Potential areas of need for students who have sustained a TBI

January 3, 2018 ACSA Writer

Article 3 of TBI series; based on information presented at ACSA’s 2017 Every Child Counts Symposium by Melissa Hatch, Esq., Hatch & Cesario, and Jarice Butterfield, Ph.D., CBIS, Santa Barbara County SELPA Director

Signs of potential physical and health issues to look out for include poor motor planning and initiation and spacial like the inability to report, respond, or orient to stimuli. Symptoms also include seizures, visual/perceptual changes, hearing changes, scars/hair loss, self-care activities, pain/headaches.

Strategies that can help students cope include rest breaks and short days, a home-based instructor, shortened and split assignments, speech or vision therapy, individual healthcare plans, seizure management.

Behavioral needs

Watch for mood swings, increased anxiety, lack of awareness of social cues, physical or verbal aggression, lack of inhibition, and difficulty empathizing. Help the student build trusting relationships through honest, caring, consistent interactions. Conduct a Functional Behavioral Assessment (FBA) to determine the functions of the behavior. Check out www.PENT.CA.GOV.

Implement an individual behavior plan based on data related to the function of the behavior and positive replacement behaviors. Intervene early in cases of situations that may escalate. Try relaxation training, daily/weekly progress reports, modification of non-academic tasks (lunch or recess), using scripts and directions for teaching and eliciting adaptive behavior, adjusting the class schedule to align to times during the day when the student with TBI may be more likely to exhibit behavioral challenges.

Communication needs

These can include difficulty expressing thoughts, trouble understanding, trouble with voice production and articulation, and aphasia (no speech or confused speech). Refer to speech and language services, utilize assistive technology, augmentative, or alternative communication, or use visuals.

Attention/Organization/Cognition needs

This refers to a shortened attention span, poor initiation, difficulty engaging in activities or being unable to attend to more than one thing at a time. Consider the environment – avoid distracting situations. Teach self-regulating techniques to keep attention (Am I paying attention? cue card or other cues). Allow for rest periods or physical activity breaks. You can also use a visual timer or alarm sounds for reminders of when to focus.

Memory & learning needs

A student with TBI may be unable to remember names, new information, rules, and steps, or tasks performed from one day to the next. You can help by establishing a structured daily routine using memory aids like calendars, schedules, lists, notebooks, etc. Have the student record and check off tasks as they are completed. Pair new information with things the student is able to recall, perhaps visual cues (schedules or sequences on a device or on the wall).

Reading needs

It is crucial that the cause of the reading problem is diagnosed in order to remediate effectively. Some of the more common causes in reading problems: Inability to see print correctly, recall words, remember letter sounds to sound out words, difficulty with comprehension due to processing, or difficulty with fluency or processing.

Strategies: Daily vocab drills, vision therapy or eye training exercises. Seek reading material with visuals/multi-sensory approaches. Listen to books on tape while reading along. Check out Orton Gillingham (most effective for initial reading instruction after TBI) and engage in timed reading trials after listening to a model reader such as the Read Naturally program.

Writing needs

If the student has trouble physically accessing writing tools, is unable to form letters or complete thoughts, or remember how to spell, help them relearn letters using multisensory strategies (sand trays, sandpaper, glue cards, large motor, etc.). Try dot to dots and tracing of letters to reinforce letter formation, trace letters written in yellow highlighter ink, or use organizational strategies for writing paragraphs, such as Inspiration Software. A computer word processor with a word prediction program or a text-to-speech program might be beneficial.

Mathematics needs

If the student is unable to remember math facts (+, -, x, ÷) or the steps required for math operations, unable to recognize numbers, or dealing with money, strategies include:

Relearning math facts through music (commercial products available), using memory aids such as touch math/touch points, utilizing drill and practice software programs, make visuals of the steps required for operations, and buying a talking calculator. Remember to take frequent breaks to avoid mental fatigue.

Cause of Math Difficulty Recommended Remedial Strategy

Due to a physical impairment

Use of assistive aids and devices such as graph 
paper, pencil grip, computer, or calculator
Due to a medical problem such as fatigue 
caused side effects of medication; 
Limit the time the student engages in cognitively 
demanding math tasks and providing short breaks. 
Breaks assignments into segments
Due to cognitive/processing problems Reteach basic math skills with the use of manipulatives
or allow the use of a calculator. 
Provide the process steps in charts or lists with visual 
supports; color code math steps.
Student previously had acquired math 
skills prior to TBI 
(note that skills will usually be ready re- 
learned as the brain heals if the student 
had once acquired the skill or memorized 
the math process or fact)
Reteaching using multisensory strategies and 
manipulatives along and allow the student to use a 
calculator until skills is regained. 
Provide the process steps in charts or lists with visual 
supports; color code math steps.


The functioning of students with TBI can change rapidly. Therefore, continuous and periodic formal assessment is paramount in relation to academic intervention. 

One tool for progress monitoring is Domains of Functioning Observation Framework Description For Individuals with TBI by Diana Browning-Wright (available at www.pent.ca.gov/frm/tbidomainsguide.pdf).

This is the last of ACSA’s 3-part article series on traumatic brain injury. To continue learning, check out recent news stories like this onethis one, and this one, and keep up with the latest medical research. You may also find these resources helpful: "What Trauma Can Look Like in the Classroom," BrainLine, the Brain Injury Support Center, and NASET.

Check out the video below to see ACSA's story on high school student Nicky Macchiavello. When Nicky was 17, a motorcycle accident at a motocross track changed his life forever. The varsity soccer player crashed and suffered a TBI, landing him in a medically-induced coma at Arrowhead Regional Medical Center for the next 2 ½ months. The Huntington Beach community rallied around Nicky, holding car washes, selling bracelets, and hosting Go Fund Me sites to help with Nicky’s medical costs. It wasn’t long before Nicky was back at school and back on the soccer team (as captain!) with an incredible story that shines a light on the power of community, friendship and a positive attitude.

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