Charting the Cs logo. Cooperate, Communicate, Collaborate. Charting the Cs Conference 2025: To Literacy and Beyond Cooperation Communication Collaboration Life After a Traumatic Brain Injury: From Visible to Invisible Sarah Golden Lacy Bryce Tuesday, April 29, 2025 "Resilience is knowing that you are the only one that has the power and the responsibility to pick yourself up." Life Before the Traumatic Brain Injury •Straight “A” Student •Varsity Wrestler •Raised and Showed Beef Cattle •Worked on the Family Farm Brenden showing his heifer at the Minnesota Beef Expo, prior to his injury. Brenden wrestling before his injury. Monday, January 9, 2023 •During a live wrestling match Brenden sustained a blow to the back of his head when he hit the wrestling room door. •When he was picked up from practice he was visibly in pain. •He had a severe headache and was able to say he hit his head during practice, but did not recall anything else from the rest of the practice. Tuesday, January 10, 2023 •The next day Brenden was evaluated by the school athletic trainer to complete a concussion protocol assessment, he could not complete the first step. We were told he had a concussion and to have him rest. •He was experiencing balance issues and he had terrible head pressure. •He did go to part of a day of school, he insisted, he had a test, he shared that he had to keep blowing up the text on his Chromebook and could still not read the words. January 11th and 12th •Head pressure continued to worsen. •He attempted to rest. •He started to cross his legs over when he walked, stumbling and needed some help at times. Friday, January 13, 2023 •Brenden got up to try and shower and was unable to get to the bathroom himself or lift his leg over the tub to get into the shower. •We took him to the Emergency Room (ER). •He was evaluated and spent most of the day in the ER, his symptoms at this point were getting worse. We were referred to the Traumatic Brain Injury Outpatient Program (TBI Clinic) at Hennepin County Medical Center (HCMC). Friday January 13, 2023 -video January 13 2023_slide 7.mp4 Sunday, January 15, 2023 •Brenden spiked a high temp. •He was taken to Sanford Hospital in Fargo, ND, where he would remain hospitalized for four days. The day we came home from the hospital - video January 18 2023_slide 9.mp4 January 25, 2023, HCMC TBI Outpatient Clinic Met with Lead Physician. She hand picked his team, which consisted of specialists in the following areas: •Neurologist •Neurosurgeon •Audiologist •Developmental Neuro Optometrist •Physical Therapist (PT) •Occupational Therapist (OT) •Speech and Language Pathologist •Social Worker Diagnoses •Traumatic Brain Injury (TBI) •Impaired Functional Mobility, Balance and Endurance •Ataxia •Alexia •Exophoria •Binocular Vision Disorder •Accommodative Insufficiency •Activities of Daily Life Impairment •Syrinx Therapy •Physical Therapy2-3 times a week •Occupational Therapy1-2 times a week •Speech and Language Therapy1-2 times a week Physical Therapy, February 21st -video February 21 2023_slide 13.mp4 Zero Gravity (Zero G), March 7th -video March 7, 2023_slide 14.mp4 Practicing in the Barn -video April 1 2023_slide 15.mp4 Balance Box, April 6th -video April 6, 2023_slide 16.mp4 Physical Therapy, April 6th -video April 6, 2023_slide 17.mp4 February -May (1 -4 Months) Post Injury •Brenden’s injury is visible to those that know him and see him. oBrenden is using a wheelchair. oTinted Glasses with Prisms oHomebound oAccessibility Ramp to get in House oShower Bench oGrab Bars For the Toilet oWalker •Lots of driving, at least 2 to 3 days a week to HCMC for therapy •3 - 4 hours a day of therapy at home each day •2 - 3 hours of school work each day •Social Life oState Wrestling Tournament (only 1 person can sit with) February -May (1 -4 Months): School Implications •Homebound Services via 504 •Special Education Instruction Setting I: Brenden WANTED to be in School! •Attending Appointments at HCMC (2+ Hour Drive One Way); impacted being in school. •Unable to read, but could write •Working with Brenden to be a Self Advocate Starting the 504 Process at School oMeeting January 25th to Develop a 504 o504 Plan with an Initial Start Date February 16th o504 Plan was Revised on February 17th Special Education Evaluation Plan •The Special Education Team met on February 16th. •Sent out an Evaluation Plan on February 17th. •Special Education Evaluation Results and Individual Education Plan (IEP) Development Meeting on April 5th. •IEP was developed and implemented on May 3rd. How a Brain Injury Impacts Your Daily Life: Left Brain •Speaking •Reading •Writing •Listening •Grammar •Number skills •Computation skills •Analyzing information •Reasoning •Logic •Sequential thinking •Time awareness •Controls the right side of your body oInjuries on the left side of the brain can cause: •Difficulty understanding spoken and written language •Difficulty expressing spoken and written language •Changes in speech •Verbal memory issues •Impaired logic •Sequencing difficulties How a Brain Injury Impacts Your Daily Life: Right Brain oOrganizing information oAbstract meaning oContext oSpatial relationships (maps and shapes) oVisual