Cognitive processing theory

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Title:
Cognitive processing theory a basis for instruction for adolescents with traumatic brain injury
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xi, 226 leaves : ill. ; 29 cm.
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Wright, Carol L., 1957-
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Thesis:
Thesis (Ph. D.)--University of Florida, 1995.
Bibliography:
Includes bibliographical references (leaves 184-194).
Statement of Responsibility:
by Carol L. Wright.
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Typescript.
General Note:
Vita.

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University of Florida
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COGNITIVE PROCESSING
FOR ADOLESCENTS


THEORY: A BASIS FOR
WITH TRAUMATIC BRAIN


INSTRUCTION
INJURY


CAROL


WRIGHT


A DISSERTATION PRESENTED TO THE GRADUATE SCHOOL
OF THE UNIVERSITY OF FLORIDA IN PARTIAL FULFILLMENT
OF THE REQUIREMENTS FOR THE DEGREE OF
DOCTOR OF PHILOSOPHY


UNIVERSITY


OF FLORIDA


1995




























Copyright


1995


Carol


Lynn


Wright















ACKNOWLEDGEMENTS


would


like


thank


committee


members


, Mary


Dykes


William


James


Hensel


Wolking;


each


Martha

has c


Rader


Christine


contributed


their


Stopka

r own


unique


patient


way


helping


me to


grow


professionally


ers


onally


as I


have


trave


this


difficult


exc


iting


path.


Extra


appreciation


extended


friend


committee


sdom


chairperson


served


, Mary


as a guiding


Dykes,


light


whose


encouragement


throughout


my years


Univers


of Florida


Thi


light


will


continue


guide


me through


many


new


challenges


that


ahead


family


deserves


a special


appreciation


that


cannot


justly


conveyed


the


words


write


want


thank


mother


whose


unconditional


love


support


alwa


been


a source


of strength


send


thanks


father,


whose


spirit


continues


influence


motivate


me to reach


beyond


perceived


limits


and


achieve


more


than


ever


thought


possible


, and


sister


Cheryl


, as my


twin


been


beside


me throughout


many


endeavors


have


pursued


shares


a part


this


dream


that


only


and


understand


Finally


want


thank


ose


friend


Judy,


who


was
















TABLE


OF CONTENTS


Page


ACKNOWLEDGEMENTS


S S S S S S S S S S S


LIST

LIST


OF TABLES

OF FIGURES


* S S S S S S S S S S SS S ~jii

* S S S S S S S S S S S S S


Abstract


INTRODUCTION


Statement


Purpose
Rationa
Definit
Delimit
Limitat
Summary

REVIEW


e
o
t
0
a


of
of t
of
n of
ions
ns o
nd O


th


Problem


he Study
the Study
Terms
of the S
f the Stu
verview o


OF LITERATURE


* . S S S S S S
* S S S S S S S S S S S


* .
tudy
dy .
f Ch


S S S S S S S
S S S S S S SS 5 1
*te SI S S S S S S S S S 1


a]


S S S S S S S S S S5 5 17


Theoretical
Theory
The Co
First
Second
S


Third
Support fo
Cogni


Orientations


of
gni
Fun
Fu
imu
Fun
th
ive


Cogni
tive P
ctiona
nction
Itaneo
ctiona
e PASS
Proce


S S S S S S S S S 5 18


ocess
ng Th
Att
: In
Succe
Pla


Mo
ssi1


Abilities


of Das .
on and Arousal
ation Coding--
e Processing .
g . .


Sand
and


Reading


S S


. 18
. 19
. 20


. 2
. 2
. 2


Using
Remed
Learn
Strat
Traum


Cogn
Read
Cog
iati
ing
egie
atic
Adol


C(
it:
ine
ni,
on
Stz
s
B1
es<


3mprehension . . . 3
ive Processing and Reading Strategies 3
3 Comprehension and the PASS Model 3
tive Processes Effectively . 4
of Cognitive Processing . . 4
rategies Instruction .. . 5
for Comprehension . . 5
rain Injury . . 6
cents and TBI . . . 6









Page


PROCEDURES


Descriptions of
Subject One


Subject
Subject


Subject Four
Subject Five
Subject Six .
Research Questions


Setting
Methods


S S S S S S S S S S78


Subjects


S . . 78


. . . 82


Two . . . 83
Three . . . 85


* S S S S SS S S S 5 86
* S S S S S S 5 5 5 5 5 87
* S S S S S S S S S 90


* S S S S S S S S S S S S91
* S S S S S S S SS S S S S 5 92


Baseline


Phases


Follow-up


(Al,
(A4)


, & A3)


S S S S S S S 5 592


Self-Questioning with


Verbali


zation


Training


S S S S S S S S S S S S 93


Paraphrasing Strategy


Instruction


. . 95


Social


Validation


S S S S S S S SS S 97


Variables


Under


Investigation


. . . 98


Independent


Variables


S . 98


Dependent


Variable


Measurement of the
Independent V


Dependent
Social Va
Trainer P


Variables
ariables


Variable


lidation Measures


performance


Procedures


Personnel


Training


Baseline Condition


(Phase


Self-Questioning with


Verbali


zation


(Phase


Baseline Condition


(Phase


Paraphrasing


Strategy


Instru


action


(Phase


Baseline Condition


Follow-up Phase


Social


(Phase A3)


(A4)


Validation


Experimental


Design


and Analysis


Experimental
Data Display


Design .
and Analysi


RESULTS


Subject One (
Subject Two (
Subject Three


Subject Four
Subiect Five


(S4)
(S5)


* S S S S S S S S S S S
* S S S S S S S S S S S S S S


.~. a a.


METHODS AND


Measures











DISCUSSION


Review


of Purpose


, Literature


, and


Methods


Review
Review
Review


Summary


scusslon


of Purpose .
of Literature


of Metho
Analysis
nd Impli


of Results


cations


Cognitive
with


Rehabilitation


Adole


scents


Reading


Compr


ehen


sion


Training


Adole


sce


with


Instructional


Efficiency


Limitations


in the


Present


Study


Future

REFERENCES

APPENDICES

A P]

B S2


C I]


D Si


BIOGRAPHICAL


OQO


arch


* * *. . . . 184



ERMISSION FORMS . . .. 195

ELF-QUESTIONING WITH
OVERT VERBALIZATION TRAINING . 203

INSTRUCTIONAL MATERIALS
PARAPHRASING STRATEGY . . 213

SATISFACTION QUESTIONNAIRES. . . 220


U


SKETCH .


S. 225


Pace















LIST OF TABLES


Table


Page


Subject


Characteristics


Subject


Characteristics


related


to Brain


Injury.


Summary of Visual


Analysis


of Baseline and


Training


Data


Subject


Summary


of Visual


Training


Data


Analysis of
for Subject


Base


line and


4.3 Summary of Visual Analysis of Baseline and
Training Data for Subject 3 ................. 134

4.4 Summary of Visual Analysis of Baseline and
Training Data for Subject 4 ................. 139

4.5 Summary of Visual Analysis of Baseline and
Training Data for Subject 5 ................. 144

4.6 Summary of Visual Analysis of Baseline and
Training Data for Subject 6 ................. 148

4.7 Summary of Subject Satisfaction Responses ...... 154

4.8 Summary of Trainer Satisfaction Responses ...... 155

4.9 Summary of Between Conditions Comparisons for
Subjects 1-6 . . . . . . .. 158















LIST


OF FIGURES


Figure


PASS


Order


Model


Ability


of Training


Subjects


Subject 1
Scores


Paraphra


Independent


during


sing


Reading


eline


Strategy


(Al)


Comprehension
and


Training


(C) .. .


Subject 1
Scores


Self


Independent


during Ba
estioning


Reading


seline


Training


Comprehension
and


(B). .


Subj


ect 1


Scores


Independent


during


Reading


eline


(A3)


Comprehension
and


Follow-up


(A4)


Subject 2
Scores


Paraphra


epend


during


sing


Reading


Baseline
Strategy


(Al)


Comprehension
and


Training


ect 2


Scores


Self


Subject 2
Scores


Independent


during Ba
estioning


Inde


during


Reading


line


Training


ndent Reading


line


(A3)


Comprehension
and


(B) ..


Comprehension
and


Follow


-up


(A4)


Subject 3
Scores


Independent


during


Reading


Comprehension


Baseline


Self-Questioning


Training


(B).


Subject 3
Scores
Paraphr


Independent


during
asing


Reading


eline


Strategy


(Al)


Comprehension


Training


(C)... ....


Subject 3
Scores


dependent


during


Reading


eline


(A3)


Comprehension
and


Subj


Page















Figure


4.10


Subject


Independent Reading Comprehension


Scores during
Paraphrasing


Baseline


(Al)


and


Strategy Training


(C) .


Subject


Independent Reading Comprehension


Scores during


Baseline


(A2)


Self-Questioning Training


4.12


Subject


Independent Reading


Scores during


Baseline


(A3)


Comprehension
and


Follow-up


(A4)


4.13


Subject


Independent Reading Comprehension


Scores during


Baseline


(A2)


and


Self-Questioning Training


Subject


(B ) . . .


Independent Reading Comprehension


Scores during
Paraphrasing


Baseline


(Al)


Strategy Training


(C) .


Subject 5
Scores


Independent Reading Comprehension


during


Baseline


(A3)


Follow-up


(A4)


4.16


Subject 6
Scores


Independent


during


Reading


Baseline


Comprehension


(A2)


Self-Questioning Training


Subject 6
Scores


Independent Reading


during


Baseline


(Al)


Comprehension
and


Paraphrasing


Strategy Training


(C) .


Subject


Independent Reading Comprehension


Scores during


Baseline


(A3)


Follow-up


(A4)


Pacre


(B).


(B)















Abstract


Dissertation


the University
Requirements 1


Presented


Florida


the


in Partial


Degree


Doctor


Graduate


School


Fulfillment


of Philosophy


COGNITIVE


PROCESSING


THEORY


A BASIS


WITH


INSTRUCTION


TRAUMATIC


FOR


BRAIN


ADOLESCENTS


INJURY


Carol


Lynn


Wright


December


1995


Chairperson:


Major


Mary


Department


K. Dykes
Special


Education


The


purpose


this


study


was


investigate


effects of


reading


diff


erent


comprehension


instructional


skills


techniques


of adolescents


with


on the


traumatic


brain


injury


(TBI


Both


techniques


are


based


on cognitive


proc


essing


theory


two


techniques


studied


were


self-


questioning


with


overt


verbal


zation


and


paraphr


asking


Reading


comprehension


abilities


were


asse


ssed


during


training


one


week


after


completing


both


training


cases.


Personal


satisfaction


with


proc


edures


instructional


effects


was


evaluated


providing


each


subject


trainer


with


a questionnaire.








multitreatment design across a single


behavior was


used


evaluate


the effects of


the


training methods on each


subject.


Training phases


each


instructional


method


consisted


five sessions


, each


lasting


approximately


one


hour.


Training for self-questioning with overt verbalization


required that subjects

to characteristics of


pattern to complete the


answer scripted questions

matrices before choosing a


matrix.


pertaining


correct


As part of


intervention,


after completing a


set of


matrices


, each


subject answered


comprehension questions


related


to written


passages


that were


read


independently.


During paraphrasing


strategy training subjects


read


selected passages with


trainer,


provided the main


idea and


details of


each


paragraph,


and answered


comprehension


questions.


After completing paraphrasing of


passages


with


trainer


, each subject answered comprehension questions


related


to written passages


that


were


read


independently.


Analysis of

instruction could


results

result


revealed that


paraphrasing strategy


positive effects


on reading


comprehension skills of


adolescents


with TBI.


Positive


effects from self-questioning training were


demonstrated.


One week


after completing both


training


phases no change


in reading comprehension was evidenced.















CHAPTER


INTRODUCTION


National


Head


Injury


Foundation


(1989)


reports


that


each


year,


in the


United


States


, over


one


million


children


will


sustain


a traumatic


brain


injury


(Michael


& Finnegan


1995


Savage


, 1991;


Lehr


, 1990)


those


children,


approximately


survive


(Begali,


1991)


70,000


90,000


will


have


a res


idual


cognitive


impairment


that


will


affect


performance


of daily


routines


(National


Head


Injury


Foundation,


highest


1989)


incidence


Sorenson


traumatic


Kraus


brain


(1991)


injury


found


(TBI)


that


occurs


among


individual


between


ages


16 and


however


Mira


Tucker


, and


Tyler


(199


report


that


incidence


almost


as high


young


children


In 1985


over


25,000


individuals


between


the


ages


required


hospital


zations


to a traumatic


brain


injury


(Max


MacKenzie


, 1991).


more


school


children


sustain


a TBI


as a high


percentage of these children re

system, schools are recognized

services for individuals with T


turn to the public education

as the primary provider of

BI (Ylvisaker, Hartwick, &











communities


develop an appropriate coordinated


effort


meet the unique needs of

component of this effort


this

will


population.


integration


primary

of successful


remediation


strategies


from both disciplines.


focus of


this study


use of


cognitive


processing


skills by adolescents with TBI


improve


their


reading


comprehension.


Depending


on severity,


a traumatic


brain


injury


can result


in a myriad


of disabilities.


Most


often categorization of


these disabilities


in one of


three areas:


physical,


cognitive,


and psychosocial.


Physical


and


psychosocial


sequelae


have a significant


impact


on educational


success;


however,


cognitive


functioning


factor that appears


In a hierarchical


to affect


schema


activity proposed by Whyte


learning the most.


for conceptualizing cognitive


(1986)


cognitive operations


(e.g.,


looking,


smelling,


hearing)


are


basic mental


activities


the base of


hierarchy.


