New Study in Journal of Head Trauma Rehabilitation Explores Predictors of High School and College Graduation for Young People with Traumatic Brain Injury

Authors included Hackensack Meridian JFK Johnson Rehabilitation Institutes’ Dr. Ashley Kakkanatt who calls for interventions to address health disparities, educational and vocational needs to help students succeed.

A new study of young people with traumatic brain injury published recently in The Journal of Head Trauma Rehabilitation1 in July of 2022, identified early predictors of graduation from high school and college after moderate-to-severe traumatic brain injury (TBI). 

The study concluded that social and demographic factors, such as race, substance abuse, and level of functional independence following rehabilitation influence graduation outcomes for young people following TBI. The authors of the study said that these factors require a variety of societal, educational/vocational, and personal interventions to help these students succeed.

Individuals from racial and ethnic minority groups not only are at higher risk of TBI2 but also encounter healthcare disparities that magnify the long-term mental, physical and cognitive health effects of TBI, including disparities in services received to support academic and vocational success. 2,3

Of note, one in every 100 Americans aged 15 to  24 visits the emergency department for TBI each year.4  While TBI can have devastating impacts for people of all ages, its effects are especially consequential for adolescents and young adults who are typically pursuing educational goals. The U.S. Department of Education  estimates that 27,000 students every year receive services for disability following TBI.5

”A broad range of efforts across society are needed to understand and combat racial inequity in the school systems to better support students with traumatic brain injury who come from ethnic and racial minority groups,” said Ashley Kakkanatt, MD, physical medicine and rehabilitation at Hackensack Meridian JFK Johnson Rehabilitation Institute and a coauthor of the study who worked on it during her fellowship training there. She now serves as an attending physician at JFK Johnson.

“Providing more intensive vocational services when young people leave the inpatient rehabilitation setting, especially for those with significant disability, could lead to more students with TBI graduating after their injury,” she added.

The study included information from 969 adolescent and young adult students, aged 16 to 24 at their time of injury, which was collected from March 1989 to September 2021.  All participants were enrolled in the multicenter Traumatic Brain Injury Model Systems (TBIMS) National Database, which is a study of individuals admitted to inpatient rehabilitation with primarily moderate-to-severe traumatic brain injury. Hackensack Meridian JFK Johnson Rehabilitation Institute* is a TBIMS study site. 

The study authors characterized differences between those who did and did not graduate from high school and college within the first five years after their brain injury and identified early predictors of successful high school and college graduation using two different statistical methods.

The study authors defined successful graduation as having a  high school diploma  or college associate/bachelor's degree at 1-, 2-, or 5-year follow-up. Predictors were sex, race/ethnicity, living in a city, preinjury substance abuse, primary rehabilitation payer, and functional independence at inpatient rehabilitation discharge. 

“Of those participants with known graduation status, 81.2% of high school and 41.8% of college students successfully graduated,” said Dr. Kakkanatt. “Graduates in both groups were more often white than Black and had more functional independence at discharge. Among high school students, pre-injury substance abuse was a risk factor for not graduating, as was identifying as Hispanic or ‘other’ race.”

Nearly 25 percent of the high school students and more than 50 percent of the college students in the study did not successfully graduate within five years after their injury. This is a lower successful graduation rate than the national rate for high school students at 86 percent in 2018-2019 and undergraduate college students at 63 percent in 2013.7

“Young people with traumatic brain injury require many types of support from the health care system, family and friends and other support networks,” said Dr. Kakkanatt. “Health care systems and government agencies need to evaluate further the needs of young people with traumatic brain injury who come from diverse backgrounds to support their educational needs and help them succeed.”

JFK Johnson Rehabilitation Institute is one of 16 Traumatic Brain Injury  Model System organizations in the United States. The Traumatic Brain Injury Model Systems (TBIMS) program, sponsored by the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR), Administration for Community Living, U.S. Department of Health and Human Services, supports innovative projects and research in the delivery, demonstration, and evaluation of medical, rehabilitation, vocational, and other services designed to meet the needs of individuals with traumatic brain injury. 

NIDILRR awards TBI Model Systems grants to institutions that are national leaders in medical research and patient care; these institutions provide the highest level of comprehensive specialty services from the point of injury through eventual re-entry into full community life.