From educational theory, we learn that in order for the learner to engage in learning, they need to believe that success will result from their effort. ‘[People] need to have confidence that, if they put in the effort, they can succeed. If there is no hope, there is no motivation’ (Barkley, 2010, p. 11). Motivational theories that address student expectations include self-efficacy theories, attribution theory and self-worth models (Cross & Steadman, 1996). Self-efficacy theories state that the learner’s belief about their ability to succeed has greater importance than either skill level or task difficulty (Bandura, 1971, 1997; Corno & Mandinach, 1983). If the person has confidence in their ability to perform a task, they will be motivated to engage in it. This theory holds an important message for professionals working with people with ABI.

In the present study, participants were introduced to Keys to the ABI Cage, with a PowerPoint presentation explaining the three-step way of looking at ABI. They then examined the Keys to the ABI Cage model—looking at the different ‘talk-about’ cards and the numerous different objects. This process showed the participant how ABI can affect people, how people feel about ABI, and factors that help people cope using everyday (non-medical) language.

By rehearsing the method with the participants in several different ways (seeing and touching) and reviewing the PowerPoint introductory digital storage disc, participants could see that they could contribute and succeed in sharing their thoughts. As the participants identified issues that affected them, they were led to discover factors that had helped or could help them in the future. They isolated strategies through which they could help themselves. This approach assisted them to have success in their own learning. On many occasions participants said ‘You’ll understand…you have brain injury’. There was relief that they could open up and voice their issues and not feel ashamed (Fig. 5.2).

However, as argued below, perceptions of success and failure are also important particularly for people with ABI given their circumstances. The person with ABI may have experienced failure in every attempted task—in many things they do, inter alia—they cannot walk, talk or even eat properly. The individual may also face failure in everything they think, they do not know what day it is, they forget names (including their own name), they do not know what a cup or a hairbrush is and they cannot follow conversations. They attribute failure (and the resultant feelings of being dumb or stupid) to nearly everything. It was recognised that having such attributes could affect their willingness to engage with Keys to the ABI Cage and the study.

Weiner’s (1985) attribution theory states that students attribute success or failure according to their perceptions of why they might have succeeded or failed in the past. Weiner suggests that success or failure of tasks can depend on factors that include ability, effort, luck, fatigue, ease or difficulty of the task. If ‘success’ depends on attributes over which the person believes they have control, such as putting in an effort, a hypothesis was made that students (people with ABI) would be more likely to have confidence to be involved with the task rather than when success depends on external conditions over which they have no control, such as the difficulty of the exam (test, questionnaire).Weiner’s attribution theory suggests that the person with ABI, whose cognition, emotions, memory and confidence is damaged, may believe that failure is most likely because they attribute the situation to be dominated by external (outside the person), unstable (the outcome is not as intended) and uncontrollable factors. They are not ‘in control’.

In order to counteract these factors, the persons with ABI involved with this study were informed in the advertisement, and during the preinterview phone conversations, that their personal insights were important, their comments were valuable and that they would be able to choose what they said. Barkley (2010) has also shown how ‘success’ is built into a task: when there is no right or wrong answers, the person is encouraged and praised for their wisdom and the person has the power to control the discussion (Fig. 5.3).

Associated with promoting success in learning as described above is the fear of failure. Evasion can be a powerful strategy to maintain control for students who do not feel it possible to gain from learning. In the absence of personal control, Barkley (2010) posits that these students have a ‘low level of confidence and expectancy of failure [that] have placed them in a state of almost chronic disenchantment’ (Barkley, 2010, p. 14). These learners recognise the value of learning to accomplish a task, but feel incapable because they ‘aren’t certain of what to do or how to do it or they doubt they can do it’ (Barkley, p. 14).

The interview aimed to have participants involved in reflection, not involved in trying to figure out how to evade questions they did not wish to speak about.

The importance of preserving the participants’ self-worth was essential to all discussions relating to failure, success and having control. Cross and Steadman (1996) describe ‘failure-accepting students’ who are resigned to failure. They feel hopeless and respond to learning tasks with indifference (Cross & Steadman, 1996). To cope with failure in daily life, people with ABI need to accept failure as a minute-by-minute, hour-by-hour occurrence rather than as defining who they are.

