Instructional Strategies for Elementary Students with TBI Susan J. Roland
Mar 26, 2015
Instructional Strategies for Elementary Students with TBI
Susan J. Roland
Everyday Instruction/Best Practices Executive Functions
OrganizationCognitive FlexibilityOrientation IssuesProblem Solving
Memory and New Learning Attention Some Specifics for Behavior
Interventions for Students with TBI Follow principles of good instruction Are often beneficial to entire group Are highly specific to the individual needs
of the student
4 Facts on Long-Term changes:
No 2 students will be alike.
Changes are unlikely to disappear fully over time; the student’s recovery will most likely only be partial.
Negative consequences may not be seen immediately but only emerge when developmental demands reveal deficits and problems.
An injured brain is less likely to meet the increasingly complex tasks all children face as they get older.Hibbard, M., Gordan, W., Martin, T., Raskin, B., Brown, M. (2001) Students with Traumatic Brain Injury: Identification, Assessment and Classification, Assessment and Classroom Accommodations : NYC, NY
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Best Practice for Instructions
Demonstrate what you want the student to do (pair visuals with verbal)
Use many positive and negative examples○ Show an example of what you want AND don’t
want
Point out how the positive examples are the
same - Point out the obvious - it most likely is
NOT obvious to some
Best Practice: InstructionUse consistent language to reduce the chance for error
Use Rubrics for grading - this is the easiest way to modify grades for the teacher and the best way to lay out expectations
Monitor student performance to prevent errors in practice and responses
Provide positive corrective feedback (“The more we work on this, the easier this is going to get!”)
Include systematic reinforcement and correction in a positive way
Best Practice: Instruction Evaluate Your Teaching
Starting level correct?Did you
○ monitor the student’s performance?○ record the student’s progress ○ Review student progress○ Change the instruction as needed until the student
is making progress in the designated curriculum
Madigan, K., Hall T.E.,& Glang, A., (1997). Effective Instructional Practices for students with ABI in Students with Acquired Brain Injury: The school’s response. Glang, A., Singer, George, Todis, B. Eds. Brookes: Baltimore
Executive Function Strategies planning, organization, initiation, time
management, working memory, flexibility cognition, memory, attention, reasoning, abstract thinking; judgment; and problem-solving
Key Components of an Intervention Plan for EF:
Get information from a variety of sources:interviews, behavior checklists, observations,
and work samples along with formalized assessment
List problem areas Link problem areas to the executive function
that best describe the problem Match information across and between
settings and domains Choose an executive function to work on,
that will be meaningful to the student
PaulPaul has been having a difficult time at school
socializing with his peers. He enjoys socializing and talking but classmates get frustrated with him because he only wants to talk about himself. When he tries to talk with his peers, they just ignore him. What has been observed is that he talks at length without allowing anyone else to speak. He only speaks about himself.
Using his goal of wanting to talk to others and addressing Paul’s needs to listen, and be more flexible in topic choice
The areas are linked to help create Paul’s intervention
What might be an intervention to try with Paul?
PaulPaul might set a goal of talking to others
about something of interest to them.Paul works with the speech pathologist to
generate a list, of topics of interest, specific to a targeted peer/individual
He role plays/practices speaking to the target person with the guidance of the speech pathologist or other mentor
Paul practices with other people using less and less adult coaching for increased flexibility in a variety of situations.
Evaluation of Paul’s Intervention
Examine the effectiveness of the intervention by documenting the following:
Were the intervention and supports put into place?○ Duration○ Frequency
How did it work?○ How many teacher prompts were needed?○ How natural was the conversation?
What’s the plan for reducing the number of supports?
