Running head: TRAUMATIC BRAIN INJURY 1

Traumatic Brain Injury: Its Effects on Learning Capabilities

Amelia Praetzel

EDU 112

Franciscan University of Steubenville

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Traumatic Brain Injury: Its Effects on Learning Capabilities

America is the land of the free; it is a place where people can come and start a new life

full of opportunity. America has come a long way regarding freedom and equality. Freedom is

understood to be freedom for all, regardless of age, race, sex, or ethnicity. What most people

forget, though, is freedom regardless of disability. There are many wonderful persons with

disabilities who suffer from discrimination and unequal opportunities. The treatment given in the

past to persons with disabilities is appalling and unfathomable. Over the years, Americans have

opened their minds and hearts to understand this atrocity and to work hard to help persons with

disabilities achieve their freedom.

According to the National Center for Education Statistics, 6.5 million children aged three

to twenty-one received services for disabilities in 2014-2015. The number of children was nearly

half that only four decades earlier. The difference between then and now is an increasing

awareness of past discrimination towards persons with disabilities and a continuous striving to

correct it. A contributing factor in the growth of these services is the Individuals with Disabilities

Act (IDEA), which was enacted in 1975. IDEA provides, among other things, free appropriate

public education (FAPE) and in the least restrictive environment (LRE). There are thirteen

disability categories under IDEA, all of which are important and require an extensive knowledge

in order to best serve the beautiful people with these disabilities. One of the thirteen disability

categories under IDEA is Traumatic Brain Injury (TBI). TBIs cause multiple challenges, but the

two most prevalent are challenges to memory and challenges to emotions and social interaction.

These challenges are often disregarded or not associated with a disability when noticed by

persons without disabilities. Human memory is taken for granted; so much of everyday living is

done through the subconscious. For example, knowing which switch in the house turns on the
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kitchen lights is easy for some but difficult for persons experiencing TBI. Challenges to emotion

and social interaction also have a big impact; persons experiencing this may shut others out and

become lonely and depressed. This is very dangerous for their lives, their health, and their

happiness. Fortunately, there are help strategies to counter these two challenges and support

persons experiencing this disability.

Definition of Traumatic Brain Injury

A TBI is a brain injury of any degree of severity caused by some external trauma. This

may occur through any physical activity in which the head collides with a hard surface (Chesire,

2015) or gets jolted (Davies, 2016). TBIs are most commonly associated with sports incidents,

but this disability could be caused by other circumstances. For example, TBI is the third most

common injury caused by child abuse (Chesire, 2015). It could also be a result of a head

penetration like wounds from gunshots (Davies, 2016). There are numerous symptoms of TBI,

including, but not limited to: difficulty speaking, thinking, comprehending, and concentrating,

behavioral abnormalities, dizziness, tiredness, moods, sensitivity to light and/or sound,

headaches, and upset stomach. TBIs are commonly experienced by high school athletes and take

up twenty-one percent of the approximately one and a half to four million sports-related TBIs or

concussions each year in the United States alone (Taylor, 2017). This is disheartening, especially

since teenagers’ brains are still developing and thus recover more slowly than those of adults,

and both short-term and long-term effects may be very serious (Taylor, 2017). According to

Schutz (2010), the students with the most traumatic injuries and most obvious symptoms are

easily identified, but those with the most severe injuries and hidden symptoms are not identified.

These students suffer the most, as they do not receive help, and thus fall drastically behind their
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peers academically, personally, and socially.

Chesire (2015) states that teachers must be aware of students presenting symptoms such

as headaches, vomiting, exhaustion, and/or distractedness. If these symptoms are present, the

teacher should contact the student’s guardian to receive any information on recent injuries the

student may have had. Less than eighteen percent of students who suffer from TBIs are identified

and receive services in special education (Ettel, 2016). Furthermore, teachers, psychologists, and

speech-language pathologists have inadequate knowledge of TBI (Ettel, 2016). As a result,

persons who have TBIs are often misidentified as having a specific learning disability (SLD) or

behavioral disorder (Ettel, 2016). Taylor also mentions that students need to report symptoms of

a TBI. However, students are not educated enough on concussions and their symptoms. Research

shows that seventy-two percent in a study of high school athletes educated on concussions

reported that they would inform their coaches if they experienced symptoms (Taylor, 2017).

Persons who experience TBIs go through a lot, but the two most common difficulties are

challenges to memory and challenges to communication and social interaction.

