How to Help Students with Traumatic Brain Injuries

Five Methods:Preparing Yourself to HelpHelping the Student to Learn Basic Classroom SkillsCreating a Specialized Learning System for the StudentCreating a Positive Learning EnvironmentWorking with Others to Improve the Student’s Classroom Experience

If a student has experienced a traumatic head injury, he or she will most likely have difficulties with learning and memory retention. However, there are ways that you can help the student to successfully continue his or her education: by helping him or her to relearn basic classroom skills, by developing a personalized learning system and by working collaboratively with others involved in the student’s life.

Method 1
Preparing Yourself to Help

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    Adjust your expectations of recovery to provide support for your child. After the TBI, your child will almost certainly be different in one way or another. In severe cases, there can be great changes in your child's emotions, problem-solving skills, and memory, depending on where the injury is. Often, your child will remember how they were before the injury, and their inability to reach that state again can cause a lot of emotional trauma and frustration.
    • Just picture being a straight-A student, who just “gets” everything really quickly and is very socially adaptable, and then waking up one day to find out that you simply cannot function the same way anymore.
    • It can also be difficult for family members, friends and school faculty to accept the new ways in which your child behaves – they might expect him or her to go back to “normal” and be disappointed when that does not happen.
    • Although they may not say it, this disappointment is almost always noticed by children and makes them feel even worse about themselves.
    • That is why it is essential to adjust your expectations and come to terms with the fact that now there is a new “normal” which is not bad, just different.
    • If you are able to believe this yourself, your child will sense it and his or her self-esteem will be boosted.
  2. 2
    Write down the positives to remind yourself and your child of their abilities. Write down, in a very positive manner, all the good things that your child currently enjoys.
    • For example, try writing down that the injury is not that severe, that there are many things that your child can still do, etc.
    • It might be easier to write all these positive statements down somewhere private, and read them whenever you are feeling doubtful or sad.
    • Having things written down makes you look at them more seriously.
    • Remember, your child can sense your disposition and is almost always much affected by it, so you can influence the way he or she views the injury.
  3. 3
    Learn about TBI to best help your child. If you know nothing about your child’s injury, you will likely be so scared of the situation, that you can't deal with it appropriately.
    • However, if you go the extra mile and learn about TBI, you will find that there will still be many positive things in your child’s life.
    • Also, by learning about the injury, you can educate yourself regarding suitable behaviors and learning techniques, which can be crucial for your child's recovery.
    • There are many books and information sources on TBI, but if you want to get the best, you should consult your child’s healthcare team. A
    • Your child’s healthcare team has experience helping parents and students cope with TBI, so they will be able to tell you which information sources will be most helpful for your specific situation.
  4. 4
    Talk to other parents to find a feeling of solidarity. It can help you deal with the trauma of your child's TBI to know that there are other people who are experiencing the same thing.
    • Talking to other parents with children suffering from TBI can make you feel less alone, less stressed, and more supported by society.
    • Chances are, even if their child has different problems than yours, parents of children with TBI have experience and knowledge that can help you deal with situations when you are worried about a certain part of your child’s life.
    • A really good thing about joining a support group for TBI parents is that you will learn about teaching techniques that will help your child excel in school.
    • In addition, seeing that other people are dealing with the same problems as you can make you and your child feel less “different”.

