Helping People Without Making Them Helpless: Fun, Functional, and Other F Words Tim Feeney, Ph.D. Project Director New York Neurobehavioral Resource Project Binghamton, NY Clinical Director School and Community Support Services 600 Franklin Street Suite 110 Schenectady, New York USA

Im a person, not a patient; and Im not yours!

Grandma Masses Rules for Success: The smart guys are the guys who learn from the other guys. Dont get all caught up in one thing; everyone believes their thing is the best thing and theyre usually wrong. So, shut-up and listen and learn and change. In order to be successful youve got to be eclectic; moreover, we need to learn from other literatures from other populations

More Grandma Masse Models collect dust on shelves. Dont fall in love with a particular approach – ideally, youll/well create a framework for intervention (a working theory) that will evolve with experience and evidence

You can make people do things that they just dont want to do but the price for doing so will be high

Poodle

FUNCTIONAL does not equal Increased/Improved performance on standardized tests

FUNCTIONAL does not equal Bowling or the The Friday Outing or the The really neat, really expensive, simulated...

FUNCTIONALequals Creating stable routines of life that enable me to do what I need to do when I need to do it.

A coach gets guys to do the things A coach gets guys to do the things they dont want to do so they can become the players that they want to be. - Walt Harris Were all coaches A good coach: A good coach: Alters his/her coaching to Alters his/her coaching to reflect the needs of the player reflect the needs of the player and conditions of the context. and conditions of the context. Never tries to play the game Never tries to play the game him or herself. him or herself.

The glass aint half empty, its half full! and You can teach 1/2 empty people to become 1/2 full people (its hard to teach 1/2 empties to become 1/2 fulls)

PERSON Motor SKills Cognition LanguageEmotionVolitionBehavior Human beings are a collection of relatively independent structures, processes, and systems

Johns Cognition AttentionPerceptionMemoryOrganizationReasoningEF Arousal Select Direct/ Filter Maintain Divide Shift Encode/Store/Retrieve Episodic/Semantic Explicit/Implicit Declarative/Procedural Involuntary/Strategic Working Memory/ Knowledge Base Remote/Recent Pro/retrospective Iconic Sequence Categorize Associate Analyze Synthesize Inductive Deductive Analogical Divergent Convergent Goals for John - John will: 1.Increase duration of maintained attention 2.Increase prospective memory from 3 to 5 minutes 3.Increase category naming from 3 to 5 members per category

Johns Language PhonologyMorphologySyntaxSemanticsPragmatics Receptive vs. Expressive Phrase Structure Rules Etc. Receptive vs. Expressive Lexicon Semantic Relations Discourse Structures Receptive vs. Expressive Speech-act Competence Conversational Competence Socio-linguistic Competence Goals for John: John will 1.Decrease mean naming latencies from 3 to 2 seconds 2.Include 5 basic story grammar elements in retellings 3.Use politeness markers in greeting people: 90%

Johns Behavior John b1 b3 b12 b4 b1 b7 b62 b17 b17 b17 b4 b6 b9 b17 b12 b3 b8 b8 b5 b6 b17 Goals for John: John will 1.Increase frequency of b3 and b12 2.Decrease frequency of b17 John is the totality of his behaviors and the systematic relationships among them

Alternative Understanding of Human Beings Sarah Pursuing personally meaningful goals While participating in culturally valued activities Using cultural tools, such as language, category schemes, mathematics, organizational supports, domain-specific strategies Mediated as necessary by individuals with greater expertise in that domain In social, cultural, and historical contexts In the presence of varied context facilitators and barriers

Intervention Goals Sarah will successfully complete ___ meaningful task, with ___ supports, possibly using ___ tools/strategies, in ___ context (setting, people, activities), in order to achieve ___ goal. Possibly focusing intervention attention on some specific aspects of cognition, communication, social skills, behavioral self-regulation, or educational/vocational skills – aspects that are either particularly weak or particularly important for Sarah.

