Traumatic Brain Injury
I.
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Background Information
Definition
Federal Definition: 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 education performance.
 TBI does not apply to brain injuries induced by birth trauma, congenital, or
degenerative.
Causes: Mostly from transportation accidents, violence such as shaken baby syndrome,
or sports injuries.
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Characteristics:
Headaches
Fatigue
Imbalance
long and short-term memory loss
attention deficits
disorganization
mood swings
anxiety
depression
lack of motivation
Prevalence
Federal Government reports that 23,864 students ages 6-21 received special education services
due to TBI in 2008 (Smith & Tyler, 2010).
Those students most likely to sustain a TBI are children aged 0-4 years and 15-19 years old.
Center for Disease Control reports that there are 473,947 ER visits for TBI made
annually by children aged 0 to 14 years.
http://www.cdc.gov/traumaticbraininjury/statistics.html
On average, 2,685 children die annually from TBIs, and more than 30,000 children per
year acquire lifelong disabilities (Fowler & McCabe, 2011).
http://www.nasponline.org/publications/cq/39/7/traumatic-brain-injury.aspx
TBI is also more prevalent in males than in females
Determining Eligibility for Special Education
Most students have to have observable severe physical or speech disabilities to be eligible
for special education services—TBI is known as the “silent epidemic” (Schutz &
McNamara, 2011) because months after surviving their injury the students seem normal
but then they can gradually decline.
http://www.eric.ed.gov.proxy-tu.researchport.umd.edu/PDFS/EJ921187.pdf
Between 9% and 38% of students with TBI are referred for special education services.
Fewer than 2% of students with TBI are eligible for TBI because it may be misidentified.
http://web.ebscohost.com.proxytu.researchport.umd.edu/ehost/pdfviewer/pdfviewer?sid=
6c5ba22f-de1e-4d1e-9b6b-01824f1be63b%40sessionmgr10&vid=5&hid=8
Sarah Greenwood
II.
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Strategy and Intervention Practices
Evidence Based
 Requires a consistent schedule and routine, needs distractions reduced, requires shortened
assignments (Smith & Tyler, 2010).
 Students with TBI don’t do well with change, so orienting them to their new classroom
prior to the first day of school of the new year is a best practice.
http://www.eric.ed.gov.proxy-tu.researchport.umd.edu/PDFS/EJ921187.pdf
 Work with the IEP team such as the student, parent, administration, aids, and
rehabilitation specialist to provide the student an easy and effective transition back to
school. Also, inform the student’s classmates of the injury so they know what to expect
and how they can help with this new change in their peer.
http://www.eric.ed.gov.proxy-tu.researchport.umd.edu/PDFS/EJ921187.pdf
 Use multi-modal teaching techniques such as overheads, videos, and hands-on activities.
Provide repetition in lessons to compensate for memory loss
http://www.sbac.edu/~werned/DATA/RESEARCH/journals/Teaching%20Exceptional%
20Children%20JOURNAL/TBI.pdf
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Promising
 Induced emotion or sudden movement can cause stress and overwork the brain, so
providing a short break for the student to regroup is a good practice.
 Close monitoring of the child’s behavior to look for any new symptoms and monitor
progress in the classroom
http://www.eric.ed.gov.proxy-tu.researchport.umd.edu/PDFS/EJ921187.pdf
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II.
Use with Caution Practices
 Intensive study sessions for homework – students with TBI have a smaller attention span
so monitoring their homework or school progress is a good practice, but an intensive
session lasting a long time may be a practice that is used with caution.
http://www.eric.ed.gov.proxy-tu.researchport.umd.edu/PDFS/EJ921187.pdf
 Motivational enhancement program- Students with TBI can show a lack of motivation so
working with the school psychologist or guidance counselor to promote a behavior
modification system may help. Use with caution as this could create an unmotivated
student as well.
http://www.eric.ed.gov.proxy-tu.researchport.umd.edu/PDFS/EJ921187.pdf
In the News
Popular Press
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State School Board Looking Into Head Injuries
http://articles.baltimoresun.com/2012-06-26/health/bs-md-concussions-education20120626_1_concussions-state-school-board-head-injuries
 Article discusses the concerns that the state of Maryland is leading a reactive stance
instead of a proactive stance on concussion research and ways to prevent concussions in
athletes.
