Traumatic Brain Injury (TBI)

Update (2025-09-24): IDEA federal definition of Traumatic Brain Injury (TBI) clarifies that TBI is an acquired injury due to external physical force and excludes congenital/degenerative conditions and birth trauma (34 CFR §300.8(c)(12)). eCFR §300.8(c)(12)

Update (2025-09-24): For concussion and mild TBI, current federal public health guidance recommends an early, gradual 'return-to-learn' with symptom-based supports; many students can return to school within 1–2 days with accommodations as needed. CDC HEADS UP — Returning to School

Documentation and Compliance

Introduction

Florida Definition A traumatic brain injury means 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 educational performance. The term applies to mild, moderate, or severe, open or closed head injuries resulting in impairments in one (1) or more areas such as cognition, language, memory, attention, reasoning, abstract thinking, judgment, problem-solving, sensory, perceptual and motor abilities, psychosocial behavior, physical functions, information processing, or speech. The term includes anoxia due to trauma. The term does not include brain injuries that are congenital, degenerative, or induced by birth trauma. This definition is found in State Board of Education Rule 6A-6.030153, F.A.C. General Overview A traumatic brain injury (TBI) is an injury to the brain caused by the head being hit by something or shaken violently. 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 injuries that can cause changes in one or more areas such as:

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. Brain injuries can range from mild to severe, and so can the changes that result from the injury. This means that it’s 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. It’s 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 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 student’s difficulty comes from the earlier injury. Although TBI is very common, many medical and educational 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 don’t receive the types of educational help and support they really need (Educating Exceptional Children, Chapter 12; National Dissemination Center for Children with Disabilities Fact Sheet Number 18 (NICHCY). Common Causes An acquired injury caused by an external physical force, resulting in total or partial functional disability and/or psychosocial impairment that require special education services. TBI accidents involve the head and may result in cognitive, social, and language deficits. Loss of a limb, broken bones, or paralysis may also result from accidents (Educating Exceptional Children, Chapter 12; National Dissemination Center for Children with Disabilities Fact Sheet Number 18 (NICHCY). Diagnostic Indicators The signs of brain injury can be very different depending on where the brain is injured and how severely. Characteristics

The signs of brain injury can be very different depending on where the brain injured and how severely. Children with TBI may have one or more disabilities, including:

Examples include difficulty with short and long-term memory, maintaining focus, concentration; problems with reading, writing, planning, sequencing, and judgment

Examples include difficulty writing and drawing; involuntary muscle contractions or tightening; seizures; partial or complete paralysis on one or both sides of the body; problems walking and with balance; problems speaking, hearing, and using other senses

Examples include sudden changes in mood and emotions; increased anxiety and/or depression; restlessness; poor motivation; inability to relate to others

Supports & Features

Strategies by Domain (Examples)

Attention & Processing Speed

Shorten tasks; chunk multi-step work; provide one direction at a time.
Prefer written + verbal directions; use highlighted key words.
Offer extended time; limit timed tests; reduce simultaneous stimuli.
Seat away from high-traffic/noise; allow noise-canceling headphones as needed.

Memory & Learning

Provide class notes, guided notes, or a copy of slides; allow audio capture.
Use external memory supports (calendar, digital reminders, checklists, cue cards).
Teach with spaced practice and frequent retrieval; overlearn essentials.
Pre-teach vocabulary; use visual organizers (timelines, concept maps).

Executive Functions (organization, initiation, planning)

Daily planner with check-ins; break tasks into micro-steps with time estimates.
Start-work prompts (“First step is…”) and end-of-task checkouts (“Did I…?”).
Color-coded materials; one notebook/folder per subject; consistent routines.
Provide a “work system” (TO-DO → DOING → DONE) and visual schedules.

Communication & Language

Give increased wait time; encourage alternative responses (pointing/typed).
Word-finding supports (word banks, starters, visuals); model concise language.
Check comprehension with brief paraphrase rather than “Do you understand?”

Sensory/Light/Noise & Headache

Adjust lighting; allow sunglasses/hat; reduce screen brightness/contrast.
Quiet test/study space; avoid bell-to-bell loud activities early in recovery.
Provide rest breaks and hydration; monitor for symptom increases and step back.

Behavior, Emotion, & Self-Regulation

Predictable routines; advanced organizer of the day; preview changes.
Teach brief regulation strategies (breathing, isometrics, short walks).
Identify a go-to adult and safe space; use private prompts rather than public corrections.

Fatigue & Endurance

Stagger cognitively heavy work earlier in the day; alternate with lighter tasks.
Half-days or reduced course load initially; gradual increases per symptom tolerance.
Document “stop rules” for symptom flare (e.g., rest 15 minutes; reduce demands).

Assistive Technology (examples)

Text-to-speech for reading load; speech-to-text when writing output is slow.
Digital organizers with reminders; visual timers; task-sequencing apps.
Noise management (noise-reduction headphones); blue-light filters as tolerated.
Note-sharing platforms; audio capture with teacher permission.

Assessment Accommodations

Extended time and reduced item sets focusing on priority standards during recovery.
Quiet test setting; breaks; alternative response formats (oral, typed, scribed).
One assessment per day; avoid heavy screen-based testing early if symptomatic.

Update (2025-09-24): Strategy set synthesized from CDC HEADS UP return-to-learn and reputable educational TBI sources; implement with gradual removal as symptoms improve. CDC; BrainLine

Implementation & Training

Classroom Implications

Summary: TBI can affect attention, processing speed, memory, executive functions, communication, sensory tolerance, mood, and fatigue. Classroom plans should reduce cognitive load, support memory and organization, and pace demands while maintaining access to grade-level standards.

Attention & Processing Speed: Expect slowed intake; provide shorter tasks, fewer simultaneous demands, and extended wait time.
Memory & Learning: Expect new learning to be fragile; use overlearning, distributed practice, and external memory aids.
Executive Functions: Anticipate difficulty with planning/initiation; provide stepwise routines, checklists, and coaching.
Communication: Monitor for word-finding, slowed output, and social-pragmatic changes; allow extra response time and offer models.
Sensory/Headache: Manage light/noise; allow rest breaks and access to a quiet space.
Emotional/Behavioral: Expect lower frustration tolerance; use predictable routines and brief regulation breaks.
Fatigue: Pace the day; prefer cognitively demanding work earlier, with planned recovery breaks.

Update (2025-09-24): Classroom implications aligned with CDC “Returning to School After a Concussion” guidance on symptom-based supports and gradual removal of accommodations. source