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Effects of TBI on Students

What areas may be affected?	What might that look like?	What may help?
PHYSICAL FUNCTIONING
Vision	Complaints of difficulty seeing words, either on the board or on paper Inability to stay on the line when writing or when reading (this may not be a vision problem) Sensitivity to bright or fluorescent lighting	Hand-held magnifiers Preferential seating Reproduction of written material – enlarged &/or bold print Paper with heavy lines Colored acetate sheets over textbook pages CCTV with magnification abilities Lighting alterations (bright vs. dim; fluorescent vs. incandescent)
Hearing	Off-task behavior Difficulty following directions Lack of response to requests for attention	Preferential seating – close to teacher, outside row with hearing impaired ear toward wall, away from sources of noise (hallway, air conditioner Teacher’s notes/outlines for student to follow &/or a copy of another student’s notes to compare with own FM amplification system
Speech	Inaccurate articulation (slurred, strained, "garbled")	Speech therapy Augmented/alternative communication picture book with snapshots of objects & people one-message recording device (e.g., Yak-Back) slate and stylus electronic communication device (e.g., MessageMate, Chatbox, AlphaTalker, Dubby, DynaMyte)
Balance	Inability to balance body in chair Bumping into walls when ambulating Falling with unusual frequency	Adaptive Physical Education Physical Therapy Occupational Therapy Support for walking (e.g., handrails, cane)
Muscle tone	Difficulty sitting in upright position Uncontrolled drooling Very rigid or very loose muscles Inability to place head/hands/arms/legs with intent	Adaptive Physical Education Physical Therapy Occupational Therapy Speech Therapy Positioning Chairs
Headaches	Verbal complaints of headache Inability to complete cognitively demanding tasks Inattention Nausea	Adherence to medication schedules Part-time attendance &/or frequent breaks (scheduled or requested)
Fatigue	Appearance of being sleepy Deterioration of quality of work throughout the day, or even by the end of an assignment	Consultation with parents regarding physician’s reports & medication schedules part-time attendance and/or frequent breaks (scheduled or requested)

What areas may be affected?	What might that look like?	What may help?
COGNITIVE FUNCTIONING
Attention or concentration	Off-task behavior Distraction caused by neighbor, extraneous noises and/or activity that can be seen through windows and doors	Signal between student and teacher/peer helper to bring the individual back to the task at hand Seating away from sources of distraction Shortened assignments
Memory	Difficulty following directions Frequent breaking of rules Forgetting to complete or turn in assignments Denial of bad behavior while being punished Inability to recall former actions	Peer companion to aid student to stay within rules and boundaries Structured environment with consistent expectations Simplified planners Visual schedules
New learning	Inability to recall information at a later time, even if the student appeared to master the material at the time of instruction	Frequent review of materials, even after initial mastery Cueing system (e.g., cards, notes, mnemonic devices, or peer cueing) Errorless learning (high rates of success) Immediate, non-judgmental, corrective feedback Well-organized presentation of material
Learning rate	Inconsistent speed of learning – one concept may require only a few repetitions, while another takes many repetitions	Repetition of material provided as needed
Initiation	Difficulty beginning work assignments No initiation of interactions with peers Lack of motivation Passive approach to most or all expected activities	Watch/timer alarm to cue student to initiate Use a script for student – "What should I be doing now?"
Organization	Writing assignments that "wander" Inability to adjust to any changes in schedules, school activities, lessons, etc.	Activity/daily planner Consistent schedule Visual organizers, outlines, and note cards to organize writing assignment.
Sequencing	Difficulty putting items in order Does not complete work assignments in a logical order	Adaptive physical therapy Occupational therapy Speech therapy Checklists/picture schedules for multi-step tasks Involvement of the whole body in activities
Generalization	Difficulty transferring skills learned in resource room or therapy to general classroom functioning	Written or pictorial step-by-step directions Instruction provided in natural/multiple settings
Planning	Difficulty planning for play and work activities Begins activities in haphazard fashion	Activity/daily planner with routine for scheduling day Consistent schedule
Thought flexibility	Difficulty coping with changes in routine Perseveration – getting "stuck" on one thought or behavior Inability to generate more than one possible solution	Preparation for changes in routine in language consistent with the cognitive level of the student Redirection from inappropriate or incorrect behavior
Abstract thought	Inability to determine thoughts behind casual comments Feelings hurt by cynicism or sarcasm Difficulty understanding figures of speech, or concepts beyond the concrete "here and now"	Group therapy with cognitive rehabilitation activities "Script" for student to get clarification of speaker’s intent
Reasoning	Difficulty with drawing conclusions Inability to figure out and apply rules in problem solving activities Difficulty with production and fluency of thought	Group therapy with cognitive rehabilitation activities
Problem Solving	Difficulty with identifying the problem, understanding need for help, generating possible solutions, &/or selecting best solution Inability to learn from trial and error	Group therapy with cognitive rehabilitation activities Training to identify breakdowns in problem solving
Information processing	Delayed responses to teacher’s questions Considerable time required to complete assignments	Adequate time for student to answer questions and complete assignments
Judgment	Bad decisions about friends, behavior, etc	Group therapy with decision-making activities Scripts and routines for negotiating difficult situations
Confabulation	Exaggeration Tells stories not necessarily based in fact	Group cognitive therapy Peer counseling Journal documenting past activities to guide student’s recollection of facts
Fatigue	"Shutting down" following cognitively demanding tasks Inability to focus as day progresses Complaints of being tired	Consultation with parents regarding physician’s reports & medication schedule Part-time attendance and/or frequent breaks (scheduled or requested)

