Sample Page

BrainSTEPS Team:

BrainSTEPS Consultant Name:

Phone

Date of this Framework:

Name of Student:

DOB:

Grade:

Parent/Guardian:

Phone:

Language Spoken in the Home

Date of Brain Injury:

Date of BrainSTEPS Referral:

School day:

100% Virtual
Hybrid -some in person school/some online
100% at School
When Attending

School District:

School Building:

Is there a BrainSTEPS Trained Concussion Management Team in this building?

School Contact Name:

School Contact Phone:

School Contact Email:

504 Date:

IEP Date:

Primary Exceptionality:

ER/RR Date:

Behavior Plan Date:

Current Therapies (School-Based or Community/Medical-Based):

Pre-existing diagnoses/conditions/health issues:

Current Medications:

Follow-up appointments (which professional and when?):

Communication Has Occurred Between BrainSTEPS and:

Parent
School
Student

Medical Doctor Name:

Neuropsychologist Name:

Occupational Therapist Name:

Physical Therapist Name:

Speech-Language Pathologist Name:

Main School Contact for Student-Name:

Teacher(s)

Name:

Class:

Name:

Class:

Name:

Class:

Name:

Class:

Name:

Class:

Name:

Class:

Name:

Class:

Name:

Class:

Directions:

1. Ask the student which of the following changes they experienced in the past week.

2. Emphasize that you are looking for changes that have occurred since the brain injury.

3. Locate the corresponding Symptom Supports document based on the student’s specific symptoms.

4. Discuss the various academic support options listed on the annotated document (or add your own).

5. The chosen Symptom Supports should then be added by BrainSTEPS consultant to the identified corresponding Symptom BISF page.

The various Symptom BISF pages will then be provided by the BrainSTEPS consultant to the school with this BISF document.

Emotional Changes

1. Anxious, Nervous, Stressed
2. Sad, Depressed, Mood 2. Restlessness, Fidgety Swings, and/or Panic Attacks

Behavioral or Social Changes

1. Changes in Relationships with Friends/Peers
2. Restlessness, Fidgety
3. Easily Frustrated, Irritable, Overwhelmed
4. Impulsive actions

Additional Notes from Meeting

For Student/Family to Do:

For School to Do:

Review with School Team, Parent, & Student

Pediatric Brain Injury- Points to Remember

1. All brain injuries are serious. A concussion is also a brain injury. All concussions are serious, too.

2. Most brain injuries (90%) occur without loss of consciousness.

3. Chemical and metabolic changes occur in the brain during injury, interfering with normal brain activity.

4. The majority of concussions (70%) typically resolve within 4 weeks, but in some students, effects may last a lifetime.
Moderate to severe acquired brain injuries may result in lifelong deficits.

5. Pre-existing or underlying conditions such as prior concussions or other severities of brain injury, attention deficits,
learning disabilities, and emotional/mental health disorders can be exacerbated by concussion. These can also extend concussion recovery time.

Considerations – All can be phased in or out fluidly based on the student’s individual needs during recovery:

● Eliminating make-up work with the exception of concepts important to future learning (typically math, science, foreign language).

● Each teacher should determine what future assignments and assessments can be eliminated and/or reduced and what assignments/assessments are essential and need to be completed.

● Structured breaks based on the individual student’s symptom threshold. Explore student’s symptom threshold – how long can the student focus on an academic activity before experiencing an increase in headache/other symptoms?

o Example: If the student can go 40 minutes before experiencing symptoms, the student’s cognitive working periods might be 30 minutes followed by a 10- minute break. Breaks can be phased out as recovery progresses.

● Identify loud environments the student may be exposed to in school and divert her to a quiet place.

● Provide the student with supplemental sources of learning when available: textbook websites, audio resources, discovery learning, etc.

● Eliminate homework during recovery with the goal of having brain rest in the evening.

● Substitute assignments in classrooms that exacerbate her symptoms. Example: Band class can be noisy. The student might watch/listen to an audiobook or video and provide a verbal report on the content.

● Provide the student with a list of what is expected in each class. The student might also check in/out with a designated person each day to assess progress and remain on course.

Comment

Directions:

Headache

Blurry or Double Vision

Dizzy or Balance Issues

Light Sensitivity

Noise Sensitivity

Fatigue and/or Sleep Issues

Memory Issues

Memory Issues

Attention and Concentration

Cognitive Fatigue

Slow Processing Speed

Confusion, Fogginess

Difficulty Making Decisions

Schoolwork Takes Longer, Missed Work Piling up

Literal Thinking

Organization

Organization of Thoughts & Words

Task Planning, Initiation, Completion

Anxious, Nervous, Stressed

Sad, Depressed, Mood Swings, Panic Attacks

Friendships

Restless or Fidgety

Memory Changes

Frustration, Irritable

Impulsive

Additional Notes from Meeting

Review with School Team, Parent, & Student

Pediatric Brain Injury- Points to Remember

Considerations – All can be phased in or out fluidly based on the student’s individual needs during recovery:

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