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The Brain, injury, and a few things to overcome!

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Title: Acquired Brain Injury Author: MACNEILK Last modified by: Kim Created Date: 2/28/2006 7:52:30 PM Document presentation format: On-screen Show (4:3) – PowerPoint PPT presentation

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Title: The Brain, injury, and a few things to overcome!


1
The Brain, injury, and a few things to overcome!
  • Presented by
  • Kim MacNeil
  • Occupational Therapist
  • April 2012

2
Outline
  • A little about the brain
  • What is an Acquired Brain Injury (ABI)?
  • Recognizing symptoms of ABI and strategies to
    work with
  • Positive Everyday Routines
  • Hypothesis Testing

3
THE BRAIN
4
The Brain
5
ANATOMY The Brain
6
NEURON
7
NEURONS Its grey and white
8
ANATOMY The Skull
  • The Brain in Bed
  • The Brains Bed

9
What is an Acquired Brain Injury (ABI)?
  • Traumatic Brain Injury result of external
    trauma
  • fall, car accident, fight, gun shot,
  • Non-traumatic result of internal source
    injuring the brain
  • Hypoxia (lack of oxygen) - near drowning, heart
    attack, fainting game, stroke (block)
  • Toxicity, meningitis, rabies, infection, stroke
    (bleed)

10
NEURONS BRAIN INJURY
11
Focal (LOCAL) VS Global (DIFFUSE) Effects
  • Coup Contra coup
  • Acceleration Deceleration
  • Rotational Shearing
  • Hematomas
  • Edema
  • Disruption of neural connection

12
Did you know
  • Level of severity is not necessarily directly
    related to outcome
  • A concussion is a brain injury too
  • Dont have to loose consciousness to sustain a
    brain injury
  • Younger is not necessarily better when it comes
    to recovery

13
NS Leading way in preventing ABI
  • As of Nov 1, 2012 everyone in Nova Scotia is
    required to wear protective helmets while
    downhill skiing or snowboarding at ski hills.

14
Recovery/Long Term Effects
  • Most (but not all) recovery occurs within first 2
    years
  • Area and extent of damage
  • Physical recovery
  • Individual
  • Environment

15
HOPE
  • Outcomes vary
  • Severity of injury does not always coincide with
    severity symptoms
  • To have hope is to envision something beyond what
    istherefore there is a goal to work towards.
    Break it up into smaller achievable goals and
    work on them one day at a time.

16
Invisible Injuries of the Brain
  • By Debbie Wilson ( survivor from Murphysboro,
    Illinois)

17
Critical factors for successful reintegration
  • EDUCATION of persons involved regarding brain
    injury
  • OPEN COMMUNICATION between all persons involved

18
Previous Approaches
  • Common mistakes include quizzing people, and
    allowing people to make the same mistakes over
    and over again so they will learn from their
    mistakes
  • Previously gave lists to remember then tested
    later

19
Errorless Learning
  • Methods of learning whereby attempts are made to
    prevent (or reduce the likelihood of) errors
    being made during the learning process.
  • Avoid trial and error learning or attempting to
    learn from ones mistakes
  • Compensate for the memory deficit by providing
    the person with the right answer from the start
    and prevent mistaken guesses.

20
Errorless Learning
  • When the right answer is not given and the
    individual is forced to guess or figure out the
    answer, errors are likely to result. When wrong
    answers are repeated, the person may learn the
    wrong answer (i.e. reinforced) instead of
    learning the correct information.
  • Errorless learning is not an intervention or
    treatment but rather a principle of learning
  • i.e. cueing instead of quizzing during transfer
    practice

21
Impairments associated with ABI Strategies
22
SYMPTOMS OF ABI COGNITION
  • New Learning
  • Attention and Concentration
  • Memory
  • Organization
  • Perception
  • Reasoning
  • Problem Solving
  • Initiation

23
New Learning
  • New material in small amounts
  • Repeat and summarize previous relevant info
  • Offer varied opportunities to use info
  • Use relevant meaningful examples
  • Check comprehension frequently
  • Allow additional time
  • Errorless Learning

24
Attention Concentration
  • Consistent, predictable, regular routines
  • Limit distractions (e.g. doors, windows, other
    students media)
  • Redirect
  • Provide breaks
  • Monitor for signs of decreased attention/concentra
    tion (redirect, cue, allow for rest)

25
Memory
  • Links to prior knowledge
  • Categorize or chunk info into small amounts
  • Repetition, repetition, repetition
  • Memory aids (e.g. sticky notes, phones apps)
  • Cues (visual, verbal, physical)
  • Rhymes, songs

