Brain Injury Support Framework

BrainSTEPS Concussion/Mild

– Step 1 of 11

BrainSTEPS Confidential Student Brain Injury Support Framework

BrainSTEPS Team:

BrainSTEPS Consultant Name:

Phone

Date of this Framework:

Name of Student:

DOB:

Grade:

Parent/Guardian:

Phone:

Language Spoken in the Home

Date of Brain Injury:

Date of BrainSTEPS Referral:

Current School Attendance:

None
Partial Days
Full Days
Full Days as Tolerated

School District:

School Building:

Is there a BrainSTEPS Trained Concussion Management Team in this building?

School Contact Name for Concussion Management Team

School Contact Name – Who BrainSTEPS Should Contact at School with Questions/Updates about Student:

School Contact Phone:

School Contact Email:

Type of Education:

504 Date:

IEP Date:

Primary Exceptionality:

ER/RR Date:

Behavior Plan Date:

Summary of Brain Injury (date of injury, cause, etc.):

Current Therapies (School-Based or Community/Medical-Based):

Pre-existing diagnoses/conditions/health issues:

Current Medications:

Follow-up appointments (which professional and when?):

Documents Reviewed by BrainSTEPS:

Medical Records.
Rehabilitation Records.
Neuropsychological Report .
Occupational Therapy Records.
Physical Therapy Records .
Speech-Language Therapy Records.
Vision Therapy Records.
All Pre & Post Educational Records.
Including: School-Based Psycho-Educational Evaluation (ER/RR).
Including: Individualized Education Program (IEP).
Including: 504 Plan.
Including: Individualized Health Plan (IHP).
Including: Informal Academic Supports Plan.
Including: Behavior Intervention Plan.
Prior BrainSTEPS Brain Injury Supports Framework .

Communication Has Occurred Between BrainSTEPS and:

Parent
School
Student

Medical Doctor Name:

Neuropsychologist Name:

Occupational Therapist Name:

Physical Therapist Name:

Speech-Language Pathologist Name:

TEACHERS

Name:

Class:

Name:

Class:

Name:

Class:

Name:

Class:

Name:

Class:

Name:

Class:

Name:

Class:

Name:

Class:

DIRECTIONS for BrainSTEPS Consultants Filling Out the BISF:

1. Ask the student which of the following Symptom Changes they experienced during the past week.

2. Emphasize that you are looking for Symptoms since their brain injury occurred.

3. Choose the correct Symptom from the lists below based on the student’s self-report.

4. Discuss the various Academic Support Options listed below each chosen Symptom with the school team.

5. Choose one or more Academic Support Options by clicking on the box next to each option. These Academic Support Options should be determined by the BrainSTEPS consultant, in conjunction with the student’s teachers.

6. The BrainSTEPS Consultant should review all current Symptoms and complete the remaining sections of the BrainSTEPS BISF with the school team.

7. The BrainSTEPS BISF can be saved and made available for immediate download as a pdf document. The BrainSTEPS Consultant can also email the BrainSTEPS BISF to school staff and parents directly from this application at the conclusion of the school meeting.

8. The student’s teachers should refer to the BrainSTEPS BISF document and implement the recommended Academic Support Options during the school day to help alleviate the student’s brain injury-related symptoms to promote learning.

9. BrainSTEPS Consultant should follow up with the student, parent, and school team within 30 days to review and update the BISF.

Physical Changes *

Headache, “pressure” in the head.
Blurry or double vision.
Dizzy or Balance Issues.
Light sensitivity.
Noise sensitivity.
Currently Not Experiencing Physical Symptoms

Other Physical Change Not Listed Above:

Headaches

Environment

Location of the student when the symptom occurs (school, home, etc.?)
What class(es) are symptoms occurring in?
Time of Day?

Activity Triggers:

What is the student doing when symptoms occur?

Triggers:

Sunlight?
Fluorescent Lights?
Computer Screen?
Phone screen?
Dark room with only computer screen on?
Noise? Reading? Writing?

Additional supports the student’s teachers should explore

Headaches or “pressure” in the head

Mindfulness has been shown to help headache pain. A common exercise is to have the student place one hand on stomach and inhale slowly through the nose to the count of four. Student should be taught to feel their stomach expand with their breath. After the count of four, student should exhale through their mouth slowly to the count of four. Student should feel their stomach deflate with the release of their breath. Repeat this cycle three times.

Environmental Considerations:

Monitor triggers that may increase headache ie bright lights, noise, movement in visual field, computer work, note taking, reading, hunger/thirst.
Adjust room lighting or use alternate light source such as lamp versus fluorescent lighting.

Student Considerations:

Allow student to wear a hat with a brim or sunglasses indoors to reduce light sensitivity / glare
Cue student to take short “eye breaks” from computer screen (e.g., focus on something across the room to give eyes a rest, close eyes for a short period of time).
Schedule longer “brain breaks” from the computer throughout day if needed.
Limit ‘screen time’ especially on small screens such as phones, SmartWatch even during non-school hours if this activity increases headache.
Discourage student from doing online learning on a smart phone – the screen is too small and can cause eye fatigue and cognitive fatigue. Encourage use of laptop or computer screen (use largest screen available).

Computer Considerations:

Use computer blue light blocking glasses to help reduce eye fatigue or use attachable blue light screens.
Increase font size (large print is defined as 16 -to 18-point bold type, depending on the typeface used); fewer words on page
Adjust screen settings to enlarge entire screen
Reduce screen glare (encourage student to sit away from windows, bright lights).
Dim screen brightness
Try alternative screen colors.
Contrast desktop screen from light to dark.
Use “high contrast” (white print on black background) to assist with reading documents on the computer or e-reader (iPad, Kindle, Nook) to read text to give eyes a break.
Use lock apps to keep time for built-in breaks, to chunk reading time, break up screen time, etc.
Use headings for any content changes on the screen
Reduce visual clutter on the screen pages to reduce visual overload

Immersive Reader.
Safari Reader on the Safari browser.
Mercury Reader extension on Chrome browser.

Instructional Considerations

Have teacher read exams to the student via Zoom or other online platform (Zoom is currently offering free subscriptions for all K-12 public schools).
Dictate answers instead of writing
Provide student with teacher notes prior to class. This allows the student to ‘listen’ and avoid near/far vision changes that may spike headache. Student may highlight key concepts.
Provide recordings of live lessons to allow student to review for missed content.
Listen to reading material – CDs, Digital, or Internet access to textbooks and reading material to listen to reading material instead of reading it, &/or to have the ability to adjust font size and background (black with white text) or dim the screen as well.
Have student use word prediction software that predicts words while the student is typing such as:

Co:Writer.
TypeIt4Me (Macs only).

Text-to-speech – for a student who may find reading too taxing they can have books or documents read aloud. Examples include:

Snap and Read
Audio Books: Audible, Scribd
Reads other types of documents- NaturalReader, Voice Dream Reader

Speech-to-text – Speech recognition software that will turn a student’s speech into text on the computer screen.

Siri’s dictation feature offers real-time speech-to-text conversion, recording the words you say as typed text on Apple products.
Mac Speech to Text (Apple products).
Dragon. Google Docs Speech to Text/Voice Typing on Chrome browser

Use a filter (pastel colored report covers or index dividers – blue, purple, or green) over paper to read text to give eyes a break
Use dark paper along with the colored filter above to block of parts of pages when reading to reduce “visual clutter”

Additional symptom-based supports not listed above:

Blurry or Double Vision

Environment:

Location of the student when the symptom occurs (school, home, etc.?)
What class(es) are symptoms occurring in?
Time of Day?
Driving? (if student is driving, notify parents)

Activity Triggers:

What is the student doing when symptoms occur?

Triggers:

Reading
Writing
Computer
Lights
Noise
other

Additional supports the student’s teachers should explore

Blurry or Double Vision

Parent should inform child’s physician of symptom.

Environmental Considerations:

Monitor triggers that may increase vision disturbances ie bright lights, movement in visual field, computer work, note taking, reading, hunger/thirst.
Discourage student from doing online learning on a smart phone – the screen is too small and can cause eye fatigue and cognitive fatigue. Encourage use of laptop or computer screen (use largest screen available).

Student Considerations:

Cue student to take short “eye breaks” from computer screen (e.g., focus on something across the room to give eyes a rest, close eyes for a short period of time).
Schedule longer “brain breaks” from activities that require reading and computer work throughout day
Limit ‘screen time’ especially on small screens such as phones, SmartWatch even during non-school hours if vision is impacted
Discourage student from doing online learning on a smart phone – the screen is too small and can cause eye fatigue and cognitive fatigue. Encourage use of laptop or computer screen (use largest screen available).
Students with vision problems may benefit from prism glasses, eye patching and/or vision therapy. Parent may wish to discuss these options with treating physician.

Computer Considerations:

Use computer blue light blocking glasses to help reduce eye fatigue or use attachable blue light screens.
Increase font size (large print is defined as 16 -to 18-point bold type, depending on the typeface used); fewer words on page
Adjust screen settings to enlarge entire screen
Reduce screen glare (encourage student to sit away from windows, bright lights).
Dim/ adjust screen brightness
Try alternative screen colors.
Contrast desktop screen from light to dark.
Use “high contrast” (white print on black background) to assist with reading documents on the computer or e-reader (iPad, Kindle, Nook) to read text to give eyes a break
Reduce visual clutter on the screen pages to reduce visual overload

Immersive Reader
Safari Reader on the Safari browser.
Mercury Reader extension on Chrome browser.

