Lifeboat for Reading

Learning to read with a Brain Injury

[This leaflet is part of the Lifeboat for Reading]

Research has shown that it is more difficult to learn to read once a youngster has an Acquired Brain Injury (ABI), but it is possible. Their needs are subtly, but significantly different from those of non-injured pupils and those who have specific learning difficulties. However sometimes needs overlap and materials may be used for pupils with an ABI. What is most important is that school and parents work together. Pupils need to practice their skills every day, including weekends and school holidays; little and often is the key to success. Every pupil who has sustained an ABI is different, so it may be that the suggestions here will not all be appropriate, but we hope they are helpful.

The difficulties encountered after an ABI vary, but often include problems with:

Memory

Attention and perception

Dual tasking

Speed of processing

Planning

Motor control

Language

Controlling behaviour

Seeing the big picture

All of these have implications for learning the skill of reading. Any programme for teaching must take account of these. The effects are seen in different aspects of reading:

Memory: memory for abstract ideas including word patterns, sounds and letters, ability to hold the words in sequence in the mind for comprehension. This is assisted by adopting a multisensory approach and also by having a high level of repetition, both in the structure of the programme and within the books chosen. Because of a shortened working memory pupils with ABI find a synthetic approach to phonics problematic; I would therefore adops an analytical approach beyond the simple CVC words. To support the memory for graphemes a concrete object is associated with each one. These should be repeated at least daily to establish them.

Attention and perception: attention to the detail of letters and sustained attention for comprehension. Present the keywords separately to begin, looking at the shape of the word, the individual letters and patterns away from all other words. Some pupils need to have a border around each word to begin in order to help them establish where one word ends and another begins; for this I use the business cards feature on a home publishing package with a decorative border.

Dual tasking: being required to deal with two things at the same time. Hence initially the focus is on decoding and comprehension skills are left until later. However the reading partner/teacher can be asked to talk about the pictures in the scheme if it is one where the pictures tell their own story and to focus on the emotions illustrated to help with social skills.

Planning: take this out of the control of the pupil to begin, adult participants should make all the decisions so that the pupil can concentrate on the skill of reading. A routine time for reading is very helpful here.

Language: Language needs to have obvious meaning for pupils with an ABI. Hence ‘keywords’ should be referred to as ‘remembering words’, as opposed to ‘sounding out words’. Split diagraphs should be given more meaning by calling them ‘magic e words’.

Conceptual understanding: there are not many concepts which need to be understood to read. It is sometimes difficult to explain how two letters make one sound and split diagraphs can cause a problem for some children. It is necessary to make the links for the pupil linguistically and also visually.

Teaching should always be in advance of need and designed so that pupils experience a high level of success in the early stages. Before starting to teach the skill of reading there are a number of pre-reading skills which should be in place. The youngster should be able to match pictures, patterns, symbols and words. If they cannot do this then Tansley figures or matching cards (snap) may be used, as well as sheets where they find the matching figures. In addition it is necessary that a pupil can find an outline shape, or word silhouette. This skill make be developed using inset jigsaws, posting boxes or shape matching games. It is also necessary to develop auditory and language skills by playing I-spy, Simon says, Hunt the Thimble (where you give directions), sounds lotto and telling stories.

Frequently ABI youngsters perseverate on their first idea, whether it was right or wrong. If the word was decoded incorrectly, the error will stick. Hence teachers have to be very careful to get a balance between teaching, and practising the skills needed for decoding, and not allowing errors to stick. One technique to achieve this is to adopt some of the ideas in errorless learning. For teaching reading this could mean teaching the individual words by sight first, using flash cards, not just saying them but also playing games with them such as bingo. You could also use word sheets, where you cut out the words and put them into phrases, or the learner does when they are more confident. Clicker 5 may be used to do this, which can help with motivation as the pupils love to ‘play’ on the computer. Only when all the words are known should the learner read the book.

It is important that repetition is built in to the chosen scheme so that the pupil has the opportunity to overlearn and hence commit to memory the words they encounter. In order to establish reading I find it is essential to keep to one scheme at a time, though it is possible to introduce a new one later, as long as the new scheme is started from the beginning so that all words in that scheme have received enough repetition to be committed to memory. Daily reading is also necessary so that the words are brought to mind often enough to establish them before being forgotten. If they tire and start making mistakes the reading session should move to a different activity so that the pupil avoids associating reading with struggling.

