Pediatric Cognitive Rehabilitation and School
[Amy Mansue] We run this cognitive rehab program,
which is a school environment that, again, sets up
really a retraining of the child's brain,
and it is staffed with a full complement of therapists,
much like I described before, except it's led by a psychologist
instead of a neurologist,
and we create an entire school day
for these kids, really training them and working with them
on their cognitive issues.
Again, for children who look and have no physical,
it's really important to do that, because they don't have
an understanding or an ability to be able to
discern the difference pre-injury post-injury.
It's a very intense program,
Children are there five days a week.
They have a full 9 to 3 schedule, and if you went in there,
you would see the signs on the wall that say,
"Matt's going to work on making eye contact
and not being agitated and not becoming frustrated with his work."
Cues so that they can literally, physically see them,
and then staff work with them on an individual plan
to try and address that as well as the regular schoolwork.
Show transcript | Print transcript
Hospital Executive Amy Mansue talks about her pediatric cognitive rehab program that is set up like a school to help a child with TBI deal with issues like frustration in addition to regular academic work.
Produced by Sharon Ladin, Justin Rhodes, and Erica Queen, BrainLine.
Amy B. Mansue, Amy Mansue is president and chief executive officer of Children's Specialized Hospital. She provides leadership to an extremely skilled team of clinicians and therapists providing specialized care for children.
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- A brain injury is not "supposed to be," nor is the trajectory for recovery, says Hospital Executive Amy Mansue. "In rehab, we help kids with TBI reach their maximum potentional not only when they are 7 but also when they're 70 ... "
Never Settle for What's "Supposed to Be"
- "One mother I worked with needed to fully grieve the son she lost but who did not die in order to embrace the child who remained," says Hospital Executive Amy Mansue.
The Healing Process: Helping Families of Children with TBI
- Hospital Executive Amy Mansue talks about how rehab specialists can help kids with TBI and their families deal with the social challenges that can arise soon after the injury, but often more importantly, months or years after the injury.
Tackling Social Challenges for Children with TBI
- "Opportunities for meaningful and fun socialization for kids with TBI are as important as any of the medical or rehab therapies they receive," explains Hospital Executive Amy Mansue.
Providing Meaningful Opportunities for Socialization for Children with TBI
- Hospital Executive Amy Mansue talks about how an individualized rehabilitation plan for a child with TBI is created with a full team of specialists and how it is reacessed and managed as the child makes progress.
Orchestrating a Pediatric Rehabilitation Plan for a Child with TBI
- Hospital Executive Amy Mansue tells the story of a child with TBI who only started to progress after she made a connection with a security guard who worked in the rehab hospital.
One Small Connection: Children in Rehab for TBI
- "Never doubt a child with brain injury," says Hospital Executive Amy Mansue. "These kids will overcome their injury and be successful. It's our job as medical professionals to help them find that success."
Defining Success for Children with Brain Injury
- Hospital Executive Amy Mansue talks about the importance of giving parents and siblings the words and supports they need to help them deal with their loved one's TBI — in the short- and long-term.
Giving Support to Parents and Siblings of a Child with TBI
- Many parents feel they could have done something to prevent their child’s injury. Some even feel the brain injury is punishment for some previous misdeed. Many times, guilt is linked to the expectation that we as parents should be able to keep our children from harm. But sometimes bad things just happen. They are out of our control.
All parents feel guilty from time to time. It’s normal. But excessive guilt can eat away at your self-esteem and even get in the way of being an effective advocate for your child.
Acting out of guilt won’t make you feel any less guilty. Instead, you can end up feeling resentful, which brings a whole different set of difficulties.
Some people compensate for guilt by trying to do more now to make up for it. They become “human doings” instead of “human beings.” Other people deal with guilt by punishing themselves, depriving themselves of things that give them joy. In either case, this can lead to an imbalance between what you think you “should do” and what you are actually doing. To keep from getting bogged down or overwhelmed by guilt, try these strategies that have worked for other parents:
This article is based upon the writings of Vicki L. Schmall, Ph.D., and is adapted with her permission. For more information, please refer to “The Caregiver Helpbook,” copyright 2000, written by Vicki L. Schmall, Ph.D., Marilyn Cleland, R.N., and Marilynn Sturdevant, R.N., M.S.W., L.C.S.W, published in Portland, Oregon, by Legacy Health System.
