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Traumatic Brain Injuries (TBI)

Well over half of the more than one million people incurring head injuries each year are between the ages of 15 and 28 years. Brain injury can result from two types of trauma:

  • external events, such as closed head trauma or missile penetrating the brain; or
  • internal events, such as cerebral vascular accident or tumors.

The consequences of brain injury are many and complex. Understanding how brain function is different after injury has much greater implications for education than does knowing the cause or type of the injury.

There is great variation in the possible effects of a head injury or an individual. However, most injuries result in some degree of impairment in the following functions:

  • Memory & Memory deficits. Long-term memory or previously acquired knowledge is usually intact.
  • Cognitive/Perceptual Communication-Distracted by extraneous stimuli
  • Speed of Thinking-Students with cognitive deficits from brain injury often take longer to process information.
  • Communication-Language Functions-writing, reading, speaking, listening, as well as the pragmatics may be impaired. Problems in pragmatics include interrupting, talking out of turn, dominating discussions, speaking too loudly or rudely, or standing too close to the listener.
  • Spatial Reasoning- ability to recognize shapes of objects, judge distances accurately, navigate, read a map, visualize images, comprehend mechanical functions, or recognize position in space.
  • Conceptualization-Deficits in conceptualization reduce ability to categorize, sequence, abstract, prioritize, and generalize information
  • Executive Functions-Ability to engage in goal setting, planning, and working toward a desired outcome in a flexible manner is often impaired.
  • Psychosocial Behaviors- behavioral disabilities may include: depression/withdrawal, mental inflexibility, denial, frustration, irritability, restlessness, anxiety, liability, impulsivity, poor social judgment, disinhibition, euphoria, apathy, fatigue, and decreased awareness of personal hygiene.
  • Motor, Sensory, and Physical Abilities-Brain injury can result in specific impairments primarily manifested in the physical or medical condition of the student after the injury.

Attributes of Students with Head Injuries

On the surface, problems encountered by the head injury survivor may seem like those common to students with learning disabilities. Many of the academic modifications listed for students with learning disabilities will also be appropriate for students with head injuries. Whereas similarities exist, there are important differences which have profound significance for effective programming. To summarize, compared to students with learning disabilities, the student with acquired brain injury may:

  • be more impulsive, hyperactive, distractible, verbally intrusive, and/or socially inappropriate;
  • have discrepancies in ability levels that are more extreme and harder to understand, such as reading comprehension four grade levels lower than spelling ability;
  • learn some material rapidly, since they may need only to be reacquainted with a process or concept which they knew pre-injury;
  • have more severe problems generalizing and integrating skills of information;
  • require on-going monitoring of tasks using independent thinking and judgment;
  • be unable to process information presented through usual remedial strategies because comprehension may deteriorate as the amount and complexity of material increases;
  • require a wider variety of strategies to compensate for the impaired memory and problems with word retrieval, information processing and communication;
  • have more pronounced difficulty with organization of thoughts, cause-effect relationships, and problem solving;
  • resist new learning strategies which seem too elementary (not accepting the changes caused by the injury);
  • retain the pre-trauma self-concept of a non-disabled student and have difficulty accepting that abilities and behaviors have changed and need to be adjusted.

Common Needs for All Head Injured Students

Structure-Survivors of recent injuries often do not organize well. Returning to or entering school may provide a badly needed routine.

Flexibility-A great deal of flexibility is needed in scheduling the re-entry. Accepting the student back as soon as possible is important. Routines may need to be slowed down, and placement decisions may need to change after periods of rapid recovery.

Reduced Demands-Reducing demands on the head injured student may involve substituting a less demanding class, altering response modes (such as oral vs. written response), providing books and lectures on tape, or providing other support services. When reducing demands conflicts with the requirements for courses, and the conflicts cannot be reconciled, the student may need to enter a special cognitive training program.

Supervision-The poor judgment and memory problems of a student with a head injury may make supervision a necessary ingredient of the educational program. For the student, this supervision could take the form of a planning and monitoring system which requires the faculty or counselor and student to plan together, set goals, report and evaluate progress.

Intervention-Head injured students are often not conspicuous before they begin to have serious trouble and they often misjudge their own problems. The head injury may make the student unable to assess the need for help without direct intervention.

For more information, please visit Working with Students with TBI.