26
How dinosaurs became extinct!
27
Organization
  • Establish maintain daily routines
  • Daily Schedule
  • Provide outlines check for note taking
  • Cue I will give you a moment to write that down,
    put that in your calendar/phone
  • Use checklists
  • Repetition, repetition, repetition

28
Perception - Vision
  • Visual Stimulation (e.g. over/under stimulation,
    clutter)
  • Use arrows/highlighters
  • Contrast colours to encourage important
    information to be identified

29
VISUAL CONTRAST
  • LOW CONTRAST
  • HIGH CONTRAST

30
Perception - Auditory
  • Limit excess noise (e.g. lower voices)
  • Establish clear eye contact
  • Be clear and specific, check for understanding
  • Use non-verbal cues

31
Reasoning
  • Provide concrete examples
  • Allow them to do the task whenever possible
  • Be direct Lets review your plan
    (Goal/plan/do/review), how did that work out for
    you?
  • Set up opportunities to learn elsewhere (e.g. at
    home)

32
Problem Solving
  • Frequent feedback
  • Compensate (lists of options)
  • Step by step (e.g.ok you checked off the first
    thing on the list, next it says you will.
    hmmm, you have completed step 1, step 2 says)
  • What do you think about? Could you?
  • Plan ahead, role play scenarios
  • Develop Scripts (e.g. no answer for test)

33
Initiation
  • Cues (verbal, visual, physical)
  • Schedule/journals/apps/reminders
  • Give options, lead (you got your pencil and the
    paper)
  • Structure, predictability, routine

34
ABI SYMPTOMS BEHAVIOUR/EMOTION
  • Agitation/frustration
  • Disinhibition
  • Aggression
  • Poor social behaviour poor awareness of
    consequences to actions
  • Depression/Self Image

35
Frustration
  • Allow opportunities for success
  • Identify antecedents to frustration
  • Chunk work into smaller manageable parts
  • Provide alternatives to acting out
  • Take a break
  • Recognize symptoms and feelings

36
Disinhibition
  • Provide chance for open, safe, communication,
  • Respond consistently (e.g. script), respectfully
    and clearly
  • If possible practice ahead of time
  • When possible be context specific
  • Use script to respond when inappropriate

37
Aggression
  • Be aware of signs of escalation
  • Use redirection
  • Be calm and aware of your body language
  • Cue them to increase awareness of their feelings
    ( I sense you may be frustrated)
  • Manage triggers (e.g. overstimulation noise,
    light, colours, fatigue)

38
Social Behaviours
  • Provide opportunities to practice appropriate
    behaviours
  • Be direct, specific, non-judgmental
  • Create Scripts
  • Set social goals
  • Role model/role play

39
Depression Self Image
  • Focus on abilities, avoid comparisons to
    pre-injury self
  • Validate emotions and work on changing them
  • Recognize symptoms withdrawal, lethargy, lack of
    interest in appearance, feelings of hopelessness
  • Liaise with family, friends, health care
    professionals

40
ABI SYMPTOMS PHYSICAL
  • Pain/discomfort, FATIGUE, Seizures, Sleep
    Disturbances, Headache and/or Tinnitus
  • Sensory disturbances
  • Musculoskeletal issues
  • Poor environment/person fit
  • Visual field neglect

41
Physical
  • Cognitive and Physical Fatigue
  • Allow for rest, shorter days, frequent breaks
  • Seizures
  • Educate on protocols, monitor, log, aware of med
    side effects
  • Sleep
  • Insomnia or excess, need for naps, everyday
    predictable routines

42
Physical continued
  • Fine Motor
  • Use computer, reduce written work, verbalize,
    time extensions
  • Mobility
  • Seating issues, adaptive equipment, accessibility
  • Self Care
  • Cue if necessary
  • Visual field neglect
  • Seating, large print, other modalities

43
Transfer of Training
  • If you want people to learn something teach it
    to them. Dont teach them something else and
    expect them to figure out what you really want
    them to do.
  • - Thorndike
  • Teach what needs to be learned in the context of
    when and where it will be used
  • Everyday functional activities are the best
    context for cognitive intervention

44
Positive Everyday Supportive Routines (PESR)
  • Positive Successful and Supported
  • Everyday In the context of everyday life,
    supported by everyday people, using functional
    teaching goals
  • Support Social collaborative, goal-oriented
    work, in a natural context
  • Routine Habit, organized scripts and supports in
    the context of everyday life

45
Basic Principles of PESR
  • The person is the core of all intervention and
    support efforts
  • Interventions and supports are organized around
    personally meaningful activities with everyday
    people (person, teachers, classmates, family,
    friends etc)
  • Positive everyday routines are the context for
    pursuit of meaningful goals

46
Basic Principles of PESR
  • Reduction of supports is part of the plan
  • Feedback is context sensitive and meaningful
  • Components of life must be integrated
  • Assessment is ongoing and context sensitive
  • Behavioral concerns are addressed via positive
    behavioral supports

