School Neuropsychology, Traumatic Brain Injury, and Other Concepts

Interventions for students with TBI

Interventions for students with TBI should focus on what the child can do and build upon those strengths (i.e., capacity or strength-based approach). Half-day schedules have been effective in teaching students with TBI because low energy is a common symptom. Remember that cognitive fatigue is a primary trait of students with brain injuries. In moderate to severe TBI cases, errorless learning techniques have proved effective. Visual charts, repetition of new information, and repetition of skills are also key strategies to employ with students who have TBI.

Agnosia

The inability to identify seen objects

Aphasia

The inability to use language

Amygdala

associated with emotions and emotional responses.

Cerebral cortex

associated with higher order reasoning.

BIRTs

several school psychologists will serve on or lead brain injury resource teams (BIRTs) and help manage concussions at the school level. Brain injury issues are readily applicable to the practice of school psychology as practitioners routinely measure and assess brain-based functions typically associated with brain dysfunction. In fact, in more than any other profession, psychologists are the experts in the measurement of brain functioning.

The limbic system

(part of the lower brain) houses several neurological structures responsible for our emotions and memories (e.g., amygdala, hippocampus, and others).

Serotonin

-associated with relaxation, sleep, and mood. An imbalance in this is implicated in clinical depression.

Problem can occur at any level of the information-processing model

A breakdown or problem can occur at any level of the information-processing model. For example, people may have difficulty learning because they have not properly "encoded" the information. On the other hand, people may have properly encoded the information and understand concepts but cannot retrieve (decode) the details of the information.

REAP Manual

A mainstream concussion management support framework is provided by Dr. McAvoy's REAP Manual. REAP stands for Reduce, Educate, Accommodate, and Pace.

Traumatic Brain Injury (TBI)

A recent legal development is that federal law allows for traumatic brain injury (TBI) to be its own diagnostic category on individualized education plans (IEPs). Like learning disabilities, a brain injury must impair the functioning of a student to a marked degree and have an educational impact to qualify for special education services. Students who have brain injuries and receive special education services typically have a medical diagnosis of a moderate or severe brain injury. Mild brain injuries (mild traumatic brain injury [mTBI]), such as concussions, generally do not qualify children for IEP services due to their temporary nature.

ADHD and the Brain

ADHD is associated with a dysfunction and neurochemical issue within the frontal lobes. However, ADHD research is still emerging and other brain structures may be implicated with this disorder.

Basic (Simplistic) Information Processing Model

Information (Input) ____________ Central Processing ____________ Expressive (Output)

Cognitive Tests in relation to TBI

Cognitive tests can help determine the functioning of the brain (i.e., what the person can do) after a head trauma. Cognitive tests for older TBI victims typically show a large amount of variation among subtest scores. Processing speed, fluid abilities, and behavioral and emotional changes are typically noted postinjury. However, there is no "classic" profile of TBI.

Concussions

Concussions are considered brain injuries and typically heal in 10 to 28 days. Despite the previous statement, even mild concussions (e.g., mild brain injury and mTBI) can cause persistent difficulties. If concussion symptoms do not resolve in several weeks, then the student may have postconcussion syndrome (PCS). Children may seem okay after a hit to the head, but damage and swelling may occur, which is why students should seek medical attention after any hit to the head that causes signs or symptoms.

Memories

It appears that no one particular area is responsible for storing all memories, but the medial temporal lobe plays a key role in long-term storage. A major part of the brain called the hippocampus is implicated in forming memories because of its role in associating emotions with events.

concussion management (supports) in schools

It is important for school psychologists to note that pediatric concussion management (supports) in schools is a rapidly evolving need for students. This area of need provides psychologists with a novel and important role in schools. A leader in the field of school psychology and concussion management is Dr. Karen McAvoy and her key resource called the REAP Manual.

Occipital lobe

Located at the back of the head, this area is responsible for processing visual information. [Vision]

Temporal lobe

Located on the right and left sides of the brain, this lobe primarily processes auditory information and language. This lobe is implicated in *reading problems* and phonological processing difficulties. Memory storage is associated with this lobe. [-Memory, Understanding, & Language)

Parietal lobe

Located roughly on the top portion of the brain, this area helps to assimilate body sensations (i.e., somatosensory). Sensory disorders are typically associated with this lobe. As a secondary role, this lobe also helps with developing symbolic associations and math skills and with integrating information. [-Perceptions, Making sense of a world, Arithmetic, & Spelling.]

