Module: Traumatic Brain Injury (Page 7 of 25)

Contents

  1. Acknowledgements
  2. Personal Stories
    1. Videos
    2. Quotes from BI support group
  3. Brain Injury Basics
    1. Definitions
    2. Lobes and functions
    3. TBI leading causes and risk factors
    4. Brain injury by the numbers
  4. Manifestations
    1. Cognitive
    2. Physical
    3. Psychosocial
  5. Other Potential Challenges
  6. Drugs and Alcohol after a Brain Injury
  7. TBI and Co-Occurring Mental and Behavioral Health Issues
  8. Institutional Accommodations
  9. Assistive Technology (AT) Accommodations
  10. Teaching strategies—
    What can instructors do?
    1. Specific Strategies for BI
    2. General Strategies
    3. Shaping the Environment
  11. Learning strategies—
    what can students do?
  12. Free Apps
  13. Prevention of TBI
  14. Brain Injury Resources
  15. References
  16. Feedback

Acknowledgements

This TBI module has been revised and expanded through the generous grant funding provided by the Colorado Brain Injury Program (CBIP) Education Grant 2014-CBIP-14-003732, offered through the Division of Vocational Rehabilitation, Colorado Department of Human Services.

Personal Stories

The following students participated in the Opportunities for Postsecondary Success (OPS) Program at Colorado State University, based out of the Center for Community Partnerships (CCP) in the Department of Occupational Therapy.

The OPS program offers individualized and holistic services to students with learning differences and/or disabilities including one-on-one support from a professional OPS Coordinator and a trained Student Mentor, to promote successful postsecondary outcomes. These OPS services complement the standard academic accommodations provided through the Office of Resources for Disabled Students (RDS) at CSU.

Michael

This is “Michael’s Journey,” a personal account of courage and determination from a college student with a traumatic brain injury (TBI). Michael pursued his dream of being the first in his family to earn a college degree. He was awarded a B.S. in Fish, Wildlife and Conservation Biology from Colorado State University (CSU) in 2014.

Dani

Dani was diagnosed in the 7th grade with Chiari Type I malformation, a structural defect in the region of the brain called the cerebellum. This is her personal story—demonstrating extraordinary levels of perseverance and determination to attend college and to educate others about the challenges of living with a brain condition. Dani is pursuing her art degree at Colorado State University.

Hailey

Video coming soon...

Quotes from the Brain Injury Support Group

The Brain Injury Support Group in the Center for Community for Participation (CCP) was founded in 2011 to provide an opportunity for individuals with brain injury to come together and share their challenges, strengths, strategies and stories about life on campus, in the community, in the family, and in other relationships while living with a brain injury (BI). Group members have also participated in activities to raise awareness, promote success, and educate the campus community about brain injury. Following are comments from a support group discussion on why it can be very frustrating to have a brain injury and why there is a need for further education.

Quotes from individuals who have a brain injury

  • “You go into EVERYTHING knowing you’ll have to work harder!”
  • “There’s a difference between needs and excuses. When I ask for help, I NEED help, I am NOT making excuses!”
  • “I’m not being lazy!”
  • “If I’m asking for help, I don’t need you to say that I look healthy or that I look fine. I really need help!”
  • “People just expect me to be the same as I was before the accident.”

Distressing Comments heard from others about brain injury

  • “You don’t look like you have a brain injury.”
  • “You’re not trying hard enough!”
  • “You’re lucky to be alive!”
  • “I know how you feel!”
  • “Why can’t you remember/feel/do...like you used to?”
  • “You are just being lazy, apply yourself!”

Brain Injury Basics

Definitions

Traumatic brain injury (TBI)
TBI is a type of acquired brain injury that results from damage to brain tissue caused by an external force. TBI can result when the head hits an object or when an object pierces the skull and enters brain tissue. TBI can also occur without any apparent physical evidence, such as with whiplash or shaken baby syndrome – where the brain gets jostled inside the skull. Symptoms of a TBI are classified as mild, moderate, or severe.
Acquired brain injury (ABI)
ABI is damage to the brain following birth, such as from a stroke, anoxia, carbon monoxide poisoning, tumors, or other causes (not as a result of an external force).
Concussion
Concussion is considered a mild TBI (mTBI). In many cases, loss of consciousness does NOT occur, though there may be alterations in consciousness such as feeling dazed or disoriented, “foggy” thinking, etc. (may be temporary or prolonged).
Diffuse vs. focal brain injury
TBI is often considered diffuse, as frequently there is injury to cells in multiple areas of the brain. Focal brain injuries are confined to a specific area of the brain.
Second Impact Syndrome (SIS)
SIS is an acute, usually fatal brain swelling from repeated head trauma, where the brain tissue has not had significant time to recover from the 1st trauma before getting re-injured.

