Returning to studies

Going back to school, university or other learning institutions can be rewarding given the right support. Common challenges include learning new material if there are memory problems, managing fatigue and fitting in socially where there may be a lack of understanding by others. There are ways to overcome these and other barriers to learning as outlined below.

An injured brain may never be restored to pre-injury capabilities, but performance can generally be improved. Difficulties are often experienced in the areas of attention and concentration. It will be necessary to gradually build up tolerance for concentrating on a daily basis. Keep periods of concentration short by allowing regular breaks. Start with ten minutes and build up slowly with a few extra minutes daily.

Some students with a brain injury have a lack of insight regarding their level of ability and may be unable to recognise that their performance and capabilities are lower than before. They may respond to negative feedback by believing that teachers are against them or find other ways to convince themselves that their performance is as it was pre-brain injury.

Planning and organisational skills can be impacted to the extent that the student knows what he or she wants to do, but has difficulty getting started. Students need support to develop a step-by-step plan. They can be encouraged to identify the task, keep it simple, and address one task at a time. The following tips can assist with planning and organisation:

• write down all the steps required to complete the task
• arrange the list of steps in the order they are to be achieved
• treat steps as self-contained goals and tackle them one at a time
• as each step is completed, reinforce it as an achievement of success
• create a distinct break between each step
• review each preceding step before moving onto the next.

Most brain injuries will result in impacts to short-term memory and the ability to retain or process new information. Students might lose books and equipment, forget appointments, ask the same questions again and again, or forget which classroom they are supposed to be in.

Fortunately, there are ways to assist memory by working out new avenues to compensate for problems. It is important that students are ‘aided’, not ‘rescued’ from their own failing memory.

Students with poor memory should use memory aids and will need the support of others through constant reinforcement. Common memory aids which can help with memory include:

• a tablet or smart phone with planning apps that store timetables, calendars, maps, links to the university and library, and A smart watch can also be helpful for reminders and alarms.
• a diary to note all class times, appointments and instructions
• a notebook to list common times and protocols
• a map of the school showing classrooms, toilets, offices, bus stop
• clearly marked exercise books and equipment
• thong necklace for keys
• wristwatch with an alarm.

People without brain injury can use their planning and organising skills to work their way through confusion. It is difficult for a student with brain injury to deal with confusion, as these skills are often impaired. Confusion typically arises due to:

• unrealistic self-expectations, g. the student may have a memory of achievement that is inconsistent with their post brain injury ability
• the student’s struggles to recognise that a disability exists
• others placing expectations that are unachievable on the student
• the student is attempting to achieve too much at once
• interruptions, noise, clutter or visual distractions around the student
• too many instructions being given to the student at once.

Teachers can play a role by discussing any issues with the student and making changes to minimise confusion.

A common trigger for stress is the feeling of helplessness or being trapped in a situation over which we have no choice or control, and people with brain injury can become agitated in these situations.

The triggers for these emotions should be identified, and where possible, avoided. When this is not possible, relaxation techniques such as mindfulness or deep breathing can be helpful. Teachers and students might agree on a strategy whereby the student takes time away from the environment when high levels of anger or aggression arise. This needs to be seen as a chance to restore balance and perspective, not as a punishment.

Impulsive behaviours as a result of brain injury are not intended to be hostile, however they can be disruptive and sometimes inappropriate. Again, teachers and students can agree on a strategy to shift the behaviour. The teacher might give a sign for the student to stop and think about what they are doing, such as a word or gesture designed to be a ‘circuit breaker’ in the behaviour.

Educational facilities are able to provide additional support for people with disability in their study, including during tests and assignments. It is a good idea to contact the school or university to let them know about anything that may impact on study such as short-term memory difficulties, mental fatigue, lack of concentration, susceptibility to stress and lowered organisational ability.

Schools and universities have resources and supports available to assist students with a disability, such as:

• learning support assistants
• extra time for assignments and examinations
• exams in a quiet room without distractions
• copies of class notes if concentration and attention are affected.

Having routines and strategies in place is advisable for students managing the effects of brain injury.

Students can try the following:

• have a balanced diet, good sleep and regular exercise
• avoid alcohol, cigarettes and other drugs
• structure the days and week with a daily planner, diary or electronic organiser
• use memory prompts, such as notepads, alarms, post-it notes, and a large notice board
• experiment with study times; and see what is the best time of day for study
• structure study times and stick to them no matter how you feel
• make use of study groups or a ‘study buddy’.

There are many resources available on good study techniques. Students with a brain injury may take longer to learn these strategies, but the same benefits are available once the skills are acquired.