Cognitive


processes


(e.g.,


naming


ability,


problem solving,


and motor


responses)


are more complex


cognitive operations.


A skill


and comprise


(e.g. ,


many


reading)


different


is an even


more complex


level


of functioning


and requires


coordinated


action of


many


different


cognitive


processes.


According to Whyte's


model,


cognitive functions are











Researchers


point out


that


difficulties with


cognitive


processing abilities such


as attention,


memory


, problem


solving,


self-monitoring,


coding


information,


perception


organization,


and reasoning


often accompany


even mild


(Begali,


1991;


Cohen,


1991;


Das,


Naglieri,


Kirby


, 1994;


Gerring


Carney,


1992


Harrington


Levandowski,


1987;


Luria,


1963


Mira,


Tucker,


Tyler


1992;


Tucker


& Colson,


1992)


According to Gordon


and Hibbard


(1991)


and Whyte


(1986)


, a key premise of


learning


is that


impaired cognitive


processes


, such


as those


listed


above,


treated before


more complex


skills.


Understanding


cognitive


processing deficits associated


with TBI

based on


providing


theory


appropriate


and knowledge


are


instructional methods

an increasingly


significant


issues


(Michael


Finnegan,


1995);


however


Savage


(1988)


reported,


few teachers


receive


training


regarding TBI


personnel


Lack


readiness and


to provide services


listed by Blosser


and DePompei


to a


capability


student


(1991)


of school


with TBI


as one of


five major


barriers


that consistently


interfere with successful


school


reentry.


needs


of students


with


challenge educators


develop educational


programs


that


go beyond


traditional


, as











planning a


child's educational


program,


is essential


establish a


link between


the


theories,


knowledge base,


treatment goals of


rehabilitation


staff


instructional


goals


and strategies


teachers.


The cognitive


processing


framework


learning


includes


concepts


from developmental


(Flavell,


1985;


Ginsburg


& Opper,


1988)


, behavioristic


(Skinner,


1975),


information


processing


(Bracy,


1986)


models.


Luria'


(1963)


model


of brain-behavior


relationships


the effects of


brain damage on


established


systems


within


the brain


is also


included.


This


theoretical


model


cognitive processing


intended


to be considered


the


only means by which


learning


occurs.


Instead,


should be considered one of


many mechanisms by which


intervention strategies


learning


can be better understood


developed.


An analysis of


conce


pts of


other theories


learning


beyond


scope


this


paper.


Statement


the


Problem


An increasing number


students are


reentering the


educational


environment


following TBI.


Because of


their


injuries they


are experiencing


cognitive deficits that


interfere with


programming


learning.


students


The


with


challenge


TBI


in educational


to integrate successful











lack


of children


academic


of current


the


difficulties


literature


empirical


of students


regarding


investigations


with


rehabilitation


concerning


Additional


researchers

recommended


report


are


that


based


many


instructional


on successes


strategies


failures


of other


special


needs


populations


and


are


designed


specifically


individuals


with


TBI


(Gordon


& Hibbard,


1991).


problem


inves


tigated


study


was


to evaluate


effects


reading


two


comprehension


instructional


different


skill


techniques


are


instructional


of adolescents


based


techniques


with


on cognitive


on the


Both


processing


theory


(Das


, Naglieri


, & Kirby,


1994)


use


techniques


improve s

technique


simultaneous


a self


pro


-ques


cessing

tioning


planning


strategy


using


skill


materials


methods


that


are


similar


ose


often


used


cognitive


rehabilitation


activities


settings


and


Strategi


dissimilar

Instruction


typical


Model


classroom


(Deshler


Lenz


, 1989)


is used


as the


foundation


second


technique


which


is a paraphrasing


strategy


The


paraphrasing


strategy


uses


materials


methods


which


simulate


ose


often


used


educators


in the


classroom.


objective


this


study


was


to provide


an empirical


test


of both


techniques


with


adolescents


with











of cognitive


social


process


validation


training


measure


and


concerning


second


the


to establi


instructional


program.


This


measure


was


obtained


through


a questionnaire


completed


each


subject


each


trainer


following


questions


were


addre


ssed


study:


What


ques


What


are


tioning


are


effects


skills


effects


training


on reading


training


self-


comprehension


paraphrasing


strat


skill


on reading


comprehension?


One


week


after


completing


training


in proc


ess


strategy


use


, what


are


the


subject'


reading


comprehension


scores


compared


those


achieved


immediately


after


training


ended?


Do subjects


report


sati


sfaction


with


newly


acquired


reading


comprehension


strategic


trainers


report


satisfaction


with


training


procedures


Rational


results?


the Studv


Students


reentering


school


after


a traumatic


brain


injury


often


experience


many


difficult


es,.


those


consid


ered


to have


had


a mild


brain


injury


researchers


identify


cognitive


deficits


such


as decreased


attention,


memory


loss


slowed


information


processing


organization,











temporal


lobes


brain


are


common


result


deficits


primarily


learning


and


memory


, planning


and


organization,


attention


concentration


, and


emotional


control


reading


abilities


(Kay


, 1986)


comprehension


primarily


(1985)


skills


found


with


the


has


specifically


cognitive


frontal


proce


associated


ssing


temporal


lobes


Strategy

considerable


-related

attention


instructional


in recent


programs


years


have


(Deshler


received

Lenz.


1989;


Pearson


Gallagher


, 1983;


Pressley


, 1990).


Decoding


reading


comprehen


sion


are


often


targeted


as primary


cognitive


process


sing


areas


these


recommended


strategies


(Bergman


Schuder,


1992


Paris


, Lipson,


Wixson,


1983;


Pressley


, Johnson


, Symons


, McGoldrick,


Kurita,


1989;


Rich


Pressley


, 1990)


The


strategies


instructional


approach


supported


through


research


like


that


conducted


Kansas


Institute


intervention


Research


model


Learning


supported


Disabiliti


KU- IRLD


-IRLD


called


Strategic


Intervention


Model.


The


strategies


success


results


instruction


of methods


approach


and


such


direct


as the


instruction


(Engelmann


Hanner


Johnson,


1989)


have


greatly


influenced


recommendations


made


to educators


regarding


instructional


strategies


students


with


However


there


have


been











theory,


research,


and medical


findings


regarding


cognitive


remediation in the rehabilitation setting


and


from results


of studies with


students with


learning


disabilities.


In designing cognitive processing and


skills


remediation programs


for students


with TBI,


educators


confront


the following


instructional


strategies


challenges:

based on


implementing


performance


results


populations other than


TBI,


interpreting


clinical


rehabilitation


techniques and applying them


to classroom


instruction,


understanding a


disability


for which


they


have received little or no


preservice or


inservice


training,


combining pedagogy based


learning with unfamiliar theoretical


on familiar theories


models


neuropsychology.


Challenges such


as these


impede the


process of modifying present educational


environments


reflect


an integration


of both


cognitive


process


training


and direct


Hibbard


training


(1991)


of skills.


According


"the most efficacious


to Gordon and


approach


to the


retraining of


complex behavior


is one


that


includes


retraining of both cognitive processes and


skills.


Training


of cognitive processes


provides


necessary


foundation for


the more complex


task


learning new


skills


and behaviors"


(p.16).











1991);


improved


memory


, attention


, and


problem


solving


(Ruff,


Baser


, Johnston,


Marshall,


Kluaber


, Klauber,


Minteer,


Neumann


1989);


, Lewis


adaptive


, Morecki-Oberg,


behaviors


Asarnow


children


Satz,


(Light


1987).


effective


educational


models


are


to be designed


development


functional


skill


school


individuals


with


TBI,


instructional


method


, based


on empiri


studi


an understanding


of sound


theory


of cognitive


proce


ssing


, must


incorporated


into


formerly


intact


learning


paradigms


(Cohen


, Joyce


, Rhoads


, & Welks


, 1985;


Gordon


Hibbard,


1991;


Light,


et al. 1987)


Definition


of Terms


Coding


when


new


or incoming


information


interpreted


terms


of what


we already


know


(Das


, Naglieri


Kirby


, 1994)


Cognition


general


conce


of knowing


perceiving


, remembering,


imagining


, conceiving


, judging,


reasoning


Savage


Wolcott,


1988)


Cognitive


rehabilitation


therapeutic


intervention


aimed


at facilitating


recovery


of mental


skill


disrupted


as a result


of brain


injury


These


include


processes


which


sensory


information


is taken


organize


ed, comprehended,


stored,


retrieved


used;










Cortex is


the outer convoluted


surface of


the brain


composed of


nerve cell


bodies and


their synaptic


connections.


is the highest and most complexly


organized


center of


the brain.


It is typically


divided


into


four main


lobes:


frontal,


temporal,


parietal,


and occipital


(Begali,


1991).


Executive


functions


include


anticipation,


goal


selection,


planning,


monitoring,


and


efficient


processing of


information


Gerring


& Carney


, 1992).


Frontal


lobe


the area of


the


brain


located at


front of


the head.


the most advanced part of


the


brain developmentally.


primary motor cortex,


frontal


lobe consists of


supplementary motor


areas,


the

and the


prefrontal


areas.


The


prefrontal


cortex


involved


in the


regulation of


attention


performance of


executive,


social


discourse,


interpersonal


functions


(Gerring


Carney, 1992).

Learning strategies is an approach to learning in which

the goal is for students to learn how to learn rather than

learn specific curriculum content. It is defined as

techniques, principles, or rules that a student uses to

learn, to solve problems, and to complete tasks

independently (Deshler & Schumaker, 1986).










Organization


is the


ability to


arrange or group


information


in a manner that improves


task


efficiency


(National


Head


Injury


Foundations,


1985).


Parietal


lobe


the top,


midportion of


the cortex.


It extends

occipital


from the central


fissure;


Rolandic


it receives and


sulcus


to the parieto-


integrates general


senses


and muscular sensations


(Savage


& Wolcott,


1988).


Planning


is a


set of


decisions


or strategies an


individual adopts

reach a goal (Das


and modifies


, Naglieri,


to solve a


Kirby,


problem and


1994).


Premorbid


period prior to


the onset of


illness


injury


(Savage


Wolcott,


1988).


Problem solving


the


ability


to analyze


information


related to a given


situation and


generate


appropriate


response options.


is a sequential


process


that


typically


proceeds


first


identifying the


problem;


generating


response options; evaluating appropriateness of response

options; selecting and testing a response; and analyzing as

to whether a solution has been reached (National Head Injury

Foundation, 1985).

Sequelae are the consequences or aftereffects of an

injury (Mira, Tucker, & Tyler, 1992).

Simultaneous processing occurs when relationships











telephone number by


looking


recalling


a general


pattern


the numbers,


reading


comprehension


skills)


(Das,


Naglieri,


Kirby,


1994)


Successive


processing


is when


information


put


sequence and

sequentially


coded;

The


it may


or may not have been


only relationship seen


presented


to exist


information


sequential


or temporal


one


(e.g.;


remembering


a telephone


number


by the order


individual


numbers


only


, word attack


skills)


(Das,


Naglieri,


& Kirby,


1994)


Temporal


lobe


that


portion of


the brain below the


lateral


fissure between


the occipital


frontal


lobes


(Savage


Wolcott,


1988).


This


lobe


contains


language,


auditory,


and memory


Traumatic


brain


areas


iniurv


(Gerring


& Carney


is an insult


, 1992)


the brain


, not


a degenerative or


congenital


nature but


caused by


external

altered


physical

state of


force,


that may produce


consciousness,


which results


a diminished


impairment


of cognitive abilities or physical


functioning


(National


Head


Injury


Foundation


, 1985).


Florida Department of


Education definition:


traumatic


brain


injury


is an acquired


injury to the brain


caused by


an external


physical


force


resulting


in total











impairments


in one


or more


following


areas


cognition;


language;


memory;


attention;


reasoning;


abstract


thinking;


judgment


; problem-solving


sensory


, perceptual


motor


abilities


information


proce


psychosocial


ssing


behavior,


, or speech.


physical


term


functions,


does


include


brain


injuries


that


are


congenital


or degenerative


or brain


injuries


induced


birth


trauma


Delimitations


Study


The


scope


focus


study


have


been


delimited


geographi


region


, subject


characteristics


means


urement


procedures


Students


from


three


school


districts,


Clay


, Duval


and


Volusia


were


included.


These


stricts


are


located


northea


st Florida


Participants


study


were


six


students


enrolled


the


public


school


stem.


Students


were


aged


9-15


and


a medical


diagnosis


traumatic


Injury


brain


Foundation.


injury,


Deficits


as defin


of at


ed by


least


National


a moderate


Head


level


frontal


and/or


neuropsychologi


temporal


st when


the


lobes


student


were


was


identified


receiving


rehabilitation


treatment


Each


student


was


at least


months


post--


injury


and


no more


than


48 months


post--injury


Each


student


was


assess


ed as having


at least


a third


grade


reading


comprehension


level.


Additionally


, students


were










intellectual,


before or


physical,


after the


sensory


injury were not


, or memory


include


impairments

d. No procedures


for randomizing were applied,


and there was


no consideration


given


sex,


race,


or socioeconomic


status of


the subjects.


study was delimited by the


procedures used


to train


and measure


the dependent


variables.


Training for the


cognitive


processing


abilities of


planning


and simultaneous


processing was


based


on procedures used


previous


investigations


planning


by Das,


Naglieri,


and Kirby


(1994).


procedures


for using self-questioning with


matrices were based on an


investigation by Cormier


, Carlson,


and Das


(1990).


paraphrasing strategy


instruction was


based on


the strategies


intervention model


by Schumaker


Denton,


and Deshler


(1984)


Reading


comprehension was


assessed

Readings


using reading passages and questions


series


from the Timed


Jamestown Publishers.


