testing used by military

used to assess the most common symptoms experienced following TBI

Question 31

State-Trait Anxiety Inventory (STAI) & Automated Neuropsychological Assessment Metrics (ANAM)

Answer 31

used by military, mood and sleep scales to provide focused assessment of mood and anxiety disturbance

Question 32

T/F: for active military following brain injury/ trauma, mission responsibilities may take precedence over recuperation and final decision is made by Commander

Answer 32

TRUE

Question 33

T/F: 44% of service (military) members with concussion meet diagnostic criteria for PTSD and mTBI

Answer 33

TRUE

Question 34

medical discharge from the military involves these 2 components:

Answer 34

Medical Evaluation Board (MEB) - informal process, physician determines if service member is able to meet medical retention standards
Physical Evaluation Board (PEB) - form fitness for duty and disability determination, eligibility for disability compensation determined