Traumatic Brain Injury

• IDEA definition includes any acquired brain injury caused by an external physical force resulting in psychosocial impairment or functional disability, or both.

• To qualify, this injury must adversely affect a student’s educational performance.

• Does not apply to brain injuries caused by congenital conditions, birth trauma, or degenerative brain disorders.

• Multidisciplinary team should conduct a full assessment.

• Often requires an evaluative report from a medical professional.

• Medical evidence of an acquired injury to the brain, caused by an external physical force.

  • Medical report from a physician.

  • Medical and developmental history.

• Compare observation in classroom setting vs. social/non-classroom setting.

• Record review: Pre-injury performance.

• Parent interview: Pre- and post-behavior.

• Teacher reports/student work (pre- and post- injury).

• Multiple assessment approaches:

• Standardized testing.

• Dynamic assessment.

• Criterion referenced tests.

• Curriculum-based measures.

• Rating scales.

• Checklists.

• Practices should address the cognitive, social, and physical impacts of the injury

• Teacher can provide preferential seating

• Divide work into smaller sections

• May provide attention cues

• Implement a self-monitoring plan

• Teachers should perform frequent checks of understanding

• Students may benefit from mnemonic devices

• Hands on learning may also be helpful

• Teachers should provide a visual schedule with consistent daily routines

• 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.

(Source)

• Punishment is not seen as effective because the student has a difficult time connecting the punishment to the inappropriate behavior. Instead, they will blame the person punishing them.

• As much as possible, provide positive reinforcement.

• May require a speech language therapist.

• May also require occupational therapy.

• 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.

(Source)

• A medical report to indicate that the brain injury was sustained must be provided.

• Document medical information that provides evidence of a TBI and the limitations (total or partial functional disability or psychosocial impairment) of such a disability.

• Clearly state how ALL evidence supports the findings of the specific skill area(s) that is impaired.

  • Cognition.

  • Language.

  • Memory.

  • Attention.

  • Reasoning.

  • Abstract thinking.

  • Judgment.

  • Problem-solving.

  • Sensory, perceptual, and motor abilities.

  • Psychosocial behavior.

  • Physical functions.

  • Information processing.

  • Speech.

• Clearly state how ALL data supports the findings that the student’s behavior is significantly below that of peers.

• Clearly state how ALL data leads to the conclusion of the traumatic brain injury adversely affecting the student’s performance in the educational setting or natural environment.

The term "Adverse Affect" for students with Traumatic Brain Injury refers to:

All findings should lead to the conclusion that the unique behaviors/challenges the student is experiencing is associated with the disability and are occurring frequently and at a level of intensity that adversely affects performance in the PRESENT educational setting or natural environment.

Clearly state how ALL data leads to the conclusion of the traumatic brain injury adversely affecting the student’s performance in the educational setting or natural environment.

Teams should explain how the traumatic brain injury is adversely affecting the student’s performance in the educational setting or natural environment.

1. Connect the student’s performance and needs to the eligibility category selected.

   • Summarize findings with a concluding statement that connects the disability with the impact on education and the need for special education.

2. Determine and identify the specially designed instruction needed to make progress in the general education curriculum (Specially designed instruction means that the student must have adapted content, methodology or delivery of instruction.)

   • Describe the nature and extent of the student’s need for specially designed instruction. What does the student need in the areas of instruction, curriculum, and/or environment?

   • Identify the instructional strategies, accommodations, and modifications that the student needs to be involved in and progress in the general education curriculum.

*Identifying the ADVERSE AFFECT of the disability on education and the connection to the need for special education

1. You must connect the student’s performance and needs to the eligibility category selected.

2. You must summarize findings with a concluding statement that connects the disability with the impact on education and the need for special education.

Here are some guiding questions that can be used to help identify the adverse affect:

Identify the specific challenges because of the disability (Traumatic Brain Injury)

1. What are the unique difficulties or challenges the student is experiencing because of the traumatic brain injury?

2. Is academic learning affected?

3. Is communication affected?

4. Is independent functioning affected?

5. Are social/emotional interactions affected?

6. In what ways are the defined areas affected?

State the need for specially designed instruction (SDI) (Specially designed instruction means that the student must have adapted content, methodology or delivery of instruction). Determine and identify the specially designed instruction needed to make progress in the general education curriculum.

• Does the student need interventions that significatly differ in intensity & duration from what can be provided solely through general education resources and services currently in place?

• Is the need for specially designed instruction connected to the category for which the student was found eligible?

• What specially designed instruction does the student need?

Students with TBI may:

• Have short- and long-term memory loss.

• Need frequent breaks due to inability to concentrate for long periods of time.

• Have seizures or other neurological changes.

• Seem depressed, anxious, or show aggressive or inappropriate behaviors.

• As a result, suffer from cognitive, physical, or behavioral impairments.

• Experience a slowed processing speed and impaired ability for abstract thinking resulting in problems with organization and planning, as well as poor problem solving and decision making skills.

• Exhibit abnormal, as well as inappropriate, social behavior.

• Experience physical impairments such as quadriplegia.

• Experience apraxia-difficulty carrying out motor planning.

• Ataxia, or difficulty coordinating muscle movements.

• Lose previously learned skills.

• Impairments vary greatly in severity.

  • May be temporary or permanent in nature.

• Three types of Traumatic Brain Injury (TBI):

  • Mild TBI-trauma to head resulting in confusion for less than 30 minutes.

  • Moderate TBI-Loss of consciousness for up to 24 hours and post-traumatic amnesia for up to a week.

  • Severe TBI-Loss of consciousness over 24 hours and post traumatic amnesia for over a week.