Sarah Greenwood
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League Launches Concussion Study
http://espn.go.com/college-football/story/_/id/8071316/big-ten-conference-ivy-league-launchjoint-study-concussions
 Article discusses how the NFL is leading research and studies on concussions and brain
injuries in football and ways to prevent them. Also, how many hits in the head is too
many before a person experiences a concussion or brain injury and the short term or long
term impact on head injuries.
Peer Reviewed Journal Articles
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Academic and Language Outcomes in Children After a TBI: A Meta-Analysis
http://proxy-tu.researchport.umd.edu/login?ins=tu&url=http://search.ebscohost.com.proxytu.researchport.umd.edu/login.aspx?direct=true&db=ehh&AN=59570652&site=ehost-live
 Article discusses how it’s important to understand that TBI has a spectrum of severity
and each child is different in the time it may take them to recover, regain and learn
knowledge.
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Intervention Strategies For Serving Students With Traumatic Brain Injury
http://proxy-tu.researchport.umd.edu/login?ins=tu&url=http://search.ebscohost.com.proxytu.researchport.umd.edu/login.aspx?direct=true&db=ehh&AN=31120748&site=ehost-live
 Article provides educators of methods to reintegrate the student with a TBI back into
school and intervention services and strategies to apply to the classroom. For example,
providing variability and flexibility was a highlight of this article.
III.
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Resources
Teacher Resources
http://cec.sped.org/AM/Template.cfm?Section=Traumatic_Brain_Injury&Template=/TaggedPage
/TaggedPageDisplay.cfm&TPLID=37&ContentID=5633
Council for Exceptional Children
 Provides tips for teachers in working with students with TBI such as proving more time
on assignments, be consistent, show students how to perform new skills and review that
they have comprehended the task. Most importantly- be patient to maximize the student’s
chances for success
http://www.sbac.edu/~werned/DATA/RESEARCH/journals/Teaching%20Exceptional%20Childr
en%20JOURNAL/TBI.pdf
Teaching Exceptional Children: Enhancing the Schooling for Students with TBI
 Provides background information about TBI, tips for teaching students with TBI, and
what to expect when they re-enter the classroom after an injury.
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Parent Resources
http://www.biamd.org/
Brain Injury Association of Maryland
 This is a great website that provides parents with support groups in their area and helps
promote brain research for those with TBI.
Sarah Greenwood
http://nichcy.org/
National Dissemination Center for Children with Disabilities
 This is a great website for parents to go to first to find out about what resources are out
there for them, their community, education laws, and provides insight on what to do if
you are new to a disability.
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Student Resources
http://tbiguide.com/
Traumatic Brain Injury Survival Guide
 An online book that provides a great description of what happens to the brain when
involved in an accident that may cause TBI. Provides resources of what to expect when
returning to school in a way a child may understand. Although, it doesn’t have
information about returning to elementary school, it could still be used as a great resource
for parents to read to their children and provide an explanation.
http://www.mtv.com/videos/true-life-i-have-a-traumatic-brain-injury/1638298/playlist.jhtml
True Life: I Have A Traumatic Brain Injury (video)
 This is a great video for other students to watch to understand what their peers with TBI
are going through each day and the struggles they go through each day.
http://www.brainline.org/
Brain Line
 This website is a great resource for students to understand their rights and laws to enforce
their rights as the student with a disability. It provides details about the IEP process and
504 plans.
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Relevant Electronic Resources for Any & All
http://www.ninds.nih.gov/disorders/tbi/detail_tbi.htm
National Institute of Health: National Institute for Neurological Disorders and Stroke
 Provides information regarding the background of TBI, prevalence, prevention, research.
http://www.msde.maryland.gov/NR/rdonlyres/FCB60C1D-6CC2-4270-BDAA153D67247324/29630/MSDEPoliciesProgramsConcussions2011_.pdf
Maryland State Department of Education: Policies and Programs on Concussions for
Public Schools and Youth Sport Programs
 Provides information for teachers, coaches, students, and parents on concussions
and awareness of concussions in student athletes, accommodations in schools, and
legal forms for all parties when a student is suspected of having a head injury.
Additional References
Smith, D. & Tyler, N. Introduction to special education: making a difference. Upper Saddle River, NJ:
Merrill.
Sarah Greenwood