Practical strategies to help students with spina bifida and hydrocephalus in the classroom
Spina bifida is a neural tube defect which occurs shortly after conception, causing weakness or paralysis below the lesion or “split spine”. In most cases, it is accompanied by hydrocephalus, where the cerebrospinal fluid surrounding the brain cannot circulate freely, leading to harmful pressure which can injure the brain itself.
Various conditions can lead to hydrocephalus. This article will focus on spina bifida and hydrocephalus and their collective implications for learning.
Where the conditions occur together, the concentration of support for the young person within the education system is often on the mobility and continence issues arising from spina bifida. However, hydrocephalus is a less visible condition and its impact on cognition is often underestimated, leading to educational and social underachievement. It is crucial to identify the impact of hydrocephalus early on, to ensure that appropriate and continuous educational support is available to the young person.
Assessment by an experienced neuropsychologist is advisable, but often students will be assessed by other specialists with little or no experience of either condition or the complex issues arising from them.
Where teachers and learning support staff are aware of the barriers to learning that these students are likely to confront, they can put in place effective support strategies which are fully integrated into the whole class teaching and learning plan.
Children with spina bifida and hydrocephalus may have challenges with memory, information processing, organisation and visual perceptual skills. Many of these difficulties arise from a slower rate of processing information. For example, it takes these students longer to understand and use information, put it into context and transfer this learning into different situations. So, although many young people with hydrocephalus may be of average ability and above, if they are not given time to process information fully before moving on to the next activity, they often fail to reach their full learning potential.
Students with spina bifida and hydrocephalus may have differences in language development, resulting in difficulty with the meaning of grammar, irony or humour, and may take everything literally. They also risk information overload. Students with spina bifida and hydrocephalus are more likely to have problems with attention, concentration and remembering information, and find decoding writing, understanding symbols or different types of text very confusing.
Planning and executing tasks can be a particular challenge, including situations requiring even a minimal level of organisational or visual perceptual skill. Many students will also have varying degrees of gross and fine motor skills impairment. Having to compensate for these deficits puts the student at a disadvantage in group learning and social situations.
Young people who find learning challenging need the same good practice approach to curriculum access as their peers. However, they need more of it. A specific and structured approach will help them to access the curriculum and a measured pace of delivery throughout the lesson will help to optimise their capacity to process, store and eventually retrieve information.
Strategies to support students
Allow sufficient time
Young people with spina bifida and hydrocephalus need more time to process information and to complete tasks than their peers, so build in additional time.
Be prepared to repeat instructions several times if necessary. Many aspects of the curriculum will have to be “over taught” to ensure the student has several opportunities to review and assess a particular piece of information, in order to assimilate it into the long-term memory. Frequent deadline reminders will be helpful.
Be clear and concise
Keep instructions short and specific, and use key words and pictures to hook the information on to. Present written information in a clear and easily read format. Content should be well spaced and important parts of the text (key words) should be highlighted.
Use clear, precise and specific language in all verbal and written information, aided by non-verbal cues and clear, closed questions. Break tasks down into snippets of clear, logical information. Use minimal didactic teaching and be as interactive as possible, but be prescriptive and concise when explaining tasks and giving instructions. Be diligent in giving regular supervision.
Introduce work in phases, to ensure the student is not overloaded and check their comprehension and understanding frequently, while ensuring they are on task and remain so. Changes in routine need to be planned for and rehearsed.
When the person is required to read information and distil key points from it, or to support an argument or formulate a hypothesis, use abridged texts or summaries wherever possible.
Easy access to equipment and to lists of essential vocabulary, meanings and concepts will help students overcome short-term memory problems and ensure vital information is rehearsed frequently to commit it to the long-term memory.
Don’t expect the student to be able to read and copy down information from the whiteboard at the same time. Instead, place printed notes and instructions on the desk beside the young person, to help them overcome visual perceptual difficulties. Hand out printed homework instructions as they leave each class. Without these, the young person will find it difficult to remember what to do.
Hard backed notebooks can be less confusing than loose leaf files, given the challenges that students have with visual perceptual issues and difficulties organising themselves, their equipment and books. Colour coding materials can be very helpful in helping students to organise topics and access the curriculum. It also helps to provide task models, sample essays and answers, writing frames and diagrammatic information.
Using learning support assistants
Assigning a learning support assistant to the student will be key to implementing these strategies. The assistant is tasked with supporting the young person to become an independent learner rather than a dependent one. Guided by the class or subject teachers, they will help to introduce these strategies and encourage the student to gradually acquire and implement them to support their own learning. By frequently prompting and reminding the student of instructions and key pieces of information, they are enabling them to engage in each learning task rather than doing it for them.
It is important that the learning support assistant and the class or subject teacher relate well to each other, and to the young person, and that they facilitate the student’s full inclusion in the class. Collectively, they need to create a structured, settled atmosphere in the classroom where unnecessary noise and distractions are minimised.
Encouragingly, recent research on brain development and plasticity supports the view that these strategies, repeated over time, can help students with spina bifida and hydrocephalus learn to manage their conditions and overcome the many challenges they face in the education system, to achieve their optimum potential in school and in life.
Catherine McCurry is Education Adviser at Shine Northern Ireland. Shine is a national charity for people who have spina bifida and hydrocephalus: