How Is Brain Injury Different from Other Disabilities?
Students with brain injury face different challenges than students with other disabilities. It’s important to understand those differences when working with students with TBI.
Brain injuries can affect many abilities needed to function well at school. Sometimes you can observe the signs of brain injury, such as problems with balance or vision. Other symptoms are invisible—such as problems controlling reactions—but all are nonetheless very real. All of these symptoms interfere with learning. Students who have had a brain injury can have day-to-day variability in skills, stamina, emotional regulation, and memory. Some students experience many symptoms, whereas others have only a few. Every brain injury is different.
Brain injury is invisible.
Invisible injuries are the hardest to understand. Despite a lack of visible signs, brain injury is serious, and the student needs classroom accommodations.
If a student enters your classroom with a broken bone or some other physical injury, you have a constant reminder that the student has sustained injuries and might need some sort of accommodations or assistance throughout the school day. However, if a student appears healthy without any obvious physical deficits, it might not occur to you that the student has any need for behavioral or academic accommodations or assistance. When a student looks fine, it is easy to assume that s/he has made a full recovery and will function at the same level as before the injury.
Brain injury affects classroom success.
Most students make academic gains after injury, but for those with moderate to severe injury, the rate of academic achievement gains tends to slow progressively over time.
Implication for teaching: Conduct ongoing assessments to make sure the student is mastering skills.
Following brain injury, students often have problems with executive function—attention, planning, goal setting, problem-solving, cognitive flexibility, and abstract reasoning. These challenges result from direct damage to the frontal regions of the brain or from disruption of connections among these and other brain regions. Problems with executive function can affect most aspects of school performance. Examples include:
- Difficulty concentrating
- Problems with organizing materials
- Difficulty shifting attention from one task to another
- Difficulty getting started with a task (initiation)
- Trouble with assignments that have multiple steps
- Frustrated or angered under “normal/typical” circumstances
One of the hallmarks of brain injury is inconsistency. Students’ performance can be uneven across academic domains.
- They might do well on material mastered pre-injury but struggle with learning new information and skills, which can cause inconsistent profiles on standardized tests.
- Skill gaps can be present throughout the range of skills; for example, a student might do well with multi-step math problems but struggle remembering basic math facts.
- They can vary in performance from day to day, for example scoring 90% on a quiz on Tuesday and 40% on Thursday.
The physical effects of a brain injury, such as fatigue, can also negatively affect classroom success. A long school day might be too much for the student to handle.
Implication for teaching: Provide rest breaks and monitor schedules. A supportive, brain injury friendly environment can reduce memory and attention challenges, increase focus, and decrease frustration, agitation, fatigue, and behavioral issues.
Students have experienced a traumatic event that could have an emotional effect. Students might have lost loved ones, witnessed injured family, or experienced any variety of emotional trauma in addition to being injured themselves. It is important to understand that such events have a powerful effect and that the student might be dealing with unsettled emotions as well as physical and cognitive challenges.
Brain injury causes challenging behaviors.
Behavior problems can be a direct result of a brain injury. The prefrontal areas of the brain are the most commonly damaged part of the brain. Damage to this area can affect emotions, impulse control, language, memory, and social and sexual behavior.
Behavior and social problems can also be an indirect result of a brain injury. Following brain injury, a student might not be able to do his work because of problems focusing or attending (direct result), then become frustrated and have an angry outburst in class (indirect).
When a student is aware that she has altered abilities resulting from the injury and cannot perform at previous levels, she might become frustrated and act out or withdraw as a reaction. That can lead to problems with social interactions and a subsequent loss of friends, which can in turn lead to depression, anxiety, and anger. This can result in further social withdrawal and acting-out behaviors. More than two thirds of students with severe TBI develop psychiatric disorders following their injury, with problems persisting or worsening over time.
Implication for teaching: Keep student successful in her work to minimize frustration.
For students with brain injury, the connection between behavior and consequences is often affected, making traditional models of behavior management ineffective. As a teacher, it is easy to get frustrated with a student who keeps doing things after being corrected or punished.
Implication for teaching: Try to defuse the situation and put an effective intervention into place to help the student be more successful. See Positive Behavior Supports to learn more.
Following brain injury, students often lack self- awareness, particularly of their own skill deficits. For example, a student might express an emotional response inappropriate for a given situation (e.g., laughing when discussing a serious topic) and remain unaware of the inappropriateness of the action despite negative reactions from peers. Peers might be frustrated with the student if s/he misses important social cues, fails to regulate behaviors such as talking out of turn, or denies post injury deficits and rejects support offered.
Implication for teaching: Deficits in social awareness can cause misinterpretations that result in confusion, misunderstanding, and conflict for both the student and his/her peers. Educators can help a student overcome these deficits by identifying and teaching needed skills.
Brain injury is traumatic for the whole family.
Unlike many disabilities, a brain injury usually occurs suddenly and unexpectedly. The student and family are now faced with a new reality and must make adjustments that will affect each member of the family. Both the student and the family have to deal with uncertainty.
Students have endured physical trauma that could have lasting effects. They might have bodily injuries to overcome in addition to the brain injury.
Families often experience guilt around the injury, which can make them sensitive and sometimes challenging to work with.
At first, the family is focused on whether the child will live and might not think about the long-term effects. As time passes, the family might begin to realize that their child may not fully recover from the brain injury. The parents can become less hopeful, discouraged, and even depressed as they mourn the loss of the child they had before the injury.
In addition to guilt and loss, the family must sort its way through a medical and school system that does not always provide information in an understandable way about what to expect as the child recovers. This only adds to the trauma of the original event by creating additional uncertainty.
Implications for teaching: When a student has a brain injury, the entire family experiences trauma. Establishing a collaborative and trusting relationship with parents can provide a foundation for the student’s success at school and at home.