Relevance
Kim Watkins, M.Ed.
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Relevance – what a great word. “What relevance does that point have?” “Is this behavior relevant to what we are doing?” “Move to strike your Honor. Irrelevant!” A vegetarian cookbook has little relevance to the Cattleman’s Club. A degree in textile making has little
relevance to a car manufacturing company. Ralph Lauren clothing has little relevance in the monastery. Relevance is defined as having a bearing on or connection with the matter at hand: having meaning, being of interest (Lexico Publishing Group, 2004). It is a feeling that accompanies or causes special attention to an object or class of objects; something that arouses such attention; a quality in a thing arousing interest (Merriam-Webster, 2004).

And that would be the hook – arousing interest. Something that has meaning to one arouses one’s interest. If one is interested, one attends. If one attends, learning probability increases. If one learns, one is more apt to develop a skill. If one develops a skill, one is more likely to repeat it. If one repeats the skill in different environments, one is generalizing. If one applies a skill successfully in a variety of areas, one is illustrating –TA DA– MASTERY! So the golden egg that we seek is really mastery. Relevance begins the process of attaining mastery.

For those of us that remember high school math, one of the biggest complaints was “I will never use this. “ An entire curriculum of “applied” mathematics has been developed in answer to this complaint. Students learn math principles as they need them in the process of planning, designing, or building something. They learn geometry for building stairs, trigonometry for rooftops, and physics for the ever-popular Hovercraft. (I understand that even the most truant of students never skip Hovercraft class.) The knowledge has a functional application, and thus, is given meaning. It’s difficult to apply oneself to a task that is fruitless (that is, not bearing fruit); that has no outcome; that is pointless, meaningless, without relevance. In rehabilitation, we seek mastery or an approximation thereof. Attainment of mastery necessitates – you’ve got it – relevance! Relevance is a very good word.

Now, learning, assimilating, and generalizing information is demanding enough in itself. Information enters the brain via multi-modalities: sound, sight, touch – all the senses. Information must be stored in a specific area of the brain for a period of time. Your brain then decides if it is important enough to make it a memory; something that may be retrieved and used again. The brain is a magnificent computer. It knows how to prioritize. It decides what is important and stores the information based upon its – yep, here we go again – relevance. So, to attain mastery we need relevance. Now, how does one make information relevant?

According to Cahill (1998):

…it would be very stupid of Mother Nature to have created a brain that remembers everything equally well, that would be a very bad idea. It must have ways of weighting information storage and creating memories whose strength is roughly proportional
to the importance of the things we’re to remember. This is a much smarter thing for Mother Nature to do and it's those weighting mechanisms that we think operate on the consolidation of memories that is what we focus on when we talk about emotional arousal influencing
the memory storage process.

It would seem that to make rehabilitation valuable, one must choose or create activities that another’s brain considers worth prioritizing. What we have here are the basics of learning. People don’t attend unless they are interested and motivated, whether they are aware of it or not.

Many folks with brain injuries have problems with frontal lobe functioning. Frontal lobes control motivation. We must incorporate bonus motivation to get past, by or around problems with the frontal lobes. Then we must reinforce this motivation to continue this process. Remember, reinforcement must be what the person being reinforced finds relevant, not what anyone else finds relevant. (Some people would not give two nickels for tickets to see the Kansas City Royals, but would give an arm and a leg for tickets to see the Kansas City Ballet.) In theory, and what I have found in practice, if the task is interesting and the reinforcement is relevant enough, one retains information. Once there is consistent retention (remember we are talking about memory issues here, so there may also need to be repetition), we then have generalization. General- ization is the ability to demonstrate a skill in a variety of areas.

Now that we have had a miniseries in learning theory, once again, the question is: how does one create relevance or motivation? The answer is with creativity. The old dog-and-pony show. Interest, laughter, challenges, and tap dancing if that’s what it takes. Males 14 to 24 years of age are at highest risk for a traumatic brain injury (so probably the Royals and not the ballet tickets). I have always been amazed that rehabilitation professionals think they can sit an 18-year-old down, who quit school at 16, who lived independently (and often not well) since 17, and who had a motorcycle accident (with a high blood alcohol content and no helmet) at 18, in front of a work sheet with a number 2 pencil and expect him to attend. There is not a lot of relevance happening there. When adults sustain a TBI, they are able to apply their accumulated life experiences and knowledge to make adjustments and adaptations after the injury. These experiences may include work-related activities, family responsibilities, and previous education. Their learning post-injury is connected to this knowledge/experience base (Lieb, 1991).

But what do you do with a kid whose knowledge base and life experiences are very different from the adult? How about an obstacle course with conga music? The obstacle course arouses his sense of competition. It offers movement (afterall, this gent was not working on a work sheet when he had his accident). It works on timing, balance, endurance, and sequencing. The music may seem odd but as Budd (1992) observes:

…there is a whole profession of music therapy and the evidence is that indeed music therapy can have a very profound effect, particularly because for a lot of people, it's not an area which they're particularly expert in, and therefore, the kinds of self presentation issues which are around in other areas in their life, are not around in music, and very often they can express through music because it's in some sense uncomplicated and uncluttered, things which they perhaps can't express or can't allow themselves to express in the media which they're more familiar with.

Now, of course, Conga music is not a must in this situation, but music adds an important imension. One of my all-time favorite “redirection” experiences was with a gentleman that had an extremely significant brain injury after being struck by a train. Because he experienced his injury long before brain injury rehabilitation was in italics, nobody really knew how to handle him. This poor gent ended up institutionalized in a state facility for almost 16 years before we encountered one another. By then, he had learned a lot of behaviors in addition to those directly related to his injury. There were times when he would become completely out of control with no discernable antecedent to his behavior.

