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Traumatic Brain Injury

DOE definition:

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

Tip Card
“Brain Injury, ADHD, LD: What’s the Difference” by Sharon Grandinette, M.S.
Lash & Associates Publishing/Training Inc. 2006

Lash and Associates will send a free catalogue and tip card upon request
www.lapublishing.com

Contact Us

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Elizabeth Padilla
Specialized Instruction
Senior Administrator, ESE
407-317-3493

Resources

"Understanding and Teaching Students with Traumatic Brain Injury: What Families and Teachers Need to Know"

Florida DOE Bureau of Exceptional Education and Student Services, 2005

Request a free copy by email to cicbiscs@fldoe.org Product number 12636

Lash & Associates Publishing/Training Inc.

www.lapublishing.com

This company has many resources for parents, educators and students related to Traumatic Brain Injury. They publish a series of Tip Cards on the subject of TBI. A free catalog and a copy of the Tip Cards may be requested through the website.

Useful Links

Brain Injury Association of Florida
http://www.biaf.org

Closed Head Injury
http://www.brainandspinalcord.org/traumatic-brain-injury-types/closed-brain-injury/index.html