TBIs have long been known as the "silent epidemic" because many people were affected by a TBI, but were not properly diagnosed. Today, awareness has grown significantly since the late 1990s (the time when my family was introduced to TBI), but there is still a way to go.
A traumatic brain injury (TBI) can significantly impact how a student learns. However, it is important to understand, much like no two brain injuries are alike, the learning impact on different students who have sustained a TBI will also not be alike. The special education departments in schools should make a concentrated effort towards understanding of TBIs because they are not always visible injuries. And the impacts will vary greatly from child to child.
The fact that a TBI could cause problems with a child's ability to learn may not be clear, or even consistent. This is important for educators to consider. How the injury affects a student's learning ability will depend on several factors, most specifically, the nature of the injury, how old the child was when he or she injured, and what area(s) of the brain were affected. The effects of a traumatic brain injury may even depend on the day. The one thing that is probably constant with brain injuries is that its effects are largely inconsistent.
A brain injury can affect a child in many ways including:
- Physical effects
- Cognitive impact
- Behavioral and emotional effects
Any and/or all of these can significantly impact learning.
The physical condition after a child sustains a TBI can impact learning. Physical disabilities can be more severe and obvious, but they can also emerge in more subtle ways. Consider difficulties with small motor skills such as holding a pencil or crayon or having problems with speech. A child may also have visual impairments, hearing loss or both. Since the brain controls all bodily movement, functions and thoughts, any number of difficulties could arise. Services schools can include in the student's individualized education plan (IEP) can include occupational and/or physical therapy to help reduce the impact of the injury on learning.
Occupational therapy after a traumatic brain injury has occurred helps children gain, or relearn, many of the small motor skills they'll need to facilitate learning.
Perhaps one of the most significant obstacles a student with TBIs can experience are the cognitive challenges that emerge after the injury occurs. Cognitive difficulties can come in the form of short-term memory loss, long-term memory loss, inability to concentrate and being able to stay on task. Or any combination of difficulties. A child may also find he or she cannot effectively filter out background noise in busy classrooms, be able to multitask or follow multi-step directions. These are skills needed for all students in the classroom, but for the child who has suffered a TBI, he or she may have more difficulty performing some of these cognitive skills.
Interference with executive functioning is probably one of the largest cognitive challenges associated with brain injuries because it impacts so many areas of learning. When a person experiences issues with executive functioning he or she may find it difficult to plan, arrange details, problem solve, set goals and/or be organized. He or she may also lack the capacity to self-regulate. The latter often emerges in the form of behavioral issues.
Behavioral and Emotional Effects
Depending on where in the brain the child was injured, behavioral issues may arise. These also can interfere with learning, and it may be a daily presence or could happen sporadically. For families who are coping with the effects of brain injury, this often presents a challenge because of the unpredictable nature of behavioral outbursts which could disrupt learning abilities either on a regular basis or occasionally.
The emotional effects of a TBI can also affect learning abilities. If a student gets easily distracted or dismayed, this can impact his or her concentration abilities. Many people who have sustained a TBI find themselves experiencing issues with socialization, frustration because they cannot do all the things they used to do or are having a hard time coping. They may also be restless, experience lower motivation and/or have anxiety. As they grow older, they may also become depressed or have difficulty controlling emotions. These issues can all affect a student's learning throughout their schooling years.
Perhaps one of the biggest challenges faced is that new and/or unanticipated problems may surface as a child grows and reaches stages of growth.
"The cognitive impairments of children may not be immediately obvious after the injury but may become apparent as the child gets older and faces increased cognitive and social expectations for new learning and more complex, socially appropriate behavior. These delayed effects can create lifetime challenges for living and learning for children, their families, schools and communities," writes the Brain Injury Association of America. 
Experts agree having a neuropsychological evaluation done is beneficial in helping develop the best education plan. When our child was younger, this was done every three years and then again when she was a young adult.
Over the years many TBI cases have gone either unnoticed or misdiagnosed. As a result, children are incorrectly or inappropriately placed into learning disabled categories for special education services. When a child sustains a TBI, he or she may have difficulties with various aspects of learning. Since the nature of the injury is much different than factors which are linked to other learning disabilities, traumatic brain injury cannot, and should not, be equated or categorized with other learning disabilities; there is no one-size-fits-all education program for the child with a TBI.
Additionally, situations that emerge can also sometimes be difficult to access because this is all going on during regular development that occurs in childhood. For my family, especially as our child grew older, it was often hard to determine what issues were related to TBI and which ones were a part of a "normal" developmental experience. Being involved and having strong relationships at school is so important for parents because working together as a team can help provide the best education experience for a child.
Children with TBIs generally travel a different journey than children who have not sustained a head injury because they may not be able to learn in the same traditional formats established in a generalized education. Schools should be mindful of this and realize that a child with a TBI may need an alternate approach to learning while still providing the least restrictive environment. In our experience, I always likened it to not being able to take the straight A to B path, but sometimes we could get there by taking the longer or different C route.
In education, being flexible, able to expect the unexpected and be willing to think outside the box can really help a student with TBI. Our child was also our school district's first experience with a student who had TBI. I will always be grateful to those educators that made the effort to really try to understand traumatic brain injury.