Well over half of the more than one million people receiving head injuries each year are between the ages of 15 and 28 years. Brain injury can result from two types of trauma: 1) external events, such as a bullet penetrating the brain; or 2) internal events, such as cerebral vascular accident or tumors. The consequences of brain injury are many and complex. Understanding how brain function is different after injury has much greater implications for education than does knowing the cause or type of the injury.

According to the Centers for Disease Control and Prevention about two million cases of traumatic brain injury were reported in 1990. The HEATH Resource Center places this figure at "more than a million" per year, with more than 800,000 surviving. More than half of the individuals who sustain brain injuries are between the ages of 15 and 28.

Each head injury survivor is unique. There is great variability in the effects of head injury on different individuals, and success in postsecondary settings may be very difficult depending on the residual impairments. Even those injuries described as minor can produce long-lasting social and educational challenges.

The Person with Head Injury

There is great variation in the possible effects of a head injury on an individual. However, most injuries result in some degree of impairment in the following functions:

• Memory – Memory deficits are probably the most common characteristic of students with brain injury. The primary problem is the inability to store information for immediate recall. Long-term memory or previously acquired knowledge is usually intact.
• Cognitive/Perceptual Communication – Distracted by extraneous stimuli, students may have difficulty focusing enough for learning to take place.
• Speed of Thinking – Students with cognitive deficits from brain injury often take longer to process information.
• Communication – Language functions (writing, reading, speaking, listening, as well as the pragmatics) may be impaired. Problems in pragmatics include interrupting, talking out of turn, dominating discussions, speaking too loudly or abruptly, or standing too close to the listener.
• Spatial Reasoning – There may be deficits in spatial reasoning including the ability to recognize shapes of objects, judge distances accurately, navigate, read a map, visualize images, comprehend mechanical functions, or recognize position in space.
• Conceptualization – Deficits in conceptualization reduce ability to categorize, sequence, abstract, prioritize, and generalize information.
• Executive Functions – Ability to engage in goal setting, planning and working toward a desired outcome in a flexible manner is often impaired.
• Psychosocial Behaviors – Some of the common types of psychosocial behavioral disabilities include depression/withdrawal, mental inflexibility, denial, frustration, irritability, restlessness, anxiety, mood swings, impulsivity, poor social judgment, disinhibition, euphoria, apathy, fatigue, and decreased awareness of personal hygiene.
• Motor, Sensory, and Physical Abilities – Brain injury can result in specific impairments primarily manifested in the physical or medical condition of the student after the injury.

Comparison with Specific Learning Disabilities

On the surface, problems encountered by the head injury survivor may seem like those common to students with learning disabilities. Many of the academic modifications listed for students with learning disabilities will also be appropriate for students with head injuries. Whereas similarities exist, there are important differences which have profound significance for effective programming.

To summarize, compared with students with learning disabilities, students with acquired brain injury may:

• be more impulsive, hyperactive, distractible, verbally intrusive, and/or socially inappropriate;
• have discrepancies in ability levels that are more extreme and harder to understand, such as reading comprehension at a level four years lower than the level of spelling ability;
• learn some material rapidly, since they may need only to be reacquainted with a process or concept which they knew prior to their injury;
• have more severe problems generalizing and integrating skills or information;
• require on-going monitoring of tasks using independent thinking and judgment;
• be unable to process information presented through usual remedial strategies because comprehension may deteriorate as the amount and complexity of material increases;
• require a wider variety of strategies to compensate for impaired memory and problems with word retrieval, information processing and communication;
• have more pronounced difficulty with organization of thoughts, cause-effect relationships, and problem solving;
• resist new learning strategies which seem too elementary (not accepting the changes caused by the injury);
• retain the pre-trauma self-concept of a non-disabled students and have difficulty accepting that their abilities and behaviors have changed and need to be adjusted.

Common needs for all students with head injuries:

Structure Survivors of recent injuries often do not organize well. Returning to or entering school may provide a badly needed routine.

Flexibility A great deal of flexibility is needed in scheduling the reentry. Routines may need to be slowed down, and placement decisions may need to change after periods of rapid recovery.

Reduced Demands Reducing demands on the head injured student may involve substituting a less demanding class, altering response modes (such as oral vs. written responses), providing books and lectures on tape, or providing other support services. When reducing demands conflicts with the requirements for courses, and the conflicts cannot be reconciled, the student may need to reassess academic goals and consider other programs of study.

Supervision The poor judgment and memory problems of a student with a head injury may make supervision a necessary ingredient of the educational program. For the student, this supervision could take the form of a planning and monitoring system which requires the faculty or (Disability Services counselor) and student to plan together, set goals, report and evaluate progress.

Intervention Head injured students are often not conspicuous before they begin to have serious trouble, and they often misjudge their own problems. The head injury may make the student unable to assess need for help without direct intervention.

Accommodations

• Assistance with course selections, reduced class load, registration and campus orientation.
• Reading lists (titles, publishers and editions) and syllabi provided well in advance. This allows ordering books on audiotape prior to the first day of class. Syllabi can also be placed on audiotape.
• Notetakers, use of tape recorder for class lecture or provide copies of the instructor’s notes for those classes the student attends.
• Extended time for testing and special arrangements (oral, large print, scribe, taped).
• Extra time or advanced notice may be needed for assignments. Also when assignments include library research, students may need to arrange library assistance.