Students may grasp the main concepts but may be unable to show their knowledge because of EF difficulties
Teach Routine○ The day should be predictable but still fun!○ Routines within your daily schedule
(stimulation breaks, set restroom breaks)○ Visual schedule (on the board for all, on
desk for a few, or an individualized picture schedule - use clock faces if you need to)
○ Creeds, chants, songs○ Utilize school organizational materials
(planner, etc)
Moving to the Large Group Explicitly teach the EF skill needed in an
applied setting○ Fade supports as soon as the student is able to
accomplish the skills○ Use external reinforcements only as necessary
Explicitly teach the skill needed in other settings to assist in generalization of skills
Guide practice of skill through group coaching or mentoring
Fade guidance as skill becomes internalized and guidance is no longer needed
Classroom Interventions for Executive Function
Changes in the EnvironmentChange the physical or social environment by
○ Changing the level of background noise○ Changing the level of visual stimulation○ Changing the physical restrictions (walls, room
size etc.)○ Use of lists or visual reminders ○ Changing the amount of organizational
structures
○Can they answer the BIG 5?
1. Know when to start
2. How much to do
3. How to do it
4. What finished looks like
5. What to do next
Specific strategies for ORGANIZATION
Organization
Use a planner or “back and forth” notebook with check-in and check-out system
Help students develop methods to organizeMaterials
– According file folders– Box on the floor rather than in the desk
Easier to access and less of an opportunity for the “black hole”
Ideas and information– Provide choices rather than open ended suggestions
Organizational strategies for note taking from lectures
Cornell notes or two column notesGraphic organizers (i.e. Thinking
Maps)Teacher provided note-taking
templatesTeacher provided guided notesFocused notes (main points - not
everything)
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Use of rubrics or other systemic methods of informing a student exactly what is expected for a job well done
Show/display positive examples of completed assignments and products
Strategies for writing○ Structured and organized○ Show/display examples and non-
examples
Specific strategies for COGNITIVE FLEXIBILITY
Strategies to Help with Cognitive Flexibility: Develop a daily routine that is maximally
functional.homework in plannerwhere and when to turn in homework
each dayschedule What is most important to you as the
teacher, parent or student?
Practice identifying multiple meanings in words, jokes, and riddlesTake advantage of on the spot teaching
when ever the opportunity arises! Encourage students to generate multiple
ways to solve problems or settle disputes Anticipate and plan for situations that
require mental flexibility and thinking on one’s feet (practice)
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Encourage students to compare current problems to previous problems and look for similarities and differences (facilitate making those connections!)
Shifting from one topic to anotherPicture or written schedules
Verbally assist students with metaphors EXPLAIN commonly used slang assume they do
NOT understand it
Self Monitoring and Checking
Helps students learn self regulation Students need to know
types of errors to look forhow to check for these errors exactly how to correct the errors
○ Give EXPLICIT instructions show an example hand-over-hand or after showing the class the example, go over to Mary and ask her to show you an example of how to “correct” an error”
Cognitive Scripting Specifics Help children understand what it looks
like to learn Teach turn taking Teach asking for help Use social stories (autism.org) SHOW what it looks like
Educational Accommodations for Orientation Issues Have student use assignment book or pl
anner. Use peer buddies Maintain consistent room arrangement,
materials. Label significant objects and materials. Teach child to look for permanent
landmarks.
Educational Accommodations for Orientation Issues (Continued)
Provide charts, schedules, maps, that describe daily routines and routes.
Have child verbalize how to get a to place before going.
Allow extra time in moving from one location to another.
Educational Accommodations for Problem Solving Role play cause and effect scenarios. Teach the structure and format of an
activity. Raise questions about alternatives for
behavior. Demonstrate application or problem
solving skills across daily routines. Provide ongoing feedback.
Educational Accommodations for Problem Solving (Continued) Provide a highly structured learning
environment. Provide assistance with alternate
solutions and courses of actions. Provide assistance with sequencing tasks
and prioritizing objectives. Provide clear expectations.
Commonsense Guidelines Always make your expectations clear. Keep focused on task on hand. Praise effort, not outcome. Pick your battles, do not force
confrontations. Don’t say “no”, say “try again”. Ask questions and give choices.
Commonsense Guidelines cont.
Speak with respect: give choices not orders; speak calmly and firmly; and do things to help the child learn.
Make a plan prior to every activity. Evaluate activities and outcomes
frequently. Create an organized, structured learning
environment. Describe and model behaviors that you
want.
