Blurry or Double Vision

• Inform physician of symptom
• 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
• Use visual cues to guide student to areas of screen or board to focus on
• Provide a reading frame to help student focus on lines when reading
• Provide copies of teacher notes. Provide notes to student prior to class. Ask student to follow along using highlighter to identify key concepts.
• Provide enlarged notes
• Provide recorded sessions so student can review, for content missed
• 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)
• Increase font size (large print is defined as 16 -to 18-point bold type, depending on the typeface used)
• 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
• Break – Put head down if needed
• Listen to reading material
• Enlarged font and pictures on screen
• Change screen brightness
• Computer blue light blocking glasses may help reduce eye fatigue
• Text-to-speech -for a student who may find reading too taxing they can have books or documents read aloud. Examples include:

1. Snap and Read
2. Audio Books: Audible, Scribd
3. 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.

1. Mac Speech to Text (Apple products)
2. Dragon
3. 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:

1. Co:Writer
2. 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
• Reduce visual clutter on the screen pages to reduce visual overload

1. Immersive Reader
2. Safari Reader on the Safari browser
3. 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. Zoom is currently offering free subscriptions for all K-12 public schools.
• Use clock apps to time built in breaks, to chunk reading time, break up screen time, etc.

Dizziness and/or Balance Issues

• Signifies possible vestibular issue – student should be evaluated by vestibular therapist. Tell the parents to report symptom to the student’s physician.
• 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.
• Sit and close eyes at desk/table until symptoms pass. Then begin again.
• Provide student pass to go to a quiet room to rest for 5-10 minutes until symptoms pass.
• Allow student to have extra time to get to and from class. Provide a second set of books at home so that student does not have to carry them
• Provide student book in each physical classroom, so student does not have to carry books to and from class
• Be mindful of the environment, e.g., hold handrail when going up or down steps
• Teacher-provided notes in hard copy so student can follow along with highlighter for key concepts. Provided notes will alleviate looking up and down which can trigger dizziness/headaches.
• Transition slowly from sitting to standing position
• 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

Light Sensitivity

• Encourage student to try out alternative screen colors
• Contrast desktop screen from light to dark
• Reduce screen glare (encourage student to sit away from windows, bright lights)
• Work in a room with natural lighting, if possible. Adjust room lighting.
• A table lamp may be preferred to overhead lighting
• Use color filters (pastel) for reading and doing worksheets (PA, use Brain Injury Toolkit box filled with colored layover tools)
• Dim the computer/phone screen brightness
• Fluorescent overhead light filter covers helps to dim direct bright lights (Amazon)
• 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
• Computer blue light blocking glasses may help reduce eye fatigue (Blue Ray blocking glasses can be purchased from Amazon, etc.).
• 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
• Teachers give verbal warning to class when turning lights on or off
• Wear sunglasses or hat to shield lights or glare. Sit away from window

Noise Sensitivity

• Adjust computer volume to student’s comfort level
• Earplugs or noise-canceling earbuds/headphones

1. o Be aware that a metal roof on house could cause noise sensitivity during a hard rain or thunderstorm.
2. o Fluorescent lights may cause noise sensitivity issues if there is a low humming sound. Try switching to a floor lamp or desk lamp

• Working in a quiet room away from distractions

1. If there is not a quiet room available, try creating a quiet corner of the room

• Warn before any siren tests (tornado, fire, carbon monoxide)
• Teacher can provide written instructions instead of verbal instructions for the child

Feeling tired, having no energy, fatigue, sleep Issues: Daytime drowsiness, sleeping more than usual, less than usual, trouble falling or staying asleep, restless sleep

• 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
• Do not allow student to take naps during the day
• Discuss the importance of a consistent sleep schedule with parents
• Have student take scheduled breaks during day, head down, eyes closed but not asleep
• Encourage light exercise during day as permitted by physician, (e.g., walking, yoga)
• Encourage student to practice good sleep hygiene
• Limit caffeine during day (no caffeine after noon)
• Limit screen time before bed
• Maintain consistent sleep patterns at night, with an early bedtime when possible
• Sleep in a dark, quiet room
• Turn off phone notifications during scheduled sleep hours
• If student is having difficulty falling asleep, have the student try one or more of the following:

1. Get out of bed and do something relaxing, once student feels sleepy, go back to bed
2. Soothing music
3. White noise (fan or noise machine)
4. Warm milk before bed
5. Relaxation techniques
6. Try not to look at the clock, this can cause anxiety which makes sleeping even more difficulty
7. Have parents consult with physician regarding the possible use of Melatonin

Additional supports the student’s teachers should explore

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

• Pair visuals with verbal information during instruction ie write page number on board, hold up book, show samples of finished projects.
• 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 a planner or agenda book, and reinforce use.
• 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).
• Regarding assessments, allow extra time, limit open ended responses. Consider instead:

1. Multiple Choice Tests
2. Word Banks
3. Reference Cards
4. Open-notebook tests

• 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.

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 or assignment book. Have parent or staff check for completion daily
• Teach explicit strategy instruction and reminders to use the following:

1. Set reminder e-notifications on computer and phone
2. Electronic calendars on computer and phone
3. 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.

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).
• Avoid information overload.

1. When reading, the student may focus better with a reading frame.
2. When reading online, limit the amount of content on screen at one time.
3. 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

1. Immersive Reader
2. Safari Reader on the Safari browser
3. 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.

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

• Eliminate naps
• Increase font size (large print is defined as 16 -to 18-point bold type, depending on the typeface used)
• 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.

1. Mac Speech to Text (Apple products)
2. Dragon
3. 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:

1. Snap and Read
2. Audio Books: Audible, Scribd
3. 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:

1. Co:Writer
2. 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

1. Immersive Reader
2. Safari Reader on the Safari browser
3. 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.

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.

Confusion, Head Feels Foggy/Fogginess

• Keep directions simple
• Provide written directions
• Allow extra time to process
• Teachers – periodic checks for understanding
• Teacher-provided notes

Trouble Making Decisions

• Give clear choices to pick from as opposed to open-ended options

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.
• Create chart for all missing work:

1. What work can be Excused.
2. What work must be completed:

1. a. What will be graded.
2. b. What will not be graded but needs to be completed to show understanding of the new process learned.

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.

Organization
Difficulty organizing materials online and/or in school

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

1. Set reminder e-notifications
2. Electronic calendars
3. To do e-lists

• 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.

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

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

• Give assistance when mapping out projects – allot for extra time needed
• Break task into manageable segments
• Explicit instruction and reminders to use the following:
• Reminder e-notifications
• Electronic calendars
• To do e-lists
• Goal, Plan, Do, Review strategy

Anxious, Nervous, Stressed

• School psychologist should screen anxiety/depression @4 weeks (see included sample of available screening tools)
• 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:

1. organizing materials and time;
2. developing small scripts of what to do and say either externally or internally when anxiety increases, and;
3. o 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

Sad, Depressed, Mood Swings, Panic Attacks

• 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