Individuals with TBI and co-occurring disabilities represent a challenge to speech and language pathologists in various rehabilitation settings. This poster describes an intervention approach used to help a group of adults with TBI increase their literacy skills in order to achieve meaningful engagement and reduce challenging behavior.

1. HELPING ADULTS WITH TBI & CO-OCCURRING
DISABILITIES SUCCEED IN READING
Melissa Capo, M.S., CCC/SLP ~ NYS/DOH Neurobehavioral Resource Project
Southern Tier Independence Center ~ Latham, NY
PRINCIPLES GUIDING THE INTERVENTIONS
1. The person is the core of all intervention and
support efforts
2. Interventions and supports are organized around
personally meaningful activities
3. Contextual supports are critical to success
4. Reduction of supports is part of the plan
5. Positive everyday routines are the context for
pursuit of meaningful goals
6. Feedback is context-sensitive and meaningful
7. Components of life must be integrated
8. Assessment is ongoing and context-sensitive
9. Behavioral concerns are addressed via positive
behavior supports
10.The ultimate goal for participants is effective self-
regulation within a meaningful life
Ylvisaker, M. (2006)
ASSESSMENT
American Speech-Language Hearing Association November 18, 2010~ Philadelphia, PAAmerican Speech-Language Hearing Association November 18, 2010~ Philadelphia, PA
SPECIFIC INTERVENTION SUPPORTS
Summary of Complex Needs and Associated Supports
INTRODUCTION
Individuals with TBI and co-occurring disabilities
represent a challenge to speech and language
pathologists in various rehabilitation settings. This
poster illustrates an intervention approach used to
help a group of adults with TBI increase their literacy
skills in order to achieve meaningful engagement
and reduce challenging behavior.
NEUROBEHAVIORAL RESOURCE
PROJECT (NRP)
To meet the chronic support needs of this population,
the NYS TBI Medicaid Waiver Program provides
clinical, medical and independent living supports to
individuals with TBI, residing in the community, who
would otherwise require nursing home level care. The
NRP is a grant-funded support to the Waiver program,
supporting individuals who represent significant
challenges to service providers and are likely
diagnosed with a pre- or post-injury co-occurring
disability (i.e., substance abuse and /or mental health
disorder).
PERSON-CENTERED PLANNING:
A Change in Culture
NRP staff were directed to provide direct and ongoing
support to a community-based program that was
struggling to successfully serve this complex
population. Like many rehabilitation programs, this
provider focused on clinician- directed interventions
which led to less than positive outcomes. NRP staff
recommended a shift in focus from traditional
clinician-directed interventions to participant-directed,
person-developed, person-centered services.
EXAMPLES: Individual Projects
• Group Facilitator
• 50 Cent Words dictionary
• Political Debate
• Novel-related research
EXAMPLES: Group Projects
•Current events discussions
•Novel-related, topic-specific research
•Novel-themed lunch
•Identification of effective
comprehension strategies
•Identification of effective decoding
strategies
SELECTED REFERENCES
Chapey, R., Duchan, J.F., Elman, R.J., Garcia, L.J., Kagan, A., Lyon, J., &
Simmons Mackie, N. Life participation approach to aphasia: A statement of
values for the future.
http://www.asha.org/public/speech/disorders/LPAA.htm
Feeney, T.J. & Capo, M. (2010). Making meaning: The use of project-based
supports for individuals with brain injury. Journal of Behavioral and
Neuroscience Research, 8(1), 70-80.
Ylvisaker, M., Feeney, T. & Capo, M. (2007). Long-term community
supports for individuals with co-occurring disabilities after traumatic brain
injury: Cost effectiveness and project-based intervention. Brain
Impairment, (8)2, 276-292.
Ylvisaker, M,. & Feeney, T. (2009). Apprenticeship in self-regulation:
Supports and Interventions for individuals with self-regulatory
impairments. Developmental Neurorehabilitation, (12)5, 370-379.
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WHO CRITERIA:
IMPAIRMENT, ACTIVITY & PARTICIPATION LIMITATIONS
DESCRIPTION OF SUPPORTS
COMMUNICATION:
Aphasia
Use of AAC
Dysarthria
Non-English Speaking
COGNITIVE:
Memory
Attention
Organization
Language Comprehension
General Reading Difficulty
Pre-injury learning disability
EXECUTIVE FUNCTION
Goal setting
Identification of obstacles
Planning/problem solving
Initiation/impulse control
Flexibility
Self-monitoring/Self-evaluation
BEHAVIORAL
Motivation
Impulsiveness
Anger Management
Substance Abuse
Mental Health (anxiety, depression, PTSD)
Lack of engagement in meaningful activities
•Implementation of Goal, Obstacle, Plan, Do, Review
structure for all activities
•Use of executive function scripts
•Supported transitional routines, individualized for
some participants
Weekly planning of future group activities
Weekly Group review of successes and needs
•Positive Behavior Intervention Supports
•Participant-centered and participant driven group
•Liberal use of supports to ensure success
• Negotiation of & weekly group review of
“Guidelines for Respect” as alternative to “rules”
•Positive Interaction Style
•See “Collaborative/Elaborative Interaction Style”
•Use of pre-negotiated support scripts/interventions
•Collaboration with Behavior Specialists
GENERAL INTERVENTION SUPPORTS
•Maintenance of weekly group routines
•Effectively trained staff and graduate student clinicians
•Positive, collaborative/elaborative, non-pedagogical interaction style
(i.e., peer to peer, staff to participant)
•Consistent, positive, antecedent-focused behavioral supports
•Pre-negotiated support scripts
•Culture of positive communication and support
•Weekly Routines
•Review of group goals/’Guidelines for Respect’
•Current Events discussion
•End of session review
•Environmental Supports
•Strategic reading organizer
•External graphic organizers
•Use of story support power point slides (see insert)
•Immediate access to internet resources
•Supportive cueing to ensure errorless learning
50 CENT WORDS DICTIONARY
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Ongoing Contextualized Collaborative Hypothesis-TestingOngoing Contextualized Collaborative Hypothesis-Testing
Identify The Problem/Obstacle(s)Identify The Problem/Obstacle(s)
Formulate HypothesesFormulate Hypotheses
(List potential supports to
facilitate
comprehension/decoding)
Test HypothesesTest Hypotheses
(Systematically, in group,
one support per week)
Select HypothesisSelect Hypothesis
(Supports identified by clinician &
selected by group. Priorities
determined by ease of testing or
most obvious)
GROUP FACILITATOR
Chapter 9 begins with Scout in another fight
with a boy from school. She is defending
herself from a rumor about her father. This
is the first of Atticus’ legal cases that
effects Jem and Scout. Scout asks Atticus
to explain why he is defending Tom
Robinson.
QuickTime™ and a
decompressor
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•Predictable communication routines
•Aphasia-friendly (simplified, multi-modality) language
•Graphic representation of concepts
•Pre-programmed scripts & discussion outlines in
AAC devices
• Participant-directed individualized communication
trainings for peers & staff
Integrate all supports
deemed effective