Cognitive, social, and health functioning of children with TBI engaged in a formal support program.

BACKGROUND: Students with traumatic brain injury (TBI) often demonstrate difficulties that impact their successful return to school (RTS). OBJECTIVE: To explore injury severity, age at injury, and time since injury as predictors for performance on measures of cognitive, social and health functioning for students' participating in a formal RTS cohort at the time of their enrollment in the School Transition After Traumatic Brain Injury (STATBI) research project. METHODS: Outcome measures across cognitive, social, and health domains were analyzed for association with the explanatory variables of interest using quantile regressions and ordinary least squares regression, as appropriate. RESULTS: Students (N = 91) injured after age 13 showed significantly lower cognitive outcomes than students whose injury occurred earlier. Additionally, students more than one-year post-injury demonstrated poorer social outcome on one measure compared to students whose injury occurred more recently. Health outcomes showed no significant association to any predictors. CONCLUSION: The results of this analysis provide a baseline for a group of students with TBI as they enter a RTS research study. This data can now be paired with longitudinal measures and qualitative data collected simultaneously to gain a deeper understanding of how students with TBI present for RTS.

Return to School After Traumatic Brain Injury: Description of Implementation Settings.

OBJECTIVE: Children who experience traumatic brain injury (TBI) of any severity may need accommodations when they return to school-the setting that manages academic achievement and learning. However, variations exist in current return to school (RTS) programs that address a child's transition to school following TBI. This article describes some of these return to school (RTS) programs and how they vary by setting. DESIGN: This article provides insights from a modified evaluability assessment that examined RTS programs and their readiness for rigorous evaluation. A secondary analysis was conducted to better describe the types and location of programs examined. RESULTS: Differences exist in program structure, access, and how care for children is monitored over time. RTS programs that serve children following TBI are located in healthcare settings, schools, and state agencies and vary in models of care due to their location and organizational structure. CONCLUSIONS: Children who experience TBI benefit from a healthcare assessment and follow-up upon RTS that includes parental involvement. Models of care for this process vary based on program location and organizational structure. Further research and program evaluation are needed to better understand effectiveness and how to optimally monitor and care for children returning to school after a concussion or TBI.

Factors impacting educational outcomes for students with traumatic brain injury in BrainSTEPS.

Purpose: To describe child pre-injury and injury factors impacting post-injury educational outcomes for students with traumatic brain injury (TBI) participating in a state-wide, school-based, school re-entry consultation program, BrainSTEPS in Pennsylvania.Method: Retrospective analysis of a BrainSTEPS annual follow-up survey.Result: A total of 296 parent surveys were completed. Analysis revealed a significant difference between levels of severity of TBI and current educational placement (p < 0.001), receipt of current therapy (p < 0.05) and need for additional consult (p < 0.05). Severity of TBI was not related to other examined educational outcome variables (i.e. school performance, current symptoms). History of TBI, symptoms and treatment were not found to be associated with educational outcomes.Conclusion: These results both support findings from previous studies, and extend previous work by highlighting ongoing needs, including continued, individualised support, of children who sustain a moderate-severe TBI during childhood, and are currently in the chronic stages of injury, with consideration of pre- and post- injury factors. Programs such as BrainSTEPS provide identification of educational needs and provide needed services and supports for children with TBI. Sensitive, validated measures are needed to further understand the role of pre-injury and injury factors on educational outcomes, particularly in programs like BrainSTEPS.

A global collaboration to study intimate partner violence-related head trauma: The ENIGMA consortium IPV working group.

Intimate partner violence includes psychological aggression, physical violence, sexual violence, and stalking from a current or former intimate partner. Past research suggests that exposure to intimate partner violence can impact cognitive and psychological functioning, as well as neurological outcomes. These seem to be compounded in those who suffer a brain injury as a result of trauma to the head, neck or body due to physical and/or sexual violence. However, our understanding of the neurobehavioral and neurobiological effects of head trauma in this population is limited due to factors including difficulty in accessing/recruiting participants, heterogeneity of samples, and premorbid and comorbid factors that impact outcomes. Thus, the goal of the Enhancing NeuroImaging Genetics through Meta-Analysis (ENIGMA) Consortium Intimate Partner Violence Working Group is to develop a global collaboration that includes researchers, clinicians, and other key community stakeholders. Participation in the working group can include collecting harmonized data, providing data for meta- and mega-analysis across sites, or stakeholder insight on key clinical research questions, promoting safety, participant recruitment and referral to support services. Further, to facilitate the mega-analysis of data across sites within the working group, we provide suggestions for behavioral surveys, cognitive tests, neuroimaging parameters, and genetics that could be used by investigators in the early stages of study design. We anticipate that the harmonization of measures across sites within the working group prior to data collection could increase the statistical power in characterizing how intimate partner violence-related head trauma impacts long-term physical, cognitive, and psychological health.

Establishing Consensus for Essential Elements in Returning to Learn Following a Concussion.

BACKGROUND: Returning to learn following a concussion is the process of managing a student's recovery during the school day by implementation of academic supports with varying intensity. Due to a lack of consensus or even guidance on Return to Learn, this paper set out to establish cross discipline consensus on some essential elements of Return to Learn using a Delphi method. METHODS: Sixteen national organizations participated in a Delphi process to reach consensus on overarching themes of Return to Learn focused on: returning a student to school, composition of the school-based concussion management team, progress-monitoring, educational safeguards, neuropsychological testing, and legislation. Two rounds of questionnaires were disseminated via email using a Delphi process. Consensus was established during round 2. RESULTS: Twelve national organizations were able to reach consensus and endorse 13 essential elements of Return to Learn following a concussion. CONCLUSIONS: There continues to be limited research on concussion Return to Learn leading to confusion in the field. In this paper, we demonstrate consensus on a number of essential elements, from a wide variety of professional disciplines who participate in the care of students following a concussion, as a starting place for some guidance on Return to Learn.

Return to learn: Transitioning to school and through ascending levels of academic support for students following a concussion.

PURPOSE: The purpose of this article is to familiarize healthcare providers and parents with educational language, laws, and processes as they relate to a comprehensive ascending level of academic supports as it pertains to promoting a smooth and supported transition to school following a concussion. BACKGROUND: Returning to learn (RTL) following a concussion is of parallel importance to returning to sport (RTS). A successful RTL is a critical part of concussion management. Many RTL articles advise healthcare providers and parents to request formalized educational supports, also known as Tier 2 or Tier 3 services, for children with concussion as they return to school. FINDINGS: Premature requests for formal (Tier 2 or 3) educational services, rather than allowing for immediate informal educational supports (known as Tier 1), can actually delay academic supports and have the potential to cause adversarial relationships between parents and schools. Additionally, this practice contradicts current research demonstrating the need for fast, flexible, temporary academic supports within the first month post-injury. CONCLUSION: Allowing school districts to direct the application of existing ascending levels of educational support for students with concussion as they return to school can promote robust and positive outcomes.