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Janis Ruoff, PhD, HEATH Resource Center. GWU (page 1 of 12) Page 1 of 12
Every 15 seconds, someone in the United States sustains a brain injury. Nearly 5.3 million Americans currently live with disabilities resulting from such injuries, the highest incidence occurring among youth and young adults between the ages of 15 and 24. Because individuals within this age group typically are preparing for postsecondary education or are of traditional college age, students with brain injuries are a growing presence on college and university campuses and within other postsecondary programs.
For students with brain injuries who are prepared to pursue postsecondary education, higher and continuing education provide wonderful opportunities for recovery and growth. Their daily challenges provide structure and cognitive retraining that can lead to maximumindependence, appropriate and fulfilling employment, and improved self-esteem. Continuing education and participation in higher education provide opportunities for mental stimulation and age-appropriate socialization, factors that promote neurological and psychological recovery. With proper and continuous planning and support, and with determination on the part of the student, individuals with brain injuries can achieve their higher education goals.
Brain injuries are complex—each is unique, and their effects on an individual frequently change over time. Thus, postsecondary education following a brain injury presents challenges to students, their families, faculty, and counselors. This paper addresses these challenges by defining the categories of brain injury and describing their impact on an individual’s ability to learn and to live independently. The paper describes learning tools and strategies to help students with brain injuries succeed in whatever postsecondary program they choose. This paper also offers specific suggestions for students, parents and other family members, instructors, academic advisors, therapists, and Disability Support Services (DSS) administrators. Case studies of two particular students with brain injuries illustrate common pitfalls and obstacles encountered when adjusting to and developing beyond the effects of injury. A resource list of publications and organizations completes the paper.
Types and Causes of Brain Injury
Vehicle crashes are the leading cause of brain injury, falls are the second leading cause, and violencerelated brain injuries are a growing concern. Males are twice as likely to sustain brain injuries as females, and a person who sustains one brain injury is three times more likely to sustain a second injury and eight times more likely to sustain a third injury. (This increasing risk factor often is due to compromised cognitive function, impaired judgment, fatigue, and other physical disabilities that accompany brain injuries.)
Fifty thousand fatal brain injuries and one million nonfatal brain injuries are sustained each year; many of these are preventable. Drug and alcohol use are directly involved in approximately half of all vehicle-related accidents resulting in brain injuries. Increased seat belt and helmet use (while cycling, roller blading, rock climbing, and so forth) could drastically reduce the number of fatalities and severity of disabilities resulting from brain injuries.
Medical professionals frequently categorize brain injuries as mild, moderate, or severe based on the length of time an individual is unconscious and the severity of tissue damage to the brain. However, these medical categories do not necessarily reflect the severity of impact on that person’s life. For example, even though the injury does not result in coma or lengthy hospitalization, a mild or moderate brain injury sometimes may create severe and long-lasting effects such as visual perceptual difficulties or chronic fatigue.
Mild brain injuries may be deemed to require no rehabilitation at the time of the injury, and doctors may advise the patient that she is "just fine" when, in fact, neurological and behavior problems persist or develop. Visual or memory impairments, fatigue, confusion, headaches, and other effects of mild or moderate brain injuries may be misdiagnosed or remain untreated. This can cause a person who has sustained a mild brain injury to think he is "going crazy" or to be perceived as lazy or malingering, when in fact he is experiencing unexpected or delayed neurological problems.
Researchers, policy makers, and social and vocational service providers define brain injuries in terms of their impact on a person’s ability to function, rather than gauging the severity of injury to the brain. Within these professions, definitions of brain injuries also distinguish between those resulting from external versus internal causes.
Traumatic brain injury (TBI) is a term commonly used to describe injuries from external causes. TBIs include open head injuries (for example, open wounds, such as from a gunshot) and closed head injuries (for example, wounds without visible signs, such as those resulting from a blow to the head or from a fall). The Brain Injury Association (BIA), a leading national advocacy group for people with brain injuries, defines 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, and which results in an impairment of cognitive abilities or physical functioning. It can also result in the disturbance of behavioral or emotional functioning.
Acquired brain injury (ABI) is more broadly defined and includes brain injuries from internal causes. According to the BIA, acquired brain injury is an "injury to the brain which is not hereditary, not congenital (present at birth), or not degenerative (progressively worsening)." The BIA’s definition of ABI encompasses brain injuries from stroke, anoxia (lack of oxygen, such as that resulting from a diving accident), or neurological disease, such as encephalitis, as well as those caused by external trauma. Note: Unless otherwise indicated, the broader definition of ABI is implied throughout this paper.
Though these varying definitions may appear confusing, their distinctions are important to understand. Elementary and secondary school officials often adhere to the definition of TBI rather than ABI when identifying students for special education and related services. Some state and local school districts follow an even more detailed definition of TBI, as written in the Individuals with Disabilities Education Act (IDEA) of 1990, when determining a student’s eligibility for services:
From the HEATH Resource Center, The George Washington University. Reprinted with permission. www.HEATH.gwu.edu.