Limitations of


Study


Generalization of


the


results of


this


study


limited


by subject


selection.


The


participants were


those meeting


the specified


criterion


for age,


type of


brain


injury,


ability


level.


subject'


previous training


in reading


comprehension may


limit


this


investigation;


however


subject received


training


in reading


comprehension beyond











Spontaneous recovery


of cognitive abilities may have


affected


the


results of


this


study.


Since subjects were


least


months post--injury


and the


study took place over a


relatively


short period


(six


to eight


weeks),


risk to


internal


validity is diminished significantly


Nonrandom selection


and small


numbers of


subjects may


be considered a


limitation of


external


validity;


however,


this


limitation


is decreased by the


procedures


used.


This


study adhered


to those recommendations


by Tawney and Gast


(1984)


for


single subject


experimental


research.


multitreatment design was


of two interventions

provided evidence of


used to evaluate


introduced

treatment


the effectiveness


singly. This design

effectiveness by replicating


effects


within


the same subject at different


points


time.


Each


treatment


phase was


conducted


five sessions,


each


session


was approximately


one


hour


long.


A longer


treatment


phase may provide


a more


thorough


evaluation of


the effectiveness potential


of a particular treatment.


However,


purpose of


this


study was


investigate


treatment


effect during this


five hours


training only.


Summary and


Overview of


Chapter


Educators are often


instructed


use cognitive


processing techniques


the basis


for the


instruction













has been


little


research


on the


effects of


cognitive


processing techniques


for children.


Some models


have been


successfully used by


students


with


learning


disabilities but


there is a


lack


of empirical


evidence of


the efficacy


these instructional


approaches


with students who


have


traumatic brain


injury


The p

effects of


purpose of


this


study was


instructional


techniques,


ivestigate

based on


cognitive


processing theory


with TBI.


used;


, on reading


Two different


these techniques


comprehension


instructional


adolescents


techniques will


are self-questioning with


overt


verbalizations and paraphrasing


strategy training.


With


increasing number of


students


with


reentering the educational


environment,


effective


educational


methods must be


developed.


intent of


present


investigation


was


to contribute


the knowledge


base needed to develop effective


teaching


models.


In Chapter


a review of


cognitive


processing


theory


of Das--Planning,


Arousal


, Simultaneous,


Successive Processing


analysis


(PASS)--is


literature


presented


it relates


along with


to remediation


planning and


simultaneous


processing


deficits.


A review of


literature related to


the Strategy


Intervention Model,


- a *1 .


I 1 I















CHAPTER


REVIEW OF LITERATURE


Teaching models


guide the design of


cognitive


instructional


rehabilitation


strategies


techniques


children


with


traumatic brain


injury


(TBI).


In Chapter


a summary


and analysis of


literature related


to cognitive


remediation and


educational


instruction for


adolescents


with


is presented.


First,


a review of


the cognitive


processing theory of


Das


, Naglieri


, and Kirby


(1994)


Planning,


Arousal


, Simultaneous,


Successive


processing


(PASS),


included.


To develop a historical


foundation,


literature


that


served


as the


basis


for this


theory was


briefly reviewed.


Literature


involving experimentation


the relationship between


cognitive


processing


reading


comprehension has


been


examined and


related


the


PASS


theoretical


model.


Basic principles


Strategy


Intervention Model

together with a re


(Deshler


view of


Lenz,


strategies


1989

for


were


presented


improving


reading


comprehension.


Additionally


, characteristics of


adolescents


with


TBI


that are relevant


to development of


cognitive


processing are











characteristics and


their relationship


to cognitive


rehabilitation


and


educational


remediation


strategies.


Theoretical


Orientations


Theory of


Cognitive


Processing


the mid-1920s


opposed

proposed


Soviet


leading psychological


a theory


psychologist


theories


localized mental


functions.


Vygotsky


.me and

Vygotsky


established the


idea


of a system of


highly


differentiated


cortical

tasks.


zones


working simultaneously


theory


of dynamic development


accomplishing new

and interaction


within the brain


provided


foundation


for much


research on cognitive development and rehabilitation,


area


science


now


known


as neuropsychology.


A.R.


Luria


developed a neuropsychological


model


which


a functional


relationship between


areas of


the brain


and specific behavior was


Luria,


1940s,


presented


(Luria,


restoration


1963).


function


Studies


after


brain injury


describe the brain


as having the


ability to


transfer


some or


of a particular


function


an area


the brain not


damaged.


Restorative


therapy,


as Luria


called


is accomplished


through various


procedures;


substitution


to an alternate area


the brain and


reorganization within


functioning


system are


procedures


addressed by











rehabilitation.

plasticity of f


Armstrong


Junctions


(1989)


as the


cites


primary


this


basis


theory


for present


clinical methods of


rehabilitation.


It is


functional


units


theory developed by


Luria


that Das and his colleagues


used


as the


foundation


PASS.


After


Luria


lesions


observed behavioral


the brains of


military


dysfunctions


patients


following


he determined


that


there were


three


main functional


divisions


(Das,


1984a)


These


functional


units


are


concerned with


attention and arousal;


coding


information;


planning and decision making.


This


notion of


functional


organization


together with


theory of


plasticity


guided much of


the research


The Cocrnitive


in cognitive processing.


Processing Theory


Planning,


Attention,


Simultaneous,


and Successive


coding


(PASS)


model


of cognitive


processing


draws


from both


information-proces


sing


neuropsychological


frameworks.


This model


was


initially presented by Das,


Kirby


, and Jarman


1979),


and revised by


Das,


Naglieri,


and Kirby


(1994).


1973


Das broke away


from the


standard hierarchical


structure


processes


between


the


three


functional


units.


Instead


, he


emphasized


interaction


and bonding


between


cognitive











Kirby presented their revisions


their


original


model


cognitive


processing.


These


revisions


reflected an even


greater


emphasis


interaction of


on planning


three


function


attention

al units


within


the brain.


The PASS model


views


behavior


in terms


three


functional


units:


planning,


attention,


and


information


coding


(simultaneous-successive


processing)


(Das,


Mensink,


Jenzen,


1990,


Das,


Naglieri,


Kirby,


1994)


Each


functional


unit


primarily


associated with a


specific area


the brain;


not considered


however,


processes


to be exclusive


to any


within


each unit


one area.


This


are


model


is not


completely new;


however,


it offers


a comprehensive


model


to conceptualize cognitive


remediation and measurement


into


processing

a framework


and sets


specific


brain functions and behaviors. Additionally, this model


operationalizes the cognitive

First Functional Unit: Atten


three


specific


unit


functional


functions


to routine


is responsible


and maintenance of


brain stem,


hemispheres


attention.


diencephalon,


(Luria,


1963).


functions identified by Luria.

tion and Arousal

ts work in concert to provide

tasks. The first functional

ating cortical tone (arousal)

It is associated with the

[ medial regions of the

According to Das, Naglieri, and











information and


planning


action.


An analysis of


research


regarding the theory


activation


(Duffy,


1957)


supports


this


concept


According


to studies


Duffy


(1957)


Malmo


(1959)


the degree


activation


the ascending


reticular


activating


system


(ARAS)


accompanies certain


overt


response variations


Duffy reported that


the degree of


activation appeared


affect


speed,


intensity,


the coordination


responses.


Both Duffy


(1957)


and Malmo


(1959)


described


the


relationship between activation


behavioral


efficiency


an inverted U.


level


performance rises


from


low


activation


up to a point that is


optimal

point p


for a


produces


given f

a fall


unction;


activation beyond


performance


level.


this


Within


optimal

the PASS


model


is the


level


arousal


and its


interaction with an


individual's ability to


code


information


plan behavior


that


forms behavioral


Second Functional


Unit


responses.

: Information Codin --Simultaneous


Successive Processina


The second


functional


unit


is responsible


receiving,


coding,


retaining


information


(i.e.,


processing


information)


(Das,


Naglieri,


and Kirby,


1994).


functions of


this


unit


are


primarily


associated with


frontal


temporal


lobes of


the brain.


According to both


Luri a


(1963t


Das


I1QQA^


' t hcaro


LA ~ ~ ~ ~u IAr tA,. tI -- S **


is strong


evidence


v


A J1


^u L










outside world may


be reflected"


(p.15).


These


two types of


processes are simultaneous


and successive.


Simultaneous


processing


involves


integration of


stimuli


into groups.


integration of


Naglieri,


stimuli


& Kirby


Successive


into a


, 1994).


processing


particular


Studies


invol


ser


(1973)


ves


(Das,


and Das and


Malloy


(1975),


based on Luria's theory


regarding


simultaneous and


successive


processing,


provided


foundation


for research


this area.


focus


these


studies was


to support


the


alternatives of


simultaneous and


successive processing to


the previously assessed


cognitive


abilities of


memory


reasoning.


(1973)


conducted


a two-factor


analysis on cognitive


test


scores


boys,


9-11


years old.


subjects were


given Raven


Coloured Progressive Matrices,


Graham-


Kendall


Memory


Designs,


a task measuring visual


short-


term memory


figure-copying task,


and a


word-reading test.


two-factor


analysis


was


interpreted


to show that the


common factors

successive int


between


egration


these

and s


tests


peed.


are


simultaneous and


Raven's


Progressive


Matrices,


figure-copying task,


and


Graham-Kendall


Memory for


Designs had significant


loadings


on a


factor


called simultaneous


processing.


Short-term memory had











a more accurate classification of


cognitive abilities than


reasoning versus memory.


and Molloy


expanded


on previous


research


when


they compared the


cognitive


tests and


factor


included


loadings


tests of


a battery


intelligence and


achievement.


A battery


tests was given


to 60


boys


grades one


and four.


These


tests


were Raven's


Coloured


Matrices,


figure copying,


memory


designs,


auditory


short-term memory,


visual


short-term memory,


cross-modal


coding,


word reading


and


color naming,


digit span--forward


and backward,


Test.


a map task


in the


, and


previously


Peabody


discussed study,


Picture


three


Vocabulary


factors


emerged and were named successive,


simultaneous,


and speed.


Differences


in factor


loadings on


some tasks


two age


groups suggested developmental


differences


in coding


information.


Das and Molloy


observed


that


younger


children had a greater


degree of


strategy ambivalence


lacked effective


use of


stimulus exposure


time.


To expand


the original


battery


tests,


and Malloy


added


digit


span,


intelligence,


and school


achievement.


significance was reading


achievement;


it emerged


as a new


and separate


factor.


This


finding


is supported


later


research


(Das,


Leong


Williams,


1978;


Das,


Naglieri,











processing


but


loads


most


heavily


an additional


cognitive


functioning


area


named


planning.


results


study


Das


Malloy


support


earlier


findings


regarding


two-


process


stinction


(simultaneous


and


successive)


made


Luria


study


and


Molloy


was


unique


that


educational


recommendations


were


made.


They


sugg


ested


that


educational


approaches


should


interact


with


cognitive


processes


modified


based


individual


process


strengths


weaknesses;


addressing


improvement


in both


Kirby


Robinson


(1987)


their


study


on reading


sabiliti


also


addressed


educational


implications


In a study


children


with


reading


sabiliti


, children


with


most


significant


reading


problems


were


found


to employ


processing


strategies


that


not


match


task


requirement.


Therefore


, Kirby


Robinson


sugg


ested


that


training


processing


weakn


esses


using


processing


strengths


an appropriate


instructional


technique


that


would


carry


over


to academic


achievement.


Third


Functional


Unit


: Planning


third


responsible


functional


planning


unit


the


organic


PASS


zing


model


one'


behavior


This


unit


primarily


associated


with


frontal


pre-










Routine


problem solving


is accomplished through an


interaction of


the first


functional


unit providing


appropriate attention,


the


second


functional


unit


processing


components of


the problem,


and


the


third functional


unit


developing,


carrying out,


and


evaluating plans of


action.


general knowledge base,


developed


through experiences


stored in memory,


provides


the context


in which all


these


cognitive processes


operate


(Figure


.1).


Most earlier studies


using


Das'


model


focused


simultaneous and successive coding;


however


, Ashman


(1985)


cited his


initial


study


conducted


1978 which focused on


the planning abilities


of subjects who were mentally


disabled and subjects who were


not.


Ashman reported


that


individuals who were mentally


disabled and


learned specific


strategies

demonstrate


to retain or

flexibility


recall


information did not


planning


strategic behavior.


According to Ashman,


lack


flexibility


planning


leads


ineffective and


inefficient


use of


strategies.


(1984b)


further


relates


the


use of


strategies


planning


skills.


In conducting


tests


to strengthen


the


validity

followed


related to a


of measures of


two methods:


task that


planning


Das's


marker tests of


involved


research procedures

planning were


strategy use;
































































































































































































































































I I


I










(1980),


in an unpublished


performance of


60 community


issertation,

college stu


studied


dents on


the

a marker


test


for planning


(Visual


Search)


and


a commercially


available game of


strategies


(Master


Mind)


The students


were first


administered


Visual


Search


task.


The mean


search


time


for the top


15 and bottom


15 subjects was


calculated.


Heemsbergen hypothesized


that


if Visual


Search


time was


those

better


representative


subjects

in using


task


who were good at


efficient


of planful


Visual


strategies


behavior,


then


Search should be

the Master Mind game


than those who were


poor.


Results


showed that


top subjects


Visual


Search


could break


the game code more quickly than


those subjects


ranked at


the


bottom in


Visual


Search.