Challenges to Memory in Learning

Persons with TBI experience many difficulties at many levels depending on the severity

of the TBI. Some of the most common challenges are short-term and long-term memory,

retention, concentration, and comprehension. This really affects the success of students in

school: they cannot function as well as they did before the incident, and may fall behind, lose

motivation, and/or get frustrated by it. Obrien (2018) mentions the constraints for persons with

TBI to prospective memory (PM), which refers to remembering future tasks and performing

them. This is harmful for students who may miss classes, forget assignments, or turn in late
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homework. School is very centered on timeliness and schedules, so a student with TBI will

suffer because he cannot keep up with due dates, appointments, and assigned tasks. It is not

because they forget about a certain task that persons with TBI fail in PM, but rather because they

forget when a certain task is to be performed (Obrien, 2018). Experiments also showed that

persons with TBI have difficulty switching between tasks or performing multiple tasks (Obrien,

2018). This is also a problem, as students must focus on multiple classes and any extracurricular

activities in which they participate.

Mayes (2018) writes about the cognitive disabilities and delays in learning; students with

TBI normally need time to get back into their routine life. This means taking half day school

days, and/or extended homework and assignment due dates. A common recurrence is that

teachers do not understand the importance of this slow transition. Students may not seem to have

disabilities in school because they may score average relative to their peers. However, as in

Douglas’s case, a student may have been exceptional before the TBI (Mayes, 2018). This makes

it challenging for students to get back to the place where they were. There is not enough support

of students with TBI and instead negative forcefulness to get over it and continue with life at the

rate they were before the TBI (Mayes, 2018). Students with TBI need support and

encouragement in their struggles; they may seem perfectly fine from the outside, but persons

experiencing TBI must readjust and retrain their brains to function smoothly. They need their

family to be a positive outlet of reinforcement and joy and their teachers to be understanding and

lenient in the process of achieving success in study. Lastly, they need appropriate self-confidence

and reliability in comprehending and performing tasks.

Support Strategies for Learning

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In order to help persons experiencing challenges from TBI, said persons must first be

identified. Unfortunately, many teachers, faculty, parents, and students are not aware of the

signs, symptoms, and responses of persons with TBI. One program that helps with this is a

school-based concussion management program. This program helps educate teachers to know

how to identify TBI, encourages parents in the care of their children with TBI, and provides

supports to students struggling with the effects of TBI. It provides a transition from hospital to

home and fulltime participation in school and aids students in achieving previous performance

levels from before the TBI (Davies, 2016). School-based supports are very helpful for

communication among all parties involved: the student, parents, teachers, coaches, and the

psychiatrist or school nurse. Specialists and occupational therapists are also helpful support

services (Mayes, 2018). Wallace and his mother believe these supports helped tremendously in

getting Wallace back into school and learning again. Both support strategies focus more on the

transition back into school and getting into the learning atmosphere, the learning state of mind.

Once a student is back in class, there are still challenges to conquer. According to

O’Brien (2018), of all types of memory, PM is the most affected by TBI. Support strategies may

vary on the degree of the TBI, but examples of supports include to-do lists, reminders, calendar

appointments, and/or task analysis. Using these supports to signal the brain is helpful because

persons with TBI cannot trigger the brain to recall future tasks. The first task analysis will most

likely be particularly detailed, to ensure its completion. As time passes, it will become less

detailed or less frequent; this helps the person with TBI grow in memory cognition and

subconsciousness. Starting out with more detailed help strategies and gradually decreasing the

extent of support may result in a significant amount of recovery, if not complete. Remembering

to include positive reinforcement and encouragement is important to keep up the morale of the
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person struggling, as it is frustrating to not remember or not be able to perform simple daily

tasks. These support strategies, among others, are beneficial to all those who are invested in the

lives of persons with TBI. One must be grateful that they are guiding all closer to equality,

including those with disabilities.

Challenges to Emotions and Society

TBI comes with many difficulties and challenges. Challenges to memory, retention,

concentration, and comprehension are prevalent in most cases of TBI. Another common

challenge for those who have suffered from a TBI is a lack of communication and social skills.

According to Childers (2016) a study of post-secondary students admitted that there are

challenges to social-emotional development that affected their college experience. Anxiety,

depression, discouragement, and irritation may appear or increase due to sustained TBI.

Alterations to one’s personality such as humor, leadership, temper, volume, and energy are also

caused by TBIs (Childers, 2016).

Persons suffering from TBIs are also affected by the reactions of those around them.

