Tate | Ya Tate ¢ ‘ rgeetesar tir. Balt Therapy DEE. STE LU aT ae Nt aes be Meus B) se 6174810649, fH) Poweley HEE Ene Introduction... veeee reese ee Seat Part 1: Living with brain injury: Information sheets 1 1 6-15 2 . 16-27 3a language & perceptual st 28-39 4 Fatigue, emotional and behavioural changes . . . 40-53 5 Awareness, insight & adjustment... 2.0 s eee +04 +++ 54-63 Part 2; Cognitive rehabilitation exercises 65 G Memory oo... ee ee cece eee e cette eee etre es 72-88 7 Language and thinking. 89-102 8 Perceptual and visuo-spz 103-105 9 Attention +. 106-113 10 Executive skills 14-144 11 Brain gym ve. ee eee parte F = 145-149 Part 3: Emotional adjustment exercises 151 12 Awareness and insight .... veers ee s 156-176 13 Adjustment and coping 177-217 14 Acceptance and growth... 4.6. ..e essere eres 218-230 Answers to exercises F cece eee BBL bbrain might have more of the therapy groups and courses with an acquired brain ‘managing all sorts of problems, from improving your meron, concentration or executive skills, to managing your anger, or fatigue. 3. Acquiring insight and awareness: Lack of insight and awareness,is 2 is worked the more efficient the athvays become. Some hologists use the phrase ‘cells fire together wire toget the darage moral ert We are beginning to understand that the Qo ey co fo ow 2 LUhelping the client to identity their problems, comparing it to ‘slowly lights on in 2 dark room raps This process may take years, be only partial. Research has shown that lack of Insight Is one of the major obstacles returning to work fee! more in control and confident Emotional adjustment: A brain injury is a life-changing event, but at first you may not be aware ol Gradually as insight improves you will begin to alter your expectations and accept your limitations. There ‘willbe dificult challenges anc F mourning the loss of ith adjustment comes 2 loved one. the ability to talk about what has happened, recognise whi changed, and move on with life. The final section ofthe book contains exercises that focus on adjustment. people feel out of cont desperate for knowledge anc advice to help them fee! more in control These exercises and information sheets are to help people understand ‘on — what thelr selfefectiveness and empowerment = "lam doing something about my problems.’ This improves ‘motivation and builds confidence, which improves ability, What is in this book? ‘The second edition has been reorganised ity and easier access, Part one formation sheets that ‘exercises for improving ‘awareness and adjustment, Hn tH It ft Who should use this book? This book Is designed to be used in 2 umber of diferent ways. Its based on ‘material that | created to use in groups, resource for therepiss working with brain- Injured people in groups. It fa resource ‘book or ‘cookbook’ where exercises or anything | can do to Improve memory or thinking si carers, family members, and stat for example at the Headway Day Centre ~ may use the book to provide stimulating activities for a brain-injured person, itations of a cookbook yokbook approach mi iming, and second, in and appropriateness. After 2 because they are ‘spontaneously improving all the time ‘and do not really know wirat they néed to adjust to, However, some of the ibe very people will have good executive skis and poor memories, and vice versa. Ikis generally accepted that people with severe memory problems and Impaired executive skills are not very goad at using internal memory strategies, whereas those with mild to moderate memory impairment and relatively intact fe skills do benefit. Many people be selected appropriately and tallored to Ingivicual needs. Running groups and courses Its dificult to be prescriptive about the size of a group. | have run two types of ‘groups aver the years, The large open ‘group at the Headway Centre may contain 20 people. | also run a sil ‘g70up with seven to nine members, ‘emphasis might be mare on stimulation, and learning coping strategies. Length of time The longth of a session is important, but ‘again there is no hard and fast rule. The Headway group runs for en hour, and certainly that is the maximum in termsof concentration, tolerance and fatigue thresholds for the members. group runs for one and 2 Format (ver the years | have developed a typical ‘ormat for my groups, which combines @ rmidture of structured activity end an small group, individuals often descriva ‘one positive and one negative thing that Usually do an exercise that looks at some aspect of awareness or adjustment Intreduction cognitive impaicment and reduced insight, it seems important to structure these lscussion topics, and not to just expect \would happen in a normal psychotherapy group. The poem on page xi group member which something of the essence of these groups and the material in this book. structuring and ordering all the activities that | have used with people over the the beginning of in bo added to and Trevor Powell Consultant Clinical Neuropsychologist = ms = = = = = ea al = 3 — = = ih Introduction What | gain from the group The group takes me a8 | am. They accept me, as they did not know me before. So, can relax completely, no need to be dsfe They do not compare my ehavlour, speech an It occasionally get weepy end upset, feeling of. tudes with pre-accident. They hit the spot and raise issues that | might not have thought about, 1 feel myself becoming more aware and growing as a person. The size 's good, neither too smeil nor very big. fone fas space if they the surprise of eat boring and we have a few laughs. Jil= — = — eS 3 ca = = = = = = = = mete PART | Living with brain injury: Information sheets\ General information 1. Information about head injury .. 