Traumatic Brain Injury
Debra Neeson Okell
Telephone: 561-434-8817 Fax: 561-434-8384
Telephone: 561-434-8066 Fax: 561-434-7307
|TBI rule revisions 6A-6.030153 (12/15/09) (.pdf)|
Recommendations for the Family of a Child with a Traumatic Brain Injury
1. If your child is confined to home or hospital, You may also call the Hospital Homebound office directly at: (561) 681-5901; Fax (561) 681-5990.
2. Obtain results from all assessments from the hospital and any rehabilitation services. Contact the Exceptional Student Education Coordinator at your child’s school and request a child study team meeting.
Traumatic Brain Injury-The Silent Epidemic
Students Who Are Physically Impaired with
Traumatic Brain Injury
A traumatic brain injury is 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 educational performance. The term
applies to mild, moderate, or severe open or closed head injuries resulting in impairments in one (1) or more areas, such
as cognition, language, memory, attention, reasoning, abstract thinking, judgment, problem-solving, sensory, perceptual and
motor abilities, psychosocial behavior, physical functions, information processing, or speech. The term includes anoxia
due to trauma. The term does not include brain injuries that are congenital, degenerative, or induced by birth trauma.
Currently only 2% of the students with a mild, moderate or severe head injury receive special education.
Changes to Watch for:
- becomes restless or fussy
- doesn’t pay attention
- confusion about time and place
- takes longer to do things
- reacts strangely to new situations
- acts without thinking
- becomes easily upset
- frequently loses temper
- tires easily or needs extra sleep
- doesn’t hear or see well
- has problems with words and sentences
- has a harder time learning new information
Warning Signs at School:
- lowered grades
- reports from teacher of uncooperative behavior or problems with learning
- disagreements with classmates
- arguments and loss of friends
- sudden mood changes
- late, incomplete and missing work
- difficulty understanding what is read
- less interest in school
Students with Traumatic Brain Injury
Exceptional Student Education Eligibility Checklist
1. The evaluation procedures include a report of a medical examination within the previous
twelve-month period by a Florida-licensed physician. In circumstances where the student’s medical care is provided
by a physician licensed in another state, at the discretion of the district administrator for Exceptional Student Education, a
report of a physician licensed in another state may be accepted for the purpose of evaluation and consideration of eligibility
as a student with a disability. The physician’s report must provide a description of the traumatic brain injury and any
medical implications for instruction; and
2. Documented evidence by more than one person, including the parent, guardian, or primary caregiver, in more than one situation. The documentation shall include evidence of a marked contrast of pre- and post-injury capabilities in one or more of
the following areas: cognition, language, memory, attention, reasoning, abstract thinking, judgment, problem-solving, sensory, perceptual, and motor abilities, psychosocial behavior, physical functions, information processing or speech; and
3. An educational evaluation that identifies educational and environmental needs.
4. The evaluation may also include a neuropsychological evaluation when requested by the ESE administrator or designee.
A student with a traumatic brain injury is eligible for Exceptional Student Education if all of the following criteria are met:
|There is evidence of a traumatic brain injury that impacts one or more of the areas listed in the student evaluation, section 2 below and
The student needs special education as defined in rule 6A.6-03411(1)(kk), FAC
Forms Required for Traumatic Brain Injury
The forms with an asterisk * must be signed by a physician
Required Screenings or Evaluations
1. Cognition and Information
2. Academic Functioning
3. Fine Motor
4. Gross Motor
5. Communication Abilities
6. Behavior and Emotional Status
7. Adaptive Skills
Additional Information on TBI
Suggested Classroom Strategies to
Accommodate Students with Traumatic Brain Injury
Speech and Communication
1. Train students to prepare mentally when waiting for their turn to speak.
2. Cue students who are unable to retrieve a word to remain calm and substitute another word or phrase in its place.
3. Arrange for students to use assistive devices for communication (letter and word boards, picture boards, and portable computers).
Verbal and Written Comprehension
1. Encourage student to repeat what was said back to the speaker in his or her own words and have student ask for verification that it was correct.
1. Keep directions, staff, material, and location of objects as consistent as possible.
2. Identify specific fixed locations to which every item is assigned.
3. Give students a daily schedule.
4. Have the student use a watch with an alarm to remember when to do tasks.
5. Send notes home warning of any changes expected in the classroom or curriculum so that the parents may prepare their child.
6. Send home written directions for completing homework assignments.
7. Code papers with different colors for each class.
8. Give student a private early warning to pack up belongings.
1. Use a visual cue to indicate that important information is coming.
2. Provide charts, tables, and maps to indicate classroom routines and important locations.
3. Make sure pictures, diagrams, and forms are uncluttered and free of extraneous material.
4. Provide lecture notes so that the student can review them at home.
5. Have another student take notes for the student with TBI.
6. Break long assignments into smaller units.
7. Help the student set short-term goals for completing a task.
8. Limit the number of steps in a task.
9. Minimize pauses between tasks to discourage distractions.
10. Over-articulate speech when lecturing.
11. Ask a peer to escort the student to the next class or location.
12. Have the student describe the route he or she will take before leaving the classroom.
1. Assign a paraprofessional or another adult as a behavior coach.
2. Set up a time-out or cool down procedure for acting-out behaviors.
3. Post classroom rules for appropriate behavior.
4. Repeat classroom rules aloud.
5. Use a quiet voice when reinforcing classroom rules.
6. Correct inappropriate behaviors by providing verbal feedback to the student regarding the behaviors exhibited and the correct behaviors expected.
7. Coach other students in the classroom about how to treat the student by using problem-solving techniques and scenarios.
8. Develop and implement a behavior intervention plan.
9. Teach awareness of all disabilities including traumatic brain injury.
10. Teach and encourage the use of relaxation procedures.
1. Shorten writing assignments.
2. Allow student to record answers on a tape recorder.
3. Provide assistance in physical activities.
4. Have a buddy help the student perform tasks.
5. Use a team or partner approach to accomplish tasks.
6. Adapt mechanical devices (e.g., key lock rather than combination lock).
1. Underline or highlight reading material for the student.
2. Repeat lecture material several times and provide many examples.
3. Arrange for a tutor or parent to review the material presented.
4. Give open note tests to compensate for memory loss.
5. Give simplified tests (e.g., remove the second-best answer in multiple choice tests).
6. Limit the amount of content in an instructional session.
7. Pace work to eliminate brain fatigue.
8. Mark left and right sides of the pages.
Summary of Best Practices for the Classroom
The following are best practices for all students, including students with traumatic brain injury. It is not expected
that implementing these practices in the classroom will call undo attention to the student. The practices can easily be
integrated into the regular scheme of events. The list provides only a few suggestions. Many others related specifically to
the needs of the individual student may be generated.
1. Understand the student’s injury and impairments and keep track of the symptoms by periodically using the student checklist.
2. When transmitting information make sure the student is ready, control the amount and rate of information,
summarize frequently, organize the content, link information to facts already known, use the student’s best mode of learning,
and encourage note taking and tape recording.
3. When giving assignments, encourage verbatim recording, verify understanding of the tasks, and provide handouts.
4. Train the student to use the time available before giving a verbal response as a time to practice or prepare for that
5. Have the student make eye contact with the speaker to confirm understanding of what is being said and
test for comprehension.
7. Simplify reading, writing, mathematics, and other assignments in order to accommodate the student.
8. Make creative use of simple visual aids.
9. Be vigilant for any confusion with curricular content.
10. Give explicit and supportive feedback, both orally and written.
11. Use assistive devices (e.g., communication boards), when necessary.
12. Use behavior management techniques, particularly positive reinforcement of appropriate/desirable behaviors.
Summary of Best Practices for Addressing
Psychological Issues in Classroom
Consider the possibility that the student is trying to respond normally to a highly abnormal situation before assuming the
student has a psychological problem. If the behavior is extreme, investigate the history of any mental health issues.
Solicit the help of a consultant with experience managing problem behaviors associated with TBI. Consider a mental
health referral to a professional who is skilled with neuro-psychological issues.
Remember that inappropriate behaviors are likely to be automatic and reflexive, deliberate.
1. Minimize use of criticism and punishment.
2. Post classroom rules.
3. Make sure the student is aware of the rule he or she is breaking.
4. Make the student aware of how he or she is behaving.
5. Limit distractions and irritating noises.
6. Re-direct the student.
7. Encourage the student to leave the provoking situation to regain control.
8. Teach the student how to substitute a desirable response (like relaxation) for undesirable one.
9. Use time-out procedures, when necessary.
9. Use behavior management techniques, particularly positive reinforcement of appropriate/desirable
The effects of brain injuries are well understood and highly predictable based on the part of the brain that was injured. The brain is comprised of the brainstem and frontal, parietal, temporal, and occipital lobes.
Although all these areas interact, each one is responsible for influencing particular types of functioning.
