Education for children following an acquired brain injury

When a child acquires a brain injury, they can present with a wide range of alterations in physical function, cognition, communication, social, emotion and behaviour regulation. The nature and severity of injury may also result in ongoing medical problems that require management. These can vary greatly depending on the extent of the injury and on the part of the brain affected. The age of the child and any of their pre-injury characteristics and medical problems also need to be taken into account. Understandably, therefore, these children may have a spectrum of special educational needs.

Returning to education is often an aim, but it is important to recognise that a child with a brain injury will be very different to the pre-injury child.  Introduction or reintroduction of a brain injured child /young person to an educational setting requires a full assessment of the child’s special educational  needs and abilities and careful consideration the  interventions / strategies to be put in place to meet these needs.  It may be that the child can return to the school they attended pre-injury, but will require adaptation of the learning environment and teaching methods to facilitate acquisition or reacquisition of skills. It may require provision of mobility aids and other specialist equipment  along with compensatory strategies and support services. However, it may not be appropriate for the child to return to the school that they attended pre-injury.  It is also important to note that following a brain injury the child will be constantly changing in relation to their recovery and therefore monitoring and reassessment is important so that there can be adaptation to their changing needs.

An Education Health and Care Plan (EHCP) is likely to be helpful. This document identifies the child’s special educational needs (Section B of the EHCP) and the provision that they require to meet those needs in the educational setting (Section F of the EHCP). It also names the educational placement which the Local Authority (LA) will fund (Section I of the EHCP). The content of the plan is legally binding on the LA who have a duty to provide and fund the educational provision set out in the plan.  It is important to remember that special educational provision can include health care provision (therapies) or social care provision provided it educates or trains the child or young person. Examples include:

• An Occupational Therapist conducting a sensory assessment and providing intervention/training.
• An Occupational Therapist assessment and providing intervention/training in relation to dressing and other self-care skills.
• Toilet training.
• Speech and Language Therapist assessment and training in relation to swallowing (dysphagia).
• Aspects of epilepsy management in the educational setting.

It is important to develop an individualised plan for entry/re-entry into education and the content of an EHCP will inform the school as to the child’s special educational needs and the provision they require.

Typical difficulties to be considered in relation to a brain injured child returning to education can include (but are not limited to):

• Physical: spasticity, balance problems, poor coordination, fatigue and problems with fine and gross motor skills including mobility.
• Executive function: the child’s difficulties in the ability to plan, prioritise, analyse and complete a sequence of tasks.
• Cognitive impairment:   memory problems, slower processing of information, language problems, concentration/attention difficulties.
• Behaviour, emotion and social awareness/understanding: loss of concentration, impulsiveness, difficulty regulating emotions, aggression, difficulty understanding social situations and awareness of danger.
• Communication difficulties.
• Difficulties with self-care: feeding, changing clothes, toileting.
• Pain.
• Other associated medical problems and medication requirements.

Effectively addressing the child’s needs so that they are ready to learn and able to access learning may include an array of interventions and strategies depending on the child’s needs. The following can be considered (this is not a definitive list):

• Specialism of staff and training in relation to the child’s special educational needs.
• Teaching methods, support and materials specific to meet the child’s needs.
• Accessibility to facilities in relation to the child’s needs. This may include time taken and distance covered to transition between classrooms and support required.
• Suitability of the learning environment in terms of classroom set up, noise, light and movement, where the child is seated and specialist seating requirements.
• Social, behavioural and emotional learning strategies and interventions.
• Presentation of learning materials.
• Communication interventions and strategies which may include e.g. oral, electronic (use of ipads and laptops), use of assistive technology, communication boards etc.
• Availability of therapies (e.g. speech and language therapy, occupational therapy and physiotherapy) and integration of therapies and interventions in the educational environment/ throughout the day.
• Mobility aids/support and other specialist equipment specific to the needs of the child.
• Medical support within the educational setting.
• Support required at unstructured times (break and lunchtime) and at meal times.
• Assessment considerations: assessment format, extra time, information and communication technology, use of a scribe and other specialist equipment.
• Differentiation of the curriculum and flexibility as appropriate.

The educational and medical teams involved with the child need to work closely together along with the child and their family. Ongoing review and evaluation is required. It is important to remember that the range of presentations following an acquired brain injury is very diverse and there is no one prescribed way to rehabilitate and provide successful re-entry into school.

Please see the resources on the Cerebra website or our website if you would like further information on EHCPs. Unfortunately, the LA does not always agree to assess the needs of the child or then subsequently to issue an EHCP. The LA may also not agree to name the school placement that parents would like or to set out the provision advised by experts in the EHCP. It is possible to appeal the decisions of the LA.  Further information is available on our website.

Boyes Turner are proud to be panel members of Cerebra and increase our knowledge of such conditions by sponsoring meaningful, targeted research. At Boyes Turner we support Cerebra’s aims wholeheartedly and are proud to raise awareness of the charity’s invaluable work.

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