Nonetheless, learning about expressive writing and memory issues in people with TBI added another layer to my reflection. Wheeler et al. (2014) found that people with TBI often have writing challenges just like those with learning disabilities. It is hard when your mind doesn’t do what you expect it to. But the good news came from the study by Chiaravalloti et al. (2016), where a simple memory training method using stories and images helped people improve their learning and everyday memory. At the same time, the cueing technique that occupational therapists use,  like shown in the video, uses prompts to help kids. With patience and the right tools, recovery is possible even if the effects of a head injury take years to show up. My “aha” was realizing how important it is to take every brain injury seriously, even if the person looks okay on the outside, Sometimes, we have the tendency to say “just use a cold compress” and once the bump on the head is gone, we think all is fine. But this shows how crucial proper medical follow-up is especially for children. As one would always say prevention is better than cure. May it be as simple as giving cold compress, to  having proper theraphy and support for the child. Every action taken is crucial to ensure the well- being of anyone and ensure they get integrated back to their usual routines.

P.S. The attached photo is from one of the videos showing a person with TBI being guided on how to carry a conversation. After responding (C – answering conversation), the student is encouraged to follow up with a question (?-ask back) to keep the interaction going form one C? to another C?. I find this quite interesting!

It makes me think of how when we do the Restorative practice in schools with our students after a fight or misunderstanding between some students, we also kind of guide students in a similar way to do a reflection of what had gone wrong. For example, we might ask, "If A did/said this to you, how else could you have reacted instead?"

"What do you think is a better way to resolve the issue?"

The CEO with Down syndrome is also very significant to me as it serves as a reminder of what a person can achieve despite all the challenges in life with friendships and bullying. She is very fortunate to have a loving mother who gave her all the help and support she needed.

From the study of "Schooling of Students with Intellectual Disabilities: Family and School Perspectives", one point stood out to me regarding the expectation of school professionals related to student performance. It stated that data shows that teachers expect from ID students the same academic performance as non-disabled students, which directly affects teaching practice. This means that teachers are not aware of the fact that they have to modify their thinking in order to cater to students with different learning needs.

How can teachers carry the same expectations about academic performance for all students when students all perform differently? Shouldn't there be a modification of expectations so as to cater to the various learning needs of each individual student?

Finally, from the study of "Expressive writing in people with traumatic brain injury and learning disability", my key takeaways include the four components of expressive writing skills identified: Reading Ease, Sentence Fluency,

Grammar and Spelling, and Paragraph Fluency.

I also learnt the new term "expressive writing disorder" and how some interventions to help people with this disorder consist of occupational therapy to improve writing mechanics or their hand-eye coordination, techniques to visualize ideas before writing, mental exercises to improve concentration and reduce errors, activities to improve proofreading skills, use of software tools for grammar and spelling checks, structured writing through goal setting and general academic skill training to enhance vocabulary and outlining skills of people with TBI or ID.

Apparently, there are no significant differences found between the LD and TBI groups regarding expressive writing disorder. This implies that it will be difficult to know if a child has challenges with expressive writing due to a learning disability or TBI.

• Help the child to make the modifications e.g. having the child sit in a location, if there is a preference to one ear or the other, so that they use their better ear to listen

• Make sure to get the child’s full attention before giving them any kind of information and check their understanding by asking them to rephrase what they have heard

• Make the learning contextual and meaningful to the child because all of us are learn better when we're learning something that is relevant

• Chunk the information as they will not be able to remember it so you lay it out step by step to help them to organise the information

•  Provide extra time for an exam, or reduce the number of questions within a stipulated time

•  Provide extra time to do what they need as they have slower processing time

• Set up a system e.g. a homework book where different subject teachers can help to record homework for the child

• Speech therapists can start working with patients with TBI at an early stage to get them out of the coma.

• Speech therapists aim to integrate TBI patients back to their former lives as much as possible, starting with overcoming the social communication difficulties. Can use strategies like the cueing system with visuals (e.g., review of video or audio recordings)

• People with TBI have trouble learning new info, especially children. Set goals for patients and give specific strategies to target the goals (checklist, step-by-step guide)

• Research shows that there are increasing academic challenges faced over time by students with complicated-mild/moderate TBI and the vulnerability of younger children to poorer development of functional academic skills.

