A traumatic brain injury (TBI) means an acquired injury to the brain caused by an external physical force resulting in total or partial functional or psychosocial impairment, or both, that adversely affects educational performance. The term applies to mild, moderate, or severe, open or closed head injuries resulting in impairments in one(1) or more areas such as cognitive, language, memory, attention, reasoning, abstract thinking, judgment, problem-solving, sensory, perceptual and motor abilities, psychosocial behavior, physical functions, information processing, or speech. The term includes anoxia due to trauma. The term does not include brain injuries that are congenital, degenerative, or induced by birth trauma.
Possible Impact of Brain Injury
This is not a comprehensive listing. For more information refer to the resources section of this website.It
is difficult to predict the result of a TBI. Some mild injuries may result in significant long term deficits, while other seemingly severe injuries have limited lasting impact. Difficulties may or may not be apparent until the child resumes the academic and social demands of school. Other students may have very obvious motor, language, or cognitive deficits. It is important to keep communication open between the school team, parent, and medical personnel in order to determine the level of support needed.
A student with a TBI may appear to be
the same as a student with a learning disability, behavioral disorder,
or ADHD/ADD. There are some important differences to keep in mind. A
student who has suffered a TBI typically will improve for several years
post injury, with the most rapid improvement in the first year. IQ may
not be stable over time and may not be a good predictor of future
success due to underlying damage to the brain. It is common for a
student who has suffered a TBI to not recognize they have deficits. The
student sees themselves as they were before. This is a function of the
damage to the brain, not typical denial. A common result is lack of
willingness to learn compensatory strategies and/or recognize their
behavior difficulties.
Growing into the Injury
Young
children who suffer a TBI may not demonstrate difficulties for several
years. Typical maturation of the brain can be impacted by the injury;
therefore, as academic and behavioral expectation increase the student’s
deficit becomes more pronounced. A key time for this is upper
elementary and middle school. Typical students are becoming more
independent, organized and socially competent. They demonstrate more
behavioral self-control. A brain injury can impact development of these
competencies. A student who previously may have been exhibiting only
mild difficulties can look more and more out of the norm.
- Fatigue: It
is not uncommon for a student who has suffered a TBI to become easily
fatigued. Underlying difficulties will be more noticeable when this
happens. A gradual return to school, reduced assignments, or short rest
breaks maybe needed. This typically improves over time.
- Memory: The
student with a TBI may retain much of their previous learning but have
difficulty with new learning. It is also not unusual for marked
differences in performance to be seen from one day to the next. Unusual
gaps in learning may be demonstrated such as remembering how to add,
multiply and divide but not how to subtract. Checklists, visual
schedules, class notes, an assigned buddy, can help support the student.
- Processing speed: After
a TBI, the student may process very slowly and need support for note
taking and extended time for assignments. Multi-step direction will need
to be written down rather than presented orally. Student may need
lecture notes to follow along during class. A tape recorder may or may
not help due to difficulty attending to just auditory information
and the time required to review the tapes.
- Behavior: Changes
can be subtle or dramatic depending on the area of damage. Student’s
with TBI often do not recognize their deficits and may not respond to
typical behavior modification due to this and memory difficulties.
Positive Behavioral Support is the recommended strategy for working with
behavioral difficulties.
- Social: The
filter for what is socially appropriate behavior can be impacted in some
students with a TBI. The student may be easily influenced by peers, act
immature, or say/do inappropriate things. This can result in difficult
with peer group, frequent behavioral referrals, and difficulty in the
community. Counseling and re-teaching of appropriate behavior is needed.
Role-play, social stories, and self evaluation checklist are possible
techniques which may be helpful.
- Emotions: After
a TBI, the student may exhibit extreme emotional fluctuations. They may
loss control for seemingly unexplained reasons, laugh inappropriately,
cry easily, or become withdrawn. Teachers need to be understanding and
observant to impending difficulties. The child may need a place to go in
order to regain self-control. New strategies for dealing with the
situation can be taught after the student calms down.
- Organization: It
is not uncommon for a student with a TBI to have significant
organizational difficulties. It can impact completion of assigned work,
finding their way between classes, keeping track of materials,
completing multi-step activities and long term projects. Possible
strategies include use of visual schedule/supports, planner, alarm
watch, PDA with auditory cue, and/or a class buddy. The teacher and
parent need to work together in order to reinforce consistent use of the
strategy.
Information taken from:“Understanding
and Teaching Students with traumatic Brain Injury: What Families Need
to Know” Florida Department of Education Bureau of Exceptional Education
and Student Services, 2005
Free from DOE Publication # 312636
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“Brain Injury, ADHD, LD: What’s the Difference” by Sharon Grandinette, M.S.
Lash & Associates Publishing/Training Inc. 2006
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