Traumatic Brain Injury in the Classroom - Google Sites

Traumatic Brain Injury in the Classroom - Google Sites

Traumatic Brain Injury in the Classroom A Workshop for Teachers Why do we need a workshop on Traumatic Brain Injury? TBI is more prevalent than previously thought A student may become a victim of TBI at any point during the school year A student with TBI will affect all members of a classroom

Students with TBI may appear as though they have Learning Disabilities, but in many cases they do not Characteristics of TBI may appear at different points in a students life, and teachers need to be prepared to respond to those changes What will I learn in this workshop? The definition and causes of TBI Characteristics of TBI Strategies for supporting a student with TBI in academic and social situations Suggestions for helping classmates support a student with TBI Strategies and materials that are used with a student who has TBI What materials will I receive?

A list of general and specific strategies for supporting students with TBI in academic and social situations Teacher created instructional materials designed for a student with TBI Materials that can be useful for a student with TBI A list of resources on TBI TRAUMATIC BRAIN INJURY Causes and Symptoms What is Traumatic Brain Injury? IDEA defines Traumatic Brain Injury (TBI) as: an acquired injury to the brain caused by an external physical

force, resulting in total or partial functional disability or psychosocial impairment, or both, that adversely affects a childs educational performance. The term applies to open or closed head injuries resulting in impairments in one or more areas, such as cognition; language; memory; attention; reasoning; abstract thinking; judgment; problem-solving; sensory, perceptual, and motor abilities; psycho-social behavior; physical functions; information processing; and speech. The term does not apply to brain injuries that are congenital or degenerative, or to brain injuries induced by birth trauma. [34 Code of Federal Regulations 300.7(12)] How common is TBI?

TBI is the leading cause of death and disability among children Each year about 1.5 million people experience a TBI, but only one million will be treated Children between the ages of 0-4 and 15-19 are most prone to TBI Males are 1.5 times as likely as females to sustain a TBI Between 9% and 38% of students with TBI are referred to special education www.braininjury.com/children.html What are the causes? Some of the leading causes of TBI are: Falls Motor-vehicle accidents

Being struck by or against an object Assaults and/or child abuse Other causes: Shaking Shaken baby syndrome Limited oxygen to the brain Heart attack Inhalation of harmful chemicals http://www.bianys.org/what_is_brain_injury.html What happens to the brain during a TBI? Force to the brain causes the brain to collide against the

inside of the skull Injury to the back of the head results in injury to the front of the brain Injury to the front of the head causes the brain to recoil and injure the front and back of the brain Shaking stretches and damages nerve cells www.braininjury.com/children.html Twisting of the brain stretches, twists and damages fibers in the white matter of the brain

A fall or a high speed accident causes damage through a pulse or pressure wave that moves through the brain What are the effects of TBI? TBI can affect any brain function Some typical symptoms of TBI are: Fatigue and/or disrupted sleep Difficulty concentrating Struggles with memory Impaired judgment Depression Irritability and/or emotional outbursts Slowed thinking Difficulty multi-tasking or changing tasks Other common results of TBI

Brain Injury can also cause: Paralysis Difficulty sequencing tasks Perseveration of thought Difficulty problem solving Receptive and expressive language difficulties Difficulty with hand-eye coordination and body awareness Vision difficulties Anxiety How is a student with TBI affected academically? Students with TBI may experience direct academic difficulties such as: Difficulty reading and/or writing

Struggles with math Students with TBI may struggle academically as a result of other impairments in the areas of: Memory Attention Language Spatial Ordering Memory An impairment in memory may affect: Memorization of math facts A students ability to form letter-sound relationships The recall of previously learned information

A students ability to hold onto information while completing a multi-step task The ability to access information stored in longterm memory Attention A students inability to attend may affect: Acquisition of all relevant material The filtering out of background noises The ability to distinguish important information from unimportant information The ability to follow multi-step directions Completion of a multi-step task Language Students with TBI may experience difficulty with expressive and/or receptive language Difficulty with expressive language may affect:

Expression of understanding of mathematical concepts Explanations of historical events or scientific discoveries Expression of comprehension of a literary text The ability to communicate effectively with peers in paired or group work Difficulty with receptive language may affect: Listening comprehension The ability to follow oral directions Comprehension of an explanation of a mathematical concept, a historical event, or a scientific process Spatial Ordering An impairment in spatial ordering may affect: A students ability to discriminate between

figures, including letters and geometric shapes Production of shapes or letters Recall of the names and/or appearances of shapes and letters Organization of materials needed to complete an academic task How does TBI alter a students personality? Students with TBI often experience changes in their personality due to an impairment in their sense of judgment Changes in personality often cause an increase in impulsive behaviors, which may appear to others as immature behavior Frequent interruptions

Blunt or overly honest comments Improper eating habits Repetition of words or phrases Inappropriate sexual comments Students with TBI are often unable to anticipate consequences of their actions If I say this, then something undesirable is going to happen How do personality changes affect social relationships?

Impulsive behaviors are viewed by peers as immature Blunt comments and frequent interruptions are perceived as rude Fatigue or lack of motivation are perceived as a lack of interest in others Sudden deficits in expressive language inhibit the ability to initiate and maintain conversation Flattened affect expresses disinterest Sudden changes in personality may cause peers to dislike the new version of the student with TBI Lauren and TBI Who is Lauren?

Lauren is a nine year old girl with TBI Lauren attends a school for children with special needs Lauren was 18 months old when she suffered an injury to her brain She receives services such as: Speech Therapy; Occupational Therapy (OT); Physical Therapy (PT); Play Therapy; academic tutoring What are Laurens strengths? Lauren easily adapts to new routines, new peers and new adults Lauren does not present behavioral difficulties in school She is always respectful to adults and considerate of peers if they are hurt or

upset She enjoys learning and spending time with peers Lauren is proud of her achievements What are Laurens struggles? Lauren shows deficits in eight Neurodevelopmental Constructs* Memory; Attention; Language; Spatial Ordering; Neuromotor Functions; Temporal-Sequential Ordering; Social Cognition; Higher Order Cognition Laurens deficits impact her ability to succeed in academic and social situations

*Mel Levine How do Laurens strengths and struggles affect heracademically? Laurens struggles in the Neurodevelopmental Constructs* affect her academic progress in: Classroom Academics: Science, Social Studies, Language Arts, Writing Lauren is in a classroom with twelve students, one head teacher, one assistant teacher, and has one-on-one support Reading Preventing Academic failure phonics curriculum and teacher generated materials Individualized instruction Decoding, encoding, comprehension Math

Stern math curriculum and teacher generated materials Factual knowledge, conceptual knowledge, life skills Individualized instruction *Social Cognition not included Laurens Struggles with General Academics

Memory: Laurens struggles affect her ability to recall previously learned information, strategies and activities Attention: Laurens struggles impact her ability to remain alert, filter out background noise, and focus on classroom instruction Language: Laurens difficulty with language impacts her ability to ask questions when information is unclear, comprehend presented material, and express an understanding of material Spatial Ordering: Lauren struggles to independently create a representation (drawing) of learned material Neuromotor Functions: Lauren has difficulty maintaining personal space, manipulating objects, and writing down her thoughts Temporal-Sequential Ordering: Lauren has difficulty independently sequencing a series of events and following multi-step directions Higher Order Cognition: Lauren has difficulty understanding abstract concepts, making connections to the material, relating what she has learned previously to what is being taught, and problem solving independently

Laurens Struggles with Reading Reading: Memory Short-Term Memory Lauren struggles to recall words or sounds she has just said and/or heard Active Working Memory Lauren struggles to write words without assistance; she has difficulty recalling letter formation and letter sounds, while holding onto the word that she wants to write Lauren struggles to decode while retaining the words that she has just read

