Case Study #1: Sam: A Grade 4 Student In February 1999, Sam was thrown from a horse. He was unconscious for several
minutes and appeared dazed and confused afterwards. Sam's parents took him to the
local hospital, where he was kept overnight for observation. Sam was diagnosed with a
mild traumatic brain injury {MTBI). He returned home the next day and to school the
following week.
At the time of his discharge from the hospital, Sam appeared tired but fine. The family
doctor informed Sam's parents that Sam might experience temporary difficulties with
behaviour and learning. They were told that these difficulties could last for days or
months, and that if they persisted over a longer period, more thorough medical and
neuropsychological assessment would be required.
At the time of the accident, Sam was in Grade 4. Sam's parents informed the school
about Sam's MTBI and changes in his behaviour that they had noticed at home. Sam
had been an average student who enjoyed school before his injury. When Sam returned
to school, it quickly became apparent that he was having difficulty with stamina,
concentration, memory, and headaches. He appeared to be easily frustrated and to be
experiencing learning challenges.
Sam's classroom teacher closely monitored his behaviour in the classroom and
observed that Sam's fatigue level was significant and affecting his ability to think and
learn. He also seemed to be frustrated by the pace of learning in the classroom and his
inability to keep up. After one week of unproductive work and several calls to Sam's
parents to discuss disruptive behaviour, a meeting was called to develop strate
help Sam. The District Occupational Therapist, who had previously worked with a
student with ABI, was invited to attend the meeting.
At the meeting, an IEP was developed collaboratively by Sam's teacher, his parents, the
school Learning Assistance Teacher, the public health nurse, the Principal, and the
District Occupational Therapist. It was determined that Sam's progress would be
reported to the team bimonthly by Sam's classroom teacher, given that problematic
behaviour and learning were expected to improve.
Sam normally travelled to school by bus; however, the full school day was too long for
him to cope when he first returned to school. Sam's school program was initially
reduced to half days, with his mother picking him up after lunch. With careful monitoring
and adjustments to Sam's educational program, he was able to resume full-time
attendance and return to his pre-accident ability level.
Sam's needs were seen to be:
• develop increased awareness of cognitive limitations
• to monitor his own fatigue level
• to express his frustrations appropriately
• to improve attention, organization, and academic performance to pre-injury
what are objectives and strategies