Teachers' strategies for the classroom

This section is aimed at teachers. Perhaps you’re a teacher reading this information, or you may be a parent who would like to print the article to hand over to a teacher.

There are some simple, practical measures teachers can take to support a child with acquired brain injury and their family.

Being involved – supporting the family

It can be of great benefit to parents to have the support of a teacher soon after their child has been diagnosed with an acquired brain injury.¹

Discharge planning meetings

These meetings take place before a child leaves hospital. A similar kind of meeting will often take place when a child leaves a specialist centre.

The aim is to make sure the child has a ‘care plan’ – a plan of action to set out what kind of care the child needs and who will provide it.² Parents sometimes find it useful for someone from the school to come to these meetings, not least because an educational professional can hear about a child’s circumstances directly from the healthcare professionals.

Sometimes a headmaster or SENCO may attend. It may be useful for you to make enquiries about meetings that could be helpful to attend.

The SEN process³

Teachers and education professionals are a key part of the Special Educational Needs process.

Other ways of getting involved before the child returns to school⁴

Sue Walker, in her book Educational Implications of Acquired Brain Injury, offers this list of activities:

• Begin preparation early
• Visit the injured child
• Work in close partnership with child and parents
• Keep active links between injured child and peers, school community and family
• Identify link person at each facility or service that is involved
• Agree who is to be the lead professional with responsibility for co-ordinating action
• Establish procedure for communicating
• Exchange/gather all relevant information
• Seek shared acknowledgement of needs for successful school entry/re-entry

The importance of awareness and information

Whatever kind of school a child attends, they will almost certainly be in contact with different members of staff at their school. Even if your child has only one teacher, they may run into other teachers on break duty, or dinner ladies at lunch.

Try to keep staff informed about the effects of a child’s acquired brain injury.⁵ Keeping the lines of communication is vital when children return to school.⁶

Teachers are often in the habit of sharing information about individual children, whatever their circumstances. And a child with acquired brain injury may benefit from this sharing.

Perhaps the child responds well to a particular approach, or being spoken to in a particular way. It’s also useful for staff to know about the ‘hidden’ nature of some of the effects,^{7, 8} and that some of the effects may not emerge until weeks, months or even years into their schooling.^{9, 10}

Teachers form a crucial link to the school for parents. And the Special Educational Needs Code of Practice for England³ makes explicit a need for parents and educational professionals to work in partnership. Keeping those lines of communication open will benefit everyone.

What information would be useful?

This checklist may be useful in thinking about what a school needs to know.

Provided by kind permission of Sue Walker.¹¹

• When and how the injury happened
• The type and severity of the injury
• How old the child was at the time of injury
• How the recovery has gone so far
• Where there any other children at the school or in the family involved in or witness to a traumatic brain injury?
• Does the child have any sensory difficulties
• Are there any physical difficulties that might affect this child’s school life? (access to classrooms, PE)
• A child’s strengths and weaknesses – perhaps they struggle with concentration or communication
• Do they have any therapy requirements which might have an impact at school?
• Do they require any special devices or equipment?
• How is their personal care? 
• Do they take any prescribed medication?
• Do they have seizures?
• Are there any other safety precautions to think of?
• Does the child or their parents have any particular concerns about the return to school? 
• Are there any behavioural concerns?
• Are there siblings at the school who may be affected by all the changes that have happened in the family?
• Are there any activities such as school trips/activities that might be difficult?

Bear in mind that some children will go back to school in stages

There is no ‘one-size-fits-all’ solution for a child’s return to school. It will very much depend on how both parents and school feel about the child coming back.¹²

Many children may go back in stages. They might start with one day a week, before increasing their hours, for example.¹³

Fatigue and tiredness may be an issue here. It may be very difficult for a child to dive straight into a full working week.

When children are back on more regular hours, coping with homework might be extremely difficult. It’s also important that children still have some ‘gas in the tank’ for time with their friends and family.¹⁴

The teacher’s role as an observer is invaluable at this stage. And keeping the lines of communication between parents and teachers is essential.

If you feel a child is overly fatigued, or struggling to take things in, you should explain this to the parents. Likewise, if you feel they would be able to increase their contact time at school, you should discuss this with parents.

Naturally, reintegration can be very difficult for children from a social perspective. Children may have to form new friendships (sometimes with younger children) or re-establish old ones.¹⁵

All of this puts a strain on children at a time when there may be struggling with self-esteem.¹⁶

In the classroom

What can teachers and teaching assistants do to support children with acquired brain injury?

A panel of educational experts made these broad recommendations:

• Be flexible, and prepared to change a child’s work or assignments
• Try to celebrate any improvements, however small
• Continually monitor progress
• Communicate with the family about progress¹⁷ (This might be achieved through a home/school diary system as well as face-to-face)

Now let’s look at some of the difficulties associated with acquired brain injury in more detail.