Long-Term Memory Lauren has difficulty recalling sight words, sounds, and stories from one day to the next Reading: Attention Mental Energy Controls Lauren is often fatigued during reading instruction She struggles to maintain her arousal level Lauren becomes fatigued after periods of productive work Processing Controls Lauren struggles to remain focused for the duration of an activity Lauren often focuses on unimportant or irrelevant material and processes information on a basic level For example: when reading a text she may point to sight words she

recognizes, rather than reading the text for meaning Production Controls Lauren is inconsistent her ability to pace herself while she works Lauren verbally reminds herself to act in an appropriate manner When she sees a teacher becoming frustrated she may say: slow, careful hands, or tap it out Reading: Language Expressive Language Lauren has difficulty articulating several sounds, which therefore affects her comprehension of the words she reads Lauren struggles with word retrieval, and therefore loses her thoughts while trying to think of a word Lauren primarily produces fragments or short sentences; she rarely produces more than two sentences/fragments at a

given time Receptive Language When reading a text, Lauren does not understand that word parts contain meaning (ie. the suffix ed means past-tense) Lauren interprets language literally She had difficulty following multi-step directions, and understanding complex sentences Reading: Spatial Ordering and Neuromotor Functions Spatial Ordering Lauren has difficulty writing words of an appropriate size that sit accurately on the lines of the paper Lauren struggles to read from a text with small words; she often cannot distinguish between words when they are close together

Neuromotor Functions Fine Motor Function Lauren has difficulty turning the pages of a text independently; the time it takes her to turn a page often causes her to lose focus and forget what she has just read/completed Graphomotor Function Lauren struggles to picture letters and numbers in her mind before writing them She often writes a letter and then discovers that she has not written the letter she had intended to write Reading: Temporal-Sequential Ordering and Higher Order Cognition Temporal-Sequential Ordering

Lauren cannot independently recall the steps needed to write a phonetic word independently Lauren understands that individual words are read from left to right, however she often skips around when reading sentences or paragraphs Lauren has difficulty sequencing events in a text Higher Order Cognition Lauren struggles to comprehend concepts in a text When Lauren struggles to decode or encode a word she cannot difficulty independently recall strategies and problem-solve Lauren is successful in learning and applying new phonics rules; she struggles when a rule has an exception For example: give, have and live are words that have a silent e at the end, but that do not have the long vowel sound in the middle Laurens Struggles with Math

Math: Memory Short-Term Memory Lauren often has difficulty discriminating the important information from the extraneous information Lauren frequently comments that a penny is shiny rather than counting how many pennies are present Active Working Memory Lauren struggles to hold a number in her mind while counting to that number Counting money and stopping when she gets to a specific amount

Long-Term Memory When returning from vacations or long weekends, Lauren often forgets the monetary value of coins Math: Attention Mental Energy Controls The materials needed for money instruction often have an affect on Laurens alertness The sound that coins make have a tendency to increase Laurens energy level beyond productivity Processing Controls Lauren struggles to maintain attention throughout an entire activity She often interrupts her own counting to insert comments about the size/shape/color of coins

Production Controls Lauren does not self-monitor her academic responses When counting nickels she consistently says: 20, 25, 50 because she slips into the technique for counting quarters (25, 50, 75); she does not self-correct this behavior Math: Language Expressive Language Lauren often struggles to retrieve the name of the coins she counts Lauren uses conceptual terms (bigger, smaller etc.) without fully understanding their meaning Lauren does not have the language to explain her reasons for solving a problem in a particular manner

Receptive Language Lauren struggles to answer questions that require understanding of math concepts Lauren cannot answer questions that have more than one part, or that are phrased in a complex manner Math: Spatial Ordering and Neuromotor Functions Spatial Ordering Lauren is inconsistent when identifying amounts of more or less, higher or lower, bigger or smaller Lauren struggles to identify if an object is inside or outside, above or below, on top or underneath Lauren inconsistently identifies basic shapes Lauren struggles to produce basic shapes

