Traumatic brain injuries (TBI) are a leading cause of death and disability among children and adolescents, with an annual incidence estimated at 180 cases per 100,000 children between the ages of 1 and 15 in the United States (Yeates,2005). Traumatic brain injuries (TBI) are defined in the special education law in the Individuals with Disabilities Education Act (IDEA 1990) as being an “injury to the brain caused by an external physical force, resulting in total or partial functional disability or psychosocial impairment” that affects a child’s educational performance (Cave,2004).
Knowing that, students learning needs are different from students with other exceptionalities (Spear,2005). General and special education teachers need to use a variety of specific strategies based on learning styles and certain resources, with students who have experienced a TBI, to promote learning in all subject areas. A TBI alters a child’s mind and changes the way he or she thinks. Teachers must be aware of this and know how to adapt in order to accommodate their needs in the classroom. TBI’s change cognition and behavior in students and no two students with traumatic brain injury will display the same characteristics (Spear,2005).
Students who have sustained a head injury may experience problems in physical, cognitive, and psychosocial areas. Physical effects With regard to physical deficits, individuals with TBI may have an array of problems ranging from sensory deficits to difficulty with mobility. Headaches and fatigue are common, especially during the early stages of recovery (Bullock,2005). Their muscles may be “weak, hypotonic, or spastic,” which could interfere with learning activities such as writing and keyboarding. They may also experience seizures.
In general, schools are more proficient at making physical accommodations for students. Cognitive Effects Cognitive difficulties are common following a brain injury and some may seem quite baffling to educators unfamiliar with TBI (New York State Education Dept. ,1997). For example, children with TBI may have short-term memory problems, yet, may be able to easily recall information learned prior to their injury. This has significant implications for assessment purposes. Furthermore, it is possible for a student to perform well on “some widely used standard assessments” using his or her prior knowledge.
Such a “false indication” of the student’s current level of functioning may prevent the individual from receiving the proper services. To avoid this drawback, several different methods of assessment should be used when attempting to determine the needs of a student recovering from TBI. Memory is only one aspect of cognition that is affected by TBI. It also commonly affects a student’s ability to attend to “instruction, mental processing speed, and thought formulation and reasoning”. These are only a few of the hardships faced by students who are affected by TBI and educators must be aware of these problems.
Psychosocial Effects Difficulties that result from changes in the student’s social, emotional, and behavioral functioning are known as psychosocial effects (Bullock,2005). The changes in the brain resulting from the injury, along with stress and anxiety brought on by rehabilitation and recovery, may cause children with TBI to exhibit unusual emotional states, such as dramatic mood swings. This emotional state can bring negative reactions from peers and teachers and makes it difficult to maintain positive relationships.
When children with TBI return to school, their educational and emotional needs are often very different than before the injury. Remembering how they were prior to the brain injury may make injured students feel “embarrassed, ashamed, or frustrated” about their change in performance in the classroom (Bullock,2005). Of the various types of difficulties resulting from brain injury, the psychosocial effects have proven to be the most challenging for school personnel and parents to manage.
Resources and Services Available The effects of a brain injury include a wide range of services and accommodations that may be needed. Highly individualized planning is also required (Zabel, 2005). Many students with mild to moderate TBI’s usually return to regular general education classes with some adaptations and modifications. Students with TBI who attend mainstream classes may also receive accommodations or related services under the Rehabilitation Act of 1973, Section 504.
Section 504 covers “all students who have a physical or mental impairment that substantially limit one or more major life activities, including learning” (Zabel, 2005). Students with more significant impairments should be referred to special education evaluation to determine if specialized services are necessary to address any cognitive, communication, physical, or social limitations. What Educational Interventions Are Successful? Students who have a difficult time concentrating or completing tasks need strategies. Teachers should present information to these students based on their strengths.
These students have to choose a way to strengthen their learning skills by practicing modalities such as learning visually, kinesthetically, or auditorily. It is important that teachers include prioritizing, structuring, and slowing down while instructing a lesson. This can simply mean talking slower, giving less information at a time, and answering questions more thoroughly(Cave,2004). ClassroomAccommodations Altering the classroom environment is essential when trying to meet the needs of a student with a TBI (Bowen, 2005).
As an educator, you may want to provide external devices and cues, which the student can use to compensate for organization, memory, and motor deficits. Assistive devices can include technical equipment and materials such as “tape recorders, calculators, electronic spellers, computers or word processors, augmentative communication devices, timers,or equipment for mobility (e. g. , wheelchair or electric scooter)”. Other external cues used to remind students include “labels, maps, checklists, pictures or icons, photograph cues, post-it-notes, calendars, planners, and journals” (Bowen, 2005).
Modifications to existing materials can assist students with TBI to learn and function in the classroom setting. Typical adjustments that allow students to participate at their grade level include providing “large print books, books on tape, and graphic organizers”. A similar approach involves “altering the expectations for student participation. ” For example, teachers may choose to allow more time on tests, reduce the amount of written work required, provide exams in multiple choice format, or give pass/fail grades rather than letter grades.
Researchers have found that modifying the educational environment and increasing the amount of structure and predictability in the child’s school day facilitates learning” (Keyser-Marcus, 2002). We must consider each child’s individual difficulties and circumstances when determining appropriate modifications. Therefore, we must assess the influence of the environment on the student’s ability to focus and learn; and we need to explore a variety of modifications before we modify the educational surroundings.
Due to the fact that many students with TBI experience difficulty with fatigue, a modified school day may be necessary for better performance. Scheduled breaks or a shortened school day may limit fatigue. Another strategy would be to schedule difficult subjects early because the student’s alertness level is higher. In addition to modifications to the school day, researchers have found “that altering the student’s workload, extending deadlines, and breaking tasks into smaller components have all improved academic performance”.
TBI Organizations The Brain Injury Association helps promote “awareness, understanding, and prevention of brain injury through education, advocacy, and community support services” (Monfore, 2005). Its web site has links to support groups and has a wealth of information on various aspects of brain injury. The Brain Injury Society is a non profit organization that works with clients, families, and caregivers to identify strategies and techniques to “maximize newfound potential for a stronger recovery” from brain injury.
This organization sponsors events, as well as provides general information on TBI, a newsletter, links to other relevant sites, and important contact information “for government officials in a position to affect legislation”. Summary Children and youth with traumatic brain injury can pose a significant challenge to educators in educational planning, teaching methods, and monitoring of students’ performance. For students who have experienced TBI, educators should be aware of the medical, neurological, and psychological issues which shape each individuals TBI case (Stevens, 1994).
The educator must understand the relevance of these issues to plan effective educational programs. Regardless of the types of accommodations and strategies we use with these students, the most effective programs depend on our willingness to learn about the specific consequences of the injuries and our attempts to customize the instruction and curriculum to meet the needs of those students. Educators have a vital role in providing the widest range of opportunities available to these students.
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