Including Exchange Participants with Traumatic Brain Injuries

Young American man in the distance looking at some livestock in Norway
International exchange, through its promotion of education and social inclusion, can be a positive and self-affirming experience during recovery from a brain injury.

In the right situation with the right supports, an individual with a traumatic brain injury can increase the boundaries of their potential while recovering abilities and a sense of identity.

A traumatic brain injury (TBI), in contrast to an intellectual disability or learning disability, is acquired through a blow or jolt to the head causing a disruption in brain function. It can involve reduced capacity in cognitive, sensory, physical, or psychosocial abilities, which previously might have been easy for the individual. 

People with TBI can struggle with a variety of different activities, including keeping track of time and space, regulating emotions, and responding appropriately when there is a lack of structure, orientation, or physical movement.

International exchange professionals can learn more about brain injuries from local brain injury associations and alliances or from state or university departments that support education, employment, or independent living for people with TBI.

Disclosure and Accommodations

No two injuries are alike. Needs can vary over time and from person to person. So, it is always good to create a welcoming environment that facilitates self-disclosure.

While it is up to the individual with TBI to disclose and request accommodations, sometimes TBI can result in a lack of motivation or understanding of how to self-advocate. Maintain balance between respecting the individual's right to privacy, and encouraging them to recognize where they need help and advocate for themselves. 

As part of the orientation to the study, volunteer, or other type of program abroad, consider discussing the way the participants can ask for help. 

Speaking in general terms, let everybody know about the availability of reasonable accommodations, giving some examples of disabilities and supports. This will create a supportive and normalizing environment in your program where people feel comfortable disclosing. 

Reasonable accommodations that a participant with TBI might request if on a study abroad program include:

  • Assistance taking notes in class
  • Preferential seating (e.g., sitting up front)
  • Instructions and materials printed for reference
  • Reminders for assignments, meeting times and or trips
  • Tutoring
  • Recording lectures or discussions
  • Assistive technology such as smart phones, tablets, or pocket planners
  • Taking a reduced course-load
  • Reducing length of assignments
  • Taking tests in a different environment
  • Time and place to rest when necessary

Program Planning and Resources

If possible, be sure that your programming follows a predictable, detailed schedule, leaving extra time and avoiding last-minute schedule changes. A participant with TBI might bring a planner or calendar device with them. If they have not figured out an effective tool for time management, participating on an exchange program might be just the push that they need to put that together. 

Direct instruction and repeat practice and reminders can assist. Making written materials available including schedule, program rules, and key destinations (such as hotel or excursion location) will help a participant with TBI keep track of what is going on.

Checking in regularly on plans and assisting in creating task lists for the next day can become part of the group program’s system, and be beneficial to those with TBI in the group who may miss information or become confused. This can occur due to dizziness, fatigue or headaches in loud settings, and make it difficult in tracking multiple conversations and other executive functions that can make it feel difficult to keep up.

Create an environment with participants that is open to discussing a need for assistance, such as regular debriefings to wrap up days on the program. People will require assistance for a variety of concerns including mental health, physical inaccessibility, understanding social cues, or managing in a crowded environment. Creating an open environment will create a better experience for all.

People with TBI sometimes benefit from peer support, and being aware of peer support groups in person or online at a host site can be beneficial. When it comes to approaching a person with TBI about trouble managing time, social interactions, or otherwise, they may trust the advice of their peers over that of a professional. Sometimes it is easier to just decline invitations or not go do something, so patience and persistence in support will lead to a more complete experience while abroad. 

See the related links section for some useful blogs and forums on living with TBI. Associations and support groups can be found in each U.S. state and in some countries worldwide. Also see the Table of Contents for stories from two exchange participants with TBI and tips on flying with TBI.