Role of Teacher in Paediatric Brain Rehabilitation

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Educational staff in rehabilitating children with traumatic brain injuries.

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Role of the Teacher in Paediatric Brain Rehabilitation In addressing whether teachers are suitable in paediatric brain injury rehabilitation services, a distinction must first be made between the provided services. Based on the services provided by Royal Children’s Hospital (RCH) in Melbourne, direct care provides functional skill rehabilitation (e.g. sitting, walking, communicating, and personal care) prehospital discharge, alongside regular family/team meetings to ensure open communication between staff and families, to prepare for readjustment to home life. The multidisciplinary team consists of nurses, doctors, occupation therapists, speech pathologists, psychologists, social workers, play therapists, music therapists, physiotherapists, and educational advisors – the teachers responsible for fulfilling the paediatric client’s educational requirements. The RCH employs one full-time teacher and two part-time teachers who work for the Victorian Paediatric Rehabilitation team. The teachers create on-ward learning environments for patients at all levels of schooling (RCH, 2012). Day rehabilitation programmes and brain injury rehabilitation clinics (outpatient services) are designed for children with ongoing difficulties post-ABI. After paediatrician or rehab specialist assessment, the child, their family and familiar community clinicians work together to identify the child’s functional limitations and devise/modify the rehab plan. Dunn and Campbell (1991) and Dunn (2000) suggest the employment of an education advisor could be beneficial at this point, considering that children spend a large portion of their life in school. A potential drawback of leaving inpatient rehab services post- ABI is the lack of communication between rehab staff and school staff – especially the classroom teacher (Cruickshank, Morse & Johns, 1980). This is a universal potential problem in Australian and other countries employing compulsory education systems. Mintz (2010) found that – in studies of students – both health care professionals and teachers had only very general knowledge relating to special needs education. He recommended increased focus on Special Needs Education among the two cohorts, as both are groups require a holistic understanding of the implications and requirements of special education. Including an education advisor – someone with Special Education training, classroom experience and consultative ability – in a team of therapists, physicians, nurses and social workers could link together the chain of knowledge extending to the child’s classroom teacher. The advisor’s accrued knowledge of the patient’s condition combined with their knowledge of the local curriculum and understanding of the logistical constraints teachers face in a classroom environment, would allow for smoother dialogue between the hospital and school. This would result in a more efficient and targeted learning experience for the child (Deidrick & Farmer, 2005).

The 8 Modules of First-Year Psychology in Practice – Paediatric Brain Injury Rehabilitation Acquired brain injuries (ABI) in children commonly cause diffuse, widespread brain damage as a result of car accidents, falls, hypoxia, shaken baby syndrome etc (Leeson, 2012). This can result in unpredictable deficits, as many areas of the brain are often affected. A broad knowledge of the following psychological modules are important in meeting all of the patient’s potential needs. Developmental psychology is the study of how a person changes, grows and develops over time. It focusses on the effects of nature and nurture on behaviour. Its importance is in identifying normal milestones of human development. Identifying diversion from these norms can assist in pinpointing the source of developmental delays. These milestones are important in rehab. If markers and outcomes are not met, it is necessary to be flexible with the plan (Bowen, 2005; Mayfield & Homack, 2005). It is important for consistency of reporting and observation that all staff have an understanding of developmental norms, including teachers in the child’s normal classroom. Personality is the interaction between one’s cognition, emotion and behaviour. The sum of these parts allows a professional to reasonably predict how someone would react to a specific set of situational stimuli. Arling & Spijkers (2009) found that assessment of personality and cognitive planning competency was relevant to rehab planning and assessment. An understanding of how differences weigh on development, emotion and behaviour is important if teachers and education advisors want to target lessons and meet the outcomes of Individual Education Plans (IEP). Staff must be aware of the involvement a person’s upbringing has on their perceptions of and reactions to situations. This is just as important when dealing with parents of injured children. Staff must also be aware, and able to communicate how, a patient will interact with society postABI. Teachers – on-ward and in classrooms – devise individual programmes for pupils of Indigenous descent (following legislation for Personalised Learning Plans for Aboriginal students) and of other cultures if necessary (Woolfolk & Margetts, 2007). Knowledge of abnormal psychology is critical in rehabilitating and teaching children with ABIs. Teachers must at least know what signs to look for that would communicate the child having further problems. Health professionals alike must be able to pick up these signs in consultations and be armed with measures to mitigate new problems. The growth field of health psychology can have an impact on paediatric rehabilitation. Its importance to paediatric ABI rehabilitation is in that it endeavours to understand the psychological influences on how people stay healthy and how they respond when they fall ill (Taylor, 2003). For instance, health psychology looks at the role stress plays in convalescing patients. Stress and anxiety is present at some point in almost all patients and is caused, not only by the incident itself, but also by social, emotional and intellectual upheaval. People in the resistance stage of Selye’s (1936) general adaptation syndrome have a weakened immune system and are at risk of ‘exhaustion,’ being the point when physiological defences cease to operate. Psychologists agree that there is a biological basis for behaviour. There is a majority agreement that genes influence one’s reaction to a set of environmental and biographical factors (Stefonsson, 2007). Due to stress, anxiety, frustration or frontal lobe damage, sufferers of ABIs may come to present behaviours that are anti-social, or damaging to themselves. An understanding of

