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The brain injured student and emotional curriculum
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For all children, the learning process has highs and lows, but for individuals who have suffered from a traumatic brain injury (TBI), the return to the classroom can mean that even subjects that were once easily understood and quickly learned can be difficult to comprehend and retain. New information has surfaced on how memory can be improved by using curriculum enhanced with the link between visual imagery (film) and emotion, to help these students rebuild their educational strategies and their lives. This article discusses perspectives at the intersection of memory, learning, artistic media, and emotion, and relates a narrative of a successful use of film to engage students with TBIs.
IntroductionArt is that in which the hand, the head, and the heart of man go together.
- John Ruskin
For many years now I have had the opportunity to work with children and young adults who have survived numerous types of accidents which left them with a traumatic brain injury. Recent statistics show 1.4 million Americans have sustained such an injury, ranging from mild to severe in type (Rutland-Brown, Langlois, Thomas, & Xi, 2006, p. 2). It is becoming perhaps the greatest single disability to affect society, since medical technology can now save the lives of these men and women, but often finds itself helpless in rebuilding their lives post-injury. As part of the cognitive rehabilitation process, some forward-thinking individuals in small programs throughout Canada and the United States have decided to use education as a way to rebuild these individuals' lives. Up until recently, and still for the most part, a purely medical model of rehabilitation is used; occupational and physical therapy, counseling, and other medical based programs are deemed standard practice. However, to help repair a damaged brain physiologically is one thing, but to help the person repair the mind is something for which a different approach is of essence. In order to fully help brain-injured people recover, it is critical that the various disciplines across the scientific and academic community realize what each has to offer the others. The use of the arts in curriculum, particularly film, is a wonderful way of seeing how one discipline can learn from another.
Perhaps the best way to look at this new development is to look at ways in which the field of education plays a role in helping an individual rebuild one's life. One particular way to look at the damaged brain of a person after an accident is to look at the brain as a muscle. Of course the brain is not literally a muscle, but by giving the mind new challenges to work on, such as language arts and mathematics, the brain uses different areas to solve problems and in a sense is being "exercised" (Sousa, 2007, p. 9). This seems to help the brain at a physiological level in that new connections can form, literally working around damaged areas of the brain, creating new connections between neurons, and enhancing what is known as brain plasticity. An understanding of this area of brain physiology alone, if properly applied, might revolutionize education (Pinker, 1997, pp. 341-343).
The importance of memory
Perhaps the single most important facet of working with brain-injured students is the realization of just how badly memory is affected by an injury to the brain. Memory is what defines us as individuals and is the basis of our understanding of who we are. The complexities of how memory works have perplexed philosophers for centuries and modern science for decades. "The nature of memory is not rightly understood if it is regarded as merely a general talent or capacity," writes Gadamer (2000, p. 17). When the brain is damaged, memory needs to find new and alternative pathways for learning, and teachers are facilitators in this process. A fully functioning memory involves more than simply being able to memorize something; the complexity of the personality and the unique experiences of the individual are woven into one's memory.
While there are some support services for teachers working in this field as of this writing, there are few principals or teachers with special training to assist in handling the problems facing these students. The teachers that are working in this new field tend work in medical facilities in collaboration with nurses, aids, and physical therapists, and research generally offers only a medical perspective on brain injury. Perhaps an even more striking example is the fact that the young men and women returning from the war in Iraq are receiving treatment for TBI on a physiological level, but not on an educational or cognitive level; however, these individuals face many of the same issues that students with a TBI in a classroom face (Hoge, McGurk, Thomas, Cox, Engel, & Castro, 2008).
The issues that arise in the classroom with students who have TBIs are often a result of memory problems. These result in a person's inability to plan and carry out activities, and to problem solve. Also, a brain injury can affect a person's ability to understand consequences for certain actions, and to consider other options. These deficits can cause an individual to fail at things many times, and often depression and lack of self-confidence results. These students' lives have changed, and when they look to a teacher for help, the teacher needs to understand the students' new lives. The obstacles that stand in the way of learning and those that stand in the way of rebuilding their lives are inevitably intertwined, and the primary obstacles are self-image and memory.
Students with TBIs may suffer from depression, but many times, general practitioners working with these students prescribe tranquilizers and sleeping pills because they the students seem more anxious than depressed. Such medications, however, have an effect on their ability to concentrate and remember what the teacher is doing in the classroom.
