Young people with disorders of consciousness: providing a personalised programme of learning

Disorders of Conciousness

Pam Walden (Headteacher) and Clare Stothard (class teacher) teach children who are receiving rehabilitation for a brain injury. They have provided this information on the learning experiences of young people with disorders of consciousness. Here they share their expertise and advice on how to give these young people the best learning opportunities possible.

All pupils are entitled to a curriculum which is characterised by personalisation, breadth, balance, coherence, relevance, differentiation and progression."
  For children with an acquired brain injury this should be part of their personal rehabilitation and care programmes.  

Initial Assessment

The first step when a child arrives to us following a brain injury is to carry out an assessment of their current abilities.  There are a number of difficulties with assessing children with disorders of consciousness for example;
  • the results are highly dependent on the way we as individuals search for behaviour
  • it is difficult to tell whether some behaviours, such as blinking or grimacing are purely reflex, or a sign the child is acknowledging a stimulus
  • we cannot simply base the presence or absence of consciousness on observing certain behaviours
  • responsiveness can be biased by the quality of the child’s language comprehension, willingness to collaborate and availability of motor control.
In the first three weeks learners are filmed whilst being presented with contrasting pairs of single stimuli focusing on one sense at a time. Firstly a baseline is established, where the child is observed with no stimuli. Any changes from this baseline when stimuli are introduced are recorded.  Examples of general response behaviours observed could be;
  • reflexes differing from baseline reflexes
  • changes in breathing pattern
  • muscle tensing or other movements unrelated to the area stimulated
  • unrelated vocalisations 
  • blinking: a change to the normal pattern
  • eye opening.


Teaching and Learning

It is important to remember that assessment is only useful if it informs the next steps of learning.
In our teaching environment we focus on the sensory and communication priorities for each learner. We look at two components of consciousness: firstly wakefulness (arousal) which is observed by looking at the presence of eye opening. Secondly we look at awareness (of self and environment) which is when learners begin to show that they are aware of activities and experiences. Learners are set individual education targets which are broken down into three stages
  • Acquisition which is the establishment of a desired response or behaviour
  • Fluency which is the rate at which a behaviour occurs
  • Generalisation which is where the behaviour can be demonstrated in a variety of contexts
These individualised targets allow for very small steps of progress to be acknowledged and measured,  individualising each learners programme.


Personalising the curriculum

Primarily we divide what we are going to teach into two parts. The first part is a personalised project based on the learner’s interests before the brain injury. It is important to remember that although the learner may appear to be passive these activities could trigger memories that may not be outwardly apparent to us. The second is a yearly cycle of termly themes which are each subdivided into three options enabling the teacher to choose the aspect that best fits the age and interests of her current class. We work on relearning sensory and physical skills lost or compromised by the learner’s acquired brain injury. Communication is integral to all learning too. We focus on the five senses (sight, hearing, touch, smell and sometimes taste) in isolation and in combination. Real objects are always used, including both familiar and unfamiliar items.  As well as liked items, disliked items are also used to provide opportunities for differentiated responses.


Case study: example of the thematic approach

George had an acquired brain injury following a stroke. He is now dependent on others for his physical, personal and safety needs and has severely increased muscle tone. Prior to his brain injury he was in full time education and had attained A* in all 12 of his GCSEs. He was studying Russian, Maths, Further Maths and Art at A level and wanted to go to Oxford or Cambridge University to study Maths and Russian. In a topic on Our World we focused on Ecosystems including the desert. Looking at the Turkestan desert gave George the opportunity to use his sense of touch by feeling dry sand. As Uzbekistan lies in the Turkestan desert and many of its people speak Russian, this gave us the opportunity to personalise the activity for George by listening to Russian speaking (one of his A level subjects).  We incorporated his love of art by looking at a painting of a Turkish sultan. Turkish coffee gave the opportunity to use the sense of smell.


Case study: example of a personalised project

Tom had an acquired brain injury following a road traffic accident. He is now dependent on others for his physical, personal and safety needs and he appears to have a visual impairment. Prior to his brain injury he was in his GCSE year at school and was predicted to do well. He liked motor bikes, fishing, football and socialising with his friends. Because of Tom’s love of football, a project based on famous footballers was designed specifically for him. In Wayne Rooney’s match preparation he uses the technique of visualisation including visualising the kit he will be wearing. This gave Tom the opportunity to look at and feel a red Liverpool football shirt and to look at a very bold PowerPoint slide of Rooney’s football shirt. Tom also practiced his auditory skills by listening to French hip-hop music; Wayne Rooney listens to this type of music (chosen by his French team mate Patrice Evra) before a match.    Pam and Clare work at the Surrey Teaching Centre at The Children’s Trust, which has the UK’s leading rehabilitation centre for children with brain injury. They provided this information to professionals at the Disorders of Consciousness in October.
Pam Walden
Pam Walden
Claire Stothard
Claire Stothard
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