the physical reasons for behaviours is necessary for clinicians and physicians. A knowledge of the implications and measures necessary to induce a behavioural alteration is necessary for classroom teachers of ABI sufferers. Education advisors need a more comprehensive knowledge of this subject. Learning – referring to a change in the way a person acts based on prior experience – is vital in getting ABI sufferers back to the level of self-reliance they had prior to the incident. As mentioned above, commonly, ABIs result in a loss of functional skills including personal care, ambulation and communication. Even after these functions have been regained to a satisfactory level, patients may still have problems behaviourally and socially. After a person obtains an ABI, there is a risk that their senses may be affected. This could result in the child not receiving enough information about the world around them. For instance, if their proprioceptive senses are affected, then the child’s most basic functionality will be diminished; they will not know where they are in relation to themselves and space. Teachers and education advisors should be aware and set tasks that allow the student to use the senses they have available (Turkstra & Kennedy, 2005). Cognitive and language difficulties are common among ABI sufferers. Aphasia can be either expressive or receptive depending on whether the Broca’s area or the Wernicke’s area is affected. If communication centres are damaged before communicative skills are learned, rehabilitation could be slow and difficult (Leeson, 2012). Teachers must be understanding of and sensitive to the varying types of cognitive and communicative impairments children with ABIs have.

Reference List

Arling, V., & Spijkers, W. (2009). Effect of personality factors on performance in rehabilitation assessment and vocational reintegration prognosis. International Journal of Rehabilitation Research, 32, 82. Berger, M.S., Pitts, L.H., Lovely, M., Edwards, M.S. & Bartkowski, H.M. (1985). Outcome from severe head injury in children and adolescents. Journal of Neurosurgery, 62(2), 194-199. Bowen, J. M. (2005). Classroom interventions for students with traumatic brain injuries. Preventing School Failure, 49(3), 34–41. Burton, L., Weston, D. & Kowalski, R. (2012). Psychology: Australian and New Zealand edition (3rd ed.). Brisbane, Qld: John Wiley & Sons Cruickshank, W.M., Morse, W.C., & Johns, J.S. (1980). Learning disabilities: The struggle from adolescence toward adulthood. Syracuse, New York: Syracuse University Press. Deidrick, K. K. M., & Farmer, J. E. (2005). School reentry following traumatic brain injury. Preventing School Failure, 49(3), 23–33. Dunn, W. (2000). Designing best practice services for children and families. In Dunn, W., editor: Best Practice Occupational Therapy, Thorofare, NJ: Slack. Dunn, W., & Campbell, P.H. (1991) Designing pediatric service provision. In Dunn, W., editor: Pediatric Occupational Therapy: Facilitating Effective Service Provision, Thorofare, NJ: Slack. Leeson, M. (2012). Paediatric acquired brain injury. Physiotherapy lecture delivered at the University of Newcastle, Australia. Mayfield, J., & Homack, J. (2005). Behavioral considerations associated with traumatic brain injury. Preventing School Failure, 49(3), 17–22. Mintz, J. (2010). Understanding of special educational needs terms by student teachers and student paediatric nurses. European Journal of Special Needs Education, 25, 225-238. Stefonsson, H. (2007). The biology of behaviour: scientific and ethical implications. EMBO Reports, 8, 1-2 Paediatric Rehabilitation Service. (2012) Retrieved from the Royal Children’s Hospital (RCH) website: http://www.rch.org.au/rehab/services.cfm?doc_id=9486 Turkstra, L., & Kennedy, M. (2005). Evidence-based practice for cognitive-communication disorders after traumatic brain injury. Seminars in Speech & Language, 26(4), 213-214. Woolfolk, A. & Margetts, K. (2007). Educational psychology. Sydney, NSW: Pearson Education Australia

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