The depression the students often face as a result of their accidents has an effect on memory in a number of ways. Firstly, they may have what psychologists term "hyper-distractibility." So much has happened to them so quickly -- injury, loss of friends, family problems, etc. -- that they just have too much on their minds. As a result, they have great difficulty focusing and concentrating on classroom activities. What appears to happen is that new information is less likely to be processed into engrams (memory traces) because of a decreased ability to focus on environmental stimuli (McEwen & Sapolsky, 1995). This is called a shallow memory trace by neuro-psychologists, and because the information is not encoded as permanently, the person is more likely to forget. Secondly, a person's ability to retrieve a memory is affected. To retrieve and reconstitute a memory can be difficult at the best of times; damage to the brain compiled with depression makes it even more difficult. Even when a person tries to concentrate on what is being taught, the other problems on his or her mind interfere with the task at hand.
Youth and memory
Memories and experiences in youth seem especially powerful and alive, but paintings, music, film, and other arts can have a similar effect on us throughout our lives. These art forms allow us to turn back the hands of time, and we are young again, as though the world was new. Educators can use art as a tool repairing an injured brain, and helping to restore memory (Willis, 2007).
In an interview, the writer Stephen King (who was once a high school English teacher himself), said something quite interesting about youth and memory. He was asked where he got his inspiration for his stories. He said that when we're young we have a marvelous third eye, imagination, and as children, imagination sees with twenty/twenty clarity. As we grow older, it dims and the boundaries of imagination begin to close in like a tunnel (King, 1993, p. 245). We lose our ability to think around corners, and as the world becomes only what we focus on and pursue -- career, family, etc. -- we lose that ability to imagine. Artists break open that tunnel and allow you to look at the world in a different way, if only for an instant, yet often that instant remains in our memory for life.
"Many artists, authors, and filmmakers seem to have the dreamy eyes of a child," author Ray Bradbury once said (King, 1993, p.117). Orson Welles's famous comment about filmmaking -- "It's the best set of electric trains a boy ever had" -- also points to the youthful exuberance that art can create in a person (King, 1993, p. 116). The students with a TBI in the classroom are, in a sense, like small children again. They have lost the trappings of a complex world and are now enthusiastic about rebuilding their lives. They want to be back in the world of friends and family, but they often feel they can never really be the same person again. The opportunity for a whole "new" person is there, and the teacher may have the key to reawakening the child in them. That childlike wonder and awe can be rekindled and used to help with memory, learning, overcoming depression and discovering their own new path. The key to this is emotion.
The emotional link
The arts can have a tremendous impact on a student's memory process. The student is often able to recall their response to what they had viewed or heard, and this, in turn, has a positive impact on their learning and on their self-esteem. The depression they face after their injuries is often linked to their poor memory and mental processing abilities. Dramatic music and visual images, and the resulting emotional responses, can have a great impact on the memory processing patterns in the brain, and help them to function more efficiently. The students can feel better about their situation, and because of heightened interest, they will often put more effort into other classroom activities.
A recent study by researchers in Finland found that stroke patients who listened to music for a few hours a day showed marked improvement in memory and focused attention, compared to individuals who did not listen to music. The study further showed that the emotional stimulation had a direct effect on the recovery at a biological level. The researchers concluded that the brain was rewiring itself and repairing the damaged areas of the brain (Sarkamo, 2008).
Recent research on how students develop or create a mental image when reading, shows that if that student can form a visual image of the text he is much more able to recall the information and develop proficiency as a reader and writer later on (Gambrell & Jawitz, 1993). This helps show the importance of both memory, and the way the brain utilizes both visual and emotional areas of the brain to encode information.
The question of how to get students focused and interested in subject content arises time and time again in the classroom, in both regular and special needs programs. The teacher's primary goal is to get and keep the students interested and focused. "Arousal is important in all mental functions. It contributes significantly to attention, perception, memory, emotion, and problem solving. Without arousal, we fail to notice what is going on - we don't attend to the details" (LeDoux, 1998).
For individuals with TBI, memory and learning new information are frequently the most prevalent cognitive difficulties facing them when returning to school. This is because often the prefrontal cortex region of the brain has been damaged, which is responsible for our executive skills such as decision making, planning, and memory recall. As it turns out, many individuals with learning problems also have difficulty with these cognitive functions, and while they are not as pronounced as with TBI students, it can be equally as frustrating for them. The interesting connection to understand is that the difficulties with memory recall and processing are very similar between someone with an acquired cognitive difficulty such as a TBI, and someone who has a congenital cognitive deficit such as a diagnosed learning disability. After working with students in the school system who were diagnosed with ADD and LD, and then working with students with brain injuries, one could easily see that their processing difficulties were very similar. This opens up an intriguing area for educators, in that if we see individuals with an injury respond to a classroom activity, in this case a film, and retain what they have seen, then the possibility of using that activity for other students with memory and retention problems becomes an exciting possibility for exploration. To be more specific, a person with a TBI often shows an immediate response to the film and can recall it later, where they could not with traditional approaches to the introduction of new information in the classroom. Students in a regular classroom may have the same response, but it is not as pronounced as with students with TBI. However the implications and possibilities for memory retention are the same.
