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Returning to School After Traumatic Brain Injury

      Parental involvement is critical when a young person is returning to school after a traumatic brain injury (TBI).

      How does TBI affect students?

      • The effects of TBI vary greatly from student to student.
      • Grades may drop or more work may be required to keep grades up.
      • Sometimes the effects of a brain injury are not obvious at first. The effects may become more noticeable later when thinking and social activities increase at school.
      • The student may require academic and emotional supports after the injury.
      Some examples of changes that may occur after a person has sustained a TBI are:
      • Physical changes
      • Cognitive (thinking) changes
      • Emotional changes
      • Behavioral changes

      Planning to return to school

      Much of the frustration and confusion related to returning to school can be avoided with proper planning. School personnel should be contacted as soon as possible after the injury to plan for the student's return to school. School systems are required to provide an individualized education program (IEP), as applicable, to help ensure a student's academic and social success. The family, rehabilitation team, and school staff must work together and share information. This step is critical as evaluation data are used to prepare a student's IEP. Some states have a brain injury educational consultant who can help local educators assess and provide services to students with brain injuries.
      Specific laws require schools to provide services for students with disabilities:
      • Individuals with Disabilities Education Improvement Act (IDEA) 2004: Helps ensure that students with disabilities receive a free appropriate education that is designed to meet their unique needs and prepare them for employment and independent living.
      • Section 504 of the Rehabilitation Act: Some students who are not protected under IDEA are eligible for other supports under Section 504.
      • Americans with Disabilities Act: Provides accessibility, nondiscrimination and greater access to workplaces, public transportation, and telecommunications.

      How can schools support students with TBI?

      It is important to obtain information about the student's pre-injury cognitive abilities. A neuropsychologist and other rehabilitation professionals can evaluate the student's current strengths and abilities, and recommend support resources both in and out of the classroom.
      Often a neuropsychological evaluation is used to answer questions such as:
      • Can the student do the work needed to advance to the next grade or to participate in specific activities/classes?
      • What are the student's cognitive strengths?
      • What are the student's social skills?
      • What are the student's physical abilities, such as strength, balance and endurance?
      • What are some of the problems the student may face, and what should educators look for?
      • What classroom strategies can be used to help the student with attention, concentration, and learning?

      What are possible classroom placement options?

      There are four types of classroom placements:
      • Classroom with Access to General Curriculum: The student will be in a regular classroom with typical peers. In addition to the teacher, a special education teacher will be available to adjust the curriculum to the student's abilities. The special educator builds supports for the student's success.
      • Resource Room: In a Resource Room, a special-education teacher works with a small group of students. Resource Room placements have the benefit of providing help where needed while letting the student remain in regular classes most of the time.
      • Self-Contained Class: Placement in a self-contained classroom means the student is taught in a small controlled setting with a special education teacher. However, the field does not promote this option because it removes the student from typical peers during the Core Curriculum.
      • Out-of-District Placement: Out-of-district placement requires the student to attend a school specifically designed to address special learning or behavioral needs. The advantage is the high degree of specialized instruction. The disadvantage is the student does not attend the neighborhood school and misses peer interactions.
      The following questions may help parents and school staff make the important decision about placement:
      • What type of setting is likely to be the most conducive to learning?
      • What are the disadvantages of not remaining in the regular classroom?
      • What structure is needed?
      • What specialized instructional techniques or technology are needed to enhance learning? How will these be provided without stigmatizing the student?
      • Does the student need to focus on functional skills to enhance independent living and employment?
      • Have the student's transition assessments revealed that the student would benefit from learning community living or employment skills in a setting outside of the classroom?
      • Does the student plan to attend college?
      Once the student is placed it is important to monitor his or her progress so changes can be made as needed. A transition specialist might assist as the student moves from grade to grade, middle to high school and from there to adult life.

      Challenging classroom behavior

      Several common triggers can cause or contribute to negative behaviors in students with TBI:
      • Students with TBI can become over-stimulated easily.
      • Students with TBI may respond negatively to an unexpected event or a lack of clear structure.
      • Physical and cognitive activities at school may overwhelm the student to the point of an emotional outburst.
      • Negative feedback and lack of support from teachers and students can contribute to emotional and behavioral problems.

      Ways educators can address challenging behavior

      • Avoid labeling the student.
      • Talk to the student to find out what is contributing to the student's behavioral flare-ups. Is it emotional, physical, cognitive, and/or social?
      • Evaluate the student's environment to determine what events may trigger behavioral problems. Also observe how the student interprets these events.
      • Provide a safe setting for the student to calm down (i.e., guidance office, resource room).
      School behavior that is counterproductive follows a pattern. The educator's task is to detect and understand this pattern through classroom observations and discussions with the student, family, and other teachers.

      Disclaimer

      This information is not meant to replace the advice from a medical professional. You should consult your health care provider regarding specific medical concerns or treatment.

      Attribution

      “Returning to School After Traumatic Brain Injury” was developed by Paul Wehman, PhD, and Pam Targett, MEd, at Virginia Commonwealth University's Rehabilitation Research and Training Center (VCU-RRTC) through a subcontract with TransCen, Inc., and funded by NIDRR/U.S. D.O.E. grant #H133A100007CFDA#84.133A and in collaboration with the University of Washington Model Systems Knowledge Translation Center NIDRR/U.S. D.O.E. grant #H133A060070. Copyright © 2010. May be reproduced and distributed freely with appropriate attribution.