6 2 What happens in a head injury? a7 3 Measuring the severity ofa head injury 8 4. Common consequences of brain injury 9 5 Areas of the bral and their func 10 6 Cross-section of the brain. oll 7 Information about stroke. 12 8 Images of stroke 13 9 Other types of ac _ 4 10 Notes for carers of people with memory deficits 2... .2...062.44, 18 Memory 11 Understanding memory 1... 12 Understanding memory 2 . 13 Memory: Using external aids... 8, 14 Memory: Using intemal strategies 20 15 How to remember people's names . 22 16 How to remember new information; study sills 24 17 Remembering to do things, routes end numbers 225 18 Memory question 26 Fle Memory quiz Ste Hee Hee reer eee tere rE Sree Herero 27 Attention, executive, language & Pete skills 20 Attention and concentration... 0.22.00. eeee essere 28 21 Ways of improving attention... 0002-00 eceee sence eeeee ee 29)Living with 2 bata injry — RT ‘ea tart — -30 44 Awareness skills quiz «+ 60 ign Fas acjustment a 3a EAT ae adjustment 62 35 — 47 Summary sheet . . 63 ees fr coping wth executive problems 36 27 Weys of improving language ski a 20 Understanding and coping wth percptvl and vsuo-sptial 3 Fatigue, emotional and behavioural changes — 29 Dealing with fatigue : oe 30 Anger management ee gee 31 Disinhibition and inappropriate behaviour... .s6eseeecseeeee dh 32 Ways of coping with disinhibition for family and carers | 33 Apathy and reduced motivation .. . . bt eae 46 eS 34 Emotional changes following brain injury 7 48 | 35 Emotions experianced by carers and relatives... wee ES 36 Depression ae | 37 Assertiveness Sl 38 Time management after brain injury ~ 62 — 839 Goel planing ater ren inary a ——| Awareness, insight and adjustment = AD Understanding awareness 0.0.0.0... .e0cceeeeae os eS 41 Ways of improving awareness . . «56 = 42 Aarons ils UERHONNANS ce veceeseceee essere FT 43 What is adjustment? oe. e cece rece es 3INFORMATION SHEET 1 Part Put INFORMATION SHEET 2 eta: ": ‘ning witha train injury — + a. ving wits a tral Injury ~ Information about ner informaion | What happens in a head injury? ‘Ger information ped nay eat seconds i 4 : — Brain swelling oedema). The brain In the UK, one million people per year | @ People with a ‘isk-iaking’parsonaliy . j attend hospital with some form of head | © People who have had a previous head if you shake up # soft blancrange in 2 OF Blood ord uaygen tothe calls of injury ~ 80 per cent are not admitted. inlay HEAT pr box - it shear, tears, and cracls, the brats end rales introranial About 270 people par 100,000 of the The injury isin two parts — primary end tesa population are admitted to hospital “The term ‘silent epidemic’ has been BEI cocondary injury ury every year. Approximately | sed to desi the increasing number 20 of these are severe head injuries, of people who survive head injury. This ===} and the rest are ether modarata or mild jury. A the rend inj : n — the brain may injues, and advances in meticel Genueene ‘nnology saving more lives. tis - a P Causes of head injury fetes i nora ee es nerve fibres, connections and axonal nate eee i acs wanlcs ane ania sheaths are stretched and ruptured. ‘oxygen in te blood to with sevre head injures who survive greeny epranrearponisen| today would have ded 30 years ago. ey taal ay ee 10-15% = we es no are mest lily to have a = a between — 1 What ae the primary mechanisms of damage? the ages of 16 and 30 (five 2 What secondary damage can occur ikely) ea ‘People over 65 years are also more at risk Tl ‘© People under the influence of alcohol 1 Why are more people today su A i 2. Who is most lkely to have a hi = ‘Wo enol you ts eis sett voy C] Stay C]_nevery [LJ Wiat wos te mas portat pit a [revenue tins _voy C1 sty CL nates] wheter rtp patie? z © sme rorm paca nance wang eB ry oO @ roommate phon canst ut Baga Wott OT Foe Lee ee ee re eet hemlet Seep Living with brain injery — Common consequences General infomation of brain injury {FORMATION SHEET 3 INFORIAATION SHEET Living wth 2 brain njay = Measuring the severity ‘Genera infomation of a head injury Physical funshat wound, for example. > Loss of sense of smell and taste between the injury, and the > Bolance problems — cizziness, cegaining of day-to-day memory and. ato > Fatigue — less stamina > Epilepsy > Sexual arousal There are two major measures of how severe a head injury is: period of PTA of between one hour and 24 hours suggests a moderate oor problem solving and head injury. PTA of over 24 hours tasking > Percaptual\visuo-spatial problems These responses inclu sungests severe hea injury, and > Memory impaitment - poor shor- > Language difficulties — opening and moving BTA of over Sever term memory problems with understanding (ec2ving) or and responding verbally to very severe head new learning expressing (speaking) at ae ae a ee > Speed of information processing - > Loss of insight and awareness of gow Coma Seale, ow Coma Seale scare, the slowed changes and deficits ‘severe the injury and the more are tobe longterm or pomenent eas Theo motional and behavioural measures are the best predictors : > Lowered tolerance of frustration — > Apathy ~reduoed mativation and outcome, temper outbursts, easily angered le get up and go: reduced > Rapid mood swings ~ mare