Traumatic Brain Injury

SPED 4100/6100
Veronica Kuehler
Traumatic Brain Injury - IDEA Definition (P.L. 101-476)
300.8. (c)(12) Traumatic brain injury means an acquired injury to the brain
caused by an external physical force, resulting in total or partial functional disability
or psychosocial impairment, or both, that adversely affects a childs educational
performance (Vaughn, p 2, 2014).
Traumatic Brain Injury - IDEA Definition (P.L. 101-476)
Applies to open and closed head injuries, which impact students in one or more areas
including:
Cognitive Processes
Language
Memory
Attention
Reasoning
Abstract Thinking
Judgment
Problem-solving
Sensory, Perceptual, and Motor Abilities
Psychosocial Behavior
Physical Functions
Information Processing
Speech
(Vaughn, p 2, 2014)
Traumatic Brain Injury - IDEA Definition (P.L. 101-476)
NOTE: The TBI definition does NOT include brain injuries that are present from
birth, or caused by disease. In addition, it does not include trauma which was
inflicted during the birthing of the child.

Students with these brain injury types fall into other categories as defined in by
IDEA.

(Vaughn, 2014)
Traumatic Brain Injury - Working Definition
Students who have a physical injury to the brain which impairs at least one area of
their social, physical, mental, or emotional life and thus impacts their academic
performance.
Traumatic Brain Injury - Severe, Moderate, Mild
Loss of Consciousness

Severe Brain Injuries: Over 6

hours.
Moderate Brain Injuries: 20
minutes to 6 hours.
Mild Brain Injuries: Under 20
minutes.
Traumatic Brain Injury - Severe, Moderate, Mild
TBIs which are severe/moderate
injuries
Permanent damage and long
lasting effects.
Students typically are eligible for
IEP.
Multiple areas impacted.
TBIs which are mild
Temporarily affect academic
performance.
Associated with Concussions
Concussions are the most typical
TBI that general education
teachers encounter.
General Education teachers still
need educated about symptoms
and academic helps while the
student recovers.
TBI - Moderate/Severe Injury The impact of a moderate to severe
(TBI, 2017) brain injury depends on the
following:

1. Severity of initial injury

2. Rate/completeness of
physiological recovery
3. Functions affected
4. Meaning of dysfunction to the
individual
5. Resources available to aid
recovery
6. Areas of function not affected
by TBI
Results in permanent
neurobiological
damage.
Brain damage at
the cellular level.
Connections are
disrupted and not
re-established.

Produces lifelong
deficits to one or more
areas.
TBI - Characteristics Moderate/Severe Injury (TBI, 2017)
Physical Characteristics:
Lethargy
Vision
Loss of bowel/bladder control
Blurred vision
Dizziness (resulting in nausea)
Loss of vision
Seizures
Difficulty with depth
Chronic Pain
perception
Headaches
Hearing
Physical pain in limbs
Sensitivity to sounds
Other pains
Ringing in ears
Inability to control limbs and/or
Slurred Speech
fine motor skills
Loss of Taste and/or smell
Paralysis
TBI - Characteristics Moderate/Severe Injury (TBI, 2017)
Behavioral Characteristics: Cognitive Characteristics
Personality changes Difficulty with Thinking Skills
Inappropriate emotional Memory (Short term and long term)
responses Attention
Irritability Judgement/Reason
Frustration Difficulty understanding the spoken
Crying language
Laughing Difficulty processing sensory inputs
Swearing (touch, smell, hearing, etc)
Depression/Aggression Impulsiveness
Denial/Lack of Awareness Confusion
Speed of Processing
Moderate/Severe
typically have long
lasting effects for
academic performance...
TBI - Characteristics Mild Injury (DHHS, 2015)

Physical Changes for Behavior or Personality

Students Changes
Fatigued Frustrated
Tires more quickly More easily upset or
Continuing headache angered
Dizziness Anxious or moody
Sensitivity to light Withdrawn or isolated
and noise Impulsive
Decreased endurance Difficulty following the
Sleep changes established routine
Socially inappropriate
TBI - Characteristics Mild Injury (DHHS, 2015)

Cognitive Changes
Easily distractible Longer times to acquire
Trouble paying attention and staying on task knowledge
Memory difficulties Processes less quickly
Trouble learning new information Easily overwhelmed
Trouble recalling information Difficulty starting and/or
Missing words and concepts completing a task
Unable to organize information Difficulty with word retrieval
Inability to follow verbal instructions For assignments
mentally Within conversations
Easily confused with multiple step
problems/instructions
Mild typically impacts the
student from days to weeks
or months. Can affect
Academic Performance
Temporarily...
Academic
Accessing the General Curriculum
Teachers can help students with a TBI by addressing their
memory challenges, by:
Breaking tasks into component parts; present parts in gradually
increasing levels of difficulty
Frequently repeating information and summarizing it
Teach the students to use post-it notes, calendars, assignment books,
etc. as self-reminders
Teach students to categorize or chunk information (mnemonics)
Providing written, as well as verbal directions, for tasks
Demonstrate mental rehearsal
Link new information to prior knowledge