Text-to-speech -for a student who may find reading too taxing they can have books or documents read aloud. Examples include:

Snap and Read.
Audio Books: Audible, Scribd.
Reads other types of documents- NaturalReader, Voice Dream Reader.

Speech-to-text – Speech recognition software that will turn a student’s speech into text on the computer screen.

Mac Speech to Text (Apple products).
Dragon.
Google Docs Speech to Text/Voice Typing on Chrome browser.

Scanners with Optical Character Recognition (OCR) software which converts print-to-speech output
Have student use word prediction software that predicts words while the student is typing such as:

Co:Writer
TypeIt4Me (Macs only)

Instructional Considerations:

Have teacher read exams to the student via Zoom or other online platform (Zoom is currently offering free subscriptions for all K-12 public schools).
Dictate answers instead of writing
Provide student with teacher notes prior to class. This allows the student to ‘listen’ and avoid near/far vision changes that may spike vision issues. Student may highlight key concepts.
Provide recordings of live lessons to allow student to review for missed content.
Listen to reading material – CDs, Digital, or Internet access to textbooks and reading material to listen to reading material instead of reading it, &/or to have the ability to adjust font size and background (black with white text) or dim the screen as well.
Have student use word prediction software that predicts words while the student is typing such as:

Co:Writer
TypeIt4Me (Macs only)

Text-to-speech – for a student who may find reading too taxing they can have books or documents read aloud. Examples include:

Snap and Read
Audio Books: Audible, Scribd
Reads other types of documents- NaturalReader, Voice Dream Reader

Speech-to-text – Speech recognition software that will turn a student’s speech into text on the computer screen.

Siri’s dictation feature offers real-time speech-to-text conversion, recording the words you say as typed text on Apple products.
Mac Speech to Text (Apple products)
Dragon.
Google Docs Speech to Text/Voice Typing on Chrome browser

Use single sided vs. double sided paper with text to allow side by side comparison vs. flipping back and forth.
Block off part of page with dark paper when reading to reduce visual clutter.
Graph paper to keep letters for writing or numbers for math problems in line.
Provide raised line paper for writing.
Provide colored/highlighted strips to assist students in following along in textbook
Use of a slant board at desk
Student may benefit from folding a paper to provide quadrants within which specific tasks are to be accomplished.
Use visual cues to guide student to areas of screen or board to focus on.
Provide visual markers to guide the student on tasks that are spatial and sequential. For instance, provide an arrow to demonstrate where to start and in what direction to proceed when computing a math problem. Visual markers might also be used to assist the student to organize information on paper (e.g., marker for name, marker for title, marker for where to place paragraphs.) .
Provide a reading frame to help student focus on lines when reading.
For students with visual field neglect, provide cues to scan entire screen for content.
Use a filter (pastel colored report covers or index dividers – blue, purple, or green) over paper to read text to give eyes a break
Use dark paper along with the colored filter above to block of parts of pages when reading to reduce “visual clutter”
Highlight instructions
The student may experience difficulty finding their place when copying from the board or a book. Such difficulty might slow rate of task completion. As a result, consider providing pre-copied tasks. When the student is expected to copy from a book, provide a piece of sticky paper the student can use to mark the last line or item copied from the text.
Have the student copy math problems with a color marker but work them in pencil to help separate the student=s work from the problem

Additional symptom-based supports not listed above:

Dizzy or Balance Issues

Environment:

Location of the student when the symptom occurs (school, home, etc.?)
What class(es) are symptoms occurring in?
Time of Day?
Driving? (if student is driving, notify parents)

Activity Triggers:

What is the student doing when symptoms occur?

Triggers:

Reading
Writing
Computer
Lights
Noise
Other?

Additional supports the student’s teachers should explore

Dizzy or Balance Issues

Parent should inform physician of student’s symptoms. Physician may want to consider vestibular issues/vestibular therapy.
Poor sleep the night before is the most important contributor after a brain injury to dizziness the next day. Parents should help to ensure the student is maintaining a consistent sleep schedule at home in the evenings, avoiding naps during the day. Naps can disrupt the student’s regular sleep schedule at night.

Student Considerations:

Avoid environments that trigger dizziness such as assemblies, cafeteria, crowded hallways, school bus if necessary
Avoid walking in busy hallways. Allow student to leave class a few minutes early or arrive late to next class to avoid crowded hallways. Allow student to eat in a quiet room if necessary.
Have student use a buddy system for hallways/carrying books
If traveling to or from second floor, use handrail at all times or provide student with elevator key.
Transition slowly from sitting to standing position
Sit and close eyes at desk/table until symptoms pass.
Provide student pass to go to a quiet room to rest for 5-10 minutes until symptoms pass.

Instructional Considerations:

Provide a second set of books at home so that student does not have to carry books or a backpack which can impact balance.
Provide student book in each physical classroom, so student does not have to carry books to and from class
Provide student with teacher notes prior to class. This allows the student to ‘listen’ and avoid near/far vision changes that may spike balance/dizziness issues. Student may highlight key concepts.
Cue student to take short “eye breaks” from computer screen (e.g., focus on something across the room to give eyes a rest, close eyes for a short period of time)
Schedule longer “brain breaks” from the computer throughout day
Provide student page numbers (or web-links) to help the student find answers in book

Additional symptom-based supports not listed above:

Light Sensitivity

Environment:

Location of the student when the symptom occurs (school, home, etc.?)
What class(es) are symptoms occurring in?
Time of Day?

Activity Triggers:

What is the student doing when symptoms occur?

Triggers:

Sunlight?
Fluorescent Lights?
Computer Screen?
Phone screen?
Dark room with only computer screen on?

Additional supports the student’s teachers should explore

Light Sensitivity

Mindfulness has been shown to help light sensitivity. A common exercise is to have the student place one hand on stomach and inhale slowly through the nose to the count of four. Student should be taught to feel their stomach expand with their breath. After the count of four, student should exhale through their mouth slowly to the count of four. Student should feel their stomach deflate with the release of their breath. Repeat this cycle three times.

Student Considerations:

Allow student to wear a hat with a brim or sunglasses indoors to reduce light sensitivity / glare
Work in a room with natural lighting, if possible. Adjust/dim room lighting. Avoid fluorescent lights. Sit away from windows where light and sun filter through.
Fluorescent overhead light filter covers helps to dim direct bright lights (Amazon)
A table lamp may be preferred to overhead lighting

Instructional Considerations:

Dim the computer/phone screen brightness
Reduce screen glare
Computer blue light blocking glasses or an attachable blue screen cover may help reduce eye sensitivity (Blue Ray blocking glasses can be purchased from Amazon, etc.
Encourage student to try out alternative screen colors
Contrast desktop screen from light to dark
Use color filters (pastel) for reading and doing worksheets
Use “high contrast” (white print on black background) to assist with reading documents on the computer or e-reader (iPad, Kindle, Nook) to read text to give eyes a break
Cue student to take short “eye breaks” from computer screen (e.g., focus on something across the room to give eyes a rest, close eyes for a short period of time
Ensure there is a lot of white space on the student’s assignments, tests, and quiz worksheets
Provide student with teacher notes prior to class. This allows the student to ‘listen’ and avoid near/far vision changes that may spike vision issues. Student may highlight key concepts.

Additional symptom-based supports not listed above:

Noise Sensitivity

Environment:

Location of the student when the symptom occurs (school, home, etc.?)
What class(es) are symptoms occurring in?
Time of Day?

Activity Triggers:

What is the student doing when symptoms occur?

Triggers:

Additional supports the student’s teachers should explore

Noise Sensitivity

Mindfulness has been shown to help noise sensitivity. A common exercise is to have the student place one hand on stomach and inhale slowly through the nose to the count of four. Student should be taught to feel their stomach expand with their breath. After the count of four, student should exhale through their mouth slowly to the count of four. Student should feel their stomach deflate with the release of their breath. Repeat this cycle three times.

Student Considerations:

Monitor student for triggers such as noisy environments ie cafeteria, assemblies, music/band/orchestra/ chorus/shop class.
Be aware that a metal roof on house could cause noise sensitivity during a hard rain or thunderstorm.
Warn before any siren tests (tornado, fire, carbon monoxide)
Fluorescent lights may cause noise sensitivity issues if there is a low humming sound. Try switching to a floor lamp or desk lamp.
Allow use of ear plugs, noise cancelling earbuds/headphones
Adjust computer volume to student’s comfort level

Instructional Considerations:

Allow preferential seating in classroom away from noisy areas such as open doors/windows, hallway noise, center type activities, seating next to HVAC/fish tank/chatty peers
Working in a quiet room away from distractions. If there is not a quiet room available, try creating a quiet corner in the room.
Establish eye contact with the student before speaking to them. Gain visual attention prior to giving instructions.
Ask student to repeat directions back to you before they start their work to ensure they understand .
Break directions down into steps and allow extra time for student to process them if needed.
Teach student to ask for help and make yourself available to them if they are having difficulty.