The bottom group of


subjects was


also observed


to exhibit


what Heemsbergen


called


"maladaptive


behaviors


planning


One example


cited was


superstitious


behavior


such


as choosing a


color


an answer


because of


likes


or di


slikes


or because that color


was


"good"


them.


SuDDort


for the


PASS


Model


Research has supported


factors


of planning


arousal,


simultaneous,


as separate


distinct


and successive


processes.


proc


One


essing abilities


first and











model


was conducted by


Naglieri


and Das


1988).


A sample of


students


in grades


, and


10 were given nine


experimental


tests.


three grade


levels,


analysis of


data


supported


organization


the


tasks


into groups.


first group was


labeled


planning


and


was


identified through


tasks on the

Visual Search


tests of Trails


(pointing to objects


(connecting numbers


letters),


in order),

and Matching


Numbers


(find


circle


two


numbers


that


are


the same).


The second group


labeled simultaneous


processing was


identified


through


tasks on


tests called Tokens


(performing


specific


tasks


with


varied


tokens),


Figure Recognition


(tracing over


shapes


embedded in


complex backgrounds)


, and


Matrices


(choosing correct


patterns


to complete sequences).


third and


and was


final


identified


group was


through


labeled


tasks


successive


of Word Recall


processing


(recalling


digits and


words),


Hand Movements


(repetition of


a series


hand movements),


and Successive Ordering


(reproducing the


specific order


an event).


In a


further study,


the Kauffman


Assessment Battery for


Children


(K-ABC)


the Cognitive As


sessment System


(CAS)


(Naglieri


Das,


1988)


were evaluated


by Das,


Mensink,


Janzen


1990)


factor


loading


on simultaneous,


successive,


planning


processes.


subtests










For the K-ABC subtests


the Gestalt Closure


(naming an


object or


scene


pictured


in a


partially


completed


inkblott"


drawing)


, Triangles


(assembling


abstract


patterns)


Matrix


Analogies


(selecting the


design which best completes a


visual


analogy),


and Spatial


Memory


(picture recall)


loaded


primarily


on the simultaneous


factor;


Number Recall


(repeating


a series of


digits)


and Word Order


(touching a


series of


silhouettes of


common


objects


order)


loaded on


successive


factor.


A large


portion


of each subtest


loaded on


the general


intelligence


factor,


thus


indicating


no superiority of


any one


processing


ability


in relation to


intelligence.


Results


the Tokens


test showed that


simultaneous coding processes can be


either verbal


nonverbal.


Analysis of


scores


on the CAS showed that


Planned


Connections


(connect,


using


a pencil,


a series


boxes


and Visual


Search


loaded


on a factor


separate


front


simultaneous


and sequential


processing.


This


factor


labeled Planning.


Crack-the-code


(determining correct


sequences)


was


involved


both


planning and sequential


processing.


Das,


Mensink,


and Janzen concluded


that results


from


this


study


confirmed that


10 subtests


ix K-ABC and


four CAS)


factored into


the


three hypothesized processing










processing thus extending simultaneous


processing to


verbal


as well


as nonverbal


simultaneous


functions.


processing was


Prior to

thought t


this


o be a


finding

process


contained


that


verbal


the K-ABC


functions.


could be


Further


supplemented


is suggested


to measure the


cognitive


process


of planning by


adding subtests such as


those


from the


CAS.


According to


Das,


Minsink,


and Janzen


this


would broaden


application.


Additional


models


that support


the theory of


separate


functional


units


the brain with primary


cognitive


processing responsibilities are reported


literature.


Bracy


(1986)


model


of cognitive


processing


expanded


Luria


interact


theory


through


Bracy


"basic


proposes


four


processes.


functional


The


areas that


first area


is the


most basic and


is similar to


the models of


Luria


(1963)


Das et al.


1994).


It plays an


important


role


in the


level


of arousal,


alertness,


and responsivity.


The second area


involved


information.


in sensation


Area


and the


three


initial


involves


processing of


integration of


sensory


sensory


information,


perception,


conception,


and memory.


fourth


area


invol


ves


response


planning,


general


cognitive


organization,


execution of


processing skills.


Bracy's


motor programs,


emphasis


and executive


for rehabilitation










foundation for


his model


remains based


on the


functional


units and importance of


cognitive processing


identified by


Luria


supported by


Das.


Another model


of cognitive


processing


rehabilitation


that


used Luria's


theory was


proposed by


Diamant and Hakkaart


(1989).


This model


functionally


integrates the neuropsychological


aspects of


Luria's theory


with


the more general


Reitan.


information


Diamant and Hakkaart


processing theory


described


the brain as an


organ whose processing


abilities regulate


"distance


between subject and object in


terms of


time,


space,


interpersonal


relationships.


They describe a model


composed


five different


levels of


information


processing


and training strategies


to remediate deficits.


five


levels are called


receptive


level


(sensory


input),


fundamental


level


(sufficient arousal


information


processing


(sequential


parallel),


integrative


level


(analysis and


synthesis


output


level


(verbal


psychomotor).


Naglieri


and Das


(1988)


and Das


, Naglieri,


and Kirby


(1994)


suggest


that the


PASS model


that


includes


planning,


attention, simultaneous

contrasts with current


and successive


tests of


processing


intelligence


(PASS)


frequently used










(coding)


and provide no


information


on the


ability to plan


or attend.


This omission


is cited by these


researchers as a


shortcoming that


results


failure of


these


tests


adequately address


Cognitive


learning problems.


Processing Abilities and Readina Comorehension


Das,


Naglieri,


Kirby


(1994)


describe


frontal


lobe area of


the brain


as the functional unit for planning.


Within the skills of this unit are the primary abilities to

form a plan of action, carry it out, and verify the

effectiveness of the plan. These abilities are related to

reading comprehension abilities. According to Luria (1966)

and Das et al. (1994), this third functional unit (planning)

relies on the second functional unit for processing and

coding information (simultaneous and successive) and the

first functional unit for proper attention to the stimuli.

With the interactive functioning of all three units, an

individual can develop plans of action, inspect performance,

and regulate behavior so that it conforms to these plans.

The individual can then compare the effects of these actions

with original intention so that correction of mistakes is

possible. The generation, selection, and execution of plans

are the three main aspects of planning and cognitive

processing (Das, 1985; Das, Naglieri, & Kirby, 1994).










coding abilities


(simultaneous and successive)


the second


functional unit.

abilities of the


Kirby

frontal


(1984)

lobe


distinguishes


as a set


the planning


"control


executive


functions


that act


to regulate or plan


encoding


information,


transform and manipulate memory


codes,


and produce a response"


Literature


relevant


to the study


of cognitive


processing


and reading


is reviewed


this


section of


chapter.


Selection of


literature


review was based


both


the construct and subjects


investigated.


Professional


literature


to meet


following


criteria


inclusion


in the review.


The study


include a


test of


successive,


simultaneous,


and/or planning processing


abilities.


The study had


to relate


findings to


reading


comprehension skill


The subjects must have been


thoroughly described


and had


to include


persons


in school


grades


two through


twelve.


The study must have been


empirical


in nature with


intervention or tests


used


described


in sufficient


detail


to permit replication.


article must have been


cited


literature











(simultaneous and successive


processing)


planning


have


been


identified


(Ashman,


1985;


Das,


1973;


Das,


Leong,


Williams,


1978;


Malloy,


1975


, Mensink,


Janzen,


1990;


Kirby


Robinson,


1987;


Naglieri


& Das,


1988).


These


tests have been used


to operationlize cognitive


processing


abilities.


The study


Heemsbergen


(Das,


1985),


cited


earlier,


is an example of


relate to processing


designing


abilities.


The


specific tasks


tasks


that


in Heemsbergen's


study required the


individual


to demonstrate


planning


simultaneous processing


abilities


that were previously


distinguished as


relating to


the


second and


third


functional


units of

monitoring


Results


the brain

g, impuls


indicated


(i.e. ,


ivity

that


memory,


, and

those


organization,


integration of st

subjects who were


self-


imuli).


ess


successful


at breaking


the code


used


less effective and


efficient planning


skills.


CoQnitive Processing


and Readinq


Strategies


Studi


have


indicated


that


reading comprehension


most closely related to


the cognitive


processing


abilities


of simultaneous processing


planning.


Planning


described


as both directive and


evaluative


(Das,


Naglieri,


and Kirby,


1994).


It directs


behaviors associated with


novel


situations and regulates


routine behavior.










of planning.


This concept


is especially


important when


relating cc

requires th

tasks and s

strategies,


ignitive processing with

iat subjects be aware of

;trategies, monitor the


and make deci


sons


strategy use. Planning

the relationships between


success of


their


about new strategies


to use


(Das,


Naglieri,


Kirby,


1994).


Flexibility


use of


strategies


was addressed by


Forrest-Pressley


and Gillies


(1983).


These


authors


argued


that


efficient


use of


reading


strategies cannot be achieved without


the metacognitive


components of


knowledge and monitoring.


study conducted by these


researchers was


The


results of


the basis


for their


argument.


this


study


Forrest-Pressley and Gillies


(1983)


144 children


included


memory


skills of


in grades


cognitive


for use of


decoding,


showed that most


strategies


were


and metacognitive


important


assessed with


tests of


information,


comprehension,


third


graders knew


single words.


Older


tasks that


language,


reading


and strategies.


about


and/or


Results


different decoding


better readers


were more


likely to


know


about decoding


skills


and


to use


them effectively


. They were described as


having both


"plans"


(cognitive)


and


"metaplans"


(metacognitive)


that


younger


readers did not


have.


Only


older


and/or


better










better readers could


express


knowledge of


many


available


reading


strategies


to meet


the demands of


various


situations.


The research


also


indicated that


older


and/or


better readers were more


proficient at monitoring


comprehension.


Forrest-Pressley


and


Gillies cite


the


results


this study


as support


for three major components


flexible strategy use by mature


readers.


They


report


that more mature


readers


do have


knowledge of


possible


alternative


strategies


(metaplans),


do spontaneously use


reading


strategies


(plans)


, and


do actively monitor and


adjust strategies.


Metacognition


and reading


abilities are discussed


further


by Wong


(1982)


Wong describes


the role


metacognition for reading


two


perspectives;


metacognition


refers


to deliberate,


conscious control


of cognitive actions


in keeping with goals


and metacomprehension


the


awareness


one's


state


of reading


and/or


listening


comprehension.


With regard


to reading;


understanding the


content


text


is reading


comprehension,


while


understanding that


one has understood


text


illustrates


metacomprehension.


According to Wong,


less successful


students appear to


lack


the awareness


that one has


or has


understood what


one


is reading


(metacomprehension)











reading


comprehension


major


component


cited


Forrest-


Press


Gillies


in the


previous


study


Readina


Comprehension


PASS


Model


Monitoring


as used


PASS


model


(Das,


Naglieri


Kirby


, 1994)


is on a less


conscious


level


than


that


described


Wong.


However,


the


function


of monitoring


within


planning


process


ses


the


PASS


model


is similar


Additionally,


eory


of cognitive


processing


based


assumption


that


thought


proce


sses


overt


behavior


are


hierarchical


Thi


arrangement


allows


an interaction


between


ess


conscious


pro


cessing


information


planning


control


those


strategies


carried


on a


more


conscious


evel


, metacognition)


relation


of cognitive


processing


frontal


lobe


more


specific


cally


planning


simultaneous


processing)


to reading


comprehension


been


demonstrated


additional


res


earch


study


Das,


Snart


, and


cahy


1982


contrasted


simultaneous


and


performance

successive)


on planning


15 students


coding

with r


tasks


leading


disability


, match


on age


grade,


with


average


readers


from


grades


and


Students


with


reading


sabiliti


were


poorer


on planning


tasks


on the


coding


tasks


than


those


students


with


average


reading











successive and planning processing


for


fourth graders


only.


For grade


significant


correlations


between decoding


three


processes,


simultaneous,


successive


, and


planning,


were


found.


Correlations


for reading


comprehension were


found to


be significant


simultaneous and planning


processes


both


fourth and sixth


graders.


Naglieri


and Das


(1987)


found


significant correlations


between cognitive processes


in the


PASS model


achievement in reading


and math.


A sample of


students


in grades


and 10 were


administered nine cognitive


processing tests.


Raw scores were


used


the analyses of


developmental


changes.


Cognitive


processing composite


scores were obtained by grouping test


scores


into


three


categories;


planning


, simultaneous,


and successive.


Developmental


earlier


significant


changes


Forrest-Pressley

improvement in


in this


study reflect those


and Gillies


achievement


(1983).

scores f


found


There was a


:rom grade


through grade


10, percentage correct


increased,


time


task completion decreased.


For both


reading and math


achievement,


coding


(simultaneous


and


successive)


planning processes were


analysis of


that


found


the test scores


reading was related


to be related.


related


to coding


A further


to reading suggested


rather than planning











Snart,


Mulcahy


(1982)


, Naglieri


and


Kirby


(1994)


refer


to thi


as the


"PASS


ocesses


being


meaningfully


related


individual


differences


in word


reading"


.141)


relationship


between


reading


cognitive


processing


was


also


demonstrated


a study


Kirby


Robinson


(1987)


Simultaneous


successive


processing


skill


, language


achievement


were


reading


assess


ed for


processes


, and


children.


reading


children


attended


regular


education


asses


grades


ranging


between


Significant


correlations


between


simultaneous


and


successive


processing


and


language


ability


were


found


Simultaneous


processing


was


significant


to general


reading


achievement.


Simultan


eous


successive


pro


cessing


were


each


related


to aspects


of language


and


reading;


however


res


ults


indi


cated


simultaneous


cess


a dominant


reading.