• There were no significant differences between the LD and TBI groups on any of the expressive writing components. TBI survivors and persons with LD do not differ markedly in terms of expressive writing skill. Measures of spatial perception, visual memory, verbal intelligence, and working memory predict writing skill in both groups. Several therapeutic interventions are suggested that are specifically designed to improve deficits in expressive writing skills in individuals with TBI and LD.

• Participants with TBI require significantly more learning trials than healthy participants to learn the same amount of information. However, once equated with the amount of information initially learnt, individuals with TBI do not demonstrate deficits in recall or recognition.

• Modified Story Memory Technique: training in context and imagery results in significant improvements in verbal learning. Behavioral interventions that specifically target strengthening the acquisition (ie, encoding and consolidation) of information during initial learning can significantly improve memory performance in TBI patients. Treatment with the mSMT had a positive impact on NP memory tests and measures of everyday functioning.

As I was looking through the video on Education Strategies for children with TBI, the strategies provided looked similar to the ones educators would provide for students with learning difficulties so I was quite surprised that a few of the articles actually concurred with my assumption. I am intrigued by the mSMT and would find out more about this technique to see if I could use it with my students who have learning difficulties.

• It was interesting to me that about 500 000 children go to the emergency department in the hospital every year in New York due to falls. These traumatic brain injuries(TBI), usually are from falls at the stairs, from the bed and worst is due to traffic accidents.

• TBI would be defined as an injury that interrupts usual functioning of the brain and its activities. It is usually caused by a hit or jolt to the head or an injury where something goes through the head.

• TBIs can cause issues with memory, information processing, talking, understanding, personality and mood.

• TBIs can be mild like a concussion and most people with it can recover completely. It can also be moderate and severe. We are able to tell the difference in severity by the length of time of unconsciousness and medical tests.

• A person that has a brain injury followed by a disability has issues with awareness. They lack the understanding of the varying contexts and goals of different settings.

• Children with TBI find learning new information difficult.- Schools have to practice differentiation of numerous aspects for them. Some areas also include preferential seating, contextual learning, chunking the information, supporting of organizational skills, extra time for exams, and lesser questions during exams.

• Having a buddy system will also help in school.

• Those with TBI may have trouble to modulate their volume level to the person they talk to. They may not have good self-monitoring skills.

• Those with TBI may also have trouble with higher level language skills where the words do not match the message it's intended to relay. Examples include sarcasm.

• Speech therapy begins very early for those with TBI. It can be as early as during coma. They may work on social communication, writing, reading, listening, swallowing, and speech disorders. The goal is for these individuals with TBI to integrate back into their former lives before the injury.

• The cost of treating severe TBI can be very costly. This includes rehabilitation and therapy.

• It is important to note that the person with TBI is not pretending to be crazy or delusional. They are merely acting on the information their brains are getting and understanding.

In the 4th video parked under the ID folder, it was mentioned "I hope that the needs of people with intellectual and developmental differences will be seen not as burdens but as gifts" which I really resonated with. I empathise with the MID individuals in the same video who kept reiterating for people to get to know them, talk to them and not their caregiver, highlighting that they are just like any regular person. Too often, there is a lack of awareness on how to interact with people with special needs which makes people not even want to try, perhaps out of fear as well. The kindergarten teacher in the next video was also very inspiring with the ways she accommodated for Elijah, her DS student. While Singapore moves towards being a more inclusive society, I hope for the schools to also bear the same mindset and for all staff to be on the same page.

I think the general consensus is really to simply be more open-minded and understanding towards the special needs community. Personally, I find unexplainable joy in interacting with these individuals and I do hope that more people can be willing to put in a tiny bit more effort to get to know such individuals instead of judge them based on their condition!

Another part that resonated with me was the speech therapist’s use of visual cues to facilitate two-way communication with an adult client. She explained that a child with TBI has even more at stake than an adult, as they are still in the process of developing foundational learning skills and the ability to be independent and eventually sustain employment. This made me more aware of how critical timely intervention and tailored support are in shaping the future of children with TBI.