Method 2
Helping the Student to Learn Basic Classroom Skills

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    Understand that the student may need to relearn skills and that you should develop his curriculum around those skills. Following a traumatic brain injury (TBI) the student may need to relearn some of his skills. He might have been adept in these skills previously, but because of brain damage you may need to help him relearn them.
    • Closely monitor the student's behavior and take note of any special needs or changes in behavior. The student might look normal to you, but there are many underlying problems that can appear late in life.
    • Students with brain injuries should be given extra time for learning. They should not be punished or scolded for not completing their task in time. They may be feeling depressed or agitated, so it's important to assure them of your love and support.
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    Help the student to develop his ability to make eye contact. Develop the student's ability to make eye contact through direct eye contact exercises, games and other activities.
    • One of the most simple and effective techniques to develop eye contact with a child is to identify their favorite picture, object or toy and then place that object on a table where you can view it easily. Ask the child to find the reflection of the object in your eyeball. Many children make excellent eye contact in this way.
    • For very young children, peek-a-boo is a helpful game which you can modify in accordance with the age of the child. .
    • Another very interesting game is the “eye blink game”. Ask the child to look at you or any other child and ask them to recognize who blinked the eye first.
    • While performing any task, keep on telling the child to “look at me”. Positively reinforce any eye contact made with praise or rewards.
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    Work to increase the student’s ability to pay attention. Use attention building exercises like play therapy or story reading exercises. For play therapy choose a toy or real pet which the child likes.
    • You can ask the child to brush the pet if it has long hair, help the child play with it, care for it and interact with it. This tremendously increases the attention span of a child in a single activity.
    • Similarly, help the child listen to a recorded story or a video story. You can also read a picture book to the child, then ask him to re-tell you the story.
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    Help the student to stay in his seat. A student with traumatic brain injury might be prone to hyperactivity and have difficulty staying in their seat. In this case positive reinforcement is the best option.
    • Praise the child for each positive behavior, such as standing near the seat, placing a hand on the seat or sitting on the seat for short periods of the time. The child will begin to connect sitting down with praise, encouraging them to do so.
    • For some extremely tantrum throwing, aggressive or hyper active child you can use holding therapy where the child is forcefully held in seat. This can be done through an enclosed chair from which the child cannot escape. You can also physical restrict the child onto the seat.
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    Focus on building the student’s ability to be compliant. Teach the child to comply with your requests through reinforcement and encouragement. Identify which types of positive reinforcement work best for the child.
    • You can use a star chart to help the child build compliance. When the child achieve a certain number of stars per week, you can give the child a tangible reinforce like a treat, or a sticker.
    • Similarly, you can use rewards like watching TV or cartoon video, but only if the child complies with your instructions.
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    Be prepared to face behavioral issues. Many children with traumatic brain injuries display behavioral issues during the recovery and rehabilitation phase. Sometimes these behavioral issues are caused by medications, hormonal changes or the brain damage itself.
    • Understand that negative behavior always happens for a reason. For example the child might exhibit negative behaviors (such as tantrums or refusing to do what their told) in order to gain attention, to avoid learning a difficult task or as a response to frustration.
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    Remove negative stimuli and use ‘time-outs’ as a way to address behavioral issues. Once you understand where the negative behaviors are coming from, try to omit the negative stimulus in order to calm the child down. If this doesn't work, you can use "time-outs" to teach the student about the behavior that's expected from them.
    • Students should be given time out for 5 to 15 minutes to regain control of their anger and return to normal.
    • Another way of dealing with negative behavior is just to ignore it.

Method 3
Creating a Specialized Learning System for the Student

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    Develop an individualized educational program (IEP) for the child. Address the individual needs of the child with TBI by developing an individualized educational program. This program may contain academic, social, cognitive, self-help and motor skill tasks.
    • There are different levels and different ages at which children achieve and acquire certain academic skills and concepts. Depending on the type of brain injury and the functioning of the child, you should alter the tasks accordingly.
    • Choose tasks that the child is not yet able to do, which are in accordance with his mental age. These skills can be accessed through various questionnaires and observation of the child.
    • It is important that you work together with the student’s teachers and healthcare team, in order to create the best IEP possible.
    • Even if the process takes a little longer than you had wanted or expected, remember that the most important thing is to achieve a curriculum that is best suited to your child and his particular needs.
    • If you rush the process, you might end up with a study plan that is too fast, too slow, or uses the wrong type of stimuli. Then you would have to go through the entire ordeal again.
    • The goal here is to encourage the student’s cognitive abilities in the best and most efficient way possible.
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    Determine the student’s strengths. Identify the strengths of the child and work along them. Even after the TBI, some areas of the student will still remain strong.
    • Some students might be good at verbal skills, or counting and mathematics or even narration. Use the skills the child is strong at to compensate for their weakness.
    • For example if he or she is good at coloring you can motivate the child to color a letter in order to make him learn the letter.
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    Divide the student’s work up into small steps. Instead of asking the student to complete a huge task in a single sitting, divide the work into many small steps. Reinforce completion of each step. Assigning a child with TBI a large, complicated task that they cannot complete will make them feel worthless.
    • Remember that progress might be slow and the child may forget things frequently. Be patient and get the child to repeat each task or skill in a repetitive manner until they have grasped it fully.
    • Don’t force them to complete the task ASAP. Avoid negative reinforcement and also punishment. It only produces poor impact on brain with no progress.
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    Have the student write as much as possible. Those students who have significant memory problems should be encouraged to write important assignments, to make notes, and also to write about their behaviors, feelings and emotions.
    • Ask them to write their own autobiography. It will keep them busy and produce valuable content that they can share and enjoy with others.
    • It will also help them to recall lost memories. The student should write all important events of his life as soon as they occur to him, before he forgets any details. This is an effective brain exercise.