Specific Strategies for Memory & NEW LEARNING
Practice, Practice, Practice repeated practice
○ spaced and varied intervals○ spiraled practice (come back to it in 1-3
months) Include pictures or visual cues with verbal
information Provide a schedule of tests, reports, and
assignments to parents several week prior to due dates
Due to difficulties of free recall of information, allow use of aids such as: a vocabulary list or a word bankopen-book and open-notes test formats
(with highlighted information)test questions in a multiple-choice or
matching format
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Focus the student’s attention on specific information: “ I’m going to read a story and ask WHO is in the story.”
Draw connections between new information and prior knowledge
Reduce the amount of information that you student is studying or working with to 5 or 6 main point rather than 9 or 10.
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Reading
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Pair visual with audio Label everyday objects Write pg. # next to Q’s to find answers Decrease independent silent reading
Start-to-Finish Books
Reading (Continued) Injury prior to learning to read = early
intervention to develop:To develop sound-symbol correspondencePre-reading competenciesTeach pattern word lists and sight words
Pre-teach vocabulary Color code highlight (i.e. yellow for Main
Idea or Topic Sentence, green for details, orange for explanations or definitions, etc.)
Math
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Practice in natural settings Figure out when lunch or recess will beginFigure out how many bills and coins lunch will
cost with 2 snacks
Do not require copying from board Provide space for ALL computations - have
student circle final answer at the end - no separate answer sheets
Math (Continued)
Provide fact tables and number lines Provide lists of rules, formulas, steps to
follow and examples - examples - examples
Use MANIPULATIVES and visuals Use graph paper to enhance
organization and spacing
Written Language
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Use a clipboard to stabilize paper Dictate “notes” for the student to “bring”
to your teammate down the hall Use of a scribe, fill-in-the blanks, true-
false, and matching formats for test Assistive Technology
Co-WriterWrite Out-Loud
Written Language (Continued) Allow student to dictate the first draft of a
writing assignment for a parent/teacher to type (word-for-word) student revises, makes additions and edits from this first draft
Allow alternatives for written assignments:http://blabberize.com/dioramatheatrical presentationa modelillustration
Educational Accommodations for Memory and New Learning Develop active learning situations Have child utilize visual imagery.
Visualizing and Verbalizing (SRA) Have child use verbal rehearsal or self-talk. Use a sufficient range of examples:
visualnon-examples
Use all resources of the curriculum ex. CD’swww.BookShare.orgStart-To-Finish Books
Have child role-play stories Provide sufficient practice. Provide cumulative review of
previously taught material. Picture Schedule Clock face schedule Materials checklists Schedules and lists on a key ring or
clipboard
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Specific strategies for Attention
Educational Accommodations for Attentional Issues Limit Noise Remove distractions Provide concrete visual cues Limit amount of info on a page. Adjust assignments. Focus on most salient aspect of
lesson. Maintain brisk pace. Repeat instructions
Use short and concise instructions. Reinforce on-task behavior. Give frequent breaks. Break assignments up. Set up personalized cuing system
based in classroom system(s)
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Emotional, Social Skills and Behavior: Strategies for Intervention
Reminders from previous presentations:For Younger Students Give clear and simple
directions Avoid time outs (the
student is NOT likely to independently regroup or calm down)
Label the emotion and direct the student to show the acceptable behavior
For Older Students: Teach strategies and how to use them
rather that offering assistance Discuss and practice age-appropriate
behaviors in real life situations Assume limited ability to generalize from
one setting to another
Proactive Communication
Always give information. Tell
the person:
○ Where you are going.
○ How much you want the
person to do.
○ How long you want the
person to do something
○ What does finished look
like?
○ What is next….
Write things down.
Don’t say “no”, say “try
again”.
Even More Proactive Communication Ask Questions & Give Choices
○ “What did I say?”
○ “Do you remember?”
○ “What can you do now?”
○ “What should you do now?”
○ “Is this going to help you?”
○ “How do you want me to help you?”
○ “What do you want?”
Coaching to help wit self image
Sometimes
mis-perceptions can lead to a lot of misunderstandings. Thank you for taking the time to learn more about some of our most misunderstood and disguised kids.
PBS &TBI Often an excellent match Uses built in
RoutinesPositive momentumNaturally occurring rewards and
consequences that can make sense to students
Questions?