The Student with a Brain Injury: Suggestions for Success in Higher Education

Suggestions for Students

Higher education can prove to be enormously beneficial to your recovery from a brain injury. In the right situation and with the right supports, further education and increased independence will challenge and expand the limits of your potential while helping you to recover abilities and develop a renewed sense of identity. Regular practice at performing myriad daily tasks, such as preparing assignments, maintaining a calendar, establishing and sustaining friendships, and living independently, can accelerate and maximize rehabilitation.

You can choose from many higher education options, and any one of them may best match your present needs, interests, and recovery. You may wish to begin by taking vocational training classes in disciplines such as auto mechanics, computing, child care, or skilled trades. Such classes may provide the foundation for satisfying and challenging employment or lead you into a two- or four-year degree program.

Whatever path you choose, you will find resources and professionals to guide you toward and through your university, college, community college, or technical school endeavors and to help answer questions and resolve challenges as they arise. The following list will help you consider your options for postsecondary study. Allow yourself plenty of time to reflect on and periodically reconsider these fundamental questions:

• What are your goals for higher education? Do you want to earn a degree or a certificate?
• How might higher education aid in reaching your goals for rehabilitation?
• What do you want to study? You may need help remembering subjects or activities that you most enjoyed before your injury. Ask friends and family to discuss these areas of study.
• Where do you want to go to school? Do you want to stay close to home at first or are you ready to live farther away?
• What do you need to do to get accepted to the school(s) of your choice (for example, applications, transcripts, high school diploma, or equivalent)?
• What are your new strengths and weaknesses in learning, managing a schedule, balancing activities, and remembering details?

Choosing the right postsecondary program is challenging for any student, but especially for students with special needs resulting from disabilities. Many higher education institutions maintain a separate office through which they administer to the special needs of students with disabilities. These offices usually operate under the name of Office of Special Services (OSS), Office of Disability Support Services (DSS), or other similar titles. (Throughout the remainder of this paper, the abbreviation DSS indicates the campus office for students with disabilities.) It is imperative that you speak directly with DSS administrators, faculty, and students at any program that you are seriously considering. If possible, you should arrange to visit a campus or facility before enrolling, to gauge the "feel" and culture and to assess campus accessibility. Also, contact HEATH (see resource listing at the end of this paper) to receive a free copy of How to Choose a College: Guide for the Student with a Disability. This booklet helps students with disabilities carefully consider their individual postsecondary needs and goals, and helps identify and evaluate suitable programs. Ask the following important questions when searching for the best possible postsecondary program for you:

• Does the campus have a DSS office and at least one staff member who is familiar with the effects of brain injury?
• Is there a support group for students with brain injuries on campus or nearby?
• If needed, are all buildings accessible to students with physical disabilities? Is the campus navigable for students with mobility impairments?
• Does the institution offer priority registration (for example, registering early and individually) or at least a strong program of assistance with registration and scheduling of classes?
• Does the institution offer tutoring services? How are such services obtained? Who pays?
• Is institution-sponsored financial aid adequate? Is assistance available for filling out forms or answering questions?
• Are medical and rehabilitation services for people with brain injuries available nearby?
• Can students receive the syllabus for each class prior to the first meeting?
• Does the institution provide notetakers and assistance obtaining a notetaker?
• Is the campus manageable in size, layout, complexity, and distractions?
• Can a student take a reduced courseload and still receive all associated student benefits, if needed (such as health care and financial aid)?
• Does the institution offer academic advising with a faculty member who understands the needs of students with brain injuries?
• Does the institution offer career guidance?
• Does the institution offer a broad range of accommodations and special services?
• Have other students with brain injuries been successful at this insitution?

Once you have been admitted to the programs of your choice, you will likely need to develop a plan for researching and applying for financial assistance. Such a plan will include consulting books and web sites about financial aid, as well as the institution’s financial aid office to learn about any campus-based or state-based funding that may be available. Also contact state agencies, such as the Division of Rehabilitative Services, Council for Developmental Disabilities, and your state BIA chapter (see www.biausa.org for contact information on each state chapter).

In addition to making plans to finance your education, you should consider the following list to help you prepare for this new experience:

• Find out how and with whom you must register (in most cases, it is the DSS office) to become eligible for services as a student with a disability. Reasonable accommodations become available only after you have declared your disability and presented documentation of the disability.
• Seek assistance identifying the specific resources that are available to help you with the areas you find most challenging (for example, math or writing labs on campus, or communitybased professionals such as physical therapists or speech-language pathologists). Talk to someone within those programs or who administers these services before you enroll.
• Seek advice from a DSS counselor, faculty member, or student advisor about which courses to take and in what combinations and sequence, and how many courses you can comfortably manage at one time.
• Seek assistance resolving your housing or transportation needs well in advance of the beginning of classes.
• Practice the route from your housing to your classrooms, library, and other frequented destinations.
• Ask the DSS office to recommend and coordinate faculty, therapists, and anyone else who can help you achieve success.
• Keep multiple copies of academic plans, schedules, and other important papers in different places (such as your files or bulletin board, your parents’ files, a friend’s room, and with your DSS counselors) for ready access.
• Experiment with daily and weekly planners and other time-management tools to help you remember class schedules, appointments, and deadlines.
• Identify any assistive devices, such as learning software, that are helpful to you. The campus computer center or library may already have some assistive hardware or software suitable to your particular needs. The Office for Technology-Related Assistance in your home state and in the state where your institution is located can recommend strategies for obtaining and paying for assistive devices. (To locate these offices, contact the Rehabilitation Engineering and Assistive Technology Society of North America, or go to www.resna.org, where links to each state office are provided. The Resources section at the back of this paper lists other organizations that focus on adaptive technology and telecommunications for people with disabilities.)

