Traumatic Brain Injury (TBI)
Report by John Sufficool
What is TBI?
Traumatic Brain Injury is defined as an injury or damage to the brain caused by an outside force. It does not include birth problems or prenatal problems. There are two major categories of TBI. The first one is closed injuries. With these injuries, the skull stays intact. These can be caused by a blow to the head or shaking. Many of these injuries come from sports, falls, or auto accidents. Many young children suffer injury from being shaken. The second category is a penetrating Injury. In this injury, the skull is breached. This is often caused by a gunshot wound or automobile crash.
Physicians separate TBI’s into three degrees of severity: mild, moderate, and severe.
- A mild injury is when the person is unconscious for less than an hour or does not lose consciousness at all. The victim may have a mild concussion and not even go to the hospital because they appear to recover quickly. Even those who do go to the doctor may be released and not experience symptoms of a brain injury for some time.
- In a moderate injury, the victim usually loses consciousness or is in a coma for more than an hour, but less than 24 hours. The victim stays in the hospital for a short time and the doctor can usually see brain damage, such as swelling or bleeding on a CT scan or EEG.
- A severe injury leaves the victim unconscious or in a coma for more than 24 hours. It usually results in a loss of some motor skill and requires a longer hospital stay which includes therapy to help recover some of the lost skills.
”Our nation's special education law, the Individuals with Disabilities Education Act (IDEA) defines traumatic brain injury as "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 educational performance. The term applies to open or closed head injuries resulting in impairments in one or more areas, such as cognition; language; memory; attention; reasoning; abstract thinking; judgment; problem-solving; sensory, perceptual, and motor abilities; psycho-social behavior; physical functions; information processing; and speech. The term does not apply to brain injuries that are congenital or degenerative, or to brain injuries induced by birth trauma.” [34 Code of Federal Regulations §300.7(c)(12)]”


Prevalence
It is estimated that 1.4 million brain injuries occur in the United States each year. 50,000 of these result in death. Men and boys are two to three times more likely to receive a brain injury than girls. This most likely results from the fact that boys play more contact sports than women. Men are also more likely to participate in more extreme activities such as motor cross, mountain biking, climbing activities, and racing of any kind.
Children often receive brain injuries as a result of common activities like climbing trees, riding bikes, skating or skate boards.
Brain injuries cannot be avoided but the threat can be lessened with proper precautions. Young people and adults should always wear a helmet when engaging in Sports and recreational activities.
Results of TBI
The result of a traumatic brain injury may not be immediately visible. Some of them can manifest themselves years after the actual injury. Others are more severe and have a major impact on the victim, their families, friends, work situation, and school life. The affects of a TBI can be divided into four major changes.
- Physical changes: headaches, tiredness, heightened sensitivity to light and sound, lack of interest, and slow reaction time. Some more severe symptoms include speech problems, seizures, and full or partial paralysis.
- Cognitive Changes: memory loss, difficulty learning new material, problems with organization, and can be distracted easily.
- Emotional Changes: difficulty dealing with changes to routine, difficulty expressing emotions, anxiety, and depression
- Behavioral Changes: moodiness, crying, nervous laughter, anti-social interactions with others, and anger.
TBI and school
Many teachers, school administrators, and medical personnel do not fully understand the affects a brain injury has on a student. Children with a TBI exhibit many of the symptoms of retardation or other learning disorders. Some of these symptoms include:
· Difficulty with logic, thinking and reasoning
· Slower to respond, react and complete activities and tasks
· Difficulty focusing attention
· Physical limitations
· Inappropriate social behaviors
· Difficulty remembering
· Trouble understanding and completing grade level work
You can see how many of these symptoms can be confused with ADHD, a learning disability, or depending on severity of the physical limitations, mental retardation. Unfortunately, these students are misdiagnosed and do not receive the help they need.
One of the main problems leading to this misdiagnosis is in inadequate testing. Most of the tests for LD include some sort of IQ testing and testing prior knowledge. Most students with a TBI can still access the information they had before the accident. Their problem is in learning and processing new information. Therefore, they pass these tests and are considered ineligible for special education services. They are labeled as lazy or uncooperative. Sometimes they are labeled as ADHD and given medication that does not help. An estimated 300,000 to 500,000 children have been diagnosed with brain injuries, but according to the Education Department, only about 14,000 have been identified through the school system under Idea or 504 legislation. Many physicians and brain experts want schools to start using tests and surveys to see if the child has ever had a head injury, even if they did not receive medical attention for it.
Mary’s Story- A Mild Brain Injury
When Mary was ten years old she was riding on the back of a four-wheeler with her older sister and they hit a large bump in the road. Mary fell off the back of the four-wheeler and hit her head on a rock. When she woke up her sister was standing over her. She got up and went home.
She soon noticed a huge bump on her head and she began to have a headache. She also felt dizzy when she stood up, so her mother asked the village health aide to examine her. The health aide told Mary’s mother to have her rest for the next few days, and if the symptoms did not get better to return to the clinic. Mary seemed to return to normal after a few days.
About a month later, Mary started school in the 5th grade.
Mary At Home:
Mary’s family does not understand that she has some long lasting effects from her fall off the four-wheeler but they have noticed some changes in her behavior. Her grandmother has noticed that when they are out picking berries, Mary is no longer the fastest berry picker. Mary is somewhat forgetful when her mother asks her to do chores, but she assumes it is because Mary does not want to do her chores. Her mother is often frustrated with Mary because she cannot decide what to wear to school or what candy she wants to buy at the store. When Mary comes over to help her grandmother do bead work, Mary seems to have difficulty learning new bead patterns. She also seems to be anxious about many different things.
Mary At School:
Mary’s teacher noticed changes in her behavior this year. Mary often forgets to turn in her homework, even though her mother says that she has done it. She also takes much longer to finish assignments than she did the previous year and she spends a lot of time trying to get organized before starting her work. She frequently talks to other students instead of beginning her work. For the first time in her life, Mary has begun to get in trouble at school. She has also gone home early from school several times complaining of a stomachache.
About the middle of the school year, Mary’s teacher decided that something must be wrong because there had been such a dramatic change in her behavior and schoolwork. The teacher recommended that Mary be tested for special education. The results of the tests showed that Mary had normal intelligence and was performing academically at her grade level. Therefore, the teacher assumed that Mary was just being lazy and did not want to work. Mary soon began crying each morning when she had to go to school. It was not until a year later when the school did additional testing did everyone realize that Mary has an information processing problem and has difficulty remembering new information, especially if she has to learn it by listening to the teacher talk.
Mary is a prime example of how easily these students can be misdiagnosed.
How can the parents and schools work together?
Parents play a very important role in helping their children with brain injuries. They need to inform the school of the injury. They also act as a go between the doctors and the school. Parents often initiate an IEP meeting for their children before they return to school so that the correct modifications are in place.
Teachers and staff also play an important role. The key to successfully educating a TBI student is in the preparation. It is extremely important to plan for the student’s return. Much of the frustration and confusion related to returning to school can be avoided with proper planning. Rehabilitation professionals should communicate with family members and school personnel to help find the most effective ways to help the student return.
It is important for teachers to find out as much about the child’s cognitive ability before the accident as possible. This can be done by contacting the child’s current or last teacher, looking at previous test results, talking to parents and family members, and consulting with consulting with the child’s medical professionals and social workers. Teachers should also research TBI and find out as much about it as they can. This will help the teachers know what to expect when they do get the child in the classroom. You need to remember, however, that every child responds differently to each situation.