A different


type


analyst


of reading


cognitive


processing


was


conducted


Sahu


(1994)


ese


researchers


investigated


effects


of stimuli


characteristics


on the


use


proc


ess


strategies


reading


comprehension


study


used


several


different


tasks


, all


presented


Oriya


orthography


assess











different


from English


orthography.


Sahu


and Kar explain


the Oriya writing


system.


Oriya


orthography


the syllabic type


type of


orthography.


has character
of orthography


stic


and


It consists


features of


both


the alphabetic
47 letters of


which
has a
sound


12 are vowels
name and the


letter.


35 are consonants.


letter name happens


The


remains constant across


phonic
1 types


to be


Each
the


sound of the


of use of the


letter
phonic


letter


letter.


Hence


the grapheme-phoneme correspondence


is almost


invariant
orthograph]
consonants


. Also,
y should be
and these


vowel


sounds


symbolically


symbols


are


in the Oriya


added to the


call


matras.


(p.7)


In this study


children,


reading


on a fifth grade


level,


from two schools


India


were


used as subjects.


Results


from this


study were consistent


with those


previously


reported using the


English


language.


Those


subjects determined to


"good comprehenders" were


relatively more


intelligent


than


poor


comprehenders.


Good


comprehenders performed better on


both


types of


coding


tasks


simultaneous and


difference


between the


successive


performance of


No significant


either coding process


was observed.


primary purpose of


the study


Sahu and Kar was


not to


assess


the relationship of


cognitive


processes


reading ability


and intelligence;


however


a correlation


between these factors


was


found,


just


it was


in other


studies.


It appears


that


this correlation is related


to the


~ ~











Usinq


Cognitive


Processes


Effectively


Cummins


and Das


(1980)


investigated


the extent


to which


simultaneous and


successive


processing were


related


performance on


the WISC-R


and academic achievement.


Subjects


participating


in the study were


95 children


, with a


mean age of


years


, 9 months.


Subjects


were


classified as


Educable Mentally


Retarded


with a mean full


sca


score


70.7


.9).


The WISC-R,


Wide Range


Achievement Test


(WRAT)


, Schonell


lent Reading Test,


previously


established marker tests of


simultaneous and


successive cognitive processing were used.


Verbal


comprehension


was found to be


unrelated to


achievement


for students


who were educably mentally


retarded.


abilities


students


were strongly


average


related


intelligence


to achievement,


, verbal


especially


literacy


skills.


In this


study


students who were


EMR,


only


Freedom


from


Distractibility


Successive


Processing


showed significant relationships


to reading


and spelling.


The lack of


use of


simultaneous


processing


for reading tasks


in contrast


findings of the


previous


studies


reviewed.


Cummins and Das


suggest


that students who are EMR


may not be applying appropriate


processing


strategies


academic tasks


(e.g


, using


successive


instead of


EMR )











Das,


Bisanz,


and Mancini


1984)


conducted a study with


groups of


children designated as


"good"


and


"poor"


readers,


different


in age but matched


on reading


level.


The purpose


the study was


to determine


cognitive


task performance


improves with


and with


reading


ability.


Further


, these


researchers examined the


subjects'


scores


on the


five


cognitive


tasks


to determine


students matched


reading


ability


, but not


grade


age,


had


equivalent


performances.


Average


and


poor readers


from grades


6 were used.


A strong correlation


between


the average readers and


both digit span


(successive


processing)


and Memory-for-


Designs


(simultaneous


developmental

also evident;


trend in

perform


processing) w

performance

nce increased


as r

for

wit


0


und.


average readers was

h age and school


grade.


Additionally,


was


found


that


performance on the


cognitive


tasks


increased


with reading


competence within


same age-grade


level.


When


the data


were analyzed in


relation to


the matched


reading ability


groups,


significant


differences


in performance were not


found between age and


grade


levels.


Significant to the discussion


regarding the effective


use of


strategies


is the


point made


Das et al.


These


O











identification reflects


encoding time that,


according


these authors,


is a function


of strategies


allocation of


attention.


was


proposed


that


not only may


individuals


who are


poor readers have


limited


attentional


resources;


poor readers


attentional


also


resources,


inefficient


thus


their use of


interfering with encoding


information.

by Cunmmins a


This


nd Das


proposal

(1980).


reflects


findings


students


in the study


that study,


classified as


freedom


from distractablity was a


factor


in reading


and spelling


scores.


Among the


findings


of a study


by Das,


Mensink


, and


Mishra


(1990)


was that


students


with reading disabilities,


regardless


performed


poorly


on the


processing tests


administered.


The subjects


this study were


fifth and


sixth


graders


45 evaluated


to have reading


problems and


children considered


have


no reading


disabilities.


purpo


ses


this


study,


entire


sample


140)


was


reclass


ified


into


poor,


average


, and good reading groups.


Twelve


selected


tests


from


the


Das-Naglieri


Cognitive


Assessment


System


(CAS)


Experimental


Test Battery were


administered.


These tests


represent all


four functions from


the PASS model


of cognitive


processing,


Planning,


Attention,


Simultaneous,


and Successive


processing


EMR,











readers clearly.


These


tests


involved not only phonological


coding but also articulation.


Based on


results of


this


study,


one


can


expect


that


individual


differences


reading,


when


partialled out,


can be correlated with


PASS


tests.


Results


also


indicate a need


for tests that


involve speech articulation


to be


included with


cognitive


processing tests.


The role


it plays


effective


use of


cognitive


processing appears


to be worthy


future


research.


Das,


Mensink,


and Mishra


(1990)


emphasize


the need to


"go beyond


disabilities.


in the assessment of


Investigation


students


with learning


language disorders and


their


association with


phonological


coding and articulation


suggested.


These studi


show that


subjects


with


lower


levels or who are considered

perform poorly on processing

This correlation may be due


to have


ta:


reading


sks associated

inappropriate


disabilities

with reading.


inefficient


use of


processing strategies


for reading.


As cited


traumatic


earlier


brain injury


this


are


paper,


often


individuals


observed


with


use


inappropriate or


inefficient


processing strategies.


Additionally,


injury to


frontal


lobe of


brain,


which


is considered


the primary


control


area for many










empirical


studies with


individuals


with TBI,


a better


understanding of


many


the reading


students with


difficulties experienced by


be achieved.


Remnedlalion


of Coanitive


Processina


Remediation of


cognitive


processing abilities has


foundation memory research and


training


(Das,


1984b).


This


research brought about a


distinction between structural


control


processes.


the


PASS


model


these


processes


relate to


strategy skill


integration of


training.


cognitive


states


process training


that the use of general


strategies


(ie;


rehearsal)


needed;


however,


an individual


must also be taught an


adequate cognitive plan for the use


these strategies.


Vygotsky referred


to the


limits of


improving


an individual


cognitive deficit


"zone of


proximal


development


zone of


proximal


development is


"the distance


that


a child


can


travel


on the


road


cognitive competence


following the


active


intervention by


teachers,


peer group,


parents,


or other


significant adults.


(Das,


1984b,


43).


A relatively


early study


Kaufman and Kaufman


examined strategy training


and remedial


techniques


associated with


eight


Success


ive-simultaneous model.


fourth-grade children with a


mean age of


Sixty-


9.4 were











below average


(grade equivalent:


groups.


These


subjects were


rank ordered and alternately


selected for


either


the control


group or the


experimental


group with


children in


each


four


groups--below average


experimental,


below average control,


and average control. Six

successive processing were


marker test

administer


average experimental,

s of simultaneous and

ed at pretest and


posttest.


Intervention


consisted


one


35-minute


session


with each child


17 weeks.


This


totaled


10 hours of


training for


each


child.


The study was designed to examine effects of


comprehensive and direct verbalization


training on the use


of successive and


simultaneous strategies.


Training tasks


were not copies


of the cognitive


tests


used


, nor did they


include materials


that were similar


in content to the


academic tasks


MAT.


Subjects


were


required to


provide constant


verbalization of


actions.


A total


of nine


separate tasks


and seven filmstrips was used during


intervention.


Since all

experimental g


subjects,


roups


in both


, improved


the control


their


average performance on


tasks;


However,


validity of


Word Attack


treatment effect


skills


is questionable.


improved significantly higher











processing tasks


not only


improved


efficiency


use of


the successive processing


strategy


performance on


nonacademic tasks


but,


improved


academic performance


in word


recognition and mathematics.


A remediation program by


Brailsford


, Snart,


(1984)


also resulted in


improved


pretest/posttest


scores for


successive and simultaneous


processing.


However


, effect on


reading comprehension was


primary


objective


study.


Twenty four children with


ranging in age


from 9


learning


to 12 years old


disabilities,


were assigned


either experimental


(strategy training)


or control


(reading


resource) groups.

between the groups


No significant differences existed


IQ or reading comprehension scores.


Simultaneous


and successive


processing were


tested


using marker tests determined


from previously


discussed


factor analyst


studies.


test reading


comprehension


levels


, grade equivalent


scores


from


the Gates-MacGinitie


comprehension subtest


were


used.


Reading


instruction


level


for each child was obtained


through administration


of The


Standard Reading Inventory.

Children in the control group received 30 minutes of

small group reading instruction daily. Comprehension and

word analysis were emphasized. Children in the experimental











task

(1979


performance.

) no task du


f


the study


iplicated any materials


Kaufman and


used


Kaufman


in either the


cognitive


test


battery


or the


reading


comprehend ion


tests


used as protests


posttests.


Both


groups


showed


significant


improvement


on the


simultaneous-successive


tests


The


experimental


group


showed significantly greater


improvement


than the


control


group on


four of


the cognitive processing


tests


and on


instructional reading


levels.


Results


this study


indicated


coding,


that active


memorization,


strategies


and retrieval


the organization,


information were


learned and


effectively used to


improve nonreading and


reading tasks.


Reading disabilities were approached


less directly


in a


study by Spencer,


Snart,


and Das


(1989)


The relationship


between spelling


and reading abilities


was


used


demonstrate


strategies.


primary


global


Improvement


focus of


nature of


cognitive


in spelling


remediation


processing


achievement


program;


was


however,


improvement on global


tasks was


also


expected.


Twenty students


who were


classified


as having


learning


disabilities were the subject;

were divided into a control a:


s for this study. The students

nd experimental group. The


------------ -----------------------











The control


group


received


typical


classroom


remediation


in spelling.


equivalent number of


experimental


hours of


experimental


group received an


remedial


program


for spelling.


For pretest and


posttest all


children


were given the Test


of Written Spelling and


previously


determined marker tests


coding


planning


Marker


tasks were from the Cognitive Assessment


System


(CAS,


Naglieri


Das,


1987


the Kaufman Assessment Battery for


Children


(K-ABC)


intervention


processing tasks


program consisted of


loaded most heavily


five global


on successive


processing and five spelling tasks.


Daily


remediation


sessions


were held within


of 20 hours of


training was


global


classroom structure.


and content-specific


given to each child


total


(spelling)


experimental


class.


Children


the control


group


received


an equivalent


number


of hours


component of


"I-Can-Spell"


the training


program.


important


for the experimental


group was


having students talk about


their


approaches


to the


tasks


(self-questioning and


verbalizations).


Posttest scores on


the Test


Written


Spelling


improved


for both groups.


Spelling


scores


at posttest


were


significantly


higher


for the students


the experimental










simultaneous,


successive,


and planning.


The authors


proposed


that


remedial


training with self-questioning


and verbalizations contributed


to improved


attention and


planning ability


overall.


authors concluded that a


training program


that


encompasses


both


global


(cognitive


processing)


and bridging


(content specific)


tasks could be


successfully used


the


classroom.


Results of


these


studi


support


the


efficacy


future


research in not


only remediating


cognitive


processes


also


use of


nonacademic global


tasks


plus


bridging


tasks


specific academic areas.


Results


regarding


improvement


in simultaneous


processing


and


planning


abilities


are


promising toward


the development


of reading


comprehension skills,


given


indications


from previous


research regarding their relationship


to one another.


Learning


Strategies


Instruction


Learning strategies are overt behaviors or conscious


thou


are


lear


inde

lear

1986


ghts that facilitate learning and task complete

techniques, principles, or rules that a student

n, to solve problems, and to complete tasks

pendently. The students learn how to learn ra

n specific curriculum content (Deshler & Schum

). Most learning strategy models are related


ion. They

t uses to



their than

aker,

to reading











(deBettencourt,


1987),


acquiring


information


from written


materials,


identifying


and storing


important information,


and written


expression


(Deshler


& Schumaker,


1986)


are also


addressed


various


models.


Learning strategic


work


coordination with and


are


part of


cognitive


processing


(Das,


Naglieri,


Kirby,


1994;


Pressley,


1990).


They may regulate


and promote


use


other overt strategies or cognitive


processes.


Because


learning


is often


strategic


deliberate,


use of


conscious objectives


and plans


is not


always efficient nor desirable.


Paris,


Lipson,


and Wixson


(1983)

acquis


recommend


nation of


using


new


reading


skills and a


strategies d

s "fallback"


during


initial


procedures


when


unexpected difficulties


are encountered.


A key

strategy i


assumption


instruction


underlying the


various models of


that education should


emphasize


teaching


students


process of


learning


as much


teaching them


specific


subject


area


content


(Deshler


Schumaker


, 1986;


Gleason,


1988;


Press


ley,


1990).


this


, students become


an active


participant


learning


process.


Most


students with disabilities


do not naturally


develop effective


learning strategies


unless they receive


explicit


instruction


their use.


Further,


these skills


are


learned best


when


at least


part


the


instruction is










a strategy


important


(Borkowski,


Weyhing,


& Carr,


1988;


Gleason,


1988).


