The quality of education available may slow the progress of students with brain injury. No matter how hard a student with a brain injury tries to achieve academically, attempts to regain some form of equality via education flounder, unless and until educational institutions make significant changes. Quality education has been called for in many public and private forums over the years. For example, the introduction of various statutes and acts, such as the Human Rights Act, was promoted on a claim that it would improve quality. Although the Act was instituted, the minimum standards sought still remain unfulfilled. Another example concerns the installation of the various standards, such as the New Zealand Qualification Authority's standards, which have not yet influenced tertiary education.

A Case History

Sam (pseudonym) had a motorbike accident in his teen-age years. He became temporarily paralyzed and was left with substantial memory loss. After this trauma and resulting setback, he had to learn to do all those things that other people take for granted. Sam became a leader in his own rehabilitation by necessity, for his injury occurred more than 20 years ago. Given that few people or professionals had a glimmer then of what was soon to take place, Sam was already struggling when others with brain injury began to survive.

Recently, the numbers of those who survive has increased dramatically (Roberts, 1979; National Institute of Handicapped Research, 1986). At the same time, greater recognition of the powerful effects of so-called "minor" brain injuries has grown (Gronwall & Wrightson, 1990).

At first, Sam sought help through the normal channels of society, but to little avail. Knowing that few people with brain injury recovered their former faculties fully, Sam set out to prove that with determination and hard work, he could succeed. Before coming to university and studying in his chosen field, Sam gained hands on experience in a variety of service industries in relevant fields. With this initial effort to gain practical experience Sam had to pass several examinations after attending extensive block courses or workshops. The block courses had difficult content. Sam regarded this material as more important than that covered later in books or journal articles. His study tactics were neither systematic nor appropriate. As one result he felt frustrated and occasionally became angry when he witnessed growing inequalities between his own career and that enjoyed by classmates. However, if anything, that experience gave him more desire to gain tangible academic achievements.

Sam attempted to share his growing knowledge by training or tutoring others in his various fields of knowledge, including his hard won skills in engineering, drafting, tool making, wood and bone carving and mathematics. Sam struggled to find learning techniques that worked for him, then tried teaching others, and then assumed that these methods would also be appropriate for his own subsequent learning at the university level.

Sam took one course on teaching mathematics through a post- secondary program but not at a university level. This course was held for teachers in an Advanced Studies for Teachers Unit. After completing the coursework, and just prior to his final examination, Sam learned that he could not succeed, as he did not already have a degree to teach. He received an A average on his assignments, however. Based on this achievement, he made the decision then to try university level studies which in New Zealand, are differentiated from teacher's training programs.

Sam signed up as a first year university student in an extramural or correspondence mode. Using the learning methods he had figured out, then used to teach others for several years with a reasonable amount of success, Sam was intensely disappointed with the results of his first year final grades. Not completely discouraged, he picked himself up and reattempted a second year. After gaining A's in assignments, and in tests following campus (block) courses, Sam was again understandably upset when final results did not match his expectations.

Sam tried to memorize materials in lectures, textbooks, and on assignments. Then when tested, and particularly with final examinations, Sam did poorly. Though he learned to parrot learned material back just as presented by the lecturer, his ability to generalize and to apply principles suffered. In his words, "most of the data covered was not even mentioned in tests. I spent hours and hours of learning and memorizing for nothing."

Sam then had a neuropsychological assessment. The assessment results were sent to the Student Counselling Service, along with recommendations for alternative learning strategies. These strategies might have been advantageous for Sam. Unfortunately the Counseling Service failed to help Sam understand and use the recommendations. Sam could not use the information, master the alternative learning strategies and understand his impairments. In addition, staff at the Counseling Service and teachers in the University could have used this information and the situation to encourage constructive learning opportunities for others as well. The information available from Sam's efforts could have been generalized so that others, especially the significant and increasing number of people with brain injury, could have had a more favorable outcome.

Sam remembers one followup meeting with the director of the Counselling Service, who asked, "Why are you trying to gain a degree in the face of adversity." Sam said, "I feel I have the ability to do academic work." The Director agreed but asked Sam, "Why bother?" Sam's reply was, "The education system was meant for everyone!"

Over the past 10 years, Sam persevered, and now has completed most of the papers required for a degree. He is proud of that achievement, but remains unhappy with the disparities of information given between lectures, texts, assignments, and other classroom work and especially, the final examinations. Further, he remains unhappy with the seeming inability of lecturers to individualize lessons, to accommodate his unique learning styles, and to offer support for his on-going efforts. Some of the rigid and arbitrary demands made by lecturers on assignments are difficult for Sam to meet. He has created his own methods for learning, his own ways of producing end products that are achieved only with great difficulty. In a sense, Sam has created alternative working and learning styles, necessitated by his cognitive impairments. These styles and the results sometimes fail to fit in the "box" required by the lecturers.

The Bigger Picture

According to the literature (Roberts, 1979; Rose & Johnson, 1992), brain injury is increasing. With the advancement in the techniques of resuscitation, recovery, management and effective treatment of the people who are more severely brain injured, more effective followup is needed. Previously these people had little or no chance of even surviving their injury. Now, they appear to be gaining access to higher education but, as in Sam's situation, are left without the special assistance required to perform well in higher education.