School psychology practices

One of the most common issues that school psychologists are required to examine involves learning disabilities. The Individuals with Disabilities Education Act (IDEA) reauthorization increased the options for identification of a specific learning disability (SLD) by permitting a number of different approaches beyond traditional IQ-achievement discrepancy comparisons. Primary areas to consider when school psychologists identify or diagnose an SLD involves a comprehensive, multidisciplinary evaluation that includes the assessment of a student's response to intervention (RTI) and an examination of a dysfunction in one or more of the basic psychological processes. The combination of multiple sources of information, valid scientific RTI data, and mainstream cognitive testing appears to be a sound approach to identifying learning disorders. It is also emphasized that clinical judgment plays an important role when dealing with complex diagnostic situations.

Ways to organize the brain and its functions

One way to conceptualize brain processes is to organize its functioning starting from how the brain develops physiologically. The first areas of the brain to develop are the regions located at the base of the brain. Basal brain areas are generally related to basic physiological functions. For example, two important basal sections are the brain stem and the cerebellum.

The primacy memory effect and recency effect

People tend to remember the first and last aspects of new information they see or hear. This is called the primacy memory effect (referring to the first piece of information) and recency effect (referring to the last piece of information).

Neurons

Primary cells at the most basic brain level Billions of neurons are connected to each other throughout the entire brain to create a neurological network. The network of neurons is connected to tightly bundled specialized neurons called nuclei. These neuronal bundles are found in localized areas of the brain that perform particular functions

Theories on Brain Injury

Research in the area of head injury is advancing at a very fast pace and some new theories are contradicting theories from just a few years ago. For example, it was previously believed it was better to have a brain injury as a child because a child's brain could heal itself more effectively than an adult's. Current thinking has significantly changed and now it is believed that a child's brain is more vulnerable to damage than an adult's.

Complex Model

Selective Attention (Person pays attention to a stimulus)------> "Encoding" Information into short-term memory (Input)----->[Information is rehearsed and associated with prior knowledge. If not, then information is forgotten and not stored]-----> Information is "coded" and stored into long-term memory (storage)-----> Information is retrieved or "decoded" from memory. Expressive (Output)

TBI Statistics

TBI is sometimes referred to as acquired brain injury. TBI may cause more than 50,000 deaths or disabilities a year. TBI is a leading cause of death in children younger than 18 years.

DSM-5

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5; American Psychiatric Association, 2013)

Memory

The average person can hold approximately seven to eight bits of information in short-term memory. Short-term memory should not be confused with working memory. In working memory, one must perform an activity while holding ideas, thoughts, and information online.

left hemisphere of brain

The left hemisphere of the brain is responsible for control of the right side of the body, and is the more academic and logical side of the brain. -concerned with language, verbal information, sequences, and factual (learned or familiar) information

DSM-5 and SLD

The newest version of the DSM (i.e., DSM-5) includes changes to the category of SLD when compared to the DSM-IV: • The DSM-5 eliminates the use of the substantial discrepancy requirement. • The DSM-5 defines a learning disorder as academic difficulties that are well below average for age, and not better accounted for as an intellectual disability, but it does not require the use of intelligence testing. • A new focus is on determining the extent of difficulties in academic areas. • Learning disorders are specific instances of a single, overarching diagnosis instead of the DSM-IV's provision of four separate disorders. • The DSM-5 utilizes a single diagnosis of specific learning disorder with specifiers that indicate the academic domain and specific skills that are impacted. • The elimination of SLD—not otherwise specified (NOS). • Addition of specifiers of degree of SLD: mild, moderate, and severe.

right hemisphere of brain

The right hemisphere of the brain is responsible for control of the left side of the body, and is the more artistic and creative side of the brain. - associated with creativity, holistic thinking, novel information processing, and visual-spatial processes.

