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Classroom Interventions for Students with Traumatic Brain Injuries Julie M. Bowen, Preventing School Failure (page 1 of 6) Page 1 of 6

ABSTRACT: Students who have sustained a traumatic brain injury (TBI) return to the school setting with a range of cognitive, psychosocial, and physical deficits that can significantly affect their academic functioning. Successful educational reintegration for students with TBI requires careful assessment of each child’s unique needs and abilities and the selection of classroom interventions designed to meet those needs. In this article, the author presents information about the range of services that are available in the school setting and discusses typical environmental and classroom accommodations that have proven effective. The author discusses a variety of specific research-based learning strategies, behavioral interventions, and instructional interventions available to educators who work with TBI students.

Most children who have sustained a traumatic brain injury (TBI), even a severe brain injury, will eventually return to a school or classroom setting following discharge from acute hospitalization (Klonoff & Paris, 1974; Rosen & Gerring, 1986). Some will return after only a brief hospitalization and others after a lengthy hospitalization and rehabilitation program. Because the recovery process can take several months or even years, many of these children continue to have rehabilitation needs and cognitive impairments and will return to school while still in the recovery stages. It often becomes the responsibility of the educational system to facilitate ongoing recovery and to provide needed services to help these children progress in their academic and social functioning. My purpose in this article is to review intervention strategies from recent research that are available to educators as they assist children with TBI when they return to the school environment. An intervention is defined as the systematic application of research-validated procedures to change behaviors through manipulation of antecedents and consequences or by teaching new skills (Bowen, Jenson, & Clark, 2004). Successful readjustment to school may require adaptation of the learning environment, acquisition or reacquisition of skills, provision of compensatory aids and strategies, as well as support services from special education providers.

Setting the Stage

Regardless of the severity of the injury and length of rehabilitation services, advance communication and coordination between the hospital, therapists, family, and the school system is a critical first step in student’s returning to school. The goal of this communication should be to gather medical and functional information to assist the school in developing an appropriate and individualized plan for the student’s reentry into school, whether it is a few accommodations in a regular class setting or an intensive special education program. This communication should be ongoing and the reentry plan determined prior to the student’s return to school. Specific classroom interventions and accommodations required to optimize a successful school reintegration should be developed after careful assessment of students’ needs, including medical, physical, cognitive, and social-emotional problems. Thus, the educational program and classroom interventions designed to benefit students with TBI must be based on the unique needs of each individual. Because of the rapidly changing needs and recovery of children with TBI, initial evaluations conducted while in the hospital may not be accurate descriptions of the students at the time of their reentry into school. Therefore, ongoing observation and assessment of students after their return to school is usually required to develop appropriate interventions and to evaluate the effectiveness of interventions.

The range of neurologic sequelae following TBI is too diverse to prescribe specific intervention strategies that work for all students, and there are few empirical studies that validate specific interventions for students with TBI. However, validated approaches that are effective for students with other disabilities similar to those of students with brain injury offer practical intervention choices for teachers working with students with TBI. Ylvisaker and colleagues (2001) suggest that students with TBI be identified by functional need and that teachers may then select from proven instructional interventions for a particular need. Although serving students based on functional needs is important, it is also critical for educators to have an understanding of TBI as a disability and of the commonly associated features of an acquired brain injury.

Common Sequelae of TBI

Children who have sustained a TBI may exhibit a wide range of newly acquired deficits or alterations in cognition, physical mobility, self-care skills, and communication skills as well as changes in emotional and behavioral regulation, which may significantly affect school functioning (Fletcher & Levin, 1988). The nature and severity of the injury, acute medical complications, age of the child, preinjury characteristics, and the interaction of these factors with the family system and environment will affect the course of recovery and school outcome (Wilkening, 1997). Each child will present a unique pattern of sequelae ranging from mild to severe.

Although there is considerable variability in outcome following TBI, there are also general features of acquired brain injury common to many children who sustain a brain injury, particularly when structural brain damage is present. These are related to vulnerable areas of the brain often affected during a closed head injury, including damage to the frontal lobes, and the anterior and medial temporal lobes. Children with frontal lobe injury typically experience greater difficulty with executive function, which includes attentional processes, self-regulation, goal setting, initiating, and inhibiting behavior. Many behavior and social problems observed in children with TBI are related to poor executive functioning. They may also have problems with organization—planning, prioritizing, analyzing tasks, and completing a sequence of activities. Cognitive impairments can include memory problems, slowed information processing, and language disturbances. Memory impairment (recalling and retaining information) is one of the most common deficits associated with pediatric TBI (Ewing-Cobbs & Fletcher, 1990). Physical functioning can also be markedly impaired following severe TBI. Loss of function in all or some extremities, spasticity, decreased motor speed, and poor coordination in fine or gross motor movements may require physical and environmental accommodations and/or assistance with self-care skills (feeding and toileting) in the school setting.

From Preventing School Failure magazine. Heldref Publications. Reprinted with permission. www.heldref.org.

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