Instructional Strategies for Secondary Students with TBI

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
 It is very difficult for the student.
 It is very rewarding for the student and the
 Successes may require you to look back
over a semester or a year to clearly
 Coaches don’t expect a kids in casts to run;
their injuries prevent them being capable.
Executive Functioning
Attention and Focus
Everyday Instruction
 Follow
principles of good instruction
 Are often beneficial to entire group
 Target the Key Concepts
 Review those key concepts regularly
 Are
highly specific to the individual needs
of the student
 Assess 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 Model
1. 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
3. Frequent assessments: Baseline and
regular formative assessments
Effective Teaching Model
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: Selfevaluation of one’s own performance.
Executive Functions
Those mental capacities necessary
for formulating goals, planning how
to achieve them, and carrying out the
plans effectively. (Leak, 1982)
Dysexecutive Syndrome
Poor social
Difficulty interpreting
other’s behavior
Poorly regulated
Ineffective planning
Decreased flexibility
Slowed processes
Limited divergent
Concrete thinking
Limited problem
Weak selfmonitoring
Reduced attention
Metacognitive Strategies
Self-regulation (“Self-talk” or Social
 A repeated phrase or narrative to help
guide the student through a specific task
– Student Planner:
○ I need to write my home work in my planner.
○ Today is Monday, find the Monday column.
○ This is math class; find the row for math on
○ Look at the “homework” section on the marker
○ Copy the homework neatly on Monday/Math.
○ Have my teacher (or study buddy) check it for
• Carol Gray
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 Management
 Kitchen or digital timers
 Day planners
Task Specific
 Checklist (homework, materials, readiness
 Color coding/labeling
 Set 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
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 Light
 Look! What should I be doing instead?
Green Light
 Go!! Choose a new direction and move
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
 Distraction management – no irrelevant
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
 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 +
 Task accommodation and self-advocating for
○ Model how to self-advocate & allow practice
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
 Lecture notes
 Completed 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
Situational Teachers
 What
does each person need
today for that specific task?
High Capability
Low Motivation
Low Capability
Low Motivation
Needs instruction
and encouragement
High capability
High motivation
Low capability
High motivation
Needs autonomy
Needs instruction
Behavior is communication; am I listening to
 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-thefly adjustments and hope it works.
Plan B
 Observe behavior, think through intervention
options, systematically apply the most
feasible option, evaluate to determine
effectiveness, make purposeful
Everyday Instruction – Effective teaching
 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?