Traumatic Brain Injury Disability Counseling Janey B. Mosier

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Traumatic Brain InjuryDisability
CounselingJaney B. Mosier
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• The terms disability and handicap are often
  misused and confused.

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Disability

• This refers to the limitation of function that
  results directly from an impairment at the level
  of a specific organ or body system.

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Handicap

• This is an actual obstacle or obstacles the
  person encounters in the pursuit of goals in real
  life, no matter what their service.

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• It is important to remember that people can have
  either just one, or both. (disability or handicap)

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VERY IMPORTANT

• The brain controls EVERYTHING we do. It controls
  ALL of our actions. This is serious. When
  damaged, the counselor, has their work cut out!
  Be prepared for the unexpected!

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• A Traumatic Brain Injury can happen because of a
  fall, vehicle accident, assault, or any other
  blunt force trauma to the head. This may cause
  people to become handicapped or
  physically/mentally disabled.

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Human Brain
Frontal Lobe
Parietal Lobe
Occipital Lobe
Temporal Lobe
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Frontal Lobes

• commanding officer of the brain controls
  impulse motivation, social abilities, expressive
  language, and voluntary movements. This part
  controls the ability to retrieve memory from
  storage and helps with organization. It also
  controls our emotions/emotional regulation.

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Temporal Lobes

• Holds the bulk of memories (recent and distant
  past), controls emotional thoughts, holds the
  ability to understand language and appreciate
  music. It also controls perceptions.

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Parietal Lobes

• This controls the sense of touch. It plays a
  major role in academic abilities. Victims may be
  unable to feel or recognize objects.

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Occipital Lobes

• Controls sight, victims may become blind

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On your mind???

• 50 First Dates
• Drew Barrymore
• Adam Sandler

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Effects of a TBI

• Physical
• Cognitive
• Behavioral
• Communication
• Emotion
• Psychological

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• Each person suffering from a TBI will have
  dramatically different recovery results. The
  hospital length will vary. The length of
  outpatient therapy will vary. Finally, the time
  before beginning counseling will vary.

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• Counseling is the KEY of the rehabilitation
  process.

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• As counselors of patients with a TBI, we must be
  prepared for a variety of challenges. Lets dive
  into what lies ahead!

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• If a client has a severe memory impairment
  because of a TBI the counselor may need to teach
  them to use tools such as
• tape recorder
• planner
• notebook
• journal

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• Counselors cannot be alarmed. The client may
  perceive them as negative or antagonistic because
  of their attempts to address their new deficits.

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• There are steps that a client with a TBI will go
  through and steps the counselor will take to
  work with them. It is important to know, these
  steps are the same for any disability, beyond a
  TBI.

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SHOCK

• This is psychic numbness resulting from an
  overwhelming physical trauma.

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Behavioral correlates

• Immobilization, cognitive disorganization ex.
  Incoherent speech, blank stare

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Counselor Strategies

• Comforting-verbally and physically, listening and
  attending, offering support and reassurance,
  allowing ventilation of feelings, referring
  person institutional care (when appropriate)

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Anxiety

• Panic-stricken reaction upon initial recognition
  of traumatic event. Remember, it may take a
  person with a TBI a long time to realize what has
  happened.

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Behavioral Correlates

• Restlessness, purposeless activities, rapid
  speech, sweaty palms, panic attacks,
  hyperventilation, fast pulse

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Counselor Strategies

• Listening and attending empathetically, offering
  support and reassurance, reflecting and
  clarifying, applying muscle relaxation procedure,
  medication may be necessary because the part of
  the brain that is damaged may be causing the
  depression

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Bargaining

• Expectancy of recovery from disabling condition
  through protest and deal making

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Behavioral correlates

• Information seeking, continuous consultation of
  physicians, contract proposals with God,
  obsessive-compulsive activities

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Counselor Strategies

• Providing accurate information, supplying medical
  facts (when back round permits and client can
  cognitively comprehend), confronting reality
  (when appropriate)

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Denial or Anosognosia

• Denial is defensive retreat from painful
  realization of disabled condition implications
• Anosognosia is when clients with a TBI deny the
  severity of the injury

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Behavioral correlates

• Lack of awareness of problems, unrealistic
  goal-plan setting, avoidance of failure-prone
  situations, ignoring or forgetting physicians
  orders, attempts at maintenance of predisability
  daily routines, overcompensation for deficiencies
  (when shielding by denial is threatened)

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Counselor Strategies

• Provide accurate information, accepting denial as
  self-protection (only at the beginning),
  clarifying, interpreting inconsistencies,
  confronting discrepancies (between verbal and
  nonverbal messages, cognitive and affective
  components, etc.), heightening self-awareness
  (Gestalt Therapy techniques). Remember these
  things may not work with Anosognosia.

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Mourning

• Relatively short grief response upon realizations
  of personal implications stemming from
  disability. People with TBI mourn over the life
  they lost. They may also mourn too, over all of
  the memories that are unable to be retrieved.

