23 Traumatic Brain Injury

This section includes the IDEA definition of the disability from federal law, along with specific information about eligibility criteria in Virginia. In addition, there is information about the prevalence, causes, and characteristics of this disability, along with specific strategies and accommodations that can meet the needs of students with this disability.

Students with a traumatic brain injury have difficulties in school due to an acquired head injury.  Typical causes are accidents, falls, abuse, and gunshot wounds. IDEA provides the parameters of the educational label, while parents, guardians, advocates, and professionals have valuable information to add about the individual.

IDEA Definition

§ 300.8 (c) (12)

Traumatic brain injury means 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. Traumatic brain injury 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; psychosocial behavior; physical functions; information processing; and speech. Traumatic brain injury does not apply to brain injuries that are congenital or degenerative, or to brain injuries induced by birth trauma.

Eligibility Criteria

VDOE Supplemental Guidance for Evaluation and Eligibility Virginia-specific guidance document that includes sample eligibility checklist (Refer to Table of Contents pages 2-4 and click on page number for disability category)

A multi-disciplinary team approach to individual evaluation procedures for traumatic brain injury (TBI) includes varied sources of information and the appropriate use of instruments sensitive to cultural, linguistic, and environmental factors or sensory impairments:

• Checklist for Comprehensive Evaluation
  In order to determine the presence of an traumatic brain injury, the evaluation should address each of the following domains. Suggested sources of data are listed under each domain.
  Psychosocial/ Cultural History

  – Family background

  – Environmental background

  – Social background

  – Cultural background

  – Developmental history

  Educational History

  – File review

  – Standardized cognitive/developmental testing

  – Educational progress

  – Documentation of tiered interventions and the student’s response to those interventions

  – Curriculum-based measures

  – Objective data on classroom performance (e.g., grades on assignments, tests)

  – Standardized achievement testing

  – Samples/portfolios of student work

  Health Assessment

– Appropriate medical statement obtained from a licensed medical provider

Emotional/Behavioral

– Documentation of tiered interventions and the student’s response to those interventions

– Clinical interview with student

– Student’s self-report

– Observable behavior in multiple settings

– Standardized report (e.g., rating scale, inventory, etc.) by teacher, parent, other observer

– Structured direct observation

Advocacy organizations

Brain Injury Association of Virginia – Information and personal support for individuals, families, and professionals. Includes link to the Brain Injury and the Schools: A Guide for Educators. The guide provides an overview of brain injury and its cognitive, behavioral, and physical consequences, with resources for teaching and non-teaching personnel.

Brain Injury Partners Navigating the School System from the Brain Injury Alliance of Colorado

University of Virginia TBI Network

ABOUT traumatic brain injury

Prevalence

TBI is the most common acquired disability in childhood and the leading cause of death in children.

26,512 Children identified eligible for services under Emotional Disturbance, 3 to 21 years old served under Individuals with Disabilities Education Act (IDEA).  This represents .4% of the total population in special education.

Visit the US Department of Education’s Open Data Platform to access IDEA Child Count Data by disability category, age, and other demographic and special education variables.

Causes

This infographic from the National Institutes of Health summarizes the main causes and strategies for prevention of traumatic brain injury in children.

Characteristics

Children who sustain TBI may experience a complex array of problems, including the following:

Medical/Neurological Symptoms: speech, vision, hearing, and other sensory impairment, decreased motor coordination, difficulty breathing, dizziness, headaches, impaired balance, loss of intellectual capacities, partial to full paralysis, reduced body strength, seizures, sleep disorders, and speech problems.

Cognitive Symptoms: decreased attention, organizational skills, and problem solving ability; difficulty with abstract concepts; memory deficits; perceptual problems; poor concentration, poor judgment; slowed information processing, and poor memory.

Behavioral/Emotional Symptoms: aggressive behavior, denial of deficits, depression, difficulty accepting and responding to change, loss of reduction of inhibitions, distractibility, feelings of worthlessness, lack of emotion, low frustration level, helplessness, impulsivity, inappropriate crying or laughing, and irritability.

Social Skills Development: difficulties maintaining relationships, inability to restrict socially inappropriate behaviors, inappropriate responses to the environment, insensitivity to others’ feelings, limited initiation of social interactions, and social isolation.

Any or all of the above impairments may occur to different degrees. The nature of the injury and its attendant problems can range from mild to severe, and the course of recovery is very difficult to predict for any given student. It is important to note that with early and ongoing therapeutic intervention the severity of these symptoms may decrease, but only in varying degrees.

Traumatic Brain Injury: What Teachers Should Know – This information sheet from the National Center for Brain Injury Research provides a snapshot of causes, characteristics, and identification of traumatic brain injury:

The characteristics of students who have TBI can vary widely depending on the nature and extent of their brain injury, and we can see much overlap in characteristics between TBI and other disability areas such as autism, ADHD, specific learning disability, emotional disability, and intellectual disability. We can distinguish TBI from other disability areas in a few key ways as noted in the information brief  from the Center for Brain Injury Research and Training at the University of Oregon.

instructional strategies

This flyer, What Teachers Need to Know about Traumatic Brain Injury (TBI),  from the Center for Brain Injury Research provides a quick reference for teachers for supporting students who have experienced traumatic brain injury

• Academic skills
  • Direct, explicit, and effective instruction
  • High rates of teacher praise
• Social skills
• Cooperation skills
  • Appropriate ways to express feelings
  • Responding to failure
  • Learning the social and nonacademic skills that match teacher expectations
• Functional skills
  • Age-appropriate skills
  • Communication skills
  • Literacy skills
  • Recreation and leisure skills
• Access to general education curriculum
  • Integrating academic standards into lessons on functional skills
  • Select and prioritize instructional targets that are meaningful for students and their families
  • Instruction must be carefully planned, systematically executed, continuously monitored for effectiveness
  • The student’s current level of performance must be assessed
  • The skill must be defined clearly and actively engage the student
  • The skill may need to be broken down into smaller component steps
  • The teacher must determine how the student can actively participate, provide a clear prompt, and gradually withdraw the prompt
  • The student must receive feedback and reinforcement
  • The teacher must use strategies that promote generalization and maintenance
  • The student’s performance must be directly and frequently assessed
• Partial participation, students can be taught to perform selected components or an adapted version of the task
• Use of functional assessment methodologies to support student’s placement and guide the development of positive behavior support plans

accommodations / modifications

Consortium for Handheld Technology

Virginia Assistive Technology System (VATS)

resources

From Community for Online Accredited Schools, Students with Traumatic Brain Injuries-Student and Teacher Resources for Success in School after a Head Injury

Brain Injury Resource Center

Center for Neuro Skills

Virginia Commonwealth University TBI National Resource Center Fact Sheets

TBI Resources from the Center for Parent Information & Resources

Traumatic Brain Injury [PDF]- This PowerPoint slide deck provides an overview of TBI.