Traumatic Brain Injuries

Brain injury can result from two types of trauma: external such as hitting the head in a serious fall or a projectile entering the brain, and internal such as a stroke or tumor. The consequences of a brain injury can be very complex and pose significant implications of higher education.

The majority of people incurring serious head injuries each year are between the ages of 16 and 28. It is reasonable to expect that a number of students may have had a serious head injury.

Depending upon the location of the injury, age of onset and quality of cognitive rehabilitation, there can be wide variation in individual degree of impairment. Most likely, however, there will be some impairment in the following functions:

Memory

Typically short term memory, the ability to store information for immediate recall, is most effected.

Concentration

Difficulty focusing enough for learning to take place.

Speed of thinking

Students often take longer to process information.

Communication

Language functions - writing, reading, and speaking - may be impaired. Impaired impulse control may also result in students interrupting, talking out of turn, speaking too loudly, speaking rudely, or standing too close to the listener.

Spatial reasoning

Ability to recognize shapes of object, judge distance, visualize images, etc.

Conceptualization

Reduced ability to categorize, sequence, abstract, prioritize and generalize information.

Psychosocial behaviors

Common types of behavioral impairments may include depression/withdrawal, frustration, irritability, anxiety, impulsiveness, poor social judgment, disinhibition and fatigue.

Motor,sensory and physical abilities

A brain injury may also result in a variety of specific physical disabilities such as hemaplegia, problems with balance, visual disturbances, etc.

Although many of the accommodation needs of students with a brain injury may be the same as those for student's with learning disabilities, there are some important differences. Students with a brain injury may be more impulsive, socially inappropriate, and show greater discrepancies in ability levels than students with LD. They may also have more difficulty with independent thinking and judgment, memory and organization of thoughts. The accommodation needs of each student with traumatic brain injury should be reviewed individually as the difficulties encountered vary with the type of injury. The student may benefit from program modifications such as the substitution of one course for another required course, part-time rather than full-time study, auditing a course before actually enrolling in it or an extension of time allowed to complete a program of study.

Instructional strategies and potential accommodations

Provide a course syllabus and reading list in advance to students who require more time for organizing their work, pre-reading assignments to improve retention, or having the material taped.
Concepts can be strengthened by using as many senses as possible when presenting subject matter. Use the chalkboard, handouts, videos, group discussions, role playing, overhead projectors, etc. Incorporate "hands on" and lab experiences when they are appropriate.
Highlight print by varying the letter size, underlining, or changing the typeface or spacing for those with reading difficulties.
Organize materials sequentially. Use concrete examples and personal anecdotes to increase the student's ability to recall information.
Review or summarize key concepts periodically when lecturing.
Minimize room distractions and interruption, i.e. close the hall door, turn off overheads and slide projectors when not in use.
Provide handouts on technical terms used in your class.
Point out the organizational items in textbooks, e.g., chapter summaries, sub-headings, graphic design, charts, maps and indexes.
Give all assignments and course expectations in written and oral form, listing tests and assignments with due dates.
Break down difficult concepts into steps or parts.
Recognize that proofreaders, if used, are simply assisting the student in producing a more satisfactory copy, not in completing the assignment.
Outline the day's lecture on the chalkboard or in a handout.
Give a brief review of the material presented and emphasize key points.
Include time for questions and answers.
Give study questions for exams that demonstrate the format as well as the content of the test and an explanation of what constitutes a good answer and why.
Extend the time allowed to complete assignments if appropriate.

Test adaptation and administration alternatives

Allow extended time to accommodate for the student's decreased reading, processing speed or physical limitations.
Avoid using double negatives and unnecessarily complex sentences.
Consider alternative test designs. Some students may find multiple choice formats confusing, matching more difficult than essay, etc.
Computer scored answer sheets may be difficult for a student with poor eye-hand coordination; a scribe or enlarging the answer sheet may be alternatives.
Use frequent, shorter exams rather than a long cumulative test at the end of a term.
Allow the use of word processors or calculators for the completion of exams.
Do not evaluate the exam based on handwriting and spelling quality.
Arrange for the student to take the exam in a quiet, separate room or office to minimize distractions.
Review exams with students after grading to explain incorrect answers and further review correct ones.
Discuss exam arrangements with the Hawley Academic Resource Center staff early in the semester to assure that the process will be smooth when the time comes.