I’ve been reflecting on some of my students with mild intellectual disabilities, and I realise that many of them also have comorbid conditions, which make it even more challenging for them to thrive in a mainstream setting. They often struggle with academic expectations, following instructions, and social interactions. Unfortunately, some of them face ridicule from peers, which further affects their confidence and self-esteem. Furthermore some teachers may struggle to engage them, with the consideration that they still need to attend 30 over students in the class. I do empathize both student with disability and teachers.

The video about the young girl who had multiple brain surgeries really showed how teachers on the ground can make a meaningful difference just by being more observant and empathetic. Simple strategies like breaking down instructions, using visual supports, or even offering a word of encouragement can significantly reduce a student’s anxiety and help them feel more included and capable.

The video about Elija, a student with Down syndrome, truly touched me. It was heartening to see how the school created a safe environment for him, constantly adapting and making thoughtful adjustments to build his confidence and empower him to be independent. As an educator, this reminded me of why I do what I do. Watching how others support and empower students with disabilities has deepened my passion and commitment. I feel inspired to do more, to learn more, and to continue finding ways to uplift and support every student in my care.

Who says students with intellectual disabilities can’t succeed? With the right support and belief in their potential, they are just as capable as anyone else.

• Even mild TBI, such as a concussion, can have a significant impact on a child's daily activities, causing problems with speaking or understanding, movement, thinking or memory, and personality or mood.

• Children with TBI may experience cognitive effects such as memory problems, difficulty recalling new material, processing information, and behavioral performance, and may require specialized educational approaches and therapies to help them adapt.

• Strategies for improving memory, problem-solving, and reasoning, as well as general communication skills, are essential for children with traumatic brain injuries (TBI), and occupational therapists play a vital role in this process.

• To support individuals with brain injuries, it is helpful to provide cues or setups that make sense to the individual, which can be thought of as interpreting for the person and helping to provide information, similar to how an interpreter would facilitate a conversation between people speaking different languages.

• Pre-teaching is another strategy that can be used to support individuals with brain injuries, which involves finding out the person's strengths and working with those strengths to provide guidance and instruction, such as the cues and guides provided to passengers on an airplane to ensure a safe flight.

• Schools play a significant role in the life of a child with a brain injury, as they spend a substantial amount of time there, often more than they spend with their parents, and it is where many behavioral problems and frustrations can occur. Additional strategies for teachers include "chunking" information into smaller, more manageable steps, providing extra time for exams, and lessening the number of questions to accommodate slower processing times.

• Specific techniques used by speech therapists may include cueing systems, visual aids, video or audio tape review, and increasing awareness of deficits to help clients make changes.

The videos also taught me a lot about ID  - how to diagnose, and the severity of the development.

For the 3rd video on ID, I like how Mary's teacher noticed that Mary looked "lost" and approached her to tell her what she is supposed to do. If all teachers can do the extra mile and check in on students who look "lost", perhaps the students might have a much better time in school.

I learnt that these are the ways that teachers can help:

• Consider how information is presented on a daily basis

  • Instructions that are only spoken once may be challenging for some students to comprehend

• Be sure to provide directions in alternative formats

  • Written words with step by step pictures

  • Ensure student understands instructions

• Sufficient time given

  • Multiple repetition needed

I also really like the video about including children with disability in kindergarten. I like how the teacher tweaked the schedule to suit the needs of the child with disability. However, in Singapore, it is not as easy to tweak the routine as there are many other components to consider in a mainstream preschool. I hope that we can do more for children with disabilities in the mainstream preschool setting but it is not only the teacher who needs to be willing to change. The principal, organisation, other teachers, parents and children will also have to be more accommodating towards children with disabilities

The video about the CEO with down syndrome was so inspiring! I wish all persons with disabilities can also watch her video and understand that they too are able to achieve great things and that their disabilities do not define them.

The articles also highlighted how students with ID often have lower expectations for success, which are further reinforced by the assumptions of teachers and peers. From my observations in a mainstream school, I have noticed that educators tend to set lower expectations for students with learning needs. When these students struggle, their difficulties are frequently attributed to their disabilities, rather than considering how environmental factors or even teaching methods might be adjusted to better support them.