Admittedly much of the literature is not optimistic. Most people with brain injuries are less fortunate than Sam, who at least had an opportunity to attend a university. Currently Sam hopes to continue, and wants to complete his degree within the next year or so. Sam states that it is still very disconcerting to hear faculty or other students argue that he and others like him should not receive any special assistance or help. Their argument is that the university system is only for "the real achievers." When the academic achievements Sam has accumulated are placed in context and grouped together, the sum total of accomplishments may not look like a lot to others. To Sam, completion of this work adds an enormous amount to his credibility and self esteem, and should demonstrate to others his courage and commitment.

Potential Solutions

Recently, Sam has become extremely concerned with the improvement of educational opportunities for those who may/will follow. He has made personal approaches to some of the lecturers in various departments, leaders of the Student Association and members of the Academic Section at his University. He has even written to the leaders of the University about his concerns. He was not after an "easy road" seeking advice on how better to prepare himself for assessments and examinations. He was suggesting that the university could and should take a more active role in designing special programs for those with brain injury. The people he contacted were sympathetic and offered encouragement, but no one came up with a strategic approach.

One obvious direction is to establish a learning laboratory to test, monitor, and assist Sam or other brain injured people design and formulate specialised learning experiences. Such a lab could develop answers to many questions about how people with brain injury learn. Further, such an approach might be broadened to create more positive attitudes in lecturers and teachers, and in other students.

After talking to other students who had brain injuries, Sam realised that these people also faced similar problems with classroom activities and life on campus. Unlike him however, they were soon unwilling to continue in the academic setting. They felt that it was easier to give up than to carry on. Sam talked with several knowledgeable experts, including psychologists and medical doctors, about the situation he observed. All those consulted had evidence that very few students with brain injury succeeded at university level education.

Having "required" knowledge and putting such information down in the order that is required for the examiners, regardless of the student's background, knowledge and experience, is hard for an average student but is much more difficult for someone who has had a severe brain injury. As Sam tried using the available services he was advised that his own methods of learning would probably give him the best results. However, he wonders, and still gets upset with his painful struggle to gain further education.

Opportunities for Post-Secondary Educational Facilities The university has, by its recent actions to improve accessibility and distribute resources, admitted that the treatment of students with disabilities was sometimes unfair in the past. The university staff compiled a manual "Tertiary Students with Disabilities: A Resource Guide for Staff" (1995) which is over one hundred pages, although only one page relates to the topic of "teaching students with head injuries." The booklet is not detailed but at least acknowledges that this area needs further attention and research. The document lists references to other works that add details to the sketchy outlines.

The university is under pressure, as are many universities these days, by the necessity to teach more students with fewer staff, at a lower cost than ever before, and in less time. Large classes, limited time, and competition for every grade and dollar limit educational opportunities. Only those who fit the so-called "normal" pathways can gain in such an environment. Lecturers have little time, and few role models are available. Teaching staff have limited interest in appreciating alternative learning strategies, little ability to individualize lessons, and little interest in accommodating to unique needs.

Funding, resources and time are three major factors that block efforts by dedicated counselors and learning laboratory specialists to design and develop strategic learning approaches. Students with brain injury need specialized support. Thus, the current match or fit between student and university is not a good one. Thus opportunities for new programs exist, and might well offer insight into regular educational and learning processes as well as the specialized ones as for students with brain injury.

Conclusion

The quantity and quality of tertiary education is changing, but at this time the educational opportunities available are a disadvantage to the student who happens to be brain injured. Universities have an opportunity to include these students, and yet universities tend to or appear to ignore their special needs. Pressures of finances, class sizes, heavy work-loads, limited interest, and so on are factors yet to be overcome. The future will see increased numbers of students with brain injuries who want higher education and they will push first for entry and second for help to continue. The pioneers, such as Sam, have much to offer, if and when decision-makers in higher education listen.

References

Currie, D. (1987). The Management of Head Injuries. Oxford: Oxford University Press.

Gronwall, D. M. A. & Wrightson, P. (1990). Head injury: The Facts: A guide for families and care-givers, Oxford: Oxford University Press.

National Institute of Handicapped Research (1986). The Silent Epidemic: Rehabilitation of People with Traumatic Brain Injury. Rehab Brief, IX, 4.

Rose, F. D. & D.A. Johnson (1992). Recovery From Brain Damage. New York: Plenum Press.

Roberts, A. H. (1979). Severe Accidental Head Injury. New York: Macmillan.

Tertiary Students with Disabilities: A Resource Guide for Staff (1995). Palmerston North, NZ: Massey University.

Ed Chambers, a pilot in an earlier career, has recently completed a bachelor's degree at Massey University. An avid outdoor person, he loves to hike and fish throughout New Zealand. Bob Gregory has been active with Disabled Persons Assembly locally and nationally. He has worked as a rehabilitation counselor, anthropologist, and psychologist. He currently teaches community psychology to third year students at Massey.