What areas may be affected	What might that look like?	What may help?
PSYCHOSOCIAL/BEHAVIORAL FUNCTIONING
Perception, evaluation, and use of social cues	Violation of others’ personal space Unable to ‘read’ body language and social cues in interpersonal activities	Social Skills Therapy to address deficits Contextualized (i.e., at lunch, during art activity) cueing to assist student during interactions
Coping with over-stimulating environment	Difficulty functioning in the lunchroom or in gym – may demonstrate with behavioral outburst	Avoidance of over stimulation Therapy to address deficits Routine for identifying anxiety and "escaping" stressful situation before outbursts
Frustration tolerance	Easily upset by failure Refusal to complete difficult work	Group Therapy to address deficits Routine for "waiting" Presentation of easy, previously mastered tasks before beginning difficult work to promote positive feelings of success
Emotional control / stability	Sudden changes in emotional state Emotional reactions (anger, sadness, etc.) out of proportion to the situation Irritability in classroom and during class activities	Group/Individual Therapy to address deficits Prevention of emotional reactions through management of environment Routine for "escaping" stressful situations and/or reducing agitation
Self Esteem	Repeated and emphasized statements indicating feelings of worthlessness, stupidity, etc.	Group/Individual Therapy and counseling to address difficulties Provision of frequent opportunities for success
Awareness of deficits	Limited insight into own abilities and behavior Denial of problems and need for help	Group/Individual Therapy to address deficits Education about strengths and weaknesses in a supportive environment Analysis and discussion of performance on difficult tasks by student and teacher Counseling for cases of psychological denial
Emotional adjustment to injury	Demonstrates social and physical withdrawal, depression or emotional disturbance	Group/Individual Therapy and counseling to address deficits Provision of frequent opportunities for success
Maturity	Immature behavior	Group Therapy to address deficits Peer modeling of age-appropriate behavior Discussion of performance in supportive environment
Relating to others	Egocentric behavior Focus solely on self with little concern about needs of others Inappropriate affection towards others Isolation of self	Group Therapy to address deficits Cueing for consideration of others’ feelings "Scripts" for interacting with others
Self-control / Inhibition	Verbal or physical aggression Impulsivity Inability to inhibit offensive behaviors Sexual acting-out Risk-taking	Group/Individual Therapy to address deficits Consistent and clearly-defined expectations Prevent aggression by eliminating triggers in the environment Peer modeling
Pre-existing behavior or learning disabilities	Learning and behavioral difficulties present before the injury become more significant areas of difficulty	Group/Individual Therapy to address needs Peer counseling/support One-to-one tutoring in difficult subject areas Assorted computer programs that address areas of need