Music, film, and other arts can often inspire students to confront difficult real-life questions and look at the world and themselves differently after their injury. Posing these questions is essential to opening pathways to learning, and using the arts is a beautiful way to create the questions. As Gardner states,
The questions are natural ones for young persons to pose. However, they are rarely articulated in explicit philosophical terms. Rather, they are posed in the language of fairy tales, myths, 'pretend' play, and, in a cinematic age, films and video.... Education in this pathway ought to be inspired by a set of essential questions: Who are we? Where do we come from? What do we consider to be true or false, beautiful or ugly, good or evil? What is the fate of the earth? How do we fit in? What is the earth made of? What are we made of? Why do we live, and why do we die? Are our destinies under the control of God or some other 'higher power'? What is love? What is hatred? Why do we make war? Must we? What is justice and how can we achieve it? (Gardner, 1993)
In this way, the questions that art creates in a person with TBI can be used to help the student better relate to issues that they themselves are dealing with: Who am I? Where am I headed now? Do people still love me?
The student who listens to music or watches film and reacts to it emotionally ultimately reacts to it physiologically. The memory connections are made at a basic cellular level as well as a higher cerebral level. Emotion becomes the catalyst between brain and mind. Daniel Goleman, in his book, "Emotional Intelligence", believes that a high emotional quotient is more important than intellectual knowledge in succeeding in life (Goleman, 1995). He states that emotions have a tremendous impact on how we process information and make decisions, and they also have a great deal to do with memory retention. The visual arts can help focus attention and aid in helping students improve both short and long-term memory retention.
War of the Worlds
I would like to give an example of the use of film in a classroom situation. I was working in a hospital situation, a separate floor that was a school for students who had suffered from various types of brain injuries. Their ages ran from 14-20 at this particular time, and all suffered from memory problems, headaches, as well as attention/concentration issues. The names have been changed for confidentiality.
The students' injuries are well described by this quote from Stein (1995): "When an injury of the brain kills neurons, a cascade of events takes place, disturbing the fine balance of neuronal functioning. Although the damage may be limited to only a small region of brain tissue, the effects are quite widespread, so that, eventually, the whole brain participates in the repair process that, in turn, may continue for months or even years after the initial injury."
I wished to find a commonality for learning for all of my students. The visual centers of the brain bring into play many areas of the brain, processing, visual recognition, memory, etc. I reasoned that if visual stimuli could have a dramatic edge to it, it may cause more areas of the brain to be stimulated.
Film, of course, is used commonly in classrooms for a number of reasons:
1. Film can be representational, providing a visual depiction of an event.
2. Film can help depict temporal organization and structure.
3. Film can be used to clarify abstract concepts by transforming them into concrete representations.
With this in mind, I decided to show my students a film that always stuck in my own memory since I was a small boy. It is the 1953 version of H.G. Wells's "War of the Worlds."
I turned off the lights and started the video; the students were all focused on the screen, as the movie began to unfold. I sat in such a position in the classroom that I could watch every student's reaction to the film. With a notebook and pen, I wrote down the student's names and next to each one I wrote the following: duration before break required, signs of fatigue, signs of headache, and if they seemed to be concentrating and following the story or not. Since the movie was about an hour and a half long, I believed this would really be a test of endurance for some of them.
Not one of the students left the room. Lyla (my teacher's aid) and I couldn't believe it, even the students with the most attention deficit problems, stayed. Bruno, Gary, both with frontal lobe injuries, Arlene and Steve who had left temporal injuries were all quiet and attentive, and made none of their usual critical comments or frequent trips for coffee. Most amazing was Dana, with his severe global damage, also following the story, reacting to the screen at appropriate times, as was the rest of the class. There were few signs of extreme fatigue or headaches, and those that did seemed to be coping far better than with traditional reading and writing exercises that I used in the classroom.
As the film ended and I turned on the lights, a flurry of questions came at me.
"Great movie, Roy, when was that made?" asked Louise a student with severe memory problems. "When that Minister was killed, that really was upsetting," said Gerry, his injury often causing him great difficulty with attention and concentration.
For the next half hour, we discussed the film and what had unfolded from it. It was like talking with a group of excited fourth graders, bright, attentive eyes, laughing, joking, it had really made the class more attentive and involved than I had seen since I started working as a teacher in the hospital. But the most fascinating results were yet to come.
The following Monday, I arrived at work, still trying to wake up as I sipped my coffee, while walking down the hall. Alan a bright teenager who had suffered a major frontal lobe injury in a motorcycle accident, walked towards me heading for breakfast in the cafeteria.
"Morning, Roy!" he said.
"Morning, Al, how are you?"
