CHALLENGES & STRATEGIES FOR VETERANS WITH TBI RETURNING TO SCHOOL

Laurel Schaefer, BFA Regional Education Coordinator

Defense & Veterans Brain Injury Center

VETERANS RETURNING TO SCHOOL

Traumatic Brain Injury is signature wound of this war. *2000 to date, 294,000 SM’s have been diagnosed with some level of TBI. AKA: The Invisible Wound

Colleges/Universities are reporting increases in Student Veterans with TBI& PTSD.

MISSION: Not only to GO to school but to SUCCEED at school!

Student Veterans are not the only people struggling…so are the instructors!

WHAT YOU WILL LEARN TODAY

Concussion Basics

How TBI Can Affect Learning

Challenges & Strategies

Other Considerations for Educators

Resources: Websites & Apps

WHAT IS A TBI ?An external force or blow to the head causing

adisruption to the normal function of the brain.

TWO CONDITIONS MUST OCCUR!

1) INCIDENT Blast ~ Falls ~ Motor Accident ~ Assault ~

2) SYMPTOMS – immediately upon occurrence

** Not all blows to the head result in a TBI

** A mild TBI is also known as a concussion

** You don’t have to be knocked out to have a TBI

SEVERITY OF TBI

Mild TBI (mTBI) Moderate TBI Severe TBI

-“dazed” to brief -unconscious -unconscious

unconsciousness 30 mins-24 hours over 24 hours

* Concussion * Unconscious * Coma

Common Symptoms Seen in TBIPhysical:•Sleep difficulties•Fatigue•Headaches•Dizziness•Blurry or double vision•Balance problems•Sensitivity to sounds &/or light•Ringing in the ears•Nausea

Cognitive:•Poor concentration•Memory problems•Trouble thinking•Slowed performance•Difficulty putting thoughts into words•Poor judgment & impulsivity

Emotional:•Anxiety•Depression•Irritability•Mood swings•Personality changes•Anger outbursts

PTSD TBI

Post Traumatic Stress Disorder and TBI

Flashbacks

Avoidance

Hypervigilance

Nightmares

Re-experiencing phenomenon

Cognitive Deficits

Irritability

Insomnia

Depression

Fatigue

Anxiety

Headache

Sensitivity to light or noise

Nausea/vomiting

Vision Problems

Dizziness

TRANSITIONING TO ACADEMIC ENVIRONMENT FOR STUDENT VETERAN

REQUIRES:• UNDERSTANDING AN OFTEN

COMPLICATED SYSTEM

• ADAPTING NEW SKILLS

• DEVELOPING SUPPORT SYSTEMS

TBI can affect: Cognition-memory, attention, organization, & problem solving

Speech

Auditory comprehension, processing, naming, reading, and writing

Visual scanning and spatial skills

Social interactions

Level the Playing Field• Disability Support Services (DSS)(Disability Student Services, Academic Support Services, Student Success Center, Student Access Center)

• Academic Advisor, Registrar, Counselors, Vet Center• Assistive technology• Campus access, map showing disability campus features • Library access• Accommodations plan (seating, test taking, etc.)

• University Learning Center• Tutors-Math , Writing and Subject • Writing & Math Labs • Supplemental Instructors

• Student Veteran’s Organizations

Challenges and Strategies when Returning to School with TBI and/or PTSD

Transitioning from Service to School:

• Regimented environment into college environment that has less direction

• Difficulty adjusting to campus culture and relating to younger students which may lead to isolation

• Adjusting to civilian life

• Minimizing impact of disability

• Uncertainty of academic long-term goalso “I feel like I have been placed on another planet.”o “This class is scarier than my deployment.”

Student Veterans with TBI may: Have headaches or physical pain which may make it difficult for them to concentrate during class

Have difficulty absorbing/comprehending the information at the speed in which it is presented in the classroom.

Instructor’s Observations

Not ask questions because they do not want to call attention to themselves as others may view them as stupid, crazed or even dangerous.

Compromised communication skills (slurred speech, difficulty forming thoughts into words or questions).

Not questioning the professor because one doesn’t question authority in the military!

