Information and resources for students with Traumatic brain injury (TBI)
What do we mean by traumatic brain injury?
Traumatic brain injury (TBI) is an impact injury to the brain which can cause learning and/or behavior disabilities (Rosenberg, Westling, & McLeskey, 2011).
What are the significant characteristics of students with traumatic brain injury?
The characteristics of students with TBI vary significantly depending on the type of injury and how the injury affected the brain of the individual (Rosenberg, Westling, & McLeskey, 2011). According to TraumaticBrainInjury.com, characteristics may include any of the following:
Cognitive deficits including difficulties with:
How many students have traumatic brain injury? What are the major causes?
Only 0.04% of school-age-children have TBI. The most common types of brain injuries resulting in TBI are:
What kind of identification and assessment procedures are used with students with traumatic brain injury?
Those with TBI will need to receive medical care, treatment, and continuous evaluation.When conducting an education evaluation for a student with TBI, the following questions will be addressed:
What educational practices improve outcomes for students with traumatic brain injury?
Students with TBI have varying progress, sometimes taking steps back. Teachers need to understand that student progress may not always be continuous and should be prepared for set-backs. Students with TBI perform best when teachers provide:
The following is a list of classroom modifications and strategies from Dade County Schools, Florida (2002):
Environmental Modifications:
What are some major issues related to educating students with traumatic brain injury?
Only a small percentage of students who have TBI are actually identified as having TBI under IDEA. Many students with traumatic brain injury are misclassified as having a learning disability, ADHD, behavior disorders, communication disorders, or physical disabilities, “but their educational characteristics and needs usually differ from these students’” (Rosenberg, Westling, & McLeskey, 2011 p. 322). “The majority of students who had identified brain injuries were receiving services under the disability categories of ‘Other,’ Speech Language, and Physical Disabilities” (Rosenberg, Westling, & McLeskey, 2011 p. 339). This may mean that students with TBI are not receiving the services they need. This is why it is very important to have the correct classification of disability on the IEP. It is equally important that teachers are addressing the unique needs of their students with TBI, and that they understand that the needs of a student with TBI are different from the needs of a student in another disability category. It is also important that teachers understand that a student with TBI will have varying abilities that may change from one day to the next.
Traumatic brain injury (TBI) is an impact injury to the brain which can cause learning and/or behavior disabilities (Rosenberg, Westling, & McLeskey, 2011).
What are the significant characteristics of students with traumatic brain injury?
The characteristics of students with TBI vary significantly depending on the type of injury and how the injury affected the brain of the individual (Rosenberg, Westling, & McLeskey, 2011). According to TraumaticBrainInjury.com, characteristics may include any of the following:
Cognitive deficits including difficulties with:
- attention
- concentration
- distractibility
- memory
- speed of processing
- confusion
- perseveration
- impulsiveness
- language Processing
- executive functions
- not understanding the spoken word (receptive aphasia)
- difficulty speaking and being understood (expressive aphasia)
- slurred speech
- speaking very fast or very slow
- problems reading
- problems writing
- difficulties with interpretation of touch, temperature, movement, limb position and fine discrimination
- the integration or patterning of sensory impressions into psychologically meaningful data
- partial or total loss of vision
- weakness of eye muscles and double vision (diplopia)
- blurred vision
- problems judging distance
- involuntary eye movements (nystagmus)
- intolerance of light (photophobia)
- decrease or loss of hearing
- ringing in the ears (tinnitus)
- increased sensitivity to sounds
- loss or diminished sense of smell (anosmia)
- loss or diminished sense of taste
- the convulsions associated with epilepsy that can be several types and can involve disruption in consciousness, sensory perception, or motor movements
- physical paralysis/spasticity
- chronic pain
- control of bowel and bladder
- sleep disorders
- loss of stamina
- appetite changes
- regulation of body temperature
- menstrual difficulties
- dependent behaviors
- emotional ability
- lack of motivation
- irritability
- aggression
- depression
- disinhibition
- denial/lack of awareness
How many students have traumatic brain injury? What are the major causes?
Only 0.04% of school-age-children have TBI. The most common types of brain injuries resulting in TBI are:
- Skull fracture
- Contusion (bruising on the brain)
- Epidural or subdural hematoma (blood clot near or on the brain)
- Concussion (slight injury to the nerve fibers of the brain)
- Diffuse axonal injury (severe injury to the nerve fibers of the brain)
What kind of identification and assessment procedures are used with students with traumatic brain injury?
Those with TBI will need to receive medical care, treatment, and continuous evaluation.When conducting an education evaluation for a student with TBI, the following questions will be addressed:
- What is the student’s current ability in key areas including academics, social development, and physical and health needs?