Best Practices for Teachers
There are many things that teachers can do to make the classroom inclusive for students with TBI. You will notice that most of these are just good teaching practices and will benefit all students.
Ø Provide extra time for the students to complete tasks. Remember, their ability to process new information may be slower.
Ø Break down the directions into step by step instructions. Do not give many instructions at a time and expect them to remember them.
Ø Model new tasks for the students. You may need to model the task in order for the student to get it.
Ø Give verbal and written instructions. Graphic organizers often help students understand the instructions or information better.
Ø Check for comprehension and skill acquisition frequently
Ø Provide repetition and consistence for the students
Ø Have consistent routines and let the students know ahead of time if there is going to be a change
Ø Try to eliminate distractions in the classroom
Ø Teach strategies to improve memory and organizational skills. Keeping journals or agenda books helps with this.
TBI: A Life Problem
Traumatic Brain Injuries can make it difficult to educate children, but it is more of a life problem than an education problem. Many people with TBI’s have to relearn basic motor skills in order to complete tasks that we take for granted. There are many rehab hospital that help these victims relearn these skills so they can reintegrate into society. There are also many technological advances and computer programs to help victims either retrain the brains or be able to speak and move about. The videos below relate the success story of two different TBI victims.
http://www.mefeedia.com/watch/28427517 http://www.youtube.com/watch?v=pPh4e14CRIs


Conclusion
Traumatic Brain injuries occur often. Teachers and parents cannot prevent all of them. It is important to be well educated as to the symptoms of TBI. When we know what to look for, we can be better prepared to help these students. Teachers and parents need to work together for the best interest of the child. They should conference often to see if there is something they can do at home and school to help the child succeed.
Intervention teams need to investigate all possible causes of a child’s struggles. We should never assume that a child is lazy, uncooperative, or has an LD. Our research should include looking at the child’s history to see if there has been some brain trauma. IDEA mandates that we identify these students and provide the proper help so that they can receive an education.
Many times the education these students need just involves good teaching practices and a little patience and understanding on the part of the teacher. In more severe cases, you may need to have support staff or special equipment for the child. In any case, the students need to be properly identified so they can receive help and funding through IDEA.
Bibliography and references:
http://menshealth.about.com/od/conditions/a/Brain_Injury.htm
http://ocd.about.com/od/causes/a/OCD_TBI.htm
http://specialed.about.com/od/disabilities/a/tbi.htm
http://www.kidneeds.com/diagnostic_categories/articles/genbraininjury.htm
http://www.brainline.org/content/2008/07/traumatic-brain-injury-susans-story.html
http://www.brainline.org/content/2011/02/returning-to-school-after-tbi.html
http://www.dlcak.org/files/pdf/Publications/EducatingStudentswtihTBI.pdf
Good resource for teachers http://www.neuro.pmr.vcu.edu/faq/faq.asp?FAQ=22
Videos: http://www.youtube.com/watch?v=S0KEpAW9y4E
http://www.youtube.com/watch?v=678At2P9NAA
http://www.youtube.com/watch?v=Sebi2Jl5Xus&NR=1