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Teaching Students with Epilepsy

Hannah AndersonDr. Vanessa Tucker

+What is epilepsy? Epilepsy is a general term used for a group of disorders

that cause disturbances in electrical signaling in the brain.

An epileptic seizure happens when the energy pulses in the brain come too fast – up to 500 pulses per second – for a short time.

Seizures can be caused by anything: Flickering lights Stopping anti-epileptic medicine High fever Sometimes there are no causes at all

*http://www.ehealthmd.com/library/epilepsy/epi_whatis.html*

+Types of Seizures There are 40 different types of seizures – some

produced by the whole brain and some produced by only a portion of the brain

Children may have more than one type of seizure in their lifetime

Epilepsy is diagnosed when a child or person has two or more seizures that are provoked by causes such as low blood sugar or a high fever

http://www.epilepsy.com/info/family_kids_diagnosis

+Whole Brain Seizures Tonic Clonic (Grand Mal)

Unconsciousness, muscle rigidity, convulsions Most severe type of seizure Student may foam at mouth and lose control of bladder during

seizure, as well as go into a deep sleep called the postictal stage after seizure is finished

Tonic = Muscle stiffness and rigidity Clonic = Repetitive, jerking movements

Absence Brief period of unconsciousness, student may appear to be

“spacing off” but actually may be seizing

Myoclonic Sporadic jerking movements; may cause student to inadvertently

throw or drop objects

Atonic (Drop Seizures) Sudden loss of muscle tone, primarily in arms and legs, which

causes student to fall

http://www.webmd.com/epilepsy/guide/types-of-seizures-their-symptoms

+Partial Brain Seizures Simple

Jerking movements, muscle rigidity, sensations interfering with seeing, hearing, speaking, etc.

Emotional and memory disturbance

Complex Involuntary yet coordinated movements such as lip-

smacking, chewing, or fidgeting

Partial Seizure with Secondary Generalization Seizure begins with conscious activity and then turns into

unconsciousness later in the seizure

http://www.webmd.com/epilepsy/guide/types-of-seizures-their-symptoms

+Pros of Inclusion Many times seizures will affect the language ability of a

child so social interaction is imperative

As the child gets older he/she may become embarrassed of their seizures so it is important that they have early positive interactions with their peers

General education students have the chance to work with the epileptic student, giving them a broader idea of their world

Epileptic student may start copying other students’ behaviors and may learn new skills throughout the year

Teaches student with seizures how to advocate for themselves and deal with issues such as post-seizure behavior, incontinence, etc.

+Cons of Inclusion Seizures can be scary for other students to see

There are a lot of para-educators and para-nurses that come with a student with a severe seizure disorder so it can, at times, become distracting in the classroom

If the epileptic student has a dog, this can be a major adjustment to some students who might be nervous around dogs

The dog can be quite distracting if it is not trained correctly

There are not as many seizure safe areas in a general education classroom

+What does the research say? Prevalence

In the US, an estimated 300,000 children under the age of 14 have epilepsy. http://www.efwp.org/programs/epilepsy_learning.shtml

Implications on learning No single aspect of epilepsy can accurately predict how a child’s

learning will be affected Many children that have had tonic-clonic seizures have some form

learning disability http://www.efwp.org/programs/epilepsy_learning.shtml

Is there anything to help with seizures’ implications on learning? “In some individuals, suppression of discharges by antiepileptic drugs

has demonstrably improved psychological function, but further work is required to determine the indications for such treatment.” Binnie, C.D., Channon, S., & Marston, D. (2007). Learning disabilities

in epilepsy: neurophysiological aspects . Epilepsia, 31, S2 - S8.

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Binnie, C.D., Channon, S., & Marston, D. (2007). Learning disabilities in epilepsy: neurophysiological aspects . Epilepsia, 31, S2 - S8.

