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: 1) external events, such as closed head trauma or 2) 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:
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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.
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Cognitive/Perceptual Communication - Distracted by extraneous stimuli, students may have difficulty focusing enough for learning to take place.
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Speed of Thinking - Students with cognitive deficits from brain injury often take longer to process information.
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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.
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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.
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Conceptualization - Deficits in conceptualization reduce ability to categorize, sequence, abstract, prioritize, and generalize information.
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Executive Functions - The ability to engage in goal setting, planning, and working toward a desired outcome in a flexible manner is often impaired.
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Psychosocial Behaviors - Some of the common types of psychosocial behavioral disabilities include depression/withdrawal, mental inflexibility, denial, frustration, irritability, restlessness, anxiety, lability, impulsivity, poor social judgment, disinhibition, euphoria, apathy, fatigue, and decreased awareness of personal hygiene.
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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:
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Be more impulsive, hyperactive, distractible, verbally intrusive, and/or socially inappropriate
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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
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Learn some material rapidly, since they may need only to be reacquainted with a process or concept which they knew pre-injury
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Have more severe problems generalizing and integrating skills or information
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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
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Require a wider variety of strategies to compensate for impaired memory and problems with word retrieval, information processing and communication
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Have more pronounced difficulty with organization of thoughts, cause effect relationships, and problem solving;
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Resist new learning strategies which seem too elementary (not accepting the changes caused by the injury)
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Retain the pre-trauma 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 injures:
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.