Instructor’s Observations

EDUCTOR’S INTERVENTION WITH STUDENT VETERAN WITH PTSD/TBI

REQUIRES:

• UNDERSTANDING of ALLOWABLE OPTIONS & TOOLS

• ADAPTING TO THE SPECIFIC ACCOMODATIONS NEEDED BY THE STUDENT VETERANS

• UTILIZING SCHOOL’S SUPPORT SYSTEMS

Sometimes the individual might feel uncomfortable around crowds;

Being in a classroom (with a lot of other students)

Being in a public place with crowds of people.

CHALLENGE #1

Managing discomfort with crowds in the classroom: The Student Veteran might feel more comfortable sitting in a place where they feels safe.

They may like to sit where they can see the door or a place where they can scan the entire environment.

STRATEGY

A Veteran returning to school may have an overactive startle response.

The Veteran may be easily startled over loud noises or if someone approaches them from behind.

CHALLENGE #2

Managing an overactive startle reflex: 1) Keep Calm ~ if you see a Student Veteran over-reacting

Do not laugh or make fun of the individual even if the situationseems humorous

2) Use healthy distractions Distraction can be a useful way of coping with stressful thoughts or feelings that seem

overpowering

3) Don’t put the focus on him or her

STRATEGY

A Veteran returning to school may be socially withdrawn. Especially those with TBI/PTSD symptoms. Often they feel disconnected or detached from others, even people with whom they once were close.

CHALLENGE #3

Encourage students to identify and take part in positive activities

People with brain injury, depression and/or PTSD symptoms may find that certain activities are no longer pleasurable, or that they may be afraid to go out and do the things they once enjoyed.

However, this avoidance only maintains feelings of despair and depression. Suggest recreation activities or acts of altruism where they can focus on the needs of others and not the deficiencies of themselves.

STRATEGY

UNTOLD EXPERIENCES

The Student Veteran may be a very private person who needs to gain complete trust from others before engaging

in general conversation.

CHALLENGE #4

Encourage Student Veterans to seek treatment from a trained therapist and/or join a support group

A number of individual treatment options as well as support groups are available for Veterans with TBI/PTSD.

Listening to other peoples' experiences with TBI/PTSD can help validate the feeling they may be experiencing.

STRATEGY

The Veteran returning to school might be experiencing pain such that they cannot tolerate sitting in the classroom for long periods of time

CHALLENGE #5

Discuss with the student beforehand about specific needs Sitting in the back of the classroom Standing up as needed Taking brief breaks Stretching

STRATEGY

Other Accommodations Professors May Offer:

• Tutors to assist in preparing for tests• Approve to have another student take notes• Allow extra time to finish test or assignments• Adapt a different test or materials format• Approve the use of assistive technology• Allow wearing sunglasses in class• Provide priority seating in class• Waive foreign language requirement

•Put things in writing (class schedules, syllabus, etc.)

•Give breaks whenever possible

•Use visuals whenever possible

•Resist calling on Student Veterans to speak

•Be tolerant if the person repeats stories and experiences

•Encourage note taking & use media whenever possible

•Be understanding of sleep problems & attention problems

• Every brain injury is different. Respect, support & dignity.

• Minimize high pressure situations. No stress

Other Accommodations Professors May Offer:

WEBSITES ~ APPS ~ DEVICES

www.dvbic.dcoe.mil

www.brainlinemilitary.org

The Bottom Line……

…..Remember to use compassion and patience when working with our Student Veterans.

These men and woman have given much to our country protecting and defending our freedoms.

Knowing how to empower your Student Veterans fosters confidence in yourself and those you teach.

QUESTIONS?

ReferencesAaron Tull, Ph.D. (Department of Psychiatry and Human Behavior at the University of Mississippi Medical Center) and http://www.americasheroesatwork.gov/resources/factsheets/tips/

CDC Fact Sheet 3/05 www.cdc.gov Ponsfor, J. (2004) Information about Mild Head Injury or Concussion; Warden, D.

“Traumatic Brain Injury Guide for Patients and Families”

Also recommended: www.americasheroesatwork.gov