Need Assistance TBI

Students with neurological problems may need special education services, adaptation of physical facilities, knowledge of special equipment, use of technology, and modification of curricular activities. Conditions such as TBI, cerebral palsy, and the like, have neurological foundations that impact the students’ speech-language skills, and ultimately, academic performance. Communication deficits may be part of another condition in which the student has motor impairments, perceptual difficulties, cognitive deficits, behavioral problems, etc. Problems may be subtle or highly noticeable.

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CP – a disorder of voluntary movement and posture. No clear relationship (if any) between the degree of motor impairment and degree of intellectual impairment

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Cerebral palsy is often associated with other disabilities. It is not unusual to find children with cerebral palsy who also have hearing or vision problems or who have intellectual impairments. We know that all these conditions can adversely affect language.

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Children with cerebral palsy are at significant risk for speech and language difficulties. The speech difficulties of children with cerebral palsy are extremely heterogeneous and depend, to a great extent, on the specific nature of the physical disability. Individuals with cerebral palsy may have speech production difficulties in one or several areas, including respiration (e.g., rapid, shallow breathing), phonation (inadequate airflow), resonation (hypernasality), and articulation. Articulation is often affected because of difficulty controlling the tongue, lips, or mouth.

Differences in early development may have an impact on language. Studies of the interactions between children with cerebral palsy and their parents has shown a pattern of conversational dominance by parents and child passivity. Typically, parents have been reported to initiate most conversational exchanges, introduce topics, ask many closed questions, and issue many commands. Children tend to reply with limited information and fail to take a similar number of turns, to initiate an equal number of exchanges, or to use a full range of pragmatic functions. Children with cerebral palsy who have better speech intelligibility have been found to initiate more conversations and to use their communication for a wider range of functions compared with nonspeaking children.

Kuder, S. Jay. Teaching Students with Language and Communication Disabilities (The Pearson Communication Sciences and Disorders Series) (p. 191). Pearson Education. Kindle

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Edition.

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Other neuromotor disorders, such as spina bifida can also affect language acquisition and development. Spina bifida refers to a group of conditions in which a portion of the spinal cord is not completely enclosed by the vertebrae in the spinal column. In some cases, part of the spinal cord protrudes. In the most serious form of the disorder, myelomeningocele, damage to the spinal cord can cause sensory and motor losses. In addition, in about 80 percent of the cases, fluid accumulates in the brain, causing the condition known as hydrocephalus. If not treated quickly, hydrocephalus can cause Intellectual disabilities. Surgery can often correct the spinal cord abnormality in spinal bifida, but some sensory and motor disabilities can remain.

Impairments in language are characteristic of many children with spina bifida, especially those who also have hydrocephalus. Although children with spina bifida often have strengths involving vocabulary and grammar, difficulties with the use of language in context have frequently been reported. Sometimes called the “cocktail chatter” phenomenon, their communicative interactions have been described as “chatty” conversations that remain at a superficial level. In addition, although their speech may be fluent and well-articulated, it may include verbal perseveration, excessive use of stereotyped social utterances, and overfamiliarity.

Many children with spina bifida have difficulties with academic skills including math and reading comprehension. Although children with hydrocephalus (which is associated with a

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number of neurological disorders, not just spina bifida) typically have good vocabulary and word attack skills, they have difficulty making inferences, understanding literal story content, and producing their own stories.

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For no other group of exceptional learners is the continuum of educational services and placement options more relevant than for those with neuromotor or neurological disorders. Some students require a complex and coordinated array of specialized instruction, therapy, and related services. In addition, the transdisciplinary approach is beneficial for students with physical disabilities.

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Environmental modifications are frequently necessary to allow a student to participate more fully and independently in school. Modifications include wheelchair-accessible classrooms or other assistive technology. IDEA defines assistive technology (AT) as devices and services needed to obtain and effectively use devices. A service is any resource that directly assists with the selection, acquisition, or use of an AT device. Adapted eating utensils, computerized speech devices, and telecommunication devices are all examples of AT.

One major consideration in the education of students with physical impairments is the physical environment of the classroom. For some students with mobility problems, this may be the prime area in which modifications must be made. Teachers must ensure that the physical layout is suitably arranged to accommodate students with physical impairments.

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The effects of TBI on learning and behavior are determined by the severity of the injury and the part of the brain that sustained damage. Although people with brain injuries make significant improvements during the first two years post-injury and continue to improve at a more gradual pace for many years, most will have permanent physical, behavioral, and/or cognitive impairments.

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Students with TBI experience a wide variety of learning and psychosocial characteristics. Moreover, physical and sensory changes also are common. The specific effect of the injury is dependent on the age of the student, the severity and location of the injury, and the time since the injury. Some individuals experience minimal changes, whereas others experience drastic changes. Learning and behavioral difficulties may persist long after the child has physically recovered.

Many children with TBI experience losses in language skills. Children who lose language functioning as a result of brain injury are said to have acquired aphasia. In other words, they have lost some language functions that they had acquired earlier. Language difficulties resulting from TBI can involve expressive language, receptive language, or both and can range from mild to severe. Two aspects of language have most frequently been reported to be affected by brain injuries: syntax and pragmatic skills. Nevertheless, many with TBI are able to recover much of their language functioning within 2 years after their injury.

In addition to impacting language and communication development, brain injuries can also have an impact on literacy skills. Children with traumatic brain injuries have been found to score significantly lower than age-, gender-, and race-matched uninjured children on achievement tests of reading, language, and mathematics.

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Students who have experienced a TBI often re-enter school with deficits from their injuries compounded by their extended absence from school. These students are likely to require comprehensive programs of academic, psychological, and family support.

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It is important that instructional strategies for students with TBI are carefully planned, systematically executed, and continuously monitored for effectiveness.

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Ten elements that should be part of an educational program for children with TBI include:

1. Maximally controlled environment. The child may need a highly structured environment where distraction is reduced.

2. Low pupil–teacher ratio. It may be necessary to provide a classroom aide or other assistant to work with the child.

3. Intensive and repetitive instruction. The brain-injured child often needs more time to learn. Reducing nonacademic activities and lengthening the school year can provide more learning time.

4. Emphasis on process. The child may need to be helped in learning how to learn. Instruction should include help in sustaining attention and on memory.

5. Behavioral programming. Instructional strategies that use task analysis and careful measurement of progress have been found to be successful.

6. Integrated instructional therapies. Integrate allied therapies such as speech and physical therapy into the student’s primary instructional setting to facilitate generalization and transfer of skills.

7. Simulation experiences. Use simulations to enable the child to transfer skills to a new setting.

8. Cuing, fading, and shadowing. Students may require cues to respond, which should be faded as soon as possible. When shadowing, the teacher closely monitors the child

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attempting a new task or moving to a new environment. 9. Readjustment counseling. This may help the child adjust to his or her new environment

and abilities. 10. Home-school liaison. It is essential to build and maintain a strong link between parents

and the school.

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