Transcript Communication following brain injury

COMMUNICATION WITH PEOPLE LIVING
WITH AN ACQUIRED BRAIN INJURY
Steve Shears MSc
[email protected]
Headway UK – the brain injury association
WWW.HEADWAY.ORG.UK
Headway UK – a registered charitable organisation in
the UK supporting and providing information to people
living with acquired brain injury and their relatives.
We also provide information and training about acquired
brain injury to health and social care professionals.
We deliver this service through a network of 117 local
support groups in all four countries of the UK.
WHY WE EXIST 1
Headway partly owes it’s existence to the fact that the
medical profession had become very good at the acute
stage of the management of head trauma and other
forms of ABI.
More patients were surviving the acute phase due to this
expert treatment.
Unfortunately this was not matched by rehabilitation and
support services for a condition that in many cases is
long term.
Headway Publications
Communication Basics
Communication – mixture of verbal and non verbal skills.
Verbal skills include – Choice of words, tone of voice,
speed of voice, order of words.
The majority of communication is non verbal – such as
facial expression, nodding our heads in agreement
(variations in this in different parts of the world) and
looking at people when they talk to us.
(Argyle 1983. Mehrabian 1971)
Communication following brain
injury
In the acute phase following brain injury the patient may have
assistance to breathe via a tracheostomy.
Communication issues in later recovery may include.
Physical injuries causing weakness to speech muscles.
Damage to specific areas of the brain that control speech and
language.
Damage to the frontal lobes, which control behaviour and
personality.
Problems with concentration, memory or other cognitive problems.
Following brain injury people may have two or more of these
problems.
Therapy for communication disorders
In the early stages of recovery patients who present with
communication difficulties should be referred to a
Speech and Language Therapist
Dysarthia: (weakness/injury to speech muscles)
Dysphasia (expressive and receptive)
Lack of attempts to communicate
Cognitive difficulties
Difficulties with non verbal skills
Communication in a therapy setting
The latter two issues on the previous slides as regards
communication is something that I am keenly aware off as a
counsellor working with people who are living with brain injury and
their families/partners/children.
Generally speaking the ‘talking therapies’ were developed and
designed around people who did not have major cognitive deficits
as to information processing, memory, executive functions and
attention!
Therefore there is a certain challenge not only in therapy but i n
general communication situations with people living with abi.
Sites of injury in the brain and communication
Other Helpful information
As a counsellor who has his practice partly in
the brain injury field, I am interested in gaining
information about the type and site of injury in
the brain in order to inform my interventions.
Good neuropsychology reports and reports from
Speech and Language Therapists and
Occupational therapists also are very helpful.
Cognitive Domains and
Communication
The issues I have to be aware of related to domain:
Attention
Memory
Information processing
Executive Functions
Visospatial processing
There may also be an overall diminishes ability to be
aware of the nature of one’s own cognitive deficits –
anosognosia.
Crosson et al model of awareness
following ABI Slide courtesy of Malia and Brannagan
Maximal
Maximal
Full Acceptance
Cognitive
Executive
Metacognitive
Skills
Growing Acceptance
Anticipatory
Awareness
Emergent Awareness
None
Personal happiness
Self esteem etc.
Intellectual Awareness
Minimal
Minimal
Attention and Information
processing
There are various types of attention skills and damage to
the neural networks serving these may result in diverse
attention problems.
Information processing may also be impaired and the
person might take longer to process information and
have reduced capacity as to how much they can take in.
If this is the case then the following strategies may help.
Strategies for Attention and
information processing problems
Speak to the person in a place that is quiet and free from
distractions.
Simplify information.
Reduce the amount to be remembered.
Ask the person to repeat it back to check their understanding.
Link the information to something the person already knows.
Little and often – as a rule.
Ask the person to organise the information for themselves. Put
things into categories.
Memory
Mostly my clients have problems with everyday
working memory such as remembering what
they have just heard or read or that they have
something that they need to remember to do
(prospective memory). So communication in this
case may be interupted by the client’s difficulty
with being able to remember what we have been
talking about or what the homework is that I
Strategies for memory
Present information in different formats.
Educate about brain injury.
Ask client to repeat back information immediately and then at lengthening
intervals.
Use of video/audio recording – give them a copy.
Take notes in session and ask client to write down their own understanding
of what was important to them in the session. Give them a copy.
Sometimes modify confidentiality so client can review the content of the
session with someone they trust.
Give written homework for client to fill in.
Executive functions
I tend to see clients when they are in an emergent
awareness stage and the organic denial has diminished.
Sometimes tasks are around alternative viewpoints and
increasing awareness of behaviours/consequences.
I sometimes use group work to teach new
strategies/skills in dealing with other people.
Establishing a client’s motivation to engage in
therapy/make changes is vital.
Issues in facial affect recognition
Finally, another dimension that I need to be
mindful of during therapy is the research into
diminished performance of traumatic brain injury
survivors on the recognition of facial expressions
of emotion. More particularly the more negative
emotions with the view from some researchers
that negative emotions may be processed by
different neural circuits in the brain.
Basic Facial Expressions of Emotion
- Ekman
Summary
Special consideration needs to be given to the
modification of traditional therapeutic approaches when
working with clients who have sustained brain injury.
Communication in therapy needs to take into account
cognitive strengths and weaknesses. Compensatory
strategies are required in a counselling situation with
people who have had a brain injury in order to maximise
the benefit of this therapeutic approach.
References
Babbaage et al (2011) Meta-analysis of facial affect recognition difficulties
after traumatic brain injury. Neuropsychology. 2011 May;25(3):277-85.
Croker,V and McDonald,S (2005) Recognition of emotion from facial
expression following traumatic brain injury. Brain Injury, September 2005;
19 (10): 787-799.
Ekman, P. (1999) Facial Expressions In T. Dalgleish and T. Power (Eds.)
The Handbook of Cognition and Emotion. Pp. 301-320. Sussex, U.K.: John
Wiley & Sons, Ltd.
Powell, T (2004) Head Injury – A Practical Guide. Speechmark.
Shears/Headway (2010 Cognitive Rehabilitation Issues Workshop Notes
and Slides.
Wilson,B (2009) Memory Rehabilitation
Your views or questions to :
[email protected]
(+44)115 9240800