Sunday, November 10, 2013

Instructional Design and TBI

As an educator and curriculum developer in a community college vocational training program, I work with many veterans.  The current cohort is comprised of approximately one-third veterans.  Over the past several years, my experience is that several of the veterans seem to have difficulty with retaining and recalling the material, which leads to frustration and in some cases, dropping the program.  While some of the students either have been, or are in the process of being, diagnosed with Post Traumatic Stress Disorder (PTSD), some of them have also sustained traumatic brain injury (TBI).  Working with counselors, we can help students with PTSD to use strategies to help them cope with stressors within the classroom.  However, what is missing is guidance in what steps can be taken to address the learning process itself in students with TBI through the instructional design.

The United States Department of Defense (2013) recently wrote, “Traumatic brain injury is one of the invisible wounds of war, and one of the signature injuries of troops wounded in Afghanistan and Iraq.”  With the enrollment of veterans of the Iraq and Afghanistan conflicts expected to rise significantly, it is likely that this program will see an increase in students with TBI (St. Louis Post-Dispatch).  While the college does have adequate resources for addressing accessibility and counseling issues, including veteran specific services, there has been nothing communicated on how curriculum development or instructional design can be adjusted to embed the strategies that will help these students succeed.

A major complaint I hear from students and especially those with TBI and/or PTSD is that they have difficulty retaining information.  One study points to impaired consolidation, the process by which information is stored and then recalled, as being the major factor in memory impairment in TBI (Vanderploeg, Crowell, & Curtiss, 2001).  It was also found that test subjects forgot new information quickly.  They also found that proactive interference, or difficulty learning something new because of existing information, is also low.  The researchers suggest these findings support their hypothesis that impaired consolidation rather than encoding or retrieval issues are the basis for the inability to retain information (Vanderploeg, Crowell, & Curtiss).

With the warnings from veterans’ advocates, “...without special attention, many will fail to graduate” (St. Louis Post-Dispatch) it is imperative that these issues be addressed.  One of my major responsibilities, in addition to developing curriculum, is the design of online curriculum that can be used by any college within this state.  As discussed by Orey (2001) in an introduction to information processing, metacognitive and cognitive strategies are learnable and of value of all students.  Online learning seems to be the perfect vehicle for incorporating these strategies.  However, the question is would these learning strategies be enough to help students with TBI.

An additional study examined the effect of presenting repeated information over time, otherwise known as the spacing effect (Ebbinghaus, 1964).  In this study, it was concluded “SE [spacing effect] is a naturally occurring learning phenomenon that can be employed to improve recall and recognition in individuals who have sustained moderate to severe TBI” (Hillary, et al., 2003).  If this is the case, it seems to me that this would be an effective strategy to incorporate into online curriculum and would be of benefit to all students.  My intention is not only would students affected by TBI benefit from embedded strategies to aid retention, but all students, including those who may have English as a second language, or who may have poor study habits, would benefit.

For more information on resources available for veterans, caregivers, and medical providers, please visit the Defense and Veterans Brain Injury Center.


Ebbinghaus, H. (1964). Memory: A contribution to experimental psychology. New York: Dover. (Originally in 1885).

Hillary, F. G., Schultheis, B. H., Millis, S. R., Carnevale, T., Galshi, T., & DeLuca, J. (2003). Spacing of Repetitions Improves Learning and Memory After Moderate and Severe TBI. Journal of Clinical and Experimental Neuropsychology, 49-58. Retrieved November 09, 2013, from

Orey, M. (2001). Information Processing Emerging perspectives on learning, teaching, and technology. In M. Orey (Ed.), Emerging perspectives on learning, teaching, and technology. Retrieved November 07, 2013, from

St. Louis Post-Dispatch. (n.d.). Retrieved November 09, 2013, from Veterans Returning to College Face Unique Challenges:

U.S. Department of Defense. (2013, November 01). Traumatic Brain Injury. Retrieved November 09, 2013, from U.S. Department of Defense:

Vanderploeg, R. D., Crowell, T. A., & Curtiss, G. (2001). Verbal Learning and Memory Deficits in Traumatic Brain Injury: Encoding, Consolidation, and Retrieval. Journal of Clinical and Experimental Neuropsychology, 185 - 195. Retrieved November 09, 2013, from

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