General Curriculum (DHHS, 2015)

 Teachers can help students with a TBI by addressing
their physical challenges, by:

Allowing frequent breaks to avoid cognitive fatigue and overload

Providing a quiet area for rest breaks
Adjusting expectations to take into account the students physical
problems (headaches, fatigue, medication side effects)

General Curriculum (DHHS, 2015)

Teachers can help students with a TBI by addressing their
attention/concentration challenges, by:
Structure and simplify the classroom environment as much as possible
Same schedule each day
Reduced clutter
Consistent cues (e.g. listen, look, name)
Written classroom rules
Establish nonverbal cueing system (e.g. eye contact, touch)
Tailor assignments and homework (three ten-minute assignments achieve
more than one half-hours assignment)

General Curriculum (DHHS, 2015)

Teachers can help students with a TBI by addressing their
behavior challenges, by:
Using positive reinforcement
Verbally acknowledge the student's strengths
Use corrective feedback (non-judgemental)
Teach the student to be self-aware about their role in the learning
Validate students

General Curriculum (DHHS, 2015)

Teachers can help students with a TBI by addressing their
processing challenges, by:
Pacing according to students processing speeds
Deliver content in small increments
Require responses (verbally, written, etc.) based on the student's
abilities
Sequence curriculum
Connect curriculum to prior knowledge
Teach how new material fits into the previous content
Advance notice for when student is going to be called on
Provide Wait-Time for class, so student can process the question
Extended time on assignments and/or tests

General Curriculum
DI
Differing Instruction

Reading
Student struggle with memory
and processing. They may not
remember what they just read or
why it is important.
Provide a good note taker
Provide Guided Notes
Have a textbook on audio
Repeat instructions and/or have the
student verbalize the instructions
back to teacher or peer
Provide written instructions with
minimal writing

Math
Learning math requires
comprehension and processing
abilities, areas which can be
affected by a TBI
Color code the steps to math problem
(1st, 2nd, etc).
Bold and enlarge print when
necessary
Repeat information verbally and
provide simplified written directions
Use math manipulatives
Chunk information and allow student
to practice step by step.
Guided lecture notes
 Writing
Some students have physical
impairments which can affect the
act of writing. The effort from
sending messages from the brain
to hand typically distracts students
from being able to write. They
spend more time practicing their
motor skills than working on the
composition skills.
Allow student to dictate their
compositions using speech to text
software.
Use graphic organizers.
Have a scribe when possible or a tape
recorder for student to use.

Proofing
Students need to focus on the
purpose of the skills, not their
motor processes.
When learning/practicing proofing
--Use color coordinating for proofing
--Allow for Text to speech software
so student can hear the errors.
--Have peer read and the student
verbally tell the peer the changes
necessary.
Repetition and Teaching
Strategies to the student
is the Key!
RTI-Meeting the needs of
Mild/Moderate TBI and
Severe
Tier II
Most students who return to school after a TBI will need Tier II interventions for
weeks, months, or longer.

1. Small Group instruction to revisit new content

2. Need to be taught how to chunk information, study skills, and other memory
techniques.
3. Repetition of content in various forms
Tier III
Specialist teaches student one-on-one

Organize content (highlighting, color coding, etc.)

Revisit content in various methods and means
How to manage behaviors and anxieties through coping skills

If the TBI is affecting their academic performance for months or years, it may be
time to refer them for a special education referral.
Brain Injury
Observation Form
http://cokidswithbraininjury.com/ckwbi/wp-content/uploads/2009/1
1/BI_Observation-Form.pdf
Resources
The USBE provides information to educators and parents of students with TBIs,
this can be found at:
http://www.schools.utah.gov/sars/Programs-Areas/Disability/Categories/Brain.aspx
http://www.schools.utah.gov/sars/Programs-Areas/Disability/Categories/Brain/TBIEducators.aspx
http://www.schools.utah.gov/sars/Programs-Areas/Disability/Categories/Brain/SchoolAdministrators.aspx
Work Cited
DHHS. (2015). Mild Traumatic Brain Injury: A Guide for Educators - When is a bump, more than a bump? Department of
Health and Human Services Health Resources and Services Adminstration:
http://www.schools.utah.gov/sars/Programs-Areas/Disability/Categories/Brain/TBIEducators.aspx.

TBI. (2017). Severe TBI Symptoms. TraumaticBrainInjury.com:

http://www.traumaticbraininjury.com/symptoms-of-tbi/severe-tbi-symptoms/.

Vaughn, S. (2014). Special Education & Traumatic Brain Injury (TBI): A summary of state definitions and guidance for
educating students with TBI-related disabilities. NASHIA, Washington D.C.
https://www.nashia.org/pdf/state_education_tbi_definitions_criteria.pdf.