Psychology

The paper presents a theoretical and practical analysis of an interview with a care worker at language school. Language impairments in children after traumatic brain injury (TBI) are the central point of analysis. The principles and findings presented by the interviewee are positioned from an interactionist perspective, which shows language as the product of both biological and social development. The interviewee makes emphasis on the collaboration and communication between children and between them and older language professionals, turning communication and articulation in a form of challenge, which children have to meet in order to develop and maintain friendly ties with their peers.

    The loss of effective communication skills and the development of language impairments in children with traumatic brain injury (TBI) are not rare. Since the middle of the 20th century, the importance of language impairments in children following brain injury has been relatively low. On the one hand, researchers in neurology and language studies lacked a clear definition and a single integrated idea of how TBI in children and subsequent brain injury are linked. On the other hand, professionals in neurology also lacked a systemic methodology necessary to help children with brain injury restore their language function. In the current state of research, speech and language impairments and TBI in children are closely interlinked. Given the impact which language impairments in children with brain injury produce on the quality of their lives, numerous professional organizations were created to address the loss of communicative abilities in these groups of small patients. Despite the lack of a single theory or methodological approach, these organizations have proved to be en effective element on childrens way to full recovery and as a result, better quality of life.

    I CAN is an international organization based in UK and created to deal with children with various types of language impairments, including those that follow severe TBI ( Can, 2009). The organization was able to create a number of special schools for children with language impairments and has already achieved considerable success in treating even the most complicated language disorders in those, who had to experience the tragic consequences of brain injury. Mrs. Sheila Shanks, a care worker at Meath School kindly agreed to shed the light on the way language impairments are being treated in practice, as well as the ways language pathologists and teachers choose in their daily interactions with children following TBI.

    Mrs. Shankss official job title is that of a care worker, but her responsibilities and obligations usually stretch beyond what is required by her position. One reason for this is that she is bound to work with children, whose needs and behaviors change on a daily basis. Another reason is in that to be a care worker means to be responsive to everything that occurs in the working environment, to which Mrs. Shanks belongs as such her position requires increasing flexibility and openness. To be a child care worker at Meath School implies the need for Mrs. Shanks to help children as they arrive to the center, to help them find their tutor, and to organize their daily activities and schedules, but often Mrs. Shanks is directly involved in different learning and playing activities and thus becomes the direct participant of the major treatment process in children with language impairments. Having spent 5 years as a care worker at Meath School, Mrs. Shanks also occupied other positions with I CAN, beginning from a volunteer, through nursing, teaching and up to care work. With her Masters in Special Education she is likely to become one of the most experienced language therapists in the organization, but she is very satisfied with her present job.

    Mrs. Shanks cannot conceal her excitement when describing her present job. She is pleased to have a chance to work with children between 4 and 11 years and old and to help them restore their cognitive and language abilities. Her obligations require that she cares for children who come to Meath School during the day  from meeting them and helping them to find their class up to developing activities and schedules for children with language impairments and helping them with their home tasks. Her typical day begins at 8 a.m. A day of a typical care worker at Meath School starts with attending a regular meeting of the school staff, discussing previous achievements, daily plans, and problems. The number of language groups during the day may vary from 2 to 6, depending on the particular day of the week (during weekends, the number of children brought to school is usually higher compared to week days). Between groups, Mrs. Shanks participates in various team projects or works to develop various communication activities for children. She may deal with individual patients, who require her attention and help when working on their individual tasks. Mrs. Shankss day usually ends between 6 and 7 p.m., and a meeting with parents often becomes a logical end to her long work day.

    The children with whom Mrs. Shanks works have various types of language impairments, but the prevailing majority is caused by TBI, which is particularly painful and problematic in smaller patients. Expressive language disorder, articulation disorder, fluency disorders, and even dysphagia often become the objects of the increasing professional concern. According to Karunanayaka et al (2007), language problems in children following TBI may underlie observed problems in academic performance, social competence, and peer integration. Previous investigations have documented deficits in expressive and receptive language skills, naming ability, and written language (p. 356). Very often, children with TBI experience difficulties when trying to utter complex sentences or to transform or synthesize information (Karunanayaka et al, 2007), but Mrs. Shanks asserts that children with expressive language disorder are the most frequent attendants of Meath school. As a result, language professionals at I CAN have experience and knowledge necessary to deal with this type of language impairment in children but they do not lose the grip of control over other, possibly more complex and more dangerous language disorders.

It should be noted, that with the knowledge and experience about language disorders she currently possesses, Mrs. Shanks cannot but recognize the overtly diffuse nature of brain injuries in children and their impact on their cognitive functioning. Recently, Mrs. Shanks has become interested in the development of dysarthria as a form of speech disturbance in children following TBI. Although dysarthria is usually referred to a group of orthopedic disturbances in children, there is a direct link between it and TBI. Mrs. Shanks is confident that cognitive failures alone cannot explain the difficulties, which children after TBI experience while speaking. In this context, Mrs. Shanks supports the findings of Loh, Goozee and Murdoch (2005) who tie tongue and lip movement to the problems with brain functioning in children. Moreover, she views language development in children as the product of both biological and social processes, which positions her as the supporter of the interactionist perspective in language and learning. She is confident that only through continuous interaction with peers and professionals can children overcome their language difficulties. Mrs. Shanks has her own complicated vision of language impairments in children after TBI, and the activities and team initiatives which she develops are expected to cover both social elements of language impairments and the physiological (physical) difficulties, which children may experience because of their brain trauma.

