Effects of brain trauma on learning outcomes

CHAPTER I: INTRODUCTION

Background to the study

Brain trauma can occur at any stage of a person’s life. Among learners, there are several events in their day to day activities, including concussion, maltreatment, physical activities, and toxic stress that may result in brain trauma. Traumatic brain injury may involve a violent blow or jolt on the head (Kinnunen et al., 2011). Traumatic brain injury (TBI) can also be caused by an object that is able to penetrate brain tissue. Concussion and other traumatic experiences profoundly limit brain development among children thus hampering their cognitive functions. The growing volume of the literature suggests that concussion adversely impacts various aspects of lives, including home, school, and social relationships among children and adolescents. According to a 2013 clinical report of the American Academy of Pediatrics, there are potential vulnerabilities to academic functioning following concussion (Bush et al., 2011). Multiple qualitative studies indicated that children may suffer from several post-concussion symptoms, such as headaches, fatigue, slowed processing of information and impaired concentration, which negatively impact academic performance (Vergara et al, 2018; O'Neill, Guenette & Kitchenham, 2010).

The several post-concussion symptoms highlighted in studies points toward a significant impact of TBI on the cognitive skills of children. The school going children may find it had focused their thought processes in an immediate aftermath of head injury. Van der Kolk (2005) showed that people suffering from TBI experienced symptoms such as memory losses, learning difficulties, poor reasoning, judgment challenges and low attention spans and so on. The researcher also indicated that TBI adversely affects executive functioning skills, such as problem-solving, multitasking, organisation, planning, decision-making, and task completion. Alternatively, Bush et al (2011) intimated that TBI could adversely impact on communication ability which is an important element in learning. The researchers also showed that in many cases students are forced to be away from school after a concussion when they are still at the symptomatic state thus impeding their ability to keep pace with the curriculum. Besides, students’ efforts to engage in cognitively challenging activities could worsen the symptoms of the brain and lead to even more school absences. For instance, high school students were to manifest more post-injury school difficulties due to the greater demand for them to balance the breadth and depth of the academic curricula and extracurricular activities compared to lower grade students (Bush et al., 2011).

Though brain trauma poses a major threat to a child’s learning achievement, organisations such as the International Conferences on Concussion in Sport and the American Academy of Neurology proposed that implementation of standardized protocols could help these children to return to normal life (Bramlett & Dietrich, 2015). However, there is still no expert consensus on a specific protocol that can be used in the management of students returning to school after concussion recovery, although some stepwise measures have been suggested. Inconsistent recommendations and lack of standard communication channels between school personnel and medical practitioners could also contribute to adverse post-injury learning and academic performance effects. It is therefore important that any protocol of post-injury academic proposal be based on evidence and understanding on concussion effects on learning. Through an examination of the frequency and examples of academic challenges students face during concussion recovery, schools can be able to evidence-based learning strategies to guide their return to school. Hence, this paper intends to explore how brain trauma impacts on learning in the classroom.

Purpose of the Study

Many school going children suffer from different extents of brain injuries before the end of the curriculum. After suffering concussion or brain trauma, they have to return to classroom settings even when still experiencing some post-concussion symptoms. Understandably, these children should return to classroom as fast as possible to catch up with their colleagues but the classroom climate should first be designed in a manner that enables effective reintegration and rehabilitation (Van der Kolk, 2005). Subsequently, the educational system is required to assist the victims to facilitate their social and academic functioning. Educators have different intervention strategies for assisting brain traumatic children after resuming to the school setting. Successful adaptation to the school may require readjustment of the learning atmosphere, support from special education providers, provision of compensatory support, and acquisition or reacquisition of skills.

Without the school support system, the children will be more vulnerable to poor performance in classroom participation and academic assessments. Bramlett and Dietrich (2015) noted that teachers face challenges in addressing students with TBI. Due to the challenge, the needs of students with TBI are not fully satisfied thus, affecting their learning and consequently academic performance. Therefore, it is necessary to understand the effects of brain trauma in classroom learning. Increased awareness of the effects of brain trauma on academic performance is needed. Thus, an urgent increase in educational strategies to help students with brain trauma is necessary. Being aware of the effects of brain trauma on students’ performance, teachers can pay more attention to the students who have had the disorder. Also, teachers’ awareness of brain trauma effects can increase their knowledge and confidence in how to deal with the affected students. Additionally, brain trauma students will recognize their limitations on classroom learning and be able to compensate time wasted in treating brain trauma (Bush et al., 2011).

Based on the past evidence, the main aim of this paper will be to enhance knowledge and provide an in-depth understanding of the direct effects of brain trauma on classroom learning. To achieve the objectives of the study, the study will examine the following: (1) the teachers’ perception on students with brain trauma, (2) the perceptions of classmates of the students with brain trauma, (3) the academic performance of students with no TBI, (4) the academic performance of student with TBI, and (5) the average academic performance as per the school grading system of each group.

