SARAH Network - Brazil
| Fifth Dimension Program |
The SARAH Network of Rehabilitation Hospitals and the University of California at San Diego, Center for Human Development, in the United States have been working together on the Fifth Dimension (5D) program in Brazil for several years now.
The 5D was developed by the Laboratory of Comparative Human Cognition at the University of California at San Diego (UCSD) and comprises an educational endeavor that utilizes mediation techniques in play-based activities to promote children’s learning and development. It involves groups of children and undergraduate college students, and is presently active in various parts of the world, bringing children, parents, professionals and students together for learning and growing. |
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The Fifth Dimension as it is being developed at the SARAH Network is unique to the other 5D programs in that, over the last 18 months, it has consisted of groups of children with cerebral palsy and, in July of 2007, a new group of children with traumatic brain injury (TBI).
The child’s involvement in this program constitutes an extracurricular activity where collaborative learning is mediated by social interactions, computer games, board games, as well as artistic and musical activities. Although the program uses computer and communication technology, other types of interaction are also created based on each group’s interests. The child’s participation in 5D is free and guided by individual objectives. It is the child who decides where to begin, how to proceed, when to change the activity and with whom to interact. The aim is to create an interactive, therapeutic environment that generates situations which can simultaneously motivate and encourage the child’s emotional involvement in the proposed activity and promote the college student’s learning and development. |
The SARAH Network |
The SARAH Network comprises 8 staffed, fully-operational rehabilitation hospital facilities dedicated primarily to the treatment of neurological problems in children and adults, and a University specializing in the neurosciences and neurorehabilitation. The SARAH Network and the University place great emphasis on research, teaching and clinical activities. The Network hospitals also attend to different areas of Brazil, with cultural variations and social traditions impacting on the main pathologies. SARAH treated over 93,600 individuals, admitted over 31,000 new patients and performed approximately 18.5 million medical and paramedical procedures in 2006 alone. The main childhood pathologies treated at the Network are neurological, namely pre- and perinatal stroke, schizencephaly, encephalomalacia, cerebral palsy, hydrocephaly, traumatic brain injury, tumors, epilepsy and spina bifida.
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| SARAH & UCSD Together |
| The components of this collaboration include examining human interaction and the use of computers, with a focus on several specific issues: the therapeutic intervention of the child with early onset brain injury; the neuroscience of development, particularly the relationship between brain plasticity and learning; and the effectiveness of structured, interactive activities based on cognitive tasks as a means of promoting socialization, learning, and development of individuals with neurological disorders. This collaborative project may generate further studies, which are essential to the consolidation and ongoing expansion of the interdependent cooperation between these two institutions. |
| The 5D project at SARAH involves a very heterogeneous group of children with cerebral palsy, with ages between 8 and 12. All of these children have varying muscle tonus and motor disorders (mixed tetraplegia, spastic triplegia, spastic diplegia and spastic hemiplegia). Levels of motor independence range from independent gait to assisted wheelchair use. From a cognitive point of view, formal WISC tests reveal IQ scores between 80 and 120 but these averages mask the fact that for every child in the group, verbal scores were higher than performance scores. Some children have attention deficits and visual impairment, i.e., strabismus, problems with acuity and hemianopsia. The families' socio-economic levels also vary greatly. While some of the parents have not finished grade school, others have a high school diploma, a college degree or a PhD. |
| This project relies on the integrated work between child, family, students and rehabilitation team. For the child with cerebral palsy, the 5D environment is a departure from a formal education setting. Consequently, the activities in this program help foster: the intellectual and social development necessary for participation in social and academic life; skill at using a computer as a means to accessing new technology; motivation for academic learning and; participation in interactive group situations. The activities are pleasurable, meaningful and developed in such a way that will allow them to be transferred to daily life. |
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| Activity groups have been created, each one comprised of: college students that are engaged in the different modules being offered, children with varying levels of participation in the project, and the rehabilitation team. Depending on the practice, individual talent and involvement in the project, the students can take on different tasks within the group. The goal is not to establish a hierarchical structure; on the contrary, it is characteristic of the 5D that the setting be plural in the sense of human diversity and the contribution of individual experiences for the constitution of a microcosm of social interactions. |
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| Support groups have been created for the parents to address their concerns and discuss the 5D program. To foster discussion and exchange, the parents watched educational videos, read articles on related subjects, and were given information about brain injury and development, as well as practical suggestions on managing their child’s needs. The 5D routine was organized to give the parents, the children and the rehabilitation team different moments of interaction during the day’s activities. |
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Educational Aspects: The Undergraduates |