Remember, don’t give up, even if you encounter setbacks or are forced to change direction. The process of discovering your new strengths and weaknesses will take time. Through persistence, you will create your own path to success. Speak regularly with family members, DSS personnel, or other students about your experiences, your successes, and your frustrations. Get in the habit of asking for help whenever you need it. Over time, you may find a favorite professor, respected classmate, or close relative who will be willing to act as your mentor—someone who inspires, supports, and challenges you as you make your way through postsecondary education and on to rewarding work and maximum independence.

Also remember that you should not rely on faculty members, counselors, and administrators to come to you and tell you what you need. Rather, you are responsible for being your own advocate. In order to become eligible for services and accommodations, a student with a brain injury must identify himself to the DSS office as a student with a disability and must present documentation of that disability. Once registered as a student with a disability on your campus, federal disability laws entitle you to request and receive "reasonable accommodations." Such accommodations merely provide equal access and the opportunity to the same programs and activities enjoyed by students without disabilities; they are not designed to guarantee your success. Therefore, you must continue to talk with faculty and advisors about your needs and problems.

The following list identifies accommodations that have helped many students with brain injuries to succeed in higher education. Consult with DSS staff or an appropriate administrator to determine if any of these are warranted or available based on your needs. (Some of these strategies may accede the legal standard of "reasonable accommodation;" others may be unfamiliar to faculty. Thus, you may not always receive the particular accommodation that you want. If a disagreement about a requested accommodation arises, be flexible, work with your DSS provider to identify a "next-best" alternative, and recognize when to pursue a new direction.)

• Using "memory aids" such as organizational software, notetaking aids, hand-held pocket organizers, notepads, or tape recorders.
• Using thought-organizing aids and strategies such as graphic organizers or information diagramming to sort out the most important points of lectures or readings and to prepare written assignments.
• Developing written strategies for taking tests, writing term papers, or managing lab assignments before attempting these tasks.
• Requesting the help of tutors to aid in understanding class material and to keep up with assignments.
• Gaining access to advance copies of clearly written class syllabi, including a description of all class requirements.
• Using index cards to "chunk" (or group small bits of) information, key concepts, or new vocabulary.
• Taking more frequent tests that cover smaller amounts of material than the rest of the class.
• Receiving extra time to prepare for oral presentations, to take exams, or to complete papers.
• Requesting frequent feedback from the instructor regarding performance expectations, information to be tested, and course learning objectives.
• Taking lengthy exams in intervals with short breaks.
• Scheduling weekly appointments with the campus writing center, if available, to obtain help in organizing and outlining papers and proofreading drafts. Similarly, math labs offer additional instruction and tutorial assistance.

Suggestions for Parents and Other Family Members

Although all postsecondary programs must provide services for students with disabilities, few institutions have extensive experience serving students with brain injuries, or offer special programs or services for brain injury. You should expect a longer pathway to academic goals for the student with a brain injury than for other family members who attended similar postsecondary institutions. The student may need to change programs several times in a trial-and-error manner before finding a good fit. Others may need to change majors several times, or adjust their academic goals by switching from a four-year program to a two-year college or technical school. The following strategies have helped other family members of students with brain injuries throughout their higher education career:

• Stay as informed as possible about brain injury, its effects, and any support that the student may need. (Consult the organizations, books, web sites, and articles in the Resources section at the end of this paper.)
• Assist the student in clarifying her interests and needs by discussing her goals for higher education, as well as her personal preferences for such things as region of the country, climate, proximity to home, navigability of campus, or size of school. These discussions will help the student identify the type of program—whether part of a college or university, community college, or technical school—that fits her needs.
• Assist the student in developing plans that consider financial need, desired academic supports, living arrangements, and transportation.
• Attend meetings, if appropriate, for orientation to the campus or other parent/family activities so that you familiarize yourself with the campus environment and with DSS personnel.
• Assist the student, as much as possible, with keeping accurate and up-to-date academic records, plans, transcripts, course schedules, and syllabi.
• Remain positive and supportive if the student experiences setbacks.
• Support the student’s decision to change majors or institutions if such a change seems warranted.

Suggestions for Instructors

There is a growing body of literature on the education and learning of people with brain injuries to inform instructors about the particular challenges confronting these students and how to teach them more effectively. The Resources section at the back of this paper suggests a few such titles.

The following list describes some techniques for you as an instructor to consider when teaching students with brain injuries. While many of these techniques are not strictly required, incorporating them into your teaching method might enable easier access of content for all students.

