1. Chapter 12 Severe/Multiple Disabilities, Traumatic Brain Injury

2. Low Incidence Disabilities
Low Incidence disability – Disabilities that do not occur very often. Together Multiple Disabilities, TBI, and deaf-blindness represent less than 3% of all children who receive special education.
Many of these individuals cannot perform the most basic, everyday tasks such as:
Eating
Toileting
Communicating basic needs

3. Severe and Multiple Disabilities
Severe disability
Significant disabilities in intellectual, physical, and/or social functioning
No single definition (perceptions of what is severe may vary and are based on a multitude of intellectual assessments
Multiple disabilities
Multiple disabilities means concomitant impairments, that causes such severe educational problems that they cannot be accommodated in special education programs solely for one impairment

4. Characteristics and Prevalence
Slow acquisition rates for learning new skills
Poor generalization and maintenance of newly learned skills
Limited communication skills
Impaired physical and motor development
Deficits in self-help skills
Stereotypic and challenging behavior
Prevalence
Estimates range from 0.1% to 1% of the population

5. Causes
In almost every case of severe disabilities, a brain disorder is involved
Chromosomal disorders
Genetic or metabolic disorders that can cause serious problems in physical or intellectual development
Complications in pregnancy – prematurity, Rh incompatibility, infectious diseases, alcohol/drug intake
Severe disabilities may develop later in life from head trauma
In about one-sixth of all cases, the cause cannot be clearly determined

6. Syndromes that may result in severe disabilities
Hurler Syndrome (lack of an enzyme) – severe MR, physical disabilities, early death
Lesch-Nyan Syndrome (genetic) – SIB, aggression, neurological problems, MR
Rett Syndrom (genetic) – Regression to 6-18 months, loss of speech, motor and social functions, MR
Cornelia de Lange Syndrome (chromosomal) – Physical disabilities, health impairing conditions, Severe MR, SIB
Angelman Syndrome (chromosomal) – Speech and language deficits, balance and gait, seizures, microcephaly, severe MR

7. Traumatic Brain Injury (TBI)
Definition
an acquired injury to the brain
Resulting in total or partial functional disability
Adversely affects a child’s educational performance
TBI is the most common acquired disability in childhood
1 in 500 school-age children will be hospitalized with TBI
Leading cause of death in children (1/3 of all accidental deaths in children)

8. Traumatic Brain Injury (TBI)
Open Head Injury – Penetration of the skull – bullet or forceful blow to the head caused by a sharp object
Usually result in specific deficits sensory or motor functions
Closed Head Injury – Head hits a stationary object with such force that the brain slams inside the cranium. Stress pulls apart and tears nerve fibers or axons
Car accidents
Shaken baby syndrome
Severity depends on the part of the brain that was injured
Mild injury (contusions) - recovery

9. Traumatic Brain Injury (TBI)
Temporary or lasting impairments
Physical and sensory changes
Lack of coordination, spasticity of muscles
Cognitive impairments
Short and long term memory deficits, difficulty maintaining attention and concentration
Social and behavioral problems
Mood swings, lack of motivation

10. What Should Be Taught?
1. Functional skills - activities of daily living skills (ADLs) 2. Age-appropriate skills 3. Making choices skills 4. Communication skills (PECS /AAC) 5. Recreation and leisure skills

11. Instructional Methods: How Should Students Be Taught?
Instruction must be carefully planned, systematically executed, continuously monitored
The student’s current level of performance must be assessed
The skill to be taught must be defined clearly
The skill may need to be broken down into smaller component steps
The teacher must provide a clear prompt to cue the child
The student must receive feedback and reinforcement
Strategies that promote generalization and maintenance must be used
The student’s performance must be directly and frequently assessed

12. Partial Participation, Positive Behavioral Support, and Small Group Instruction
Students can be taught to perform selected components or an adapted version of the task
Positive behavioral support
Use of functional assessment methodologies to support student’s placement
Advantages of small group instruction
Skills learned in small groups may be more likely to generalize
Provides opportunities for social interaction
Provides opportunities for incidental or observation learning from other students
May be a more cost-effective use of teacher’s time

13. The Challenge and Rewards of Teaching Students with Severe and Multiple Disabilities
Must be sensitive to small changes in behavior
The effective teacher is consistent and persistent in evaluating and changing instruction to improve learning and behavior
Working with students who require instruction at its very best can be highly rewarding

14. Fyffe et al Participant – Matt, 9 year old boy with TBI
Target Behavior – touching or attempting to touch others in the area of the groin, buttocks or breasts.
Functional Analysis – 20 min sessions 1) Demand, 2) attention, 3) play.
Results suggested attention function
Treatment – FCT + EXT - use of graduated guidance to hand the experimenter an attention card.
Results?