- What general curriculum goals are appropriate for the student, and to what extent and in what ways can the student participate in the general curriculum?
- What additional areas of instruction must be addressed?
- What related services and supports will be required to provide the student with an appropriate education (Rosenberg, Westling, & McLeskey, 2011 p. 329)?
- IQ test
- Assessments in reading, writing, and math
- Assessment of adaptive behavior skills
- Problem behavior rating scales
- Developmental and social history
- Speech & language assessment
- Occupational therapy evaluation
- Physical therapy evaluation in cases where students have gross motor problems (Logson, 2014)
What educational practices improve outcomes for students with traumatic brain injury?
Students with TBI have varying progress, sometimes taking steps back. Teachers need to understand that student progress may not always be continuous and should be prepared for set-backs. Students with TBI perform best when teachers provide:
- Instructional content that is presented in various ways and is appealing to student interest
- Help with organization and structure
- Review of previous material covered and a written outline of the material to be covered
- Repetition during instruction and emphasis of key ideas
- Positive reinforcement
- Immediate, specific feedback and correction
- Encouragement to ask questions about things they don't understand
- Assignments that are broken down into smaller sections
- Various methods of student response
- Pictures, diagrams, and other visuals
- Predictable routines
- An environment free from distractions
- Assistive technology
- Opportunities for the student to evaluate his own learning and notice the strategies, accommodations and interventions that are working best for him (Rosenberg, Westling, & McLeskey, 2011)
The following is a list of classroom modifications and strategies from Dade County Schools, Florida (2002):
Environmental Modifications:
- minimize extraneous auditory and visual stimulation (use study carrels or room dividers)
- provide preferential seating
- arrange seating to allow for more space between students
- provide small group instruction
- structure student's activities and schedule to limit number of changes and reduce unstructured time
- limit number of persons that the student deals with each day
- provide the student with a written schedule and keep the schedule as consistent as possible
- provide area to keep supplies, books, etc., away from student's work area
- select a classroom buddy
- gain the student's attention before speaking
- break complex tasks down into component parts and complete each part before trying to combine the components
- provide frequent repetition of important tasks
- utilize the child's best sensory modality
- question student to be sure the information was received and interpreted clearly and provide feedback as necessary
- provide cueing systems in the form of assignment books, placing task cues on student's desk, etc.
- provide verbal and written instruction
- shorten assignments and/or divide assignments into parts
- structure thinking processes graphically through outlines, graphs, flow charts and models
- develop a system for maintaining organization
- facilitate note taking by providing outlines with major headings
- give short frequent quizzes, rather than all inclusive exams
- accompany homework with written instructions
- initiate a behavior modification program for academic and/or interpersonal behavior skills encouraging student to chart his or her progress.
What are some major issues related to educating students with traumatic brain injury?
Only a small percentage of students who have TBI are actually identified as having TBI under IDEA. Many students with traumatic brain injury are misclassified as having a learning disability, ADHD, behavior disorders, communication disorders, or physical disabilities, “but their educational characteristics and needs usually differ from these students’” (Rosenberg, Westling, & McLeskey, 2011 p. 322). “The majority of students who had identified brain injuries were receiving services under the disability categories of ‘Other,’ Speech Language, and Physical Disabilities” (Rosenberg, Westling, & McLeskey, 2011 p. 339). This may mean that students with TBI are not receiving the services they need. This is why it is very important to have the correct classification of disability on the IEP. It is equally important that teachers are addressing the unique needs of their students with TBI, and that they understand that the needs of a student with TBI are different from the needs of a student in another disability category. It is also important that teachers understand that a student with TBI will have varying abilities that may change from one day to the next.
For more information about teaching students with TBI, visit the following websites and view the document and video below:
http://www.brainline.org/content/2008/07/classroom-interventions-students-traumatic-brain-injuries_pageall.html
https://www.naset.org/traumaticbraininj2.0.html
http://specialed.about.com/od/disabilities/a/tbi.htm
http://learningdisabilities.about.com/od/publicschoolprograms/a/braininjuryprgm.htm
http://www.braininjury101.org
http://www.mayoclinic.org/diseases-conditions/traumatic-brain-injury/basics/definition/con-20029302
http://www.brainline.org/content/2008/07/classroom-interventions-students-traumatic-brain-injuries_pageall.html
https://www.naset.org/traumaticbraininj2.0.html
http://specialed.about.com/od/disabilities/a/tbi.htm
http://learningdisabilities.about.com/od/publicschoolprograms/a/braininjuryprgm.htm
http://www.braininjury101.org
http://www.mayoclinic.org/diseases-conditions/traumatic-brain-injury/basics/definition/con-20029302