The symptoms can be medical, cognitive, behavioral, and/or social. 

Even Mild concussions can cause symptoms such as include headache, confusion, lightheadedness, dizziness, blurred vision or tired eyes, ringing in the ears, bad taste in the mouth, fatigue or lethargy, a change in sleep patterns, behavioral or mood changes, and trouble with memory, concentration, attention, or thinking. 

People with Moderate and Severe TBI may have the symptoms of mild TBI with the addition of headache that gets worse or does not go away, repeated vomiting or nausea, convulsions or seizures, an inability to awaken from sleep, dilation of one or both pupils of the eyes, slurred speech, weakness or numbness in the extremities, loss of coordination, and increased confusion, restlessness, or agitation.(“Traumatic Brain Injury | National Institute of Neurological Disorders and Stroke,” n.d.)

 

A limited ability to sustain attention and/or poor memory skills, including but not limited to, difficulty retaining short term memory, long-term memory, working memory and incidental memory. 

An inefficiency in processing, including but not limited to, a processing speed deficit and/or mental fatigue. 

Deficits in sensory-motor skills that affect either one, or both, visual or auditory processing, and may include gross motor and/or fine motor deficits. 

Delays in acquisition of information including new learning and visual-spatial processing. 

Difficulty with language skills, including but not limited to, receptive language, expressive language, and social pragmatics. 

Deficits in behavior regulation, including but not limited to, impulsivity, poor judgment, ineffective reasoning and mental inflexibility. 

Problems in cognitive executive functioning, including but not limited to, difficulty with planning, organization and/or initiation of thinking and working skills. 

Delays in adaptive living skills, including but not limited to, difficulty with activities of daily living (ADL). 

Delays in academic skills, including but not limited to, reading, writing, and math delays that cannot be explained by any other disability. They may also demonstrate an extremely uneven pattern in cognitive and achievement testing, work production, and academic growth. (“Brain Injury in Children and Youth: A Manual for Educators,” 2018)

In addition to the specific effects of the brain injury, students may struggle with frustration, anxiety and depression with the loss of their skills.  Peers may also struggle with reconciling the changes in the student compared with the person before the TBI.  Peers may be affected by the students lack of personal boundaries and impulse control as behaviors may create safety concerns and/or disrupt learning in the classroom. 

Seating away from distractions and near positive peer role models, provide clear expectations for behavior in the classroom and learning objectives, break assignments into smaller chunks and frequently check for understanding, provide a variety of learning activities so that students have an opportunity for movement after sitting and for breaks after periods of concentration.  Tie new learning to previous learning and to areas of student interest. Provide alternative testing environments away from distractions and additional time as needed. Provide copies of class notes or outlines.  Have students “teach” concepts to a peer right after the teacher has given large group instruction.  Teach and encourage mindfulness and positive behavior self monitoring and refocusing strategies. Use written or picture organizers and check off completed steps.  

In addition to the accommodations mentioned above, strategies that help a student who has difficulty with impulse control include having the student repeat the question before answering or waiting 10-15 seconds before answering.  Provide fidgets, wiggle seats and/or the opportunity to stand during lessons. Provide classroom jobs such as passing out papers that allow movement.   Provide verbal and/or non-verbal cues between teacher/student. Provide extra adult support to the student for transitions between activities and/or moving from classroom to other areas of the school.  

Have well established rules and routines, give instructions one at a time, focusing on the most important information and give students time to process between instructions.  Provide written directions that include visuals.  Reduce the number of questions/assignments required. Try not to pressure the student to hurry. Provide graphic organizers and teach them how to use them. Teach students how to highlight dense text and how to study from notes. Teach the student how to advocate for themselves in asking for people to slow down.  

