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?

Once again, thank you! I concurr with you on our first neuropsychological screening. I think the concussion program is doing more a screening to catch obvious issues. I think you could get the same thing with the Impact testing with far less cost. To me, athelete or not, it makes sense to have some sort of baseline on all students. I think many parents would pay to have a baseline established on the off chance something happened. I don't know if it is just awareness, but the incidence of concussions seems to be raising. I just heard of a 3rd girl in my daughter's class that has a concussion and know of two that had them prior to school starting.

BTW - I my daughter's school is amazing! They are prioritizing her health about anything else. They seem to totally understand the issues she will struggle with when she does return to school. They are fully support a gradual return and have zero expectations of her to do any work inititially. If she doesn't make it back fulltime, they will still let her move forward with her class and we will figure out when she is well enough how to make up the missing credits. They relieves a huge amount of stress from our lives.

hi Nancey


try not to overlook something that is so important to a young person the social and fun aspect of there life ,

doing fun things with your friends is a big step back to normality,

all these test are frightening and upsetting , and with the brain, the results have no quick fix or magic pill ,

the young brain has a much higher chance of full recovery, I have just been told my neuropsicologica test result and that my injuries are permanent, I am 48 and its still a blow

so try to play it down ,and go easy on her the academic part is important but not as important but try not to set her up to fail as self image at that age .

well you must remember huh

best wishes

I agree with vini.

It is far more important for her to understand the NEW her than it is for her to keep up with her classmates. She will need to understand that some of her friends will not accept the new her. This is NOT her fault. Even some teachers will not be appropriately accommodating.

She will hopefully be able to grow a thicker skin for those who refuse to understand and accept the new her. I lost many friends after my serious concussion in 4th grade. I did not understand why they were abandoning me. It would have been very helpful to understand that my personality had changed. Now I know that I was no longer a "sweet little boy" as my mother's terms expressed it recently.

I asked my wife what kind of personality changes she saw in me after a concussion in 1999. She said I became apathetic. I was usually very directed and responsive. Instead, I would not respond to many things. Sometimes, I would finally respond and blow up because the issue became overwhelming.

Previously, I would get home from the job of the day and go to my office to make calls and contact prior leads to see if I could close a sale and schedule a job. After the concussion, I would finish my work and get home and zone out. I was no longer the aggressive, pro-active self-employed person that I had been for 25 years prior.

So, watch for these personality differences and the reaction of others around her. She may need a social worker or therapist to help her with these issues.

Let her know that you are there for her and willing to help her work through these personality struggles and the social implications. Let her know that you do not fault her when she fails. Let the hugs flow freely and wildly whenever she is struggling. Try to learn to laugh with her at some of her struggles. It is a sort of sighing laugh as in "Oops, I did it again."

You might even come up with a code word or phrase for recognizing those times. It would just mean you understand her struggle without making a big deal of it. A offhand remark could be something like, "I guess we have to wipe that off our shoes." This would be more appropriate for a guy. Something softer would be better for a girl. Maybe, "Drats, It's just another run in your/my nylons."

You might also suggest that she be aware of the friends who like a quieter and slower social life/setting. These friends will become a valuable resource for her. The ability to just sit quietly and have girl talk or study talk without a stereo blaring will open up new opportunities for friendships.

hi Nancey

I would just like to say ,that your daughter has every!!!!! chance of making a full recovery,

but it just takes time, this board is shared with TBI and pcs I had multiple skull fractures with csf leakage I am 2yr post injury,

others have had multiple concussions , and suffer the combined effects,

it really differs from person to person injury to injury, many factors come into play, age is a key factor and it is still very early days,

young people have came to this board got answers and recovered and moved on excepting, that an injury is permanent and life long is in my opinion is not the way to go,

although in some cases it undoutiby is, one of the questions that comes up here often . is how long will this last,

the medical profession often can,t say, because they are being honest with you , they do not know, these are the bench marks with brain injury --- the period of unconsciousness , known as the glasgow coma scale,

then post injury 4hrs 24 hrs 36 hrs 1 week 2 weeks 1 month six months 1 year 18 months at all of these date recovery/ improvement is possible only after 2 yrs

dos the profession except the injury may be permanent, but this is not set in stone, but studies indicate this to be so

ask your doctors first, I am no expert just someone struggling with ABI

hope this helps best wishes