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 with a short-term memory, 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.

Many students with an ABI have a lack of insight regarding their level of ability, and may be unable to recognise that their performance and capabilities are functioning at a reduced level. They may respond to negative feedback by believing that teachers are against them, or find other ways to convince themselves that their performance is still normal.

Planning and organisational skills can be impaired 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 an 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 impairment of 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 and it can be an exciting challenge to work 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 provide compensation to memory deficits.include:

• 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 etc.
• 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, e.g. the student may have a memory of achievement that is inconsistent with their impaired ability
• the student’s inability to recognise that a disability exists
• others having too high an expectation of 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 personal stress is the feeling of helplessness or being trapped in a situation over which we have no control. Disciplined or authoritarian environments can add to the student’s belief that he or she is deprived of alternatives. The student should be able to choose from a number of options in dealing with these emotions.

The triggers for these emotions should be identified, and where possible, avoided. When this is not possible, relaxation techniques such as meditation can be helpful. Teachers and students might agree on a strategy whereby the student takes time out 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 or inappropriate. Again, teachers and students can agree on a strategy to stop 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. In time it will become an automatic process.

All educational institutions now have policies that make allowances for people with disabilities in relation to time given for tests and assignments. These institutions are frequently unaware of the multiple impacts on a student’s abilities, such as short-term memory difficulties, mental fatigue, lack of concentration, susceptibility to stress and lowered organisational ability. Students should contact their disabilities officer to make suitable arrangements for tests and assignments.

Schools and universities have resources available to help students with a disability learn new material. Students may need to provide information about their particular disability in order to gain access to these resources, as there can be limited awareness of brain injury in many organisations. A doctor or neuropsychologist can provide a letter to document that a person has a valid disability.

It is necessary for a student to explain the accommodations or special help they require, such as:

• extra time, 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, most do better in mornings than evenings
• 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. Most survivors say that learning compensatory strategies is one of the hardest challenges in their lives, but their determination and perseverance paid off, and has made them better people.