At the end of this chapter, you should be able to:

• Describe how traumatic brain injury can affect a student’s social, academic, and emotional abilities.

• Recall effective teaching practices for working with students with traumatic brain injury.

• Understand how they can encourage participation.• Describe strategies that would be helpful to the transition of students with TBI.

Chapter 13 Objectives

Traumatic Brain Injury

Chapter Objectives

Who Is Jarris Garner?

• Jarris is a 10-year-old girl who was involved in a serious car accident when she was only seven months old.

• Jarris spent much of her recovery at her grandmother’s home, so she could be in quiet surroundings.

• Her mother had her enrolled in the Language Acquisition Program in order to focus on her use of language and communication, even learning sign language (ASL).

• Her entire family learned ASL in order to communicate with her, and Jarris learned how to be part of a social community.

• She is currently in a general education classroom; she enjoys sports, but has to avoid contact sports so as not to reinjure herself.

Chapter 13

Traumatic Brain Injury

• Traumatic brain injury (TBI) is an acquired injury caused by external physical force.

• Most common term for the effects of external physical force is concussion• Two types of brain injury not covered:

– Anoxia: loss of oxygen from illness or accident– Congenital brain injury: injury present at birth

• Two types of TBI:– Closed head injury

• Post-concussional syndrome– Open head injury

Defining and Identifying Traumatic Brain Injury

How Do You Recognize Students with Traumatic Brain Injury?

Describe traumatic brain injury

http://pediatrics.about.com/gi/dynamic/offsite.htm?zi=1/XJ&sdn=pediatrics&zu=http%3A%2F%2Fwww.tbiguide.com%2F

• Characteristics will vary according to:– Site and extent of injury– Length of time student was in a coma– Student’s maturational stage at the time of injury

• Possible changes due to TBI:– Physical– Cognitive– Linguistic– Social, behavioral, and personality

Describing the Characteristics

How Do You Recognize Students with Traumatic Brain Injury?

Describe traumatic brain injury

http://kidshealth.org/parent/general/body_basics/brain_nervous_system.html

http://www.pbs.org/wnet/brain/3d/index.html

• Major causes:– Accidents

• 28% of all accidents result in head injuries– Falls– Violence-related incidents

• Are the leading cause of TBI-related death• Child abuse• Shaken-impact syndrome

– Sports and recreational injuries

Identifying the Causes

How Do You Recognize Students with Traumatic Brain Injury?

Describe traumatic brain injury

• Emotional Stages of Recovery– Confusion and agitation– Denial– Anger and depression– Testing phase– Uneasy acceptance– Emotional adjustment

Identifying the Causes

How Do You Recognize Students with Traumatic Brain Injury?

Describe traumatic brain injury

Determining the Presence

How Do You Evaluate Students with Traumatic Brain Injury?

Figure 13-7

• Personal intervention plan• Team should ask:

– What can the student do now?– What does the student need to do next?– Who will be responsible for the student’s educational program?– How will the team determine if the educational program is working for the

student?• The team will:

– Obtain as much knowledge as possible– Know the student’s specific deficits– Not equate the student’s physical recovery with overall recovery– Be clear about expectations– Not give the student major responsibility for making decisions if his disability

interferes with decision-making abilities

Recall effective teaching practices for working with students with traumatic brain injury.

How Do You Evaluate Students with Traumatic Brain Injury?

Determining the Nature and Extent of Services

• School re-entry– establish linkage between the trauma center/rehabilitation hospital and the special

education team at the school– determine whether the child needs to relearn material previously known– supervision may be needed (i.e. between the classroom and restroom) as the child

may have difficulty with orientation– because the child's short-term memory may be impaired, what appears to have

been learned may be forgotten later in the day– Demonstrate new tasks, state instructions, and provide examples to illustrate ideas

and concepts– Be prepared for students' reduced stamina and increased fatigue and provide rest

breaks as needed– Keep the environment as distraction-free as possible.

Recommendations

How Do You Recognize Students with Traumatic Brain Injury?

Recall effective teaching practices for working with students with traumatic brain injury.

Including Students

How Do You Assure Progress in the General Curriculum?

Recall effective teaching practices for working with students with traumatic brain injury.

What You Might See What You Might Be Tempted

to Do

Alternate Responses Ways to Include Peers in the Process

Behavior The student may show behavior and personality changes, such as temper, outbursts, anxiety, fatigue, or depression.

Respond with strong disapproval and discipline her new behavior.

Reward her positive behaviors. Provide predictable routines that encourage normal behavior patterns while teaching her new ways to respond within the school environment.

Give her time to work in natural settings with peers who will encourage appropriate behavior yet show acceptance during the relearning stage.

Social

interactions

She may have forgotten social skills and experience social misunderstandings because of her new identity struggles.

Ignore her social difficulties and hope they go away.

Work with both the speech pathologist and the school counselor to plan the best ways to use language and social skills in successful situations.

Allow friends with whom she feels secure to role-play social activities. Structure new opportunities for successful inter- actions. Use videotapes for self- evaluation.

Educational

performance

Learning new information may be difficult for her, or it may take her much longer to process information.

Require extra work in areas of difficulty rather than focus on holding skills and what she can accomplish.

Capitalize on what is familiar to retrieve and develop memory, organization, and cognitive processes. Prioritize the academic skills she needs to learn.

Have her brainstorm and work with her peers/friends to practice skills as well as to plan future projects and educational aspirations.

Classroom

attitudes

She may appear easily distracted, have headaches, or show a lack of motivation during instruction.

Reprimand her apparent lack of participation. Discipline her or excuse her from class activities.

Allow her to take rest periods. Modify the amount and intensity of her assignments.

Pair her with a partner and friend who can help her focus and participate meaningfully during instruction.

• Learning and behavioral difficulties– Difficulty with logic, thinking and reasoning– Slower to respond, react and complete activities and tasks– Difficulty focusing attention– Physical limitations– Inappropriate social behaviors– Difficulty remembering– Frequently puzzled or challenged by grade level work– Difficulty learning– It is believe that TBI has a profound effect on new learning even though previous

learning may remain in tact– Never underestimate the potential for growth and development– Some TBI children will have speech and language deficits

Characteristics

How Do You Recognize Students with Traumatic Brain Injury?

Recall effective teaching practices for working with students with traumatic brain injury.

• Best Practices– Become informed, work with the parents to understand as much as you can about the child– Exercise patience and alter your expectations,– Set the student up for success– Repeat instructions, directions as needed and provide one direction at a time– Allow the student more time to complete tasks and reduce the workload if needed– Activities/tasks requiring the student to concentrate for long periods of time should be

avoided– It's important to remember that the student takes a longer amount of time to process

information– Be sure to have consistent routines and rules– Keep distractions to a minimum– Remember to assess this student with an approach that will meet his/her needs - i.e.,

additional time, more observation etc.– Make sure the IEP is in place and that it is flexible - a working document. Each child with TBI

is unique in needs.– The child may require a modified schedule and or a behavioral plan– The child may need direct support in organizational strategies

Recommendations

How Do You Recognize Students with Traumatic Brain Injury?

Recall effective teaching practices for working with students with traumatic brain injury.

• Altering curriculum and instruction– Mnemonics

• Keyword method• Pegword method• Letter strategies

– Acronyms– Acrostics

• Augmenting curriculum and instruction– Review background knowledge– Modifications and accommodations– Alter how students practice and demonstrate what they are learning

Planning Universally Designed Learning

How Do You Assure Progress in the General Curriculum?

Recall effective teaching practices for working with students with traumatic brain injury.

• Collaborating to meet students’ needs– Collaboration is crucial in facilitating a reentry to school from a hospital or

rehabilitation center– A core team can be used to develop plans and foster communication

between family and professionals– The diverse perspectives of team members allow for more active problem

solving

Planning Universally Designed Learning

Chapter Objectives

How Do You Assure Progress in the General Curriculum?

Chapter 13 Technology Tipshttp://wps.prenhall.com/chet_turnbull_exceptional_4/0,8158,952953-,00.html

http://en.wikipedia.org/wiki/Personal_digital_assistant

What Can You Learn from Others Who Teach Students with Traumatic Brain Injury?

The Early Childhood Years

• The Children’s Place, Kansas City, Missouri• A non-specific program dedicated to serving the needs of preschool children

with challenges caused by their environment• The program often serves as a transitional program after a rehabilitation

center.• Team members work closely with the child’s primary caregiver, and the

program is continued in the home.• The program works to also transition students into a traditional preschool

program.

Early Childhood

Chapter Objectives

What Can You Learn from Others Who Teach Students with

Traumatic Brain Injury?

The Elementary Years

• Centennial Elementary School, Lawrence, Kansas• Jarris attended Centennial Elementary in the general education program.• Her teachers had to learn about TBI as she progressed.• A supportive collaborative team developed a program that would accelerate

Jarris’ learning while meeting her immediate needs.• Her general education classroom teacher advocated for less pull out services,

and made numerous accommodations.• A special education teacher now conducts ASL workshops for any student

who expresses an interest so that they may communicate with Jarris.

Elementary

Chapter Objectives

What Can You Learn from Others Who Teach Students with

Traumatic Brain Injury?

The Middle and Secondary Years

• Shawnee Mission West, Shawnee Mission, Kansas• Middle and secondary students with TBI often need interventions that refine

self-management, learning, thinking, and problem-solving abilities.• Sometimes students may exhibit significant behavioral problems that require

specific instruction.• Teachers work to do functional behavioral analyses and develop plans to

prevent problem behaviors and develop better social interactions.

Middle and Secondary

Chapter Objectives

What Can You Learn from Others Who Teach Students with

Traumatic Brain Injury?

The Transitional and Post-Secondary Years

• Pepperdine University, Malibu, California• Students need to identify post-secondary institutions that are consistent with

their strengths and needs.• It is important to work with professors to let them understand the disability and

the student’s needs.• One challenge may be the ability to be independent and attend to basic daily

needs.• Study skills will also be a crucial need.

Chapter Objectives

What Can You Learn from Others Who Teach Students with

Traumatic Brain Injury?Transitional and Post Secondary

A Vision for Jarris’ Future

• Jarris has mastered ASL and can communicate effectively with her family, teachers, and schoolmates.

• Jarris’ parents want her to be able to choose and pursue whatever dreams she has.

• They believe she has the potential to succeed, and believe this developed from her early involvement with the LAP.