Project Status/Updates

What We Know

  • TBI is the leading cause of death and disability affecting Ĺ million children each year, 0 and 20 years of age. (1,2)
  • The brain is intricate and complex! Head injuries often result in impairments in more than one area of functioning that can make reintegrating back to the environment even more challenging for everyone involved. (3)
  • Neuroplasticity and neural reorganization play a key role in neuropsychological (overall cognitive functioning including skills of executive function that include memory, decision making, and problem solving), scholastic (reading, writing and arithmetic), social (socialization, peer interactions and friendships), and physical rehabilitation in children and youth with ABI. However, this physiological potential and successful outcome is largely dependent on environment. (4)
  • Adolescents who have reintegrated to the school community and primary learning environment identify that the supports (peer, family, and school staff) are an integral component of cognitive, behaviour, and physical success. Positive relationships, interactions and curriculum modifications were associated with good experiences at school, whereas negative experiences were fostered by poor environmental support. (5)
  • Emotional and behavioural lability may be presented as challenging behaviours for educators and can interfere with learning in children and youth who have experienced ABI. Challenging behaviour is the result of both internal (personality, physical/medical conditions) and external (learning, home, and community) variables that can be improved; however, educators note that insufficient pre-service and in-service training is available to provide adequate support to such students. (6)
  • School is the primary reintegration and learning environment for students, however, brain injury is NOT a recognized exceptionality recognized by the Ontario education legislation. (7) Many students with ABI succeed academically, socially, and emotionally, while others do not.

Our Project

  • The aim of this study is to identify the important factors that predict successful reintegration to optimize outcomes for students who have experienced an ABI across Ontario.
  • Specifically, we want to know how student- (preinjury status, impairment, and neurocognitive abilities pre- and postinjury) and school-based (educator awareness, approach, instruction, policy & procedure) variables affect studentís school adjustment, social, emotional, and academic functioning.
  • So far, as was observed pre-study, we have found that injury severity does not predict academic and social outcomes. Therefore, independent of injury severity, children are struggling in these domains.
  • However, injury severity does predict behavioural adjustment - the more severe the injury, the more the student, parent, and teacher report challenges with behavioural competence. As severity increases so do parent, child, and teacher reports of anxiety.
  • Students with ABI identify challenges in the area of social inclusion domains; whereas parents observe their children to demonstrate greater challenges with anxiety and hyperactivity; teachers view the studentís perception of social struggle as a response to anxiousness and conduct/misbehaviour.
  • Neuropsychological capacity, as a more specific measure of injury severity, on the other hand does predict academic, social and behavioural competence - the greater the capacity, the better the performance on measures of cognition (learning and memory, executive functions), the greater the sense of inclusion and participation and the greater the sense of behavioural control and management.
  • Interestingly, school-based factors have an impressive impact on outcomes of academic and social adjustment; the fewer policies and procedures in place for students with ABI (such as valuing and non-categorization, use of new validated knowledge, early interventions, IEP availability, ongoing assessment, etc.), the more students report feeling inadequate, depressed, and anxious. When policies are in place, benefits to social and academic competence are evident.

What You Need to Know

  • Despite academic outcomes, such as numeracy and literacy scores as a primary focus for the academic (currently Ministry initiatives), successful school outcomes can be/need to be? defined more broadly. Social and Behavioural Adjustment as Outcome Goals are as important, not just in terms of the studentsí experience/quality of life, but also in terms of being determinants of intervention, inclusion, and ultimately remaining in the school environment.
  • Students with ABI are feeling anxious, overwhelmed, misunderstood, and unable to cope in their changing environment. When policies, provisions, and supports are in place for students they are more academically and socially capable of thriving in their educational environment which will not only make them feel adequate and included in the classroom, but will translate outside of the classroom and later in life.

What You Need to Do

  • Advocate-as health care professionals and family members recognize the school system is unaware of ABI in the classroom, and may not recognize your child or clientís challenges.
  • Educate- Inform the studentís teacher and school of his or her ABI and the unique effects it has on learning. Visit or contact OBIA for a resource book to provide your childís school.
  • Modify-implementing small changes in the classroom through education can modify practice to better improve outcomes in school, development, health, and in life.
  • Make a difference-you have the knowledge to make a large difference in the success of the student and child in your life, so spread the word and be involved.


1. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. (1999). Traumatic Brain Injury in the United States: A report to Congress.

2. Ornstein, T.J., Levin, H.S., Chen, S., Hanten, G., Ewing-Cobbs, L., Dennis, M., & Schachar, R. (2009). Performance monitoring in children following traumatic brain injury. Journal of Child Psychology & Psychiatry, 50(4), 506-513.

3. Sharp, N., Bye, R., Llewllyn, G., & Cusic, A. (2006). Fitting back in: Adolescents returning to school following severe acquired brain injury. Disability and Rehabilitation, 28(12), 767-778.

4. Kapapa, T. (2010). Head trauma in children, part 3: Clinical and psychosocial outcome after head trauma in children. Journal of Child Neurology, 25(4), 409.

5. Mealings, M. (2010). 'School's a big part of your life...': Adolescent perspectives of their school participation following traumatic brain injury. Brain Impairment, 11(1), 1.

6. Westling, D. L. (2010). Teachers and challenging behavior: Knowledge, views, and practices. Remedial and Special Education RASE, 31(1), 48.

7. Zinga, D., Bennett, S., Good D., & Kumpf, J. (2004). Educating Educators about Acquired Brain Injury. Journal of Developmental Disabilities, 10, 159-163.

Please contact us for further information.
(905) 688-5550 ext. 3556 or ext. 5523

Ontario Neurotrauma Foundation
Brock University