Structure, planning and routine

Some children with acquired brain injury struggle with sequences – doing things in the correct order.¹⁸

This may make it hard for a child to get going on a task because they might be unsure where to start.^{19, 20} This is sometimes called ‘pathological inertia’.

One way of helping with this is to try to maintain routine in the classroom.²¹ If there is a sense of consistency, then students are likely to settle in to their activities more quickly. They ‘know where they are’ with things.

For some children with acquired brain injury, a change in schedule or the interruption of a plan may be quite distressing. Regular routines might be applied to things like:

• The way students start their class time
• The way activities are set up and explained
• The way activities are finished
• The way homework is given to the class.

Children may benefit from individual explanation about what they are expected to do, with some gentle questioning to check they have understood. 

Structuring work wherever possible can be very useful. Children may benefit from help in drafting and structuring essay plans to help get them started. Heavily structured work such as sentence completion, may be well suited to a child with acquired brain injury.²² 

Talking to a child with acquired brain injury about organisation can be helpful. It may be useful to provide them with a step by step guide so they know what they have to do.^{21, 23} Break information down wherever possible and ask children to repeat and/or summarise information to aid retention.²⁴

Memory and reminders

Memory is another common difficulty for children with an acquired brain injury.^{25, 26}

And it is a foundation skill in a learning situation.²⁷ 

Children might need help in these ways: 

Recording homework assignments clearly and simply

Understanding what they need to do – an overview of the lesson may help

Checking they have everything they need to do their homework.

Some schools have a dedicated space for parents to access homework or lesson notes. This can be a useful way of keeping parents involved.

Concentration

Children with acquired brain injury may struggle with their attention span.^{28, 29} They might be easily distracted³⁰ and have difficulties with physical and mental tiredness.³¹

Keep distractions to a minimum in the student’s work area to a minimum.³² Where possible, divide work into small sections or steps. It may be useful to ask the child to repeat or summarise information that has been presented. ‘Chunk’ information down wherever possible.³³

Struggling to keep up with conversations, instruction and feedback

Some children may take longer to process information and may struggle to keep up with conversations.³⁴ Again, the effects of fatigue can play a role here.³¹

Sometimes it may be necessary to allow more time for the completion of tasks or activities, or for them to be modified. It may be useful to use a Dictaphone for children to talk into as an ‘evidence store’, rather than relying entirely on written work. 

Think about the balance of open-ended and closed questions. It can help children follow the lesson if expectations are clearly stated, and frequently reviewed. Immediate feedback is also useful.³⁵

Impulsive behaviour

Impulsive or disinhibited behaviour can result from acquired brain injury. Some children may say inappropriate things, while others may be more physically, or sexually impulsive.³⁶

A calm environment, diffusing situations that have the potential to escalate, and encouraging children to stop and think can all be helpful.

Irritability, anger, emotional behaviour

Many children with an acquired brain injury have some difficulty keeping emotion in check. Parents talk about their child having ‘a shorter fuse’ than they did before the injury.

Sometimes children can become angry or emotional at seemingly trivial things.³⁶ Perhaps over time, teachers can spot the circumstances leading up to these outbursts, and manage to avoid them.

It may be helpful to acknowledge the child’s irritation, and talk with them about ways of managing their feelings. Some children may benefit from regular one-to-one sessions with the school’s Special Educational Needs Co-ordinator or counsellor.

Nutrition/hydration

Children may suffer from tiredness or headaches during the school day. Discreet reminders to drink water, and/or eat an energy snack may help.

Bullying

Bullying may occur in any school and children with acquired brain injury, and/or their siblings may be more vulnerable.

Getting around

Many children experience some form of physical difficulty following an acquired brain injury. Difficulties may include problems with balance, movement or tiredness.^{37, 38}

They may have difficulties:

• Getting around school.
• Teachers may need to be flexible about allowing children to leave classes earlier to give them time to get around.
• Some schools will consider room and timetabling changes.
• Getting to and from school.
• Transport arrangements may need to be considered.
• Getting around the playground.
• After-school clubs. They may feel too tired to do anything after school and this may leave them feeling left out.¹⁴

Siblings of children with brain injury

The brother or sister of the child with an acquired brain injury may be at the same school. Perhaps you are reading this because you yourself teach the sibling of a child affected by acquired brain injury.

Teachers can play a crucial role in supporting siblings through a difficult time.³⁹ In some circumstances, children may be more comfortable talking to teaching staff than parents or friends.

It’s also important for staff at the school to be aware of the strain a sibling may be under. Circumstances at home – which may be busy or fraught – may have an impact on a sibling’s ability to keep up with their schoolwork.⁴⁰

Discuss this with the family and the siblings themselves and explore strategies that may help. The needs of siblings are extremely important and must be considered. 

Must try harder DVD

This booklet and DVD could be useful to parents of children who have acquired brain injury, their teachers, SENCOs and others involved in meeting their educational needs.

The film and accompanying booklet provides an understanding of why educational difficulties can arise after acquired brain injury.