Additional symptom-based supports not listed above:

Sleep *

Sleeping more than usual
Daytime drowsiness
Sleeping less than usual
Trouble falling asleep
Trouble staying asleep
Restless sleep
Currently Not Experiencing Sleep Symptoms

Fatigue and/or Sleep Issues

Environment:

Is student taking naps during day?
Is student on a regular sleep schedule?

How was sleep before brain injury?
When is student experiencing fatigue?
Is student more awake during AM or PM?

Additional supports the student’s teachers should explore

Sleep

Poor sleep is the most important contributor after brain injury to daytime sleepiness. Parents should help to ensure the student is maintaining a consistent sleep schedule at home in the evenings, avoiding naps during the day. Naps can disrupt the student’s regular sleep schedule at night.
Be aware! Attention, concentration, new learning, retrieval, processing speed, behaviors and headaches often worsen when a student’s sleep has been disrupted after a brain injury.
Parents should inform physician of ongoing sleep disturbances. Physician may consider possible use of over the counter sleep aid such as Melatonin.

Student Considerations:

Monitor for symptoms of sleep issues such as feeling tired, low energy, fatigue, daytime drowsiness, sleeping more or less than typical, trouble falling and/or staying asleep, restless sleep
Follow a strict sleep schedule – go to bed and wake at same time daily (including weekends)
Avoid stimulation 1 hour before bedtime:

Limit caffeine during day (no caffeine after noon)
Limit screen time before bed
Do not exercise before bed

Turn off phone notifications during scheduled sleep hours
Do not allow student to take naps during the day at school or home
Establish a designated place and time (such as a nurse’s office after lunch) to rest, but not nap (napping can throw off the student’s sleep schedule even more).
Encourage light exercise during day as permitted by physician, (e.g., walking, yoga)
Sleep in a dark, quiet room. Use of nature sounds, sleeping apps may be beneficial.
Have student take scheduled breaks during day, head down, eyes closed but not asleep
Allow student to stand at desk or walk as needed to “wake up”.

If student is having difficulty falling asleep, have the student try one or more of the following:

Get out of bed and do something relaxing, once student feels sleepy, go back to bed
Soothing music
White noise (fan or noise machine)
Warm milk before bed
Relaxation techniques
Avoid looking at the clock which can cause anxiety and make sleeping even more difficult

Instructional Considerations:

Allow student to move (stand up, stretch, get a drink, run an errand)
Cue student to take short “eye breaks” from computer screen (e.g., focus on something across the room to give eyes a rest, close eyes for a short period of time)
Schedule longer “brain breaks” from the computer throughout day
Permit as much time as necessary to complete tests and assignments.
Alternate ways to evaluate (projects or oral presentations instead of written tests).
Provide student with teacher notes prior to class. This allows the student to ‘listen’ and focus on instruction/learning. Student may highlight key concepts.
Coordinate timing of tests with wakefulness.
Allow testing in separate room. Allow tests to be taken in an environment with fewer distractions.
Allow student to take short breaks as needed during testing.
Limited hours of testing per day.
Allow student to respond verbally to test questions.
Modify classroom and homework assignments:

Student does every 2nd or 3rd problem
Student does 50% of the problems/questions,

Use a timer and draw a line across their homework page at the end of 10 or 15 minutes of sustained work

Additional symptom-based supports not listed above:

Thinking & Learning (Cognitive) Changes *

Memory: Forgetful, difficulty remembering, difficulty with new learning, misunderstands
Memory: Remembering to do things on time
Attention & concentration
Cognitive Fatigue: Feels worn out, exhausted, tires easily, drowsy during the day
Slow Processing Speed: Slow to respond, reacts slowly
Confusion, fogginess
Difficulty making decisions
School work takes longer, missed work is piling up
Literal thinking, doesn’t get jokes
Difficulty organizing materials
Organization of thoughts and words
Trouble planning, starting, doing, finishing a task
Currently Not Experiencing Cognitive Symptoms

Memory Issues

Forgetful, Difficulty Remembering, Difficulty/Frustrated with New Learning, Misunderstands

Environment:

Location of the student when the symptom occurs (school, home, etc.?)
What class(es) are symptoms occurring during?
Time of Day?

Activity Triggers:

What is the student doing when symptoms occur?

What are the triggers?
Is the student comprehending?
Does the student comprehend better when s/he hears or sees

Additional supports the student’s teachers should explore

Memory Issues
Forgetful, Difficulty Remembering, Difficulty/Frustrated with New Learning, Misunderstands

Provide the student with plenty of opportunities for repetition and clarification.
Encourage the student to write things down and make lists.
Grade the student’s work based on his mastery of information rather than on work completed.
Teach the student how to use and sync phone and computer calendars, reminders, notes.
Provide simple, written directions in a note or text message.
For review of math and science concepts, utilize the free Khan Academy website (www.khanacademy.org).

Utilize cueing strategies for IN CLASS WORK such as

Multiple Choice Tests
Word Banks
Reference Cards
Open-Notebook or Open Book

Utilize cueing strategies for TESTS & QUIZZES such as

Multiple Choice Tests
Word Banks
Reference Cards
Open-Notebook or Open Book

When chunking tests, only have the student study for the chunk that will be given.
Provide the student with an extra set of textbooks to keep at him if she often forgets to bring materials to school.
Allow extra time for in class work, homework, tests, quizzes.
Encourage the student to keep pencils sharpened, notebooks organized, and materials close so she is ready to go as soon as lesson begins.
Shorten assignments by letting the student complete only even or odd number problems.
Provide the student with visual reminders if possible; provide a visual schedule for younger students.
Use graphic organizers for the student.
Record online session content so the student can review.
Use work samples to help reinforce newly learned steps (i.e., math).
Have the teacher or parent check for understanding of directions, concepts, etc.
Offer “office hours” via Zoom, etc.
Use simple, concise instructions with concrete steps. Speak slowly when giving directions.
Stick to daily class routines.
Break down large assignments into smaller components with individual deadlines.
When students begin a new assignment, provide them with a checklist or rubric that explains how the assignment will be graded.
Communicate clear starting points for tasks, instead of just giving students a due date.
Encourage the student to review class notes every night with a parent. This will help the student understand what information is missing or unclear. The next day, she can ask you in class to clarify information that is missing or unclear.
Use books with audio or text-to-speech software with students who may benefit from seeing and hearing words at the same time.
Poor sleep the night before contributes to memory issues the next day. Parents should try to keep the student on a regular sleep schedule at night. Avoid napping as it can throw off the student’s regular circadian rhythm for sleep.
For multiple choice questions, use white out on parts of paper or to eliminate some multiple-choice answers.
Eliminate less critical information and facts from a copy of your notes (or those of a capable peer) using white out tape.
Provide concrete cues on the student’s desk – taped 100s charts, math number lines, alphabet, vocabulary lists, word bank lists taped alphabets for printing or writing, etc.
Highlight important words or phrases in reading assignments.
Use of an Academic Planner for all school years that is checked each morning and each afternoon by a teacher or other staff member for accuracy. Student may need taught how to use this strategy repeatedly.
Check progress and provide feedback often in the first few minutes of each assignment.
Provide the student with an overall executive summary of (chapters, sections, etc.).
Pre-teach the main ideas/key content before classroom instruction occurs.
Provide a copy of any assignments or directions written on the blackboard/screen.
Permit or provide student with a recording of lessons.
Cue the student in advance before calling on them to answer questions. Allow student to write answers to questions before being called upon. This requires pre-planning on the teacher’s part.
Use of a calculator, whenever possible, for math calculations.
Scaffold multi-step processes by breaking them into parts for the student.
Visual charts/schedules at desk/in binder
Underline key words in text the student will read. This will draw attention to this information as well as provide a reference the student can refer to if memory fails the student.
Weekly home-school communication tools (notebook, daily log, phone calls or email messages).
Provide study guide in advance of tests and quizzes.
Provide sample test (not the same problems, but same format as test) prior to exam as a study guide.
Testing in separate room. Allow tests to be taken in an environment with fewer distractions.
Provide extended time on tests.
Allow student to take short breaks as needed during testing.
Permit open book, notes and/or internet use on tests/assessments/quizzes.
Permit student to explain wrong answers on assessments.
Provide student a word bank of choices for answers to test questions. This aids retrieval and cognitive fatigue issues also.
Permit as much time as necessary to complete assignments.

Additional symptom-based supports not listed above:

Memory Issues

Remembering to Do Things On Time

Environment:

Location of the student when the symptom occurs (school, home, etc.?)
What class(es) are symptoms occurring during?
Time of Day?

Activity Triggers:

What is the student doing when symptoms occur?

Additional supports the student’s teachers should explore

Memory Issue
Trouble Remembering to Do Things On Time

Help the student to develop a schedule for long-term projects.
Allow for extra time needed when mapping out time frame for projects.
Encourage student to use an agenda, assignment book, or phone app.Have parent or staff check for completion daily.

Set reminder e-notifications on computer and phone
Electronic calendars on computer and phone
Create To Do e-lists on computer and phone

Some students will do better with a binder that has color coded folders inside. One for work to be done, one for work completed. Or use a color-coded system for each class, each colored section for each class will include one folder that says “To Do” and another that says “Done.” Explicit strategy instruction will be required to learn and then reinforce use of this system.
Poor sleep the night before contributes to memory issues the next day. Parents should try to keep the student on a regular sleep schedule at night. Avoid napping as it can throw off the student’s regular circadian rhythm for sleep.
Check progress and provide feedback often in the first few minutes of each assignment.
Provide a copy of any assignments or directions written on the blackboard/screen.
Switching tasks: Student can set a timer or use a watch to alert them when to wrap up what they are doing, and when to get ready for the next task.