This


attributional


training has


been


shown


to enhance


the maintenance of


strategy use


(Borkowski,


Weyhing,


Carr,


1988).


Often students


with


learning disabilities


lack an


awareness of


their


own behavior or thinking processes


(metacognition)


(Herr,


1988;


Moore


& Kirby,


1988;


Wong,


1982)


produce


inaccurate


results without recognizing


them.


Self-management skills


are an


important part of


strategy


instruction.


With


instruction


techniques


such


as self-questioning


(Weinstein,


Ridley,


Dahl,


Weber,


1989)


(i.e. ,


verbalizations)


and


self-monitoring


(Gleason,


1988)


(i.e. ,


checklists,


proofreading)


work will


be completed more


accurately and


independently


(Archer,


1988)


These skills


are especially


important


the student


to be able to


generalize


abilities outside


the classroom setting.


Deshler


and Lenz


(1989)


define


success of


a given


strategy through


two criteria.


How the


strategy helps


student


completing the


task


(effectiveness)


is the


first


criteria;


the second criteria


based


on how


facilitates


completion of


effectiveness


learner;


task


efficiency


the demands of


a timely manner


is relative to


situation


(efficiency)


the task and the


and learner determine










learning strategies


preferences,


(Pressley,


perceived difficulty


1990).


Individual


the task,


prior


knowledge,


perceived


importance


task,


learner


expectancies


abilities;


are


variables


that determine


the appropriate strategy


a student


will


or should


use


for a


particular task


(Kirby


Pedwell,


1991;


Paris


, Lipson,


Wixson,


1983;


Weinstein,


Ridly


, Dahl,


Weber,


1989)


relation to the


present


study this


issue


is especially


important.


Students


with


traumatic


brain


injury


characteristically


have deficits


in many


these


learning


areas


(Savage


Wolcott,


1988).


Strategies


improved,


strategic reading take many


forms.


Suggested methods


include


advanced


organizers


(Herr


1988


Robinson,


1961),


summarizing


or paraphrasing


(Herr,


1988;


Kirby


Pedwell


, 1991)


enhancement


(Herr


, 1988;),


elaboration


(Weinstein,


Ridley


, Dahl,


Weber,


1989),


predications


(Cunningham


Cunningham


1987;


Hennings,


1991;


Stauffer


, 1969).


Models


for strategic


learning


have


certain strategies and methods


that


overlap with other


models.


Additionally


effectiveness


with certain


most have research


populations.


indicating

When determining


appropriate


needs of


strategies to use for a particular 1

e individual and the situation must b


earner, the

'e the first










to approaches


as relying


on either


"deep


or surface


processing


This


theory


similar


that


addressed


Biggs


(1988)


Proponents


common


learning


strategies


such


as underlining


, note-


taking


, and


summarizing


have


argued


that


ese


activities


help


students


become


more


actively


involved


learning


These


activities


increase


amount


of attention


focus


and


student


effort


given


on main


to a task


eas


(Hennings


(Gleason


, 1991)


, 1988)


increase


connections


knowledge


between


(Cunningham


text


& Cunningham,


material


1987)


and


and,


previous


therefore,


result


, what


Kirby


and


Pedwell


described


, more


active


deeper


that


processing


causes


approaches


an improvement


deeper


in learning,


cess


activity


themselves


Biggs


(1988)


Kirby


and


Pedwell


have


argued


that


(intrin


individual


sic


students


, meaningful)


approach

or surface


tasks


in either


(extrinsic


rot


a deep

e memory)


ocess


manner.


Essential


Reading


a model


proposed


Hennings


1991)


that


promotes


active


processing


model


a comprehension


strategy


in whi


ch readers


survey


a text


before


reading


target


or predict


the


main


idea.


prediction


used


to track


and


modify


their


points


. After


reading,


they


think


about


point


, relate


to what


they











things they will


read


about and read to


test


their


previous knowledge and


predictions.


theory of


automaticity


the basis


a model


presented by Bos


(1982).


According


to this


theory,


fluent reader


automatically processes


information


at the


visual


and phonological


levels


is therefore able to


focus attention on


integrate


meaning


information with


codes


prior


in the


text


knowledge.


A lack of


fluency requires attention be given


to basic reading


processes


instead


of comprehension.


Procedures of


repeated


readings are used to develop


cites studies showing success


fluent,


automatic reading.


with students with


learning


disabilities and with


those who were mentally retarded.


the studies cited,


when


a fluent reading


level


was achieved


significant improvement


in comprehension was also


found.


decrease


in motivation


and


interest


interfere with


students'


cites


progress


lack of


using


motivation


as a


procedure.

significant


Halliha

factor


(1989)


for many


students with


poor reading skills.


The Strategy


Intervention Model,


developed at the


Kansas


Institute


for Research


and Learning Disabilities


(KU-IRLD)


is a model


that has


received extensive


research.


The population of


students on


which


this model


was


validated










environment


significant


deciding


appropriate


interventions


instruction,


components


environme


the


(Deshi


model


Lenz


are: curriculum,

, 1989). Use of


this


model


been


associated


with


improved


student


performance


(Deshler


Lenz


1989;


Gagne'


, 1988; Schumaker,


Deshler

1986).

incorpo

literat


(Pressl


Instruc


recipro


rehears

material


display


mainten

Th

instruc


Strand


Strand.


learning

Strand


, Alley, & Warner, 1983; Ellis, Deshle

The instructional scope and sequence

rate effective teaching principles fro

ure on metacognition and motivation th

ey, Goodchild, Fleet, Zajchowski, & Ev

tion in each learning strategy include

strategy, student goal setting for str

cal teaching techniques and modeling,

al, extensive practice in controlled a

Is, feedback, student performance moni

, mastery learning, and generalization

ance activities.

e learning strategies curriculum consi

tional strands: The Acquisition Strand

and Expression and Demonstration of C

Each strand consists of several task

ig strategies. The strategies in the A

enable students to gain information fr


r, & Schumaker,

of this model

m the

eories

ans, 1989).

s a description

ategy mastery,

verbal

nd advanced

touring and data

and



sts of three

, the Storage

ompetence

-specific

acquisition

om written










Strand consists of


strategies


that


enable students


complete


ass


ignments


, to effectively


express


themselves


writing,


and to


take


tests


(Schumaker,


Denton,


Deshler


1984).


For the


purposes of


this


study


, a method similar to


the Paraphrasing strategy


, in


the Acqui


sition Strand


, will


be used as one of


Strategies


interventions.


for Comprehension


Although reading


comprehension


is consistently


identified as a


primary


factor


educational


success,


this


may not be reflected


comprehension


a study by Durkin


actual


instruction


(1979).


instruction.


the classroom was


In a study


Reading


focus of


intermediate


grade


teachers Durkin


and her


colleagues observed a


total


17,997 minutes of


instruction


. Durkin


found


that fewer than


50 of


17,997 minutes


(.25%)


contained


any comprehension


instruction.


analyzed


When manuals


for directions


percentage of


basal


teachers


space devoted


reading


regarding


this


series were


comprehension,


topic did not


fare


much better.


predominant


directives


in the manuals


consisted of


many


questions


students


to answer


about


the selections they read


many worksheets and


workbook pages


for students


to complete


independently.


Durkin especially noted the


similarity


of what was


provided










school


systems;


Corrective


Reading


(Engelmann,


Hanner


Johnson


, 1989),


Direct


Instruction


(Weisberg,


1988),


Reading


Mastery


(Engelmann


Brunner


, 1988)


, Whole


Language


McCaslin


, 1989),


the strategies


previously


reviewed


are


example


es.


significant


results


Durkin'


study


support


need


an updated


review


of present


instructional


methods


used


ssroom.


review


would


help


determine


progr


ess


been


made


toward


increasing tn

The most


time

obvious


spent

s need


on comprehen


sion


strategic


instruction


intervention


reading


self-correction


, a skill


frequently


cited


a deficit


associated


with


(Begali,


1991;


Gerring


Carney


1992


Mira


, Tucker


Tyler


, 1992


When


novel


words


or comprehension


failure


are


encountered


, readers


need


access


to rereading,


using


contextual


cues


other


strategic


aids


to under


standing


(Pari


, Lipson


, & Wixson


1983)


Poor


readers


do not


carry


out


many


, typical


strategies


comprehension


that


more


skilled


readers


Pari


, Lipson,


Wixson


(1983)


cite


following


examples


of basic


, but


often


unuse


, skill


reading


comprehen


sion


: skimming,


scanning


, rereading,


integrating


information


, planning


ahead


, taking


notes


, and


making


inferen


ces.










those


listed


above


are often


pointed


out as deficient.


With


further


analysis


literature


on cognitive processing


the role


functional


units


the brain


(Luria,


1966;


Das,


Naglieri


Kirby,


1994);


it becomes clear why


many


individuals with


TBI


are not


using these skills.


Skills


such as those


identified by


Paris,


Lipson,


and Wixson


(1983

with


)


as necessary for


cognitive processing


reading comprehension are associated

g abilities identified as primarily


related to the frontal lobe of the brain.

temporal lobe area is highly susceptible to

accident.

Paraphrasing is one method of elaborate

improve reading comprehension. It is a str

recommended for students with TBI. It rela

learner is trying to learn to what he or sh

(Weinstein, Ridley, Dahl, & Weber, 1989).

strategies require "invention" (Hennings, 1

that requires the reader to create rather t

ideas. Hennings (1991) warns that some par

strategy instruction calls for students to

paragraph and analyze it for the main idea,

students to "retell" stories and include sp

It is Hennings concern that this type of ac


The frontal-

injury during an



ion used to

ategy often

tes what the

e already knows

Good paraphrasing

991), a process

han locate,

aphrasing

read an isolated

or requires

>ecific elements.

:tivity does not


*

I










Cook


and


Mayer


(1983)


called


paraphrasing


Mixed


Strategies


Summarizing


Underlining


model


earner


reads


part


passage,


then


pauses


to take


notes


summarize


that


portion.


Note


taking


occurs


after


reading


stening


material.


Herr


(1988)


recommends


paraphrasing


strategy


within


Strategy


Intervention


Model


Schumaker,


Denton,


Deshler,


1984).


this


model


, paraphrasing


is defined


as a


strategy


designed


improve


recall


of main


ideas


facts.


According


to Schumaker


et al. research


has


shown


that


students


' comprehension


retention


scores


increase


proportion


quality


quantity


the


paraphrase


statements


they


make


while


reading


a passage.


Paraphrasing


requires students to read short passages of materials and

rephrase the content, including the main ideas and facts, in

their own words.

This paraphrasing strategy appears to heed some of

Hennings warnings but not all. The isolated nature of the

reading passage and the recall of specific information are

two concerns that appear to remain. Advantages of this type

of strategy are (a) the students actively interact with the

material, (b) the method of instruction requires that the

student maintain a high level of attention, and (c) by










A study


Torrance


, Lee,


& Olson


(1992)


investigated


developmental


changes


in children'


understanding


paraphr


ase


as equivalent


in meaning


actual


text


story.


Eight


stori


were


read


to 54


students


ranging


from


to 9.9


years


A marker


sentence


in each


story


was


used


to signal


an accompanying


paraphrase


statement.


Results


showed


that


was


until


age


or 7


years


that


children


judged


equivalent


meaning


between


a paraphrase


and


actual


text.


This


finding


significant


determining


the


appropriateness


strategy


adolescents


with


developmental


delays


Traumatic


Brain


Injury


Adol


esce


It is essential


for


children


who


have


a traumatic


brain


injury


(TBI)


to develop


good


basic


academic


social


skills


ese


skills


will


build


foundation


increase


ingly


difficult


learning


situations


that


occur


school


injury


significant


as well


influence


immediately


of early

afterward


learning


is one


before


aspect


many


that


differentiate


the


adolescent


who


a TBI


from


other


outcome


damage,


are


students


degree


causal


agent


Additional


nature


, site


variables


primary


injury,


related


secondary


premorbid


- a -l a


i.


A


l










Contrary to early


beliefs,


a child


or adolescent does


not necessarily recover


from a


"better"


than an


adult


(Savage,


1991;


Shapiro,


1985).


Physiological


differences


potentially make


different


trauma


from trauma


Myelination of


neurons


to an adu


immature brain significantly

It, mature brain.


the brain


along with changes


synapses


and dendrites continue,


sequentially


, until


the end


second


decade of


life


(Begali,


1991;


Shapiro,


1985).


Unfortunately


, this


period


correlates


with


the ages at which


one is most


likely to


receive a brain


injury,


to 24


years


(Bigler


, 1987;


Savage,


1991).


The number of


severe


injuries


in the


19-year


range


equals


that of


the previous


14 years combined


(Lehr,


1990).


Often students


are


seen to


learn


rapidly soon after


returning to school.


This


is most often


only


"relearning"


of previously


known


information


(Begali,


1991)


Difficulty


"new


learning"


is cited


as a


common


residual


cognitive


impairment.


The earlier


age an


individual


injured,


the smaller the knowledge base on which


to relearn old


skills


and acquire new


information.


This creates


significant


problems


for the adolescent who


is moving


into


an educational


environment


that


is expecting basic academic


skills


to be mastered.


It will


also


be expected that


this





I










abstraction,


comprehension


rather


than


on rote


acquisition


of information


(Lehr,


1990)


these


three


areas


are


frequently


as difficult


an individual


with


Psychosocial


issues


their


effect


on educational


performance


are


extremely


signifi


cant


adolescent


should


always


be a consideration


in educational


programming


Adol


escence


is typically


a time


sexual


scovery


establishing


identity,


increasing


ependence


, and


career


planning


Many


or all


these


issues


may


be greatly


altered.