Recommended: The Centers for Disease Control and Prevention “Heads Up” website for many more important concussion and brain injury resources for individuals with brain injury, parents, school and athletic personnel/coaches, and health care professionals.

Lobes and Functions

Image source: Blausen Gallery 2014 [1]

General functions of the brain (CDC) [2]

Frontal lobe
responsible for complex and social behaviors, speaking, reasoning, planning, and making decisions
Parietal lobe
aids in orienting the body in space, hand-eye coordination, figuring out what objects are
Occipital lobe
interprets visual stimuli
Temporal lobe
responsible for memory, hearing, understanding speech

For more in-depth information on brain functions and observed problems, please consult: Lehr, R. P. (2015). [3]

TBI — Leading Causes and Risk Factors

Image source [4]

Risk Factors [5]

Among TBI-related deaths for 2006–2010:

  • Men were nearly three times as likely to die as women.
  • The leading cause of TBI-related death varied by age
    • Falls were the leading cause of death for persons 65 years or older.
    • Motor vehicle crashes were the leading cause for children and young adults ages 5-24 years.
    • Assaults were the leading cause for children ages 0-4.

Among non-fatal TBI-related injuries for 2006–2010:

  • Men had higher rates of TBI hospitalizations and emergency department (ED) visits than women.
  • Hospitalization rates were highest among persons aged 65 years and older.
  • Rates of ED visits were highest for children aged 0-4 years.
  • Assaults were the leading cause of TBI-related ED visits for persons 15 to 24 years of age. Falls were the leading cause for all other age groups.
  • The leading cause of TBI-related hospitalizations varied by age:
    • Falls were the leading cause among children ages 0-14 and adults 45 years and older.
    • Motor vehicle crashes were the leading cause of hospitalizations for adolescents and persons ages 15-44 years.
  • Blasts from exploding devices – leading cause of TBI for active duty military in war zones
  • Since 2000, over 300,000 service members have sustained a TBI, with approximately 20% deployment-related. (Defense and Veterans Brain Injury Center) [6]
  • The vast majority of TBIs sustained by members of the U.S. armed forces is still mild, also known as concussion, and of those service members who sustain a mTBI, most recover and return to duty within seven to 10 days. Common causes of these TBIs are motor vehicle crashes, falls, sports and recreation activities, and military training. (Defense and Veterans Brain Injury Center). [6]
  • The most common combat-related TBIs occur via concussive blast waves produced by IEDs or “road-side bombs”- these are considered primary blast injuries (Taber, Warden, & Hurley, 2006). [7] A secondary blast injury occurs when shrapnel and debris are propelled from a blast and causes penetrating injuries to the brain. A tertiary form of blast injury occurs when an individual is thrown by the force of the blast against stationary objects, causing acceleration/deceleration injuries.

Brain Injury by the Numbers [4]

Annually in the U.S., TBIs result in:

  • 2.5 million people sustained a TBI in U.S. in 2010
  • 50,000+ deaths
  • 280,000+ hospitalizations
  • 2.2 million emergency department visits

According to the Brain Injury Alliance of Colorado [BIAC]):[8]

  • 6 million Americans currently have a long-term or lifelong need for help to perform activities of daily living as a result of TBI (point being, you’re not alone, and help is available!)
  • 40% of those hospitalized with a TBI had at least one unmet need for services one year after their injury. The most frequent unmet needs were:
    • Improving memory and problem solving
    • Managing stress and emotional upsets
    • Controlling one’s temper
    • Improving one’s job skills

Manifestations

Brain injuries vary considerably from individual to individual. A person may have a few manifestations or may have several. The term “invisible injury” is often used to describe a brain injury, because symptoms are frequently not outwardly apparent or obvious to others. This aspect can make the experience of living with a brain injury frustrating and isolating. Brain injuries not only impact the individual, but often also impact family, friends, teachers, colleagues, and other community members. And a mild TBI (mTBI) may be anything but mild to the person experiencing it!

Following are potential general symptoms and some implications for each.

Cognitive

Impaired memory - may have difficulty with…

  • retrieving information for exams
  • remembering critical deadlines, appointments, instructions
  • recalling names of classmates, professors, colleagues
  • finding way to/from a location

Slowed processing speed - may take longer to…

  • finish exams, take notes, complete assignments
  • learn new concepts
  • read
  • form responses – verbal and written
  • organize thoughts

Concentration and attention – may have difficulty with…

  • losing focus, “zoning out”
  • becoming overwhelmed, easily confused
  • keeping up with lectures, notes
  • multi-step instructions

Planning, organization, time management – may have challenges with…

  • misplacing items, assignments
  • underestimating amount of time needed to prepare assignments and study for exams
  • balancing academic/work, social and personal needs and obligations
  • changes in routine
  • breaking large projects into smaller, more manageable pieces

Written and/or verbal communication – may have challenges with…

  • word finding, sentence formation
  • taking longer to answer questions
  • taking longer to write papers
  • advocating for self
  • getting to the point

Impaired judgement, problem solving – may have difficulty with…

  • impulsive behaviors and decisions (which may impact self and others)
  • safety awareness
  • association between behaviors and consequences
  • being easily influenced by others

Decreased initiation and follow-through

  • may need assistance to begin an assignment/project, but then can continue on own or with less assist
  • OR, may begin assignment, but then is challenged by follow-through to completion

Reading, math concepts – may have challenges with…

  • reading fluidity
  • math comprehension, building on concepts
  • abstract/theoretical thinking
  • identification of errors made

Physical

Fatigue, sleep issues – may have difficulty with…

  • “hitting a wall”, exhaustion which affects stamina and alertness for classes, studying, working, daily living
  • missing classes or exams, tardiness, leaving class early
  • completing assignments on time
  • sleep pattern changes, which can magnify other symptoms

Headaches, migraines, chronic pain, seizures – may have challenges with…

  • absences, tardiness
  • inability to concentrate fully
  • completing assignments on time
  • needing to leave class early
  • side effects from associated medications, which may impact level of participation, attendance, performance

Sensitivity to sensory input: light, sounds, motions, smells, tastes, textures – may be impacted by…

  • inability to filter out extraneous noises or movements of others in order to concentrate on lecture or work
  • flickering, overhead or bring lights, background or loud noises, excess movement
  • others wearing perfume, hair spray, highly scented lotions, etc. May trigger migraines, nausea, dizziness

Motor planning, tremors – may result in…

  • difficulty handling equipment or tools, handwriting or other fine motor skills
  • delayed reaction time

Speech – may result in…

  • slowed, slurred speech which may be difficult to understand
  • delayed responses

Mobility

Vision

Hearing

Psychosocial

All of the following can significantly and negatively impact academic and work performance and daily life activities!

Depression, isolation

  • grieving loss of “old self” and how things used to be
    • comparing current academic or work performance to previous (before injury), “I used to be a 4.0 GPA student, now I have trouble getting C’s and D’s!”
  • feelings of isolation: “No one understands what I’m going through! I’m in this alone!”
    • may be accentuated in less familiar/newer environment (college); dealing with being away from home
  • changes within the social network - distancing self from friends or friends may begin to disconnect because of behavioral changes or because of lack of understanding
  • withdrawal from academic and social environments, absences, tardiness
    • missing out on full college experience because of fatigue, anxiety, depression, pain, overstimulation, feeling overwhelmed
  • loss of interest in schoolwork and other activities
  • suicide ideation, attempts

Anxiety, irritability, anger/outbursts, mood swings

  • test anxiety, unable to complete assignments because of feelings of being overwhelmed
  • “I seem to be taking things the wrong way!”
  • over-reaction to feedback, grades, may demonstrate inappropriate behaviors or verbalizations
  • “I feel so anxious, my heart is racing. I feel detached, like I don’t belong!”
  • becomes upset and/or cries easily, and not always able to identify specific reasons

Stress, frustration, poor coping skills

  • impaired ability to focus on classes & studying because of heightened stress levels
  • exhaustion from “just trying to hold it together” (takes an enormous amount of energy every day)
  • disorganization
  • impaired ability to identify potential solutions to problems
  • avoidance of activities
  • “I’m tired of having to explain myself all the time to everyone!” “People often don’t believe me!”
  • dealing with stress and fatigue of continually explaining injury to others in order to receive help or raise awareness

Loss of self-esteem, confidence

  • embarrassment about forgetting names, assignments, schedules, appointments
  • feelings of letting others down, not meeting expectations of themselves and others. “I should be able to function like everyone else”, decreased self-esteem
  • may be unable to do things used to do, or doing things takes more effort or time – disappointment in self
  • unaware of or disbelief in his/her full potential