owe on untae > Deion ingushaness, tat cone fo mi or > Emotional lat crying or - T wath tect cad ed ope a Hn? Eran! ity ere soe jee 2 Hor do yous see of esd a x sade >> Emotional flattening ~ reduced > Anxiety, depressed mood, emotional sensitly oF tone (unting) ‘Whet do you think are your five most serious problems after your bran injury? wer oe fa ist) vey Sty [Ne wmy [3] What was tmp pbk et 8 © ws pgp mays nacpes cy en iy Weak © Tow 208INFORMATION SHEET 5 Areas of the brain and their function looks ike two halves of hemisphere sensation on the right-hand side of the boll, and vice versa. For most people, the recognition and ienbiyng ctu, Cerebellum, Located below the occipital the head. Important ‘motor movernent, and speech articulation, memory, hearing and Understanding speech. bes. Located behind the ears, tawards the back of the head. Important as anger and fe hippocampus (involved with memory). Bb PEE iM He Part sng with bra inary ~ (General information INFORMATION SHEET 6 Cross-section of the brain Frontal lobe ~ executive jons, thinking, planning, be ~ ‘memory, hearing and understanding speach Diencephaton ‘and limbic systém, including the amygdala {primitive emotional reactions), ‘hypothalamus (erousal ~ sleep, temperature, apy hippocampus (memory) (Wey Estey CL] Rotvoy Chat ws te mon ingot po 8? = \ierecraie momosnee wr LD way C1 faves CD wat _O mermennn ernie ohn OT- Scciroriation si Sor ert et or a : iig with a rin iy = Information about stroke Genel ntraton Stroke For your brain to function, it needs a make a complete recovery, and of ae left with some disatilty. Only 25 er cent of people who have a stroke and are left with disability are under the ‘age of 65 years. 50-80 per cent of pressure, high cholesterol and diabetes. ‘The effects of stroke Strokes affect peoole in different ways, depending on the a affected, the severity of the damage and how healthy the person was before the stroke. Strokes can often affect: > Thought processes: cognitive functions, memory, executive skits and perceptual ski >» Mood and how we feel > Communication ~ speaking and understanding language. For further support and information about strokes, visit the following websites t Approximately one third o people who have a stroke di 1 Name two types of stroke 2 Identity the four main areas sect by stoke? Images of stroke Haemorthagic stroke 7 Biood leaks into brain tissue. Subarachnoid and intracerebral haemorrhage Blood bleeds in the brain (intracerebral hhaemorthage) or blood bleeds between the brain and its thin tissue covering (subarachnoid haemorrhage). 7 aT ving wi 2 brain injury ~ ‘General inforaaton Ischemic stroke Blood clotting stops the supply of blood to part ofthe brain. Subdural haematoma ‘Subdural haematoma A collection of clotting blood that forms in the subdural space in the brain, putting pressure on the bral, 12 © tose ay vest ornare Te Ban ny Watt OT owe 208INFORMATION SHEET 9 Other types of acquired brain injury and is not degenerative (an illness that has a progressive decline). Soe and head are types of ABI. Below are some ther ways that a brain injury could be resulting in a severe loss of mamory. Other causes of neurotoxic brain injury ‘dependent on the weurotoxi, Infections of the brain Encephalitis is an inflammation of the . There are @ number of different Viruses and bacteria which cause encephalitis; one of the most commen causes is the Herpes-Simplex virus. This type can be treated drug, but early diegnost reduce long-term damage. In many I make @ good recovery , ut narve cells in the Pact ving witha rain ning ~ Genera information Meningitis is an infection of the ‘membranes that cover the brain (the meninges) leading to swelling of the brain, Recovery from Meningitis again vaties from person to person. Hypoxia/Anoxia Intereuption of the supply of oxygen to the brain is referred to as anoxic or hypoxic brain injury, The mast common causes of ‘noxicihypoxic brain injury are: + Respiratory or cardiac arr’ + Very severe asthma attack. + Very low blood pressure as a rasult of disturbed heart function or loss of blood. + Smoke inhalation, + Diabetic coma. + Drowning and strangulation. Brain tumours Abrain tumour is an abnormal mass of tissue inside the skull, which is caused by calls dividing at an increased speed. hore are two types of brain tumour ‘malignant and benign. ‘Malignant tumours often invades surrounding tissue causing damage, whereas ‘benign’ tumours growing in an enclosed space of the skull may damage healthy tissue by compression. 1 What is hypoxic brain injury and name one cause? 2 Describe two types of infection to the i ia — = = — — = = = — = = = = = — = = INFORMATION SHEET 10 Part | ising with» brain injury — Notes for carers of people ‘Memory with memory deficits Look after yourself. You need to look and are often ater yourself so resources and energy to support the brain injured person Get into regular routine, Develop and sick to reguiar routines for everyday Be ‘actives. This helps to dereese cof new People with memory deli pater pow what they are doi may get a a be problem may not. Provide an organised tiving ‘environment. To ease the ci Remove distra the living environment distractions iy w placa’. Use external aids such as a calendar, memos and labels. = Ensue that you get the atlenton when you are giving Keep it short and simple. Keep instructions short, and follow up with ten information if necessary. Be clear ut what you say. Review and restate, Be prepared to review and imation several 1 10 help remembering 7 Identiy three things that would have an adverse efect on any indviduats| memory. 