Working with Students with

Traumatic/Acquired Brain (TBI/ABI)

Impairment

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

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

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

Definition

• Traumatic brain injuries are the result of an external force to the brain

• Acquired brain injuries are the result of internal complications such as an aneurysm or stroke

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

TBI/ABI - CognitiveFunctional

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

TBI/ABI - CognitiveFunctional 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

TBI/ABI - CognitiveFunctional

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

TBI/ABI - CognitiveStrategies

• 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

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

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

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

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

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

TBI/ABI – PsychosocialFunctional 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

TBI/ABI – PsychosocialFunctional 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

TBI/ABI – PsychosocialFunctional 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

TBI/ABI Case Study - ACatherine 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.

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.

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.

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.