Additional symptom-based supports not listed above:

Attention and Concentration

Environment:

Location of the student when the symptom occurs (school, home, etc.?)
What class(es) are symptoms occurring during?
Time of Day?

Activity Triggers:

What is the student doing when symptoms occur?

Additional supports the student’s teachers should explore

Attention and Concentration

Have the student work in a quiet space.
Have the student use noise cancelling headphones or ear plugs.
Reduce distractions in the student’s work area (physically clear table/desk off, not seated near window or door).

When reading, the student may focus better with a reading frame.
When reading online, limit the amount of content on screen at one time.
Utilize more white space between lines/sections. Use content headers to direct student’s attention to changing content.

Reduce visual clutter on the screen pages to reduce visual overload
Immersive Reader
Safari Reader on the Safari browser
Mercury Reader extension on Chrome browser

For students with visual field neglect, provide cues to scan the entire screen for content.
Reduce distractions by using blank pieces of paper to cover all but one of the questions on a worksheet.
Use a highlighter or sticky notes to be an active reader and to stay focused.
Listen to audio instead of reading or while reading.
A teacher should use headings for any content changes on the screen.
Provide teacher notes to the student prior to class. Allow the student to follow along with highlighter to identify key content.
Provide scheduled “brain breaks.” Use a timer (phone, computer, stand-alone) to cue the student when break starts and stops.
Chunk information and assignments into manageable pieces for the student.
Provide non-verbal cues to help reinforce student’s focus (physical tap on shoulder, chat box reminder for online work).
Establish a verbal cue word the teacher can say to remind the student to pay attention (e.g., One, two, three…eyes on me; Listen, look, etc.).
Provide student with fidget sensory tools to stay focused while teacher is speaking.
Provide student with fidget seat, rubber ball seat, or standing desk to wiggle while working
Teacher should obtain student’s full attention before providing instructions.
Teacher can use a highlighting tool, pointer, flashlight, or laser pointer to point out objects/words to focus on during board instruction.
Ask student to orally summarize information that was just presented.
Pair written and oral instructions
Provide student a 5-minute timed period at the end of in class work, to check over assignment before turning in.
Poor sleep is the most important contributor after a brain injury to attention and concentration. Parents should help to ensure the student is maintaining a consistent sleep schedule at home in the evenings, avoiding naps during the day. Naps can disrupt the student’s regular sleep schedule at night.
Attention can become worse as the day goes on. When possible, try to schedule tests and critical learning activities earlier in the day.
Highlight key directions.
Highlight important words or phrases in reading assignments.
Provide the student with an advance organizer before a class lecture consisting of an outline of the material to be presented. The student can complete the partial outline by taking some notes while listening to the lecture to remain on track and focused.
Provide colored/highlighted strips to assist students in following along in textbook.
Check progress and provide feedback often in the first few minutes of each assignment.
Allow student to respond verbally to test questions.
Alternate ways to evaluate (projects or oral presentations instead of written tests).
Permit or provide student with a recording of lessons.
Utilize short, concise directions. Avoid use of excessive language, figurative language. For instance, her teacher should say: “Take your math book. Turn to page 54.” Her teacher should not provide instructions the following way: “Now, close your social studies book. I want you to go get your math book from your desk- no talking- and then turn to page 54. No talking- just get the book out and turn to the page.” Short and concise directions are important. Directions can be given one at a time if needed and written down.
Provide this student with a quiet, distraction free area for quiet study time and test taking. It is the responsibility of the teacher to take the initiative to privately and discretely (do not draw peer attention to the student) “send” this student to a quiet, distraction free room/area for each testing session. It is important to assure that once the student begins a task requiring a quiet, distraction free environment that no interruptions be permitted until the student is finished.
Seat student near the source of instruction and/or stand near student when giving instructions to help the student by reducing barriers and distractions between him and the lesson. It is important to encourage the student to sit near positive role models to ease the distractions from other students with challenging or diverting behaviors.
To reduce distractions for the student, computers and other equipment with audio functions that are used in the classroom by other students should be used with earphones to eliminate the sound being broadcast into the classroom.
Minimize clutter on desk and in classroom.
Provide student a word bank of choices for answers to test questions.
Give private, discrete cues to student to stay on task, cue the student in advance before calling on him, and cue before an important point is about to be made (example: “This is a major point.”).
If student is off task, have a pre-established cue (between the teacher/paraprofessional and student) such as a should tap to redirect the student to task.
Provide sample test (not the same problems, but same format as test) prior to exam as a study guide.
Testing in separate room. Allow tests to be taken in an environment with fewer distractions.
Provide student extended time on tests.
Permit student to explain wrong answers on assessments.
Permit as much time as necessary to complete assignments.
Allow student to take short breaks as needed during testing.

Additional symptom-based supports not listed above:

Cognitive Fatigue

Environment:

Location of the student when the symptom occurs (school, home, etc.?)
What class(es) are symptoms occurring during?
Time of Day? AM/PM?

Activity Triggers:

What is the student doing when symptoms occur?

Triggers?
Ask about student’s sleep schedule at night/home
Ask student what symptoms occur with cognitive fatigue (or how they know they are experiencing it)

Additional supports the student’s teachers should explore

Cognitive Fatigue
Feels worn out, exhausted, tires easily, drowsy during the day

Adjust screen settings to enlarge entire screen
Dim screen brightness
Encourage student to try out alternative screen colors
Contrast desktop screen from light to dark
Rest when needed, but do not take naps during day
Maintain consistent sleep patterns at night, with an early bedtime when possible.
Turn off phone notifications during scheduled sleep hours.
Limit screen time before bed.
Limit caffeine.
Light exercise during day as permitted by physician, e.g., walking.
Break up screen time tasks.
Computer blue light blocking glasses may help reduce eye fatigue.
Reduce screen glare (encourage student to sit away from windows, bright lights).

Speech-to-text – Speech recognition software that will turn a student’s speech into text on the computer screen. Siri’s dictation feature offers real-time speech-to-text conversion, recording the words you say as typed text on Apple products.

Mac Speech to Text (Apple products)
Dragon
Google Docs Speech to Text/Voice Typing on Chrome browser

Text-to-speech -for a student who may find reading too taxing they can have books or documents read aloud. Examples include:

Snap and Read
Audio Books: Audible, Scribd
Reads other types of documents- NaturalReader, Voice Dream Reader

Scanners with Optical Character Recognition (OCR) software which converts print-to-speech output

Have student use word prediction software that predicts words while the student is typing such as:

Co:Writer
TypeIt4Me (Macs only)

Cue student to take short “eye breaks” from computer screen (e.g., focus on something across the room to give eyes a rest, close eyes for a short period of time). Schedule longer “brain breaks” from the computer throughout day.
Clock apps to time built in breaks, to chunk reading time, break up screen time, etc.
Reduce visual clutter on the screen pages to reduce visual overload
Immersive Reader
Safari Reader on the Safari browser
Mercury Reader extension on Chrome browser

For students with visual field neglect, provide cues to scan entire screen for content.
A teacher should use headings for any content changes on the screen
A teacher can read exams to the student via Zoom or other online platform.
Eliminate less critical information and facts from a copy of your notes (or those of a capable peer) using white out tape.
For multiple choice questions, use white out on parts of paper or to eliminate some multiple-choice answers
Provide student a word bank of choices for answers to test questions. This aids retrieval and memory issues also.
Modify classroom and homework assignments.

Student does every 2nd or 3rd problem,
Student does 50% of the problems/questions,
Use a timer and draw a line across their homework page at the end of 10 or 15 minutes of sustained work
Student can demonstrate that they understand the main learning concept(s) taught that day, rather than having them complete full worksheets

Use of a calculator, whenever possible, for math calculations.
Provide concrete cues on the student’s desk – taped 100s charts, math number lines, alphabet, vocabulary lists, word bank lists taped alphabets for printing or writing, etc.
Allow extra time to turn in homework, do not dock grade for being late.
Allow student to use another way to prove learning has occurred, rather than writing/typing essays (such as an outline instead of essay). A way that is less cognitively demanding.
Provide a word (or phrase) bank for fill in the blank test questions.
Check progress and provide feedback often in the first few minutes of each assignment.
Reduce the number of questions on tests.
Provide the student with an advance organizer before a class lecture consisting of an outline of the material to be presented. The student can complete the partial outline by taking some notes while listening to the lecture to remain on track and focused.
Use Post-it notes to mark assignments in the textbook. Write the assignment requirements on the Post-it notes.
Provide student page numbers (or web-links) to help the student find answers.
Provide a vocabulary list with definitions.
Provide a complete copy of notes before class that the student can highlight during instruction (such as highlighting key words).
Pre-teach the main ideas/key content before classroom instruction occurs.
Allow student to abstain from participating in activities at signs of overload .
Provide study guide in advance of tests and quizzes.
Provide sample test (not the same problems, but same format as test) prior to exam as a study guide.
Allow student testing in separate room. Allow tests to be taken in an environment with fewer distractions.
Allow student extended time on tests
Provide student short breaks as needed during testing.
Permit open book, notes and/or internet use on tests/assessments/quizzes.
Provide student a word bank of choices for answers to test questions. This aids retrieval and cognitive fatigue issues also.
Allow student to respond verbally to test questions.
Alternate ways to evaluate (projects or oral presentations instead of written tests).
Permit student to explain wrong answers on assessments.

