Accommodations Guide for Students with Brain Injury

Jeffrey Kreutzer, PhD, Nancy Hsu, Department of Physical Medicine and Rehabilitation Virginia Commonwealth University
Accommodations Guide for Students with Brain Injury

The long-term effects of brain injury can be catastrophic for students at any level. Early on, students with the most severe injuries are unable to attend school. Some require home schooling until they recover enough to travel and attend classes with other students.

Research shows that brain injury often harms basic cognitive abilities such as memory, learning, attention and concentration, word finding, and visual perception. Injury can also harm important academic abilities such as reading, arithmetic reasoning, vocabulary, writing, and spelling. Parents and students often worry about falling grades and failure. Concerns about passing the school year, graduating high school, or graduating from college with a degree are often expressed.

Frequent complaints from students with brain injury include:

  • I study for twice as long as I used to, but I’m doing much worse.
  • I can’t remember anything I read no matter how many times I re-read the same thing.
  • I study hard and feel like I know the material. Then I go into the test and can’t come up with the answers.
  • Essay exams are murder. I need 20 minutes to think of what I want to say and then the time has run out.
  • I get so tired I can barely get through the school day. At night, I’m just too tired to do my homework.
  • I’m so distracted. I can pay attention for five minutes and then my mind wanders.
  • I go to every class, but nothing sinks in.

Most of the time, school systems are very willing to provide accommodations to students with brain injury. “What are accommodations?” you might ask. Accommodations are special services or arrangements designed to help survivors overcome and offset injury related limitations.

Students and parents often don’t know that many kinds of accommodations are available to help students succeed. Many are also unaware of what accommodations are appropriate and reasonable for them. Having a thorough evaluation of academic and cognitive abilities is a first step toward understanding a student’s special needs. Evaluations can be performed by neuropsychologists, educational psychologists, and school psychologists. Students and parents are encouraged to seek an experienced brain injury professional who can thoroughly document academic strengths, limitations, and recommended accommodations. Nearly all schools require documentation of disability and recommendations in order to provide accommodations.

To help you understand what accommodations might be appropriate for you or your student, we have prepared a partial list of commonly recommended accommodations on the next page. Talk to the psychologist or educational specialist helping you to determine what is best for your situation.

Classroom Accommodations:

  • Allow additional time to complete in-class assignments
  • Allow for extra or extended breaks
  • Provide student with instructor’s notes or help student obtain quality notes from other students
  • Allow student to audio record lectures for later playback
  • Provide both oral and written instructions; clarify instructions
  • For lectures, provide student with an outline or study guide when available
  • Allow use of a portable computer with spelling and grammar checks for assignments and note-taking
  • In grading work, reduce emphasis on spelling and grammatical errors unless it is the purpose of the assignment
  • Permit referencing a dictionary or thesaurus for assignments
  • Provide preferential seating at or near the front of the classroom
  • Reduce quantity of work required, in favor of quality.
  • Avoid placing student in high pressure situations (e.g., short time frames, extensive volume of work; highly competitive)
  • Exempt student from reading aloud in front of classmates because of impaired reading skills.

Test Accommodations:

  • Allow additional time to complete tests.
  • Provide for completion of tests in a quiet, individual environment with the goal of minimizing distractions.
  • Administer long examinations in a series of shorter segments with breaks allowed between sections.
  • Allow oral examinations and assist student in having responses scribed, as needed.
  • Assess knowledge using multiple-choice instead of open-ended questions.
  • Allow student to clarify and explain responses on exams (and assignments).
  • Permit student to keep a sheet with mathematic formulas for reference, unless memorizing the formulas is required.
  • Permit student’s use of a calculator.
  • Permit the student to utilize a dictionary and thesaurus in writing test responses.
  • If two exams are scheduled on the same day, allow student to reschedule one for another day.
Posted on BrainLine October 27, 2011.

Written by Jeffrey Kreutzer, PhD and Nancy Hsu, PhD, Department of Physical Medicine and Rehabilitation Virginia Commonwealth University, Richmond, VA. Used with permission. www.pmr.vcu.edu.