When some students do not succeed, they would rather let people think they are lazy (question their effort) rather than think they are dumb (question their ability). Some students do not even try because they believe there is a low possibility of success—Covington (1993) refers to these students as ‘failure avoiders’. Similarly, people with ABI have to overcome their abhorrence of admitting they do not know how to do up their buttons or tie their shoelaces and their self-worth and self-esteem is affected by their differences and difficulties. Fear of failing and being seen as dumb can block and inhibit learning.

Keys to the ABI Cage method was developed to allow the participant to preserve their self-worth because the tool acknowledged their enormous challenges in an empathetic way and asserted that they had special insight and wisdom, which they were invited to share with others with ABI. Self-worth models put forward the hypothesis that people are strongly motivated to preserve their self-worth (Fig. 5.4).

‘Active learning’ principles were used in Keys to the ABI Cage. Learning is taking an idea or concept and making it part of the personal knowledge and experience of the learner. This is done by connecting concepts and ‘accommodating’ (Barkley, 2010)—fitting or altering the existing structure to accommodate the new learning and action as a result.

People grasp new information in different ways: some ‘through experiencing the concrete, tangible, felt qualities of the world’, relying on their senses and ‘immersing themselves in concrete reality’; some through ‘symbolic representation or abstract conceptualisation—thinking about, analysing or systematically planning’; some through watching others and reflecting on what happens—reflective observation; some ‘jump right in and start doing things—active experimentation’ (Kolb et al., 2000, pp. 3–4).

Coulson and Harvey (2013) propose a model of scaffolding reflection for experience-based learning: over four stages students need to be ‘supported to reflect’, to ‘reflect for action’, to ‘reflect in action’ and then to ‘reflect on action’. This model links learning to change through reflection and offers maximum agency to the person to convert thoughts to actions over time—to explore the ‘dropped handbag at the traffic light’ and to apply new forms of action to see what works.

People with ABI who may have an unreliable memory might panic when they forget what they were told or instructed to do. But having the Cage in front of them and ‘talk-about’ cards in their hands, they had a way to review the issues that led to certain conclusions as they figured things out for themselves. Additionally, people with ABI may become paralysed when trying to judge if they did give the correct answer, so they needed to know that it was okay to revisit their ideas (Fig. 5.5).

Keys to the ABI Cage was also devised to encourage what Csikszentmihalyi (1990, 1997) terms ‘flow’. Flow happens when the person becomes so absorbed in an engaging and interesting task that action and awareness merge. According to Wlodkowski (2008) in order to foster flow, firstly the goals must be clear and compatible, allowing the learner to concentrate, even when the task is difficult. This linked to ‘negotiated curriculum theory’, where goals are negotiated with the person. Secondly, the feedback was immediate, continuous and relevant so that the learner was clear about how well they were doing. Thirdly, the challenge carefully balanced skills and knowledge while stretching the learner’s capacities (Wlodkowski, 2008, pp. 267–268). These concepts were incorporated into Keys to the ABI Cage tool to establish flow (Fig. 5.6).

No single teaching and learning strategy is applicable to all people. It is necessary to differentiate sufficiently to allow differing engagement styles. de Sousa’s (1987) theory of association was implemented in Keys to the ABI Cage where a combination of pictures, symbols, objects and words was used to provide a framework to support the participant’s ideas. The participant was assisted to emotionally respond to the process by the purposeful use of humour and Keys to the ABI Cage being ‘different’ and eye-catching and a unique way to revisit their ABI experience in a safe space. Emotions were acknowledged as an important element in the whole ABI experience, as emotions can influence transfer and obtaining attention.

Brain scans have shown that retention can be improved when new learning makes sense and it can be connected to experience (Barkley, 2010). Memory difficulties affect every aspect of learning new information. By embedding strong emotional context, repetition and visual imagery learning was more likely to become part of long-term memories. Pictures and objects were used to help the participant make connections so they could make sense of and retain more than by simply reading or being told information.

As retention of the learning needs ‘adequate time to process and reprocess information so that it can be transferred from short-term to long-term memory…this requires time and usually occurs during deep sleep’ (Barkley, 2010, p. 23). By allowing participants to reflect further upon their concepts, they were given ‘Some Further Thoughts’ sheets so that they could record any further thoughts they had in the days following the interview (Fig. 5.7).