Best Practices for Teachers with Students with a Traumatic Brain Injury (TBI)

I started my college journey six months after brain surgery and my subsequent release from the hospital and retirement from the military.  I was apprehensive and nervous going back to school as I realized I was not able to function at the same level I performed at even six short months before.  It took me four times longer to read a passage or text, my recall wasn’t nearly as immediate or robust as it was previously, I had difficulty sustaining focus on a single task, I was constantly searching for words and my speech was slowed, and I had to relearn how to learn.  The remnants of the incident had since healed, but the mental scars still lingered and manifested themselves on a near daily basis.  Unfortunately, my story is a fairly common tale.  As a student veteran who suffered from a traumatic brain injury (TBI) and treated for post-traumatic stress disorder (PTSD), I know first-hand the struggles many individuals, especially veterans, face when entering a higher education setting after an injury.  However, as we are each unique in our own way, the specific manifestation of a TBI or PTSD is also unique to each individual.  As my exact condition might not be identical to another’s, the basic tenets of what I learned as both a student, and since then as an educator, have given me an invaluable perspective which I hope to share in this post.

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Definition of a TBI

For background, a TBI is a specific type of brain injury resultant of an external force via a bump, blow, jolt, or barometric wave of energy to the head causing either an open or closed injury that disrupts the function of the brain (Faul, 2010).  A TBI can occur when a head hits a windshield during a car accident, shrapnel enters the brain after a blast, or even from the pressure of a nearby explosive event.  Conversely, not all head injuries result in a TBI, and the severity can range from mild (brief loss of consciousness) to severe (extended period of unconsciousness and memory loss) (CDC, 2011).

The recent rise in instances of TBI over the past decade can be attributed to the growth of knowledge in the subject and the attention it is receiving from the media and sports industry.  Although TBIs are often undiagnosed and not reported, it is more prevalent than multiple sclerosis, breast cancer, and HIV combined (Leibson et al., 2011).  Unfortunately, there is a dichotomy in perception with TBI.  It is becoming more apparent and stressed upon by the medical community that TBIs need be to seen and treated as a disability, but the majority of the population still do not see the critical nature of having these injuries examined.  This creates the larger problem of individuals going undiagnosed, which is especially difficult in higher education as the most common age range for a TBI is 15-26, and these individuals are less likely to seek medical attention on their own (Novak & Bushnik, 2008).

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Inclusivity in Practice

During our lunch and learn discussion, “Building a Inclusive Classroom,” faculty members provided their best practices for building inclusive learning spaces.  In the spirit of inclusivity, they have offered to share them with us and the college community.

Many of the faculty focused on the way they set an inclusive tone during their first day and first weeks, including sharing the responsibilities of syllabus creation, policies, and schedule.  Some of the faculty also talked about how to maintain this spirit of collaboration throughout the course by “checking in” with students and providing methods of on-going discussion and conversation.

Building the Environment for Learning

  • Establishing shared responsibilities and classroom rights on the first day
  • Collaborating on due dates and the course schedule
  • Co-creating student-paced class/unit “guides” that serve as checklists and enable students to envision learning outcomes for the week
  • Doing a “check-in” at the beginning of class: where are they with the material? what are the “ah-ha!” moments? the muddiest moments?
  • Asking students to choose the discussion topic and/or choosing “discussion leaders”
  • Helping students to develop their own classroom policies, i.e., late work, attendance, rubric and assignments
  • Using discussion boards for ongoing course discussion

In addition the classroom environment, faculty members provided their best practices for creating inclusive assessments of student learning.  As one faculty member noted, “it’s important that assignment provide students with an opportunity to ‘show off’ what they know.”

Building the Tools for Assessment

  • Giving students the opportunity to propose an alternate assignment or project if they feel it will benefit them
  • Having students complete a “group test” where they provide evidence and justifications for their answers
  • Encouraging and facilitating peer review sessions for final papers
  • Voting on the structure of projects and the types of exams

Look for more about inclusivity in the classroom in our upcoming professional development and our continuing blog series on the topic.  Thank you to all the faculty who provided these best practices.