Research Questions

This paper seeks to answer the following questions:

i. What are the effects of brain trauma in classroom learning?
ii. How is the academic performance of Students with TBI?
iii. How is the academic performance of the student with no TBI?
iv. What is the school average performance?

To answer these questions, the researcher examines the school-related effects of concussion in students, especially those who are actively symptomatic and are still undergoing concussion clinic treatment compared to those who have recovered from a concussion. In doing so, the researcher shall explore the level of student and teacher concern regarding the injury’s potential effects on academic learning and achievement. Besides, the researcher will investigate specific types of academic challenges and disciplines, which are adversely affected by TBI. Finally, the researcher explores the significance of the link between post-concussion symptom severities to the academic outcomes.

Theoretical framework

Traumatic brain injuries (TBI) or concussions account for at least 0.3 percent of the population (Diamond, 2015). Most of the children who suffer from concussion often end up in classroom settings in a matter of days or weeks. Recent studies that the incidence rate of people suffering from TBI has been on a gradual increase. Significant number of these TBI patients including children is often discharged in hours while up to 25 percent tend to show some post-concussion symptoms such as headaches and cognitive problems (Diamond, 2015). Nevertheless, negligible number of these cases ends in neurosurgical intervention. These children TBI patients are managed in the classroom settings. Theoretical Domains Framework (TDF) offers a comprehensive framework comprising of multiple theoretical domains and constructs. Experts developed TDF to assist in studying implementation and development of implementation interventions (Michie et al., 2008). TDF is effective in a wide variety of settings including classroom setting in exploring factors that impact on clinical behavior changes and other features that may influence the child’s response to environmental changes. Most significantly, TDF helps to monitor how TBI impact on learning outcomes among children.

Classroom environment is complex and is characterized by unique features that may have considerable impact on the learner’s response to perceived environmental changes (Michie et al., 2008). In these cases, evidence-based guidelines are availed to guide the care of the student with TBI within the classroom setting. However, studies showed that differences in management practices can potentially lead to inconsistencies on how the guidelines are implemented. These inconsistencies thus lead to negative learning outcomes among these students resulting to low academic performance or inability to catch up with the rest of the students (Francis et al., 2012). This paper describes how TBI impacts on learning through a theory and evidence-based study on management of TBI in the classroom setting. Drawing from TDF, the researcher discusses how TBI impacts various elements of academic performances and behavioral changes.

Conclusion

This paper seeks to enhance understanding of how brain trauma specifically traumatic brain injury affects students’ learning in the classroom. As most of the previous work on the relationship between brain trauma or injury and learning focuses more on rehabilitation and return to normal activities, there is a knowledge gap as to how the affected students can effectively return to the classroom and the challenges, which they face within their contemporary learning environments. The findings of this study will, therefore, help in designing appropriate classroom settings to enable seamless return for post-concussion students and advise education stakeholders, such as teachers, parents, and school administrators on initiatives and school policies that can help post-concussion students to catch up with the rest of the students.

The dissertation shall comprise of four more chapters. Chapter II (Literature review) provides a comprehensive review of past studies and theories on brain trauma and learning. The presented literature relates to how brain trauma affects academic performance, cognitive and executive functioning as well as rehabilitation measures to enable an effective return to the classroom. In chapter III, the researcher discusses the research design and specific details of how the study will be conducted. Chapter IV and Chapter V will focus solely on the actual research conducted. The study results are presented in Chapter IV while Chapter V presents an interpretation of the findings.

CHAPTER II: LITERATURE REVIEW

Introduction

The purpose of this literature review is to provide the reader with a general overview of brain trauma and its impact on students pursuing various learning or academic goals. Recently, studies on brain trauma and its impact on the learning or cognitive and executive functioning of the victim have become a popular research topic across various related academic disciplines. In the last two decades, several researches have been conducted to primarily explore the impact of traumatic brain injury or concussion on young people. The first part of this chapter defines brain trauma and discuss its general effects on children or students. Next, the impact of brain trauma on academic performance and learning, in general, is presented. Finally, a brief overview is given on how students can be integrated back into the classroom after TBI.