School Neuropsychology

The study of brain-behavior relationships as they apply in a school setting and how neurological factors might impact a student's academic functioning.

Neuropsychology

The study of brain-behavior relationships.

school neuropsychologist

The term school neuropsychologist is still unregulated in many states, but the field and acceptance of this subspecialty is growing. School neuropsychologists believe that most learning dysfunctions, behavioral disorders, and emotional disorders are brain-based issues. By understanding the neurological underpinnings of brain functioning, school neuropsychologists are better able to provide answers to parents about why their child is having difficulty in school. It is also important to remember that a traditional school psychologist may administer a mainstream cognitive assessment, such as the Wechsler Intelligence Scale for Children, Fifth Edition (WISC-V), and the results interpreted through a neuropsychological lens if the practitioner has the appropriate training.

Upper regions of the brain

The upper regions of the brain are associated with complex functions commonly associated with sensory processes, information processing, and purposeful behavior. These highly evolved brain areas influence verbal communication, fine motor movement, vision, emotions, rational thought, comprehension, and reasoning.

brain lobes

There are four major lobes of the brain that play a major role in processing, information, thinking, memory, and regulating behavior. While sections of the brain may play a "primary" role in specific functions, there are other areas that are typically recruited for proper functioning. In other words, one brain area is typically not 100% responsible for a specific function because the brain works as an integrated system.

neuroelasticity (plasticity)

There is debate over neuroelasticity (plasticity), or how the brain heals itself. Current research illustrates that children are more at risk for permanent brain damage than adults. The younger the developmental age, the more at risk the person is for various types of long-term problems.

Determining TBI

There is neither a solitary test for a brain injury nor a typical profile for brain injury. Each brain injury manifests itself differently in individuals. With the previous statements in mind, common neurological functions that are sensitive to brain insults are processing speed, attention, and memory. After a brain injury, crystallized skills and knowledge generally return to a degree, whereas fluid abilities are prone to significant disruption. Children with significant TBI require frequent assessments because they may show drastic changes in the first year of recovery. Both cognitive and personality changes could be evident after a TBI.

Endorphins

These are a natural opiate similar to morphine that are released to moderate pain.

Broca's area and Wernicke's area

These are implicated in language problems and reading difficulties. Broca's area is linked to expressive language, whereas Wernicke's area is associated with receptive language.

Glutamate

This is a significant excitatory neurotransmitter that is released by nerve cells in the brain. It is responsible for sending signals between nerve cells. Under normal conditions, it plays an important role in learning and memory. This is one of the most prevalent neurochemicals in the brain and is related to a substantial number of disorders and neurodegenerative diseases.

Frontal lobe

This lobe is largely responsible for executive functions. This area does not necessarily process information as much as it controls other aspects of the brain (e.g., it is the brain manager or executive). This lobe helps in planning future actions and regulating behavior. It is also responsible for cognitive flexibility and helps people shift to different aspects of problem solving or topics. [-Executive functioning, Thinking, Planning, Organization, Problem Solving, Emotions, Behavior Control, & Personality]

Dopamine

This neurochemical is involved in producing positive moods and emotions. It is associated with reward, pleasure, and novelty seeking. It is implicated in Parkinson's disease and ADHD.

Corpus callosum

a bundle of nerves that connects both halves of the brain and allows for communication between the two hemispheres.

Hemisphere Operations

a refinement of the right versus left hemisphere model involves an emphasis on new versus routine information processing. Some experts believe the right half of the brain is responsible for processing novel information. Once the novel information is processed and understood, it is transferred to the left side of the brain where it becomes part of the person's knowledge base. The left side stores routine, familiar, and factual information. Previously learned information is later retrieved and used when a person engages in routines or responds to the environment

The brain stem and cerebellum

control involuntary functions such as breathing, heart rate, gross motor movement, and arousal. Brain injuries to these basal areas are extremely serious as such injuries can be fatal (e.g., can stop heart beat, breathing, and consciousness).

motor cortex and sensory cortex

controls movements; controls sensations Between frontal lobe and parietal lobe

Broca's area

expressive language

Symptoms and signs of TBI

headaches, sleep disruptions, mood swings, personality changes, light or noise sensitivity, and balance problems.