Mild Traumatic Brain Injury
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Intervention
Individuals who suffer a mild traumatic brain injury may require interventions for problems related to attention, motor restlessness, language processing, memory and learning and executive functioning and problem solving. The following suggestions are provided to assist the child in recovering from their injury. Every suggestion may not be appropriate for each child.
Attention:
- You may need to cue the child to pay attention to important information
- Gain the child's attention, make sure he is looking at you and then begin to speak
- Use slow and distinct speech but not so slow and over-exaggerated that it is distracting to the child.
- Information should be provided in short, concise segments
- As attention may fluctuate, it is important to allow for several repetitions of instructions and information
- It is important to break up your presentation periodically and summarize important points
- If changes in routine are anticipated, inform the child ahead of time
- Plan for a sufficient amount of time between tasks so that child can put closure to one and begin to prepare for the next.
- Avoid divided attention tasks; expect the child to attend to only one activity at a time.
- Avoid seating arrangements that are distracting (back of the room, near vents, fans, clocks, doors or windows )
- Earplugs and headsets are helpful to the child during independent work time.
- Avoid visual clutter in the child's work area
- Small group work is recommended to reduce distractions
- Frequent breaks are often needed
Motor Restlessness:
- Child may need to stand periodically while working
- Provide the child with jobs that involve physical movement: cleaning the blackboards, passing out papers, taking messages to the office, etc.
Language Processing:
If the child has difficulty in processing some aspects of language the following are recommended:
- Information should be concrete and concise; avoid abstract terms and figurative language as much as possible
- Augment with non-verbal communication such as gesturing and pointing
- Paraphrase, summarize and repeat often
- Include visual information as much as possible to augment the verbal (written instructions, pictures, graphs, maps)
- Ask questions that require short answers, or one-word responses
- Give the child sufficient time to formulate a response
- Allow the child to communicate with gestures and/or sign if needed.
Memory and Learning:
The ability to learn new information may be affected by Mild TBI. Old learning is generally not affected although the child may require cueing to retrieve the information.
- Child should use an assignment book to keep track of assignments, schedules, materials needed, due dates, etc. He may need to be cued to use this initially
- Remember and use the "3 R's": Repetition, Review and Rehearsal
- The child should repeat information immediately to ensure accuracy
- Include old spelling words in new spelling lists, and old information with new facts as a way of re-teaching material
- Be sure that child has retained old information over time before introducing new information
- Child may need to over-learn information
- Involve all the senses and use mental imagery when appropriate
- Try to anchor new learning to old or previous experiences to help solidify memories
- Teach and utilize memory mnemonics
- Provide the child with written instructions whenever possible and avoid multiple-step directions
Executive Functioning and Problem Solving:
Executive Functions have to do with performance: regulation of attention, emotion and behavior as well as planning, organizing, self-monitoring and initiation. Cognitive functions have to do with skills. Both can be affected by Mild TBI.
- Often a classroom "buddy" is helpful to assist the child when confused or having problems
- The environment should be highly structured and consistent
- Assignments may need to be broken down; help child estimate how much time he will need to complete each task
- Goals and objectives should be well defined.
- Tasks may need to be shortened or simplified
- Child may need help identifying appropriate solutions to problems
- Child may need help shifting solutions, tasks, etc.