Pre-teach vocabulary and/or give notes to parent/student before class.  Allow students to use books/notes on assessments.  Use multiple choice questions instead of essay/short answers  Incorporate repetition/practice of new material and allow breaks between.Teach memory strategies: visual imagery, grouping information, mnemonics, connecting information to what the student already knows. Make emotional connections to  help trigger the limbic system.   Competition games are often effective.  Provide an extra set of books for home.  Provide a designated folder for homework.  Teach how to use technology like notes, calendar and alarms. During classroom instruction, if the student has their  hand up, call on them first so they don’t forget the question/response.  Teach memorization strategies like mnemonics.  Encourage/help students create a visual picture.  Ask the student the 5 Why questions to help with reading comprehension.  Use Errorless learning strategies to discourage guessing. Encourage students to self advocate to have information repeated or presented in another way.  Teach children in themes across content if possible. 

Students can be overwhelmed by visual/auditory stimuli or can need more sensory input.  Students should have access to earphones, sunglasses and quiet spaces to reset as well as rest breaks.  Recess and lunch are not rest for students with TBI. They may need an alternative location to eat with a small group of friends.  Students who need more stimuli should be allowed to chew gum or crunchy snacks, and be given weighted vests or blankets, stretch bands on chairs and other fidgets.  Students may need to transition before other students when the halls are quieter.  Students should be encouraged to participate in individual sports and activities that build strength and balance but don’t put the student at further risk of injury.  Allow the student to work in different positions including standing or laying on the floor.  Limit the amount of information on and/or use a ruler for visual tracking on a page.  Work with the physical and occupational therapists to determine needed adaptive equipment and technology such as special pencil grips or text to speech apps.  Give the student prepared materials rather than requiring them to cut or fold so they can focus on content.   (“Brain Injury in Children and Youth: A Manual for Educators,” 2018)

 

2. Following instructions can be challenging for students with hearing loss, especially within noisy learning environments. Take appropriate steps to eliminate as much background noise as possible. Consider things like the air conditioner, foot-traffic, and proximity to major thoroughfares. By doing what you can to minimise the level of noise overall you will reduce the possibility of a student with hearing loss mishearing your instructions.   

3. Students with hearing loss use a lot of concentration and effort to complete tasks, and are likely to tire. This may cause the students to become disengaged. Help students with their concentration by using assistive technologies, e.g an amplification system which may help amplify a single voice over classroom noise.   

4. Introduce new concepts in small steps and deliver the lesson at a measured pace. It is also important to keep directions concise and simple and to support your verbal instructions with visuals. Present instructions up on a board, so there is always a point of reference for the student. Also provide them with printed notes or electronic visuals through their device.    

Resources specifically for Educators

Resources for Parents and Educators

Self Advocacy Tools for Students returning to the classroom

(Inclusive teaching: Intellectual disability).

Inclusive teaching: Intellectual disability. ADCET. (n.d.). Retrieved September 14, 2022, from https://www.adcet.edu.au/inclusive-teaching/specific-disabilities/intellectual-disability 

MN Department of Education. (2019). (rep.). Manual on Developmental Cognitive Disability (DCD). 

Brain Injury in Children and Youth: A Manual for Educators. (2018). Retrieved September 17, 2022, from http://www.cde.state.co.us/cdesped/tbi_manual_braininjury

Colorado Kids with Brain Injury. (2022). Retrieved September 17, 2022, from https://cokidswithbraininjury.com/

LEARNET: Living Education And Resources Network by the Brain Injury Association of New York State. (n.d.). Retrieved September 17, 2022, from http://www.projectlearnet.org/for_teachers.html

Traumatic Brain Injury | National Institute of Neurological Disorders and Stroke. (n.d.). Retrieved September 17, 2022, from https://www.ninds.nih.gov/health-information/disorders/traumatic-brain-injury

Traumatic Brain Injury (TBI): Pediatric Causes and Prevention Strategies. (2019). Retrieved from https://www.nichd.nih.gov/newsroom/digital-media/infographics/TBIinKids

In my year of teaching, this could have helped me navigate recognizing the signs of low incidence disabilities and given me tools to support the students who have them. I may have been able to be more proactive in implementing support systems and offering accommodations to these students.