TRAUMATIC BRAIN INJURY
was 7 years old when she was hit by a car while riding her bike.
She broke her arm and leg. She also hit her head very hard. The
doctors say she sustained a traumatic brain injury. When she came
home from the hospital, she needed lots of help, but now she looks
In fact, thatís part of the problem, especially at school. Her
friends and teachers think her brain has healed because her broken
bones have. But there are changes in Susan that are hard to understand.
It takes Susan longer to do things. She has trouble remembering
things. She canít always find the words she wants to use. Reading
is hard for her now. Itís going to take time before people really
understand the changes they see in her.
traumatic brain injury (TBI) is an injury to the brain caused
by the head being hit by something or shaken violently. (The exact
definition of TBI, according to special education law, is given
below.) This injury can change how the person acts, moves, and
thinks. A traumatic brain injury can also change how a student
learns and acts in school. The term TBI is used for head injuries
that can cause changes in one or more areas, such as:
and other physical activities,
and/or hearing, and
term TBI is not used for a person who is born with a brain injury.
It also is not used for brain injuries that happen during birth.
The definition of TBI below comes from the Individuals with Disabilities
Education Act (IDEA). The IDEA is the federal law that guides
how schools provide special education and related services to
children and youth with disabilities.
Definition of TBI
nationís special education law, the Individuals with Disabilities
Education Act (IDEA) defines traumatic brain injury as...
ď...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 childís
educational performance. The term 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;
psycho-social behavior; physical functions; information processing;
and speech. The term does not apply to brain injuries that are
congenital or degenerative, or to brain injuries induced by birth
trauma.Ē [34 Code of Federal Regulations ß300.7(c)(12)]
Common is TBI?
More than one million children receive brain injuries each year.
More than 30,000 of these children have lifelong disabilities
as a result of the brain injury.
What are the Signs of TBI?
The signs of brain injury can be very different depending on where
the brain is injured and how severely. Children with TBI may have
one or more difficulties, including:
disabilities: Individuals with TBI may have problems speaking,
seeing, hearing, and using their other senses. They may have
headaches and feel tired a lot. They may also have trouble
with skills such as writing or drawing. Their muscles may
suddenly contract or tighten (this is called spasticity).
They may also have seizures. Their balance and walking may
also be affected. They may be partly or completely paralyzed
on one side of the body, or both sides.
with thinking: Because the brain has been injured, it is common
that the personís ability to use the brain changes. For example,
children with TBI may have trouble with short-term memory
(being able to remember something from one minute to the next,
like what the teacher just said). They may also have trouble
with their long-term memory (being able to remember information
from a while ago, like facts learned last month). People with
TBI may have trouble concentrating and only be able to focus
their attention for a short time. They may think slowly. They
may have trouble talking and listening to others. They may
also have difficulty with reading and writing, planning, understanding
the order in which events happen (called sequencing), and
behavioral, or emotional problems: These difficulties may
include sudden changes in mood, anxiety, and depression. Children
with TBI may have trouble relating to others. They may be
restless and may laugh or cry a lot. They may not have much
motivation or much control over their emotions.
child with TBI may not have all of the above difficulties. Brain
injuries can range from mild to severe, and so can the changes
that result from the injury. This means that itís hard to predict
how an individual will recover from the injury. Early and ongoing
help can make a big difference in how the child recovers. This
help can include physical or occupational therapy, counseling,
and special education.
Itís also important to know that, as the child grows and develops,
parents and teachers may notice new problems. This is because,
as students grow, they are expected to use their brain in new
and different ways. The damage to the brain from the earlier injury
can make it hard for the student to learn new skills that come
with getting older. Sometimes parents and educators may not even
realize that the studentís difficulty comes from the earlier injury.
What About School?
Although TBI is very common, many medical and education professionals
may not realize that some difficulties can be caused by a childhood
brain injury. Often, students with TBI are thought to have a learning
disability, emotional disturbance, or mental retardation. As a
result, they donít receive the type of educational help and support
they really need.
When children with TBI return to school, their educational and
emotional needs are often very different than before the injury.
Their disability has happened suddenly and traumatically. They
can often remember how they were before the brain injury. This
can bring on many emotional and social changes. The childís family,
friends, and teachers also recall what the child was like before
the injury. These other people in the childís life may have trouble
changing or adjusting their expectations of the child.
Therefore, it is extremely important to plan carefully for the
childís return to school. Parents will want to find out ahead
of time about special education services at the school. This information
is usually available from the schoolís principal or special education
teacher. The school will need to evaluate the child thoroughly.
This evaluation will let the school and parents know what the
studentís educational needs are. The school and parents will then
develop an Individualized Education Program (IEP) that addresses
those educational needs.
Itís important to remember that the IEP is a flexible plan. It
can be changed as the parents, the school, and the student learn
more about what the student needs at school.
Tips for Parents
about TBI. The more you know, the more you can help yourself
and your child. See the list of resources and organizations
at the end of this publication.
with the medical team to understand your childís injury and
treatment plan. Donít be shy about asking questions. Tell
them what you know or think. Make suggestions.
track of your childís treatment. A 3-ring binder or a box
can help you store this history. As your child recovers, you
may meet with many doctors, nurses, and others. Write down
what they say. Put any paperwork they give you in the notebook
or throw it in the box. You canít remember all this! Also,
if you need to share any of this paperwork with someone else,
make a copy. Donít give away your original!
to other parents whose children have TBI. There are parent
groups all over the U.S. Parents can share practical advice
and emotional support. Call NICHCY (1-800-695-0285) to find
out how to find parent groups near you.
your child was in school before the injury, plan for his or
her return to school. Get in touch with the school. Ask the
principal about special education services. Have the medical
team share information with the school.
your child returns to school, ask the school to test your
child as soon as possible to identify his or her special education
needs. Meet with the school and help develop a plan for your
child called an Individualized Education Program (IEP).
in touch with your childís teacher. Tell the teacher about
how your child is doing at home. Ask how your child is doing
out as much as you can about the childís injury and his or
her present needs. Find out more about TBI. See the list of
resources and organizations at the end of this publication.
the student more time to finish schoolwork and tests.
directions one step at a time. For tasks with many steps,
it helps to give the student written directions.
the student how to perform new tasks. Give examples to go
with new ideas and concepts.
consistent routines. This helps the student know what to expect.
If the routine is going to change, let the student know ahead
to make sure that the student has actually learned the new
skill. Give the student lots of opportunities to practice
the new skill.
the student how to use an assignment book and a daily schedule.
This helps the student get organized.
that the student may get tired quickly. Let the student rest
in touch with the studentís parents. Share information about
how the student is doing at home and at school.
flexible about expectations. Be patient. Maximize the studentís
chances for success.
Brain Injury Association
(formerly the National Head Injury Foundation), 105 North Alfred
Street, Alexandria, VA 22314. Telephone: (800) 444-6443 (Family
Helpline); (703) 236-6000.
Emergency Medical Services for Childrenó National Resource Center,
111 Michigan Avenue N.W., Washington, DC 20010-2979. Telephone:
Office, 4351 Garden City Drive, Suite 500, Landover, MD 20785.
Telephone: 301-459-3700; (800) 332-1000; (800) 332-2070 (TTY).
Alliance, 690 Market Street, Suite 601, San Francisco, CA
94104. Telephone: (415) 434-3388; (800) 245-6686 (CA only).
P.O. Box 769, Algodones, NM 87001. Telephone: (505) 867-2368.
Head Injury Hotline,
212 Pioneer Building, Seattle, WA 98104. Telephone: (206) 621-8558.
DeBoskey, D.S. (Ed.). (1996). Coming home: A discharge manual
for families of persons with a brain injury. Houston, TX: HDI.
(Telephone: (800) 321-7037; (713) 526-6900.)
DePompei, R., Blosser, J., Savage, R., & Lash, M. (1998).
Special education: IEP checklist for a student with a brain injury.
Wolfeboro, NH: L&A
Publishing/Training. (Telephone: (919) 562-0015. Web:
DePompei, R., & Cluett, B. (1998). All about me! Wolfeboro,
NH: L&A Publishing/Training. (For use by elementary school
children with TBI. Available from L&A, at the phone number
Glang, A., Singer, G.H.S., & Todis, B. (1997). Students with
acquired brain injury: The schoolís response. Baltimore, MD: Paul
H. Brookes. (Telephone: 1-800-638-3775.)
Lash, M. (1998). Resource guide: Children and adolescents with
brain injuries. Wolfeboro, NH: L&A Publishing/Training. (See
phone number above.)
Lash, M., Wolcott, G., & Pearson, S. (1995). Signs and strategies
for educating students with brain injuries: A practical guide
for teachers and schools. Houston, TX: HDI. (Telephone: (800)
321-7037; (713) 526-6900.)
Savage, R. (1995). An educatorís manual: What educators need to
know about students with TBI (3rd ed.). Houston, TX: HDI. (See
phone number above.)
Snyder, H. (1998). Elvin the elephant who forgets. Wolfeboro,
NH: L&A Publishing/Training. (A 16-page picture book for children.
Available from L&A at the phone number above.)
Ylvisaker, M. (1998). Collaborative brain injury intervention:
Positive everyday routines. San Diego, CA: Singular Publishers.
(Telephone: (800) 521-8545.)
with permission from:
National Information Center for Children and Youth with Disabilities
P.O. Box 1492
Washington, DC 20013
This fact sheet is made possible through Cooperative Agreement
#H326N980002 between the Academy for Educational Development and
the Office of Special Education Programs. The contents of this
publication do not necessarily reflect the views or policies of
the Department of Education, nor does mention of trade names,
commercial products or organizations imply endorsement by the
U. S. Government. This information is copyright free. Readers
are encouraged to copy and share it, but please credit the National
Information Center for Children and Youth with Disabilities (NICHCY).