In the article, Learning Disabilities in Epilepsy: Neurophysiological Aspects, the authors of this article found that when a seizure lasts more than 3 seconds, there is some cognitive impairment

They also found some specificity in the types of learning difficulties as to where the seizures were spiking When a seizure spiked on the left, quite often that person had verbal

difficulties When a seizure spiked on the right, that person often had difficulty

handling non-verbal materials

Overall, the authors found that the seizure activity and discharges on the brain do actually cause an impairment on a child’s educational learning abilities

Some research has also been done on the effects of antiepileptic drugs, and the researchers mentioned that these drugs to help a child to focus and retain information more steadily, but they admitted that more research needed to be done on this topic.

Can Seizures Actually Affect Learning?Article Review #1

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Bishop, M., & Boag, E. (2006). Teachers’ knowledge about epilepsy and attitudes toward students with epilepsy: results of a national survey. Epilepsy & Behavior, 8, 397 - 405.

In this article, Bishop and Boag had 512 elementary and middle school teachers fill out a questionnaire about their beliefs and attitudes towards epileptic students, as well as their overall knowledge about epilepsy.

The results found that teachers generally had a very positive attitude about epileptic students, but there were significant deficits in the knowledge that teachers had about epilepsy

The results also found that there were many teachers who did not have regular contact with epileptic students, but were open to the situation when it arose.

This lack of overall knowledge about epilepsy left teachers searching for ideas as to how to effectively reach out to epileptic students, and the academic program they should be on.

The researchers found that a teacher’s attitude and willingness to learn has a direct impact on their comfort level of teaching students with epilepsy.

Teachers’ Attitudes About EpilepsyArticle Review #2

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Epilepsy and Learning. (2009). Retrieved November 09, 2010, from http://www.efwp.org/programs/epilepsy_learning.shtml

This website contains many valuable pieces of information on epilepsy and how it affects a child’s learning.

This site reports that every child’s learning difficulties are different due to the vast variability of the types of seizures. Some contributing factors as to how much the seizures will affect learning are how

long the seizures have been occurring, the severity of the seizures, and the age of the child.

Some seizures, though, are not as severe, such as absencia seizures, where the student looks like he/she is dozing off, but these seizures can cause a student to lose out on the instruction being given.

Anti-epileptic drugs The drugs that students with seizures take can also have an effect on learning,

because quite often these drugs will make the student drowsy or so hyperactive that they struggle to concentrate

Overall, this site explains that each child is different in their learning strengths and difficulties, but understanding these struggles will help a teacher be much more effective. The drugs that students with seizures take can also have an effect on learning,

because quite often these drugs will make the student drowsy or so hyperactive that they struggle to concentrate

Epilepsy and LearningArticle Review #3

+Modifications

*These modifications are primarily for students who are with a para-nurse to take care of their seizures or can

predict their seizures coming*

Sound specific instruction Gives the student the opportunity to verbally express his/her

knowledge about the sounds

Guided coloring activities Coloring can be a great fine-motor activity for students

Stamps for name to help with fine motor issues Allows students to feel independent about showing their

name

Larger pictures for coloring Because many epileptic students have issues with fine

motor skills, larger print and larger pictures to color are effective

+More Modifications… Puzzles and electronic games to help with letter name

retention Anything with pushing buttons instead of only writing can

help a student display their knowledge

Signing to help with language deficits Due to language deficits, using sign in the classroom can

help to ease communication issues

Set clear expectations of parameters around learning Students respond well to boundaries and consistent

schedule http://www.uscupstate.edu/uploadedFiles/library/about/

faculty_staff/Vol1_Issue2.pdf

+Accommodations Always have a visual schedule for student

Have a specific spot that the student will sit to enable a routine to be made

Openly communicate about seizure protocol with all staff involved

Allow student to point to numbers and letters to show learning if language skills are affected

Allow student more time for activities for them to feel like they have to time to complete it to their full ability

+Seizures Remain calm

Do not restrain individual

Follow school and parent approved protocol

If convulsing, lower student to the floor away from hard objects

Loosen ties and shirts

Have a plan as to how to take class out of room if child is having a seizure (dependent on age of class)

Child may lose consciousness In this case, stay with child and if he/she regains consciousness,

reassure them If the child loses consciousness, there is usually a bladder/bowel issue

that comes as well

For a non-convulsive seizure stay with the child until the seizure has passed and then document seizure length

All information taken from http://www.as.wvu.edu/~scidis/epilepsy.html

+Safety Plans For students with seizures or any medical condition, the staff may be

asked to provide medicine, call 911, or perform other seizure related duties

Children with potentially life threatening conditions must have a safety plan that is written by the school nurse. The school nurse should be in collaboration with the child’s doctor or designated nurse.