Although I have not supported any students with TBI, watching the video deepened my understanding of how it can affect a child’s cognitive and social development. Beyond immediate physical recovery, children with TBI often struggle with emotional regulation, memory, attention, and communication, which can affect their ability to learn and interact with peers. Travis’s story was eye-opening, as it showed how a sudden injury can change a child’s life, not just academically but also socially. This reminded me that educators need to be aware of such invisible challenges and to holistic support that addresses the challenges.

In my line of work, I have not come across children with TBI; however, I witnessed my friend get concussed in a primary school football match. He was vomiting quite a lot and said that he was feeling nauseous. He was immediately brought to the hospital via ambulance. He was back to his normal self the next day.

The other takeaway was about Collette, the CEO with Down syndrome, and her inspirational words: "Focus on the abilities and not the disabilities." It resonated so much with me, and as we have learned about the importance of the strength-based approach and PBIS, I thought that the video sums it up nicely.

I currently have a P2 boy, who is a year older than his peers, with Down syndrome. I could see a lot of improvements in terms of his ability to adapt and how his communication skills with his peers and teachers have improved. His friends are now not just "helpers" but truly enjoy his company and play with him during recess. Although he may not be able to comprehend the academic side of things, it heartens me to see that he is really enjoying his time in our school.

I strongly resonate with Collette’s statement: “No matter who you are, you can make a great difference in this world. Do not focus on the disabilities but direct it to your abilities.” This captures the essence of strength-based perspectives in working with individuals with disabilities.

However, an essential factor behind such success is the support system surrounding the individual. In Collette’s case, her mother played a pivotal role in nurturing her dreams, understanding her challenges, and enabling her growth. I’ve personally seen similar examples where strong family support made a significant difference.

During a school trip to New Delhi, India, I visited a pottery workshop run by a teenager with intellectual disability. She was clearly the leader of the space, with her parents providing not only the physical environment but also the emotional support and time needed for her to hone her skills and pursue her passion. Closer to home, the founder of Joan Bowen Café in Singapore—named after her daughter—established a social enterprise to provide training and employment opportunities for individuals with disabilities. The café was inspired by her daughter’s love for baking and reflects how family vision and support can translate into meaningful inclusion.

This aligns with the insights shared by Maturana, Mendes, and Capellini (2019), who emphasized the importance of considering both family and school perspectives to create inclusive and effective educational experiences for students with intellectual disabilities. Families provide the foundation—emotionally and financially—while schools contribute through skill acquisition, instruction, and collaborative partnerships. No single stakeholder can drive change alone; a supportive, interconnected community is key to enabling individuals with intellectual disabilities to achieve their dreams and to live as equals within society.

In my experience as a SPED teacher, I currently teach a student with intellectual disability resulting from a traumatic brain injury (TBI). The child sustained significant brain trauma as a baby when she was accidentally dropped by her helper, which led to long-term developmental challenges and a diagnosis of ID. She now requires ongoing speech therapy and occupational therapy to address her needs. Yet, despite these challenges, her growth has been positively shaped by the strong support network of her parents, therapists, and teachers. Together, we have created a nurturing and structured environment that respects her pace of learning and builds on her capabilities.

Understanding and supporting the learner from their unique perspective is key to helping them discover their strengths and thrive.

This topic is close to my heart for 2 things: 1) I was a SCDF paramedic for 7 years before I became SEN Officer. I had a fair share of traumatic head injury cases which I attended. True to the statistic in US, road traffic accident is the major cause TBI. I got to see 1st hand the effect of head/brain injuries. For instances, terms like 'raccoon eyes' which is the contusion around both eyes and 'battle sign' which is the flow of cerebral fluid coming out from the ears. These are some major signs that patient is suffering from brain injury.

2) During my infant year exploring and exposing myself to the special needs area, I was volunteering myself at Rainbow Centre Margaret Drive. I came across a 12 years old boy who had cerebral palsy. He was always accompanied by his mother to school. I had a chance to talk to his mum to find out more about him. Mother shared that he was born like any typical boy. They came to Singapore for better prospect. The boy was actually bright and potential scholar. However, unforeseen incident happened. On the fateful day that they reached Singapore, the family met with a major road traffic accident. The boy had a brain injury which caused him to be at the current state. Sadly, father couldn't accept the fate and had distant himself from his son. It was a tragic story to share with you, Dr Liz.