- Try to eliminate “should” from your vocabulary. You might try replacing it with “I would like to…” or “I’ll try to…” Challenge the idea that a parent “should be able to keep a child free from all harm.” Although a parent’s role is to protect, no parent’s abilities are perfect.
- Apologize when it is appropriate. The only time guilt is appropriate is if, in fact, you did something you regret. The best antidote for that kind of guilt is to make amends and apologize. Make sure, however, that you’re not apologizing for things that are beyond your control. You are only one person, without superpowers. You are doing the best you can under your current circumstances.
- Don’t let other people push your "guilt button." All parents feel a normal degree of guilt. (“I spend too much time at work and not enough at home.” “I buy too many things for my child.” “I don’t buy enough.”). Sometimes, children and others close to us can work our weak spots. If you feel guilty about your child’s injury, you are particularly vulnerable. Remind yourself that it’s healthy to set boundaries. Agreeing to do things you will later regret isn’t healthy and it can make you resentful. It’s okay to say “no.”
- Look at what you've already accomplished. Chances are you have already done many things to help your child. The next time you feel guilty, try to give "equal time" to acknowledging all the good things you do. You may be surprised to discover that it's really quite a lot.
- Face it, trace it, and erase it. It’s important to acknowledge whatever part you may have had in your child’s injury. It’s equally important to forgive yourself. Acknowledging your role, rather than repressing or denying it, will allow you to move on and support your child better. Carrying guilt around prevents you from being a good advocate. Letting go doesn’t mean you don’t care. In fact, it’s just the opposite. Letting go clears the way for more positive feelings, like joy and serenity, which open the heart for truly genuine expressions of care.
- Break the “blame habit.” If it is easy for you to feel guilty, you may have a history of frequently taking responsibility or blame for things. In general, taking responsibility is a good thing. But it is possible to take responsibility inappropriately, to assume that you are to blame, even when things happen that are out of your control. This outlook is not healthy for you, for your child, or for other people around you.
- Talk with a counselor or clergy. Living with a child with a brain injury can be extremely challenging. If you don't talk to anyone else about the situation, you are likely to lose objectivity. It’s easy to get caught in your web of emotions. Talking with a counselor, rabbi, or minister can bring a fresh, unbiased look at the situation. Someone who does not have a history with your child can often help you sort out a more balanced view of your feelings.
- Develop a new perspective. Sometimes we feel guilty because we have feelings we wish we didn't have. You may want to feel loving toward your child all the time, but for any number of reasons, you find yourself being irritated or critical instead. Your child may have difficult behaviors and personality changes that are difficult to manage. This can be trying, but finding a new interpretation for your child’s actions can help. For example, instead of worrying how you are going to solve your child’s problem, it can be more productive to acknowledge that your child needs attention and this is just a way of asking for it. A new perspective on your circumstances can lead you to new, less stressful ways of responding.
- Focus on what you can do now to help your child. What new lessons will you and your family learn from this experience?
Wade, Shari L. , and Cincinnati Children's Hospital Medical Center. 2002. Putting the Pieces Together: An Online Intervention for Pediatric Brain Injury. Materials adapted from study.
My Child's Brain Injury: Coping with Guilt
- Many high schools offer programs in technology or culinary arts, for example, that are one way for teens with TBI to learn some skills as jumping off places for future career opportunities.
Programs in High Schools Can Help Teens with TBI Set New or Different Goals
- Dr. Juliet Haarbauer-Krupa talks about how parents and schools can partner with medical facilities to better understand how a brain injury can affect a student socially, behaviorally, and academically.
Partnerships Among Schools, Parents, and Medical Facilities Can Be Beneficial
- Although states and school systems vary, schools can be great resources for kids with TBI — and their parents. Support services can range from 504 plans and special ed to transition plans for teens.
Using Schools as a Resource After a Brain Injury
- Dr. Juliet Haarbauer-Krupa talks about the advantages for adolescents with TBI to talk with their vocational rehab counselors before leaving high school.
For Teens, the Benefits of Vocational Rehabilitation Before Leaving High School
- Ninety-nine percent of services kids will need after a TBI will be in the school setting. Teachers are key.
Transcript of this video.
Targeting Teachers in Treating Brain Injury in Children