47
Importance of Routines
  • Routines have a positive impact on
  • Independence
  • Problem Solving
  • Planning
  • Organization
  • Learning (i.e. able to learn physio exercises but
    can not remember am care)

48
Everyday
  • Find out what is meaningful to them and explain
    everyday things to them (i.e. their progress, a
    procedure and so on) in that context
  • Examples NASCAR, Electrical Work

49
Steps to Organize Routines
  • 1. Identify successful and unsuccessful
  • routines of everyday life. Whats
  • working, whats not working?
  • 2. Identify changes that have the potential
  • to transform unsuccessful routines into
  • successful routines (including changes
  • in the environment and the behaviors
  • of others.)

50
Steps to Organize Routines
  • 3. Identify how changes in routines include
  • activities that are motivating to the person.
  • 4. Implement needed supports to organize routines
    so that the individual experiences success and
    receives intensive practice in
  • context.
  • 5. Gradually withdraw supports and expand
    contexts as much as possible.

51
Goal
Plan
Predict
Do
Review
52
Hypothesis Testing
  • Common sense approach of systematically teasing
    out what contributes to failure and what
    contributes to success.
  • Poor performance happens for many reasons, we can
    perform well by applying many different supports
    and strategies

53
Steps to Hypothesis testing
  • Identify a problem
  • Formulate all hypothesis
  • Select a hypothesis
  • Test hypothesis
  • Review results

54
Scripts
  • Scripts structure involvement / interaction with
    promote procedural learning (steps to do, knowing
    how to do it, automatic)
  • Conversation non-threatening
  • Well selected language
  • Mass practice
  • Embedded in meaningful activities
  • Across everyday partners (team, family)

55
Scripts
  • Positives
  • Allows people to think out loud
  • Gain self awareness
  • Coach person to be their own coach
  • Facilitates typical development of executive
    functions (Higher level cognitive tasks such as
    problem solving, reasoning, attention, self
    awareness)

56
Scripts
  • Scripts may be used for different daily
    interactions including
  • Orientation Script
  • Problem Solving
  • Behavioural
  • Big deal/Little Deal
  • Experimental Routine

57
Example Orientation
  • Say Hi _insert persons name__, it is a
    ___weather__(i.e. fairly mild day) for December
    __. I cant believe Christmas is in only_____
    days. The year 2004 is almost over. I know you
    have been meeting many people since you came into
    the hospital on October 16 so you may not
    remember me. My name is ____________ I am your
    _____________ (i.e. friend from __________, your
    therapist). I just came by to see if .

58
Contextualized Collaborative Hypothesis-Testing
Whats the problem? (Using the two strangers in
the doorway rule)
Hypothesis Formulation (Why is s/he doing this?)
Hypothesis Selection (Begin with easiest to test
or most obvious)
Hypothesis Testing (Protocol for
experimentation Plan A - Plan B - Plan C Testing
time line)
59
Summary of CLASSROOM STRATEGIES
  • Emphasize function
  • Provide low stimulus environment
  • Role play socially appropriate beh
  • Assist with organizational skills and attention
    to task
  • Allow for frequent breaks and rests
  • Allow for extra time
  • Repeat new information frequently
  • Maximize opportunity to practice new skills

60
Summary of CLASSROOM STRATEGIES cont
  • Prepare ahead of time for transitions
  • Recognize signs of frustration and assist in
    decreasing
  • Consistent and predictable routines
  • Clear expectations
  • Focus on positive everyday supportive routines
  • Communicate regularly with stakeholders
  • Become informed about ABI

61
Just because
  • One strategy is learned doesnt mean it will be
    used again OR generalized to other tasks
  • Someone can tell you all the steps to complete a
    task it doesnt mean they can do it

62
Patience, Flexibility, Forgiveness
63
References
  • Bennett, Dr. S., Good, Dr. D., Kumpf, J.,
    (2003). Educating Educators about ABI. Brock
    University and the Ontario Brain Injury
    Association.
  • Wilson, D. Invisible injury of the brain.
    Newsletter of the Brain Injury Association of
    Canada (2012, February). Retrieved from
    http//biac-aclc.ca/en/category/newsletters-biac-i
    mpact-pathways-ahead/
  • Ylvisaker, M. Feeney, J. T. (1998).
    Collaborative Brain Injury Intervention Positive
    everyday routines. Singular Publishing Group,
    Inc. San Diego, CA
  • Websites
  • Brain Injury Association of Canada
    http//biac-aclc.ca/
  • Brain Injury Association of Nova Scotia
    http//biac-aclc.ca/en/
  • Learnnet http//www.projectlearnet.org/
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