Traumatic Brain Injury, School Adjustment

Patient History

Academic performance prior to or since the injury can be retrieved from school records. However, often information regarding the injury, especially if sustained before the student entered first grade, between school years, or during a transition from one school level to another, initially may be absent. This deficit may be corrected by contacting previous institutions. In addition, parents are a source of information regarding the where and when of the injury. It is the implications of age and time since injury that are hardest to assess. Age at injury is associated with skills already acquired (speech, reading, writing, and abstract thinking), and time since injury is associated with the developmental nature of recovery. That is, more basic skills, if previously acquired, are the quickest to return. The more skills acquired and mastered prior to injury, the more reserve exists, and is potentially available, post-injury (Sherwin & O'Shanick, 1998). Furthermore, while recovery may continue for years after injury, the most dramatic and rapid recuperation will occur in the first year after injury. However, in the early phases of recovery, physical stamina may be low, and the fine art of negotiating ability versus tolerance must be practiced. In contrast, while stamina might be higher as the time since injury lengthens, cognitive recovery tapers off. Thus, if the student is many years post-injury and is still experiencing significant academic difficulties, expectations of dramatic changes are not realistic. Finally, it is not unreasonable for a student who was injured at a young age to adjust to elementary school and later begin to experience difficulties as the limitations in post-injury cognitive skills become apparent when the academic demands increase around the transitions to junior high, high school, or university.

Injury Variables

Injury variables are most associated with the type and severity of cognitive deficits exhibited. For example, damage to the left hemisphere can result in language production/comprehension difficulties; frontal lobe damage can result in memory deficits. These often mirror more traditional learning disabilities. And if the injury is unknown to the school, the difficulties may be misdiagnosed and mistreated. While the behavioral presentation of TBI and learning disability (LD) may appear similar, the underlying processes are vastly different. Therefore, interventions appropriate for one are rarely appropriate for the other (Begali, 1992).

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