2 Make a list of the ways in whieh you could improve the organisation of the {tev rent cou matin ea?” voy LD Shy CT Toh wha wa pt pa Sosa ||_fewntoar den wae soeth vey C)_ sy Cony C) Wane mt int et 15Parti ving wit bain injury — ‘Memory “INFORMATION SHEET 11 Undersianding memory 1 Memory involves 2 numberof different skills and stages, and can be likened to @ sophisticated music system in which CDs are recorded and stored, and then rom storage and replayed when reat 3 stage of memory is recor “Temporary retention of feraphong, video) information (CD/DVD plays) sor, fling cabin!) but a process involving @ number of sages: the mechanism by which information enters the brain. If nis not rehearsed or practised, then 3p. For instance, ies before you begin to ESSA Wronwation sieer2 1 EEE 7 a Understanding memory 2 Memory sifferent aspects to memory, with a variety of names, which can be y, memory can be term and future) and usually a ‘Short-term, or ‘recent memory’. This is information that is stored just long encwgh to be used. It may be a few minutes, or hours, or days. The hippocampal area in the middle of the brain is thought to be important for laying down moxe permanent memories. v > Long-term, or ‘remote memory’. This is memory for ‘episodes', or things that have happened to you In the past. It is also called ‘episodic memory’, or ‘autobiogrephical memory’ y Prospective memory. This is the involves @ certain amount of plan {ype of memory is thought to be closely brain, where organising and pianning Is based > Verbal, semantic or auaitory memory. Ti ‘Words and language tend to be located this isthe area that is , You remember 3 story Images. When you temporal area of the brain > Motor memory. This is remembering a particular motor skill, such as riding a bicycle, thought to be associated with the cerabel remembering a ‘procedure’, such as how to switch on "T What are the five processes Involved in memary? 2 Describe two different types of memory, and say roughly where they are located in the brain, Tw lat yond issn? Wey LT Stasty L) Rete L) Whi wos tpn pl re v (© Wipe nay ona arco he ey Hotes OT PoeINFORMATION SHEET 13 peat BES, ronwarion sweer 19 Part | . 4 Living with 2 brain injury ~ ‘Living with a bran inry ~ Memory: Using external aids Memory : BES Memory (0 Extamal aie eal us a varely of ‘trl moory | (6) Getting into ar arte ppentiapepints ed Raraien ba Stott hp os remeber hngs, > Rois an go fees rer ary at foe to ophone numbers, ita we have ada ain yo ese meray aie bac rot. We might make notes; keep a dia > Pay bills on time if possible, or 7 7 Use # calender or fig system, of set up standing ore z Bet into @ regular routine. > Carry out certain activities on corain dys. Some simple measures can be taken to > fee naar celal oe hfe oe betel reminders of events and ‘weekly use). ace, in rcer treages, ad fo Mp Koop trometer obvious eee eee (q) Improve wellbeing: > Calendar. A large wall calendar > Keep a kitchen timer by the (©) Adopt your environment: > Any sess and depression is vel for ting coun cooker. lr ae et > Koap «reap ond pen by he it inortanteppeinent rd rons sa top a tlepnve sora! ecasions cern activity > Putup a notieboard > Watch. Ue 2 dater-cperaied | > List telephone numbers. exp 2 boar or mame beard wate that ean bee to ee is of mpornttelprone ly prompt to numbers by the phone. planner > Investigate electronic page to keep such a8 the Meuropager system. Prominent plece, > Label cupboards or doors 1 (b) A place for everything, and eae ee verbal messages, ety > Personal computers are very > 1 d Have 2 hay ring by the doo emer oat a alee > Tolephone answering machi > where you always hang your ys. > Have a special place where you can help to reduce the problema ‘of phone messages boing surable > Stay physica Carry out some exercise at least forgotten oF lost. Rs once @ day, ever > Make lists. Writing shopping song for a walk. lists before going to the shops > White on the back of your hand. > Be assertive, Learn to ‘say 10" to 6r todo lists to helo you Sometimes just 2 letter of the excessive demands, or things that ‘organize your day. ‘are not important. > Manage your time. Take breaks. Learn to relax and took after yourself 1 Think of any other externat i laters to post by the door, put post by the door 2 Discuss which three exter a =s Es eI =i eI fool es — — Ler Le a a — — a aed =. peat vey Cl Sify C)taty Cwatt mat mont pont roo) 18 rach Bean Wak Fe = BA | © wreenore iene J anny Meo E7012 © vm wpe nares proonnesIFORMATION SHEET 14 Internal strategies are things that you ‘do imide your hea! © ty omer n, Pay attention; focus on what ing said, and try to reduce background distractions. You Repeat and rehearse. Repeat Inoritin cv ae ov, erty your is useful when trying fo learn Someone's name, 3 tlephone number Aim for ‘deep-level processing’. The thoughts, 0 knowledge you have about something ~ however silly or bizare ~ the deeper the - Memory: Using internal strategies © Wis page sy ie phocorie frisevconl wo The an ery Meteo © Te pate vg wit 3 bain injury — ‘Memory {evel of processing, and the better you will remember. the right hemisphere thinking of @ word uses mai brain. Mind maps or spider diagrams. These se the broken down 10 2 picture or map. The mind map 15 2 number of routes, with sections of