Research-Based Intervention Strategies Related to Common Characteristics of Individuals with Brain Injury Fluctuating Attention Characteristic: Fluctuating Attention Appropriate Pacing Strategy: Appropriate Pacing Delivering material in small increments and requiring responses at a rate consistent with the individuals processing speed increases the acquisition of new materials.

Research-Based Intervention Strategies Related to Common Characteristics of Individuals with Brain Injury Memory Impairment Characteristic: Memory Impairment Errorless learning and high rates of success in interactions Strategy: Errorless learning and high rates of success in interactions Acquisition and retention of new information tends to increase with high rates of success (and error frequency increases with frequent errors and error correction).

Research-Based Intervention Strategies Related to Common Characteristics of Individuals with Brain Injury Organizational Impairment and Inefficient Learning Characteristic: Organizational Impairment and Inefficient Learning Task analysis of activities and advance organizational support Strategy: Task analysis of activities and advance organizational support Careful organization of learning and tasks including systematic sequencing of intervention targets and advanced organizational supports increases success.

Research-Based Intervention Strategies Related to Common Characteristics of Individuals with Brain Injury Inefficient Learning and Inconsistency in Performance Characteristic: Inefficient Learning and Inconsistency in Performance Massed practice and review including frequent cumulative review Strategy: Massed practice and review including frequent cumulative review Acquisition and retention of new information and consolidation of old information in memory is increased with frequent, routine-based review.

Research-Based Intervention Strategies Related to Common Characteristics of Individuals with Brain Injury Inefficient Feedback Loops and Implicit Learning of Errors Characteristic: Inefficient Feedback Loops and Implicit Learning of Errors Errorless learning combined with corrective (and brief) feedback when errors occur. Strategy: Errorless learning combined with corrective (and brief) feedback when errors occur. Many individuals with severe memory and learning problems benefit from errorless learning. When errors occur, learning is enhanced when those errors are followed by non-judgmental corrective feedback.

Research-Based Intervention Strategies Related to Common Characteristics of Individuals with Brain Injury Frequent Failure of Transfer/Concrete Thinking and Learning Characteristic: Frequent Failure of Transfer/Concrete Thinking and Learning Facilitation of transfer, generalization, and maintenance via contextual teaching. Strategy: Facilitation of transfer, generalization, and maintenance via contextual teaching. Generalization is more likely when skills are taught in the context in which they will be used (context is encoded with information). In addition, using a general case approach (wide range of examples and settings) increases generalization.

Research-Based Intervention Strategies Related to Common Characteristics of Individuals with Brain Injury Unpredictable Recovery, Unusual Profiles, and Inconsistency in Behavior Characteristic: Unpredictable Recovery, Unusual Profiles, and Inconsistency in Behavior Ongoing assessment and flexibility in curricular modification. Strategy: Ongoing assessment and flexibility in curricular modification. Adjustment of interaction based on ongoing assessment of the individuals progress facilitates learning and allows for curricular modifications on the fly.

Research-Based Intervention Strategies Related to Common Characteristics of Individuals with Brain Injury Impaired Strategic Behavior/ Impaired Organizational Functioning Characteristic: Impaired Strategic Behavior/ Impaired Organizational Functioning Strategy-based intervention. Strategy: Strategy-based intervention. Organized intervention designed to facilitate a strategic approach to difficult tasks, including organizational strategies.

Research-Based Intervention Strategies Related to Common Characteristics of Individuals with Brain Injury Decreased Self-Awareness/ Denial of Deficits Characteristic: Decreased Self-Awareness/ Denial of Deficits Self-awareness/attribution training Strategy: Self-awareness/attribution training Facilitation of individuals understanding of his/her role in learning

Research-Based Intervention Strategies Related to Common Characteristics of Individuals with Brain Injury Behavioral Difficulties Characteristic: Behavioral Difficulties Positive behavior supports Strategy: Positive behavior supports Using an approach to behavior intervention that focuses primarily on the antecedents of behavior in the broadest sense (including setting events and establishing operations), environmental management, and role improvement.

