IDEA's Definition of "Traumatic Brain Injury"
"...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 child’s educational performance. The term applies to open or closed head injuries resulting in impairments in one or more areas, such as cognition; language; memory; attention; reasoning; abstract thinking; judgment; problem-solving; sensory, perceptual, and motor abilities; psycho-social behavior; physical functions; information processing; and speech. The term does not apply to brain injuries that are congenital or degenerative, or to brain injuries induced by birth trauma
injury.
Traumatic Brain Injury
A traumatic brain injury (TBI) is an injury to the brain caused by the head being hit by something or shaken violently. (The exact definition of TBI, according to special education law, is given below.) This injury can change how the person acts, moves, and thinks. A traumatic brain injury can also change how a student learns and acts in school. The term TBI is used for head injuries that can cause changes in one or more areas, such as:
thinking and reasoning
understanding words
remembering things
paying attention
solving problems
thinking abstractly
talking
behaving
walking and other physical activities
seeing and/or hearing
learning
Mild traumatic brain injury occurs when:
Loss of consciousness is very brief, usually a few seconds or minutes
Loss of consciousness does not have to occur—the person may be dazed or confused
Testing or scans of the brain may appear normal
A mild traumatic brain injury is diagnosed only when there is a change in the mental status at the time of injury—the person is dazed, confused, or loses consciousness. The change in mental status indicates that the person’s brain functioning has been altered, this is called a concussion.
Symptoms of mild traumatic brain injury:
Headache
Fatigue
Sleep disturbance
Irritability
Sensitivity to noise or light
Balance problems
Decreased concentration and attention span
Decreased speed of thinking
Memory problems
Nausea
Depression and anxiety
Emotional mood swings
The majority of people with Mild Traumatic Brain Injury recover after one year.
Moderate traumatic brain injury occurs when:
A loss of consciousness lasts from a few minutes to a few hours
Confusion lasts from days to weeks
Physical, cognitive, and/or behavioral impairments last for months or are permanent.
Persons with moderate traumatic brain injury generally can make a good recovery with treatment or successfully learn to compensate for their deficits.
Severe brain injury occurs when a prolonged unconscious state or coma lasts days, weeks, or months. Severe brain injury is further categorized into subgroups with separate features:
Coma
Vegetative State
Persistent Vegetative State
Minimally Responsive State
Akinetic Mutism
Locked-in Syndrome
Signs of Traumatic Brain Injury
The signs of brain injury can be very different depending on where the brain is injured and how severely. Children with TBI may have one or more difficulties, including:
Physical disabilities: Individuals with TBI may have problems speaking, seeing, hearing, and using their other senses. They may have headaches and feel tired a lot. They may also have trouble with skills such as writing or drawing. Their muscles may suddenly contract or tighten (this is called spasticity). They may also have seizures. Their balance and walking may also be affected. They may be partly or completely paralyzed on one side of the body, or both sides.
Difficulties with thinking: Because the brain has been injured, it is common that the person’s ability to use the brain changes. For example, children with TBI may have trouble with short-term memory (being able to remember something from one minute to the next, like what the teacher just said). They may also have trouble with their long-term memory (being able to remember information from a while ago, like facts learned last month). People with TBI may have trouble concentrating and only be able to focus their attention for a short time. They may think slowly. They may have trouble talking and listening to others. They may also have difficulty with reading and writing, planning, understanding the order in which events happen (called sequencing), and judgment.
Social, behavioral, or emotional problems: These difficulties may include sudden changes in mood, anxiety, and depression. Children with TBI may have trouble relating to others. They may be restless and may laugh or cry a lot. They may not have much motivation or much control over their emotions.
A child with TBI may not have all of the above difficulties. Brain injuries can range from mild to severe, and so can the changes that result from the injury. This means that it’s hard to predict how an individual will recover from the injury. Early and ongoing help can make a big difference in how the child recovers. This help can include physical or occupational therapy, counseling, and special education. It’s also important to know that, as the child grows and develops, parents and teachers may notice new problems. This is because, as students grow, they are expected to use their brain in new and different ways. The damage to the brain from the earlier injury can make it hard for the student to learn new skills that come with getting older.
Teaching
The educational needs of child with TBI will change quickly after the injury. Therefore, the child’s IEP goals and objectives must be developed initially for achievement over short periods of time, 4-6 weeks, rather than six months to a year as is traditionally done. Likewise, the child may need more frequent assessments than other children with disabilities.
Find out as much as you can about the child’s injury and his or her present needs.
Give the student more time to finish schoolwork and tests.
Give directions one step at a time. For tasks with many steps, it helps to give the student written directions.
Show the student how to perform new tasks. Give examples to go with new ideas and concepts.
Have consistent routines. This helps the student know what to expect. If the routine is going to change, let the student know ahead of time.
Check to make sure that the student has actually learned the new skill. Give the student lots of opportunities to practice the new skill.
Show the student how to use an assignment book and a daily schedule. This helps the student get organized.
Realize that the student may get tired quickly. Let the student rest as needed.
Reduce distractions.
Keep in touch with the student’s parents. Share information about how the student is doing at home and at school.
Be flexible about expectations. Be patient. Maximize the student’s chances for success.
Technology and modifications
For skills the child will never recover, such as memory, I will need to teach the child coping mechanisms, such as using a planner, a tape recorder, or other organizational aid.
Because the child may not have memory skills and/or lack the ability to determine cause and effect, any behavior modification plan must be concrete and short-term. For example, the child may have lost the knowledge that one is to be quiet in a library. To teach that behavior, I will rehearse the behavior with the child, talk about it, and provide clear guidelines as to what is expected and the consequences of incorrect behavior.
I will need to spend more time on antecedents verses consequences if the child does not cooperate, the child with TBI often will have impulse control problems. It takes concentrated, intensive effort (for the child) to learn behavior.
Physical protection must be considered when working with students with TBI. Whether because of loss of balance, impaired judgment, or an increase in impulsive behavior, these children are prone to additional head injuries. Therefore, close supervise is necessary on the playground, they may need change classes when the halls are less crowded, or, if conditions warrant, to wear a helmet at school.
Electronic organizers to enhance memory and organizational skills
Annotations
http://www.neuroskills.com/children.shtml I think this website is beneficial not only for myslef but would be an excellent source of information for parents
http://www.biausa.org/education.htm possibly the most informative website I found
http://specialed.about.com/cs/behaviordisorders/a/samples.htm good source for behavior plan contracts and reward charts
Zasler, N. (1996). Medical Rehabilitation of Traumatic Brain Injury. Hanley & Belfus, Inc: Philadelphia, PA. Easy to read information on subject
http://www.biausa.org/elements/research/CSUN05.pdf powerpoint presentation on various memory devices-interesting
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