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HELPING ADULTS WITH TBI & CO-OCCURRING
DISABILITIES SUCCEED IN READING
Melissa Capo, M.S., CCC/SLP ~ NYS/DOH Neurobehavior...
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Helping Adults with TBI and Co-occurring Disabilities Succeed In Reading

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.

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Helping Adults with TBI and Co-occurring Disabilities Succeed In Reading

  1. 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. QuickTime™ and a decompressor are needed to see this picture. 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 QuickTime™ and a decompressor are needed to see this picture. 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 are needed to see this picture. •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

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