Neuromotor Functions Fine Motor Function Lauren has difficulty manipulating small objects When counting objects, her fine motor difficulties impact her ability to develop one-to-one correspondence When counting by ones, Lauren often selects two objects and counts them as one Graphomotor Function Lauren struggles to write numbers clearly and correctly Math: Temporal-Sequential Ordering and Higher Order Cognition Temporal-Sequential Ordering Lauren struggles to identify patterns in numbers or shapes Lauren has difficulty following a series of steps needed to answer a

question Higher Order Cognition Lauren struggles to use and understand the terms: more, less, bigger, smaller, before, and after Lauren has not been introduced to computational math facts (addition, subtraction) without the use of manipulatives, because the concepts behind the facts are too abstract She cannot create an association between the plus sign and the notion of moving two small groups of manipulative together to make a larger group Lauren does not understand that she can pay for an object without exact change Paying 60 cents for an item that is 58 cents and expecting change How does Lauren struggle socially? Laurens difficulty initiating and maintaining

conversations affects her ability to interact productively with peers Laurens inability to refrain from inappropriate physical contact with peers affects the development of meaningful relationships Laurens difficulty independently generating ideas impacts her ability to play with peers Laurens struggles with receptive language impact her comprehension of conversation topics INSTRUCTIONAL STRATEGIES AND RECOMMENDATIONS Meeting the Needs of Students with TBI Tips for Using Strategies in the Classroom Prior to implementing instructional

strategies, analyze the students strengths and weaknesses Institute strategies to support specific areas of difficulty Only utilize strategies when necessary; be careful not to provide unnecessary support Frequently reevaluate the effectiveness of strategies Memory: Classroom Support Repeat instructions and write them on the board Provide a student planner to record all assignments, and monitor its usage Create a visual calendar of events and upcoming assignments

Create visuals of learned information Reduce the need for memorization of material Allow students to use calculators instead of requiring memorization of math facts Teach tricks for learning material When learning the locations of the states some tricks are: Minnesota looks like a crushed can of mini-soda, Mississippi, Alabama, Georgia and South Carolina spell MAGS etc. Link information to students prior knowledge Create visuals to support memory When asking a student to recall facts about the Inca, use a visual to remind the student of who the Inca are

Provide multi-sensory instruction such as: Singing songs to remember facts, physically interacting with science materials, exploratory learning through the use of manipulatives Memory: Self-Reminder Skills Teach the use of post-it notes as a reminder strategy Provide students with an individualized calendar and teach the skill of recording events and assignments as they are given Teach the skill of making a To Do list Model techniques such as:

Chunking or categorizing information Mental rehearsal of information Using key words or examples as reminders of information Looking for tricks to learn material Attention Reduce distractions in the classroom Place students near the front of the room to minimize distractions from other students and to increase proximity to the teacher Remove extra materials, use a divider for independent work and reduce visually stimulating material from the walls Divide work into smaller sections

Provide breaks between sections Drink of water, physical activity (jumping jacks, walk down the hall), brief games (Simon Says) Have students rephrase directions or summarize recently presented material Use cue words and phrases to alert students to important information Im going to give a direction; Some important information is coming; The three key parts of the process are etc. Utilize nonverbal cues Eye contact; tap on the shoulder or desk; proximity Color code, highlight, and bold important information

Allow the use of headphones or ear plugs whenever possible Language Repeat instructions and write them on the board Have the student repeat the directions Break sentences down into smaller, meaningful chunks Alert students to important information Create visuals to represent important spoken material Create opportunities for students to investigate material, rather than presenting all information orally