Additional symptom-based supports not listed above:

Slow Processing Speed

Environment:

Location of the student when the symptom occurs (school, home, etc.?)
What class(es) are symptoms occurring during?
Time of Day?

Activity Triggers:

What is the student doing when symptoms occur? Triggers?

When asked a question in class?
When reading? When doing math?
Does student ask a lot of questions when you (teacher) have already provided directions verbally?

Additional supports the student’s teachers should explore

Slow Processing Speed
Slow to respond, react, takes longer to think through things

Allow student extra time to process information.
Extended time on tasks and tests, including standardized assessments. Testing may be conducted in a separate and/or small group setting to allow for breaks and extended time.
Allow students the opportunity to complete lengthy tests over the course of multiple administrations.
Assignments, tests, and homework could also be shortened. Focus on mastery of specific content, but cut repetition
Present student with novel material and complex instructions at a controlled pace, with repetition and clarification provided as needed.
Grade accuracy over speed.
Record classes (online or in person) so that the student can review the content as many times as needed.
Have student use word prediction software that predicts words while the student is typing.
Provide student copy of class discussion questions beforehand to prepare verbal answers.
Check in consistently with student to ensure the student understands what is being taught.
Give simple written directions and speak slowly when giving oral directions.
Use graphs and other visual aids.
Use a signal to engage the student if he appears to be losing focus.
Always provide student with simple written directions and also speak slowly when giving directions.
Give the student an extra set of textbooks to keep at home if he often forgets to bring what he needs to or from school.
Reduce the need for handwriting. Examples include using fill-in-the-blank questions or allowing work to be done on a computer.
Use methods other than worksheets to reinforce new concepts.
Allow student to work on the computer to reduce the need for handwriting.
Use fill-in-the-blank or multiple-choice questions to reduce the need for handwriting.
Develop projects and assignments that allow the student to demonstrate what she knows without having to complete a written report.
Consider allowing student to type notes and assignments. This may be faster and easier for students who struggle with handwriting.
Teach students to use abbreviations when taking notes in class.
Evaluate a student’s work based on mastery of the information, rather than on the amount of work completed.
Use simple, concise instructions with concrete steps. Speak slowly when giving directions.
Stick to daily class routines.
Break down large assignments into smaller components with individual deadlines.
Provide student with written steps to a task, rather than having to rely on cold recall.
When students begin a new assignment, provide a checklist that explains how the assignment will be graded.
Communicate clear starting points for tasks, instead of just giving students a due date.
Encourage the student to review class notes every night with a parent. This will help the student understand what information is missing or unclear. The next day, she can ask you in class to clarify information that is missing or unclear.
Use books with audio or text-to-speech software with students who may benefit from seeing and hearing words at the same time.
Slow processing speed makes a student more vulnerable to distractions. Distractions can be related to either visual or noise. Try to make environment as distraction free as possible.
For multiple choice questions, use white out on parts of paper or to eliminate some multiple-choice answers.
Physical activity increases activity in the areas of the brain where processing happens. Low impact walking is an activity that can increase activity safely for a student.
Poor sleep can worsen slow processing speed. Parents, be sure the student maintains a consistent sleep schedule.
Provide the student with an advance organizer before a class lecture consisting of an outline of the material to be presented. The student can complete the partial outline by taking some notes while listening to the lecture to remain on track and focused.
Utilize short, concise directions. Avoid use of excessive language, figurative language. For instance, her teacher should say: “Take your math book. Turn to page 54.” Her teacher should not provide instructions the following way: “Now, close your social studies book. I want you to go get your math book from your desk- no talking- and then turn to page 54. No talking- just get the book out and turn to the page.” Short and concise directions are important. Directions can be given one at a time if needed and written down.
Provide concrete cues on the student’s desk – taped 100s charts, math number lines, alphabet, vocabulary lists, word bank lists taped alphabets for printing or writing, etc.
Have extra time to process spoken information and directions Allow adequate time for student to answer questions to permit the student time to form a thoughtful answer.
Visuals for math problems for sequence of steps.
Student should be exempt from timed tests for now, as timed testing may not be indicative of the student’s actual knowledge base due to slowed processing speed.
Student should not perform timed math tests or drills.
Cue the student in advance before calling on them to answer questions.
Provide a table of math facts for reference.
Allow extra time to turn in homework, do not dock grade for being late.
Allow extra time for the student to process when you ask a question.
Provide a copy of any assignments or directions written on the blackboard/screen.
Student should not be required to take handwritten notes.
Check progress and provide feedback often in the first few minutes of each assignment.
Permit as much time as necessary to complete assignments.
Pre-teach the main ideas/key content before classroom instruction occurs.
Provide a vocabulary list with definitions.
Allow student to use another way to prove learning has occurred, rather than writing/typing essays (such as an outline instead of essay). A way that is less cognitively demanding.
Employ test formats that require recognition (multiple choice, matching, true/false and fill in the blank with an associated word bank) in favor of test formats that require recall (essay, fill in the blank without a word bank, writing definitions).
Permit or provide student with a recording of lessons Provide a complete copy of notes before class that the student can highlight during instruction (such as highlighting key words)
Reduce the number of questions on tests.
Provide sample test (not the same problems, but same format as test) prior to exam as a study guide.
Permit student to explain wrong answers on assessments.
Provide testing in separate room. Allow tests to be taken in an environment with fewer distractions.
Provide extended time on tests.
Provide short breaks as needed during testing.
Provide student a word bank of choices for answers to test questions. This aids retrieval, memory, and cognitive fatigue issues also.

Additional symptom-based supports not listed above:

Confusion, Fogginess

Environment:

Location of the student when the symptom occurs (school, home, etc.?)
What class(es) are symptoms occurring during?
Time of Day?

Activity Triggers:

What is the student doing when symptoms occur?
Triggers?

Additional supports the student’s teachers should explore

Confusion, Head Feels Foggy/Fogginess

Keep directions simple
Provide written directions
Allow extra time to process
Teachers – periodic checks for understanding
Teacher-provided notes
Take schedule rest breaks
Check progress and provide feedback often in the first few minutes of each assignment.
Provide student page numbers (or web-links) to help the student find answers.
Provide a vocabulary list with definitions.
Permit open book, notes and/or internet use on assessments.
Permit student to explain wrong answers on assessments.
Provide a copy of any assignments or directions written on the blackboard/screen.
Allow extra time to turn in homework, do not dock grade for being late.
Permit or provide student with a recording of lessons.
Provide study guide in advance of tests and quizzes.
Reduce the number of questions on tests.
Provide sample test (not the same problems, but same format as test) prior to exam as a study guide.
Permit student to explain wrong answers on assessments.
Provide testing in separate room. Allow tests to be taken in an environment with fewer distractions.
Provide extended time on tests.
Provide short breaks as needed during testing.
Provide a word (or phrase) bank for fill in the blank test questions.

Additional symptom-based supports not listed above:

Difficulty Making Decisions

Environment:

Location of the student when the symptom occurs (school, home, etc.?)
What class(es) are symptoms occurring during?
Time of Day?

Activity Triggers:

What is the student doing when symptoms occur?

Additional supports the student’s teachers should explore

Trouble Making Decisions

Give clear choices to pick from as opposed to open-ended options
Check progress and provide feedback often in the first few minutes of each assignment.
Role play with the teacher through decision making steps. Use social stories.
Use direct instruction in evaluating and choosing.
Teach student self-talk strategies using a script, to help walk themselves through their decision-making process. Example, “First, I need to think about what the two options I must choose from. Second, I need to think about the possible outcomes of each decision. Then, I will choose the option that makes the most sense to me. After, I will evaluate the final decision I made and it’s outcome either immediately afterwards or in X # of days with my teacher.“
Use verbal prompts and cues.

Additional symptom-based supports not listed above:

Schoolwork Takes Longer, Missed Work Piling up

How far behind is the student?
Has there been a significant decline in grades for an extended period of time?
Does student have many absences?

Additional supports the student’s teachers should explore

Schoolwork Takes Longer, Missed Work Piling Up

Focus on essential key content for the day and remove repetition once mastered.
Allow student to take pictures on phone of assignments or other tasks to be completed.
Check in with student 5 minutes before class and 5 minutes before going home at the end of the day to ensure the student has assignment planner filled out completely, has correct books, etc. While doing this, focus on reinforcing the strategy verbally by talking through this organizational process each day using a consistent script. This will help the student self-regulated over time, with repetition from the teacher.
Assign limited amounts of homework and accept what amount the student is able to complete without increasing symptoms.
Focus on quality and not quantity.
Do not use daily recess as a time to make¬up missed schoolwork.
Do not remove recess as punishment.
Provide a vocabulary list with definitions.
Provide the student with an overall executive summary of (chapters, sections, etc.)
Use of a calculator, whenever possible, for math calculations.
Provide a complete copy of notes before class that the student can highlight during instruction (such as highlighting key words).
Provide a copy of any assignments or directions written on the blackboard/screen.
Allow extra time to turn in homework, do not dock grade for being late.