"Fine, you know, I was thinking, do you think the Martians killed the Minister because he was a Minister, or because he was just a human?"
I stopped sipping my coffee, "What?"
"You know, in the movie on Friday," Alan clarified.
"You remember that?"
"Yeah, sure," Alan looked at me, puzzled, "Why?"
"Well, for one thing Al, you usually have problems remembering anything from the classroom the next day, let alone three days later."
A smile beamed across his face, "Hey, you're right, how did I remember that film?"
I was about to offer some sort of answer when Gerry and Dana came down the hall, both limping on opposite sides from each other, due to their injuries. "Hey, Roy," said Dana, "Gerry and I were just talking about the movie on Friday."
"Wait a minute," I said, "You guys, too?"
"Yeah," said Gerry, "that was quite a film, considering it was made in the fifties."
I talked with the three of them about it for a few minutes, and then rushed down to the office to tell my colleagues. What is important to keep in mind, is that these students had trouble with encoding even basic memories, and this was a significant occurrence.
Conclusion and recommendations
The effect of the film "War of the Worlds" on me as a child was an emotional one as well as evoking new thoughts and ideas about the world. Later, as I researched how the mind-brain connection worked, in order to help my students, many key factors and theories began to show why that film impacted me so long ago, and how memory was tied into emotion. The most striking element of all is how it was affecting my students whose memory problems were so pronounced.
My work with brain injured individuals centers around the use of dramatic visual imagery and its effect on memory. Does it work? Yes, I have seen the results with students with TBI both academically and socially. I believe that this will also hold true for students in mainstream classes as well, since memory problems and retention of information is a universal problem facing all educators. As of this writing, I will be experimenting more with the use of film imagery as a means to help brain injured students with memory encoding. I would wholeheartedly recommend the use of emotionally based and visually striking films as a basis for memory stimulation and retrieval. I believe it is a way for challenging and enriching the human heart and the human mind. Often the philosophies of man are made more attainable through artistic expression. They become ideas, not distant from us, but something we can incorporate in our lives. I believe films often allow this to occur, and as a result they teach us something about life. Everyone loves a story, particularly one with a moral. As a teacher, I can choose such films, and allow the student to ask questions about his life and life in general. These types of questions can allow them to get in touch with the 'self.' It is those emotional inquiries that help students with a traumatic brain injury to define the 'self' once again. It is an honor to think I can contribute to this in some small way with my teaching method for these students, and possibly with students of all types and abilities.
I sincerely hope that other professionals, not only from the teaching field, but other professions working with brain injured individuals and other student populations will benefit from this paper. There is much work and research to be done. I, for one, will continue to look at the impact of dramatic visual images on memory. I have just scratched the surface. There is also a need for more study on brain function and learning, and the ongoing brain versus mind dilemma continues. As an educator, I can contribute to our understanding of the human brain and mind by my observations and classroom methods. I hope other professions will contribute what they can as well, to our understanding of ourselves. It is an exciting time. To quote the classic television series "Outer Limits" control voice, "You are about to participate in a great adventure" (King, 1993, p. 77).
References
Gadamer, H. (2000). Truth and Method. New York: Continuum.
Gardner, H. (1993). Frames of mind: The theory of multiple intelligences (10th ed.). New York: Basic Books.
Gardner, H. (2000). The disciplined mind. New York: Simon and Schuster.
Gambrell, R. & Jawitz, P. (1993). Mental imagery. Reading Research Quarterly, 28, 264-276.
Goleman, D. (1995). Emotional intelligence. New York: Bantam Books.
Hoge, C., McGurk, D., Thomas, J., Cox, A., Engel, C., & Castro, C. (2008). Mild traumatic brain injury in U.S. soldiers returning from Iraq. New England Journal of Medicine, 358, 453-463.
King, Steven (1993). Danse macabre. New York: Everest House Publishing.
LeDoux, J. E. (1998). The emotional brain: The mysterious underpinnings of emotional life. New York: Touchstone Press.
Lazaraus, R. (1999). Emotions and Adaptation. New York: Oxford Press.
McEwen, B. & Sapolsky, R. (1995). Stress and cognitive functioning. Current Opinion In Neurobiology, 5, 205-216.
Pinker, S. (1997). How the mind works. New York: W. W. Norton Books.
Rutland-Brown, W., Langlois, J. A., Thomas, K. E., & Xi, Y. L. (2006). Incidence of traumatic brain injury in the United States. Journal of Head Trauma, 21, 544-548.
Sarkamo, T. (2008). Music listening enhances cognitive recovery and mood after middle cerebral artery stroke. Brain, 131, 866-876.
Stein, D. (1995). Brain Repair. New York: Oxford University Press
Willis, J. (2007). Brain friendly strategies for the inclusion classroom. Alexandria, VA: ASCD.
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