Other Potential Challenges

In addition to those noted above, there may be additional challenges that a person with a brain injury may encounter:

  • Uniqueness of each brain injury – “if you know one person with a brain injury, you know one person with a brain injury!” This is because there are many different factors and combinations that make a person’s brain injury distinctive, such as: severity of the injury, whether there was loss of consciousness (LOC) or not and if so, for how long, area(s) of brain affected, individual’s age at the time of injury, whether & how quickly medical treatment was sought, whether rehabilitation was received, individual’s general health prior to injury, and others.
  • Variability of symptoms, behaviors, feelings, abilities over time – may change from day to day, even hour to hour. This can make it difficult to build a routine or feel dependable.
  • Complexity in separating out symptoms of brain injury, mental health issues, Post-Traumatic Stress (PTS), etc. … even more complicated when factor in alcohol and/or drug use.
  • Grieving process – not only for self, but possibly grieving for others who were lost [motor vehicle accident, natural disaster, victim of crime, etc.].
  • Denial of injury or may not be fully aware of relationship between injury and associated challenges (“I just feel different”), or recognizing changes and dealing with potential sadness & frustration as start to identify the changes & the possible long-term challenges and implications.
  • Recent TBI vs. older injury – changes may still be occurring with a more recent injury vs. an older injury where person may have had time to develop and become knowledgeable about strategies and compensations that are helpful.
  • Legal issues – may be present in part because of the circumstances surrounding the injury (such as a motor vehicle accident) or because of domestic, financial or lifestyle complications that may arise after the injury.

Substance use/abuse

Alcohol and drug use may be considered a way to cope with changes that have occurred. The following highlighted segment is from the Defense and Veterans Brain Injury Center. [9]

Drugs and alcohol after a brain injury

There are many reasons why using drugs and alcohol after a brain injury is not recommended. Here are a few of the main ones:

  • People who use alcohol or other drugs after they have a brain injury don’t recover as much.
  • Brain injuries cause problems in balance, walking, or talking that get worse when a person uses alcohol or other drugs.
  • People who have had a brain injury often say or do things without thinking first, a problem that is made worse by using alcohol and other drugs.
  • Brain injuries cause problems with thinking, like concentration or memory, and using alcohol or other drugs makes these problems worse.
  • After brain injury, alcohol and other drugs have a more powerful effect.
  • People who have had a brain injury are more likely to have times that they feel low or depressed, and drinking alcohol and getting high on other drugs makes this worse.
  • After a brain injury, drinking alcohol or using other drugs can cause a seizure.
  • People who drink alcohol or use other drugs after a brain injury are more likely to have another brain injury.

Treatments and strategies

People with brain injury and their families should know that there are treatments and strategies out there, and ones that can be very effective. Some of them include:

  • Journaling
  • Attending a support group
  • Learning to cope with cravings
  • Setting realistic goals
  • Building self-esteem
  • Medication

It’s crucial for people to get treated for both the TBI and the addiction simultaneously and by someone who knows about both. Seek out a program or programs where there is collaboration and communication between the brain injury treatment providers and the substance abuse treatment providers.

Additional reasons not to use drugs and alcohol after brain injury:

  • potential interference with prescription medications being taken for symptoms of brain injury and/or other conditions such as depression, anxiety, pain, insomnia, seizures, etc. Alcohol/drugs and prescription meds can be a dangerous mix!
  • person may forget to take critical medications when under the influence of alcohol/drugs
  • increased fall risk, which may cause another TBI

TBI and Co-Occurring Mental and Behavioral Health Issues

Some research findings:

  • Suicide and mortality - 3 times higher in persons with TBI than in the general population, even 5 years post-injury, attributed to increased depression and substance use. Also alcohol & drug use disorders and depression were higher in patients with TBI both pre & post-injury (Fazel et al., 2014). [10]
  • Individuals with TBI - 4 times likelier than general population to attempt suicide; presence of mental illness makes person with TBI 10 times more likely to attempt suicide than someone with TBI alone; disinhibition associated with TBI increases suicide risk (Wasserman et al., 2008). [11]
  • Findings from Mackelprang et al., 2014. [12]
    • People with TBI have higher rate of suicide ideations (SI) - almost 7 times higher than general public
    • co-morbidities in mental health (bipolar, depression, etc.) increase suicide ideations
  • Individuals with TBI reported low psychosocial health (double the rate of general population), and only 36% of those reported receiving any mental health services (McCarthy et al., 2006). [13]
  • Research suggests that a childhood TBI increases likelihood of behavioral health problems in adolescence and adulthood, and the younger the age of injury, greater effect may be (Corrigan et al., 2013). [14]
  • There is often a high level of emotional distress following TBI and there may be a tendency to utilize nonproductive coping strategies (avoidance, self-blame, worry, drugs/alcohol, etc.) which are associated with higher levels of anxiety, depression, and psychosocial dysfunction and lower self-esteem levels (Anson & Ponsford, 2006). [15]
  • Association between the number of TBI’s, substance use, & psychiatric diagnoses (Corrigan & Deutschle, 2008). [16]
    • With 3+ TBI’s - average 2 times as many psychiatric diagnoses as those with no TBI
    • With 3+ TBI’s – individuals began substance use an average of 5 years before those individuals without a TBI

Recommended site for additional resources related to TBI and co-occurring mental health symptoms: Department of Veterans Affairs, Mental Illness Research, Education and Clinical Center (MIRECC). [17]

 

Institutional Accommodations

There are a number of things educational institutions can do to assist students who have experienced a TBI, including:

  • Accessible transportation services
  • Alternative Format - text books and print materials can be made digital
  • Alternative testing arrangements- extra time; less distracting environment; provision of a reader/scribe; and use of a computer, including adaptive software and hardware
  • Counseling Services
  • Ergonomic Evaluation
  • Flexible Attendance Policy
  • Note Taking Support
  • Priority Registration

Assistive Technology (AT) Accommodations

Following are some of the latest AT accommodations available that may be helpful to individuals with brain injury. For a complete list of AT solutions, please visit the Assistive Technology Resource Center (ATRC) at Colorado State University.

Teaching Strategies—What Can Faculty Do?

Specific strategies that may be helpful for students with a brain injury:

Frequent Breaks
Allow the student to take small, frequent breaks.
Reinforce Directions
Reinforce directions visually and verbally to meet the student’s learning style and check for comprehension.
Allow student to take test in a different location with fewer distractions, and with additional time, if needed
The Disability Service Office will assist students in providing alternative arrangements. Extra time may be needed for processing of information.
Allow student extra time when responding or presenting information
Student may need extra time to process information and organize thoughts.
Clearly communicate your attendance policy
Decide if you are able to have a flexible attendance policy; if not, inform students at the beginning of the semester. Encourage a student who will not be able to regularly attend class to withdraw if attendance and class participation are important.
Provide notice of changes to the class routine or classroom environment
If there is a change in the classroom environment, location, assignments, class schedule or any other change in routine, give advance notice so student is better able to prepare.
Furnish lecture notes ahead of time
Allows student the opportunity to process, organize and review information to be better prepared for lecture.
Offer alternative presentation formats for assignments
Facilitates opportunity for student to present learned information in optimal learning style format (written, verbal, graphics, demonstration, etc.)
Furnish time estimates on exams, assignments
Assists with time management.
Avoid use of sarcasm and figures of speech
Interpreting abstract information may be difficult.
Utilize concise, bulleted statements
Assists with processing and organizing of information.
Use of consistent terminology
Reduces chance for error or misinterpretation of information.
Foster an encouraging, validating, academic environment
Important for the student to feel validated and encouraged, especially when he/she is dealing with potential loss of self-esteem and confidence after a brain injury.
Pay attention to student’s demeanor
Recognize signs of fatigue, anxiety, overstimulation, being overwhelmed. Student may need to take a break or may need to be excused for class period. Be able to provide students with counseling & medical resources on campus, if needed.
Recognize the uniqueness and variability of symptoms with brain injury
Each brain injury is different and symptoms can vary day to day, which may affect academic performance and consistent class attendance. Prescription medications taken for treatment or lessening of symptoms may also impact attendance and performance. Use of sunglasses and/or brimmed hat may be needed in the classroom to help with visual or migraine symptoms.

