Moving from Medical Care to Educational Services

As your child returns to school, be alert to the following signs for concern:


  1. Meet with school and rehabilitation staff to determine how the brain injury is affecting your child.
  2. Discuss concerns with specialists or rehabilitation staff, especially the neuropsychologist who evaluated your child in rehabilitation.
  3. Ask for advice on developing a plan.

Rehabilitation Therapy at School

At this point in your child's recovery, rehabilitation services will fall into two types: medical rehabilitation therapy and educational rehabilitation therapy. Medical rehabilitation was the type of therapy your child received while in the hospital or rehabilitation program. Your child may receive one or both types of rehabilitation therapy after returning to school.

Students who need therapy to help them learn may be eligible for educational rehabilitation services provided by the school. It is important to remember that the school is an educational program, not a rehabilitation program. Your child will be eligible for rehabilitation therapy provided by the school if it is educationally necessary and part of the educational plan.

Physical, occupational, or speech therapy sessions at school may be shorter and less frequent than at the hospital. A common concern of parents is that their child is not getting enough therapy at school. Ask the therapists to explain the schedule for therapy, why it differs from previous programs, and how it will help your child at school and at home. The therapist at school may suggest additional medical therapy at home or an out-patient program if it is needed.

Sara had speech and physical therapy five days a week plus occupational therapy three times a week while she was in the rehabilitation hospital. When she went to school, they could only give her a half-hour with the speech therapist twice a week and one hour a week with the occupational therapist. We worried that she would lose some of the progress she had made. The school explained that they were responsible only for therapies related to her education. We set up some extra sessions with a private therapist in a rehabilitation clinic. We had to get special approval, but our insurance agreed to pay for 15 sessions.

Changing Needs

Children's needs change as the brain recovers from the injury and as the brain matures over time. Recovery from cognitive changes is harder to predict than physical recovery. Learning is a continual process that requires different skills as children enter different grades and study different subjects. Evaluation of your child's strengths and difficulties is an ongoing process because some changes may not show up for months or even years after an injury. There are critical points to watch for where children with brain injuries often have difficulty. These include:

At these points, it is important to:

Over time, you will become an expert on brain injury, and your experience as a parent becomes even more important. You are the only person who has seen your child progress through the many stages of care and recovery. You are also the one who sees your child consistently while teachers, classes, and schools change. You can help your child by:

  1. Providing information to new teachers and school staff about your child's medical and rehabilitation treatment
  2. Sharing observations of your child's strengths and difficulties
  3. Being an effective advocate by knowing your rights and those of your child under the state's law for education
  4. Coordinating the flow of information between teachers, classes, and schools
  5. Remembering that educating the school about brain injury is a long-term process, not a one-shot deal
  6. Finding experts on brain injury in your community to consult with the school as needed
  7. Working as partners, rather than adversaries, with educators whenever possible
  8. Exploring your child's hopes and goals to build a vision of your child's future

TIP: Be firm, but reasonable.

Try to keep a positive relationship with the school, even though you may have disagreements. Advocacy is not the same as arguing. Choose what is most important, and pick your battles carefully. Be flexible when you can.

Other parents are often the best resources. You are not the first to go through this. Ask the Brain Injury Association of New Hampshire to help you find parents with children of similar ages who have had brain injuries. Through their "Connections" program, the Brain Injury Association can put you in touch with survivors of brain injury or their family members. They can share with you their experiences with schools, information about effective strategies, and knowledge about resources. It is often other parents who can best understand your concerns, questions, and worries because they have shared them.

You have the right to bring a friend, other parent, or advocate with you to any meeting with the school, including a formal IEP meeting. You also can ask the team's permission to tape record meetings, so you can review information later or share it with your family.

As a parent you will have many roles, or "wear many hats", as you work with school staff to help your child get needed services and prepare for the future. You will be an advocate, a detective, a leader, a squeaky wheel, a coordinator, and an expert on your child. Whenever you feel frustrated or confused, remember that you have a commitment and perspective unmatched by any professional. You are the parent and always will be.