information oFace recognition oIntuition oEmotion •Imagination •Detecting motion •Music and art awareness •Controls left side of the body oInjuries on the right side of the brain can cause: •Impairments in attention •Left neglect •Memory issues •Decreased awareness of deficits •Loss of “big picture” thinking •Altered creative or music perception •Changes in speech Traumatic Brain Injury Checklist •Orientation and Attention to Activity •Starting, Changing, and Maintaining Activities •Absorbing and Retaining Information •Language Comprehension and Expression •Visual Perceptual Processing •Visual Motor Skills •Sequential Processing •Problem Solving, Reasoning, and Generalization •Organization and Planning Skills •Impulse Control •Social Adjustment and Awareness •Emotional Adjustment •Sensorimotor Skills Traumatic Brain Injury Eligibility Part B •Intellectual/Cognitive •Academic •Motor •Communication •Sensory •Social/Emotional/Behavioral •Functional Skills/Adaptive Behavior Fitting the Traumatic Brain Injury Checklist into the Qualifying Areas •Orientation and Attention to Activity: Functional Skills/Adaptive Behavior •Starting, Changing and Maintaining Activities: Functional Skills/Adaptive Behavior •Absorbing and Retaining Information: Intellectual/Cognitive •Language Comprehension and Expression: Communication •Visual-Perceptual Processing: Intellectual/Cognitive •Visual-Motor Skills: Motor •Sequential Processing: Intellectual/Cognitive •Problem-Solving, Reasoning, and Generalization: Intellectual/Cognitive •Organization and Planning Skills: Functional Skills/Adaptive Behavior •Impulse of Self Control: Social/Emotional/Behavioral •Social Adjustment and Awareness: Social/Emotional/Behavioral •Emotional Adjustment: Social/Emotional/Behavioral •Sensorimotor Skills: Motor How Brenden Met Criteria: • 18/24 = 75% Sensorimotor Skills: Motor •Visual Perceptual Processing4.5/12 = 38% •Visual-Motor Skills5.5/15 = 37% Accommodations •Assignments •Behavior Management •Environmental / Physical Accommodations •Sensory •Instruction •Instructional Materials •Organizational Skills •Language (Receptive, Expressive, and Social Pragmatic) •Grading •Pacing •Self Management •Testing June -August (5 -7 Months) Post Injury •Walking the school hallways with walker, getting use to the different surfaces. •Driving to HCMC about 2 times a week for PT, OT and Speech therapy. •Heat became a significant problem. •Social Life oVery Limited •Planned Field Trips as required by therapists •Getting back to showing cattle. •How is the injury visible oWheelchair oWalker oCane/Walking Stick oExaggerated Walking Pattern oTinted Glasses oFalls •Family Support, Extended to Sibling June -August (5 -7 Months) Post InjuryOver the Summer: School Implications •Extended School Year (ESY) services over the summer with direct instruction in reading oIntensive multimodality instruction •ESY Services for Credit Recovery June -August 2023 -video 1 June 25 2023_slide 34 (video 2).mp4 June -August 2023 -video 2 June 25 2023_slide 34 (video 2).mp4 June - August 2023, play video 1 July 8 2023_slide 35 (video 1).mp4 July 10 2023_slide 35 (video 2).mp4 June - August 2023, play video 1 July 24 2023_slide 35 (video 3).mp4 June -August 2023: Brenden’s Summer Goals •Show his cattle •Attend the State Fair •Start school without needing to use the walker or elevator •Attend school full time with a full schedule Brenden with his steer at the county fair. September to December (8-11 months) Post Injury •From Visible to Invisible oWalking with a walking stick oExaggerated step continues oTransitions to not using the walking stick oTinted Glasses •Appointments oSeptember: Virtual oOctober, November, December: In Person •Social Life oAttempted attending sporting events oShowed cattle oGoing to Noonanswith trainer September -December (8 -11 Months) Post InjurySchool Implications Return to School 2023-2024 School Year (10th Grade) oInformation to his teachers oTeacher notes were very important to Brenden oWould spend 3 - 4 hours per day reviewing his school day and doing homework oDemonstrated superb communication and planning with his teachers when he was going to be absent for appointments. oHe was trying various assistive technology tools; but not sticking to them … AT SCHOOL. oBreaks Cattle Shows •Brenden continued to show at cattle shows in the fall and winter, he used his show stick to help him keep his balance when walking in the ring. •This activity became a driving motivation to continue to work hard at school and therapy. Brenden showing his heifer. December 23, 2023, Christmas Video for his HCMC Team December 23 2023_slide 40.mp4 January 2024 (12 Months) Post Injury Officially Graduated from TBI Outpatient Program at HCMC o4 Emergency Room visits o4 days hospitalized o11 Magnetic Resonance Images (MRI) oSpinal Tap o23 providers o148 appointments Brenden with his family and therapy team at HCMC. January -June 2024 (12 -17 Months) Post Injury •From Visible to Invisible oGait and walk are normal oStill wearing glasses with prisms; but they are not tinted oBack driving the tractor, helping on the farm oFarmer’s Permit (March) oDriver’s Licence(June) oSocial Life oSuccess attending