Traumatic Brain Injury: Perspectives From Educational Professionals J. Darrell Mohr and Lyndal M. Bullock, Preventing School Failure (Heldref Publications) (page 3 of 4) Page 3 of 4

Physical Effects

With regard to physical deficits, individuals with TBI may have an array of problems ranging from sensory deficits to difficulty with mobility. Headaches and fatigue are common, especially during the early stages of recovery. Their muscles may be weak, hypotonic, or spastic, which could interfere with learning activities such as writing and keyboarding. They may also have seizures. In general, schools are more adept at making physical accommodations for students, so it is not surprising that, for the most part, the focus group participants indicated a relative level of comfort in their skills and abilities to accommodate physical effects of TBI.

Cognitive Effects

Although the prospect of accommodating the physical effects of TBI posed no problems for the focus group participants, they did not view themselves to be so adept at meeting cognitive needs of students with TBI. Cognitive difficulties are common following a brain injury and some may seem quite perplexing to educators unfamiliar with TBI. For example, children with TBI may have short-term memory problems, yet may be able to easily recall information learned prior to their injury. This phenomenon has significant implications for assessment purposes. For example, it is possible for a student to perform well on some widely used standard assessments using his or her prior knowledge. Such a false indication of the student’s current level of functioning may prevent the brain-injured individual from getting all the services needed. A few participants of the focus group pointed out and briefly discussed this potential pitfall as an important consideration. Some participants correctly mentioned that to avoid this pitfall, several different methods of assessment should be used when attempting to determine the needs of a student recovering from TBI (Deidrick & Farmer, 2005; Mayfield, 2005; Savage, 1991).

Psychosocial Effects

Difficulties that result from changes in the student’s social, emotional, and behavioral functioning are known as psychosocial effects. The organic changes in the brain resulting from the injury, along with stress and anxiety brought on by rehabilitation and recovery, may cause children with TBI to exhibit unusual emotional states, such as dramatic mood swings. Such emotional dynamism can bring negative reactions from peers and teachers and makes it difficult to maintain positive relationships. When children with TBI return to school, their educational and emotional needs are often very different than before the injury. What sometimes makes things worse is when the injured students remember how they were before the brain injury and feel embarrassed, ashamed, or frustrated that they can no longer perform as they once could. Of the various types of difficulties resulting from brain injury, the psychosocial effects have proven to be the most challenging for school personnel and parents to manage (Clark, 1996; Mayfield, 2005; Tyler & Mira, 1999).

Ideas for Improvement

We asked participants to mention some things that should occur to facilitate the success of students with TBI in schools. Again, those participants who had benefited from some type of formal training had the most to offer, and their answers were generally aligned with specific recommendations found in the literature.

• TBI should be regularly represented through informational sessions at education conferences, because many educators rely on them as their primary source of professional development.
• There are students who, for what-ever reason, seem to fall through the cracks. Perhaps their injury was not deemed significant enough at the time to warrant a lot of attention, but later on, problems emerge. An effort should be made by educators to maintain attention to the TBI, from the point of injury through graduation. Educators and families should create a system that maintains continuity of communication and support.
• More should be done to put systems in place that support parents and families, because they are an important part of the equation in the child’s recovery. They provide valuable information and the opportunity for continuity in the effort to recover skills and abilities. Schools should empower parents so that they do not feel helpless—they can help their child, and help themselves, in the process.
• Who could form coalitions with existing support groups—those who have already experienced TBI could share their personal experiences with educators and parents.
• Who should consider developing expert teams within the district whose members get ongoing, specialized training from medical and rehabilitation personnel. These teams could then train school personnel and parents when the need arises in their school.

Educators' Concerns

Some of the concerns mentioned regarding meeting the needs of students with TBI coincided with those that have been voiced by educators around the country (Bowen, 2005; Bullock et al., 2005; Chapman, 2000; Deidrick & Farmer, 2005). Most of the participants (86%) felt that there is an overall lack of knowledge regarding the diverse educational needs of students with TBI. This initial concern appeared to be directly related to the participants’ perception that there is a lack of formal training opportunities for educators. In addition, all participants who received formal training expressed the need for the course work/staff development to be supplemented with some direct handson experience working with individuals with TBI. As for the teachers’ levels of self-confidence in being able to handle the challenges associated with having a new student in their class following a severe brain injury, 63% indicated that they would be intimidated, given their current level of knowledge about TBI.

Besides those concerns directly related to TBI, some felt there was a need for more work to be done on the systems that support students. For example, some expressed a desire to see more attention paid to the improvement of teaming and collaboration in general. This makes sense, because if professionals are not skilled and practiced at working together, education services are likely to be disjointed and inadequate, at best.

Conclusion

Although the research base regarding school-aged children with TBI is extensive and has produced many valuable resources for educators, whether that information is reaching adequate numbers of school personnel remains questionable. It is clear that educators see the importance of obtaining the best training available and are eager to learn more in order to offer the best support possible to students and their families. We must continue to work to find effective ways of preparing educators to meet the diverse needs of students with TBI.

From Preventing School Failure, Summer 2005. Heldref Publications. www.heldref.org.

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