Create chart for all missing work:

Chart of Schoolwork That is Uncomplete

	Based on What Cannot be Excused:

What work can be excused	What work cannot be excused	What work will be graded	What work will not be graded but still can be completed

Checkboxes

If student is signficiantly behind in work may have conversation about dropping class and/or leveling down in class (e.g., Advanced Placement (AP) to honors to academic)
Discuss the possibility of taking a medical exeption for the marking period and the other 3 marking periods will be averaged together. Student will need to know the content but won’t be graded.

Additional symptom-based supports not listed above:

Literal Thinking

Additional supports the student’s teachers should explore

Literal Thinking

Limit joking and sarcasm or explain when not understood.
Present the student with various idioms each week and discuss the literal definition versus the actual meaning. Have the student use the idiom in several sentences. Review throughout the week.
Pre-teach the main ideas/key content before classroom instruction occurs.
Teacher should observe classroom/recess/peer communication interactions for any issues. Consult with speech and language pathologist if it does not resolve.
Don’t use sarcasm or inferences when speaking to the student.
Utilize short, concise directions. Avoid use of excessive language, figurative language. For instance, her teacher should say: “Take your math book. Turn to page 54.” Her teacher should not provide instructions the following way: “Now, close your social studies book. I want you to go get your math book from your desk- no talking- and then turn to page 54. No talking- just get the book out and turn to the page.” Short and concise directions are important. Directions can be given one at a time if needed and written down.
Teacher should explain metaphors nuances and multiple meanings when used in class and in reading material.

Additional symptom-based supports not listed above:

Organization

Activity Triggers:

What is unorganized?

Desk? Locker? Cubby? Entire desk area? Planner? Forgetting to bring things to or from school or to/from class.

Additional supports the student’s teachers should explore

Organization
Difficulty organizing materials online and/or in school

A teacher should use headings for any content changes on the screen.
Discourage the student from doing online learning on a smartphone. Encourage use of laptop or computer screen (use largest screen available).
Explicit strategy instruction in how to use graphic online or hard copy organizers, and then the teacher provided (repeated) cueing to use them throughout the school day depending on classwork.
Present information in chunks.
Provide assistance with mapping out projects when needed allowing for extra time required.
Use concept mapping software – to help the student organize thoughts, get started on a writing assignment, plan a project.

Explicit instruction and demonstration regarding how to organize their desktop folders and files for online learning.
Explicit instruction and reminders to use:

Set reminder e-notifications
Electronic calendars
To do e-lists

Poor sleep the night before contributes to organization problems the next day. Parents should try to keep the student on a regular sleep schedule at night. Avoid napping as it can throw off the student’s regular circadian rhythm for sleep.
Check progress and provide feedback often in the first few minutes of each assignment.
Provide graph paper for calculations.
Use of an Academic Planner for all school years that is checked each morning and each afternoon by a teacher or other staff member for accuracy.
A teacher should check in with the student daily when the student arrives and at the end of the day to ensure the student has what they need for classes and home.
Use an alarm to help with time management.
Mark texts with a highlighter.
Use a planner or organizer to help coordinate assignments.
Receive study skills instruction.
Minimize clutter on desk and in classroom.
Help the student set up a system of organization using color coding by subject area, especially with materials that need to be stored in a school locker during the day. Color code items. For instance, put some red tape on a math textbook along with red tape on the math notebook. Color code items that help the student with organization tips and that provide information about what is needed.
Permit the student to check-in with this advisor first thing each week (Monday mornings) to plan/organize the week and last thing each week (Friday afternoons) to review the week and to plan/organize homework for the weekend.

Additional symptom-based supports not listed above:

Organization of Thoughts & Words

Environment:

Location of the student when the symptom occurs (school, home, etc.?)
What class(es) are symptoms occurring during?
Time of Day?

Activity Triggers:

What is the student doing when symptoms occur?

Triggers?

Additional supports the student’s teachers should explore

Difficulty Organizing Thoughts or Words Uses Wrong Words When Speaking

Allow extra time for a response
Allow student to prepare in advance for response by providing question or prompt beforehand
If symptom persists beyond 5 months, consider speech/ language screening
Poor sleep the night before contributes to organizational problems the next day. Parents should try to keep the student on a regular sleep schedule at night. Avoid napping as it can throw off the student’s regular circadian rhythm for sleep.
Provide the student with an advance organizer before a class lecture consisting of an outline of the material to be presented. The student can complete the partial outline by taking some notes while listening to the lecture to remain on track and focused.
The teacher should refer to the headers when each new section begins, as a prompt for the student to ensure they are on the same section.
Provide a vocabulary list of new words with their corresponding definitions.
Permit student to explain wrong answers on assessments Check progress and provide feedback often in the first few minutes of each assignment.
Provide a complete copy of notes before class that the student can highlight during instruction (such as highlighting key words).
Keep workspace clear of unrelated materials and clutter.
Provide a word (or phrase) bank for fill in the blank test questions.
Allow student to respond verbally to test questions.

Additional symptom-based supports not listed above:

Task Planning, Initiation, Completion

Environment:

Location of the student when the symptom occurs (school, home, etc.?)
What class(es) are symptoms occurring during?
Time of Day?

Activity Triggers:

What is the student doing when symptoms occur?

Additional supports the student’s teachers should explore

Difficulty:
1) Planning 2) Initiating 3) Finishing a Task

Give assistance when mapping out projects – allot for extra time needed.
Break task into manageable segments.
Provide student with assistance in breaking complex multi-step tasks into smaller steps.
Support and direct instruction in developing outlines/timelines for planning long-term assignments or projects.
Provide study guide in advance of tests and quizzes.
Check progress and provide feedback often in the first few minutes of each assignment.
Provide a copy of any assignments or directions written on the blackboard/screen.
Use of task analysis is helpful. Rather than relying on the student to have to remember steps to complete something, provide student with cues on a notecard. This is less cognitively taxing, saving the student’s mental energy for learning.
Use of an Academic Planner for all school years that is checked each morning and each afternoon by a teacher or other staff member for accuracy.
Develop an individualized assignment checklist for self-monitoring.
Break long assignments into chunks and assign time frames for completing each chunk.
Break instructions into short, sequential steps; dividing work into smaller short “mini¬-assignments,” building reinforcement and opportunities for feedback at the end of each segment; handing out longer assignments in segments; and, consider scheduling shorter work periods.
Explicit instruction and reminders to use the following:

Reminder e-notifications
Electronic calendars
To do e-lists
Goal, Plan, Do, Review strategy

Emotional Changes *

Irritable
Sad
Depressed
Anxious or Nervous
Stressed
Panic Attacks
Currently Not Experiencing Emotional Symptoms

Environment:

Location of the student when the symptom occurs (school, home, etc.?)
What class(es) are symptoms occurring during?
Time of Day?

Activity Triggers:

What is the student doing when symptoms occur?

Triggers?

Additional supports the student’s teachers should explore

Emotional / Irritable / Sad / Depressed Supports/Anxious or Nervous Stressed School Supports / Panic Attacks

School counselor/team to help student manage expectations due to the student not being able to perform academically as they did prior to the concussion.
School counselor/team to validate students’ feelings but offer solutions for support and strategies.
Assign an adult staff member as a “touch base” person who the student feels comfortable going to when emotions surge Add: Additional supports the student’s teachers should explore.
School psychologist should screen anxiety/depression @4 weeks
Limit make up work. Focus on essential learning items.
Exercise as permitted by physician
Attend local virtual concussion support group
Peer support
Brain injury support and training for the student to gain a better understanding of concussions/brain injury

Help student develop simple strategies to manage anxiety, such as:

Organizing materials and time.
Developing small scripts of what to do and say either externally or internally when anxiety increases, and.
learning how to relax under stressful conditions.

Teach student to practice relaxation techniques such as mindfulness meditation, progressive muscle relaxation, controlled breathing, and visualization to help reduce anxiety and stress and increase feelings of relaxation and emotional well-being.
Try thought challenging, also known as cognitive restructuring, to challenge the negative thinking patterns that contribute to his anxiety and replacing them with more positive, realistic thoughts. The student’s school counselor should help with this.
Online yoga

Relaxation techniques

Headspace App.
Calm App.
Rest, deep breathing, talk to parent, counselor, about different relaxation techniques.
Cognitive-behavioral techniques such as thought stopping, visual imagery and focusing on the positive and future goals.
YouTube mediation before bed: A Walk on the Beach: Guided Mediation with Lori Granger.

Apps for deep breathing such as the following:

Long Deep Breathing.
Relax Melodies.
Breathe2relax.
Relax and Sleep Well.
I Can Relax.
Universal Breathing by Saagra.