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Behavioral correlates

• Loss of appetite, sleep disturbances,
• slouched posture, sobbing, crying episodes,
  slow body movements, low energy level

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Counselor Strategies

• Listening and attending, supporting and
  reassuring, allow client to vent feelings,
  reflect and clarify, heighten their self
  awareness, guide the client to recognition of
  inner resources and strengths

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Depression

• Relatively extended and generalized bereavement
  of lost body part or function
• Some clients with TBI are dealing with loss of
  former life and dealing with their new personality

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Behavioral Correlates

• Loss of appetite, sleep disturbances, sobbing,
  crying episodes, slow body movements, lethargy,
  silence, unkempt personal habits, slow and
  monotonous tone of voice, suicidal ideation

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Counselor Strategies

• Listening and attending, supporting and
  reassuring, reflecting and clarifying, guiding
  client to recognition of inner resources-strengths
  , reinforcing positive self statements,
  confronting and restructuring unrealistic beliefs
  and expectations, engaging client in physical
  activities

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Withdrawal

• Resignation from social-interpersonal interactions

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Behavioral correlates

• Apathy, passivity, avoidance of human contacts,
  excessive sleep, deterioration of personal
  habits, silence, disrupted eating habits

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Counselor Strategies

• Reinforcing social interpersonal contacts,
  teaching assertiveness skills (assisted by role
  playing), bring client into contact with support
  (socialization, self-help) groups
• An excellent group for local survivors of a TBI
  is PABIA (Pittsburgh Area Brain Injury Alliance).

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Internalized Anger

• Self-directed bitterness and resentment often
  associated with guilt feelings

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Behavioral correlates

• Self-blame, self-abuse, self-injuries, incidents,
  suicidal ideation, passive aggressiveness,
  argumentativeness,
• lip biting, facial twitching
• Caution There is a high link between TBI and
  alcoholism.

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Counselor Strategies

• Teaching expression of anger in socially-approved
  manner, teaching relaxation techniques, heighten
  self awareness, contracting (for decrease in
  acting out behaviors), confronting, teaching
  responsibility taking for ones on behaviors
  (reality therapy), Assisting in choosing from
  alternative and more socially appropriate
  responses, apply behavioral modification
  techniques to clients maladaptive aggressive
  responses, identify real cause of anger, provide
  drug/ alcohol rehab (when necessary)

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Acknowledgement

• Intellectual recognition of future implications
  stemming from disability and their integration
  into ones changing self concept
• Some clients with a TBI will NEVER reach this
  point.

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Behavioral Correlates

• Intellectualization of specific areas of
  disability and their daily impact, discussion of
  disability and the obstacles it creates, uses of
  sarcasm, initiation of social contacts,
  initiation of future plans

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Counselor Strategies

• Planning and developing goals, reinforcing
  positive self-statements, reflecting and
  clarifying frustrations, encouraging use of
  humor, discussing and modeling new behaviors,
  teaching assertiveness techniques, giving
  feedback on progress and adaptation, teaching
  problem-solving skills, changing and
  restructuring the environment, shaping behaviors
  (operant conditioning), rewarding appropriate
  newly learned behaviors, teaching self
  responsibility

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Acceptance

• Affective, in addition to intellectual
  internalization of future implications from
  disability and their integration into ones
  changing self-concept

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Behavioral correlates

• Positive self-statements and optimistic future
  outlook, relaxed posture, use of humor,
  self-assertiveness, perusal of specific future
  plans, discussion of disability, its emotional
  aspects, and ways to overcome obstacles created

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Counselor Strategies

• Refining assertiveness skills, give client
  feedback on progress, upgrade problem-solving and
  decision making skills, shaping behaviors,
  setting priorities, specifying and refining
  goals, encouraging further interpersonal
  relationship-building, assisting client in
  joining and participating in support groups

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Adjustment-adaptation

• The final phase in the coping process.
  Behavioral adaptation and social integration into
  a newly perceived world.
• Even in a Brain Injured client doesnt or cannot
  acknowledge their disability they will still
  eventually adjust with time.

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Behavioral Correlates

• Risking of new situations, accomplishment of
  plans and goals, self-assertiveness, purposeful
  activities, attempts at functioning
  independently, persistence in the face of
  (possible) failures, successful overcoming of
  disability-related obstacles

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Counselor Strategies

• Giving positive reinforcement for efforts made,
  providing information and periodic feedback on
  psychological social, and vocational adjustment,
  refining problem-solving skills, encouraging
  person to maintain independence, reviewing
  periodically clients functional level in
  community-based support system(s), proving
  occasional follow-up sessions (when requested)

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• Family members may also go through many of these
  stages. There may be group family counseling or
  individual counseling for a family member as they
  deal with all of the changes.

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REMEMBER

• These are the educated guidelines and suggestions
  for dealing with a client that has a Traumatic
  Brain Injury. You are also, hearing it from a
  real SURVIVOR!!! Depending on the individual and
  their limitations counselors may have to be
  creative when coming up with ideas and techniques
  to help the client maximize their potential.

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References

• 1.Guth,M. (1996) Brain Injury
  Rehabilitation The Role in the Family
  in TBI Rehab. Texas HDI Publishers.
• 2.Livneh,H. Evan, J. (1984) Adjusting to
  Disability Behavioral Correlates and
  Intervention Strategies. Personnel and
  Guidance Journal, 62, 363-366.
• 3.Marinelli, R.P. Orto A.E.D. (1991) the
  Psychological and Social Impact of Disability
  (3rd ed.). New York Springer.
• 4.McAlaster, R., Lundgren, G, Higa, C. (1996).
  Teaching Persons with Brain Injury What to
  Expect. Tampa HDI Publishers.
• 5.Senelick,R.C. Ryan C.E. (1998) Living with
  Brain Injury. Alabama Health South Press.
• 6.Wright, B.A. (1993). Physical Disability-A
  Psychosocial Approach (2nd ed.). New York
  Harper and Row.