Head Injury / Traumatic Brain Injury
More than one million people incurring head injuries each year are between the ages of 15 and 28 years of age. Brain injury can result from two types of trauma: external events, such as closed head trauma, 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 knowing the cause or type of the injury.
The Student with a Head Injury
There is great variation of the possible effects of a head injury on an individual. However, most injuries result in some degree of impairment in the following functions:
- Memory— Memory deficits are probably the most common characteristic of students with brain injury. The primary problem is the inability to store information for immediate recall. Long-term memory or previously acquired knowledge is usually intact.
- Cognitive/perceptual communication— Distracted by extraneous stimuli, students may have difficulty focusing enough for learning to take place.
- 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— Spatial reasoning refers to the 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— The ability to engage in goal setting, planning, and working toward a desired outcome in a flexible manner is often impaired.
- Psychosocial behaviors— Some of the common types of psychosocial behavioral disabilities 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.
Comparison with Specific Learning Disabilities
On the surface, problems encountered by the person who has survived a head injury 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 significance on effective programming.
To summarize, compared to students with learning disabilities, the student with an 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 at a level four years lower than spelling ability
- Learn some material rapidly, since they may need only to be reacquainted with a process or concept which they knew preinjury
- Have more severe problems generalizing and integrating skills or information
- Require ongoing 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 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 pretrauma self-concept of a student without a disability and have difficulty accepting that abilities and behaviors have changed and need to be adjusted
Common Needs for Students with Head Injuries
- 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. 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 student with a head injury may involve substituting a less demanding class, altering response modes (such as oral vs. written responses), providing books and lectures on tape, or providing other support services. The students may need a reduced course load or classes that meet for shorter periods of time and should be encouraged to enroll in a study skill refresher course.
- 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 member and the student to plan together, set goals, and report and evaluate progress.
- Intervention— With head injuries, 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.
Taken from Gugerty, J. and Knutsen, C. (Eds.). 2000. Serving Students with Significant Disabilities in Two-Year Colleges: Office of Disability Services * Springfield Technical Community College , Springfield , Massachusetts . Madison , WI : Center on Education and Work.