Method 4
Creating a Positive Learning Environment

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    Give positive reinforcement often. Positive reinforcement produces a pleasant impact on our brain. It motivates our brain to repeat the reinforced behavior in order to experience the pleasant feeling again. Positive reinforcement can be provided by a family member, a teacher and even by the student himself.
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    Allow the student to rest or go home when needed when needed. Students with traumatic brain injuries get exhausted easily and need rest. Therefore, children with TBI should not be forced to stay in school for very long periods of time, like other students. They should be allowed to leave school earlier and should also be given plenty of breaks throughout the day.
    • The physical and mental abilities and capacities of a child might be limited initially during the rehabilitation phase, it is important to gradually increase the attendance at school instead of imposing strict attendance and difficult tasks initially.
    • Make the work given more home based and gradually increase the difficulty level. The assessment will reveal the current capacities and functioning level of the child. Plan and structure the environment accordingly.
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    Create a flexible schedule for your student. Teachers should be less demanding. The routine and assignments should be flexible. There should be no time limit for such students. They should be allowed to have rest many times a day and should be given separate place for getting relaxed and getting out of agitation.
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    Allow the student to participate in leisure activities often. Patients with brain injuries should be allowed to spend most of their time in leisure activities. If they enjoy watching TV, playing games or passing time on internet; give them enough time to enjoy these activities. Take them to beach, to a park or to the cinema, they should be allowed to have as much fun and enjoyment as possible. Develop some new hobbies like gardening, walking, painting etc.
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    Make sure that the student has the ability to move around as needed. Students with TBI often have problems in moving from one place to another. They should be given seat near teacher with some good student beside them. They should be given enough space for moving. They should also be helped while changing their class according to subject. Teacher should allow them to leave 5 minutes earlier for reaching other class without having difficulty or confusion.

Method 5
Working with Others to Improve the Student’s Classroom Experience

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    Create a team to assess the student’s abilities and progress. Once the child with TBI enters school environment, assessment is the first step. The school therapist, psychologist, behavior therapist, and physiotherapist team should all coordinate and compare assessments of the child. The usual problems that are seen after TBI include:
    • Motor disabilities, including both fine and gross motor skills.
    • Slow processing speed.
    • Cognitive impairment. For example, a child of average intelligence might lose cognitive skills and fall into the category of mild intellectual disability following the injury.
    • Behavioral problems caused by issues with recovery, suffering excessive pain and having difficulty adjusting to their new life..
    • Memory loss in the form of amnesia, or loss of memory of some events. Poor short term memory and forgetting issues.
    • Lack of attention and concentration.
    • Changes in personality (for example, a social child might become isolated).
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    Consult a special education provider for tips on how to best teach the student. Some schools possess teachers that are experts in providing special education. If your child's school does not currently employ such a teacher, talk to the school authority and ask them to hire a special education expert.
    • Alternatively, you could consider sending your child to another school that has adequate facilities and staff to cope with his TBI.
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    Schedule regular meetings with everyone involved in the student’s education. Intervention according to ongoing observation and assessment should be made by parents, doctors, teachers and other important figures around the patient. There should be regular meetings especially between parents and teachers. Special needs, improvements and requirements should be discussed. It is very important for the teachers to collaborate with the doctors, therapists, parents and other rehabilitation team working with the child.
    • You will have an idea about child’s present functioning, home environment and chances of improvement
    • It will give you an idea about the child’s progress.
    • Being a teacher you might find some deficit for example the child having difficulty with motor skills and may talk to the physiotherapist about it and device ways to manage.
    • This collaborative environment will also help all the team members along with the family to help out in rehabilitation in educational settings.
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    Take the time to learn about the student’s specific disability. The student himself, his parents and teachers should have enough knowledge about traumatic brain injuries. They should be encouraged to read many books and articles about TBI. They should also take the time to identify the specific symptoms related to the child's injury. This will enable them to deal with the problem more effectively. Some of the most common side effects of TBI include:
    • Dementia: People who suffer from dementia as a result of brain injury shows both memory problems and cognitive impairments. Their ability to think or reason is lost or significantly impaired. Their language skills are also greatly affected. They may even undergo personality changes. Most often they become worse with the passage of time. The patient may become increasingly aggressive.
    • Retrograde amnesia: People with retrograde amnesia do not remember their past. They forget what happened to them in the past. They may still show their abilities, but past memories of their life’s events is lost. They may not recognize their past friends or relatives. They may forget about how they got injured.
    • Anterograde Amnesia: This is more common and happens when the person can't remember ongoing events. The person forgets everything that happened to him from the time of head injury. He may not recognize new acquaintances and may need to resolve a [problem that was resolved the previous day.
    • Delirium: State of blurred consciousness where the sufferer has difficulty in concentrating, which results in misinterpretations, illusions and in severe cases, hallucinations.
    • Alzheimer’s disease: This begins with memory problems, lapses of attention and significant impairment in language and communication. In the later stage, the person might not even remember his name or be able to complete simple tasks.
    • Personality problems:Damage to certain brain areas (frontal lobes), causes major changes in personality. The person loses his ability to show appropriate emotions. He feels confused, indecisive and aggressive.

Sources and Citations

  • Comer, J. R. (2008). “Abnormal psychology”. (7th Ed.) Princeton University Press, pp.518-523.
  • Ponsford,J.,Sloan,S.,&Snow,P. (2013).Traumatic brain injury: Rehabilitation for everyday adaptive living.(2nd ed.). New Yoork, NY:Psychology Press.
  • Semrud-Clikeman,M.(2001).Traumatic brain Injury in children and adolescents: Assessment and intervention. New York, NY: The Guilford Press.
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Categories: Injury and Accidents | Teaching Students with Special Needs