chunks. You can ‘map to aid recall. When your searching for that information, visualise the map, and search the different areas of the map. What hand comes? What corner? This techn good for remembering pr information such as notes for exams. Question ~ 5Ws and PORSI trying fo remember som a newspaper story, ask yourself the five "W" questions: ‘Wnat?', ‘Where "When, ‘Who?', and Why?” Breek down information into those s categories. Use these questi remembering a story Th alphabet stand for particular 7A Stories or rhymes. Make up a story or rhyme that contains the information you want to remernber. Mnemonics are useful such as ‘Richard Vale’ for remembering the colours of the rainbow (first letter gives you the colours them easier to remember. ‘The rhyming peg method. The shyming peg method is @ good way of ing Wists, and is @ stimulating mental exercise. You need to lean a list of 185, oF pegs, which thyme with t 10 digits. One = bun, two = shoe, three = tree, four = door, five = sticks, seven = heaven, eight make the bun 2s big 28 a dou n you need to rem place it in your image. Galo by afew nour days. ‘Litt learning, while progres he best way of studying race by using retrieval or actions Her cueing. ters ofthe alphabet and when you reach the the person's name, it som: ‘prompts recall ding wth brain ner ‘Memory learning. If you have a severe cues. This involves retracing a sequence of events good for »g somebody's name. Go through cone by one, letter of imes egies you use, or could use. istens to the football, © pase may pero tarmac am ony The Bain guy WErADoak ®t Fowe 201 outed Wat Wey Bey C)_ etary ED wt beat Pi 907 SEqGT oy e201INFORMATION SHEET 15, How to remember people’s names Repeat the name to yourself under your ke a picture oF association. Tr king the name to the name ative, oF famous peopl he name suggests to y lude Mr Brown or Mr Shor, could be pictured as an onion. Create a bizare visual image of the name, and then include the person in the image. For remembered. Part ning wth 2 bata inary — ‘Memery INFORMATION SHEET 15, Pick out unusual facil features. Look carefully at the person's face, and sharpen your observational powers. Be ‘aware of any prominent features, such 238 bushy eyebrows, long ha, or small form an exaggerated and then associate this the persoa's name, For image to the name. Mr could be remembered by eyebrows as handlebars the name back. Repeat the ame back to them in times as possible, the person's name Pest! bing wth a bran aur - Memory First-letter cueing. It you can't remember the name, go through the letters of the alphabet sionly to try to prompt recall of the name, The letters acl as @ minimal prompt, and ssomatimes this is all that is required to Situational cueing. Try ‘seeing’ the person in a fow ctfront situations where you right tiave come across them inthe house, at wor, ina shop. Imagining the situation can also promt recal sometimes. with their name, someone's name. 1 Think of someone you know, and make at leest two associations 2 Describe what you can do to aid recall when you cannot remember“iuroniiatio stiget 16 7 Re iNFORIMATION SHEET 7 ~ tere eet it Ling with rary = % : Living with ba inary — How to remember new ‘Memory Remembering io do things, ‘Memory information: study skills routes and numbers ‘Make mind maps. Conden: from handwritten text to spider slagrams, or mind maps, on ta pieces of paper. Use different pons, and number Environment. Ensure that your Remembering what you were supposed Remembering a route: to be doing: raw or purchase a map hig For example, you have gone upstairs to fetch something and cannot remember ‘can then further condense thesa large colourful sheets to numbered key ideas ‘on index cards. supposed to he doing? Who was it for? Why? When? Where? and a biscuit. Or do something different for 5-10 minutes ~ such as taking some | reading to rehearsal. exercise, or doing some chores. Remembering to do something: > Use a calender clay, alarm, merry board or makile phone teminder to prompt you fr events and things to do. three separate chunks > Wake viol images of whet you eae need to remember, inking it to what > fake an association ifthe mile you are doing immediately before section of the phone number is 303, study periods ~ pethzns to a cup of tea 902-465-1254 is easier to selective in your reading. Try not ‘on too much in one go. Pick out and after. toed the A303 which > Positioning: place letters to post by 3 West Coun described on page 23. the front door so you are more likely > Expanded rehearsal: look at your to see them and remember to toke ‘number with the strategy, test ‘hem with you yourse, then rehearse again and Make 2 plan or a timetable for study. Pin up this timetable in your work area, speed of processing, fou can check you are doing the ‘then take in a tape recorder or borrow somebody else's notes. rehearsal times. rats bloc of ed i in 9p of study te, 7 John keaps Tosng his umbrelia, What can he do to prevent tis? 2. Your friend has moved to a new address, how would you remember the new route fo got there? 3 Think of any olher strategy that might help you to remember to do something. PENEDODDDED NDE What can you do to improve your ft Ter er di of aa? Wey) Sips L)_tereey Ca wae a int to 0 6 | | revrteastaaentme mest vy CD Sey C)_ tty L)_wst se ant tr? ny ha Bn iy Won OTF 319 | 28 © happy expat aco. Tena Woe TPs 3 © mansrniytapromepe wsINFORMATION SHEET 18 Pati ing with 2 brain ijuy ~ Memory questionnaire emery INFORMATION SHEET 19 Parl Living witha brary — Memory quiz Mermory 11 How bed do you think your short-term memory is compared with before your injury? Thesame [] si Much worse [J 2. Wite down two extorna strategies problem. For example: You have a doctor's appointment White on calendar. > You keep misplacing your keys in the house Date (questionnaire and independent scorer column. Scoring _Raee = 2 Fartally agree = 1 Disagre = 0 — > You forget what you went to the shops to buy Question Setacoe | tndopendnt ser > You forget what you cid last weekend "eee [eres] tee | Toe” foraee| 3 0 internal strategies or mental activities that you can deliberately may improve your memory for: > Remembering somebody's name .. > Remembering @ telephone number . > Remembering a list of 10 bits of information for an exemination . 1 often forget where | have 2 I somtimes find ateeuision story ortho plotofa] | book ficult to flow, | 1 often forget words, oF find they are on the tip of my te [a eften forget things, and have to go back for Len, [5 | sometimes forget things that | did the day bafore. 6 | ovget todo things that | have planned to do, * Explain why you are more likely to remember something if you make a visual Image of it~ for example, imagining Mr Baker made of white dough, you wanted read in the newspaper, what compensat to remember it? remember an ati ategies could you mation written on 7 What are some of the pracesses involved in memory? INTERPRETATION reopen egos / / | ‘TOTAL SCORE Ste / deyingit = = ow let days ies? vey] siphy LI Aeteey Ca{ TNFORATION SHEET 20 Attention and concentration ‘on-concrate Way to someting without it beng placed in front of you, and fo make links between diferer this area often say that | inds drift off, or that they get istracte. > Selective attention involves selecting ing and take notes at the ssame time, ‘conversation at the same movement from conscious did nat happen, then we would quickly become overloaded by the demands of life, Following brain injury, it seems that information can be taken in processed and then acted upon ~ ‘how fast the cogs tur tomatic and conscious processing. Why is this an important concept to to understand? > Organisation skills are many diferent INFORMATION sHEET"21 Ways of improving attention ‘out loud, you stay on the right can help yoursel ‘rack. > Use environmental cueing, Have 2 cue card in your work area with a simple message on it, such as ‘ ich acts as cue to stay focussed fr to check your work. ‘Set yourself targets or goals. Having something definite to work towards will help you fo stay motivated. Y Pi “iin wid a bain injury sation you feel you iceded and you cannot 3 informat that the person slows down y OF repeats himsaf. ‘once, as this leads to mistakes. > Don't rush things. Take your time and pace yourself, > Apply structure. Make 2 plan, or break things down into manageable part. > Self monitor or chock and double check your work. Make that a habi @ spe may esheets tor ectons a ey Te Brn uy Webect ©T FwelINFORMATION SHEET 22 Executive skills: ‘What are executive skills? Think of the hat a typicel good management requires. He needs to plan; organise; direct; control; set realistic goals; organise the staps to achieve those goats; initiate action programmes; ‘monitor progress; and adjust those plans. He also needs to be aware of sections ofthe orchestra. If the conductor {s nat working propery then each part of the orchestra may play out of order, at the wrong volume, or atthe wrong speed. In the seme way, ifthe executive skis are not working wel, then all ather brain functions may be cootinated incorectly 36 to significant problems what are they? Part Living wth rain injury ~ ‘Attention, executive, language & perceptual sis behind the forehead). This part of the brain is connected to all other brain areas, end ‘commuricates’ with them with a rich interchange of informatio. and amount of structure given task also varies So, many people are n the problems in more detail. cause of the nature ofthese problems, itis often very hard for the brain recognise the cific! Components of executive ski Executive functions are divided into various skis. Here, we have broken them dawn for ease of recall, so that ‘most of them begin withthe letter 'S' (0 Stepping bac to step back and view a nce, rather INFORMATION SHEET 22 i oy (wa o wi ‘Storting: Sel an activity without help or prompting from anyone else. Sequencing and planning: The to break down an overall fable steps or sequences and then follow those steps. This is at the heart of the ability to plan and organise, ‘Summarising: The ability to see ~ and what is a minor detail; then to gather togethar alt the Information and summarise it, distracted by irelevancies; staying focused. Satf-monitoring: The ability to assess the appropriateness and effectiveness of what is dane, and ta be able to identify mistakes and careless errors. Part | Living with bri inary ~ ‘Attention, execute, language ‘perceptual skis (ull) Shifting, switching and solving problems: The ability to recognise 2 problem; work out an alternative solution, and then shift the pattern of responding to ¢ new pattern. This involves switching attention. sometimes we have to ‘keep @ on tem, {tive syndrome. This sometimes known syndrome’, or as af ipervisory attontion syste nal lobe syndrome’. People with present very well fon casual 2cqus and may convince people that they have well ‘What do a ‘managing lobes have in commer themselves? Nine are listed, all beg Deseribe what you understand by the term ‘executive s ‘When are problems with executive sk Name as many components of ex scar’ and the frr at|FORWIATION SHEET 23, Ways of improving executive skills Recognise that you have a problem. You now have to think things through more deliberately, whereas before it would have been on automatic ‘Stepping back > Take a step back ~ don't rush in — survey the situation. Think about it for a few moments. Starting, or > > If you have a problem getting started, reward yourself for achieving specific tasks. Sequencing and planning >> Make a list of the steps needed to achiova the task. the steps in the correct order, pethaps ticking off each one as you have achieved it > Tek to yoursef by starting and v Shi > Patt Living wt aban injury = ‘ion, executive, langage & percept! sis ie sentence, “The main nd then talc tire of day, morning ~ not “Take frequant breaks - never work for longer than one hour without a le of tasks, check ‘olng according to plan, 3 following questions, ‘and provide short clear answers to them: (2) How will | know that my plan Get feedback from others. Ask them to be honest end direct. sifting or solving problems. ‘Wheat are the other options?” from a diferent self how someone ESSE Wronwarion sheer2s Te = ‘Stopping, oF selfinhibition > Ask for feedback from others ~ Tell me if I'm a Bit over the top.” > Question yourself, ‘Have I overdone ie’ > Look out for how others ate reacting. Self awareness > Identity your strengths and weaknesses Ling wi a bain injury ~ ‘tention, executive, language ‘8 perceptual sis ‘Ask for feedback. Predict how wall you will do on a task, and then see how you do. report after the task is done, vY ing those things that you did woll and the things that ware not done so well KEY SKILLS 1 Stop, step back ‘sk yourself questions Make a list @ plan Remove distrections Be tidier, more organised improve your executive skills? > ‘Which of these individual executive sls is your biggest problem? 6 Use white boars, calendars, notebooks etc 7 Check and double check ~ seit monitor 8 Talk to yourself 9 Ask for advice and feedback What ate the two most effective individual steps that you personally take to 32 © te rpe my ve oscars om amy Me Barony Wonk OT hot 2012INFORMATION SHEET 26 Executive skills questionnaire Part} ving with 3 bain injury — ‘Attention, executive, language & pareptual sis [rv pssesesnessennntene of the statements and mark the 32 hep to ask someone who fependent scorer column. Disagree = 0 Sacco anning and organi ifcalty doing more than one ting at 3 T have afcty weighing up the pos and cons, dacicing on what fs important and king decisions [5 Tam more impulsive, of the consequencas from one ea to the 7 i ave aificay summar ‘gating tothe point, or‘seing the wood fom the tee 1 tend to hal Fan, Black and white’ or Field 9 | ave problems pansing walle goal, and working out the stops to achive those goals. ky switching attention ng conversation. "TOTAL SCORE INTERPRETATION Serene 210-20; This supa at your eect usrepiyDebeen sls andi 5-20: Ths suet hat you me Patt Living witha bra Injury ~ Attrtion,excutv, language “perceptual si INFORMATION SHEET 25, Executive skills quiz How bad do you think your executive skills are, compared with before your The seme C] Slightly worse [] Much worse [7] ~ From the fst low, mark thos skis that re eect kl wth atk [Reming ard on Ding two tings a the sare tire | Remembetns you cilahond Secing bat sles of an argument Spoking orig language Moki deskions Noting wee you make a isiaka | Woking ward a gas The silly fo surimarie iran Good eyesight ‘Which part ofthe brain do executive skits tend to be associated with? y general, and the nal lobes of the brain? rector of a company, 2 have in common, wi a ‘What do the managin conductor of an orches leges you could use to help with, or compensate for, Identity three pr your executive skills di Which of the following jobs would be most sulted to, and least suited to, @ person nt executive skills deficits? Rank in order and then discuss. Vieng on thet ie busy Nebo eluant [Tieng a garden arte loo al the being ans Managing a large furniture removals company ATT ow wear yo fe ee? ver El ste Cl) netvey C) What waste mom prt emo Paoed atu any The baw oy Weack © rst 202 © | nomen Gaye tine vor CD hy CL] tevoy L) wii yar oma ya TE 0 mmr rn ermineINFORMATION SHEET 26 Some useful strategies for coping with executive problems Part Living witha brain injury — ‘Atinton, execu, language 4 perceptual sls Steps Involved in Problem Solving in Executive Tasks ae op (Pe, Oo Step back: Stop and identity the main problem. (What am | trying to achieve?) ' Consider what are the options or possible solutions? 1 Weigh up what isthe best option? (Weigh up the pros and cons of each.) t Plan out the steps involved to reach the solution. (Think about timing and strategies.) 