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Speech and Language Therapy after Brain Injury

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Speech and Language Therapy after Brain Injury Liz Ackroyd Jo Frost Therapy Midlands Ltd * * * * * * * * * * * * * * * * * * * * * * About Therapy Midlands A team of ... – PowerPoint PPT presentation

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Title: Speech and Language Therapy after Brain Injury


1
Speech and Language Therapy after Brain Injury
  • Liz Ackroyd
  • Jo Frost
  • Therapy Midlands Ltd

2
About Therapy Midlands
  • A team of speech and language therapists
    providing assessment and therapy to adults and
    children with speech, language, communication and
    swallowing difficulties.

3
Functional context sensitive rehabilitation in
brain injury Making therapy engaging, relevant
and facilitating generalisation
4
  • Im me not a patient and Im not YOURS
  • Person centred
  • Individualised approach
  • No-one like having decisions made for them and
    not everyone likes the same thing

5
(No Transcript)
6
What is Functional Context Sensitive
rehabilitation?
7
Focus and goals
  • Traditional therapy approach
  • Functional context sensitive rehabilitation
  • Improve performance
  • Eliminate or reduce impairment
  • Acquire compensatory behaviours
  • Reduce disability even when impairment persists
  • Achieve functional objectives
  • Participate in chosen activities
  • Change environment to reduce impact of impairment
  • Modify expectations/support

8
  • The goal may look something like this
  • Fred will successfully complete ___ meaningful
    task, with ___ supports, possibly using ___
    tools/strategies, in ___ context (setting,
    people, activities), in order to achieve ___
    goal.

9
Assessment
  • Functional context sensitive rehabilitation
  • Traditional therapy approach
  • Standardised tests identify strength and weakness
  • Use this to generate hypotheses about treatment
    approaches
  • Observation and ongoing hypothesis testing
  • Collaboration between all significant people
  • Battery of tests
  • Identify weakness and strength
  • Use for assessing and treatment planning
  • ?assumption that real world improvements will be
    associated with improvements on scores

10
Treatment
  • Traditional
  • Functional context sensitive rehabilitation
  • Impairment based work if it can be generalised
  • Practice on functional tasks
  • Practice strategies and compensatory behaviours
    in functional contexts
  • (Park Ingles 2001)
  • Goal to eliminate or reduce impairment
  • Isolated specific components of language
  • hierarchical

11
Setting
  • Traditional
  • Functional context sensitive rehabilitation
  • Out of context
  • Inpatient /outpatient settings by trained staff
  • Within context
  • Activities of everyday life
  • Personally relevant settings
  • Social/vocational/
  • educational

12
(some of..)The challenges of therapy
  • Limitations of generalisation
  • People live in the real world following traumatic
    brain injury
  • Time
  • Cost
  • Engagement
  • Training

13
The rehabilitation journey
  • Early- dealing with shock and quickly changing
    picture.
  • Post acute rehabilitation- conflict between hope
    and revealing limitations not ready to fully
    engage in all that rehab can offer
  • Post hospital discharge- identifying abilities
    and a changing sense of self
  • Most able to engage with functional context
    sensitive rehabilitation

14
  • All therapeutic interactions need to consider the
    functional impact it can have
  • On the ward making basic choices enabling people
    to make discharge decisions giving some control
  • In order to live successfully with the impairment
    people need to be able to take charge of their
    lives as much as is possible

15
Living successfully with acquired communication
needs
  • Accept your new reality come to terms with the
    loss
  • Take charge of your life living as
    independently as possible whatever that means
  • Learn communication skills even if just pointing
    to something or setting a topic using whatever
    means

16
  • Build strong relationships engaging with others
    is one of the best ways of facilitating recovery
    post stroke
  • Get involved in activities old routine, adapt
    find new ones that suit you better now
  • Develop a sense of purpose a fulfilling life is
    rooted in a sense of purpose
  • (Brown et al, 2010)

17
What does it actually mean?
  • Developing a new sense of self
  • Goals and aspirations for this new self
  • Eclectic and thinking outside of the box to
    incorporate therapeutic opportunities within
    meaningful, everyday interactions
  • Facilitating maintenance of friendship/support
    network

18
Project approach
  • The individual works on a meaningful goal which
    will have an outcome
  • The therapist gets to use this as a platform in
    order to work on a number of skills and
    strategies

19
  • Focus Motivation
  • Decision making
  • Specific language skills
  • Social communication skills
  • Personal identity
  • Processing,
  • Planning
  • Organising

20
John
  • 35 year old
  • Traumatic brain injury
  • 3 years ago
  • Wheelchair
  • Aphasic
  • Reduced insight into some of his difficulties
  • Goal I want to be able to drive

21
(No Transcript)
22
Look for functional opportunities
  • Technology
  • The I pad and smart phones offer endless supports
    prompts and therapeutic opportunities.
  • Diary
  • Spell checker
  • Semantic feature analysis
  • Project management
  • AAC devices

23
  • Social media offer possibilities of information
    sharing support reducing isolation.
  • Face book
  • twitter
  • Personal blogs as a mechanism for coming to terms
    with a new sense of self
  • With caution!!

24
And finally.
  • Demonstrate respect all the time, especially when
    interacting with someone that you dont like (or
    who doesnt like you!).
  • Seek the insights of everyday people --find the
    hidden experts and use their expertise.
  • Keep your hat in your hand never forget you will
    always be a visitor in the life of the person
    with whom you are working.

25
tweeters
  • _at_lostVoiceGuy
  • _at_wifeofstroker
  • _at_neurohero
  • _at_pvssupportgroup
  • _at_tactusTherapy
  • _at_grace_carpenter
  • _at_aware4aphasia
  • _at_lafcadio01
  • _at_madrunkate
  • _at_diffstrokes
  • _at_connectaphasia
  • _at_headwayUK ( and all the regional groups)
  • _at_thestrokeassoc
  • _at_UKABIF
  • Can be useful! Use with caution

26
  • Follow us on twitter
  • _at_SALTatTM
  • You can download a copy of this presentation from
    our website
  • www.therapymidlands.org

27
  • Thank you for listening
  • Does anyone have any questions/comments??
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