My daughter is 15 and a freshman in high school. She been out of school for 3 months due to PCS issues. We just completed a round of neuro-psych testing and test the detailed reports next week. She has executive function issues that will impact her learning when she is ready to return to school. The physical issues are more limiting then the cognitive ones right now.

The school is fabulous and will provide any accommodations that she needs. In working with the school, our initial plan was to have her return 2nd semester, adjust the schedule (which is perfect) and waive a couple of classes, figure out how to get credit with special projects in others and give her full credit in a couple of other if she passed the final. All of this was great - except she is not ready to go back - not even part time.

What have other parents done? Have you pulled your kids from school? Did you have them repeat the year?

As one who endured academic struggles during my sophomore year and again in college, the most important advice I can give is go slow and try not to set too many expectations. As she gets better, if she chooses to get more intense, let it be her choice. Try to help her find her comfortable speed and intensity. Also. let her find her comfortable subject matter to pursue.

Try to learn to read her body signals. Mostly her eyes and facial expressions. Ask her how she is doing in comparison to what you see in her face. My wife can read my face quite well. If we are visiting friends, she can tell when I have reached my limit. Sometimes, your daughter may not be able to define how she is thinking/feeling at the time, but later, she will be able to tell what was going on in her mind.

Sometimes, my mind gets stuck trying to get any kind of thinking traction. I will be looking at my surroundings trying to figure out what I am supposed to be doing. This is usually a result of getting over-stimulated or what some call "over-attending." In over-attending, the brain is trying to do too much at once, maybe a thought that is too complex or too many variables in a thought process or too many stimulations to process. .

If she tries to attend class, she will likely need to sit in the front so she does not have visual distractions. She might need to use foam earplugs to reduce the background noise and especially the students talking in the back of the class.

She will likely be very easily distracted. Note taking may be difficult if not impossible. Some teachers may have too much 'clutter' on the walls and in the front of the class room. This can be a distraction.

She may do best with multi-sensory learning. This is when two or more senses are used to grasp information, visual and auditory, auditory and tactile (note taking), practical ( hands on), etc.

My daughter struggled to learn from classroom work but quickly excelled when her studies included hands on practical experience. The visual and tactile combination are her strong learning modes.

You might do some googling for multi-sensory learning. There are some good on-line resources.

Common problems could be visual processing and auditory processing. A neuro-psych assessment can diagnose these areas.

The body and brain is going through many changes during these early teen years. Try to take it slow so the brain can heal without stress.

Spending time with or working with animals or small children can be helpful. They have much simpler communication needs that can be very stress relieving.

Although the physical issues may appear to be more limiting, the cognitive issues are like the part of an iceberg that is underwater. The cognitive issues are what make PCS/MTBI survivors the 'invisible wounded.' The emotional stresses of trying to rehab the physical body can complicate the cognitive issues. Physical stresses can help with rehabing the body. They can be detrimental to the cognitive rehab.

I have a friend who is paralyzed from the waist down. Her limitations are far easier to endure than the cognitive struggles of PCS/MTBI. The stress of 'word finding' and other communication dysfunctions disrupt the ability to compose one thoughts. The cognitive sense of being literally "lost" in thought can be immense. Some say we need to "stop" to think. This means we need to stop moving. Stop looking. Turn off sounds (radio/steroe/others talking.), try to ignore tactile sensations, just so we can get our mind to focus on a simple thought.

I routinely will close my eyes so I can try to focus on a thought or even hear what someone is saying.

I used to be able to drive my truck, eat, listen to talk rag dio and find an address on a map, al at the same time.

Now, when my wife is driving (I don't drive anymore), we need to pull to the side of the road, turn of the radio, turn off the air conditioner fan, just so I can focus on reading the map.

These may or may not be symptoms of your daughter. Keeping an open mind to accommodate any symptoms like these will greatly reduce her stress. When I got the neuropsych assessment report, I finally could see that my brain was broken. I was not going crazy or such imagining my dysfunctions..

Be ware that simple tasks like going to the grocery store, may be over whelming. The enormous amount of visual stimuli can be a problem.

So, just love her, hug her when she is willing, be quietly with her if she wants, and be patient.

My best to you all.

Thank you Mark. It is nice to be able talk to other people that have experience in this area.

Patience - I try my best every day. It's hard. A broken leg or torn ACL would have been so much easier to deal with. You see it, there is a rehab protocol, it easy to measure progress and other get it. Most people don't seem to understand the impact even a seemingly mild blow to the head can cause.

First, determine what you feel she is ready to do.