One day, quite by accident and mostly out of desperation, a therapist began singing “Home on the Range,” as this participant commenced to assault him. The gent stopped, smiled (he had a beautiful smile, by the way), and began singing along. The behavior that had destroyed an enormous amount of property (including a table full of lunch on one occasion) was stopped by singing. It always had to be that song. We tried other songs without success and quickly went back to “Home on the Range.” We did not know why this worked. After some head-scratching, we decided that it didn’t matter why it worked, only that it worked. So, we began using “Home on the Range” as a reinforcer since it was so effective. When
he displayed adaptive behavior, we literally sang. It was not your standard fare, but if music worked, then music it would be.

Other motivators (reinforcing, thus relevant) are much more planned. A participant needed to lie on a mat on his back to stretch his stomach muscles. This was an exercise to aid in sitting balance. He had been stooped over in his wheelchair and had very tight stomach muscles. It hurt to stretch them; it hurt so much that he did not care about sitting balance. When asked what would get him to lie on his back, he made the statement, “A girl.” Now whether I felt this was sexist or inappropriate did not much matter. What mattered was that he lie on his back so that he could eventually sit up independently. We approximated. Posters of Britney Spears and some Sports Illustrated-type females were taped to the ceiling above the mat. This gent, who often required two people to transfer him, all but jumped from his chair to lie on the mat. One does the best they can with what they have (Theodore Roosevelt, sometime in the last century).

“You don’t see many neuro-rehab programs where the participants are walking around drinking beer.” This is what my former boss (not former by virtue of the beer) said when he showed up in the middle of our fish fry. “It’s near beer-I swear!” In rehabilitation, one talks a lot about what one can’t do anymore. It seemed unrealistic that a twenty-something participant, who spent the majority of his time in pool halls and at rodeos, would stay away from any of those places. A fish fry with beer: same idea. There were all kinds of training processes and experiences available through this activity. Experience dictates, especially in rural areas where there are not a lot of options for young folks, that they will go back to pool halls, rodeos, and fish fries. It’s not our job to teach them not to do these things. It’s our job to teach them to do these things safely. And by the way, motivation is typically not an issue with this activity. One gets to fish, fry, drink, be outside, and throw washers while waiting for the fish to fry. It has meaning. Participation is ensured. People like it. That’s because it is relevant.

Now, take shooting pool. One moves through space and knows where one is while moving through space (proprioception). Hand-eye coordination is required to shoot the balls. Range of motion takes place to move the cue. It all comes about incidentally as a component of the game. Pool requires sequencing, pragmatics, and balance. Korrick (2003) states:

Maintaining balance is a complex process in which information coming in from the eyes, inner ear, and sense of touch tells the brain what position the body is in, as related to its surroundings. The brain then processes the information and passes it on to the muscles and joints in the body to coordinate the movements needed to maintain balance. The brain also passes on information to the eye muscles to help position the eyes so the person can see clearly while moving.

Balance may be addressed with balance beams, boards, and walking a straight line. Sequencing may be addressed with sequencing cards and rote activities. Hand-eye coordination may be addressed through a variety of rote activities (a personal favorite of meaningless work is the huge shape boards that are filled, dumped out, and filled again). All this, when one could be playing a couple of games of pool and getting the same benefits. If you were a twenty-year-old male which activity would be relevant?

All too often adversarial interactions occur and poor relationships develop between those requiring and those providing services. Sometimes it is the nature of the injury. Many times it is the nature of the remediation. Boredom and an unwillingness to participate in meaningless activities are reported as behavior problems. Many times the “problem behavior” is on the part of professionals offering services.

When activities offered to those served are relevant, negativity within the therapy process is diminished. Stevens (2003) points out:

The three immediate outcomes of harmonious functioning--peak learning, peak performance, and peak happiness--are usually followed by three delayed outcomes. These delayed outcomes are less certain, but can have powerful effects over time. These delayed outcomes include increased liking for the activity, increased self-esteem, and increased physical health. Increased liking for the activity per se causes us to want to do it more.

Relevance--a feeling that accompanies or causes special attention to an object or class of objects; something that arouses such attention; a quality in a thing arousing interest (Merriam-Webster Online, 2004). So, we are back where we began. If those served need to learn to walk, talk, and interact with their world all over again, we could spend just a little time being interesting. It’s not that hard to be relevant.

References

Budd, M. (1992). Music and the emotions: The philosophical theories. London: Routledge.

Cahill, L. (Interviewee). (1998, June 1). Emotions and memory: How different emotions influence one’s memory. Radio National: The Health Report with
Normal Swan [Radio broadcast/interview]. Retrieved March, 2004, from http://www.abc.net.au/rn/talks/8.30/helthrpt/stories/s11051.htm

Korrick, S. H. (2003, June 6). Balance problems after brain injury. Retrieved March, 2004, from Brain Injury Resource Foundation database:
http://www.birf.info/artman/publish/article_74.shtml

Lexico Publishing Group, LLC. (2004). Dictionary.com. Retrieved May, 2004, from http://dictionary.reference.com/search?q=relevant&db

Lieb, S. (1991, Fall). Principals of adult learning: Adults as learners. [Electronic Version]. Vision. Retrieved May, 2004, from University of Hawaii, Honolulu Community College Web site: http://honolulu.hawaii.edu/intranet/committees/FacDevCom/guidebk/teachtip/adults-2.htm

Merriam-Webster Online. (2004). Retrieved May, 2004, from http://www.m-w.com/cgi bin/dictionary?book=Dictionary&va=interest

Stevens, T. G. (2003). How does harmonious functioning affect self-esteem, health, and motivation? You can choose to be happy. Retrieved May 17, 2004, from http://front.csulb.edu/tstevens/h73DELAY.HTM

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