    Needless to say, language impairments in children with whom Mrs. Shanks works or meets while fulfilling her job obligations impact the quality of their learning. On the one hand, they are not always able to express their thoughts and to form logical sentences on the other hand, because of their language disorder children often lose attention and fail to concentrate on the process of acquiring and processing new knowledge. Mrs. Shanks knows that the current state of research does recognize the link between the loss of attention and language impairments that follow TBI in children, but throughout her work she was also able to observe this link in practice. That attention is the critical element of successful learning is not a secret, but for Mrs. Shanks, the link between learning, attention, and language impairments forms a kind of a vicious circle while language impairments negatively impact attention in children and result in the loss of concentration, this loss of concentration and attention deficits slows down the progress in dealing with language impairments among children after TBI. This is exactly what Finneran, Francis and Leonard (2009) state in their research and this is also what has already become a reality for Mrs. Shanks. That is why cooperation with other language professionals, as well as the emphasis on the continuous communication and collaboration between children are the key to success in different groups of children coming to Meath School.

    As a care worker, Mrs. Shanks often possesses information about children, which may not be available, accessible, or known to other language professionals at school while occupational and language therapists deal with children during their lessons, a care giver is involved in broader interactions with children and their parents and can thus discover and identify language problems that may go unnoticed in the process of training. For this reason, Mrs. Shanks is often involved in creating reports about children and their progress in dealing with language impairments, especially expressive language disorder and aphasia. When asked about the contribution, which language professionals and care workers can do for children who experience language difficulties after TBI, Mrs. Shanks says that their school and their organization in general are critical for improving the quality of life in such children. Traditional schools fail to address specific needs of children with language disorders, while Meath School and its professionals provide a balance of support and challenge that encourages pupils to make progress in all areas of the curriculum (I CAN, 2009). For example, TBI in children is often associated with the loss of consciousness, and the duration of unconsciousness results in different degrees of axonal injury and cerebral concussion  health conditions that make treatment of language disorders in such children even more problematic (Murdoch, 1990). More importantly, Meath School provides conditions necessary to develop close friendly ties between children with similar language problems  as a result, they become open to each other and develop better language skills. The need for children to express themselves to their peers often becomes a form of a challenge, which they cannot meet unless they are able to articulate their thoughts and memories. As a result, speech therapists, occupational therapists, physical therapists, care workers and teachers altogether create an environment, which makes it possible to address these complications and to enhance the pace of learning in children after TBI  the processes which are difficult and even impossible at public schools.

    Mrs. Shanks is confident that continuous education and attention to research findings is the basic component of her professional success, and she recommends that other language professionals pay special attention to what researchers and scholars in neurological studies publish in professional journals. For example, with her emphasis and attention toward dysarthria, Mrs. Shanks became increasingly interested in how electropalatography may reduce the symptoms and signs of articulation impairments in children with post-traumatic brain injury (Morgan, Liegeois  Occomore, 2007). These scientific findings are further evaluated and adjusted to the practical environments, in which Mrs. Shanks cooperates with other professionals. Regular meetings with other professionals and continuous collaboration with related organizations all over the world often become the sources of interesting discoveries and findings, which specialists share and then use in their practical work. Certainly, Mrs. Shanks does not forget about the impact of culture on language impairments. She believes that language impairments in children after brain injury impact their ability to create macro and micro structures in language, but these structures also heavily depend on the culture-specific language patterns, which children and their parents and or caregivers use in daily environments. As a result, separating culture from language therapy is undesirable and even impossible, given the importance of language for childrens subsequent development and learning. However, the most important aspect of Mrs. Shankss professional success is the emphasis she makes on continuous communication between children in groups. In all her findings and discoveries, she intentionally or unintentionally reveals her respect of and commitment to the principles of collaborative learning, where children have an opportunity to communicate with each other and with older care workers and caregivers, thus acquiring more effective language skills and learning how to overcome their language difficulties in different situations.

    Interactionist perspectives in language development and acquisition show language as the product of both biological and social processes. As a result, interacting with peers and older care workers is critical in treating language impairments in children after TBI. Mrs. Shanks, a care worker from Meath School, is the direct support of the interactionist view of language in such children. She makes special emphasis on the need for children to interact with each other and with other adults. As a result, practical communication creates a form of challenge, which children are bound to meet in order to articulate their ideas and memories to other children. Although collaborative learning also poses some problems, and although not all parents can readily understand and accept the principles of shared knowledge and shared authority that are essential for collaborative language development, Meath School seems to have been able to overcome these difficulties through continuous communication with parents. I personally believe that the interactionist theory provides excellent opportunities for maintaining a reasonable balance of social, psychological, and biological factors of language development in children with language impairments following TBI.