Research Analysis - Qualitative Questions

Danielle Blagg, Mark Anthony Brennan, and Joseph Brown , Jr.

University of Texas in San Antonio

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Abstract

Many children deal with Traumatic Brain Injuries (TBI) on a broad range of severities but because of misdiagnosis of minor TBIs and the lack of qualitative studies documenting their quality of life, educational and social support struggles. The research presented will look into furthering the research development of adolescents with Traumatic Brain Injuries (TBI) and advocate through transformative methods about this group’s needs and possible lack of support programs. The overall TBI research needs to be developed further in order for there to be the promulgation of changes for this specific population. The chance to forge change justifies the need for this study, which will discover the effects TBI causes to adolescent learning to mitigate the void of little to no qualitative data research in this matter and also identify any shortcoming with the programs for this group of individuals.

What are the Learning Effects and Programs for Traumatic Brain Injury Adolescents in K-12

Introduction/Problem Statement Comment by caitlin baker: Comment by caitlin baker: You can remove this heading; my mistake

Traumatic brain injuries are a mysterious illness in the world today, peculiar in our country — this problem compounded by the fact that many cases of TBI go undocumented and unstudied. Our children are severely affected by TBI because the gaps in the documentation for adults and are even worse for adolescents from misdiagnosis of minor TBIs or the lack of quality studies of adolescents with TBI. In the US, an average of 1.4 million TBIs occur each year, including 1.1 million emergency department visits, 235,000 hospitalizations, and 50,000 deaths; however routinely reported US national data underestimate the true burden of TBI (Langlois, J. 2006). Several gaps in research on adolescents home life, learning/education, and long-term health have grossly underrepresented by current research. Comment by caitlin baker: Need citation Comment by caitlin baker: Need citation Comment by caitlin baker: Remove extra space Comment by caitlin baker: Need citation

This oversight leads to the need for our study, which will discover the effects TBI causes to adolescent learning. We will try to fill a gap left by the lack of qualitative research in the matter and also identify any shortcoming with the programs for this group of individuals. Relatively little is known about the impact of TBI on children’s daily functioning which this information is important for two reasons. (Stancin, 2002). The 1st is documentation of effects on children’s functioning would clarify the types and range of impairments and disabilities in this population. (Taylor, 1999) Secondly, these outcomes would provide information relevant to the needs of the children for medical, mental health, and educational. (Taylor, 1999) Comment by caitlin baker: Seek to Comment by caitlin baker: Specify adolescents; or who is under study Comment by caitlin baker: first Comment by caitlin baker: remove extra space; period goes after citation Comment by caitlin baker: see above

We will use a theoretical framework of disability with a transformative approach to bring possible change to the way TBI adolescents receive support and usher to the forefront their daily complications and complexities to function in a school and home environment. An adolescent with TBI typically needs special assistance in the learning (i.e., classroom), social acumen, and behavioral stability, however, in these areas very little research exists to invoke a better focus on the children needs. There must be a continued quality of life, education, and community support for the children and their family needs to exist and if not advocacy is demanded to recognize the shortfalls and to make changes. Comment by caitlin baker: Yes!!!!!!!

Positionality Comment by caitlin baker: Offer an opening sentence to help the reader understand the way you organized the positionality by researcher. I like the way you did this!

J.B . Comment by caitlin baker: Thank you for openly sharing J.B.; very powerful

This study related to me in many ways but the primary interest was the lack of information about support learning especially or their life in general. Education is essential in my family because my mother was a generation away from a sharecropper, and education was believed to be the only way they could change their position. I saw my mother work a full-time job, run a family, and go to school to get her nursing degree and become an RN. I had to motivate myself and continue to learn to excel in education, not for my family but my edification. I believed my mom knew that achieving a nursing degree would better our family situation, but I feel meant more to her to accomplish this task for her self-worth. She received a sense of pride and enjoyment from being able to support her family better. I felt the same when I received my engineering degree because I already had a family and they were expecting me to help them even at the young age 21. Responsibility must be one of these aspects that must be taught and reinforced. Young people need to know that they matter and that they have something important to contribute and they are in control of something. I see the ability to self-motivate can be learned behavior with continues enforcement through visual support by demonstrating this value to a child; and by providing the techniques that will encourage this line of thinking and internal motivation. It is said that real education comes through the stimulation of the child's powers by the demands of the social situation in which he/she finds themselves (Flinders, 2017 p.33). Understanding that everyone cannot be an independent learner, however, the ability to be piqued upon striving after education can be self-engaged. Comment by caitlin baker: Add ,

Danielle Comment by caitlin baker: Thank you Danielle; very well-articulated. If you can just add one sentence to sum up how your positionality relates to the research you chose to do.