local sporting events oAttending longer events with more people is still challenging and exhausting oBrain Injury Awareness at Church Attending Activities Brenden attended wrestling matches, trying to find his new normal as a spectator of the sport that was once very central in his life. Brenden at a wrestling match with his good friends. January -June 2024 (12 -17 Months): School Implications Annual IEP Meeting was held 14 Months after the injury oEverything is GREAT, per Brenden! •Parents prompted … “Is everything really great?” oBrenden was taking an AP Biology Class. •What did it take from Brenden to successfully complete this class? oUse of accommodations was slipping at school; but was using some of them at home. From Visible to Invisible •Visible oReadily seen by the outside world •Mobility impairments •Invisible oFelt only by the survivor themselves oAn illness, impairment, or health problem that impacts the individual’s daily life but cannot be immediately seen by other people oCan include emotionally, cognitively, and physically impaired The Invisible Injury •An invisible injury allows you to “blend in” to the world without being forced to discuss your injury •Emotionally isolating when the reality of daily symptoms and struggles are not known/shared •Serious misunderstandings between friends, family, coworkers, and even doctors who may not recognize the challenges faced •Personal relationships with friends and family can result when the injury/disability is not understood •Just because pain or struggle is not visible does not mean its not there May 10, 2024 “The most beautiful part of this picture isn't even seen. My son suffered a traumatic brain injury that required him to have to learn to walk and read again. Seventeen months after his injury he was able to take part in his school's FFA sponsored drive your tractor to school day. It was this very community and my son's learned drive and work ethic that allowed this very moment to happen.” Joe Bryce Brenden driving his tractor to school. July -December 2024 (18 -23 Months) Post Injury •Invisible oEverything is 3 Steps •Pre-Plan: Easy Day Before •Plan: Event •Post-Plan: Exhausted from Event oReading Confirmation Cards oVision •Visual Breaks oMemory •Social Life oSummer Activities •Boating •Valley Fair oSlow to Commit to Activities oOver Analyzes going to Activities •Sporting Events •Mid Winter July - December 2024 (18 - 23 Months) Post Injury: School Implications o1st Semester oCollege Chemistry oCollege US History oBuilt in Study Block •Everything is FINE! •Determined to achieve at the same rigor as everyone else •Using the strategies that the TBI Clinic recommends January 2025 (2 Years) Post Injury •Invisible •Vision concerns continued, started weekly vision therapy back at HCMC oEyes not working together oTwo new pairs of glasses, took prisms out, one pair for reading, one for distance Brenden and his sister, Briella, holding up a poster of pictures of their cattle and logo. 2 Years Post Injury: School Implications •Schedule adjustments for attending weekly appointments •Classes 2nd Semester oCollege Composition I oCollege Chemistry oCollege US History oStudy Block • Making sure teachers understand vision needs Accessing Resources •We live in Outstate Minnesota •The HCMC Traumatic Brain Injury Clinic is 136 Miles from home, and takes 2 Hours 12 Minutes to travel. •Amazing providers who scheduled all the appointments together, but this was exhausting for Brenden! •Lacy’s knowledge as a Special Education Teacher for teaching her son how to read again. Learning to Be a Self Advocate •Learning about the accommodations/modifications in his IEP •Processing how things make him feel and what he can do about it and then acting •This means learning what life is like and how to accept the challenges Brenden giving presentation at church during Brain Injury Awareness Month. Planning for Transition to Adulthood •Transition to College oDisability Services •Transition Team oDisability Specialist oVocational Rehabilitation Services •Executive Functions •Executive Dysfunction oSchool work oSocial problems oWork problems Brenden in the barn showing his little cousin the cattle. •Individuals with a TBI may not know what accommodations they are going to need and they may not have the executive functions to anticipate and plan. •Recovery from TBI continues for YEARS, so accommodations WILL change as the individual and their difficulties change. •Additional support may be needed for emotional responses. •Monitoring the outcomes of accommodations is critical. Brenden’s Favorite Quote Strength is not the absence of struggle. Even strong folks come up short, question themselves, navigate uncertainty, and experience hardship. Real strength is not a status, it is a decision. It is looking every condition, circumstance, and conundrum in the eye and determining …in this, through this, and in spite of this, I WILL RISE. Charting the Cs logo Thank you! Sarah Golden Physical Health Disabilities Teacher Traumatic Brain Injuries Specialist Other Health Disabilities Specialist Email: sgolden@alexschools.org Lacy Bryce Parent Special Education Teacher Email: lbryce@alexschools.org