Ann Glang

Rehabilitation and ongoing support after pediatric TBI: twenty years of progress.

This article summarizes major developments of the past 20 years in both acute and chronic management of children with traumatic brain injury. The article begins with brief summaries of developments in acute and rehabilitative medical management and physical rehabilitation. Because long-term cognitive, behavioral, academic, and family issues tend to be dominant after pediatric TBI, more attention is given to these topics. The article ends with a list of general themes that have been identified as critical in providing effective long-term services and supports to children with TBI and their families.

Educating students with TBI: themes and recommendations.

Ten educational consultants and researchers, each with extensive experience working with children with traumatic brain injury (TBI) in school settings, identified seven themes related to serving this population in public schools. These themes are discussed under the headings (1) incidence of TBI and prevalence of persistent educational disability, (2) diversity and central tendencies within the population, (3) assessment, (4) intervention and support in school settings, (5) training and support for educators, (6) intervention and support for families, and (7) systems change and flexibility. For each theme, a set of recommendations is provided, forming an educational research and policy agenda for pediatric TBI.

Online training in sports concussion for youth sports coaches.

The purpose of this study was to evaluate ACTive: Athletic Concussion Training using Interactive Video Education, an interactive e-learning program designed to train community coaches of youth ages 10–18 in effective sports concussion prevention and management practices. Seventy-five youth sports coaches from across the country completed the study over the Internet. Results of a randomized control trial demonstrated significant differences between treatment and control participants on measures of: (a) knowledge about sports concussion, management, and prevention; (b) attitudes about the importance of preventing sports concussion; and (c) intention and self-efficacy in sports concussion management and prevention. The results suggest that ACTive is an effective method of training youth sports coaches who are in an important position to reduce risks associated with sports concussion.

Redefining success: results of a qualitative study of postsecondary transition outcomes for youth with traumatic brain injury.

ObjectivesIdentify factors that influence postsecondary education outcomes for students with traumatic brain injury (TBI). DesignQualitative longitudinal. ParticipantsThirty-three young adults with TBI, their parents, and knowledgeable others. ResultsStudents with TBI who received transition services that linked them with disability services and support agencies were more likely to complete postsecondary programs. Internal factors such as positive attitude and determination were also associated with success. ConclusionsSurvey items measuring constructs such as “use of accommodations,” “enrolled in special education,” and “high school graduation” mask a range of experiences. Transition supports geared to the postsecondary education goals of students with TBI are needed.

Awareness intervention: who needs it?

It is widely accepted that awareness deficits present challenges to recovery and should be addressed as part of rehabilitation programming. Response to awareness intervention is commonly Inferred from measurements that rely on reports by subjects and significant others. This article describes the findings from a pilot study that examined the relationship among a variety of awareness indicators in three individuals with brain damage over a 9-month period. Results suggest a dissociation between behavioral and perceptual indices of awareness. Changes in behavioral indicators of awareness selected by care givers were not related to changes in self- or caregiver ratings. The clinical and research implications of the findings are discussed

Tailoring Direct Instruction techniques for use with elementary students with brain injury

This article describes three case studies in which Direct Instruction techniques were used to teach students with brain injuries who participated in a 6-week tutoring program. The subjects were three children with closed head injuries who exhibited significant learning problems: two boys, ages 8 and 10, and a girl, age 6. After approximately 12 hourly instructional sessions, all three students made substantial academic progress as demonstrated by probe data collected in their targeted instructional areas (reading, language, math, and keyboarding). The gains were seen in both discrete and more complex skills, and some of the gains made represented new learning. In addition, the aggressive outbursts of one student were decreased substantially through use of a self-monitoring technique in the context of academic instruction. Results from these case studies suggest that Direct Instruction is a promising approach for teaching both academic and behavioral skills to students with TBI.

A comparison of two psychosocial interventions for parents of children with acquired brain injury: An exploratory study

Parents of children with acquired brain injury experience severe stress. Many experience periods of emotional distress related to their childs injury and its sequelae. This study compared two kinds of support groups for parents of children with sequelae of severe brain injury. One group participated in a psychoeducational stress management program that emphasized instruction in coping skills and group discussions of coping efforts. The program included regular homework assignments, practice exercises, and follow-up discussions of the use of skills. The second group was an informational support group. Parents identified topics that they wanted to discuss and were also encouraged to share their feelings with group members. The impact of the two groups was measured with standardized self-report measures of depression and anxiety. Parents in the stress management group experienced significant reductions in depressive and anxious symptoms. Parents in the informational and sharing group, as a group, showed increases in depressive and anxious symptoms.

Longitudinal investigation of the post-high school transition experiences of adolescents with traumatic brain injury.

Objective:To describe outcomes for youth with traumatic brain injury (TBI) transitioning from high school to adulthood. Design:Longitudinal design using univariate and multivariate analyses, including survival analysis to predict time to outcomes of interest and longitudinal growth modeling to evaluate factors that predict rates and levels of outcomes over time. Main Outcome Measures:employment, post–secondary education, and independent living status. Participants:Eighty-nine youth and young adults (aged 19–25 years) with TBI (19 mild–moderate TBI and 70 severe TBI). Results:Individuals entering adulthood following childhood TBI experienced fluctuations in rates of employment, enrollment in post–secondary education, and independent living. A higher likelihood of being enrolled in post–secondary education following graduation from high school was associated with being female, later age at injury, and higher socioeconomic status. Overall greater likelihood of employment was associated with higher socioeconomic status, while employment upon high school graduation was associated with more severe injury and lack of rehabilitations services. Greater likelihood of independent living was associated with later age at injury and nonreceipt of rehabilitation services, while shorter time until independent living was associated with less severe injury. Conclusion:Knowledge of how specific factors affect transition outcomes can be used to tailor transition interventions and resources to the needs of students with TBI. Findings related to special education and medical rehabilitation services should be interpreted with caution as the criteria for receipt of both types of services and the links between such services and functional outcomes are unclear.

Validated instructional practices: application to students with traumatic brain injury.

ObjectiveThere is a lack of empirical evidence of effectiveness for instructional interventions for children with traumatic brain injury (TBI). This article addresses this issue by providing an in-depth examination of instructional methodologies validated with other populations of students (with and without disability) and their potential for teaching children with TBI. DesignLiterature review. ConclusionsTwo instructional approaches—Direct Instruction and cognitive strategy intervention—have significant evidence supporting their use with many populations of children, with and without disabilities, and address many of the common needs and learning characteristics of students with TBI, thus showing particular promise for these students. Given the efficacy of these 2 approaches with students with similar learning and behavioral characteristics, the authors recommend establishing and funding a systematic research agenda to test their effectiveness with students with TBI.

What does it take to collaborate with families affected by brain injury? A preliminary model.

Background:Collaboration refers to a process in which family expertise is acknowledged and used to direct selection, implementation, and evaluation of treatment plans. Although the skills required to create collaborative partnerships with families are a mainstay of practice for certain rehabilitation disciplines, others have traditionally worked in client-clinician dyads that emphasize the role of the professional as responsible for client change. In addition, the existing collaborative models for working with families affected by brain injury require intensive resources and supports, making collaborative partnerships difficult to create within todays clinical and educational service delivery environments. Result:In this article, we report our efforts to create an accessible set of collaboration procedures for rehabilitation professionals working in clinical and educational settings with individuals with brain injury and their families. A 2-year, qualitative study with eight families led to the development of a preliminary model and prescriptive manual for applying collaborative principles to practice. Conclusion:We review the components of the model and implications for practice.