School psychologist should screen anxiety/depression @4wks
Rest, deep breathing, talk to parent, counselor, relaxation techniques
Concussion online support groups
Peer support
Brain injury support and training for the student to gain a better understanding of concussions
Parents should explore CBT therapy options within the community for student

Poor sleep the night before contributes to poor emotional control the next day. Parents should focus on keeping the student on a consistent sleep schedule at night, with no napping during the day (naps can throw off the circadian rhythm of sleep).
If the student is worried during the school day with anxious or intrusive thoughts, the student should be taught to set aside 30 minutes each day of “worry time.” When a worry creeps in during the school day, the student should remind themselves that they will worry only during the 30 minutes they have set aside later in the day. During this designated worry time each day (preferably after school) the student should set a timer and write down and then focus on all of their concerns and worries. When the 30 minutes is over, the student should remind themselves that if they begin to worry during the next 24 hours, they will have 30 minutes again the next day to do the same thing. This helps the student keep focused. Do not do “worry time” near bedtime, as worrying may disrupt sleeping.
For students who are anxious, worry, or experience constant intrusive thoughts, remind the student that thoughts in their head are like cars on the road. They travel in and out constantly. When a car (thought) drives past, we should not chase the cars (thoughts). Let the car drive past us. The student may find the mantra, “Don’t chase the cars” useful during these times of worry.
Exempt student from missed work due to brain injury
Provide extended time on tests and assignments
Provide teacher support for strategizing about missed/late work.
Utlize the “Big Deal/Little Deal” strategy
Use of an immediate “Cool Down Pass” to take a break from the classroom. Teach the student how to use the “Cool Down Pass.”. Walking down the hallway, getting a drink, standing outside of the class for a few minutes, coloring pages in the back of the classroom, using a mindfulness app with headphones.
When the student feels intense emotions, remind them to focus on breathing. For 60 seconds, take deep breaths and hold each for 6 seconds. Breathe in through the nose and hold, and then out through your mouth.
Talk to student about paying attention to what is happening in their body when they feel agitated (for example, are they tapping their foot, clenching their fists?) That way they can start to recognize when they need a break before losing control. Student should be told they can ask for short break to help remain calm.
When student experiences intense feelings, take a moment to focus on input from all five senses: touch, sight, smell, hearing, and taste. (Example: Choose any color and spend 1 minute finding objects near you in that color).
If the student begins to have a panic attack, provide them with an ice pack or ice cube. Holding a cold compress to their chest, holding ice cubes in their hands, eating ice or holding it against the roof of their mouth, rubbing ice cubes along their face and arms. The brain cannot focus on both panicking and the feeling of the cold ice at the same time and should default to focusing on the cold ice feeling. The ice shifts attention to the coldness, and this distraction lowers amygdala activation in the brain
Provide a quiet corner or room to calm down and relax when anxious
Buddy system: Pair student with a peer to aid with transitions to lunch and recess (these less structured situations can trigger anxious feelings)
Provide student with extra time and warnings before transitions.
Use pre-recorded video presentations of the student for presenting in front of the teacher (instead of the class)
Visual schedules to anticipate the day/week/month
Advance notice of upcoming transitions
Special sign or signal between teacher and student to notify if student is having a panic attack or other emotionality and needs to leave class.
Allow testing in separate room. Allow tests to be taken in an environment with fewer distractions.
Provide extended time for tests
Allow student to take short breaks as needed during testing

Additional symptom-based supports not listed above:

Behavioral or Social Changes *

Changes in Relationships with Friends/Peers
Easily Frustrated, Irritable, Overwhelmed
Restlessness, Fidgety
Verbal outbursts
Physical outbursts
Poor judgment and disinhibition
Impulsive behaviors
Risky behaviors
Rigidity and inflexibility
Currently Not Experiencing Behavioral or Social Changes Symptoms

Additional supports the student’s teachers should explore

Friendship Changes & Peer Social Supports

Voice texting, Facetime, Skype, talk on the phone, continue to socialize with friends in small gatherings, 1 or 2 individuals at a time.
Do not restrict all extracurricular activities, adapt them.
Peer support strategies.
Discuss with student what is appropriate/inappropriate language and behaviors. Use video modeling or role-playing and scripts. Be very explicit.
The student may not always understand when s/he does something right. It is important to let the student know s/he is doing well through positive reinforcement and be explicit on what behaviors are appropriate.
It is important to try to anticipate times or situations which are most likely to provoke outbursts and head them off preventatively. Instead of just pointing out what a child should not do, it is essential to teach the desirable alternative behaviors which help the child get what he wants in a socially acceptable way. Offering the child frequent, short breaks and/or using systematic rewards for his compliance (such as private time to play a video game) are additional means for reinforcement of his cooperative efforts.
At school, allow the student to take 1-2 friends if the student needs to separate from over stimulating environments (e.g., leave cafeteria to eat lunch with friends in a quieter room, etc.).
If parent allows, educate student’s peers on changes the student is experiencing since the brain injury. Encourage ways they can support their friend’s recovery.

To Foster Friendships: Pair students strategically. Group work and working in pairs can foster friendships. Pair by similar interests rather than by skill ability.
At all times avoid the use of sarcasm, continual criticism or bringing attention to student’s different needs in front of peers; and recognize that this student will respond significantly better when encouraged and when positive achievements are noticed and mentioned.
Provide student with leadership responsibilities in the class that provides them the opportunity to interact positively with other students.
Provide students with opportunities to share thoughts, ideas, backgrounds, talents, items, etc. in class with other students.
Utilize school-staff peer-led recess activities to increase peer interactions.
Enroll student in social skill groups (such as Lunch Bunch or Circles of Support) via the school counselor, school social worker, speech therapist, etc.
Do not withhold Prom, Homecoming, or other once in a lifetime event for students with brain injury due to their symptoms. Instead, provide supports to manage their symptoms during the event.

Additional symptom-based supports not listed above:

Frustration, Irritable

Environment:

Location of the student when the symptom occurs (school, home, etc.?)
What class(es) are symptoms occurring during?
Time of Day?

Activity Triggers:

What is the student doing when symptoms occur?
Triggers?

Additional supports the student’s teachers should explore

Frustration , Irritable, Overwhelmed Easily Often, students become frustrated and irritable when cognitively fatigued

Build in breaks throughout the day. Provide the student a schedule for when breaks will occur. Use a timer as needed.
Provide the student with a touch – base adult (teacher, parent) who the student knows they can connect with during the day for emotional support when overwhelmed, frustrated, and irritable.
Many students are trying to makeup work while simultaneously trying to keep up with new content. Provide them extended time for all makeup work.
Periods of deep breathing built into the day, cued by teacher/adult.
Exercise as permitted by physician (e.g., walking).
Relaxation techniques should be first taught, and the n used by the student when he or she feels irritable or frustrated. Relaxation times should be built into the day, just as breaks are scheduled. Relaxation techniques can occur simultaneously with breaks.
Present work in manageable segments.
Provide periodic c hecks for understanding.
Provide student with a touch base teacher to help them not feel as overwhelmed with access to that person during the day as needed.
Provide student someone at the school to touch base with – a safe adult of their choosing “hot pass” or “cool off card” which is a card the student gets, and they can leave class, flash the hot pass to the teacher, and go to office, guidance counselor, nurse (designated ahead of time) to cool off, if they feel a negative behavior coming on.
Use time warnings and increased transition time
Be aware of the student’s signs when they are starting to lose control. Be proactive in dealing with the issues BEFORE the student has a meltdown
Provide a sample test (not the same problems, but same format as test) prior to exam as a study guide
Provide testing in separate room. Allow tests to be taken in an environment with fewer distractions.
Allow student extended time on tests
Allow student to take short breaks as needed during testing

Additional symptom-based supports not listed above:

Restless or Fidgety

Environment:

Location of the student when the symptom occurs (school, home, etc.?)
What class(es) are symptoms occurring during?
Time of Day?

Activity Triggers:

What is the student doing when symptoms occur?

Triggers?

Additional supports the student’s teachers should explore

Restless, Fidgety
Often, students become restless and fidgety when cognitively fatigued

Build in breaks throughout the day. Allow the student to move around the classroom as needed or at set intervals.
Mark a 2 or 3 foot space around the student’s desk with masking tape on the floor. Let the student move around this space as needed without bothering other students.
Provide student a schedule for when breaks will occur. Use a timer as needed.
Relaxation techniques built into the day. Periods of deep breathing built into the day, cued by teacher/adult.
Provide student with fidget tools.
Provide student with fidget seat, fidget seat pad, leg bands for fidgeting.
Provide student with fidget tools (but be sure the fidget tool you provide doesn’t become a distraction to others)
Use sensory tools such as an exercise band that can be looped around a chair’s legs (so fidgety kids can kick it and quietly get their energy out)
Provide student with special seating (wobble seats, sit on therapy balls, t-stools, disco-sit, bean bag chairs, or positioning wedges

Provide student with scheduled sensory breaks.
Student can go to the office to deliver something.
Bathroom breaks scheduled over time for student.
Increase teacher awareness of sensory issues–smells, sounds, lighting; and have them adjust sensory experiences as appropriate.
Allow student to work in a variety of positions; laying flat on the floor propped on elbows, standing at a table or easel, or lying on side and using a clipboard to write on

Additional symptom-based supports not listed above:

Additional supports the student’s teachers should explore

Verbal outbursts

Additional supports the student’s teachers should explore

Physical outbursts

“Hot Pass” or “Cool Down Pass” which is a card the student gets and they can leave class, flash the hot pass to the teacher, and go to office, guidance counselor, nurse (designated ahead of time) to cool off, if they feel a negative behavior coming on
Substitute teachers: Prepare the student for substitute teachers and changes to the daily schedule in advance.
For transition difficulties, provide advanced notice prior to transitions. Use a timer or give student a verbal cue that it will be time to change activities. Increase time for transitions.