Female, white, middle-upper class family: all essential elements of identity. Each identifying word does not define who I am, and it is simply all different elements that put me together. If I had to pinpoint three major players of my identity development, it would be my mother, father, and uncle. My mother, a law enforcement officer for nearly 30+ years, always encouraged me to tell and believe the truth. My father, a lawyer of almost 50+ years, taught me knowledge is something you find in books, people, and articles. The combination of these two individuals allowed me to acquire a belief about the world around us and that it is made up of the good and the bad and the right and the wrong; there is only small room for error and an in-between.

My Uncle, Uncle Anthony, as I called him was a clinical psychologist up until the time he passed away three years ago this July. Anthony was the smartest, most intelligent, and most intellectual human I ever knew. Anthony had such an impact on my life, in the way I thought about people, the way I felt about life and religion, spirituality, and the way I viewed myself. The uniqueness about him and the way he carried himself was so much different than anyone I had ever known. Living in Lexington, Massachusetts his entire life, and me, a girl from San Antonio, Texas, our lifestyles were completely different. His psychologist side of him intrigued me and built up my desire to study the human mind. Our experiences together and our talks about life and what it all meant was a crucial time in my life.

Mark Anthony Comment by caitlin baker: Thank you Mark Anthony; you are so well-spoken.

As a former combat army veteran, I have unfortunately seen the tremendous impacts that a traumatic brain injury (TBI) can have on a person's life. After these war heroes have returned home from there volunteered service they were limited to no resources that are provided by the federal government, or the process takes so long that the time it takes in between the accident and treatment a remedy could have already been introduced to prevent further brain damage. We know just from the military side of things, not even including the impact the military science has had in other areas like sports or medicine, but let us examine the helmet for instance. It was always used to protect the head and brain. In time there have been advances in the technology, and as the technology advances from the military, it passed onto other industries, like the NFL.

The importance of protecting our most crucial asset in our body is essential. Without our brain, would we be conscious beings with rational thought? Would we be able to dream, see things in metaphors, and am for a higher sense of purpose? Does one do this when they are in a comma? The brain is a beautiful and magnificent organ in the body and is always a step ahead of the decision we have already made. Comment by caitlin baker: coma

Literature Review

Traumatic Brain Injury (TBI) is a research area that affects not only the patient, but also those who are supporting the patient, including family members, hospital and medical staff, and their caregivers. TBI is a topic that has looked through multiple different lenses and faucets, from "insiders’ viewpoints," qualitative studies, quantitative studies, from an Epistemological Disability viewpoint in mind. Considering we are trying to find ways to prevent, and not only treat TBI.

According to the Disability Law Center (2008), there are two categories of brain injuries which include acquired and congenital brain injuries. Inherent brains injuries happened before the birth of a child as a result of congenital disabilities, the effect of drinking alcohol while pregnancy among mothers and some difficulties during the process of delivery. On the other hand, Acquired Brains Injuries take place after the births whereby they may result from medical conditions such as encephalitis, Stroke, meningitis, aneurysms, and brain tumor. Brain inquiries do not arise from medical conditions only, Traumatic Brain Injuries (TBI) occur after accidents involving vehicular crashes, hunting accidents, sports injuries, and falls. Comment by caitlin baker: cite each sentence in this paragraph;

People with brain injuries often develop cognitive problems. There are four categories of cognitive problems including information processing, attention and concentrations, memory and executive functioning. This problem relates to the learning process of a person’s because their child is unable to pay attention while at schools for the required number of hours or unable to multitask, such as listening and taking notes at the same times (Scwartz & et al., 2003). These problems affected their learning processes of the child in schools. Teachers have strived to solve the issues of traumatic brain injury experience with children in school by developing unique means of training which is presenting information to the student using multi-sensory formats as well as hands-on learning opportunities. Comment by caitlin baker: add citation Comment by caitlin baker: add citation Comment by caitlin baker: need citation

Children with traumatic brain disorders are recognized to be accompanied by difficulties in refusing to answer questions in class or beginning their assignments when they required the teacher to add some time for them to process the information acquired due to the defects of information processing (Barman, Chatterjee, & Bhide, 2016). For examples, a student with TBI may be struggling to comprehend and understand the lesson talk by a teacher at the end of the sessions while the teacher is highlighting instructions for their assignments. In the end, the child ends up missing the assignment instructions (Barman, Chatterjee, & Bhide, 2016).