General Strategies

Provide Accessible Course Materials
Ensure that all curriculum materials (syllabus, notes, presentations, assignments, etc.) are available in an accessible format that can be used and manipulated by a computer (Word, HTML, RTF, PDF, etc.). To learn how to create accessible materials, see Training Modules and Tutorials on this website.
Plan Ahead
Select textbooks and materials needed for the semester as early as possible.  Students with disabilities will need time to take class materials to the Disability Service Office for conversion to an alternative format.
Provide Structure
Provide a syllabus and class assignments with clearly delineated expectations and due dates.
Provide Guided Notes on the Web
Prior to lectures, provide students with consistent, structured notes that are in an accessible format. Since students with disabilities sometimes have more difficulty than others in processing new information (especially while simultaneously trying to take notes), having notes ahead of time will increase students’ ability to follow along during class and more effectively process course content. If it is not acceptable for all students to have lecture notes ahead of time, make alternative arrangements for students with disabilities such as emailing lecture notes to the student(s) or setting up an office mailbox where the student(s) can receive notes ahead of time.
Provide Multiple Methods of Presentation
Present information and ideas in multiple ways in order to address different learning styles.
Engage students in multiple ways of learning
Incorporate active teaching/learning methods where possible. For example, problem-based learning activities, community projects, in-class activities and discussions, etc.
Encourage Multiple Methods of Expression
Offer more than one way for students to demonstrate what they have learned in class. For example, students can be given a choice between taking a test, writing a paper, giving an oral presentation, producing a video, etc. Additionally, keep in mind that some students may have difficulty working in a group. Alternative ways of completing a group assignment may need to be considered.
Repeat or paraphrase questions and responses so that the whole class can hear.
This is especially important in large classrooms and when a microphone is used during live and taped presentations.
Highlight Key Points
Provide an overview when introducing a new topic, and highlight key points in a variety of ways throughout class lessons and in written materials. Use visual, verbal and interactive cues for added emphasis. This helps students know what to expect and what is most important, thus improving their ability to achieve the learning objectives.
Summarize Key Points
Summarizing key points at the end of each class will increase the student’s ability to process and integrate new information.
Chunk Information
Break large amounts of information or instructions into smaller segments (“chunking”).
Provide Study Aids
Provide study questions, study guides, and opportunities for questions and answers to help students review and clarify essential course content.
Allow the use of digital recorders
Provide students the opportunity to process and review class material at their own pace, both after class and later during the semester. Review of material in this manner is especially helpful in preparation for mid-term and final exams.
Engage with Students who Self Advocate
Team up with students with disabilities (who disclose their accommodation needs) to determine a plan that is effective for all involved.

Shaping the Learning Environment

Enhance Lighting
If possible, turn off overhead, florescent lights and provide natural lighting. Overly bright and/or flickering lights can trigger symptoms for some students.
Create a Calming Environment
Eliminate any unnecessary visual and auditory stimuli in the classroom; and try to maintain a routine. Allow for only one person at a time to speak.
Create an Environment which Minimizes Fatigue and Injury
Create a station where all needed materials are located, minimizing the amount of movement around the classroom. Ask a student to hand out materials versus having all students walking around. Set up lab/work stations with all equipment within reach. Minimize extraneous noises, lights or sensory stimuli.
Recognize significance of classroom scents
Some students with a brain injury are very sensitive to perfumes, colognes, lab materials, food odors, and other fragrances. These may trigger migraines, nausea, dizziness or other symptoms.
Seating and Positioning
Encourage the student to sit away from doors, air conditioning units, windows, or any other possible sources of distraction. Sitting in the front of the room may reduce distractions.

Learning Strategies—What Can Students do?

Advocate for self
Connect with the Disability Service Office (DSO) to learn about available services and supports. Communicate with instructors about personal learning style and any individual accommodations that are being requested. Ask for clarification on material when unsure. Students should also be encouraged to read the ACCESS Self-Advocacy Handbook for College Students with Disabilities, available on this website.
Peer Support
Seek peer support of other students with disabilities. Check with the Disability Service Office to find out about peer support groups. Find groups of people in your classes to study with that are respectful of your learning needs.
Plan Ahead for books in alternative format
Books should be ordered one semester in advance of when they will be needed so as to allow time for format conversion. The Disability Service Office will be able to help with this process.
Record the class lecture
Ask professor if you may record lectures. It may be beneficial to place the recorder in the front of the class, near the professor for optimal sound quality.
Ask for Teacher or Peer Notes
This will allow you the opportunity to concentrate on lecture content without trying to keep up with writing notes at the same time as hearing the information.
Regularly utilize a planner or cell phone app
Schedule assignments, appointments, deadlines and do this consistently.
Locate & create advantageous study space
Become aware of your optimal study space – is it in a quiet location with no distractions, or in a busier location such as a coffee shop, indoors or outdoors, with music in background or not, etc.?
Pay attention to signs of fatigue, schedule regular breaks
Rest, stretch, eat something nutritious, or walk around to give yourself a break. It is important to take a break rather than “pushing through” to the point of exhaustion.
Stay hydrated and pack nutritious snacks for optimal learning
Important to eat balanced meals and snacks throughout the day and stay hydrated to maintain brain function (water is suggested rather than sodas, high sugar drinks).
Seek assistance when needed
If there are changes in symptoms, feelings, behaviors, performance, stress level, seek medical or counseling help on campus, or talk with trusted friends, family members or other supports. Don’t try to go it alone. Everyone needs help at some point in life - don’t be afraid to ask for help!
Educate yourself and others around you
Learn to identify your needs, recognize your reactions to people and circumstances, environmental and other triggers, develop coping skills and stress management techniques. It can also be very empowering to help other people in your life understand your needs, challenges and successes and to help them understand more about brain injury.