Brain Stem Injuries
1. May experience both physical and cognitive effects
2. Regulates major life-support
3. Slow thinking, disorganization of thought, and poor awareness of changes or new occurrences
5. Sleep disturbance
6. Diminished awareness
7. Impaired balance and coordination, and/or losses of sensation and movement
8. Uneven cadence of speech
9. Flaccid or spastic paralysis of limbs (usually on one side of the body); or body-sense disturbances including numbness,insensitivity, or odd sensations
Frontal Lobe Injuries
1. Impulse control
2. Initiation, planning, organization, mental flexibility, and monitoring of errors.
3. Susceptibility to mental overload.
4. Impulsive responses that result in a tendency to break rules of proper conduct (e.g., fighting)
5. Monitoring or alertness to his or her own mistakes and inappropriate interpersonal behaviors.
6. Passive and unresponsive; can smell smoke without putting into action any fire-safety
7. Late in responding to a shift in conversation or direction
8. Decisions may seem to take forever and speech may be infrequent, employing a limited number of words.
TBI Middle School Students/Frontal Lobe Injuries
The control systems of the frontal lobes are relatively inactive at birth and continue to be limited in function during early
and middle childhood. Children of this age depend upon adults to modulate and control their emotions, to make plans for them,
and to set limits for acceptable behavior. At puberty, the last major maturational change in the brain is the full wiring-up of
the frontal systems. Hormonal changes of puberty intensify the child’s desires and emotions and the frontal lobes become
fully functional to take control of them. This fact about development has an important implication for the education of
students with TBI at the middle school level. It is during that age when greater controls are expected. However, a child with
this type of brain injury that was previously undetected may now suddenly appear to be disorganized, impulsive, and out
Parietal Lobe Injuries
1. Perceptual impairment, language comprehension deficits
2. Safety issues, judgment disorder, and difficulty making sense of self and others
3. May cause individuals to have difficulty recognizing changes in their body state. Hence, they
tend to stay too cold or too hot, remain seated in an uncomfortable position, or be hungry or thirsty without realizing the problem or doing anything about it.
4. May be locked in the past and not realize there is any damage and therefore may reject instruction.
5. Mental maps are made and used here. The routes taken to drive to a certain location or where on the street the car is parked are imprinted in the mind.
Individuals with injury to this area of the brain are at great risk of losing their way in the community and in buildings. They also tend to misplace belongings.
6. The parietal lobe brings together all kinds of information to produce understanding. The left parietal
lobe generates understanding of ideas expressed in words, including stories, articles, explanations,
and requests. Damage to this area has serious scholastic consequences in that individuals are unable
to extract complex meaning from words and sentences. The right parietal lobe gives the big picture
both in visual images and in forming ideas. Since judgment depends upon the ability to visualize the
negative consequences of an action, right parietal injuries produce impairment of judgment and files
containing information already learned about specific people.
7. Social intelligence may suffer. The reading of emotions and nonverbal communications (including
implied messages) may be diminished. The processing system that generates intuition, the
lightning-quick understanding that goes beyond what you can explain in words, is also based here.
This is the part of the brain that takes over in emergencies. It also guides response to novel situations,
including the early stages of learning any new skill.
8. Depth perception, perception of shapes and contours, and whole-part relationships are part of this
Temporal Lobe Injuries
1. May impair the ability to interpret sounds.
2. May affect ability to automatically turn down sounds that are too loud.
3. Can produce aphasia or loss of the ability to understand speech.
4. May compromise ability to perceive the emotions or emphasis in another’s voice.
5. May show excessive emotions (e.g., crying and tearing up a test paper with one mistake) or
inappropriate laughter in place of other more appropriate emotions.
6. May be able to learn only one fact at a time or a few facts in a few minutes.
7. May not be able to learn in usual ways like reading a chapter, listening to an explanation, observing a
demonstration, engaging in hands-on activities, or looking at a picture.
Occipital Lobe Injuries
1. Injury may produce problems in recognizing and identifying visual stimuli.
The previous information was taken from:
“Understanding and Teaching Students with a Traumatic Brain Injury,
What Families and Teachers Need to Know”
This is one of many publications available through the Bureau of Exceptional Education and Student
Services, Florida Department of Education, designed to assist school districts, state agencies that
support educational programs, and parents in the provision of special programs.
For additional information on this publication, or for a list of available publications, contact the
Clearinghouse Information Center, Bureau of Exceptional Education and Student Services, Florida Department
of Education, 628 Turlington Building, Tallahassee, Florida 32399-0400.
Phone (850) 245-0477; FAX (850) 245-0987
# 312636 Understanding and Teaching Students with Traumatic Brain Injury: What Families and Teachers Need
to Know, 2005.
Web Page Links
Florida Brain Injury Association
Florida Department of Health
Florida Brain and Spinal Cord Injury Program
Brain Injury Association of America
National Center for Injury Prevention and Control
The Brain Injury Recovery Network
The Brain Trauma Foundation
Coaches Tool Kit
TBI Fact Sheets