This group of pupils also need structure and routine in their lives. An established script for learning to read, is important so that the focus may be on the skills and not the setting. It may seem to lack imagination, but it is important that reading takes place at the same time and in the same way every day. It is also important that they get to know the characters and do not swap reading schemes frequently. This brings security and therefore enjoyment.

The technique of chunking also helps, as it assists a poor working memory. Work on onset and rime can facilitate here, using flip-books to explore words with the same pattern. Some spelling courses take the same approach and may be incorporated. Because of the variation in phonic patterns, the teaching of pure phonics does not appear to be helpful after ABI. However when it is incorporated into onset and rime work or chunking, they can be beneficial (eg sh-out-ed). Certainly the common morphemes may be profitably taught (eg ed, ing, est, er) together with the strategy of ‘get rid of the ending’ by covering it with the finger, as ABI learners do not seem to be able to see the root word without physically removing the ending. To explore this in reading I use a phonic based scheme, generally after the first 75 keywords are known, which introduces phonically regular words, thus practising onset and rime. It is important that the scheme also repeats new words sufficiently to provide the necessary practice.

Orientation difficulties, which frequently follow ABI, mean that teachers should not take for granted that their pupils will ‘read’ a word left to right. The accepted norm that in English and other western languages we read L to R, must be constantly emphasised. This difficult is responsible for a number of common reversals eg on/no, was/saw.

Decoding new words is more difficult for learners with ABI, even if they do not have an acquired dyslexia, because of the irregularity of English phonics. Another way adults decode is to guess or predict what it might be from the context, and cloze exercises encourage this skill in learners but prediction can be a problem if you are unaware of the possible double meanings of words. One of my pupils read:

The letters are posted when he should have read The letters are painted referring to illuminated initial letters. His understanding of letters as meaning the sort in envelopes led to a wrong prediction.

When a young person is concentrating hard on decoding the words, they do not always understand what they have read. This is doubly so for ABI pupils, who also have difficulties in empathising with others and picking up nuances in social situations. Right from the beginning of learning to read, they will need to be shown that reading makes sense and is fun, but not necessarily required to undertake ‘comprehension’ exercises or discussions. Usually the pictures in reading schemes have a lot to discuss and in sometimes also contain material which may be used to tell the story where a restricted vocabulary has prevented this, to sequence or to interpret. This material may be used to develop skills which are difficult after ABI, such as empathy, understanding facial expression and gesture, cause and effect, reading between the lines and understanding ambiguity through interpretation of pronouns. It is also helpful to relate the reading material to experiences which the young person may have had.

Finding out what strategies a young person is using to decode and understand a piece of reading is not always easy. Miscue analysis is very helpful here, especially if comprehension questions are asked in addition. Such questions should include literal/factual questions, inferential questions, indirect questions requiring reorganisation of the material, evaluative questions, predictive and antecedent questions. The errors, corrections and attempts at decoding and comprehension reveal a great deal about the strategies being used.

Once the pupil passes out of ‘learning to read’ and reaches the stage of ‘reading to learn’ there are a number of strategies which may be taught to help the pupil focus on the content of what is being read. The simplest of these is ‘wh’. When reading the learner should try to answer the wh questions, What? Where? Why? Who? When? How?, often remembered as “Five bums on a rugby post”. These may then give a structure to notes which may be made and will help to encode the material before it is committed to memory. A more rigorous system is SQ3R: Survey, Question, Read, Review (find main ideas), Recite (or make notes). This may be done in most subject areas, and though there are books with exercises which develop these skills, it is better to teach and learn them in the context of other work.

© SHIPS Project August 2009

Appendix

Pre-reading skills

To check and develop perception skills

Jigsaws

Matching games with pictures (wrapping papers are a good source of pictures). Play pairs, snap, lotto

Matching and then making Tansley-type figure with sticks (on a separate sheet)

Inset puzzles, shapes and pictures eg totty blocks (SbS)

Match a picture with its silhouette

Find the difference puzzles

Let’s look (LDA/Philip & Tacey) has a lot of perception activities which could be made into a workbook

Usbourne books, find the duck, find the pig etc are good for looking at detail

For looking at parts to whole you could use ‘What is it?’ or What’s missing? Both from Hope

Eventually match a word with its silhouette

Although these are called pre-reading skills, it is worth continuing to practise them; this may be something which the family could do. I have found in the past that after an ABI these skills need to be re-emphasised from time to time. Frequently these skills may be combined into games, and there are several computer, card and board games which could be played to practise them.

