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Students with TBI experience a wide variety of learning and psychosocial characteristics. Moreover, physical and sensory changes also are common. The specific effect of the injury is dependent on the age of the student, the severity and location of the injury, and the time since the injury. Some individuals experience minimal changes, whereas others experience drastic changes. Learning and behavioral difficulties may persist long after the child has physically recovered.

Many children with TBI experience losses in language skills. Children who lose language functioning as a result of brain injury are said to have acquired aphasia. In other words, they have lost some language functions that they had acquired earlier. Language difficulties resulting from TBI can involve expressive language, receptive language, or both and can range from mild to severe. Two aspects of language have most frequently been reported to be affected by brain injuries: syntax and pragmatic skills. Nevertheless, many with TBI are able to recover much of their language functioning within 2 years after their injury.

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In addition to impacting language and communication development, brain injuries can also have an impact on literacy skills. Children with traumatic brain injuries have been found to score significantly lower than age-, gender-, and race-matched uninjured children on achievement tests of reading, language, and mathematics.

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Students who have experienced a TBI often re-enter school with deficits from their injuries compounded by their extended absence from school. These students are likely to require comprehensive programs of academic, psychological, and family support.

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It is important that instructional strategies for students with TBI are carefully planned, systematically executed, and continuously monitored for effectiveness.

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Ten elements that should be part of an educational program for children with TBI include:

1. Maximally controlled environment. The child may need a highly structured environment where distraction is reduced.

2. Low pupil–teacher ratio. It may be necessary to provide a classroom aide or other assistant to work with the child.

3. Intensive and repetitive instruction. The brain-injured child often needs more time to learn. Reducing nonacademic activities and lengthening the school year can provide more learning time.

4. Emphasis on process. The child may need to be helped in learning how to learn. Instruction should include help in sustaining attention and on memory.

5. Behavioral programming. Instructional strategies that use task analysis and careful measurement of progress have been found to be successful.

6. Integrated instructional therapies. Integrate allied therapies such as speech and physical therapy into the student’s primary instructional setting to facilitate generalization and transfer of skills.

7. Simulation experiences. Use simulations to enable the child to transfer skills to a new setting.

8. Cuing, fading, and shadowing. Students may require cues to respond, which should be faded as soon as possible. When shadowing, the teacher closely monitors the child

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attempting a new task or moving to a new environment. 9. Readjustment counseling. This may help the child adjust to his or her new environment

and abilities. 10. Home-school liaison. It is essential to build and maintain a strong link between parents

and the school.

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