1. Instructional Strategies for Elementary Students with TBI
Susan J. Roland

2. Areas for Interventions
Everyday Instruction/Best Practices
Executive Functions
Organization
Cognitive Flexibility
Orientation Issues
Problem Solving
Memory and New Learning
Attention
Some Specifics for Behavior

3. 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. 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 4

5. 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

6. 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

7. 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

8. Executive Function Strategies
planning, organization, initiation, time management, working memory, flexibility cognition, memory, attention, reasoning, abstract thinking; judgment; and problem-solving

9. 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

10. 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

11. What might be an intervention to try with Paul?

12. 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.

13. 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?

14. Students may grasp the main concepts but may be unable to show their knowledge because of EF difficulties

15. 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)

16. 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

17. 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

18. Can they answer the BIG 5? Know when to start How much to do
How to do it
What finished looks like
What to do next

19. Specific strategies for ORGANIZATION

20. 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

21. 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)

22. 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

23. Specific strategies for COGNITIVE FLEXIBILITY

24. 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?

25. 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)

26. Shifting from one topic to another
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

27. 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”

28. 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

29. 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.

30. 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.

31. 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.

32. 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.

33. 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.

34. 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.

35. Specific Strategies for Memory & NEW LEARNING

36. 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

37. 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

38. 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.

39. 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 39

40. 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.)

41. Math Practice in natural settings Do not require copying from board
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

42. 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

43. 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, true- false, and matching formats for test
Assistive Technology
Co-Writer
Write Out-Loud 43

44. 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:
diorama
theatrical presentation
a model
illustration

45. 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
Start-To-Finish Books

46. 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

47. Specific strategies for Attention

48. 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

49. 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)

50. Emotional, Social Skills and Behavior: Strategies for Intervention

51. 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

52. 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

53. 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”.

54. 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?”

55. Coaching to help wit self image

56. 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.

57. PBS &TBI Often an excellent match Uses built in Routines
Positive momentum
Naturally occurring rewards and consequences that can make sense to students

58. Questions?