For reading

Keywords

Most of the words we read are contained in the first 100 keywords, many of which are ‘remembering words’ rather than ones which may be worked out. There are a few schemes which introduces new words in a planned manner, with built in high levels of repetition. Such schemes tend to be the more old-fashioned key words schemes and include Ladybird Peter & Jane, Ladybird Tom & Kate, Nisbet Kathy & Mark, Ginn 360 among others.

To teach keywords

Make cards of the first 8 or 10 key words in the scheme you have chosen. Make a board with these on.

Look at each word separately (away from others) either on a computer or on the cards. Look at any patterns in the words, examine the letter order and shape

Ask the pupil to type the words, or write them on different surfaces eg carpet, the child’s back, in sand, in wet cornflour etc

Make the words out of play-doh (making sure the letters are made in left to right order)

Play games such as lotto, snap, matching pairs etc with them.

Word silhouettes

Ask the pupil to pick them up as you name them, Then when he/she knows them fairly well he/she can name them while you pick them up.

Eventually use them as ‘flash’ cards

When they are known, read the books using those words, while teaching the next set of words

Put the words in a word bank on the IT programme Clicker and use them to ‘write’ sentences on the word processor and give practice with reading them.

Phonics

As ABI pupils usually have a shorter than normal working memory it is often difficult to hold a large number of sounds in working memory in order to blend them, hence they need to learn to ‘chunk’ sounds together. This is known as onset and rime, and while this is not helpful for all pupils it seems to help the ABI pupil. Books which outline this is Overcoming Dyslexia: A Straightforward Guide for Families and Teachersby Beve Hornsby, or Overcoming Dyslexia: a practical handbook for the classroom by Broomfield and Combley.

Developing phonological awareness

Read a lot of simple rhymes and rhyming stories

Singing lots of repetitive songs

Miss out the last word of the line in rhymes and see if the pupil can predict it

Use percussion instruments to tap of the rhythm of words and poems

Tap out the pupil’s name and develop this to tap out syllables in names of animals, football teams, dinosaurs or other things which interest the pupil – SHIPS has a booklet for this

Make sure the pupil pronounces words correctly. If necessary, have a ‘word of the week’ which is practiced at a particular time each day (we used bath time!)

Play with words changing the initial sounds – this works in well with the flip books (se below).

Onset & Rime

Teach the initial sounds of the letters, not the names, associating them with real objects, pictures, making collections of objects which start with the same sound, and later which end with the same sound,

Teach the skill of blending letters to make words using C-V-C words

match pictures with their initial letter, firstly keeping apart sounds which are similar, eg n and m, and later asking the pupil to distinguish between similar sounding/looking letters

make the letters out of play-doh, draw them on the pupil’s back, ‘write’ them with a finger on different surfaces eg carpet, cornflour, sand, a brick wall etc

When these are known, extend to double letters eg st, sc, sl, sp (there are lists in Overcoming Dyslexia)

Make lotto boards for the sounds using the pictures in Overcoming Dyslexia or the SHIPS sheets

Make a card for each sound with a cue picture on the back and practise as ‘flash’ cards. If the pupil does not know then let them have a look at the picture. The idea is that they should use their imagination to recall the sound associated with the letters

Attach an action to each sound to help the memory as in the Jolly Phonics scheme (SBS or Winslow)

If the pupil is learning to type then the rime being learned may be practice in typing sessions. In this way a tactile sense is being used to reinforce the visual, however it is important that the pupil does not look at their fingers while typing.

Make flip over books to practice rimes – keep the rime the same and change the onset. If you need a list of rimes please ask.

Make flipover books with the same onset and different endings – this can only be done when rime is established

Vowel sounds

Make a collection of things with the same vowel sound.

Make a board with different objects and ask the pupil to put a counter on the ones with the same vowel sound – this is hard

When it comes to learning double vowel sounds introduce cue cards which have the letters on one side and the cue picture on the back. Where there are two or more sounds for one letter write that number with the letter(s) and require the pupil to recall all the sounds appropriate to that combination of letters – I have a sheet of cue pictures if you would like it. This again works on using the visual memory of real items to cue the symbolic.