General effects of brain trauma in children

A violent blow or a jolt may cause traumatic brain injury leading to significant consequences on the victim’s life activities and experiences. According to Treble-Barna et al (2017), trauma can be generally defined as an experience where a person’s internal resources are not sufficient to help them cope with external stressors. The researchers noted that traumatic experiences can occur once in a lifetime and can be ongoing for a long period of time. Some people experience multiple traumas such that trauma becomes a chronic part of their lives. One of the most common forms of trauma is known as complex trauma or relationship trauma. Complex trauma is defined as a traumatic exposure that is longer and/or results from multiple incidents. Complex trauma is also attributed to personal threats, violence, child abuse, neglect, and sexual assault and bullying, and so on. In general, this type of trauma affects children in several ways, including attachments and relationships (Carrion & Wong, 2012). The value of relationships with peers, parents, and caregivers to children is immense. For instance, children learn to trust others, regulate their emotions and interact with the world through the attachment they form at a young age. Children who are traumatized have a lowered ability to form relationships or regulate their emotions (Kinnunen et al., 2011). Due to numerous conceptualizations of trauma, it is important to focus on specific traumatic events and risk factors, such as physical and emotional issues. From this perspective, trauma can be described as an overwhelming experience that can potentially alter a person’s belief regarding the world.

Apart from emotional and psychological traumas, there is special type of trauma that results from head injuries. Blaiss et al (2011) highlighted that head injuries can be attributed to accidents, sporting activities or disasters can potentially lead to injuries to the head resulting in brain trauma (traumatic brain injury/TBI). TBI occurs when an external force puts intense pressure on the brain leading to injury. Some of the most common causes of TBI include violence, vehicle collisions, and falls, and so on (Blaiss et al., 2011). Brain trauma occurs due to sudden acceleration or deceleration within the cranium or through a complex combination of movement and sudden impact. Brain trauma that occurs at the moment of injury results from alterations in cerebral blood flow and skull pressure. Meanwhile, Langebahn et al (2013) defined brain injuries based on the cause. For instance, traumatic brain injury (TBI) is often associated with injuries that originate from external causes, such as open head injuries. According to Brain Injury Association (BIA), TBI can be defined as an injury to the brain caused by external physical force leading to an altered state of consciousness and maybe impairment on the cognitive abilities or physical functioning of the affected individual (Langebahn et al., 2013). TBI can also cause a disturbance in a person’s behavioral and emotional functioning. On the other hand, acquired brain injury (ABI) encompasses brain injuries that originate from internal causes. Langebahn et al (2013) defined ABI as injury to the brain that results from stroke, anoxia or neurological disease, such as encephalitis. In some cases, ABI can result in external trauma.

The extent of the brain injury determines the length of time it will take for a person to return to normal activities and their effectiveness in performing various tasks. In clinical practice, brain injuries are categorized as mild, moderate and severe depending on the length of time that a person is unconscious or based on the severity of the tissue damage (Treble-Barna et al., 2017). However, these categorizations do not necessarily reflect on the exact impact of the trauma on a person’s life. For instance, in some cases, the injury may not lead to a coma or hospitalization but could lead to a more severe and long-lasting effect, such as chronic fatigue or visual perceptual difficulties. Medical practitioners suggest that mild brain injuries may not require rehabilitation at the time of injury (Davies et al., 2013). Furthermore, Davies et al (2013) indicated that in the case of mild brain injuries other effects, such as visual and memory impairments, confusion and fatigue may be misdiagnosed or remain untreated. Due to this, the person who is suffering from a mild brain injury can sometimes feel that they are ‘going crazy’ when in fact they are experiencing neurological problems.

Effects of brain injury on an individual can be observed in one or multiple brain functions, including cognitive, physical and sensory functions. Mollie (2016) indicated that brain injury may also impact on the psychosocial abilities of the person or ability of the person to improve on various cognitive tasks. Mollie (2016) also indicated that this type of trauma results in neurological and psychological damages that may hamper a child’s educational journey. According to a large epidemiological study conducted on adults, brain trauma was reported to have adverse childhood experiences among the youth (Langebahn et al., 2013). In another study funded by the Centers for Disease Control and Prevention, researchers found that people who experienced any form of trauma during their childhood were more likely to be suspended from school (Blaiss et al., 2011). These people also had low grades, performed poorly in academic assessments and suffered a considerable risk of language delays. These alarming rates of school struggle and failure have led to numerous studies aimed at establishing the exact parts of the brain affected by trauma or TBI.

The complexity of the brain and its unique relationship with every task that a person’s body performs cannot be overstated. Spitz et al (2012) showed that brain functions are hugely interconnected such that any damage could potentially sever or disrupt the established pathways thus requiring time for the affected parts to heal and new connections to form. Brain injury can result in suspended consciousness for a single day or months or even years leading to unique physical and emotional challenges on the injured person. This condition could hamper the person’s strides towards more independence. Even in cases of mild brain injury (concussion), some problems, such as headaches, fatigue, fluctuations in cognitive ability, poor vision or hearing, and perceptual impairments could be hindered (Davies et al., 2013). Moderate to severe brain injuries could result in loss of consciousness that in many cases results in hospitalization or rehabilitation. In this regard, students who suffer from brain injuries could require medical rehabilitation or a slowed process of returning to school.

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