Pediatric TBI: Intervention
"The functional impact of TBI in children can be different than in adults—deficits may not be immediately apparent because the pediatric brain is still developing. TBI in children is a chronic disease process rather than a one-time event, because symptoms may change and unfold over time (DePompei & Tyler, in press; Masel & DeWitt, 2010)."
When reading the following intervention possibilities for pediatric TBI keep in mind that these are positive behaviour supports. Research shows that children with TBI do not learn the best from consequences of their own behaviour; which is a common behavioural learning approach used in traditional classrooms. Moreover, intervention approaches are proven to be most effective when they are done in a team-based and collaborative way.
This article is heavily based off of the paper by Ylvisaker & Feeney (2007). To read the full article use the reference cited below.
1. Cognitive/Executive Function (EF) Focus: Daily Routine, Negotiation and Choice.
Daily routines in school and at home are analyzed
Decisions regarding the minimum amount of work to be accomplished and support plans for achieving the goals are made
Time demands (eg, “You must finish these 2 pages in 5 minutes.”) are eliminated from the routine as they tend to result in oppositional behavior and therefore are unproductive
2. EF Focus: Goal-Obstacle-Plan-Do-Review Routine.
Students are given a “map” that represents the sequence of activities
Goal: What are you trying to accomplish?
Obstacle: Is this going to be hard or easy? What might stand in the way?
Plan: How do you plan to get this done? What do you need? What are the steps? How long will this take?
Review: What were you trying to accomplish? How did it work out? What worked for you? What did not work? What was easy? What was difficult? What adjustments need to be made?
3. Cognitive/EF Focus: Graphic Advance Organizers.
One photo or drawing or, a sequence of photographs or drawings is used to guide the student through organizationally demanding tasks.
Place the photos or drawings in binders or booklets that can be hidden away when not being used.
4. Behavioral Focus: Positive Momentum.
Ensure plans include relatively easy tasks with a guaranteed high level of success and reinforcement before difficult or stressful work occurs
Try and have a student-preferred activity before every challenging activity
5. Cognitive/Behavioral Focus: Reduction of Errors.
Staff must provide sufficient modelling and assistance to reduce errors the student experiences
Errors often result in negative behaviours from the student which in turn reduce efficiency of learning
This method aligns with the principles of “errorless learning” which have demonstrated effectiveness for people which whom have significant memory impairment
6. Behavioral/Communication Focus: Escape Communication.
Students are to be taught positive communication alternatives to escaping or avoiding (eg, “I'm done” or “I need a break”).
Encourage these alternatives at transition times and when students begin to appear anxious or upset, and to reward the students' use of positive escape communication. Providing opportunities throughout the day for the child to practice using strategies (e.g. asking for a break) before a disruptive behaviour has occurred avoids unintentionally reinforcing the unwanted behaviour. Read more about this here.
7. Communication Focus: Adult Communication Style.
Instructional assistants are trained to
(1) increase their frequency of supportive and reinforcing interactions with students,
(2) anticipate students' difficulties and offer assistance or model escape utterances, and
(3) avoid “nagging” (as perceived by the students).
Hope this helps with your future pediatric TBI clients!
-S
References
Ylvisaker, M., PhD, & Feeney, T., PhD. (2007). Pediatric brain injury: Social, behavioral, and communication disability. Physical Medicine and Rehabilitation Clinics of North America, 18(1), 133-144. doi:10.1016/j.pmr.2006.11.007