Provide students with a structure for presenting information orally When sequencing information use first, next, then, last Allow students to demonstrate understanding through alternative means, rather than oral expression Preview vocabulary words for a unit, and provide students with opportunities to practice using the vocabulary words Spatial Ordering Create a checklist of necessary materials for an activity Provide students with opportunities to practice spatial memory and output Present students with a figure and then have them draw the

figure from memory Discuss strategies used to recall the components of the figure Design multi-sensory activities that allow students to develop spatial perception Instruct students to run from a tree, to a rock, to a tree and then have them figure out what would come next in the pattern Provide students with a reference sheet of common shapes and objects This can be used as a reference for the names of the shapes, or when production of a shape is necessary Neuromotor Functions Incorporate movement into instruction

Students march to the east side of the room, hop to the west side of the room Student does jumping jacks and frog hops to show the answer to 2+3 Practice hand-eye coordination while reviewing information Throw the ball while practicing math facts Assign a buddy when performing activities that require strong fine motor skills Filling a test-tube, using tweezers to extract an object from another Allow students to use a computer or an alpha-smart to complete long written assignments

Teach note-taking skills and abbreviations for common words and long words with: w/; because: b/c; at: @; homework: hw Attach an alphabet strip to the desk Use consistent language when teaching letter formation Handwriting Without Tears Curriculum Temporal-Sequential Ordering Display the daily schedule to provide an understanding of the structure of the day

Use visual and audio timers to help students manage their time effectively Provide time reminders consistently throughout an activity 5 minute warning Use consistent language to cue students into the sequence of an activity First, next, then, last Design a multi-step activity and then have students sequence the steps taken Have students make lemonade, and then sequence the steps it took to make lemonade Provide an individual checklist of steps, and write the steps on the board

Provide the opportunity to practice sequencing events Photograph the various steps taken in a classroom activity and then have students sequence those steps Sequence pictures of a daily process, such as brushing teeth, getting dressed Higher-Order Cognition Provide hands-on, multi-sensory experiences to enhance concept formation When studying the heart, have students run up and down the hallway and monitor their own heart-rate Provide a list of strategies for problem solving in various situations Practice utilizing the strategies in controlled situations Teach students to look for rules and patterns in material

Ancient civilizations began around rivers; one syllable words that end in the letter e have a long vowel sound in the middle Help students form a personal connection to material by activating prior knowledge Assist students in make cross-curricular or cross-unit connections by presenting visuals and reminding them of what has been taught Help students expand answers by providing a framework for what qualifies as a comprehensive answer, as well as examples of sufficient and insufficient responses A comprehensive answer should include personal experience and evidence from the book Social Cognition: Communication

with Teachers and Peers Limit the use of sarcasm and explain any use of figurative or abstract language Clearly state how your feelings are being affected by students actions; dont expect students to read facial expressions and body language Teach the other students in the class to do the same Your effort on this work is making me very happy or Your harsh tone is hurting my feelings Use visuals and role-playing to provide students with instruction in how to read tone, facial expressions and body language Provide students with language to express their own emotions, and practice using that language in a controlled environment Develop a list of topics to discuss in a variety of situations, and role-play the use of those topics With friends: talk about sports, shopping, T.V. shows etc; with parents: talk about school, games played with friends, other family members etc.

Video-tape student interactions and analyze how ones actions affect other students in the class Grabbing a pencil made a friend angry; sharing toys made friends happy Provide students with assistance during group activities Assign a buddy to help with group collaboration and expression of ideas Assessment Recommendations Provide a quiet environment, away from the other students Read questions and passages to the student Remind student of previously taught strategies Comprehension strategies, organizational strategies, test-taking

strategies Periodically check for understanding Refocus student and remind him/her to take breaks Provide extended time Break the assessment into smaller, more manageable components For students who require immediate feedback on their performance, continually provide words of encouragement Lauren and the QRI: Word Lists