• Provide all accommodations, support, and assistive devices indicated by the student’s DSS counselor.
• Present information, training, or experiences that are age appropriate and pertinent at that time (and remember that interests may change during the recovery process).
• Make learning experiences meaningful and present material in a context that helps reinforce the student’s memory of that material.
• Reinforce and provide feedback to the student about the process of thinking, rather than targeting rote memorization techniques, to encourage metacognition (or, thinking about thinking). Offer comments that reinforce the importance of the thinking process, such as "that’s good thinking" or "that’s an interesting thought," and ask questions beginning with "how," "why," or "what if."
• Provide cognitive mediation: In other words, discuss thought-organization strategies and provide your own examples that practice this technique, such as how to construct a research paper from the development of key ideas.
• Teach or practice requisite skills for new tasks or tasks that were difficult before injury.
• Teach skills and concepts in small, manageable "chunks" and review each before moving on to the next skill or concept.
• Provide opportunities for the student to paraphrase what he has learned or give her specific instructions for assigned tasks. This technique helps to avoid misunderstanding and clarifies any potential pitfalls the student may encounter while performing the task.
• Where possible and appropriate, integrate theory with practice and practice with theory.
• Be patient. Offer multiple trials for the student to make errors and help them see the value in learning from their mistakes.
• Use task analysis—the strategy of breaking down a task or activity into small steps—where appropriate.
• Use a diagnostic-prescriptive approach to teaching, by targeting teaching methods to a particular student’s strengths and disability-related needs.

Suggestions for Academic Advisors

Studies that address the general learning process of students with brain injuries and their experiences at the elementary and secondary levels suggest that following a brain injury, the learning process is altered and some aspects of normal learning are permanently impaired. The injured brain can heal, however, and make remarkable adaptations and effective use of compensatory strategies. As an advisor to a student with a brain injury, you may wish to consider the following suggestions:

• Familiarize yourself with the effects of a brain injury, especially in the areas of cognition and emotional adjustment.
• Request information from the student and family, if appropriate, about the student’s history of recovery from brain injury and about her special needs (for example, partial loss of vision or hearing may accompany the injury but may not be readily apparent).
• Work with the student to assess the educational environment, to identify needed accommodations, and to determine a course load that is not overly demanding.
• Maintain regular communication with the student and monitor the current plan’s effectiveness or need of modification.
• Refer the student to support resources on or near campus, if needed, or to a counselor who can determine what type of support the student might need.
• Consider recommending a reduced course load, instructors with whom you feel the student might work most successfully, and courses that match the student’s abilities at that time.
• Provide written information in easy-to-remember formats that are not overwhelming to the student, and provide duplicate copies to the parents or DSS personnel, if appropriate. (Remember to be mindful of a student’s guaranteed right to confidentiality. By law, you may not disclose information to parents without the student’s permission. Visit the web site of Disability Access Information and Support at www.janejarrow.com for a detailed discussion of confidentiality.)

Suggestions for Disability Support Services Providers and Therapists

In your roles as DSS providers and therapists for students with brain injuries, you may need to be more proactive in identifying required support than you typically are for students with other disabilities. The only thing constant about brain injury is that it changes all the time. The effects of a brain injury often fluctuate from day to day, and in the course of recovery the brain moves through stages in healing and acquiring new coping strategies. As a result, those with brain injuries may become confused about their abilities and limitations. (Service providers and therapists should not simply accept at face value what students with brain injuries report about their progress.)

Students also may be confused about or unaware of the accommodations and supports they need, in which case the service provider may recommend that a neuropsychologist or speech-language pathologist assess the student’s needs. Such assessment provides a detailed profile of a student’s cognitive strengths and weaknesses. DSS staff can then help the student understand the results of the assessment and use them to plan majors, select courses and schedules, and identify effective compensatory strategies. Assessment results may indicate that the student needs to adopt new approaches.

Some brain injuries also impair a student’s ability to initiate action, making it difficult for them to seek help or to be effective self-advocates. Therapists and DSS personnel should encourage students to develop these skills, which are so critical to the postsecondary success of students with all types of disabilities. Furthermore, students with recent injuries may be unfamiliar with available supports; DSS personnel can provide this important information.

DSS professionals help students identify needed accommodations. They also can rehearse with students how to request these accommodations from faculty and other instructors. Role-playing is an effective tool for teaching these skills. For example, the DSS professional assumes the role of the instructor while the student practices describing the brain injury and requesting needed accommodations. Service providers also should encourage frequent meetings with students and provide information in a concise, easy-to-remember format.

Students with brain injuries also may need help reacquiring many of the skills necessary for independent daily living, such as doing laundry; maintaining a well-balanced diet; prioritizing tasks; opening bank accounts and balancing checkbooks; keeping track of scheduled work, school, and social activities; recordkeeping; and using informational sources such as libraries, the Internet, maps, and dictionaries.

When working with students with brain injuries, remember that their ambitions remain unchanged despite the injury: They still desire meaningful work, satisfying relationships, good health, and a sense of making a positive contribution to the world.