Living Life Fully after Brain Injury: A workbook for survivors, families and caregivers

Living Life Fully after Brain Injury: A workbook for survivors, families and caregivers

Robert T. Fraser, Ph.D., CRC, Kurt L. Johnson, Ph.D., CRC, and Kathleen R. Bell, M.D., Editors

Brain injury recovery is a long journey for survivors, families and caregivers. Whether you are a civilian or veteran who has survived a brain injury, a family member or caregiver, a clinician, advocate, or direct care staff, you will find this workbook is a valuable resource and tool for living a full life after brain injury. It pulls together…

· Scientific information from evidence based research

· Range of topics from coma to living in the community

· Compelling personal vignettes to illustrate content

· Tools for personal assessment and practical strategies

· CD with worksheets for personal and professional use.

This is the publication that has been missing up to now in the field of acquired brain injury. With chapters by 19 national experts on brain injury, it is informative at a “cutting edge” level but presented in a format and writing style that is empowering and clear for individuals and families. A CD contains 46 worksheets that can be printed and used by survivors, families and clinicians.
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Full Description

This workbook is designed as both a reference for in-depth clinical information as well as a hands-on tool for addressing the many challenges of living with a brain injury. As survivors, families and caregivers achieve new goals, encounter setbacks, and meet new challenges, this workbook provides information, strategies, tools, and checklists that will guide the reader through the next phase of recovery.

Twelve chapters discuss critical issues that most survivors, families and caregivers deal with at some stage in recovery after a brain injury. The workbook starts with helping readers understand what happens when the brain is injured and describes the complex medical issues involved for survival. As all families know, medical treatment comes at a cost, and there are many more hidden costs for families. A chapter on financial and health care concerns tackles the often confusing array of disability benefits, financial support, and health insurance. As survivors leave the hospital or rehabilitation setting, the chapter on neuropsychological assessment helps prepare them for returning home and reentering their community. Next is a chapter on the use of medications for the behavioral and emotional changes that often accompany a brain injury, with worksheets to help manage medications and to discuss treatment with your physician.

The next chapters address the changes in behaviors that are so often stressful, confusing and difficult to manage at home. Closely linked to this topic is a chapter on the emotional challenges, including depression and anxiety, that can affect both survivors and caregivers.

Next is a chapter on employment strategies and resources for survivors who are seeking a first time job or are considering returning to work. Closely linked to this is the next chapter on managing cognitive changes and fatigue in order to lead a more productive and fulfilling life.

For those readers with a child who has been injured, there is a special chapter on returning to school after brain injury that focuses on the critical transition to adult life.

The risks of alcohol and other drug use after brain injury are frankly discussed, as substances are too often used in attempts to fight depression, isolation, and other losses. The chapter on veterans discusses not only the consequences of blast injuries and brain trauma but also post traumatic stress disorders (PTSD) as service members return home. Because so many survivors have found themselves socially isolated as time passes since their injury, the final chapter focuses on re-connecting with relationships and community activities.

As you can see from this list, the authors have addressed a wide range of topics and issues that survivors, families and caregivers have said are critical for their recovery.

Details
Item LVLF
ISBN# 9781931117609
Pages 211 pages plus CD with 46 worksheets and forms
Year 2011

Authors

About the Editors

Robert T. Fraser, Ph.D.

He is a professor in the University of Washington's Department of Rehabilitation Medicine, joint with the Departments of Neurological Surgery and Neurology and consultant with Associates in Rehabilitation and Neuropsychology. Dr. Fraser was recently appointed to the Social Security Administration to advise on the revision to the disability eligibility process. He is an active counseling and rehabilitation psychologist, a certified rehabilitation counselor and a certified life care planner who directs Neurological Vocational Services within Rehabilitation Medicine. Within neurological rehabilitation, he has specialized in epilepsy, brain injury, and multiple sclerosis.

Dr. Fraser is author or co-author of more than one hundred publications and co-editor on four texts. He has been awarded numerous Federal grants by the Department of Education (NIDRR and RSA). He has focused on vocational rehabilitation and employment research with evaluation of innovative psychosocial rehabilitation strategies, prediction of vocational rehabilitation outcome across different neurological disabilities, and understanding demand-side employer behavior toward qualified workers with disabilities.

Kurt L. Johnson, Ph.D., CRC

He is a professor in the Department of Rehabilitation Medicine, Head of the Division of Rehabilitation Counseling, and Director of the University of Washington Center for Technology and Disability Studies. He received his Ph.D. in Rehabilitation Psychology from the University of Wisconsin-Madison in 1984 and taught at Florida State University prior to joining the University of Washington in 1990.

He has worked with survivors of traumatic brain injury and their families during all phases of their recovery from acute care to returning to work and the community. He is also an active researcher and teaches at both the undergraduate and graduate levels. Dr. Johnson has managed multiple grants related to disability including the U.W. Model Systems Knowledge Translation Center, the Americans with Disabilities with Act Knowledge Translation Center, the Multiple Sclerosis Rehabilitation Research and Training Center, and grants investigating the use of technologies to aid cognition and navigation for people who have survived brain injury.