Those who have misconceptions about persons suffering from TBIs may have a negative effect,

especially when it comes from a teacher. Lack of support also worsens the emotional effects of

TBI (Childers, 2016). One woman explained to Childers (2016) the fears that occur. She would

overbook herself socially because she feared being left out or forgotten. This may lead to a

viscous cycle of social anxiety leading to overbooking oneself, producing academic anxiety. It is

also difficult when persons suffering from these symptoms are misdiagnosed as simply having

anxiety or depression, rather than having a TBI. Students and teachers should be aware of the

effects a TBI may have on their peers or students and encourage them in their struggles.
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Not only do persons who had a TBI suffer from inward emotional and social difficulties,

but they are also unable to determine the emotional state of others (Knox, 2009). Research

results showed that persons with TBIs were less capable of recognizing facial expressions than

those in the control group. Knox (2009) determines that the issues for persons with TBI arising

from this inability to detect emotions and atmospheres are trifold: possible inappropriate

reactions toward others, difficulty determining appropriate behavior, and misunderstood

communication. It is hard for both persons in this situation because communication is an integral

part of our lives and necessary for human interaction.

Learning is not just about academics; it is a very complex system, grounded in

communication and social skills. Thus, persons with a TBI suffer in school because of the

detriment to their social and emotional skills. However, these skills are not lost forever. They can

be fought and retaught, and one may be able to return to the person who one was before the

incident.

Emotional and Social Support Strategies

Behavioral supports in the school setting are very beneficial for persons suffering from

TBI. School psychologists play a large role in the support of the student. The psychologist will

utilize a Functional Behavioral Assessment (FBA) to define under what circumstances the

student is behaving in an adverse manner (Aldrich, 2012). Then reinforcement, punishment,

models, prompts, and task analysis can be used to teach the student how to respond to situations.

Teachers are also involved in the support of their students with struggles in behavior by

reaffirming good behaviors and not tolerating ill behaviors. Parents must accept the difficult fact

regarding changes in behavior and try their best to help their child to work through them and
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relearn how to behave in situations. Overall, encouragement and support from the teacher and

parents or guardians is of the utmost importance.

There are supports for emotional symptoms as well. Childers (2016) states that family

and teacher support, self-determination, and academic accommodations are important resources

for persons suffering from TBI. Family and teacher support is the most important of the three as

getting through depression and anxiety of TBIs is very difficult without positive attitudes

surrounding one and keeping one going. Self-determination is also a driving force during times

of emotional difficulty. Academic accommodations for seating arrangements, participation, or

assignments may help until the student is able to fully handle the school setting. Emotional

symptoms are more complex than other struggles are because there is not one correct response.

Therefore, it is important for teachers to build a strong relationship with their students. Then they

will be better equipped to support their students and encourage them through the depression,

grief, anxiety, and/or irritation. Thus, social skills and communication challenges are

counteracted through emotional support.

Lastly, there are supports for communicational impediments. Part of communication with

others is being able to interpret their emotions and understand their expressions, but persons

suffering from TBI have difficulty with these tasks. One support to help regain this skill is

therapy targeting (Knox, 2009). Starting out with pictures, one can minimize complexities and

memory needed to focus on one form of communication. This also gives one more time to assess

the expression. For example, a photo of someone frowning should stimulate possible expressions

such as anger, frustration, or concentration (Knox, 2009). This method of rehabilitation can be

used with matching a facial expression to its situation or a label to a situation. Unfortunately, this

support program is not as effective as the supports for emotional and behavioral challenges are,
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but it is still beneficial to persons suffering from TBI.

Conclusion

TBIs affect the entire life of the student, not just a short period of time after the injury

takes place. Sometimes side effects are even delayed in showing themselves until much later in

life when more challenges arise. This is difficult for the injured party because he or she may not

know the cause of the challenges they are facing and therefore cannot receive effective support.

It is difficult for the instructors because they may become frustrated when the student is

struggling and may seem to not care. Everyone must remember that a person could be going

through something that one does not know about and that everyone should strive to help others

along their road in life.

TBIs cause impairments of different kinds and different severities. There are visible side

effects and invisible side effects. The visible side effects include: lower grades, impaired

memory, and physiological impairments. The invisible side effects include: mental, emotional,

and functional struggles. The world needs to be supportive and understanding of persons with

TBI. Fortunately, persons with disabilities have many more supports recently then they had

decades earlier. Thanks to 504 plans, IEPs, FAPE, IDEA, and LRE, students with disabilities are

better provided for, included in more activities, and feel genuinely valued.

There is still room for much improvement, but the support system has become more

prevalent and successful in the last quarter century. Persons suffering from TBIs need many

different types of support for physical, mental, emotional, social, and communicational

impairments. Professional support systems are successful and beneficial, but the support systems

that are most effective are the support of family, friends, teachers, and peers. The support they

give is love—a real concern for the health and wellbeing of the person.
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