Staff needs to be trained by medical professionals and not just parents – staff need to operate under the legal boundaries that are given to them

All staff must be aware of the key aspects of the safety plan, such as when to call 911, medicines he/she might need, and the line of communication when the seizure occurs – these plans should be review at least once a quarter.

ALL medical questions and orders must go through the school nurse

When a child is having a tonic clonic seizure, the immediacy of their care is critical – therefore these safety plans and orders are of utmost importance

*Tucker, V. (personal communication, November 23, 2010*

+After the seizure…. Students are often embarrassed about their seizures

and other children’s reactions to them

Give the student a quiet place where he/she can relax after a seizure, as well as a place to change if there was a bladder or bowel movement accident during the seizure

The nurse may provide specific instructions as to how to help someone that is just coming out of a seizure

Reassure the student as these seizures can be very scary

Document length of seizure, protocol taken, and be very communicative with parents

+Dealing with Dogs If seizures are severe enough, some students may have a

seizure dog

These dogs will have a special harness on them that will signify when they are working

Talk to the parents about how strict they want to be about the “no-touch” rule when the dog is working

Be aware that seizure dogs are often very protective of their charges

Survey classroom quickly at the beginning of the year to ask if any child is afraid of dogs, as classroom switches may need to be made

Be communicative up front with parents of general education students to assure them that the dog will not affect their child’s learning

+Recommendations for the Dog Have a rest mat ready for the dog in the classroom

Set up a “petting party” every once in a while so students have the opportunity to pet the dog

Make dog seem like part of the class, and stress his importance to all students in the class

Talk to parents about the dog’s signals he/she will give when student is about to seize

Create a bond with dog when he is off work so a trust can be built

Have some treats ready for students to give the dog if they are uncomfortable at first

+Recommendations for the Classroom

Set up special jobs for epileptic students to help you with – whether it is delivering mail, sorting papers, or leading the line

Have parents come in and explain epilepsy so students have some knowledge about it

Praise the student often about his/her successes in school because often they feel very self-conscious about their seizures

Never let ‘em see you sweat – know the protocol so well that the epileptic student can trust that you will know what to do when he/she does seize

+Food For Thought..

Your attitude matters – if the students see that you are bothered by the extra work or are unsure around the epileptic student, it can affect their emotional mindset towards school Bishop, M., & Boag, E. (2006). Teachers’ knowledge about

epilepsy and attitudes toward students with epilepsy: results of a national survey. Epilepsy & Behavior, 8, 397 - 405.

Depending on the severity of the seizure disorder, life expectancy is never guaranteed, so enjoy your student and all of the amazing things they will teach you!

+References

Binnie, C.D., Channon, S., & Marston, D. (2007). Learning disabilities in epilepsy: neurophysiological aspects . Epilepsia, 31, S2 - S8.

Bishop, M., & Boag, E. (2006). Teachers’ knowledge about epilepsy and attitudes toward students with epilepsy: results of a national survey. Epilepsy & Behavior, 8, 397 - 405.

Epilepsy and Learning. (2009). Retrieved November 09, 2010, from http://www.efwp.org/programs/epilepsy_learning.shtml

Glass, J. (2009). Types of Seizures and Seizure Symptoms - WebMD. Retrieved November 22, 2010, from http://www.webmd.com/epilepsy/guide/types-of-seizures-their-symptoms

Strategies for Teaching Students with Epilepsy. (2009). Retrieved November 09, 2010, from http://www.as.wvu.edu/~scidis/epilepsy.html

Tucker, V. (personal communication, November 23, 2010

What Is Epilepsy? (n.d.). Retrieved November 09, 2010, from http://www.ehealthmd.com/library/epilepsy/epi_whatis.html

Whessler, J. (2006). Diagnosing Epilepsy In Children. Retrieved November 28, 2010, from http://www.epilepsy.com/info/family_kids_diagnosis