I provided Lauren with the opportunity to explore the materials prior to administration Reduced novelty of materials I prepared Lauren for possibility of encountering unfamiliar material We reviewed decoding strategies, twice, prior to administration I explained the rules of the assessment No talking, I cant help her, no skipping around, breaks at end of sections Modeled appropriate testing techniques Reading straight down the list, not skipping around Modeled inappropriate testing techniques Skipping around, peaking at the other words

Extended time limit for words to count as automatically identified Accounts for processing difficulties Lauren took a break between word lists When frustrated, Lauren took a break and we reviewed helpful strategies Lauren and the QRI: Reading Comprehension I previewed materials and steps taken throughout assessment Steps: 1. Answer questions; 2. Read story; 3. Talk about story; 4. Answer questions

Selected decodable passage from QRI Prior to administration, I provided Lauren with the opportunity to explore materials I provided choices for answers to questions; supported questions in assessment with more specific questions QRI: What is a frog?; Me: Is it a person or an animal? Reviewed material prior to asking for a prediction I just asked about a frog, a bug and a pig. What are these things? (animals). What do you think the story will be about? Prompts to decode misread words Break between sections After breaks, I reread passage to her between sections

Helps with difficulty with short-term memory I prompted elaboration on the retelling with questions and descriptions of the pictures Provided articles to elicit responses to explicit and implicit questions QRI: What was on the plant? Me: an (ant!) What else can be done to support students with TBI? Maintain constant communication with parents Communicate with all of the students teachers and/or therapists regarding his/her strengths and struggles Continually reevaluate students

Assess their academic progress Note any changes in personality and/or cognitive functioning How can the other classmates help? Develop community building activities Assign a daily buddy, or for each activity Teach other students how to support students with TBI in the classroom, without doing their work for them Teach students how to collaborate in an effort to assist students with TBI in their areas of difficulty For example, if a student with TBI struggles with fine motor skills such as cutting, but is strong at drawing, encourage the other students to support him/her in a way that emphasizes his/her strength

Teach the other students to be flexible with harsh tones used by the student or impulsive behaviors displayed by the student Lauren in the Classroom Effective Strategies and Samples of Student Work GENERAL ACADEMICS General Academics In the morning, previewing the schedule of activities and therapy sessions helps prepare Lauren for her day

o During direct instruction, Laurens one-to-one support sits near her and frequently rephrases or repeats directions, asks questions to assess comprehension, and redirects her attention to task Lauren is provided with frequent sensory breaks throughout her day; need is determined based on perceived attentional and sensory needs o

Reminders of therapy sessions and possible schedule changes occur throughout the day Breaks include: jumping jacks, pushing the wall, getting a drink of water, using a tool such as a squishy ball or a drip timer Removing Lauren from the classroom to complete assignments in a quiet environment helps maintain her focus and reduce distractions Previewing an activity and photographing the activity helps Lauren recall information more easily An image of an eye is placed on Laurens desk as a reminder to look at the board for directions All directions are written on the board in the form of words and symbols The days of the week are placed on Laurens desk to assist her with gaining an understanding of time o o The days are placed on a piece of Velcro and are changed daily

Laurens desk is labeled with: Yesterday was; Today is; Tomorrow will be Materials used in the Classroom An image of an eye is placed on Laurens desk to remind her to look at the board for the directions Visual Materials in the Classroom A monthly calendar is in a visible location of the classroom. Each morning Lauren points to the appropriate locations on the calendar while stating the date. A daily schedule is also in a visible location in the classroom. Each morning Lauren reviews the schedule, identifying which periods she will miss due to therapy sessions.

