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The physical education program and teaching strategies for individuals with traumatic brain injury

This is an excerpt from Principles and Methods of Adapted Physical Education 13th Edition With HKPropel Access by Kristi Roth,Melissa D Bittner,Elizabeth Foster,Jean Pyfer,Laurie Zittel.

Traumatic Brain Injury

A traumatic brain injury (TBI) is an injury to the head that results in minor to serious brain injury. TBI is the major cause of injury, death, and long-term neurological impairment in children and adolescents and the most common cause of acquired disability in childhood and adolescence. The effects of head injuries on school behavior depend on the extent of the insult to the brain tissue.

Characteristics

The location and severity of brain injury greatly affects the characteristic behaviors of the individual with a TBI and the speed of recovery. In general, attention and concentration, memory, executive functions, cognition, and motor and language functions are impaired to some extent. The more severe the injury, the more persistent the behavior, learning, and academic problems. Although rapid recovery of most functions occurs during the first 2 or 3 years after injury, problems frequently persist for longer periods. When the frontal lobe is involved, cognitive impairments occur in attention, executive functioning, and problem-solving. Damage to the temporal regions of the brain results in problems learning new information. Gross motor skills, including static and dynamic balance as well as coordination of the two sides of the body, are usually the most negatively affected. Difficulty processing and integrating information, as well as abnormal brain activity, contributes to negative behaviors, including low tolerance for frustration, aggression, impulsiveness, and noncompliance. In addition, seizures are three times more likely among individuals with TBI than those without TBI, with the risk doubling as late as 5 years after the injury.

Special Considerations

The extent of the brain injury will determine the number of special considerations that must be made. The behavior, attention, and performance of a person who has acquired a TBI will vary from day to day. The sensitive teacher will attend carefully to clues that indicate the type of day the student with brain injury is experiencing and will adjust expectations for the student accordingly. Allowance must always be made for basic organizational problems and learning difficulties that have resulted from the insult to the brain tissue.

It is critical that students who have a TBI, no matter how mild, be carefully monitored before returning to participation in sports because TBIs that follow one another have a confounding effect. The reason for this is that the effects of repeated concussions are cumulative. The Centers for Disease Control and Prevention (2024d) includes five gradual steps in their Return to Play Progression, which is adapted from the International Concussion Consensus Guidelines. The steps, presented in table 14.1, are for physical educators, athletic trainers, and coaches who monitor an athlete’s return to play.

The Physical Education Program and Teaching Strategies

Physical exercise improves motor function, elevates mood, and contributes to perceptions of better health in individuals with TBI. The type of physical education provided for the student with a TBI will depend on test results and the teacher’s judgment of the student’s capability. The more individualized the program, the less frustration the student will experience. If the student is given opportunities to pursue their own exercise program, a peer partner could be effective in keeping the student with TBI on task and following appropriate safety procedures.

The physical education program should include aerobics and strength exercises as well as stretching. Initially, the student should avoid high-intensity exercises, in particular those that affect blood pressure, such as resistance training. Instead, they should engage in exercise of low to moderate intensity that does not evoke symptoms (e.g., headache, confusion, dizziness, nausea, numbness, fatigue). As strength and endurance improve, the intensity of the exercise can be increased.

Depending on the extent and severity of brain injury, the following educational modifications may need to be included in the IEP:

• A reduced number of classes
• A schedule that includes the most demanding classes in the morning, when the student is fresh
• A resource room with the assistance of an aide
• Rest breaks as needed
• Small group or one-on-one physical education program
• Peer tutoring
• Counseling
• Provisions for recording lectures and extra time for completing written work and examinations

Physical education personnel should be particularly attentive to ongoing psychomotor, cognitive, and behavior problems following the trauma. Care must be exercised in sequencing motor tasks, providing instructions, and simplifying motor demands. Tasks should be reduced to their simplest components, instructions should be brief and to the point, and game strategies should be simple rather than complex. The student should be given the option of taking themself out when the demands of the class prove to be too frustrating to handle on a given day. Any adjustments that will reduce the student’s frustration to a minimum and increase their ability to cooperate in a group setting will contribute to the student’s success in physical education.

The individual with a strong support system of friends and family will have greater opportunities to be active in community settings than will the individual who has little or no outside support. Persons with TBI who understand the components of a healthy lifestyle and who have been taught to select activities that promote that lifestyle will be more likely to seek out opportunities to stay active. The adapted physical educator can assist a student with TBI in generating a toolbox of skills for pushing through days when their TBI may cause them to feel unmotivated to engage in physical activity.

Caution should be exercised when selecting activities. Highly competitive sports, in particular those that involve contact, can easily provoke a sensitive individual and result in undesirable impulsive, aggressive behaviors. Less competitive games and exercise routines provide the same benefit without the potential negative emotional and physical outcomes.

Adapted physical educators should be sensitive to the fact that TBI can be an emotionally challenging disability for families to navigate. There is a wide range of symptoms and significant variability in improvements. Families often must navigate many medical appointments and setbacks and must accept that the student may be different from how they were prior to the injury or may always struggle with long-term effects. Constant communication with families can be highly beneficial and supportive.

More Excerpts From Principles and Methods of Adapted Physical Education 13th Edition With HKPropel Access

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