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Acquired Brain Injury

Special Education Part III, Spring 2013


on 1 June 2013

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Transcript of Acquired Brain Injury

Traumatic injury car accident
sports-related injury Medical problem or disease tumour
brain aneurysm
stroke An acquired brain injury (ABI) is damage to the brain that occurs after birth. Statistics

50,000 Canadians sustain brain injuries each year

Thirty per cent of all traumatic brain injuries are sustained by children and youth, many of them while participating in sports and recreational activities

Young males are twice as likely as females to sustain a brain injury ACQUIRED BRAIN INJURY Each brain injury is unique

after injury, the brain learns to reroute information and function around the damaged areas
the effect of the injury is as varied as the brain's many functions
rate of recovery is not predictable
can involve a prolonged or life-long process of treatment and rehabilitation Physical Changes

A brain injury can cause physical changes that may be temporary or permanent. A person with a brain injury may have difficulty with:
Alertness, Fatigue
Movement / mobility (e.g., balance, coordination, weakness)
Speech and language - not able to make sounds
Bladder / bowel control
Pain, headaches
Sleep patterns
Senses - vision, hearing, touch, smell, taste Cognitive Changes

A brain injury can affect the way a person thinks, learns and remembers.
Common challenges include:

focusing on a task or shifting from one task to another
concentrating for long periods of time
good memory of past events or previously learned material
short term memory loss is most common
difficulty learning new material or a new skill
CAUSES Cognitive Changes Processing speed

Planning, organizing and sequencing

speech is slow, slurred or difficult to understand
finding the right words to say
understanding what is being said
reading and writing
difficulty with social aspects of conversation such as taking turns, reading social cues, recognizing facial expressions Emotional and Behavioural Changes These changes can be the most difficult for the person with ABI to deal with, as they are much more difficult to detect than physical or cognitive changes. Associations
Brain Injury Association of Canada http://biac-aclc.ca/
Ontario Brain Injury Association http://www.obia.ca/
Toronto ABI network http://abinetwork.ca/about-us
Living Education and Resource Network by the Brain Injury Association of New York State http://www.projectlearnet.org/what_problems_are_seen.html

Medical community linked to schools
Holland Bloorview Kids Rehabilitation Hospital http://www.hollandbloorview.ca/
The Hospital for Sick Children http://www.aboutkidshealth.ca/En/HealthAZ/Pages/default.aspx?name=A
The Ontario Association of Speech-Language Pathologists and Audiologists https://www.osla.on.ca/en/abi Resources for specific strategies and accommodations Ontario Teachers' Federation http://www.teachspeced.ca/index.php?q=node/668

Educating Educators about ABI http://www.brocku.ca/abieducation/pdf_files/English_E-Book_web.pdf

Teaching Students with Acquired Brain Injury http://www.bced.gov.bc.ca/specialed/docs/moe_abi_resource_rb0116.pdf

Traumatic Brain Injury Resource Network http://cokidswithbraininjury.com/educators-and-professionals/information-matrix/ General Techniques for dealing with students with ABI While each injury is unique, some general techniques can be used to address common situations:


a way of disengaging a person from a particular mode of behaviour and moving him/her to an alternative behaviour. Its intent is to assist an individual to shift his cognitive “mind set,” particularly when he cannot do so at all or easily

Situation: Student is overstimulated and becoming angry during recess.

Redirection: Redirect the student to a quieter environment; example: guide her to another location either through role-modeling such as walking with her and/or inviting her to the other room “Could you go and sort the pencils in the storage room?”. In Ontario, acquired brain injury is not a recognized exceptionality

Instead, it is considered a diagnosed medical condition Restructuring

a technique used to guide a person to construct another understanding, perspective, interpretation of an event/thought/belief that will have positively and correctly reflected the events of the situation being discussed.

Situation: While walking to the chalkboard, Tom tripped on a chair leg and fell. Bob helped him up; Tom was not hurt. Rick’s response:
"Yesterday Tom was walking up the aisle to sharpen his pencil when he fell and hurt his arm because Bob tripped him."

Restructuring: Utilize restructuring to emphasize the truthful parts of
Rick's story (e.g., “That’s too bad that Tom tripped, I’m glad he was not hurt. Bob is a friendly boy and it was very nice of him to help Tom up when he tripped on the chair."). Back door approach

an expression used to describe interventions that are implemented without the person being aware or confronted, and/or interventions that are compatible with, but not identical to, what the person is doing.

Situation: A student with an ABI is constantly late for class because he cannot cope with the combination lock on his locker. He claims that other students change locks on him.

Back Door Approach: Agree that it is really hard to be sure that your lock hasn't been tampered with. Then get the student a foolproof special lock with a key. Keep a spare key handy. Positive reinforcement

is rewarding “wanted” behaviour, thereby increasing the occurrence of the “wanted” behaviour. It is letting someone know that what he has done is correct, appropriate, and appreciated.

Situation: A student is regularly verbally abusive.

Positive Reinforcement: Use the least intrusive intervention possible to control the verbal abuse. Positively reinforce the student between outbursts for appropriate interactions with classmates and staff. Active ignoring

involves the continued monitoring of a person’s behaviour while deliberately not responding or reacting to it.

Situation: Student talks out inappropriately during class.

Active Ignoring: Without stopping the lesson, glance at the student so that eye contact is made and then look away, continuing with the lesson. Discuss behaviour with student at an appropriate time. Cueing

is any type of signal that is used to prompt another person to either engage or disengage in a particular behaviour.

Situation: Student consistently fails to begin work when requested.

Cueing: Identify what specifically the student has problems initiating (e.g., finding page in text, gathering materials). Depending on the assignment, use verbal prompts (and/or a list), visual reminders, or proximity to assist the student to begin work. Antecedent-Based Approach

a student who has an ABI may no longer have the ability to learn from consequences (Consequence Focused Approach)
by identifying the antecedent and modifying the environment/situation accordingly, you decrease the chance that the person will engage in the behaviour

Situation: Jimmy must sit down to look at his daily schedule and then complete a writing assignment. When asked to sit down, Jimmy walks to the other side of the classroom.

Antecedent-based approach: Instead of consequencing Jimmy, which may lead to him becoming more oppositional, the teacher turns his negative behaviour into a positive behaviour, saying “Good idea, Jimmy, we will need a pencil. While you are over there can you please grab one so we can get this work done?” Is NOT related to... a congenital disorder or developmental disability such as cerebral palsy, autism, muscular dystrophy

a process that gradually damages the brain such as dementia, multiple sclerosis, Alzheimer's Disease, Parkinson's Disease Behavioural and emotional changes include:
Agitation - usually in the early stages of the injury when they are disoriented or confused
Explosive anger and irritability
Lack of awareness and insight into their own behaviour
Impulsivity and disinhibition - break rules of social behaviour
Emotional control - laugh or cry very easily; express feelings inappropriately
Self centredness - concerned only with own needs
Apathy and poor motivation
Depression - common in later stages of rehabilitation
Anxiety, loss of confidence
Inflexibility and obsessive behaviour - unable to jump from one idea to another, stuck on one particular thought; stubbornness
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