Toler handout 2 classroom accomodations tbi by rnrj9uO


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Structuring the Environment

Because a TBI involves a progressive recovery process, a student’s physical and mental endurances may be
limited during their initial return to school and steadily improve over time. Therefore, consideration of
different schooling options may be necessary, including homebound instruction, gradual increase in school
attendance, or change in class schedules to a less demanding course load. Academic programming and
scheduling must be flexible and customized to fit children’s changing needs. Class enrollment and
expectations should be based on students’ current, rather than previous, academic performances. Rather
than push students quickly through classes and require them to make up missed assignments, students
should be allowed additional time to relearn concepts and regain skills.

Structuring the school environment is a way to manage antecedents or consequences contributing to many
problem behaviors, and to prevent the behavior from occurring. Many of the environmental strategies that
will optimize success for students with TBI are effective with students with other learning problems. These
strategies can be employed in general or special education settings. If attention, sensitivity to
overstimulation, disinhibition, and emotional lability are identified as problems, the classroom environment
should be quiet and simplified. Noise and activity levels should be controlled and unnecessary distracters
and sensory stimulation (including noise, light, and movement) should be minimized (Farmer & Peterson,
1995). This may require seating the student near the teacher or by an appropriate peer, providing a study
carrel, removing extra materials (e.g., pencils, books, papers), and dividing work or task lengths into
smaller sections. Students may use an FM unit or earplugs to reduce external noise. Students may need a
designated space in which to rest or take time out from stimulation and be allowed to have “down time.”

Special attention should be given to the physical arrangement and structure of the classroom to facilitate
mobility and accommodate physical needs. A student with poor mobility may need assistance to participate
in typical classroom activities. The school may need to ensure the availability of accessible bathrooms and
ramps. Frequently traveled areas should be sufficiently wide for smooth transition and be free of obstacles.
Students may need to be specifically taught and allowed to rehearse the routines of the learning
environment, including building orientation and room design. Students in secondary schools may have a
particularly difficult time navigating hallways and moving from class to class. Providing extra time for
transitions and leaving class a few minutes early, before other students are in the hallways, is often
recommended. A peer buddy or an adult aide may be assigned to help with hallway transitions, to provide
physical assistance (e.g., in the lunchroom or bathrooms), and to ensure safety.

Classroom structure should also include a predictable and consistent routine. Consideration should also be
given to the length of school day that students can tolerate, their nutritional needs, and their fatigue levels
and need for rest breaks; classes should be scheduled to capitalize on optimal attention periods. For
students who are easily fatigued, a schedule consisting of alternating instruction, activity, and rest periods
may be needed. Students with challenging behaviors are more likely to engage in appropriate, on-task
behaviors when presented with a positive, well-understood daily routine. Providing a written schedule or
posting a visual chart of the daily routine will help reduce confusion. Students may need simplified
instructions, written or picture checklists of task steps, maps, or strategically placed signs to carry out tasks.
It is important to involve the student in reviewing the schedule at the beginning of the day or period and
verbally review the steps. Transition times and out-of-classroom activities should be preplanned and
structured to reduce stimulation and emotional distress. Using auditory or visual cues to signal changes in
the routine and giving the student advance warning is also helpful. Teachers of the same student should
agree on environmental strategies and apply them consistently throughout the school day.

Typical Classroom Accommodations

Another way of altering the environment is to provide external devices and cues that the student can use to
compensate for organization, memory, and motor deficits (Mateer, Kerns, & Eso, 1997). Assistive devices
can include technical equipment and materials such as tape recorders, calculators, electronic spellers,
computers or word processors, augmentative communication devices, timers, alarms, and beepers or
equipment for mobility (e.g., wheelchair, walker, electric scooter). Other external cues used to remind
students include labels, maps checklists, pictures or icons, photograph cues, post-it-notes, calendars,
planners, and journals. A memory notebook is one such compensatory aid that has been used to assist in
memory and organization following TBI. The memory notebook can be very flexible and may contain maps,
checklists, feelings log, and other information (e.g., telephone numbers, names of contact people). Students
should be trained to use the notebook (Tate, 1997).

Modifications to existing materials can assist students with TBI to learn and function in the classroom
setting. Typical alterations that allow students to participate at their level include providing carbon paper
notes, large print books, books on tape, and graphic organizers (visual displays to organize information). A
similar approach involves altering the expectations for student participation. For example, allow more time
on tests, reduce the amount of written work required, provide exams in multiple-choice format rather than
recall format, and give pass–fail grades rather than letter grades (Mateer et al., 1997). It is important that
students are not simply given aids or devices to use without adequate training to recognize when and where
appropriate aids are useful, and how to use the strategy properly. Table 1 provides a sampling of external
aids and interventions that can be used to assist students with attention, memory, organization, and
processing speed deficits

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