Teaching Strategies for Children with TBI
Just as you have heard throughout the book, each child or adolescent who experiences traumatic brain injury has a unique outcome, so a cookbook of teaching strategies for every learning problem cannot be offered. As you have also read though,many students with TBI experience a similar constellation of problems. The general strategies offered here will apply to many students who have had a TBI, whether or not they qualify for educational assistance under IDEA.

Reduce Distractions
This can be accomplished in several ways. A smaller student-teacher ratio will reduce the distractions of other students. Preferential seating (e.g., away from door, near teacher, or away from windows), a quiet environment, or a classroom in which a limited amount of noise and activity are tolerated will reduce distractibility. Some students will need a schedule that involves fewer changes in classes; others will need to change classes when fewer people are in the hallways.

Provide Structure
The school team or administration should assist in selecting a teacher whose teaching style provides structure and routine. It will probably be important for your child to routinely know the expectations of the teacher. For example, the teacher should go over expectations for each assignment or class period, assignments should be posted in the same place, and transitions between activities should follow a predictable routine. Providing your child with written reminders or timelines for long-term assignments, going over assignment sheers daily, or breaking assignments down into steps are all ways to impose structure for success.

Use External Aids
A notebook that can aid your child's memory is often essential. Included in such a notebook might be the daily, weekly, or monthly schedule as appropriate; an assignment checklist; assignments or notes organized appropriately; or visual cues for study strategies. Your child will likely need instruction and consistent daily follow-up on the use of such a notebook. After sufficient practice, your child may be able to use it automatically.

If a memory or study strategy has worked well for your child, it would be appropriate to provide your child with an external aid such as a cue card with the steps in using the strategy. For example, your child might be allowed to use a card that has pertinent math formulas written on it. Not only does such an external aid provide the steps of the strategy, but its presence reminds your child to use the strategy.

Increase Self-Awareness
One of the hallmarks of TBI is the lack of insight that survivors typically have into their difficulties. Educators need to acknowledge this fact. That is, they need to understand that your child is not purposefully behaving in a certain way. Then, when opportunities arise, teachers can have private discussions with your child to increase his self-awareness, and more importantly, to suggest strategies to change the problem behavior. For example, your child may tell the same story over and over to teachers or friends. A teacher who witnesses this behavior might speak to your child about it later and set up a signal to let him know when it is happening so that he can become more aware and try to change this behavior.

Focus on Process Rather Than Just Content
Your child's IEP goals and benchmarks should not just address the content material he is expected to learn. They should also address processes such as attention, acquistion, memory, and generalization and how they will be taught. For example, one of your child's IEP goals may be to increase reading comprehension for facts from a social studies text. However, if sustained attention is a problem area that ultimately affects academic tasks such as reading, then specific goals to increase sustained attention also need to be set.

Teach Strategies That Can Generalize
Students with TBI sometimes have trouble with generalization; that is, with using skills taught in one situation in a variety of different situations.

Generalizing is especially important if your child relies on external aids and strategies to become more independent. As teachers and therapists work with your child, they should offer several possible strategies and discover which ones work best for him. Then the basic components of the strategy should be generalized across learning environments so that your child is not required to use a fundamentally different strategy in each situation. For example, if step-by-step picture cues help your child remember his daily routine, then picture cues might also be used to prompt him for the correct steps of a mathematics process.

Provide Opportunities for Repetition
Variability is also common in students who have had a TBI. That is, a skill seems to have been acquired one day, only to be absent the day. Opportunities for frequent review and repetition will be necessary.

Incorporate Active Learning
Students who have experienced TBI often think and act concretely, finding it hard to infer and/or abstract. For example, they may have trouble learning about fractions without using hands-on manipulatives such as a pizza or a pie. Multiple opportunities for hands-on active learning should be provided. New learning should be linked very concretely to old for the best possible chance of acquisition and retention. Continuing with the example of fractions, a child who learned the concept of using a sandwich could use a sandwich to demonstrate.

Provide Extra Time
Reduced processing speed is another hallmark of TBI. Even if school performance is accurate, it is often much slower. This is usually because it takes longer for the student to take in, organize, and act upon information . There may also be difficulties in motor speed when responding, either verbally or in writing. Allowing extra time for tests and class work will probably be necessary.

A related problem can be fatigue. Besides taking longer, some of these cognitive processes may also require more mental energy. Your child may therefore need an occasional rest period, or simply a periodic mental break.

Use Direct Language When Instructing
Students with TBI might also have difficulty processing complex language, particularly when it is lengthy or spoken rapidly. To help your child understand, teachers should: