Introduction
Generally Speaking
General Tactics
Attention
Perceptual and Motor Ability
Comprehension
Memory
Problem Solving and Decision Making
Planning and Organisation
Maths
Homework
Life Experience Learning

Introduction
Learning is a varied experience for all children. Nonetheless there are several cognitive characteristics that are common to many children with spina bifida and hydrocephalus. In comparison with the physical and health aspects of this disability, these characteristics have received little attention.

This page outlines some of these cognitive issues and offers a list of strategies to enhance the learning experience of students with spina bifida and hydrocephalus. It is our hope that this resource will assist teachers and parents alike.

The strategies that follow are designed to be adaptations and variations of teaching practices that are currently used in educational settings around Australia. They have been put into specific categories to provide parents and teachers with a list of ideas to fall back on if the student with spina bifida and hydrocephalus demonstrates a need for extra support in a particular area.The information was researched and compiled by Stacy Corish and edited by Tom Eastland.

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Generally speaking
Students with spina bifida and hydrocephalus are often sociable, talkative (particularly with adults), and personable. They show a tendency toward above average verbal skills, although the level of understanding of their own vocabulary is limited. Most fall within the 'normal' range of intelligence.

Students with spina bifida and hydrocephalus show a tendency toward specific learning difficulties which may be generalised under the following categories:

• attention
• perceptual and motor ability
• comprehension
• memory
• problem solving and decision making
• planning and organisation
• mathematics.

These learning difficulties are neurologically based and are not behavioural problems that reflect poor motivation or a lack of interest in learning. Students who display hydrocephalus associated learning difficulties are unlikely to understand the nature of the deficit, and will require assistance in developing tactics that assist them to manage. Left alone to compensate they may have difficulty distinguishing fact from fiction; feign understanding; make irrelevant answers and questions (particularly in stressful situations); or divert attention. Inevitably the student will underachieve.

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General tactics
The points that follow could be said to be good teaching practice for any child. Students with hydrocephalus respond particularly well to them.

The student with spina bifida and hydrocephalus will often:

• be motivated by the experience of progress. Portfolios of their work, for example, will enable the student to see a link between effort and success.
• work best at the things that they can do, and things that are of interest to them. Utilising the child's personal strengths will provide an opportunity for success in as many areas as possible.
• have areas of expertise and interest that they, their peers, and family may be willing to adapt in relation to the curriculum.
• For example, a student who has had significant hospitalisations and is comfortable doing so may present a report about a particular body part or procedure, or they may construct an activity book for other patients.
• need feedback that is directive rather than corrective.
• will appreciate work that is appropriate to their chronological age, especially if they are aware that they are learning at a different rate to their peers.
• better understand the nature of their academic ability if they are given honest, constructive, and tangible feedback.
• need the difficulty of some work reduced, or assignments shortened.
• be well placed to achieve mastery if they can see a relevant application for a skill, and the opportunity to practice.

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Attention
It is not unusual for young children with spina bifida and hydrocephalus to be easily distracted. They seem hyperactive and are often referred to as having 'poor concentration'. As they become older, they are more inclined to demonstrate reduced alertness and arousal, thereby gaining a reputation for passivity, laziness and/or a lack of interest and motivation. For many, it is difficult to sustain attention for the time that a task might require.

Some students struggle to identify the most salient aspect of a task, and when there is no obvious objective for them to focus on, their concentration will lapse. Tiredness, difficulty with understanding, or the child's attempts to block out general classroom or school noise can also result in a student seeming inattentive or restless.

The student with spina bifida and hydrocephalus will often:

• benefit from one on one teaching; single activities; sitting close to the front, near the teacher and away from the flow of activity.
• find the interspacing of high demand work periods with more relaxing activities easier to handle.
• be helped by reminders of where their focus should be.
• learn to communicate more effectively if redirected when their conversation wanders or becomes repetitive.
• better attend to subject matter that they perceive to be of interest or relevance.
• respond well to some form of explanation about the problematic nature of their behaviour. It is possible that they do not properly understand what it means to concentrate, focus, pay attention etc. Furthermore, such terms may hold negative connotations for the student if they have learned to associate them with reprimand.
• appreciate some help in learning to recognise a lapse in concentration. This may involve a quiet word or a secret signal.

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Perceptual and Motor Ability
Most students with spina bifida and hydrocephalus have problems with perceptual and motor ability. Perceptual problems include understanding pictures (particularly detailed and photocopied illustrations); discriminating between shapes; recognising and reproducing symbols; figure ground discrimination; and spatial judgements (ie. size, space, distance and direction, and concepts including up and down, over and under, in and out, above and below etc).

Motor problems involve impaired dexterity of the hands and arms and cause the student to have difficulty with pens, pencils, rulers, scissors and other manipulative equipment. Left and mixed handedness is more common, and students show a tendency toward delay in choosing a dominant hand.

Impaired perceptual and motor ability results in clumsiness and slow and untidy handwriting. This is often a source of distress for the student, particularly if they notice that peers seem to manage. The student may fall behind in work and find it difficult to complete written tasks in a given time. One possible solution may be the introduction of a keyboard.

Perceptual and motor problems are also likely to impede the student's ability to manage map work, draw and interpret detailed diagrams and handle equipment. This becomes more of an issue as the student progresses to higher levels of geography, science, maths, physics etc.

The student with spina bifida and hydrocephalus will often:

• when young, enjoy practicing drawing letters and numerals in the air, on the blackboard, in sand etc.
• appreciate the occasional head start so that work is finished alongside peers.
• require an alternative medium in which to present material eg. audio tapes, computers or typewriters, posters, verbally.
• find books with prominent lines easier to write in.
• require some special equipment eg sloping desks, pen and pencil grips and chubby pens.

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Comprehension
Although students with spina bifida and hydrocephalus often have large vocabularies and appear to have no trouble understanding single words, many have problems formulating language for written work and conversation. Communication may seem nonsensical at times and there are students who will not be able to demonstrate understanding of the stream of words that they have used.

Difficulty in connecting sentences, or relating a sentence back to the original thought may be apparent, particularly in speaking exercises and written work. For some students, making a relevant comment about what somebody else has said can pose a problem. Students who have slow thinking and comprehension speed should be encouraged to take time to formulate an answer rather than respond impulsively. Finally, the student with spina bifida and hydrocephalus may have difficulty discerning what is or is not relevant or important. Therefore large amounts of high level information should be minimised.

The student with spina bifida and hydrocephalus will often:

• when young, need instructions given one at a time, small amounts of information, and time to think about answers.
• need to feel secure in the amount of time that they have to formulate an answer, tell a story, share information etc.
• be most successful in answering when given prompts and additional information.
• need to have work monitored for understanding and relevance.
• need to be asked a few questions to ensure a thorough understanding of the work set, especially in higher grades.
• be assisted by knowing who to approach regarding queries, concerns etc.
• better absorb main themes and key points if they are highlighted eg underlined in passages, emphasised by the teacher as they speak, discussed by the class etc.
• be most successful if comprehension activities relate to personal experience, hobbies, or special interests.
• glean understanding from personally chosen materials eg magazines, a car manual, a brochure.
• on occasion need simplified texts and references or alternative presentations eg a video instead of a novel.

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Memory

Some students with spina bifida and hydrocephalus have poor short-term memory. However, it is more common for them to have problems with storage and retrieval. Whether or not the student understands a concept, and how relevant or interesting it is, are factors that can make a difference to the student's capacity for recall.

Visual memory is often weak. Associated difficulties include copying, especially off the blackboard; finding a spot on the page after having glanced away for a moment; and sequencing. Auditory retention is generally better. Therefore, use of speech ie talking to oneself; audio tapes; and rhythm may be useful.

The student with spina bifida and hydrocephalus will often:

• be more likely to remember if rituals, routines and repetition are applied to learning experiences.
• be assisted by a calendar, timetable, written notes and lists, a journal or a diary.
• reinforce processes if they talk to themselves through activities.
• benefit from word association.
• remember key points if they are assisted in working out what they are and what they mean etc.

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Problem Solving and Decision Making

Due to the physical nature of their disability children with spina bifida and hydrocephalus do not experience as many interactions with the environment as do other children. Consequently learning with regard to requests and expectations is limited, which means that many do not understand how their behaviour affects their environment. A student who does not understand cause and effect has reduced power in terms of the impact that they will have.

Further, generating and maintaining a plan will be problematic. For example, the student may find it difficult to define the essence of the problem, generate strategies for resolution, choose a solution, initiate action, or alter their approach when necessary.

Many students with spina bifida and hydrocephalus are ineffective at generalising, and transferring problem solving experience from one situation to another.

The student with spina bifida and hydrocephalus will often:

• establish a 'can do' approach to problem solving if they are given the opportunity to practice and succeed.
• benefit from an array of options rather than a right or wrong, good or bad choice.
• gain a better understanding of cause and effect through brainstorming and the implementation of solutions, particularly if they are relevant and of interest.
• need the opportunity to generalise problem solving strategies. Significant prompting will help with the transfer of solutions from one situation to another.

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Planning and Organisation

Spina bifida and hydrocephalus associated difficulties with planning and organisation stem from an impaired ability to know when and where to start. Some students manifest this in their day to day tasks while others struggle predominantly in novel or unstructured situations. As students become older and independence becomes more significant, many have trouble organising themselves well enough to meet extra demands. This can look like laziness and inactivity. However, it is better seen as a signal for extra support and empathy.

The student with spina bifida and hydrocephalus will often:

• be helped by colour coded books and equipment. The younger student, could use one colour for everything including books, reading folder, pencil case, bag etc. so that their possessions are easily recognised. The older student who is expected to be more responsible could colour code according to subjects. For example, maths books and folders and associated equipment could be covered or labelled in red and corresponding red stickers in diaries indicate to the student collect red items and go to maths.
• be able to keep notes in order and good condition using lightweight folders that come with plastic sleeves. Alternatively, the student may prefer one large folder with separate compartments so that all subjects are kept in one place.
• appreciate a clearly visible timetable. For the younger student it may be pictorial and on the wall. For the older student it could go on the back of a book, a door, inside a locker, or on a desk.
• be more organised if they are encouraged to use a diary.
• need ample practice at constructing plans.
• be more inclined to initiate action if they are prompted in a way that motivates self prompting.
• submit work that is more detailed if permitted on occasion, to hand up a dot point plan rather than a complete assignment
• appreciate skeletons for larger assignments. These may be as detailed as much as is necessary to support the student in presenting an assignment of peer quality.
• be helped by the introduction of essay maps as a formula for writing. The student who requires substantial prompting can hand in an essay map full of detail while another student uses it for planning, or in lieu of a first draft.

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Maths
Maths is the most common academic deficit for students with spina bifida and hydrocephalus, probably because it involves all of the fore mentioned abilities ie attention; perceptual and motor ability; comprehension; memory; problem solving and decision making; and planning and organisation.

The student must not be allowed to accept that they 'can't do numbers'. Rather, with constant reward and encouragement, tasks that are broken into several small steps, and opportunities to practice that aren't too long, the student can learn to manage basic concepts. Some students develop rote memorisation of facts and procedures. However, translating mathematical concepts to concrete examples requires significant understanding. Therefore learning must be centred on consolidating pre-skills in order to facilitate understanding.

Maths pre-skills include:

the ability to follow

• sequential direction.
• spatial orientation: recognising the relative position of a number in order to know its value ie 60 as opposed to 6 and the ability to judge left from right which affects concepts of place values, fractions, integers, geometry, trigonometry and all concepts after that.
• the ability to discern emerging patterns in incoming information.
• visualisation: the ability to hold data in the mind's eye and manipulate it ie working memory.
• the ability to estimate: to know what to expect in an answer.
• deductive thinking: the ability to go from the general to the specific.
• inductive thinking: the ability to go from the specific to the general case.

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Strategies to teach these skills

Sequencing

• Talk about first, second, third, fourth etc as much as possible.
• Ask questions about first, second etc to increase the student's consciousness of order.
• Have the student use comics to identify the sequence of events.

Spatial orientation

• Draw attention to the fact that numbers can be written to represent different values ie 1 is used to represent 10 in the number 18 and 1 in the number 21.
• Have the student count piles of materials, consisting of between 20 and 100 pieces, and encourage him/her to form groups of 10. The portion of material counted in each session needs to be stored in lots of 10 so that next session, the entire pile does not need to be recounted. This process of sorting is the framework for place value.

Patterns

• Use the student's favourite colours.
• Use manipulative objects
• Copy a pattern; find what comes next; extend a pattern ie build a staircase from blocks; make own patterns
• Have the student think out loud as s/he searches for patterns. Ask the student why a certain piece was selected.

Visualisation

• Use die or dominoes to assist sight recognition ie have the student count a number of objects and find the corresponding number on a domino.
• Have the student note that numbers higher than 6 must be made using a combination of dominoes ie 7 is made up of the numbers 6 and 1, 5 and 2 etc. It is not necessary to mention addition. Rather, the emphasis should be visualising the combinations that comprise the total.
• Have the student calculate simple sums in her/his head and document the answers. Increase the difficulty level according to the student's competence. Work in small bursts and offer frequent praise bearing in mind that this work requires significant concentration.

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Estimation

• Begin by providing obvious choices for the student to select from. If possible attach purpose to the question. For example, estimate how many children from our class are here today so I can get enough newsletters, 1 or 27: estimate how long it will take us to learn estimation so that I know when to plan our next set of lessons, 2 weeks or 3 years; estimate how warm it will be tomorrow so that you know whether or not to bring a jumper, 25 degrees or 987 degrees; will this jug of water fill the drink containers of 4 cages or is it enough for just 1.
• Look through newspaper headlines for estimates ie 40 years worth of sun, sand, surf; GST adds $10m to the school bill; 400 youth jobs offer.
• Provide immediate feedback regarding how well the student has done.
• Ask the student how they came up with the estimate.
• Once the student seems to manage estimation, have them work on rounding off numbers with a view to using them for calculations.

Deductive Thinking

• Talk about, and as much as possible demonstrate, the application of mathematical concepts.
• Prompt the student to find situations wherein they can use a general rule.

Inductive Thinking

• Help the student to work out what they have done in a specific case in order to identify a general rule.

The student with spina bifida and hydrocephalus will often:

• appreciate and have enthusiasm for maths if they believe that they will be empowered by it.
• see maths as valid and applicable if provided with relevant and interesting opportunities to practice concepts
• find it easier to align symbols and numerals if they use graph paper.

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Homework
Managing homework can be problematic for the student with spina bifida and hydrocephalus. Most tire easily, and everyday tasks such as getting dressed, bathing, toileting and therapy, followed by social and sporting commitments, tend to dominate spare time.

The student with spina bifida and hydrocephalus will often:

• benefit from having the opportunity to complete homework in class, possibly in lieu of an agreed upon lesson.
• especially as they get older, need to negotiate with parents and teachers regarding how much and on what nights homework is manageable.

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Life Experience as an Opportunity for Learning
Life experience is rich with opportunity for social interaction; role models, skill acquisition and practice; decision making; the highlight of areas of promise; mistakes from which to learn; responsibility; age appropriate experience; success…

The student with spina bifida and hydrocephalus could:

• benefit from genuine work experience opportunities in the school. For example: the student could count stock or the takings, organise lunch orders, and make sandwiches in the canteen; s/he could issue late notices, check in/out books, return books to the shelves, and handle computer bookings in the library; s/he could answer the telephone, photocopy, type notices, and staple notices in the office.
• be supported in organising regular volunteer work in the community ie Meals on Wheels, in an 'Op Shop', hospital, nursing home visits etc.
• choose a work experience venue according to her/his aspirations and s/he could be responsible for initiating the placement
• benefit from class and individual visits to learning environments such as nurseries, farms, factories, hairdressers, beauticians, offices, shopping centres.

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