Traumatic Brain Injury (TBI)

Strategies

It is important to implement strategies that address the needs of the individual.  We recommend that you apply these strategies across home, school, and community contexts.

Memory and Cognition 
  • Repeat instructions and directions as needed and provide one direction at a time.
  • Remember that the student may take a longer amount of time to process information.
  • Have consistent routines and rules to promote procedural memory.
  • Provide student with an outline so they can anticipate content and transition.
  • Use pictures or visual cues to alert the student of the need to do something different.
  • Practice systematic verbal rehearsal - student may have to "practice" a verbal cue and what is expected.
  • Teach memory strategies and memory tricks such as elaborative rehearsal, mnemonics, limericks, etc.
  • Use a scribe or note-taker and have notes photocopied at the end of class to give to student.
  • Check for understanding - recognition vs. recall.
  • Modify work amounts and shorten assignments to the minimum necessary (increase gradually if student is successful).
  • Be very specific and to the point - use simple, concrete language.
  • Provide specific feedback on responses - state that an answer is correct or needs more input.
  • Be aware that students are not likely to raise hands and ask questions.
  • Be aware that students may ask the same question over and over because of poor short-term memory.
  • Be prepared to accept inconsistencies in performance.
  • Alert students to transition between classes (and remind them what class is next).
  • Allow student to tape-record lectures.
  • Clearly define class requirements, exam dates, and when assignments are due.
  • Provide handouts and visual aids.
  • Allow student to take notes directly onto an outline.
  • Use more than one way to demonstrate or explain information.
  • Break information into small steps when teaching a new or relearned skill.
  • State lesson objectives, review previous lesson, and summarize periodically.
  • Review major points at the conclusion of each class lecture.
  • Allow time for clarification of directions and important information.
  • Provide study guides or review sheets for exams.
  • Provide alternative means for the students to do tasks, such as dictation or oral presentation.
  • Provide verbal and visual reminders in class of impending deadlines and due dates.
  • Write assignments on the board or pass them out in written form.
  • Break tasks down for large projects or papers and set deadlines for each part.
  • Allow the student more time to finish schoolwork and tests.
  • Give the student written directions for multi-step tasks.
  • Show the student how to perform new tasks, and provide examples.
  • Have consistent routines and if the routine is going to change, let the student know ahead of time.
  • When teaching a new skill, give the student many opportunities to practice the new skill, and check for generalization.

Social Skills and Emotional Regulation 
  • Consider a modified schedule and / or a behavior plan.
  • Start a behavior modification program for academic and/or social skills and have student chart their progress.
  • Be aware that a previously effective behavior plan may not work due to memory deficits.
  • Talk with the student ahead of time and discuss the discipline plan.
  • Have student be prepared for schedule changes, such as late start, substitute teacher, early dismissal, etc.
  • Let student carry pictures of family and friends.
  • Structure student's activities and schedule to reduce the number of unexpected changes and unstructured periods.
  • Explicitly teach coping and de-escalation strategies.
  • Engage the student in role-play scenarios to target specific social responses.

Inattention and Impulsivity 
  • Allow the student more time to complete tasks and reduce the workload if needed.
  • Avoid activities requiring the student to concentrate for long periods of time.
  • Keep distractions to a minimum - use study carrels or room dividers as needed.
  • Provide direct support in organizational strategies.
  • Have student keep a planner or agenda, where all assignments are written down.
  • Use a communication book with parents.
  • Provide preferential seating.
  • Arrange seating to allow for more space between students.
  • Provide small group instruction.
  • Provide the student with a written schedule and keep the schedule as consistent as possible.
  • Provide an area for supplies and books (away from the student's work space).
  • Select a classroom buddy.
  • Limit task list to 5 things, and when each task is completed immediately erase that task or check it off.
  • Gain the student's attention before speaking.
  • Provide breaks as needed.
  • Question the student to be sure the information was understood, and provide feedback.
  • Use cueing systems in the form of assignment books and task cues on student's desk.
  • Provide verbal and written instructions.
  • Shorten assignments and divide long assignments into parts.
  • Use outlines, graphs, flow charts and models.
  • Give short frequent quizzes, rather than all-inclusive exams.
  • Accompany homework with written instructions.
  • Always put written directions in the same place every time.
  •  Have a written schedule placed where it can be viewed every day.
  • Teach student to use a system of reminders such as post it notes, white boards, daily planners, daily schedules, etc.
  • Use highlighters to signal important points for easy reviewing.
  • When teaching note taking, make sure notes answer all of the "WH" questions.

Speech & Language
  • Use mnemonic devices such as rhymes or songs to remember names.
  • Read books and other materials that have pictures in them.
  • Allow student to have processing time when you ask questions.
  • Provide directions one at a time.
  • Give directions in verbal and written form.

Physical
  • Realize that the student may get tired quickly, and let the student rest as needed.
  • Be aware of and use the student's best sensory modality (e.g. auditory, visual).
  • Be aware of any medications the student takes and its side effects.
  • Provide preferential seating if the student has visual difficulties.
  • Be aware of any gross or fine motor difficulties.