1. Children with mild to moderate traumatic brain injury (TBI) may experience lasting academic difficulties, even if they initially appear to recover well. The study found that while these children were less likely to receive school support services two years after their injury, their need for support became comparable to that of children with severe TBI by six years post-injury. This suggests that the effects of TBI can emerge or worsen over time, highlighting the importance of continuous monitoring.

2. The study challenges the belief that younger children recover more easily from TBI. Instead, it reveals that those injured at a younger age are at greater risk for long-term academic struggles. This underscores the critical need for ongoing educational assessments and targeted interventions to ensure these children receive necessary support and do not fall behind.

3. I am glad that in Singapore, we do have programs like the Brain Injury Programme at NNI that offer specialized care, rehabilitation, and support services that can help children manage the long-term effects of TBI and improve their educational outcomes. - nni.com.sg/patient-care/specialties-services/clinical-specialties/brain-injury-programme

   
   

   In my years as an educator, I did not come across any students with TBI however after reading all the resources and articles related to TBI, I now recognize the importance of understanding its impact and will no longer overlook or take it lightly.

   
   

From the article- Schooling of Students with Intellectual Disabilities: Family and School Perspectives

• Families of students with intellectual disabilities (ID) primarily expect their children to achieve literacy, viewing it as a milestone for overcoming limits and gaining inclusion in society.

• Literacy is considered a pathway to better job opportunities and an improved quality of life.

Many families believe mainstream schools provide stronger academic learning, motivating their preference for transferring students to these schools.

However, the question remains whether mainstream schools are truly the best fit for children with special needs. As a mainstream primary school educator, I've witnessed firsthand the challenges that parents and children face when trying to navigate this environment.

Many have attempted mainstream education, only to find that it doesn't meet their child's unique needs and ultimately thrive in sped schools like Grace Orchard or Metta.

A parent I worked with, whose child transferred to Grace Orchard, found that coupled with individualized support at Cognitive JE (Home – Cognitive Development Learning Centre) was more effective than mainstream schooling.

Her experience and insight into her child's needs struck me as particularly enlightened.

Especially after watching the video about Matthew, I was deeply moved. He had fallen from a second-story window and sustained a traumatic brain injury. Although he appeared to recover fully and lived a seemingly normal life for 14 years, the effects of the injury slowly resurfaced. Over time, Matthew began to feel like he was losing himself and was eventually diagnosed with severe depression. Despite undergoing multiple therapies, taking medications, and receiving unwavering support from his parents, he struggled to overcome it. Tragically, he ended his own life five years later.

His devastated parents, in an effort to honour and validate his experience, decided to donate his brain to a research centre. There, tests and MRI scans revealed that the initial brain injury had never truly healed, and the damage was extensive. This discovery not only brought a sense of closure to his family but also gave them comfort in knowing that Matthew’s brain could help advance research and support other young individuals with traumatic brain injuries.

Do watch the video here: https://www.youtube.com/watch?v=fpq_o17O_Ls&t=102s

Jokes like that reflect a lack of understanding about the seriousness of brain injuries. It reduces what could be a complex neurological challenge into a punchline, and it reinforces harmful stereotypes about people who may struggle with impulse control, emotional regulation, or cognitive processing. What might look like “odd” behaviour on the outside could actually be the result of real trauma to the brain — trauma that has altered the way a person experiences and responds to the world.

I have not encountered anyone with TBI before but I sure will not laugh at such jokes anymore as I am more informed now that this can occur to anyone at any point of their lives.

The education approaches used with individuals with TBI are quite similar to those who receive early intervention.

On ID – Individuals with ID can also lead meaningful lives therefore, it is important that learning is customized so that they can learn to the best of their abilities.

The next path that made me decide to choose AED LBS when I crossover from AED T&L was a trip to a special school in Johor for a level camp. The chances to interact with the individuals and teachers to understand the different education system and support given. It was an eye-opener and made me realize that these group of individuals need others to help to empower and advocate for them. It has reinforced the importance of adapting communication methods to meet the needs of each individual, ensuring that they feel heard and understood.

Watching the video resources on ID on "Treating People with Intellectual Disabilities with Respect". I felt the management took advantages and signs of bullying towards my colleagues. They should be given equals rights and avoid speaking about them as if they are not present and engage them directly.

