School-Based Cognitive Interventions for Children with Postconcussional Disorder

Article excerpt

Children with postconcussional disorder face unique challenges when moving from the rehabilitation setting to the education setting. Diagnostic criteria of postconcussional disorder are reviewed. Stages of the recovery process are described. Sample educational interventions are identified for cognitive deficits associated with attention, memory, organization and problem solving.

The neuropsychological sequelae following a traumatic brain injury (TBI) can be devastating for both the patient and the family. Approximately one million children sustain a TBI each year, which represents approximately one-sixth of all pediatric hospital admissions (Batchelor & Dean, 1996).

Postconcussional disorder is a syndrome that follows from a traumatic brain injury that involves a cerebral concussion sufficiently severe to result in the loss of consciousness (Kaplan & Sadock, 1998). The concussion can come from either a penetrating wound, which usually leads to highly localized brain damage; or from a blunt force trauma, which usually leads to diffuse axonal shearing and injury.

The brain trauma of postconcussional disorder is usually precipitated by a pedestrian-automobile collision or a playground accident. Most children with postconcussional disorder will withdraw from school while participating in a hospital rehabilitation program. After short-term recovery is established, these children usually return to their school. As a result of the concussion, these children often experience a significant worsening of school or academic performance dating from the trauma.

Teeter and Semrud-Clikeman (1997) indicate that the consequences of an acquired brain injury have not been adequately researched, which is particularly problematic given that an acquired brain injury is considered a separate handicapping condition requiring special education support. Consequently, school personnel face the challenging task of assisting with the rehabilitation health-care plan while, at the same time, developing an individual education plan that will assist with the child's adjustment to the school environment.

Symptoms

Children with postconcussional disorder often experience one or more of the following symptoms: (1) a period of unconsciousness lasting for more than 5 minutes after the brain trauma, 2) a period of posttraumatic amnesia lasting for more than 12 hours, and 3) a new onset of seizures that occurs within the first 6 months after the injury (American Psychiatric Association [APA], 1994). Symptoms of this disorder can include fatigue, disordered sleep, headaches, dizziness, irritability or aggression, anxiety, depression, affective lability and apathy. The incidence rate for boys varies from 150 to 200 per 100,000 prior to age 5, and increasing to 400 per 100,000 at age 15; while the incidence rate for girls varies from 100 to 170 per 100,000 prior to age 5, and increasing to 300 per 100,000 at age 15 (Batchelor & Dean, 1996).

Purpose

The purpose of this article is to review a sample of classroom interventions available to school staff when treating cognitive symptoms associated with postconcussional disorder. The article focuses exclusively upon school-age children having experienced blunt force postconcussional disorder; and does not discuss symptoms associated with penetrating injuries to the brain, where outcomes are more predictable and influenced by the site of the lesion (Sellars, Vegter & Ellerbusch, 1997). The interventions described in the article do not necessarily generalize to children with shaken-impact syndrome, which usually results in a more significant intellectual impairment; and the interventions do not necessarily generalize to children with cognitive symptoms associated with such medical conditions as stroke, aneurysm or tumor.

Recovery Process

The course of recovery for the child varies according the site and extent of injury; however, the recovery typically involves three stages (Corbett & Ross-Thomson, 1996). …