Everyday Lauren reviews the days of the week. The visual above resembles the days of the week that Lauren Velcros to her desk each morning. LANGUAGE ARTS Reading: Decoding Lauren benefits from individualized direct instruction and consistent practice of phonics rules and patterns (Preventing Academic Failure) A checklist with words and pictures is used as a support for independent spelling of phonetic words A multi-sensory approach to instruction is utilized o

o Tracing sight words while spelling them orally, orally spelling words while marching around the classroom, singing songs to remember the spelling of words When tapping sounds in words, placing letters on Laurens fingers allows her to physically tap out the sounds This enables her to feel how many sounds are in each word Collaboration with classroom teachers, therapists, parents, and nonschool personnel enables Lauren to generalize phonics rules to other settings Lauren benefits from color-coding of new sounds, words or phrases

Highlighting new material in comprehension texts allows her to generalize phonics spelling patterns Reading: Comprehension Lauren benefits from literal questions that occur directly after listening to a teacher read the passage out loud Collaboration with classroom teachers, therapists, parents, and non-school personnel enables Lauren to generalize comprehension strategies, such as predicting and sequencing, to other settings A multi-sensory and interactive approach allows Lauren to recall events in a passage with more efficiency o

o Using dolls to act as the characters Acting out stories with the teacher Repetition, repetition, repetition! Previewing new material, teaching material directly, revisiting material constantly Using books or creating materials that repeat sounds, words or phrases Materials for Generating Sentences

To complete this activity, Lauren orally dictated the sentence to her teacher. After dictating the sentence, she counted the number of words in the sentence, and drew lines for each word. She then wrote each word on the lines. Drawing the lines for the words helps support Lauren with her struggles with active working memory, because she has difficulty recalling the sentence she wants to write while focusing on spelling each word correctly. Materials for Spelling A checklist is used to help Lauren spell phonetic words independently. Materials used for Reading In reading, Lauren learned phonics spelling patterns, such as glued sounds. Lauren initially struggled to discriminate between the glued sounds, and therefore a chart was created to help her recognize the difference between the spelling of the words. Handwriting Without Tears paper is used for all written

activities in order to maintain consistency between classroom instruction and reading group instruction. Materials used for Reading Every night Lauren receives this homework template as her reading homework. The template helps ensure consistency between home and school. The first page of the template allows Lauren to practice her sight words nightly, as well as recently taught spelling patterns (on this homework she was learning bonus letters). Lauren also practices saying the day of the week to assist with her sense of time and understanding of the

days of the week. The second page of the template contains two lines from a story Lauren read during reading group that morning. The repetition of the lines helps with fluency and retention of previously read material. Lauren also struggles with wh questions, and therefore who and where questions are included in the template as well. MATH Math: Skills Teacher generated materials are created to ensure a slow and structured approach to counting money o o

Consistent language is used to limit her effort to comprehend spoken language o Lauren learned to count pennies, dimes, then dimes and pennies, then nickels, then nickels and pennies Materials are color-coded to increase access to material stored in longterm memory, and to reduce a need to structure information independently Color-coding also helps to reduce attentional distractions When counting dimes and pennies: Count by tens and switch to ones Daily repetition of material is utilized o

When learning money, each day Lauren reviews the names of the coins, the values of the coins, and how to count the coins (by ones, fives, tens etc.) Math: Concepts A multi-sensory approach to teaching conceptual terms (before, after, bigger, smaller, higher, lower) is utilized, but several attempts have been unsuccessful o o o Lauren is provided with a physical number line (taped to the floor), and she jumps to the numbers that come before or after the numbers that are dictated

Lauren is provided with visuals (arrows for before and after, pictures for more and less, and bigger and smaller) To learn number values, Lauren created tactile number cards which she sequences daily according to value Materials used for Math Each day, Laurens lessons are structured in a similar manner. Before starting the lesson, Lauren reviews the schedule while her teacher previews the material that will be taught that day. Materials used for Math Repetition and consistency of assignments Repetition and consistency are essential components of Laurens

instruction. Repetition helps with recall of information, while consistency eliminates the strain of figuring out a new structure of an assignment. *See Appendix A for a math unit that utilizes extensive repetition and consistency of assignments. Materials used for Math Money is a life skill, and is therefore a large focus with Lauren. This worksheet is used to help Lauren count to a specific amount. The green and blue lines under the numbers remind Lauren to use a certain number of dimes and a certain number of pennies to form a specified amount. This activity helps support Laurens struggle with active

working memory, because she is able to look back at the number to determine how many dimes she needs and how many pennies she needs to make the number, rather than try to hold the number in her mind while counting. INTERNET RESOURCES on TBI