Say could she go back to school for say two classes. Then have a tutor in
her home for two more classes that she can do most of on her own with some
help. Say like English and Math if she is good at this class. Or a social studies
class maybe.

Then have her maybe take a couple of classes for summer school.

You have to just figure out what is best for her. And then do what she can
do.

Honestly, with a school that will work with you. This is half the battle.

I'm a advocate for parents with children with disabilities. If I can be of more
help let me know.

Donna

Donna - Thank you for your suggestions. A gradual return to school is what we have been working on. I do think there are some classes she maybe able to work on at home. I think part of the issue right now is that she doesn't feel like her brain is working well enough to do the work. I think after she talks to the neuro-pychologist on Tuesday, she may feel better about things. There are some areas of her brain that are working well and some not so well. I think she needs someone to really explain it all to her in terms she can understand. The first neuropychologist that did an initial screening (45 minutes worth of tests) basically told her cognitively she was fine and she felt far from fine.

A neuro-psychologist who will make an "all fine' diagnosis based on 45 minutes of testing is not worth your time in my view.

I had a 45 minute mini-neuro-psych assessment. Not much value, especially since it is not necessarily enough time to show any mental fatigue.

He probably did a Mini-Mental Status Exam and Trail Making test and a few other verbal tests.

The Trail Making test is often miss-graded. Just because both the A and B test times are within normal limits does not mean much. A time on test A that is low then a time on Test B that is just below the upper limit shows a differential that can indicate a cognitive/perception problem. Many psychologists will not do follow up study of the Trail Making test as would be helpful when grading a subject with high functioning. The high functioning will show up as a low time on the A test. The problems may show up as a longer time but still within normal ranges on the B Test due to the added need to shift. This differential is a good indicator of a problem.

There is also a tendency to rest up prior to the appointment. This will tend to hide the fatigue factors.

As most of us know, we have days when we can perform at extremely high levels with no reason, then days when we are functioning at a high level and crash with no obvious reason. In hindsight, we may see the triggers for the crash. It takes experience to be able to avoid the triggers with any consistency. Even then, our avoidance techniques are not fool proof.

The neuro-psych will hopefully give her and you and idea of how to tailor her activities so that they do not cause an over load. Working until an overload happens can be counter-productive. The recovery time can easily be more setback than the value of the extra effort.

The goal is to do as much as is comfortable without over-doing it. This may take time to develop a sense of when to quit. As I mentioned before, learning how to recognize the eye and facial expressions that signify these limits will be valuable.

I will frequently try to push to far on my computer. One of my symptoms is my keyboard starts to get a green color to it. It does not make any logical sense but it only happens when I push too far.

Can anyone explain this strange phenomenon?

Absolutely would prefer an ACL or broken bone injury. Nobody suggests athletes are "faking" those, you know for sure when they heal, etc. Ugh.

PClearner

So true, and here in our world no one is faking. We hope both girls
recover.

Donna

I get a lot of "she looks fine" - but if you know her - you know she's not. I've even had a hard time convincing her doctors of that! I think all high school students need a baseline established - athlete or not.

PCSLearner - thank you for those suggestions. Those are all things I have been looking into the past week or so. She attends a private Catholic high school, so it would be a little more challenging to dual enroll her in the public HS to get in home services. I am also looking at online classes and a couple of local schools that have one-on-one instruction.

I do think she'll be ready to go back part time in soon. She actually told me she was bored and asked about going back. That was th first time I had heard either of those things in 3.5 months! If I could just get her to sleep well enough - then she'd be able to handle part if a day in school.

Nancy,

What do you mean by <If I could just get her to sleep well enough - then she'd be able to handle part if a day in school. >?

Do you observe her sleep behavior? Does she have any standard routine for sleep?

Sleep has been a big issue for me since my injury. I have a number of observations that I could share once you help me understand her sleep issues.

Regarding help with her schooling, Just because she goes to a private school does not mean she does not have access to services as a disabled student. Whether it requires dual enrollment (probably does so that the local district can get state ADA moneys) or not, she should have access to the same services as a public school student.

Depending on the state, homeschool families sometimes access the state services under the disability provisions of the ed codes.

When somebody says "She looks fine," remind them that she is one of the millions of invisible wounded in this country. Their support of her needs will go a long way toward helping society reduce its marginalization of the brain injured.

Studies suggest that upwards of 80% of incarcerated and homeless persons are brain injured. Our society tends to kick them to the curb because they do not look hurt. There are many brain injured who are only a disability check and high utility bill away from homelessness.

My best to your daughter, Hugs to all,