Fun as an Important Element of Rehabilitation Therapeutic: Serving to sure or heal Fun: Lively, joyous, playful Do you ever ask yourself: Where is the fun? rather than Are we having fun yet?

FUN IS NOT: Worrying about being politically correct Worrying about being politically correct Going to therapy Going to therapy Doing a workbook activity Doing a workbook activity Working on fricatives in the speech closet Working on fricatives in the speech closet Working to meet some fricking criterion on Working to meet some fricking criterion on some fricking test before I can get out of this fricking place Being told to be realistic Being told to be realistic Being told to be realistic by some snot- Being told to be realistic by some snot- nosed twenty-something who hasnt lived life like I have

FUN IS: The 1st time Kids The 1st time Kids Play Joking Play Joking Friends SpongeBob Squarepants Friends SpongeBob Squarepants Laughter Hope Laughter Hope Feeling connected Feeling useful Feeling connected Feeling useful Viagara Being naughty Viagara Being naughty Love Pure joy Love Pure joy Doing something you really like with someone Doing something you really like with someone you really like Accomplishing something meaningful Accomplishing something meaningful

Its important to have fun with and create opportunities for fun and to laugh a lot even in the face of significant challenges

MINDSETS NOT CONDUCIVE TO FUN: The Oprah Type - victim/tragedy/altruist The Oprah Type - victim/tragedy/altruist Typical utterances: Typical utterances: Suffers from... Victim of... The Dr. Kildare Type - medical orientation The Dr. Kildare Type - medical orientation Typical utterances: The patient... The Dr. Phil Type - control/territorial The Dr. Phil Type - control/territorial Typical utterances: You gotta... We tried that before, itll never work Because Im the expert This is my area, dont mess with me!

MINDSETS CONDUCIVE TO FUN: Flexible Flexible Typical utterances: Yeah, we can do that. That looks interesting, different than I thought but its worth a try. but its worth a try. Collaborative Collaborative Typical utterances: Whaddaya think? Geez, thats a good idea, lets give it a shot. Mature Mature Typical utterances: Youre right! Some things I cant change.

MINDSETS CONDUCIVE TO FUN: Risk taking Typical utterances: Well, I dont know what might happen... Whats the worst that could happen? Whats the benefit? Sometimes its easier to ask for forgiveness than for permission than for permission Hopeful Hopeful Typical utterances: Hey, were onto something here! Lets give it a shot. Sure, we can do that. Self-EffacingSelf-Effacing Typical utterances: I dont think I could think like that. I couldnt ever.

Friendly (adj.) 1 like, characteristic of, or suitable for a friend, friends, or friendship; kindly 2 not hostile; amicable 3 supporting; helping; favorable

Fellowship (n.) 1 a mutual sharing, as of experience, activity, interest, etc. 2 a group of people with the same interests; company; brotherhood

Frequent (adj.) 1 occurring often; happening repeatedly at brief intervals 2 constant; habitual.

Faithful (adj.) marked by or showing a strong sense of duty or responsibility

Feeling (v.) to be moved by or very sensitive to

Fair (adj.) just and honest

Fabulous (adj.) very good; wonderful

Fantastic (adj.) seemingly impossible; incredible

Folly (n.) 1 a lack of understanding, sense, or rational conduct; foolishness 2 any foolish action or belief 3 any foolish and useless but expensive undertaking.

Foolhardy (adj.) bold or daring in a foolish way; rash; reckless

Fiasco (n.) a complete failure.

Fail (v.) to be deficient or negligent in an obligation or duty

Fecal (adj.) of or consisting of feces

Four Lessons to Live by: Hope is an essential part of any successful plan of support. Form follows function. Think about what the individual needs and then create a way for that to happen in a flexible manner. The more you try to force something or someone to change, the more it (or he or she) changes you. When all else fails, a sense of joy and a sense of humor can get you through a whole lot!

Finished (adj.) 1 ended; concluded 2 completed 3 highly skilled or polished; perfected; accomplished 4 given a certain kind of finish or surface, as of paint, wax, etc. 5 defeated, ruined, dying, etc. 6 no longer dealing with or concerned with.