| One of the aspects of the 5th Dimension is the educational opportunities that it offers the undergraduate students involved in the program. This project has been developed, in part, as a practical Continuing Education Course in Pediatric Rehabilitation based on cultural psychology at SARAH University for Rehabilitation Sciences. In this hands-on program, college students interact with children who have cerebral palsy in mediated situations, thereby encouraging critical thinking and reflection about the practical aspects of the activities. The 5th Dimension helps promote the student’s ability to formulate clear questions, seek out appropriate answers with the help of a the children, their fellow undergraduates, and the professional team, thereby also expanding their theoretical bases. The process yields results in critical thinking, knowledge, self-confidence, and personal growth – which can all be incorporated into the practical activities with the children. As the students analyze and reflect on the interactive situations with the children in the 5th Dimension, they gradually become active participants in a process of change of which they, too, are subjects1. Based on a situation of mutual cooperation, the project offers the chance for the undergraduate students to acquire experiences that will enrich their discussions and broaden their reflections throughout their undergraduate education. |
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Associated with the practical aspects of training and education, the project aims at a close link between teaching and research. As a team, the students engage in and focus on the study and analysis of situations experienced by the child-student team in day-to-day practice. The undergraduates participate in collecting and analyzing research data involved in the decision-making process and all aspects pertaining to overall decisions and basic premises of the study. The students’ discovery process is guided by professionals from the rehabilitation team (physicians, neuropsychologists, teachers, physical therapists) working in constant cooperation. |
Results So Far |
Results thus far at SARAH have been extremely encouraging. Children participating in the program have shown such marked improvements in their cognitive and social development that their teachers are coming to SARAH to find out what is going on. Parents also report generalized improvements in several developmental domains that have the net effect of making the children more independent. Other areas have also showed marked changes: Generalization of learning: At the beginning of the program, the children were evaluated while playing the Tetris game during an fMRI exam. Although they do not play Tetris as part of their training in the Fifth Dimension project, they nonetheless all scored better in the games when assessed at semester's end. Neuroimaging/learning: In the first post-Fifth Dimension semester, we observed an increase in bilateral activation of the brain areas involved in the activities. This demonstrates that the children were more engaged in the activity (the first pre-Fifth Dimension evaluation revealed less activation and very low game scores). After 12 months the same neuronal network was activated bilaterally, but with a significant decrease in the activation volume, which seems to indicate that learning was consolidated. Self-image (Self-concept): We evaluated the children's self-image prior to starting the program. Children who had problems with self-image and self-esteem showed significant improvement at each subsequent evaluation, especially in the social and personal contexts and in the final scores. Interaction/independence: The children, parents and teachers each answered a questionnaire with 26 items. The results showed that, with time, there was substantial improvement in the children's independence levels and in their interaction with others in different settings; interestingly, the children themselves noticed the greatest changes in the various dimensions. Changes in the parents: After observing their child's improved independence, interactions, self images and computer-based learning, a number of parents said that they were seeing how much their child was really progressing. One mother stated, "She changed a lot, but I think that I changed even more. The way I see my daughter has changed. I've started to value her opinions, to respect her." Another mother said, "I now see that my daughter can be independent. I even let her Other parents reported: "[My daughter] Carla* was stagnated but now she’s grown a lot. She’s more independent and she even traveled by herself during vacation... She’s more self-confident and is making new friends. She was an actress in a movie made here [at the 5D]. That experience was very important for her.” “[My son] Roberto* has changed so much – and so have I. He was very dependent on me but now I let him go some places alone. He’s become more independent. I’ve gotten better too; I used to cry a lot because I couldn’t accept it when he messed up. I believe in him more.” “Fernando* had a difficult time being accepted, especially in school. At home he almost didn’t engage in anything. Now he’s doing more things on his own. His self-esteem has gone way up, if someone at school harasses him he answers by saying that prejudice is a crime! There’s a boy in our neighbor who used to call him ‘cripple’. One day Daniel drew a child in a wheelchair and wrote on it: Prejudice is a crime – I am physically challenged!” Teachers: “...Ana* started the 5D program and, after about two weeks, she started to speak up, started showing us the problems she was having, the things that she was interested in, started interacting more with her classmates, became empowered in her learning. Now she asks questions, is more responsible with her work and her growth has been excellent. […] She stopped being a spectator and became a participant, began socializing. All this started happening rather quickly…” * Names have been changed to protect the children’s privacy
Twenty-five undergraduates have participated in the 5D at SARAH over the last 18 months. In their own words: “…Our freedom at the university is limited, and so is our participation in formulating the activities... at 5D I saw that we weren’t there only to put preformulated activities into practice. We were there to create alongside the professionals. I saw myself in a totally new situation...” |