Comments (14)

Please remember, we are not able to give medical or legal advice. If you have medical concerns, please consult your doctor. All posted comments are the views and opinions of the poster only.

I believe that the only way I can get my stuff together is by having a tutor for certain subjects.

My granddaughter is entering 7th grade and they put her in all typical classes. Where her IEP said life skills classes. Her reading level is around 3rd grade there is know way she will be able to follow along in typical classrooms. It's hard finding educators who specialize with TBI. The problem with TBI is the individual looks typical on the outside but no body knows what she's been through and how damaged her brain is. Help!

my grandson was injured in 2012 and has a TBI as well as partial paralysis he was put in a class for children with severe disabilities, my grandson mind is great he forgets easily but he is still able to communicate, being in this class with students who cannot talk has caused him to go backwards along with the fact that his parents have not kept up with what he needs. I am his grandmother and when he is with me he works so hard to get better then he returns home where it is not continued and he has to start all over every time what can I do to make them see what he needs and to get everyone on the same page. I fear his muscles will atrophy and it will be to late. I need advice asap

My daughter is 12 years old and is a brain tumor survivor. She had a stroke during the surgery to remove the brain tumor. I have a question for you folks out there. I have noticed that standardized end of grade testing is very unfair to my child. Many of her modifications and accommodations with her school work include having material read to her as well as someone being her scribe. She struggles with visual fatigue as well as difficulty with scanning large amounts of text. My daughter's scores on standardized end of grade testing do not reflect her academic ability and skills. My daughter needs additional modifications and accommodations on tests that are not allowed on standardized testing. Has anyone been able to request a medical exception for standardized testing and been successful?

My son is in 7th grade and we have "opted out" of State and Standardized Testing. As a parent you can "opt out" of most, if not all. We did try accommodations for awhile, they allowed his, but it was miserable for everyone. It did not accurately access his knowledge anyway. I hope that helps, good luck.

My daughter got great accommodations in High School but colleges give hardly any. She has memory loss and diminished memory recall. I know she's smart enough to be in college. There's tons of advice for IEP's, where do I go to get help for post secondary education?

I completed my Bachelors and Masters Degrees after my TBI! It was hard and took me longer than other students...but I did it! There were many accommodations available for students with disabilities! I recommend you call a college and speak to Disabled Student Services. They can help you!! Good luck!

What types of accommodations/adjustments did your college make for you to aid your memory during exams/tests? Did they allow open notes/books, multiple choice exams/tests? Did your TBI cause short term memory problems or difficulty in recalling answers during exams/tests?

Throughout my life I was embarrassed to tell anyone about everything that you describe: 

I study for twice as long as I used to, but I’m doing much worse.
I can’t remember anything I read no matter how many times I re-read the same thing.
I study hard and feel like I know the material. Then I go into the test and can’t come up with the answers.
Essay exams are murder. I need 20 minutes to think of what I want to say and then the time has run out.
I get so tired I can barely get through the school day. At night, I’m just too tired to do my homework.
I’m so distracted. I can pay attention for five minutes and then my mind wanders.
I go to every class, but nothing sinks in.

I am now an adult and I have had employment throughout my life without letting anyone know of my daily (and by the minute) struggles. How do you break a child out of the shell of embarrassment without letting them feel like they are less than the rest of their peers?

Do you have guidelines on how to help student with TBI with social problems, inappropriate behaviors etc..? 

Students written up for being loud/yelling when frustrated etc..even when student may not realize it. Especially with multiple diagnosis.

Do you know if there are special accommodations for foreign languages cause it is required for graduation with a diploma in some states.

Can I rewind the world and read this 6 months ago? In May, at the end of the school year, after going from Honor Roll to failing, my daughter's school "suggested" I withdraw her so as to preserve her GPA. I'm homeschooling her with virtual school back up and we are going nowhere fast. Nightmare in Florida @shaztwit

Do you know if they can make accommodations for a test like the gre?

Thank you I am glad for advise to help me just to hold on to information is a task . This helps me, for I know how to spell, but I can't get the word out from in my head . So the use of a small dictionary helps me .