Instructional Strategies for Secondary Students with TBI

Randy Thomas

Marathon vs. Sprint Building success with a student who has

a TBI takes consistent, focused, hard work.It is very difficult for the student.It is very rewarding for the student and the

teacher.Successes may require you to look back

over a semester or a year to clearly recognize.

Coaches don’t expect a kids in casts to run; their injuries prevent them being capable.

Overview

Everyday Instruction Executive Functioning Memory Attention and Focus Behavior

Everyday Instruction Follow principles of good instruction Are often beneficial to entire group

Target the Key ConceptsReview those key concepts regularly

Are highly specific to the individual needs of the studentAssess key concepts: pre,

formative, & summative

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

Effective Teaching Model1. Task analysis – break the task down to

steps with clear beginning and ending point.2. Use Direct-instruction to prevent the

acquisition of errors in newly developed practices. Examples and non-examples are beneficial. Paint a clear picture of expectations.

3. Frequent assessments: Baseline and regular formative assessments

4. Frequent reviews combining visual and verbal ques.

5. High rates of correct, practice trials: 5 trials is not enough, 30-50 practices with mass practices initially followed by consistent reinforcement practices.

6. Metacognitive strategy training: Self-evaluation of one’s own performance.

Effective Teaching Model

Executive FunctionsThose mental capacities

necessary for formulating goals, planning how to achieve them, and carrying out the plans effectively. (Leak, 1982)

Dysexecutive Syndrome Impulsiveness Poor social

judgment Difficulty interpreting

other’s behavior Perseveration Poorly regulated

attention Disorganized Ineffective planning

Decreased flexibility Slowed processes Limited divergent

thinking Concrete thinking Limited problem

solving Weak self-

monitoring Reduced attention

Metacognitive Strategies

Self-regulation (“Self-talk” or Social Stories)

A repeated phrase or narrative to help guide the student through a specific task – Student Planner:

Examples of External Aids A student may take 15 minutes trying to start but

perceive that it has only been 1 or 2 minutes.

Time ManagementKitchen or digital timershttp://www.online-stopwatch.com/Day planners

Task SpecificChecklist (homework, materials, readiness

routines)Color coding/labelingSet up all classroom binders exactly the same

Homework Helper 1. Pull out homework list (planner…etc.) 2. Make homework list in priority order 3. Start working now! Start my timer.

a. Find book, worksheet, & pencil. b. Read directions. c. Ask for help only if you need it.

4. Turn in completed work!Great Job! Keep working hard!

Examples of Metacognitive Strategies

Self-monitoring of Attention Monitoring progress and/or success during

an activity Step-by-step task-specific checklist can be

used to support difficult tasks May include error checking and motivation

on the checklists Student self rates success during and after

task and documents successful strategies

The On-task Traffic Light!! Red Light

Stop!! Am I doing what I am supposed to be doing?

Yellow LightLook! What should I be doing instead?

Green LightGo!! Choose a new direction and move

forward!

Examples of Environmental Modification-Physical Set up Seating – have the same seating in all

classrooms if possible…i.e. front right side. Sound management – ear plugs or head

set Distraction management – no irrelevant

items

The more that a student’s environment is standardized across classrooms, the easier it is to focus on instruction in each class.

Examples of Environmental Modification-Physical Set up Structure task in step-by-step format. Give one portion of a task at a time.

Single step instructions Routinize tasks. Put time estimates at the top of the

paper. Assign a peer buddy.

Natural Support Modify instruction style to accommodate

individual student.

Facilitate a supportive social environment. School counselors are a great resource to engage

classmates in creating a supportive climate.

Work towards common expectations and practices between home and school.

Combination Approaches External Aid + Metacognitive Practice

Digital timer combined with self-talk Natural Supports + External Aid

Classroom/school-wide culture and assignment completion system

Environmental Modification + Metacognitive Task accommodation and self-advocating

for help○ Model how to self-advocate & allow practice

Memory Short term memory is broken. Try carrying water using a tea strainer to

better understand their frustration. You look at the board, say in your head

what you need to write down, look down at your paper….what was that again?

Provide the aids necessary to compensate.Lecture notesCompleted graphic organizers

Attention and Focus Students remember the beginning and end

of a lesson.

Chunking limits the forgotten middle.

Break up the lesson with physical activities.Sensory diet

Crossing the midline engages both sides of the brain and causes both sides to communicate.

Situational Teachers

High CapabilityLow Motivation

Needs encouragement

Low CapabilityLow Motivation

Needs instruction and encouragement

High capabilityHigh motivation

Needs autonomy

Low capabilityHigh motivation

Needs instruction

Behavior Behavior is communication; am I listening to

understand? What is being communicated? I don’t know what I’m supposed to be doing. I don’t know how to do the work. I count using my fingers and can’t

remember my multiplication facts, and you want me to do what?

I don’t want to look like an idiot; I’d rather just be in trouble.

There are Two Plans Plan A

Oh, let’s just sporadically provide individualized instructions and make on-the-fly adjustments and hope it works.

Plan BObserve behavior, think through intervention

options, systematically apply the most feasible option, evaluate to determine effectiveness, make purposeful modifications.

Summary Everyday Instruction – Effective teaching

model Executive Functioning – Select the most

needed target. Memory – Provide aids as needed. Attention and Focus – Chunking and

physical activity Behavior – What is this kid saying?