(2001). Brain injury in children. Retrieved February 16, 2008, from Brain Injury.com Web site: http://www.braininjury.com/children.html (2006). Cognitive and communication disorders.. Retrieved February 16, 2008, from Neuro Skills Web site: http://www.neuroskills.com/cogcomm.shtml Blosser, J., & DePompei, R. (2001). The road to rehabilitation-Crossing the communication bridge: Speech, language, & brain injury. Retrieved September 14, 2007, from Web site: http://www.biausa.org/publications.roadToRehab5.pdf Children with acquired brain injury. Retrieved February 16, 2008, from Survival Guide Web site: http://seniors.gov.ab.ca/CSS/bii/survival_guide/chapter_11.pdf Facts about traumatic brain injury. Retrieved September 14, 2007, from Web site: http://www.biausa.org/aboutbi.htm Lash, M. (2000). Teaching strategies for students with brain injuries. TBI Challenge!, 4, Retrieved February 16, 2008, from http://www.biausa.org/word.files.to.pdf/good.pdfs/teaching.strategies.for.studen

ts.with.brain.injuries.pdf NICHCY. Retrieved February 16, 2008, from IDEA's Definition of "Traumatic Brain Injury" Web site: http://www.nichcy.org/pubs/facshee/fs18txt.htm JOURNAL RESOURCES on TBI Bowen, J.M. (2005). Classroom interventions for students with traumatic brain injury. Preventing School Failure. 49, 34-41. Bullock, L.M., Gable, R.A., & Mohr, J.D. (2005). Traumatic brain injury: A challenge for educators. Preventing School Failure. 49, 6-10. Cave, B.K. (2004, Marc/April). Brain injured students: At my school? In my room? The Clearing House, 77(4), 169-172. Deidrick,. K.M. & Farmer, J.E. (2005). School reentry following traumatic brain injury. Preventing School Failure, 49, 23-33. Keyser-Marcus, L., Briel, L., Sherron-Targett, P., Yasyda, s., Johnson, S., & Wehman, P. (2002). Enhancing the schooling of students with traumatic brain injury. 34, 62-67. Mayfield, J., & Homack, S. (2005) Behavioral considerations associated with traumatic brain injury. Preventing School Failure. 49, 17-22. Max, J.E., Schachar, R.J., Levin, H.S., Ewing-Cobbs, L., Chapman, S.B., & Dennis, M. (2005). Predictors of secondary attention-deficit/hyperactivity disorder in children and adolescents 6 to 24

months after traumatic brain injury. 44, 1041-1049. Mohr, J.D. & Bullock, L.M. (2005). Traumatic brain injury: Perspectives from educational professionals. Preventing School Failure. 49, 53-57. Todd, A.W., Horner, R.H., Vanater, S.M., & Schneider, C.F. (1997). Working together to make change: An example of positive behavioral support for a student with traumatic brain injury. Education and Treatment of Children, 4, 425-440. Yeates, K.O., Armstrong, K., Janusz, J., Taylor, H.G., Wade, S., & Stancin, T. (2005). Long-term attention problems in children with traumatic brain injury. 44, 574-584.

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    Cmt and Tremor - Is It Really Cmt?

    Nerve root involvement in CIDP. One of the first papers written about this was by Crino, Grossman and Rostami, "Magnetic Resonance Imaging of the Cauda Equina in Chronic Inflammatory Demyelinating Polyneuropathy" Annals of Neurology 1993 33 y/o man with 5...