Through my work involvement, I have also had the opportunity to work with educators who are dedicated to improving the lives of children with ID. These collaboration determine the importance of a multidisciplinary approach to care. Especially in SPED school environment where professionals such as therapist, job coach and parents working hand in hand to provide comprehensive support for individuals ID.

Reflecting on these experiences, I am reminded of the critical need for specialized care and support for individuals with ID. It is essential that we continue to advocate for their rights and work towards creating inclusive environments that allow them to thrive. The journey has not only deepened my understanding of intellectual disability but has also instilled in me a sense of empathy and commitment to providing the best possible care for all individuals, regardless of their abilities.

My most poignant takeaway that warms my heart is seeing the interviews of people with ID in the Special Olympics clip. It is a call for healthcare professionals to treat people with ID fairly instructed of giving them “substandard” treatment. The vision of the Special Olympics is to see the people as gifts and not as burdens.

I must say that this video is not just about healthcare but for ALL. Everyone should look beyond the physical to what lies beneath and in “meeting the people”, I feel touched. Many of them have an innate desire to be seen, to be talked to, to be loved, to be valued and to be the best version of themselves. One of the videos stated that of all the people that have ID, 85% are mildly impaired and capable of ALOT. All they need is a chance like Collette- the CEO of a cookie company whose mother saw her, listened to her and supported Collette to find her sense of purpose and passion. It got me thinking about how important a support network is in ensuring that people with disabilities get an equal chance and a level playing field.

One of the aims of the healthcare programme in the Special Olympics was to provide an inclusive platform for people with ID- to meet with experts just like any other person and this brought me back to an earlier module that we had to do-Issues and Trends and the hot topic of what inclusive education is and what it is not. I really enjoyed the chapter “Teaching Students with Moderate to Severe Intellectual Disabilities in General Education Classroom” as it clearly spells out what inclusive education is not. Alas, in mainstream schools, we are still not anywhere near the inclusive state of education and have some ways to go. It is a good reminder of where we can be and a personal guide for me even as I continue to advocate for SEN in school. :)

I truly enjoyed also the Disability Awareness video where they shared tips on how to be more inclusive to someone who has ID- be it considering how information is presented or like the teacher- simply looking out and guiding the person back to the task. I think having a person on a wheelchair be the host is also a visual and poignant reminder of what a person with disabilities can do, when given the chance :)

Another takeaway I have is the way speech therapy is done for someone who has a Traumatic Brain Injury. I see the importance of using visuals as an accompaniment and as a tool for them to follow. The details that were uncovered in that short clip highlighted the intricacies of daily speech and the many things to consider- the visual and the pointing really helps and I am reminded that I can also use simple visuals like that to also reinforce teaching and learning.

When I think of TBI, the physical part always comes to mind (the blood, the gore and the concussion) but it had not really dawned upon me how learning and emotions will be affected as the brain is really the CPU of the human body. Therefore, the video on signs and symptoms of TBI is helpful. I am also touched by the story of Tyler who had a TBI when he was younger and now, with the help of therapy and supportive parents is able to cope- the sharing by his mum and Tyler himself shows how lonely and helpless the journey can be and so it is important the like-minded individuals come alongside these families to support. The therapist recounted a moment when she met a 17-year old who self-inflicted a gunshot wound to his head and she could not fathom why he would do that but after working with him and his family, her perspective changed and I find that so so precious. <3

With regards to Intellectual Disabilities, I appreciated the focus on understanding ID as a developmental condition rather than a limitation of potential. The distinction between intellectual functioning and adaptive behavior was particularly valuable. It helped me understand how individuals with ID may experience the world differently, but are still capable of growth, learning, and meaningful contribution when given the appropriate supports. This perspective is important in shifting public and professional attitudes toward inclusion and empowerment rather than deficit and dependence.

One aspect that stood out in both topics was the emphasis on the role of educators and caregivers. For TBI, the unpredictable nature of recovery means that teaching strategies need to be individualized and flexible, often requiring collaboration with therapists and families. For students with ID, consistency, structure, and patience are crucial, along with a strengths-based approach that builds on what the learner can do. These insights reinforced for me the importance of a multidisciplinary approach and the value of empathy and patience in working with diverse learners.