TBI-Traumatic Brain Injury:

It does NOT have to be the End!

(Creating new pathways for an improved life).

C R E ATE D B Y: D O V I E A . G O R D O N - M A F P, B A

F O R E N S I C P S Y C H O L O G Y P R O F E S S I O N A L

2

Disclaimer

For the purpose of learning to now live with brain injuries and cognitive deficits, I would not allow this Power Point to be edited for grammatical correctness and order. I made that conscious decision because the world needs to know that it is perfectly okay to not be politically correct. There is nothing politically correct about brain injuries and therefore, I have been learning not to make apologies for how my brain process information and transmits it onto paper.

Therefore,

Enjoy,

8/29/2016

3

Introduction

Purpose: Sharing this information is from a personal/professional position based on experience(s).

I spent the last several years obtaining degrees in psychology and clinical mental health counseling in the hot pursuit of becoming a licensed therapist. But in September of 2014, all of that changed as I was sitting a Red Light on I-17 exit and Peoria avenue in Glendale, AZ when I was rear-ended by a driver that was on his phone messaging his significant other.

The normal life as I once knew it in the realm of (physical capabilities, neurologically, neurocognitive, psychologically, personally, professionally changed forever in that spit second of the other driver making a poor choice while driving.

8/29/2016

4

Introduction cont.

Seeking medical attention and neuro assessments are after being physically involved in an accident. For decades on-end, there has been stigma surrounding individuals for seeking and needing treatment for psychological trauma regardless of the severity.

At the time of the auto accident, I was in the of my second masters degree in clinical mental health counseling and enjoying every step of the way, at least most of the time. Within two to three weeks after the auto accident, I began to experience a rapid decline in my speech processes, muscle control of my limbs, lapses in time, blank stares, fragmented thoughts, etc.

8/29/2016

5

Introduction cont.

Although I spent a significant amount of time working in the behavioral health/mental health field, I did not realize most of the challenges would come in ways that I could not have even imaged.

I immediately began to have many discussions with my PCP and make referral requests for the specialist that we both felt was a need at the time.

When I decided to share with others in my personal life as well as professional life, the responses were pretty unfavorable because of the stigma that society created for individuals seeking needed treatment.

8/29/2016

6

Introduction cont.

However, I decided to provided this food for thought to those that questioned my decision to request referrals to see a therapist that specialized in trauma/brain injuries and PTSD.

Food for thought: To go to school for years to become a licensed therapist in order to provide treatment to others. How could I expect others to trust my therapeutic position and treatment practices if I do not entrust therapist that have gone before me to provide me with the therapeutic services that I need to recover from the neurocognitive brain injuries that were sustained in the auto accident.

8/29/2016

7

Learning to Live with Brain Injuries &Neurocognitive Deficits

Everything and Everyone in the life changes!.

First greatest challenge that I witnessed and experienced as I proceeded through my healing and wholeness process, is that denial and refusal to accept the major changes to the life of a loved one.

The second greatest challenge on the journey of healing and wholeness, was and at times, still is; associates, acquaintances, and family members continue the attempts to treat me as if I have no mild cognitive impairments, memory loss experiences, fragmented thoughts at times, or my pause button pushed and everything mentally and orally goes blank.

8/29/2016

8

Challenges to Effective Treatment

• When family members, friends, and acquaintances refuse to accept the changes that no one has control over, it can have a profound negative impact on the outcome of the loved one’s treatment.

• When family members will not attend medical or therapeutic appointments to gain understanding of the life of someone with brain injuries and neurocognitive deficits.

• Doing research to gain an understanding of the medications that the loved one has to take daily as part of treatment.

8/29/2016

9

Learning to face the dark side of traumatized emotions

• Anger

• Bitterness

• Wrath

• Hurt

• Pain

• Hatred

• Despair

• Loneliness

• And a tremendous amount of others that will appear at various stages of the healing and wholeness journey.

8/29/2016

10

Some Damages that can be caused by others

TEXTING & DRIVING

• Frontal Lobe Syndrome

• Executive Function deficit

• Memory Loss

• Moderate to severe anxiety

• Moderate to sever depression

• ADHD

• Post-traumatic Stress Disorder PTSD

• Mild Cognitive Impairment (MCI)

• Involuntary muscle movement

• Seizures

• Sciatica

• TMJ of the jaw joint

• Chronic Pain

8/29/2016

11

Definition of Traumatic Brain Injury(TBI)

• According to (Gregory, 2007, p. 457-458), traumatic brain injury or TBI has been termed an inclusive term that encompasses everything from a “mild” concussion to severe brain injury (Bigler, 1990).

• However, TBI is most commonly the consequence of a blow to the head, and concussion is probably the Most common form of TBI(Gregory, 2007, p. 457-458).

.

8/29/2016

12

FRONTAL LOBE DYSFUNCTION

• Nauta (1971) summarized the effects of frontal lobe dysfunction as a “derangement of behavioral programming.”

• Motivational-like problems that involves a decrease in spontaneity, a decreased in productivity, a reduced rate of behavior, and also a lack of initiative

• Challenges in making mental shifts and perseveration of activities and response

• Problems in stopping that are often described as impulsivity, overreactivity, and difficulty in holding back a wrong or unwanted response

Deficits in self-awareness that resulted in an inability to perceive performance errors or to size up social situations

A concrete attitude (Goldstein, 194) in which objects, experiences, and behavior are all taken at their most obvious face value (Gregory, 2007, p. 457-458).

8/29/2016

13

The Four Lobes

• Frontal Lobe• The anterior portion of the cerebral

cortex, rostral to the parietal lobe and dorsal to the temporal lobe

• Occipital Lobe• (ok sip I tul) The region of the

cerebral cortex caudal to the parietal and temporal lobes

(Carlson, 2010, p. 85-86)

• Parietal Lobe• (pa rye I tul) The region of the

cerebral cortex caudal to the frontal lobe and dorsal to the temporal lobe

• Temporal Lobe• (tem por ul) The region of the

cerebral cortex rostral to the occipital lobe and ventral to the parietal and frontal lobes

(Carlson, 2010, p. 85-86)

8/29/2016

14

Brain Image and Segments

8/29/2016

15

CDC STATISTICS

CDC

Based on previous research, in 2009, the Center for Disease

Control (CDC) released their latest statistics on Brain injury.

(Brain Injury Association of America, March 18, 2013, para. 1)

• 1.1million were identified in office-based physicians

• 84,000 in outpatient departments

• 2.1 million in emergency departments (ED)

• 3000,000 in hospitalization records

• 53, 000 died (Coronado et. Al. 20120

8/29/2016

16

Accurate Diagnosiscan include but are not limited to

• Neuropsychological Tests

• Lab work

• MRI-full head scan

• EEG

• EMG

8/29/2016

17

Habilitation (Follow-through at Home)

Create a list of Crisis contacts

• People you know

• Call-A-Nurse

• Behavioral health crisis hotline

• Establish an Emergency Transportation contact person

Contacts

• Setup auto refill at pharmacy

• Utilize desktop calendar for appointments

• Set alarms on phone, computer, and watch for medications times

• Establish ADA transportation setup through Phoenix

• Establish telephone calls for medication reminder as well as for meal preparations

8/29/2016

18

Self-Habilitation , cont.

IN-HOME• Create a time schedule chart based on a 24-

hour time period

• Create a detail list/outline of previous daily routines and activities

• Now, because of the changes in your life; create a NEW daily activities

• Being and staying consistent with all medical appointments

• Taking medications on time daily

• Attending all support groups that are apart of the treatment plan

• Continual research on new updates

• At least every six months, discuss a medication evaluation with the PCP or sooner if any negative changes are noticed

8/29/2016

19

Self-Habilitation, cont.

• Wash Face for rejuvenation

• Shower or bathe often-for stress relief

• Drink plenty of water, juice, and other liquids

• Go outside for at least 15 minutes in the morning, afternoon, and evening.

• Create a collection of comedy

• Read comic books

• Contact with greenery

• Enjoy puzzles in every form imaginable

ASK FOR WHAT YOU NEED

& HELP WHEN YOU

NEED IT!

8/29/2016

20

Effective Treatment PlanningEffective treatment planning can consist of, but not be limited to the following:• Collection of all medical and behavioral health records and Collateral data• Rational Emotive Behavioral Therapy (REBT)• Play Therapy• Gestalt Therapy• Occupation Therapy• Music Therapy• Cognitive Behavior Therapy (CBT)• Adlerian Therapy• Group

8/29/2016

21

STAGES OF CHANGE

•In this stage, people see no need to change. They may be involuntary clients, seeking help because of a court order or family pressure.

Precontemplation

• Individuals that are in this stage recognize that hey have difficulties but have not made a commitment to take action needed for change.

Contemplation

•Clients at this point, have decided to change and have even taken some small steps toward change.

Preparation

• In the action stage, people are now motivated and committed to make changes. They exert effort over time to accomplish those changes.

Action

•People act in ways that are likely to maintain and continue their positive changes and avoid relapse.

Maintenance

8/29/2016

22

Ten Step Change Processes1) Consciousness raising

2) Catharsis/dramatic relief

3) Self-reevaluation

4) Environmental reevaluation

5) Self-liberation

6) Social liberation

7) Counterconditioning

8) Stimulus control

9) Contingency management

10) Helping relationships (Prochaska & Norcross, 2003, pp. 516-517).

8/29/2016

23

Group Activities for TBI Patients

• Arts and Crafts Therapy

• Hand painting

• Brush painting

• Pottery

• Water activities

• Crocheting

• Knitting

• Needle threading diagrams

8/29/2016

24

Brain ActivitiesFor Brain Injury Patients

• Reading a loud daily unfamiliar material

• Read Poetry-(VARIETY)

• Mathematical equations and tables (+, -, x, and /)

• Oral Grocery store list (A-Z)

• Naming of Continents• Countries

• Automobiles

• Foods

• Specific things (A-Z) Alphabetical order.

8/29/2016

25

BRAIN ACTIVITIES cont.Left & Right

LEFT BRAIN-BRAIN ACTIVITIES

• Word Search puzzles

• Spot the difference

• Numerical Signs

• Spatial: Tetris

• rubix cube

• Board games, etc.

RIGHT BRAIN-BRAIN ACTIVITIES

• Jacks: with jacks and the ball

• Handheld puzzles

• Sequence games & activities

• Hidden pictures

• Spot the difference

• Solitaire-any version

• Jewel Quest-all versions, etc.

• .

8/29/2016

26

References• Source: http://www.ncbi.nlm.nih.gov/pubmed/23127680

• Brain Injury Association of America. (March 18, 2013). http://www.biausa.org/announcements/new-data-shows-3-5-million-people-sustain-a-tbi-each-year

• Carlson, N. R. (2010). Structure of the nervous system. In Physiology of behavior (10th ed., pp. 85-86). Boston, MA: Allyn & Bacon.

• Gregory, R. J. (2007). Neuropsychological assessment and screening. In Psychological testing (5th ed., pp. 457-458). Boston, MA: Pearson Education.

• Prochaska, J. O., & Norcross, J. C. (2003). Systems of psychotherapy: A transtheoretical analysis (5th ed.). Pacific Grove, CA: Brooks/Cole

8/29/2016