2. CHALLENGES & STRATEGIES FOR VETERANS WITH TBI RETURNING TO SCHOOL Laurel Schaefer, BFA Regional Education Coordinator Defense & Veterans Brain Injury Center

3. 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!

4. WHAT YOU WILL LEARN TODAY  Concussion Basics  How TBI Can Affect Learning  Challenges & Strategies  Other Considerations for Educators  Resources: Websites & Apps

6. WHAT IS A TBI ? An external force or blow to the head causing a disruption 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

7. 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

8. Common Symptoms Seen in TBI Physical: 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

9. 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

10. TRANSITIONING TO ACADEMIC ENVIRONMENT FOR STUDENT VETERAN REQUIRES: UNDERSTANDING AN OFTEN COMPLICATED SYSTEM ADAPTING NEW SKILLS DEVELOPING SUPPORT SYSTEMS

11. TBI can affect:  Cognition-memory, attention, organization, & problem solving  Speech  Auditory comprehension, processing, naming, reading, and writing  Visual scanning and spatial skills  Social interactions

12. 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

13. 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 goals o “I feel like I have been placed on another planet.” o “This class is scarier than my deployment.”

14. 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

15.  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

16. 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

17.  S ometimes 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

18. 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

19. 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

20. 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 situation seems 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

21. 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

22. 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

23. 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

24. 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

25.  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

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

27. 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

28. 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:

29. WEBSITES ~ APPS ~ DEVICES www.dvbic.dcoe.mil www.brainlinemilitary.org

30. 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.

31. QUESTIONS?

32. References Aaron 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)www.cdc.gov Information about Mild Head Injury or Concussion; Warden, D. “Traumatic Brain Injury Guide for Patients and Families” Also recommended: www.americasheroesatwork.govwww.americasheroesatwork.gov