When Your Child Goes to School After an Injury.

Lash M. Boston, MA 02134-4646, Exceptional Parent Magazine, 1992, paperback, 67 pp, illus, $7.50.

This book is aimed at assisting the family and child in making a smooth transition from the medical setting back to the school setting after a traumatic injury.

The thesis of the book is that the expectations and reactions of others to the injured child will affect the adjustment of the child at school. Throughout the book, the author relates common reactions experienced by parents, teachers, children, and physicians on topics relating to the injury, healing, and return to school. Each section of comments is followed by an explanation summarizing the view of the commenting group. Parents, for example, frequently hope and expect that, once the child is discharged from the hospital and returns to school, everything will return to normal. Teachers may feel unprepared to deal with the special needs of the child returning to school, and their uncertainty may be complicated by a lack of understanding of the cause and course of the disability. The involved child must deal with acceptance, or lack thereof, by the other children. Finally, physicians frequently do not understand the special education system and are unsure of their role and the information they need to provide. Chapter 1 recommends open and frequent communication between the parents and school personnel, and each subsequent chapter addresses specific concerns.

The second chapter serves as an introduction to special education, beginning with a summary of Public Law No. 101-476: Individuals With Disabilities Education Act. It is explained that federal law sets a basic standard for all states, and that each state then determines the exact services that it will provide. A glossary of words commonly used in special education includes terms such as "advocate," "assessment," "due process," "educational objectives," "individualized eduction plan," "least restrictive environment," and "zero reject." Although the term "inclusion" is not in the glossary (hopefully it will be added to the second edition), the concept is covered under "least restrictive environment," which explains that children with disabilities should be educated with children who are not disabled whenever possible. The term "assistive technology" also did not make the glossary, but is introduced in this chapter and is more thoroughly covered in later chapters.

Chapter 3 encourages parents to become their child's service coordinators and provides a series of checklists to assist them in obtaining the information necessary to develop an educational plan and make the transition from hospital to school. The checklists are divided into categories. The physical needs checklist covers mobility, positioning, breathing, fatigue, medications, toileting, eating and drinking, and social activities. The sensory needs checklist covers vision, hearing and noise, and sensation. The learning needs checklist covers changes in cognition, speech and communication, and judgment. There are also checklists for social needs, transportation, and emergency plans. The parent is given specific suggestions regarding how to be an effective service coordinator and where to obtain additional information and training.

The fourth chapter concentrates on preparation for the child's return to school through communication with all involved prior to the actual return. Specific suggestions are given to make connections between the teacher and child, teacher and hospital staff, and child and classmates. The book does not overlook the possible impact that the injured child returning to school might have on siblings. Chapter 5 addresses issues related to traumatic brain injury that might affect school performance. The author describes potential problem behaviors, such as impulsiveness, inappropriate sexual behavior, and passivity, using a descriptive, "teacher reports" approach. The parent is provided with a list of questions for each category to assist in better defining the problem and to begin addressing potential changes to improve the behavior.

Speech and communication are covered in chapter 6. The pros and cons of different types of aided and unaided communication systems are addressed. The section on choosing technology provides a list of questions that might be used by any education team considering the purchase of augmentative communication systems. It is emphasized that the child should be involved in choosing a communication system and that communication is an evolving process. Chapter 7 addresses transportation safety. The parent is provided with a list of questions to ask, specific safety rules for transporting wheelchairs, and a list of safety resources. The final chapter encourages the parent to become familiar with laws, other than those addressing education, that might directly affect the rights of children with disabilities, such as the Americans With Disabilities Act and the Rehabilitation Act. The book concludes with a resource list. Although the book was intended to be used by families of children who have experienced traumatic injury, children with disabilities frequently have much in common regardless of the cause of disability, and the questions and resources might benefit others. I think that this is a very helpful book, but suggest that, before using it, a parent review the material with a professional, because a great deal of information is provided. In fact, reviewing this book together would be an excellent method of opening communications between school personnel and the family. From a physical therapist's perspective, I appreciate the effort made by the author to explain the differences in school-based therapy and therapy provided in the medical setting.