1 Carry out the plan t Monitor progress and adjust plan accordingly. Evaluate (Was it @ success what were the positives and negatives?) H eM 1 eater ait Ling wit bala ijary ~ ‘Aitenton, executive, language 4 perceptual sil INFORMATION SHEET 27 Ways of improving language skills > Use gestures and signs associated with a particular word if you cannot access exactly that word. Problems with language are often refered to as ‘aphasia’ and can be broken down using language fo express a complex ing the right the corcect sound. Second rocaptive aphasia ~ the understand the speech of others. This Helping people who have a language otffieulty > Do not speak very quickly, and try to use short sentences with familiar words. ‘can vaty fom mild receptive aphasia, ‘hen you are less able to understand ‘complex sentence formations, to severe recoative aphasia, when you do not understand language at Coping with word-finding difficutties v Jump from ore topic to ‘conversation sckground noise and other Do not pressurise the person, insisting that they say the word, and not get hung up on finding the exact Fight word. Remember that sgplting the message across which person's name, ask yoursel questions, such as, "Is the person male?’ Then go through letters of the alphabet. > Be patient. 1. Kdentify one way of trying to recall a person’s name if you can't think 2 Identify two strategies to help communicate with petson who has a significant word-inding dificult. [erect dyer sane ca” vey C)staniy CE) tetvey L] int now wat 36 i é i © we emp mays exon forsee ec a vin ry Weak © T Rowe 2083 Von wt ou echt? very] tay L)_netwy Chat ns erat mot po 38 © Wisp nyt emepad o manerahae Te a Wy Woon ©INFORWATION SHEET 22 Understanding and coping with ‘Our perceptual and visuo-spat help us to make sense of the Information comes in through our senses ‘and ine process the information in the ‘centres largely in the back ofthe brain {og the parietal and occipital lobes). iu, people may have tlstance, with object attention and awareness of one side of space (e one side oftheir visual fil). Even though they can sense that side, they cennot process and perceive that sensory information. Others may struggle to judge distance, read maps, recognise objects or faces, or to put mechanical things together Strategies to improve perceptual > Be pre Faw tong you wi ‘Altenton, executive, language ‘& percepual ss perceptual and visuo-spatial difficulties > Slow down: take your time on the making mistakes, v when you feel more alert. > Practise copying comple shapes, Ensure you ate consck your head left to you can focus on and use you to stay on track. If you have a left-sided neglect, the v visuo-spatial ability > v v v y INFORMATION SHEET 28 Tips for perceptual difficulties during walking: Plan your pattern before you begin iv and obstacies on your weaker side Reduce conversation whilst walking, ‘or even siop walking to have a walking and safety. Be aware of your position on the avemeni/cotridor ~ check frequently pavemenijencidor to maintain a central position. Pick landmarks or visual objects on ‘your weaker side to me ving wit abr ‘Attention, execu Tips for perceptual diticulties during reading: > Got your focus on the task by v Scan for the outline ofthe paper ane id keep your left hand atthe to know where the you vireo sa. ing, use your finger to man foi and tery taek of the ‘bp back and try again, you lok fully to the le ‘entire sentence, {s involved with perception and visuo-spatial ability? led visual neglect, and tend to ignore things on the lett side, plan what you ; 38 © vrs be proc ar ncond man Te Maw uy Wt OTe 2038“INFORMATION SHEET 29 Dealing with fatigue Fatigue can have a negative effect on your mood, physical functioning, attention, memory and communication ‘and tolerance levels. A vicious cycle is ansiety, and becomes worse with increased stress. > Mental fatigue: Previously automatic tasks naw take more conscious effort to compl ‘and working harder to think an: focus ean ako you mental tid wakefulness > Information processing is slower due to inflammation ofthe nerves, so the brain has to work harder to do what v The brain stem, which controls consciousness, waking and the rhythms of sleeping, may be damaged. Ways of coping with fatigue For some people, fatigue improves over time; however for many people fatigue is a condition that they have to learn to ‘manage in the long-term, Often there is & to the same fee achieved prior ity and > Recognise the early warning signs; do not keep pushing yoursel, Dort the tous ee o whereby you alternate between feling fine and exhausted. v ‘means planning your days rd it. Ty to est , with periods of fatigue, then gredvl comploxity of each task as you improve. ‘leap more and buildin rests. Do ‘not feel bad about having a sleep in the afternaoa for say 45 minutes. If ‘el tired, your brain is saying close daw’. Listen to your v HME brain. f Say no’, delegate and prioritise. Say “no! to excessive demands of otters, raft ing ith 2 in ary Falige, emetional and ‘behavioural changes diferent Be a moming person. Do your most demanding activity in the moming, ‘when you are most alert and have the most mental energy. Eat regular meals. Eating a meat ccan often boost energy levels. Avoid large amounts of caffeine (eg coffee) aithaugh alertness is increased, only fasts a short period end only increase once worn off. Resoarch has shown active helps reduce fatique and builds stamina ~it also may improve mood and sleep quality. ‘Treat your fatigue like a bank account. Your energy levels are tke @ bank account that you need to manage. You need to keep puting in ‘g00d quality rest and not taking out too much mental act nasty penalty, 30 avoid that. Koop a diary. Keeping 2 record of the activities that you do wil give you more of an awareness of haw much you are doing and whet the tregers ‘are that provoke fatigue. © Ws pane expe shone risen ww oy The Ban ry Werk ©T Fa 2013 © ispape ay php fx nce ey The Bas yy Wok Taal 2013