Home > Faculty Support > Teaching Guides > Traumatic Brain Injuries

by Katherine A. Kimes, M.A.

Statistics

According to the Centers of Disease Control report (2001) to Congress, 1.5 million Americans sustain a traumatic brain injury (TBI) annually. Each year 80,000 Americans experience the onset of a long-term disability following a TBI and more than 50,000 people die as a result of TBI. Additionally, the CDC estimated that 5.3 million Americans currently live with disabilities resulting from TBI. Individuals who sustain TBI can display a wide variety of functional impairments.

Facts

The Brain Injury Association defines traumatic brain injury (TBI) as "an insult to the brain, not of degenerative or congenital nature, caused by an external physical force that may produce a diminished or altered state of consciousness, which results in an impairment of cognitive abilities or physical functioning." TBI can also result in a myriad of disturbances other than cognitive or physical: the problems can be communicative, perceptual, psychosocial, behavioral and/or emotional. According to the CDC—National Center for Injury Prevention and Control, automobile accidents are the leading cause of TBI. A study done in 1990 showed the incident rate of TBI to be higher than that of epilepsy, Parkinson disease, multiple sclerosis, Huntington disease, mental retardation, spinal cord injuries, HIV/AIDS and breast cancer.

There are various characteristics that differentiate students with TBI from other disabilities, which educators need to be aware of. These characteristics include:

1. emotional, behavioral and/or social problems
   
2. difficulty with generalizing, integrating and structuring information
   
3. lack of sufficient stimulation to allow for possible recovery of function
   
4. varying levels of memory remaining intact
   
5. varying ranges of impairment (for example, students who appear to have limited physical ability may still possess strong cognitive ability, while those who have no physical limitations may possess limited cognitive ability)
   
6. unusual discrepancies in ability levels, inconsistent patterns of performance and uneven cognitive deficits
   
7. a combination of conditions which do not fall easily into categories of disability
   
8. a pre-morbid self-concept of being "normal"
   
9. a shifting neurological profile (improvements in the brain can happen throughout life: i.e., recovery of function)

Basic Brain Area Function In Relationship to TBI

Obtaining a general understanding of the brain and its function is important to understanding the student in the post-secondary education environment. Each problem area affects other areas and many times resolving one problem can have a major impact on other problems in relationship to the student's academic, physical, social/emotional/behavioral adjustment to post-secondary education.

1. Frontal Lobes: most anterior, right under the forehead; responsible for our executive functions (how we plan, organize and make decisions); involved with abstract thinking and understanding nonverbal cues; controls our inhibition and initiation; regulates emotions and consciousness.

Possible sequelae if damaged:

1. paralysis
   
2. loss of spontaneity in interaction
   
3. inability to plan multi-step tasks (sequencing)
   
4. inflexibility in thought process
   
5. obsessing on a single thought
   
6. inability to focus
   
7. mood changes
   
8. personality changes
   
9. difficulty with problem solving
   
10. inability to express language

2. Parietal Lobe: near the back and top of head; responsible for visual attention, touch perception, body orientation in space, muscle coordination, sensory integration and discrimination, and spatial orientation.

Possible sequelae if damaged:

1. inability to name objects
   
2. can't attend to more than one item at a time
   
3. problems with reading and drawing objects
   
4. unable to locate words for writing
   
5. difficulty distinguishing between left and right
   
6. difficulty doing math
   
7. lack of body awareness or space (resulting in problems with self-care)
   
8. inability to focus attention
   
9. difficulty with hand eye coordination

3. Occipital Lobes: most posterior, at the back of the head; responsible for visual processes, i.e. visual interpretation, convergence and accommodation and depth perception, eye focus.

Possible sequelae if damaged:

1. visual field cuts
   
2. difficulties locating objects in the environment
   
3. difficulties identifying colors
   
4. hallucinations
   
5. visual illusions
   
6. word blindness
   
7. difficulty recognizing drawn objects
   
8. difficulties with reading and writing

4. Temporal Lobes: side of head above the ears; responsible for language, memory, auditory comprehension, information retrieval and acquisition of new learning.

Possible sequelae if damaged:

1. hearing deficit
   
2. agitation, irritability, childish behavior, receptive/sensory aphasia (doesn't understand what people are saying)
   
3. temporal lobe seizures
   
4. difficulty recognizing faces
   
5. difficulty understanding spoken word
   
6. selective attention
   
7. difficulty identifying and verbalizing objects seen
   
8. short-term memory loss
   
9. interference with long-term memory
   
10. increased/decreased sexual behavior
    
11. categorization problems

5. Brain Stem: deep within the brain, leads to spinal cord; responsible for involuntary processes (i.e., breathing, heart rate, autonomic nervous system) alertness/arousal, balance, oral musculature, regulation of appetite/sleeping.

Possible sequelae if damaged:

1. decrease capacity for breathing
   
2. problems with the oral musculature
   
3. inability to swallow
   
4. difficulty with organization and perception of the environment
   
5. problems with balance and movement
   
6. dizziness/nausea
   
7. sleep problems
   
8. coma
   
9. death

6. Cerebellum: located at the base of the skull; responsible for balance and equilibrium, muscle coordination and some memory reflex for motor acts.

Possible sequelae if damaged:

1. loss of ability to coordinate fine movements
   
2. inability to walk
   
3. inability to grab objects and/or reach out
   
4. tremors
   
5. vertigo
   
6. slurred speech
   
7. inability to make rapid movements

Postsecondary Education Barriers for the TBI Student

According to the CDC-National Center for Injury Prevention, the risk of TBI is highest among adolescents and young adults, the age group of students entering post-secondary institutions. However, many limitations still surround a student with TBI once they gain access to post-secondary institutions. A primary limitation is the lack of educators/administration knowledge and understanding of the possible sequelea of TBI, which usually results in an inadequate level of support services available to the student at the college/university level. This is difficult to imagine especially since post-secondary institutions can be an ideal stepping-stone in the TBI recovery process for students' cognitive and social recovery. This exemplifies why it is so very important for educators/administration to understand the possible positive ramifications of receiving a post-secondary education on the recovery process of students with TBI--to ultimately provide an accessible, conducive learning environment.

Therefore, it is important for educators to have the necessary background knowledge and support systems already in place to accommodate the post-secondary education TBI population. Educators need to understand that every TBI is different and therefore, students' needs will also be different. The special services provided to TBI students need to be specifically tailored to the individual student, recognizing his/her academic strengths and weaknesses.

However, a generalized guideline for possible support services can and should be considered for every student with TBI. These academic supports include, but are not limited to:

1. tutoring
   
2. computers
   
3. calculators
   
4. possible alternative assignments
   
5. note takers or a copy of instructors' notes
   
6. detailed syllabus
   
7. preference in seating arrangements
   
8. taped texts and tape recording of lectures
   
9. readers
   
10. test proctoring and non-standard test design and administration (i.e. extended time, different test formats, etc.)
    
11. developmental and/or organizational classes

Additionally, an academic advisor and/or learning specialist should help the student with specific support strategies towards the goal of completing the student's degree. These include planning, developing and providing assistance to the student with his/her program; selecting a major, minor, and courses; an appropriate course load and a periodic evaluation system of placement assessment to determine the development of an individual student plan; and monitoring the student's progress and any changes in needed in support services, as well as advocating on the student's behalf when such changes are deemed appropriate.

Statistics from the American Council on Education (1989) showed students who have survived TBI represent the fastest growing student population requiring special support services on college campuses today, which is why it is important for post-secondary educators to acknowledge, understand and become attentive to the needs of students with TBI.