Working with Students with Traumatic/Acquired Brain (TBI/ABI) Impairment

1. Working with Students with Traumatic/Acquired Brain (TBI/ABI) Impairment

2. Traumatic Brain Injury/Acquired Brain Injury • Incidence • CDC reports that brain injuries are the leading cause of death and lifelong disability in children, adolescents, and young adults • 1.5 million survive a brain injury per year • 230,000 are hospitalized each year due to a brain injury • 50,000 die each year from brain injuries

3. Incidence • CDC estimates that 5.2 million persons in U.S. live with a lifelong TBI/ABI • Most common cause – motor vehicle accidents, violence, recreational accidents

4. Definition • Persons with TBI/ABI have sustained a permanent injury to one or more areas of the brain from either external or internal events or both • Called many things: closed head injury, acquired brain injury, traumatic brain injury, and head trauma

5. Definition Traumatic brain injuries are the result of an external force to the brain Acquired brain injuriesare the result of internal complications such as an aneurysm or stroke

6. TBI/ABI - Cognitive Functional Limitations • Lowered achievement in one or more areas of learning • Impaired comprehension • Gaps in prior learning Strategies • Make learning meaningful and present material in a context that helps reinforce the student’s memory of the material • Use multi-modality teaching

7. TBI/ABI - Cognitive Functional Limitations • Disrupted learning pattern • Slow thought processing • Reduced attention span • Geographic or temporal disorientation Strategies • Reinforce and provide feedback to the student about the process of thinking, rather than targeting rote memorization techniques, to encourage metacognition

8. TBI/ABI - Cognitive Functional Limitations • Difficulty understanding cause and effect • Difficulty with the ability to execute complex coordinated movements Strategies • Teach or practice requisite skills for a new task or tasks that were difficult for the student before the injury • Use task analysis – the strategy for breaking down an activity or task into small steps

9. TBI/ABI - Cognitive Functional Limitations • Lack of awareness of impairments and needs • Inability to prioritize thoughts or determine the main idea • Difficulty following a sequence or schedule Strategies • Be patient. Offer multiple trials for the student to make errors and help him/her see the value of learning from their mistakes

10. TBI/ABI - Cognitive Strategies • Teach skills and concepts in small, manageable “chunks” and review each before moving on to the next skill or concept • Discuss thought-organization strategies and provide your own examples that practice the techniques, such as how to construct a research paper from the development of ideas to the final written paper

11. TBI/ABI - Physical & Sensory Functional Limitations • Fatigue or decreased stamina • Unsteady gait • Limited upper and lower extremity ambulation Strategies • May need to break up work into smaller more manageable units • Allow extra time to complete assignments and exams

12. TBI/ABI - Physical & Sensory Functional Limitations • Sensory impairments (visual/hearing) • Cranial-facial injuries Strategies • Provide written materials in accessible formats such as Braille, large print, audiotape, or electronic files • Use verbal descriptions to communicate anything being given in written or hard copy format

13. TBI/ABI - Physical & Sensory Functional Limitations • Quadriplegia and other mobility impairments • Impaired motor skills • Chronic pain • Seizures Strategies • Students with upper body limitations may need writing assistance. Some may choose to tape record lectures/study sessions

14. TBI/ABI - Physical & Sensory Functional Limitations • Slurred speech and other speech impairments • Hormonal changes • Metabolic disturbances Strategies • Some students experience regular flare-ups of a chronic condition requiring bed rest and/or hospitalization. Arrangements may have to be made to work with student off campus

15. TBI/ABI – Psychosocial Functional Limitations • Loneliness • Isolation • Depression and other possible psychiatric issues (mental disorder due to a general medical condition) • Less open to change Strategies • Establish effective goals to improve student’s self-esteem • Promote a consistent routine and structure

16. TBI/ABI – Psychosocial Functional Limitations • Loss of self-esteem and confidence • A sense of disconnection from peers • Impulsivity, poor anger control, poor social skills Strategies • Encourage student to focus on strengths • Be consistent with expectations and standards • Provide a structured environment with a routine the student can learn and expect

17. TBI/ABI – Psychosocial Functional Limitations • A sense of having lost their old selves and not liking the new person they have become • Inability to handle stress Strategies • Avoid overloading the student with too much new information at one time

18. TBI/ABI – Psychosocial Functional Limitations • Frustration adjusting to and balancing the multiple demands of postsecondary study and independence Strategies • Allow extra time to complete assignments and exams • Allow student to work at his/her own pace

19. TBI/ABI Case Study - A Catherine is a 22-year old freshman in your program. She sustained a brain injury as a result of a car crash at age 18, just after graduating from high school. She has spent the last three years in hospitals and rehabilitation programs. During her first semester, Catherine took a reduced course load of two academic classes and an elective, swimming. She met weekly with her tutors and did fairly well in all classes.

20. She also began dating for the first time since her accident, and during winter break went to several parties. Now in her second semester, Catherine’s confidence has grown because of the assistance she has received from the SSS program. However, because of her new level of confidence, she refuses any help, saying she wants to be independent and “make it on her own”. Unfortunately she is failing all her classes and is beginning to feel depressed.

21. TBI/ABI Case Study - B Eric is a 17-year old junior in high school where he plays football on the varsity team. During the homecoming game, just before Thanksgiving, he was tackled and sustained a closed head injury. He was admitted to the nearby hospital just for observation, but remained out of school for the rest of the semester due to headaches and fatigue. His doctor instructed him not to play football the following season.

22. Eric returned to school in January and remains popular in his classes and at parties. However, Eric rarely turns in any of his class work, and the work he does complete is inadequate. His tutors note that when they talk to Eric that his speech is becoming slurred. They have also noticed that he walks with a limp and that his eyes appear unfocused. Eric’s tutors have become very concerned and have reported their growing concerns to you.