Transcript Slide 1

Instructional Strategies for
Elementary Students with TBI
Susan J. Roland
 Everyday
Instruction/Best Practices
 Executive Functions
 Organization
 Cognitive Flexibility
 Orientation Issues
 Problem 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: Instruction
 Use 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
Paul
 Paul 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?
Paul
 Paul 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 Environment
 Change 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.
2.
3.
4.
5.
Know when to start
How much to do
How to do it
What finished looks like
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 organize
 Materials
– 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 notes
 Graphic organizers (i.e. Thinking
Maps)
 Teacher provided note-taking
templates
 Teacher provided guided notes
 Focused 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 planner
 where and when to turn in homework
each day
 schedule
 What is most important to you as the
teacher, parent or student?
 Practice
identifying multiple meanings in
words, jokes, and riddles
 Take 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 another
 Picture 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 for
 how 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
planner.
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 bank
 open-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
Pair visual with audio
 Label everyday objects
 Write pg. # next to Q’s to find answers
 Decrease independent silent reading

 Start-to-Finish Books
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Reading (Continued)

Injury prior to learning to read = early
intervention to develop:
 To develop sound-symbol correspondence
 Pre-reading competencies
 Teach 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

Practice in natural settings
 Figure out when lunch or recess will begin
 Figure 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

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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
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, truefalse, and matching formats for test
 Assistive Technology

 Co-Writer
 Write Out-Loud
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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/
 diorama
 theatrical presentation
 a model
 illustration

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:
 visual
 non-examples
 Use
all resources of the curriculum ex.
CD’s
 www.BookShare.org
 Start-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
 Routines
 Positive momentum
 Naturally occurring rewards and
consequences that can make sense to
students
Questions?