Free Apps

Following are some phone apps that may be helpful and are current as of June, 2015:

Name

Description

Price

Device

Helps With

Breathe2Relax

Hands-on stress management tool with diaphragmatic breathing exercises. Designed to help you with mood stabilization, anger control, and anxiety management.

Free

iOS, Android

Anxiety, Stress, Coping

Relax Melodies

Helps create a calming environment that may help you fall asleep and stay asleep.

App includes 50 sounds to relax to and has a timer function to stop music once you’re asleep, and an alarm to set for when you need to be awake.

Free

iOS, Android

Anxiety, Stress, Coping

Worry Box

App that allows you to write down your thoughts, anxieties, and worries. The app then helps you think them through by asking questions and giving specific anxiety-reducing help. Everything you enter is password protected.

Free

iOS, Android

Anxiety, Stress, Coping

Cozi Family Organizer

Organization app that contains a shared calendar, shopping lists, to do lists, and family journal. Helps whole family stay organized and in-sync.

Free

iOS, Android

Organization

Evernote

Help remember everything across all of the devices you use.

Stay organized, save your ideas, and improve productivity. Take notes, capture photos, create to-do lists, record voice reminders, and make notes completely searchable.

Free

iOS, Web, Android

Organization

Dragon Dictation

Voice recognition app that allows users to easily speak and instantly see their words on the screen.

Send short text messages, longer email messages, and update your Facebook and Twitter statuses without typing a word.

Free

iOS

Communication

 

 

PREVENTION OF TBI

Act preventively whenever possible. Be aware that once you have a TBI, you are at greater risk of sustaining another TBI

  1. Helmet use – approved, properly fitted helmets are important and are recommended for many sports and daily activities, particularly for any activity in or near traffic.
  2. Seek medical attention if you have an impact to your head and/or something doesn’t feel right.
  3. Athletes – report impacts to head, don’t return to play too soon, get checked out rather than wonder. When in doubt, best to sit it out.
  4. Raise your self-awareness about distracted driving, distracted cycling (swerving into traffic, hitting curbs), and distracted walking (falling off curb while looking at cell phone). NOTE: texting is considered especially dangerous when driving because you are distracted in 3 ways (visually, manually, and cognitively).
  5. Use your seat belt every time, even for short distances
  6. Wear brightly colored, reflective clothing at night for increased visibility
  7. Double check traffic before crossing streets – always!
  8. Do not drink and drive or drive under the influence of marijuana or other drugs

For other recommendations see: Brain Injury Safety Tips and Prevention [18]

Resources — Traumatic Brain Injury

Brain Injury Alliance of Colorado
The “go-to resource for help and services for survivors of an injury to the brain, their families and providers.”
Brain Injury Association of America (BIAA)
General information and resources on brain injuries
Colorado Brain Injury Program (CBIP), Colorado Department of Human Services
The CBIP “has been established to help people with brain injury and their loved ones by assisting with accessing needed supports to maximize recovery now and in the future.”
Defense and Veterans Brain Injury Center (DVBIC)
Offers many resources and education on brain injuries and veteran services.