Additional supports the student’s teachers should explore

Poor judgment and disinhibition/ Impulsive behaviors / Risky behaviors

Poor sleep the night before contributes to impulsivity the next day. Parents should try to keep the student on a regular sleep schedule at night. Avoid napping as it can throw off the student’s regular circadian rhythm for sleep.”
Allow the student to listen to calming music with headphones
Use a soft voice and slow down your speech and movements while talking
Allow the student to move around. Provide opportunities for physical action – pace in the rear of the classroom, do an errand, wash the blackboard, get a drink of water, go to the bathroom, etc.
Do not use daily recess as a time to make¬up missed schoolwork.
Do not remove daily recess as punishment.
Permit the student to play with small objects kept in their desks that can be manipulated quietly, such as a soft squeeze ball, if it isn’t too distracting.
Use the “Stop, Think, Act strategy.” When the student or teacher notices the student acting on the first thing that pops into their mind, have the student STOP and count to 3 while they think about the possible outcomes of what they are about to do.
Breathing techniques can help students relax or calm down when feeling out-of-control. A simple exercise that they can do is to focus on breathing for 60 seconds. Breathe in through the nose, hold breath for 6 seconds, and then breathe out through the mouth.
Teach student to wait until others have finished talking before sharing their thought. If the student finds themself disrupting conversations, they should try silently repeating the question(s) before offering an answer. This can help them avoid cutting others off when they are speaking.

Additional symptom-based supports not listed above:

Additional supports the student’s teachers should explore

Rigidity and inflexibility

Poor sleep the night before contributes to poor mental flexibility the next day. Parents should focus on maintaining a consistent sleep schedule for the student with no naps during the day. Naps can throw off the circadian rhythm of the student’s sleep schedule.
To improve mental flexibility, practice simple routines out of order. For example, parents can ask the student to get dressed or ready for bed in a different order. Teachers can change the order of a typical routine for the student.
Provide student teacher generated types/written classwork and homework steps for lengthy assignments. Encourage student to cross each step off as it is completed.

Additional symptom-based supports not listed above:

Send a PDF of this report to the following email(s): *

Emails should be comma separated. ([email protected], [email protected])

Additional Notes from Meeting

For Student/Family to Do:

For School to Do:

Review with School Team, Parent, & Student

Pediatric Brain Injury- Points to Remember

1. All brain injuries are serious. A concussion is also a brain injury. All concussions are serious, too.

2. Most brain injuries (90%) occur without loss of consciousness.

3. Chemical and metabolic changes occur in the brain during injury, interfering with normal brain activity.

4. The majority of concussions (70%) typically resolve within 4 weeks, but in some students, effects may last a lifetime.
Moderate to severe acquired brain injuries may result in lifelong deficits.

5. Pre-existing or underlying conditions such as prior concussions or other severities of brain injury, attention deficits,
learning disabilities, and emotional/mental health disorders can be exacerbated by concussion. These can also extend concussion recovery time.

Considerations – All can be phased in or out fluidly based on the student’s individual needs during recovery:

Eliminating make-up work with the exception of concepts important to future learning (typically math, science, foreign language).
Each teacher should determine what future assignments and assessments can be eliminated and/or reduced and what assignments/assessments are essential and need to be completed.
Structured breaks based on the individual student’s symptom threshold. Explore student’s symptom threshold – how long can the student focus on an academic activity before experiencing an increase in headache/other symptoms?
o Example: If the student can go 40 minutes before experiencing symptoms, the student’s cognitive working periods might be 30 minutes followed by a 10- minute break. Breaks can be phased out as recovery progresses.
Identify loud environments the student may be exposed to in school and divert her to a quiet place.
Provide the student with supplemental sources of learning when available: textbook websites, audio resources, discovery learning, etc.
Eliminate homework during recovery with the goal of having brain rest in the evening.
Substitute assignments in classrooms that exacerbate her symptoms. Example: Band class can be noisy. The student might watch/listen to an audiobook or video and provide a verbal report on the content.
Provide the student with a list of what is expected in each class. The student might also check in/out with a designated person each day to assess progress and remain on course.

MOVING FORWARD:
1.School staff should not rely on the student to ask for the academic supports listed in this document. Often, the student will not know to ask for the academic support until they are symptomatic. The purpose of this document is to alleviate symptoms during the school day, so they do not interfere with learning.
2. Designate one teacher as the advisor/supervisor/coordinator/liaison for the student and the implementation of this BrainSTEPS plan at the school-level. This individual should review the student’s progress in using the academic supports recommended in this document in one month (or sooner). This individual should be the direct link for communication between BrainSTEPS, and the student, the parent, and the school team.
3. Teachers should report to the school team and parent if the interventions and/or accommodations listed within this report are ineffective so the team in conjunction with BrainSTEPS can re¬convene and modify the plan as needed.
4. For high school students only, if the student’s signs and symptoms of brain injury do not resolve, the student should be referred to their local county Vocational Rehabilitation office by their school team or parent. This is an important part of transition for students with disabilities, whether the student receives special education or not.
5. For high school students planning to attend college, the school counselor should apply for the College Board ACT and SAT formal academic accommodations prior to testing. This must be done well in advance of the test. The application must be completed and turned in, in time for a decision to be made by the College Board. The school should provide adequate documentation of the student’s current deficits as well as current accommodations that are in place at the high school.

For high school students only, if the student’s signs and symptoms of brain injury do not resolve, the student should be referred to their local county Vocational Rehabilitation office by their school team or parent. This is an important part of transition for students with disabilities, whether the student receives special education or not.

For high school students planning to attend college, the school counselor should apply for the College Board ACT and SAT formal academic accommodations prior to testing. This must be done well in advance of the test. The application must be completed and turned in, in time for a decision to be made by the College Board. The school should provide adequate documentation of the student’s current deficits as well as current accommodations that are in place at the high school.

Your BrainSTEPS consultant can be contacted at any point in time until your student graduates to provide brain injury-related school staff consultation and training to support your student’s needs. BrainSTEPS is here to support this student until graduation.

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Brain Injury Support Framework

BrainSTEPS Concussion/Mild

BrainSTEPS Confidential Student Brain Injury Support Framework

TEACHERS

DIRECTIONS for BrainSTEPS Consultants Filling Out the BISF:

Headaches

Headaches or “pressure” in the head

Blurry or Double Vision

Blurry or Double Vision

Dizzy or Balance Issues

Dizzy or Balance Issues

Light Sensitivity

Light Sensitivity

Noise Sensitivity

Noise Sensitivity

Fatigue and/or Sleep Issues

Sleep

Memory Issues

Memory Issues Forgetful, Difficulty Remembering, Difficulty/Frustrated with New Learning, Misunderstands

Memory Issues

Memory Issue Trouble Remembering to Do Things On Time

Attention and Concentration

Attention and Concentration

Cognitive Fatigue

Cognitive Fatigue Feels worn out, exhausted, tires easily, drowsy during the day

Slow Processing Speed

Slow Processing Speed Slow to respond, react, takes longer to think through things

Confusion, Fogginess

Confusion, Head Feels Foggy/Fogginess

Difficulty Making Decisions

Trouble Making Decisions

Schoolwork Takes Longer, Missed Work Piling up

Schoolwork Takes Longer, Missed Work Piling Up

Literal Thinking

Literal Thinking

Organization

Organization Difficulty organizing materials online and/or in school

Organization of Thoughts & Words

Difficulty Organizing Thoughts or Words Uses Wrong Words When Speaking

Task Planning, Initiation, Completion

Difficulty: 1) Planning 2) Initiating 3) Finishing a Task

Emotional / Irritable / Sad / Depressed Supports/Anxious or Nervous Stressed School Supports / Panic Attacks

Friendship Changes & Peer Social Supports

Frustration, Irritable

Frustration , Irritable, Overwhelmed Easily Often, students become frustrated and irritable when cognitively fatigued

Restless or Fidgety

Restless, Fidgety Often, students become restless and fidgety when cognitively fatigued

Verbal outbursts

Physical outbursts

Poor judgment and disinhibition/ Impulsive behaviors / Risky behaviors

Rigidity and inflexibility

Additional Notes from Meeting

Review with School Team, Parent, & Student

Pediatric Brain Injury- Points to Remember

Considerations – All can be phased in or out fluidly based on the student’s individual needs during recovery:

Your BrainSTEPS consultant can be contacted at any point in time until your student graduates to provide brain injury-related school staff consultation and training to support your student’s needs. BrainSTEPS is here to support this student until graduation.

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Memory Issues
Forgetful, Difficulty Remembering, Difficulty/Frustrated with New Learning, Misunderstands

Memory Issue
Trouble Remembering to Do Things On Time

Cognitive Fatigue
Feels worn out, exhausted, tires easily, drowsy during the day

Slow Processing Speed
Slow to respond, react, takes longer to think through things

Organization
Difficulty organizing materials online and/or in school

Difficulty:
1) Planning 2) Initiating 3) Finishing a Task

Restless, Fidgety
Often, students become restless and fidgety when cognitively fatigued