These children cannot be recognized as forgetful instead their memory is more pronounced. The students have problems in learning new concepts, storing and retrieving the information. They are more efficient to remember the things they had learned before the brain injury but not those learned after. Also, their executive functions such as planning and organizing ideas are disturbed. The child is unable to complete a report at a given time or set priorities (Disability Law Center, 2008). They also have problems to solve minor changes like how to answer essay questions or what to do in case they lost their pen. Comment by caitlin baker: Cite this sentence and the two following Comment by caitlin baker: cite

Consequently, the effects on the function of the brain also affect how the students behave. Behavior emanates from various interrelated issues. The child with TBI encounters physical challenges to deal with headaches, fatigues, and dizziness and vision problems (Disability Law Center, 2008). They met emotional changes such as depressions due to brain injuries. Neurological evaluations are one of the programs embraced to help the student deal with brain injuries. Neurologists are intended to identify their areas of difficulties experienced by the students by observing their behaviors, after which they advise the teachers and parents on the initiates to take to improve the performance of the child. Comment by caitlin baker: cite, cite, cite

Theoretical Framework Comment by caitlin baker: this seems to be a continuation of the lit review not the theoretical framework

According to Konrad, et al. (2011), there are long-term cognitive as well as emotional sequelae of that TBI, which is inconclusive, which a person with a mild brain injury takes time without seeking treatment. TBI individuals experience significant impairments of the cognitive domains of subjects of health control. The effects of the cognitive range from medium to large, they can be recognized as depression, self-perceived deficits, negative response based and compensation claims. Depression is relatively higher among patients with TBI. When individual experience minor traumas for a long time, they increase the risks of long-term cognitive as well as emotional disorders, which are essential in the social and professions life of individuals. TBI lead to long-term Neuro-functional disruptions which are not detected by the magnetic resonance imaging; hence they are needed to seek clinical and forensic evaluations of TBI of us to prevent the long-term effects construed. Comment by caitlin baker: cite all sentences; they all appear to come from readings

When describing the prevalence of TBI problems and risk factors related to post-injuries, it is essential to the long-term behavioral effects of TBI (Konrad & et al., 2011). The increase in the number of cases of TBI incidents those other injuries whereby the injury correlates to the experience of various characteristics such as Pre-injury child status, neuropsychological outcomes and family measures. Children with higher rates of cases require follow-up that compared with orthopedic injured children. The social life of children with TBI is also affected whereby they are not able to establish good relations with their peer, due to the defected in their practices and behaviors (Scwartz & et al., 2003). Comment by caitlin baker: again cite all sentences; Comment by caitlin baker: check apa for et al; no & Comment by caitlin baker: see APA for et al

According to Yivisakers, Turkasta, and Coelho (2005), communication disorder specialists working with patients of TBI focus on the rehabilitation of the social, cognitive and behaviors dimension of their disabilities. The practices engage in are guided by the existing Americans Speech-language and Healing Association, which linked communication effectiveness. Personality changes caused by a TBI are a result in the development of behavioral defects. Children and parents of TBI inured children are required to actively participate in the programs by improving the knowledge, skills, and relationship of the sufferer. Collaborative engagement will help in developing the social interaction competence of the child. Comment by caitlin baker: cite throughout

The existing literature shows that many people have been interested in studying the area. The researcher will use the current research in developing the basis of this study. However, various gaps identified by the researcher whereby the studies consider do not link the problems or the effects of TBI the particular issues that will help in solving that problem. The researcher will be interested bridging the gaps by identifying the impacts and specific programs the will be used to deal with the defects. Comment by caitlin baker: what existing literature; cite Comment by caitlin baker: perhaps use a different wordprograms that address improved functioning of students with TBI in the school setting?

These various perspectives on disability familiarize the way questions of access get approached in education settings. Most schools operate within a medical model of disability. Typically, to get assistive accommodation, disabled students must prove that they have a diagnosed disability. These accommodations treat disability as a variation from the norm. If schools were to embrace a social or cultural perspective on disability, the goal would be to increase accessibility for all students, regardless of whether they have a formal diagnosis.