General Disability Resources

Americans with Disabilities Act (ADA)
ADA Home Page (U.S. Department of Justice)
ERIC Digest
Overview of ADA, IDEA, and Section 504
Equal Access to Software and Information (EASI)
Workshops, publications, and resources about computer access for people with disabilities
University of Washington - Disability-Related Resources on the Internet
A comprehensive list of Web sites and discussion lists related to disability.
Faculty Room
The Faculty Room is a site for faculty and administrators at postsecondary institutions to learn about how to create classroom environments and activities that maximize the learning of all students, including those with disabilities. This page is specific to faculty rights.
PACER Center – Champions for Children with Disabilities
ADA Q& A: Section 504 & Postsecondary Education
U.S Department of Education, Office of Civil Rights
Three documents by the Office of Civil Rights describing the rights of wounded warriors to a postsecondary education under the new GI Bill:
U.S. Department of Health and Human Services (HHS),
Office of Civil Rights (OCR)
Discrimination on the Basis of Disability
U.S. Equal Employment Opportunity Commission (EEOC)
Titles I and V of the Americans with Disabilities Act of 1990 (ADA)

References

1Lobes of the Brain: Blausen.com staff. "Blausen gallery 2014." Wikiversity Journal of Medicine. DOI:10.15347/wjm/2014.010. ISSN 20018762. Accessed June, 2015.

2The Aging Brain: A Lesson on Alzheimer’s Disease. Centers for Disease Control and Prevention (2015). Accessed June, 2015.

3Lehr, R. P. (2015). Brain function. Accessed June, 2015.

4Centers for Disease Control and Prevention. (2015). Injury prevention and control: Traumatic brain injury. Leading causes of TBI. Retrieved from http://www.cdc.gov/traumaticbraininjury/get_the_facts.html#Howbig. Accessed June, 2015.

5Centers for Disease Control and Prevention (2015). Injury prevention and control: Traumatic brain injury. Retrieved from http://www.cdc.gov/traumaticbraininjury/get_the_facts.html#risk. Accessed January, 2015.

6Defense and Veterans Brain Injury Center (2015). DoD worldwide numbers for TBI. Retrieved from http://www.dvbic.org/dod-worldwide-numbers-tbi. Accessed June, 2015.

7Taber, K. H., Warden, D. L., & Hurley, R. A. (2006). Blast-related traumatic brain injury: What is known? Journal of Neuropsychiatry & Clinical Neurosciences, 18, 141-145.

8Brain Injury Alliance of Colorado (2015). Brain injury facts & figures. Retrieved from http://biacolorado.org/education/brain-injury-facts-figures/ . Accessed June, 2015.

9Defense and Veterans Brain Injury Center (2015). Why not to use drugs and alcohol after a brain injury. Retrieved from http://dvbic.dcoe.mil/life-after-tbi/substance-abuse?audience[0]=1 . Accessed June, 2015.

10Fazel, S., Wolf, A., Pillas, D., Lichtenstein, P., & Långström, N. (2014). Suicide, fatal injuries, and other causes of premature mortality in patients with traumatic brain injury: A 41-year Swedish population study. JAMA Psychiatry, 71(3), 326-333.

11Wasserman, L., Shaw, T., Vu, M., Ko, C., Bollegala, D., & Bhalerao, S. (2008). An overview of traumatic brain injury and suicide. Brain Injury, 22(11), 811-819.

12Mackelprang, J. L., Bombardier, C. H., Fann, J. R., Temkin, N. R., Barber, J. K., & Dikmen, S. S. (2014). Rates and predictors of suicidal ideation during the first year after traumatic brain injury. American Journal of Public Health, 104(7), e100-e107.

13McCarthy, M. L., Dikmen, S. S., Langlois, J. A., Selassie, A. W., Gu, J. K., & Horner, M. D. (2006). Self-reported psychosocial health among adults with traumatic brain injury. Archives of Physical Medicine and Rehabilitation,87(7), 953–961.

14Corrigan, J.D., Bogner, J., Mellick, D., Bushnik, T., Dams-O’Connor, K., Hammond, F.M., Hart, T., & Kolakowsky-Hayner, S. (2013). Prior history of traumatic brain injury among persons in the traumatic brain injury model systems national database. Archives of Physical Medicine and Rehabilitation, 94, 1940-1950.

15Anson, K., & Ponsford, J. (2006). Coping and emotional adjustment following traumatic brain injury. The Journal of Head Trauma Rehabilitation, 21(3), 248-259.

16Corrigan, J. D., & Deutschle Jr, J. J. (2008). The presence and impact of traumatic brain injury among clients in treatment for co-occurring mental illness and substance abuse. Brain Injury, 22(3), 223-231.

17Department of Veterans Affairs, Mental Illness Research, Education and Clinical Center (MIRECC) VISN 19 Rocky Mountain Network:www.mirecc.va.gov/visn19. Accessed June, 2015.

18 Centers for Disease Control and Prevention (2015). Brain injury safety tips and prevention. Retrieved from http://www.cdc.gov/headsup/basics/concussion_prevention.html. Accessed June, 2015.

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