Past


peer


groups


may


drift


away,


ability


to drive


or work


may


be impaired


, the


student


may


have


to attend


special


education


asses


previous


long


-range


vocational


or college


plans


may


now


be inappropriate.


Recovery


or improvement


from


described


not


as a


static


event


as a process


that


occurs


over


an extended


period.


children


adolescents


, thi


ocess


recovery


improvement


is imposed


on the


ongoing


process


development.


dynamic


nature


of neurological


recovery


functioning


(Ylvi


saker


, Hartwick


Stevens


, 1991)


global


impact


injury,


sca


uttered"


nature


abilities


disabilities


separates


these


students


from


others


have


disabilities


(Cohen


, Joyce,


Rhoades,










Cognitive Rehabilitation


Systematic


programs


of cognitive rehabilitation are


relatively new.


During


there was a


significant


decrease


the mortality rates


of soldiers due


to head


injuries


more effective neurosurgical


Rehabilitation efforts

dramatically at the end


techniques


begun during WWI


the war.


were developed.

decreased


During WWII


rehabilitation hospitals


were again needed.


Not


until


1975


did rehabilitation programs begin


to focus on


the


remediation of


cognitive


and behavioral


deficits


instead of


only speech


, language,


and


physical


impairments.


Rehabilitation

deficits were


programs


first


addressing cognitive


established by Ben-Yishay


and behavioral


Israel.


1978


Ben-Yishay


established a


day treatment


program at New


York University;


this


program led to the development of


similar programs


throughout


United


States


(Boake


1989;


Boake,


1991)


Most


these


programs continue


to focus


primarily on adult patients.


With the


increase


in rates of


in children,


more


centers are


providing


services to


them.


With


this


increase has come


recognition


that


children cannot be treated as


"little


adults"


(DePompei


Blosser


1991;


Lehr


, 1990).


Not only do cortical


structures


differ


in children,


the demands


placed


on them when










Approaches


to cognitive


rehabilitation


vary


Prigatano


(1987)


argues


that


true


recovery


function


after


brain


injury


can


only


occur


with


"reg


generation


anatomical


substrate"


, regeneration


of neurons)


time


there


is no evidence


possible,


therefore,


to support

Prigatano


that


call


regeneration


recovery


"readjus


tment


--getting


along


with


lost


function


states


that


as long


as the brain


"alive"


can


continue


to learn


readapt.


Prigatano


category


zes


three


approaches


to cognitive


retraining


: (1)


use


compensation


to get


around


a deficit;


the


use


substitution


to solve


a problem


that


the


brain


can


solve,


alternate


specifically


methods;


impaired


cognitive


attempts


to retrain


functions


Model


of cognitive


remediation


need


to be developed


based


individual


with


a traumatic


brain


injury;


many


model


are


based


on stroke


patients


Additionally


model


should


theory


driven


empirically


based


A final


recommendation


emphasis


zed


throughout


recent


literature


relations


to everyday


tasks


To be


judged


success


ful,


intervention


methods


should


generalize


beyond


rehabilitation


setting


real


world


patient.


of computers


cognitive


retraining


is an example










microcomputers


to provide cognitive


rehabilitation


patients with TBI.


William Lynch,


though a


proponent of


computer use


in cognitive


rehabilitation,


is concerned


about


fast


pace at


which


use of


computers


for this


purpose


is growing.


Lynch addresses


issues


such as


ecological


validity


(Lynch,


1992a),


structure of


treatment sessions


(Lynch,


1989),


and selection of


patients and software


(Lynch,


1992b).


Throughout


his


research,


Lynch


recommends


additional


empirical


studies on specific techniques


and


software.


Bradley,


Welch,


Skilbeck


(1993)


cite much


Lynch's work in


their research.


Like Lynch,


Bradley


et al.


see


computers as


a quickly


growing


asset


to cognitive


rehabilitation but also warn


potential


problems.


These


authors


list the


following


advantages


to using


a computer


for cognitive rehabilitation:


increased scope


complexity


training programs,


accurate


and


rapid


feedback,


ability


to motivat'

learning,


, flexibility,


incidental


ease


learning


overlearning,


of computer use,


autonomy

and data


storage and


analysis.


Additionally,


these


authors


list


possible disadvantages:


inappropriate


use of


programs,


operational


difficulties,


software deficiencies,


lack of


or poor generalization


to everyday


life.











other


researchers


Prigatano,


1993)


(Gordon

describe


Hibbard,


a rapidly


1991;

growing


Oddy,


1993;


scipline


that


nas


done


enough


validate


efficacy


or develop


understanding


success


or failure


treatment


concerns


expre


sse


d by


ese


authors


increase


when


analy


sis


literature


related


to cognitive


rehabilitation


Bruce


(1978)


children

in a stud


or adole


scents


regarding


conducted


outcome


children


following


severe


head


injuries,


reported


that


generally


, children


and


adol


esc


ents


had


a better


functional


prognosis


than


adults


with


similar


injuries


Not


until


years


later


researchers


begin


recognize


the


inaccuracy


of Bruce'


findings.


Factors


related


developmental


process


that


children


adolescents


were


going


were


through,


considered.


physically


Blosser


, cognitively


DePompei


and


psycho


1989a)


socially,


Lehr


(1990)


Ylvisaker


et al. (1990)


, suggested


that


not


only


was


progno


children


and


adolescents


generally


better


than


adults;


typically


was


worse.


A review

theoretical


Sohlberg


approaches


when


Mateer


treating


(1989)

cogniti


addressed t

ve deficits


hree

for


children


Approach


, the


adults.


These


Functional


are


Adaptation


General


Approach


Stimulation


, and











This approach


orients


treatment


toward


a specific cognitive


area.


It is based


on Luria's


theoretical


model


of specific


yet interacting neurological


functioning


areas of


the brain.


Tasks are administered repetitively,


goals


and objectives


are hierarchically


organized,


and remediation is conducted


through a data-based approach.

determined by generalization of


Measures


improvements


success are

to real-world


situations.


The foundation


the Process-Specific


approach


is the


assumption that distinct


cognitive


processes


regulate


behaviors and


improvement of


accomplished through


targeted


these


processes can be


treatment.


theoretical


base


is Luria's,


should


also be


assumed


that cognitive


processing of


information


takes


place


through an


interaction


between functional


units


within the


brain


and that this


should be considered during treatment.


Sohlberg,


Mateer,


and Stuss


1993


recommended a model


to provide appropriate


rehabilitative


executive processing deficits

organization, initiation, and


such


treatment for


as planning,


self-regulation.


This model


incorporated a


theoretical


base,


an understanding


neuropsychological


treatments


components of


to manage executive


executive


function


deficits,


impairments.


and

Within











multiple simultaneous


tasks,


developing


following


agreed-on agenda


for action,


and route


finding tasks


were


suggested interventions.

teach specific strategies


the intent was


These exerci


ses


completion o


to help the subjects acquire


were not

f tasks;


planning


used


instead


and


problem solving abilities


internally


, the same


intention


advocated by Das,


Naglieri,


and Kirby


(1994)


their


PASS


model.


The goal


of rehabilitation for cognitive


processing


skills


is to develop remediation programs based


integrated methods


arranged hierarchically.


This


hierarchical


approach


is consistent with developmental


theories of


learning such


as that


presented by


Piaget'


(Ginsburg & Opper,


1988).


It is


recommended that


interventions


included


in cognitive rehabilitation should be


arranged


so that


the behavior


being taught


is constantly


expanded while building


on a


foundation


of either


intact or


remediated cognitive


processes.


Additionally,


training must


be relevant to the


individual's


life and


generalize


to real-


world functioning


(Gordon


& Hibbard,


1991;


Gordon,


Hibbard,


& Kreutzer


, 1989;


Prigatano,


1987;


Sohlberg


, Mateer


Stuss,


1993)


Experiential


or progressive learning theory,











recommendations


for programs


of cognitive


rehabilitation and


basic theories of


learning


should be


investigated


further to


assess


the efficacy of


cognitive


rehabilitation.


and Educational


Strategies


Improved problem solving


, thought organization,


critical


thinking,


Soc


skills may


the highest


goals of


cognitive rehabilitation


educational


training


for adolescents with TBI.


Adequate


problem solving


abilities


enable a student


to assume a


"self-coaching"


role


and to


learn and achieve


independence more quickly.


Training


in problem solving


students with TBI.


is especially


increase of


important


new problems


these


students


face as a result


their


injury


the high


rate


of injury to


frontal


lobe area


the brain,


which


involved in


problem solving


increases


the challenges


educational


environment


significantly


(Das,


Naglieri


Kirby


, 1994;


Haarbauer-Krupa,


Henry


Szekeres


Ylvisaker,


1985).


problem solving process


involves


first


ability


to think hypothetically


and second,


multiple


types


organized reasoning abilities


Haarbauer-Krupa


et al.


identify these


reasoning


abilities


as:


isolation


of main


ideas,


divergent


thinking


, reflection


on the


relevance











and monitoring.


These


abilities


are


not only associated


with functions of


frontal


lobe


(Luria,


1966);


within


model


of cognitive


processing presented by


Das,


Naglieri


and Kirby


(1994)


they


are


included


the cognitive


processes of


simultaneous and


successive coding,


planning.


As discussed


earlier


in this chapter,


studies


have found functional


behaviors


such as


reading


to be


related to


these cognitive


processing skills.


Educational


paradigms for students with TB

between the academic behaviors


I have not bridged


required in


the gap


the classroom and


cognitive process


training.


In school,


students


who


have


received


cognitive


rehabilitation are often


expected


integrate cognitive


skills that may have been worked on


in isolation,


under a


different


theoretical


model,


with


experienced professionals


in the


field


of TBI,


settings


unlike


the classroom.


They will be expected


to general


these skills


into an


environment


that may


ask


them


to listen


to a direction,


remember


, read specified


items on a worksheet,


think


about the material,


write


answers


to questions


and,


throughout,


screen out


distractions


- all


this


just


complete one


task


(Cohen


, Joyce,


Rhoades,


Welks,


1985).


The expectations


the


"real"


environment


(i.e.,











and abilities of


strategies


the student,


from both


and should


educational


integrate


rehabilitation


disciplines


(Blosser


DePompei,


1991,


Cohen,


1991,


Cohen,


Joyce,


Rhoades,


Welks


1985).


Reading


Comprehension.


Suggestions


educational


programming for students with TBI frequently include

strategy instruction to compensate for impaired memory and

word-retrieval problems, to aid retention of information,

and improve comprehension. Reading comprehension is a more

complex skill than many other reading and academic skills

students with TBI will encounter. Gerring and Carney (1992)

state that even as decoding, reading fluency, and word

attack improve, reading comprehension may remain several

grade levels below the other skills. Poor reading

comprehension is often identified as the most significant

cause of difficulty in the academic content areas. These

authors emphasize the need for teachers in subject areas

other than language and reading to be aware of deficits

common to TBI and the possible impact on learning. There

are many recommendations for instruction of reading

comprehension for students with TBI. These recommendations

include paraphrasing, frequent self-questioning, class

discussions, tactile and visual augmentation, frequent











1992,


Rhein


Farmer


, 1991).


A major concern


the


lack of


empirical

Direc


evidence


to support


Instruction


(DI)


these recomme

techniques are


nations.


another method


with a research


foundation


learning


disabilities;


however


, there


increasing


interest by those researching


TBI.


Glang


, Singer


, Colley,


and Tish


(1992)


conducted


study using DI tech

Three students ages


niques with


and


elementary stud

10 participated.


lents with TBI.


After


hourly


instructional


sessions,


three


students made


significant academic


improvement in reading,


language,


math,


and keyboarding


successful


Research has


with students


shown


method to be


with reading disabilities


and there


are unpublished reports


success


with students


with TBI.


The results of


these studies


support


the need


continued


empirical


research with


this


population


using


and other


recommended


instructional


techniques.


Summary


According to


theory


cognitive


processing


mental


processes mediate


behavior.


Early studies


by researchers,


such as the Soviet neurologists


Vygotsky and


Luria,


related


behavior to damage


in various


areas of


the brain.


Luria was


primary


in the


initial


identification


11 ntinl


areas


the brain and theory


of cognitive


process


remediation.











Kirby


(1994)


operationalizes


Luria'


original


functional


unit


theory


The


functional


system


theory


is the


position


accepted


most


contemporary


neuropsyc


hologi


(Begali


1991


Lehr


, 1990)


Factor


analytic


studies


have


establi


shed


that


common


subtests


, used


frequently,


from


struments


such


as the


ABC,


WISC


, and


Binet


load


four


process


areas


named


planning


, attention,


simultaneous,


successive


proc


ess


(PASS


Certain


subtests


can


be used


as markers


ese


cognitive


processes


Although


studies


identify


these


process


sing


areas


and


functions


primarily


associated


with


them;


integrated


nature


model


demonstrates


that


interaction


between


the


functional


units


along


with


use


knowledge


base


is necessary


to perform


nearly


tasks


focus


present


study


is on


the


relationship


between


reading


Studi


hav


abiliti

e shown


that


the

all


PASS

four


mod


cognitive


processing


abiliti


identified


PASS


model


are


associated


with


reading


skills


however


, the


influence


of a particular


process


depends


on character


of both


learner


stimuli


Reading


comprehension


, which


the


area


addre


ssed


in the


present


study,


has


been


most


closely


associated


with


simultaneous


coding


and


planning


abiliti


Remedial











abilities


can


trained


that


reading


skills


have


improved


along


with


this


training.