Research Questions Comment by caitlin baker: Sum up by listing each question at the end

Looking into furthering the research development of adolescents with Traumatic Brain Injuries (TBI), research needs to be understood and developed further for there to be advocated changes made for this specific population. After reading literature, our group proposes the question: What are the effects of traumatic brain injury on adolescents in their learning development? Research shows adolescents who suffer from traumatic brain injuries struggle in the classroom. Taking the central question even further, we ask the question: What are the learning effects on adolescents in grades K-12 with TBI at the school and what programs have been implemented for these specific population? It is essential for educators to understand how TBI affects adolescents and what the difficulties are for these students. Specifying what a TBI is, assuming the effects of TBI, and discovering which programs implemented in schools in this day and age is an area where many schools lack knowledge. In this qualitative study grounded in the transformative frameworks, we aim to study the difficulties in learning development for adolescents and what programs have been implemented in the school to help these students be successful. Comment by caitlin baker: The researchers ask this question: Comment by caitlin baker: Elaborate this in the section for theoretical framework

Furthering the central research question, we ask: where are the areas in schools that need improvements when it comes to providing adequate services for students with traumatic brain injuries? Currently, there is little research done on TBI; specifically, there is little research done on what is put in place for schools to help students with traumatic brain injuries. In order to research the programs implemented within schools to help students with TBI, we also need to ask the question: how are teachers trained to teach students with TBI and is there enough training provided to these educators? Understanding the training teachers go through to assist students with TBI will allow us as researchers to give the discovered information to K-12 schools. If I school does not have proper training or enough training for these educators, students with TBI will continue to be at a disadvantage.

Operationalization Terms

Adolescents: Students in grades K-12

Students : Students enrolled in public and private schools across the United States who have suffered a TBI. Comment by caitlin baker: If it is qualitative are you looking across the country?

Traumatic Brain Injury (TBI): A traumatic brain injury (TBI) is an insult to the brain, not of a degenerative or congenital nature, but caused by external physical force that may produce a diminished or altered state of consciousness, which results in an impairment of cognitive abilities or physical functioning. (Neuroskills.com) Comment by caitlin baker: Check apa

Programs implemented for students with TBI: any program, disability service, or special assistance for students who have suffered a TBI.

Areas in schools that need improvement: identifying the schools that have trained teachers to provide students with TBI assistance, and identifying those schools that have no programs or training to give students with TBI proper educational services through interviews.

Enough training: evaluate if teachers 1) Know and understand the effects of TBI, 2) If the teachers have been trained to educate students with TBI, 3) Ask about what types of training they have received, and 4) If they haven’t received training, how they work with students with a TBI.

Teachers: Random teachers willing to participate in the study who teach grades K-12 in public and private schools. Comment by caitlin baker: What about paras? Only teachers?

References Comment by caitlin baker: References are double-spaced Comment by caitlin baker: Look at apa; no vol or pg

Barman, A., Chatterjee, A., & Bhide, R. (2016). Cognitive Impairment and Rehabilitation

Strategies After Traumatic Brain Injury. Indian Journal Of Psychology Medicine, Vol.38(3), pg 172-181.

Disability Law Center. (2008). Educating Students with Traumatic Brain Injury. Alaska:

Disability Law Center of Alaska.

Halldorsson, J. G., Flekkoy, K. M., Arnkelsson, G. B., Tomasson, K., Magnadottir, H. B., &

Arnarson, E. O. (2012). The scope of early traumatic brain injury as a long-term health

concern in two nationwide samples: Prevalence and prognostic factors. Brain Injury,

Vol .26(1), p.1-13, 26(1), 1-13 Comment by caitlin baker: Check apa

Flinders, D.J. & Thornton, S.J (2017). The Curriculum Studies Reader, page 33

Schwartz, L., Taylor, H. G., Drotar, D., Yeates, K. O., Wade, S. L., & Stancin, T. (2003). Long-term behavior problems following pediatric traumatic brain injury: prevalence, predictors, and correlates. Journal of Pediatric Psychology, vol 28(4), 251-263. Comment by caitlin baker: Check apa

Stancin, T. (2002). Health-related quality of life of children and adolescents after traumatic brain

injury. Pediatrics, vol 109, pg e34.

Taylor, H.G. (1999). Influences on first-year recovery from traumatic brain injury in children. Neuropsychology, vol 13, page 76-89. Comment by caitlin baker: Check apa

Yivisakers, M., Turkasta, S., & Coelho, C. (2005). Behavioral and social intervention for individuals with traumatic brain injury: a summary of the research with clinical implications. Seminar in Speech and Language, Vol 26 (4), pg 256-267. Comment by caitlin baker: Check apa