Communication Suggestions

Give timely feedback to the student; errors need to be corrected as soon as possible.


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Traumatic Brain Injuries Brain injury can result from two types of trauma: external such as hitting the head in a serious fall or a projectile entering the brain, and internal such as a stroke or tumor. The consequences of a brain injury can be very complex and pose significant implications of higher education. The majority of people incurring serious head injuries each year are between the ages of 16 and 28. It is reasonable to expect that a number of students may have had a serious head injury. Depending upon the location of the injury, age of onset and quality of cognitive rehabilitation, there can be wide variation in individual degree of impairment. Most likely, however, there will be some impairment in the following functions: Memory Typically short term memory, the ability to store information for immediate recall, is most effected. Concentration Difficulty focusing enough for learning to take place. Speed of thinking Students often take longer to process information. Communication Language functions - writing, reading, and speaking - may be impaired. Impaired impulse control may also result in students interrupting, talking out of turn, speaking too loudly, speaking rudely, or standing too close to the listener. Spatial reasoning Ability to recognize shapes of object, judge distance, visualize images, etc. Conceptualization Reduced ability to categorize, sequence, abstract, prioritize and generalize information. Psychosocial behaviors Common types of behavioral impairments may include depression/withdrawal, frustration, irritability, anxiety, impulsiveness, poor social judgment, disinhibition and fatigue. Motor,sensory and physical abilities A brain injury may also result in a variety of specific physical disabilities such as hemaplegia, problems with balance, visual disturbances, etc. Although many of the accommodation needs of students with a brain injury may be the same as those for student's with learning disabilities, there are some important differences. Students with a brain injury may be more impulsive, socially inappropriate, and show greater discrepancies in ability levels than students with LD. They may also have more difficulty with independent thinking and judgment, memory and organization of thoughts. The accommodation needs of each student with traumatic brain injury should be reviewed individually as the difficulties encountered vary with the type of injury. The student may benefit from program modifications such as the substitution of one course for another required course, part-time rather than full-time study, auditing a course before actually enrolling in it or an extension of time allowed to complete a program of study. Instructional strategies and potential accommodations Provide a course syllabus and reading list in advance to students who require more time for organizing their work, pre-reading assignments to improve retention, or having the material taped. Concepts can be strengthened by using as many senses as possible when presenting subject matter. Use the chalkboard, handouts, videos, group discussions, role playing, overhead projectors, etc. Incorporate "hands on" and lab experiences when they are appropriate. Highlight print by varying the letter size, underlining, or changing the typeface or spacing for those with reading difficulties. Organize materials sequentially. Use concrete examples and personal anecdotes to increase the student's ability to recall information. Review or summarize key concepts periodically when lecturing. Minimize room distractions and interruption, i.e. close the hall door, turn off overheads and slide projectors when not in use. Provide handouts on technical terms used in your class. Point out the organizational items in textbooks, e.g., chapter summaries, sub-headings, graphic design, charts, maps and indexes. Give all assignments and course expectations in written and oral form, listing tests and assignments with due dates. Break down difficult concepts into steps or parts. Recognize that proofreaders, if used, are simply assisting the student in producing a more satisfactory copy, not in completing the assignment. Outline the day's lecture on the chalkboard or in a handout. Give a brief review of the material presented and emphasize key points. Include time for questions and answers. Give study questions for exams that demonstrate the format as well as the content of the test and an explanation of what constitutes a good answer and why. Extend the time allowed to complete assignments if appropriate. Test adaptation and administration alternatives Allow extended time to accommodate for the student's decreased reading, processing speed or physical limitations. Avoid using double negatives and unnecessarily complex sentences. Consider alternative test designs. Some students may find multiple choice formats confusing, matching more difficult than essay, etc. Computer scored answer sheets may be difficult for a student with poor eye-hand coordination; a scribe or enlarging the answer sheet may be alternatives. Use frequent, shorter exams rather than a long cumulative test at the end of a term. Allow the use of word processors or calculators for the completion of exams. Do not evaluate the exam based on handwriting and spelling quality. Arrange for the student to take the exam in a quiet, separate room or office to minimize distractions. Review exams with students after grading to explain incorrect answers and further review correct ones. Discuss exam arrangements with the Hawley Academic Resource Center staff early in the semester to assure that the process will be smooth when the time comes. Communication Suggestions Give timely feedback to the student; errors need to be corrected as soon as possible.
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