Instruction


warning


strategies


another


technique,


with


a cognitive


processing


base


, used


to improve


reading


skill


frequently


Model


used


teach


of strategy

students w


ins


ith


truction

learning


are

problems


Most


models


address


remediation


of reading


skills


often


similar


skill


are


addressed


with


variations


strategies

drawing in


used.


ferences


Typical reading

, scanning and


skill


addre


surveying


ssed


text,


include


recogni


zing


main


ideas


, organi


zing


information


, attention


text,


remembering


facts


, fluency


reading


, word


attack,


word


recall


Various


paraphra


sing


or summarizing


strategies


are


used


primarily


improving


reading


comprehens


skill


Paraphras


an effec


tive


strategy


improve


reading


(Schumaker


comprehension


, Denton,


students


Deshler


with


, 1984


earning


This


disabilities


strategy


require


use


previous


knowledge


requires


invention


creation


information;


memory;


problem


solving;


organ:


izing


abiliti


adol


esc


ents


with


traumatic


brain


injury


cognitive


proce


ssing


ass


ociated


with


simultaneous


coding


planning


are


often


most


difficult


Cognitive


processes


such











setting;


planning


and organizing;


and monitoring


(Adamovich,


1991;


DePompe i


Blosser,


1991;


Haarbauer-Krupa,


Henry,


Szekeres,


Ylvisaker,


1985)


are frequently


impaired.


Current recommended academic


instructional


methods


for these


students often


are based


on research


with


other populations


and do not consider the


significance of


basic cognitive


processing


impairments


relative to TBI.


Theories of


cognitive


processing that


serve


as the


basis for cognitive rehabilitation are


also


relevant


academic techniques


support the


such


recommendation


as strategy

n that the


instruction.


focus


Both


instruction for


students should be how the student


processes


not simply providing specific responses.


This


information,


concept


consistently


Additionally


structure that


stressed


both


were


important


techniques

automatic


individuals


provide some


for the


with TBI.


organization and


student before the


accident.


When


planning


for the educational


needs of


adolescents with


TBl,


link must be established between


theories,


knowledge base,


rehabilitation and


treatment


the educational


goals


goals of


and


cognitive


instructional


methods of


teachers.


present


study researches


the effects


two


different


learning techniques,


self-questioning










cognitive processing theory


use methods


improve


simultaneous


processing


planning


skills.















CHAPTER

METHODS AND


PROCEDURES


The training


chapter were designed


testing


to teach


procedures described


adolescents with


this


traumatic


brain


injury


(TBI)


improve


their reading


comprehension.


The methods


presented


incorporate cognitive


processing


theory and strategy instruction.

comprehension questions related


Performance


to independent reading


passages was used


to evaluate


effects of


two


instructional


techniques,


self-questioning with overt


verbalizations


paraphrasing,


both


of which are based on


theory of


cognitive


processing


(Das,


Naglieri,


& Kirby,


1994).


This chapter


includes


following


sections:


descriptions of


the subjects,


setting,


stimuli,


variables


under


investigation


measurement


variables,


procedures


, and


the experimental


design


analysis.


Descriptions


Subjects


Six students


participated


this


study.


The


students,


9 to


years


in age,


were enrolled in special


education


and/or regular


education


classes


in Duval,


Clay,


or Volusia


Counties


in the


state of


Florida.


A detailed


description of











race,


age,


grade,


educational


classification are


summarized


in table


Each subject's


reading


comprehension score


Test of


as assessed with


Academic Achievement


the


for participation


Woodcock-Johnson


this


study,


included


table


3.1.


Table


summarizes


information relevant to


subject


brain


injury


The subject'


initial


post-injury


neurocognitive evaluation,


information


provided by the


parent or guardian,


and


educational


records


were


used to


obtain


information relative


injury


and post-injury


cognitive

cause of


functioning.


injury,


Table


primary site(


includes date of


injury


injury,


initial


cognitive


functioning


score and accompanying disabilities.


To participate


in the study


, each


subject was


required


to meet


state of


following


Florida,


criteria:


Department


the


of Education,


subject met


definition


eligibility


educational


services


students with


traumatic


brain


injury


(see definitions


in chapter


the subject was


presently between


the ages


of 9


and 15;


the subject's


injury was


primarily to


the


frontal


lobe of


the brain as documented


in the medical


records;


the


subject was at


least


18 months


no more


than


48 months


post


injury;


subject had a


reading


comprehension












80





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ability


level


at least


third grade as assessed on


the


Woodcock-Johnson Revised


Test


Academic Achievement within


previous


six months;


comprehension grade


level


student's


was at


present reading


least one and one-half


grade


had no


levels


below grade


physical,


sensory,


placement


level;


or behavioral


student


deficits


that


significantly


interfered


with


their


ability to


read or


answer


questions;


the


student


was not r


ece


giving


any


other reading comprehension


instruction while participating


in this


study


; (i)


student was


taking no medication


that


would interfere with their


ability to participate


in the


training


activities;


and


student was enrolled


in a


school


based educational


program.


Permission for this


study was


obtained


from the Duval


County


School


Board Administration,


the University of


Florida


Institutional


Review


Board


, Genesis Rehabilitation


Hospital


Institutional


Review


Board


, the


student


parent or


guardian


, and the student


(see Appendix A).


Subject One


Subject


(Sl)


was


a sixth


grade white male


, age


years 4

head in


months.


On 04/05/92,


jury secondary to


he sustained a severe closed


a bicycle


versus motor vehicle


accident.


The pickup truck was


reported to have run over











score


A CT


scan


revealed


a contusion


in the


left


frontal

mastoid


lobe,


left


blood


temporal


sinuses


fracture,


a fractured


and


bilateral


left

parietal


skull


fractures


ults


neuropsychological


neurobehavioral


evaluation,


conducted


approximately


90 days


post-


injury,


indicated

attention


following


deficits


concentration,


mildly


: moderate


impair


impaired


ed aural


compreh


ension,


severe


impaired


V'S


scanning


, mildly


impaired


abstract


reasoning,


mildly


impaired


cognitive


flexibility


, sev


erely


impaired


visuoperceptual


skill


profoundly

delayed re


impaired


call/memor


immediate

v. and im


..


recall/learning


paired


, impaired


executive/self-


regulatory


skill


time


of hi


participation


study


was


35 months


post-


injury


He demonstrated


independent


fine


gross


motor


functioning


was


successfully


following


educational


curriculum


consistent


with


an intellectual


functioning


level


in the mildly


mentally


handi


capped


range


was


below


the


academic


ability


level


displayed


prior


injury


comprehension


was


grade


evaluated

equivalent


to have

score


a present


reading


on the


Woodcock-


John


son


Test


Academi


Achievement.











injury


from


a close


range


gunshot


wound.


bullet


caliber)

midline.


lodged


penetrated the

traveled through


occipital


skull

h the


lobe


just

entire


S2 did


right


right


not


front


hemisphere


lose


consciousness


A CT


scan


revealed


a right


frontal


hematoma,


left


parietal


subdural 1


hematoma,


right


hemisphere


mass


tissue


damage


, and


right


hemisphere


shift.


Results


initial


neuropsychological


evaluation


conducted


approximately


one


month


post


-injury


, indicated


neurocognitive


functioning


consis


tent


with


a Pediatri


Head


Trauma


Scale


score


An additional


neuropsychological


neurobehavioral


evaluation


conducted


approximately


days


post


-injury


indicated


following


defi


cits


: seve


rely


impaired


intellectual


functioning,


moderately


impaired


verbal

impuls


skill


ivity


profoundly


, moderately


impair


impaired pe

ed learning


rformance

ability,


skill


severely


impaired


memory


newly


earned


inform


ation,


impaired


oral


fluency,

impaired


severely

abstract


flexibility,


impaired

reasoning


moderate


visuoperceptual

, moderately im


profoundly


skill


paired


impaired


hand


, mildly


cognitive


speed


severely


impaired


eye-hand


coordination


At the


38 months


time


post


of hi


-injury


partic


He di


ipation


splayed


study


left


was


hemiplegia;











level


the mildly mentally handicapped


range.


This was


slightly below the academic ability


level


displayed prior to


injury.


Past educational


records


indicate


that


was


in the Exceptional


Education Program


students with


specific


learning


disabilities


before


the accident.


He was


following regular


education curriculum with special


criteria


applied for success.


S2 was evaluated


to have


a present


reading comprehension grade equivalent


score of


.9 on


Woodcock-Johnson


Test of


Academic Achievement.


Subject Three


Subject Three


(S3)


was


a seventh


grade white


female,


age 13


years


months.


On 08/31/93


sustained


a severe


closed head


injury secondary to a bicycle


versus


motor


vehicle accident.


lost


consciousness


at the scene.


initial


neuropsychological


evaluation


indicated a


Glasgow


Coma Score of


A CT scan


revealed


diffuse edema


throughout


eft hemisphere with


left


to right


hemisphere


shift


in the


frontal


lobe


region.


A subdural


hematoma


left


frontoparietal


region and


skull


fracture were also


identified.


A neuropsychological


90 days post-injury


evaluation


indicated


conducted approximately


following cognitive


deficits:


verbal


learning,


language


skills


, memory,










time of her


participation


this


study


was


18 months


post-injury.


She demonstrated independent


fine


and gross motor


functioning.


had been


in the


school


based environment for


following an

intellectual


only


educational

functioning


four months and was


curriculum level


level


successfully


consistent with an


the mildly mentally


handicapped range.


This


was below the academic ability


level


displayed


prior to


her


Injury.


Past


educational


records


indicate that S3


was


functioning on a


generally


average to


low-average


ability


level


before the


accident.


S3 was evaluated


to have


a present reading comprehension


grade equivalent score of


on the Woodcock-Johnson Test


Academic Achievement.


Subiect Four


Subject Four


(S4)


was


a sixth


grade white


female


, age


years


injury


10 months.


secondary to a


On 02/15/92

bicycle ve


S4 sustained


a closed head


rsus motor vehicle


accident.


The automobile was


traveling


at approximately


30 to 40 mph.


was


thrown


from her


bicycle


and


landed


on the


road.


lost consciousness at


the


scene


remained


in a


coma


approximately


30 days.


An initial


neuropsychological


evaluation


indicated a


Glasgow Coma


Score of


A CT scan


revealed hemorrhaging


the brain with a skull


fracture











pneumonia


during


early


stages


recovery


neuropsychological


evaluation


conducted


approximately


days


post-in jury


indicated


a Pediatri


Head


Trauma


Level


neurops


ychological


evaluation


conducted


approximate


60 days


cognitive


post-


defi


injury


cits


indicate


moderately


the following


impaired


intellectual


range


intelligence


, mildly


to moderate


impaired


verbal


skill


severely


impaired


rformance


skill


Moderate


impairments


information


processing,


visual


process


ing,


long-term


retention


were


identified.


Mild


to moderate


impairments


in academic


skill


were


noted


time


of her


partic


ipation


study


was


36 months


gross


post


motor


-injury


demonstrated


functioning


was


independent


successfully


fine


following


a standard


present


sixth


academic


grade


abiliti


curriculum


are


track


noted


however


to be below


, her


average


to high


-average


injury.


was


range


evaluate


ability


to have


identified


present


before


reading


comprehension


grade


equivalent


score


on the Woodcock-


Johnson


Test


Academi


Achievement


Sihibe


ct Five


Subject


was


an eighth


grade


white


male


, age


years


8 months


On 09/18/92


S5 sustained


a severe


closed










scan revealed a


left


temporal


contusion,


hemorrhaging


in the


frontal


lobe,


and a skull


fracture.


On Day


after


injury


, S5 was medicated


point of


coma.


Approximately six days


later


he was


awake,


responsive,


and following


initial


commands.


neuropsychological


evaluation conducted


approximately

Trauma Scale


30 days


score of


post-injury


II-I.


indicated a Pediatric Head


Predominant characteristics


were moderately


impaired sensory ability,


moderate to severe


expressive


language deficits,


and mild


to moderate receptive


language deficits.


An additional


neuropsychological


evaluation was conducted approximately


60 days


post-injury.


These


test results revealed


to be


functioning


in the


severely

cognitive


impaired


intellectual


abilities ranged


from


range.

the a


academic


average to


profoundly


impaired range.


Scores


indicated mildly to


severely


impaired


potential


acquiring new


knowledge,


with his greatest weakness noted


the


language based


skills.


Neuropsychological 1


and neurobehavioral


deficits


identified


in the evaluation


included:


fluctuating


attention

mildly im


and concentration,


paired aural


double


comprehension,


sion,


mildly


mild dysarthria,

impaired










achievement


scores


in math


oral


language


were


commensurate


with


pre-injury


eve


functioning.


has a hi


story


behavior


problems


treated


with


Ritalin)


below


average


academic


functioning.


time


of hi


participation


this


study


was


30 months


t-injury


He demon


strated


independent


fine


gross


motor


functioning


was


successfully


following


educational

functioning


curric

level


ulum


level


consistent


mildly


mentally


with


an intellectual


handicapped


range.


was


evaluated


to have


a present


reading


comprehension


grade


equival


score


on the


Woodcock


-Johnson


Test


Academic


Achievement


Subject


Subject


Six


(S6)


was


a fifth


grade


black


female,


year


2 months


. On 03/11/91


sustained


a severe


closed


head


injury


secondary


to a bicycle


versus


motor


vehicle


accident.


was


found


comatose


scene


continued


to be


comatose


several


additional


hours


. Her


initial


Glasgow


Coma


Scale


score


was


An initial


scan


revealed


frontal


lobe,


right


thalamic


left


occ


ipital


contusions;


obstru


ctive


hydrocephalus


ventricle


Additional


diagno


SiS


included


a fracture


the


first


vertebra


(cl)


with


no spinal


cord


involvement,


IS


L.~I1


i.