Kathleen R. Bell, M.D.

She is a Professor in the University of Washington's Department of Rehabilitation Medicine and has been the Chief of Service at UW Medical Center since 2006. She has been the Medical Director of the Brain Injury Rehabilitation Program at UWMC since l996.

For over 25 years, Dr. Bell has concentrated her clinical care, teaching, and research in the area of brain injury in a variety of settings. She has been the Project Director for the UW Traumatic Brain Injury (TBI) Model System for the past eight years, and her specific TBI research interests have included telephone-based counseling, post-traumatic headache, exercise after TBI, and medical education.

About the Chapter Authors

Samantha M. Behbahani, Psy.D., M.S.ClinPharmCarlos Albizu University, Miller S chool of Medicine/Jackson Memorial Medical Center

Kathleen R. Bell, M.D. - Professor and Director, BRAIN INJURY Model System, University of Washington Department of Rehabilitation Medicine

Charles H. Bombardier, Ph.D. - Professor, Department of Rehabilitation Medicine, University of Washington School of Medicine

Pat Brown, Ed.D. - Clinical Associate Professor, Department of Rehabilitation Medicine, University of Washington

Allison N. Clark, Ph.D. - Assistant Professor, Department of Physical Medicine & Rehabilitation, Baylor College of Medicine; Investigator, Brain Injury Research Center, TIRR Memorial Hermann

Charles Drebing, Ph.D. - Associate Director of Mental Health for Psychosocial Rehabilitation, Bedford Veterans Administration Medical Center; Associate Director, New England Veterans Administration, Mental Illness Research Education and Clinical Center; Assistant Professor, Department of Psychiatry, Boston University School of Medicine

Dawn M. Ehde, Ph.D. - Professor, Department of Rehabilitation Medicine, University of Washington

Jesse R. Fann, MD, MPH - Associate Professor, Department of Psychiatry and Behavioral Sciences, joint with Rehabilitation Medicine and Epidemiology, University of Washington

Robert T. Fraser, Ph.D., CRC- Professor and Director, Neurological Vocational Services Unit, Department of Rehabilitation Medicine, University of Washington

Gwendolyn J. Gerner, Psy.D. - Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland

Efrain A. Gonzalez, Psy.D., M.S.ClinPharm, ABPP - Miller School of Medicine/Jackson Memorial Medical Center

Kurt L. Johnson, Ph.D., CRC - Professor and Head, Division of Rehabilitation Counseling, Department of Rehabilitation Medicine, University of Washington

Thomas A. Novack, Ph.D. - Professor, Physical Medicine and Rehabilitation, University of Alabama at Birmingham

Maureen K. O'Connor, Psy.D., ABPP-CN - Director of Neuropsychology, Bedford Veterans Administration Medical Center

Angelle M. Sander, Ph.D. - Associate Professor, Department of Physical Medicine & Rehabilitation, Baylor College of Medicine/Harris County Hospital District; Senior Scientist & Director, Brain Injury Research Center, TIRR Memorial Hermann

David J. Schretlen, Ph.D., ABPP - Department of Psychiatry and Behavioral Sciences, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins School of Medicine

Pamela Targett, M.Ed. - Director of Employment Services, Virginia Commonwealth University

Kathryn M. Yorkston, Ph.D. - Professor and Head Division of Speech Pathology, Department of Rehabilitation Medicine, University of Washington

Paul Wehman, Ph.D. - Professor, Department of Physical Medicine and Rehabilitation Counseling, Virginia Commonwealth University

Contents

Ch 1 Medical Issues and the Nature of Recovery after Brain Injury by Kathleen Bell, M.D.

Ch 2 Financial and Healthcare Concerns by Robert Fraser, Ph.D.; Kurt Johnson, Ph.D.

Ch 3 Neuropsychological Assessment by Gwendolyn Gerner, Psy.D.; David Schretlen, Ph.D.

Ch 4 Medications: Psychopharmacology after Brain Injury by Samantha Behbahani, Psy.D.; Efrain Gonzalez, Psy.D.

Ch 5 Managing Behavioral Changes by Thomas Novack, Ph.D.

Ch 6 Managing Depression, Anxiety, and Emotional Challenges by Dawn Ehde, Ph.D.; Jesse Fann, M.D.

Ch 7 Employment Strategies and Resources by Robert Fraser, Ph.D.; Paul Wehman, Ph.D.; Pamela Targett, MEd

Ch 8 Strategies and Accommodations to Manage Cognitive Changes and Fatigue by Kurt Johnson, Ph.D.; Kathryn Yorkston, Ph.D.

Ch 9 Returning to School after Brain Injury: Transition to Adult Life by Pat Brown, Ed.D.

Ch 10 Alcohol and Other Drug Use after Brain Injury by Charles Bombardier, Ph.D.

Ch 11 Veterans and Brain Injury by Maureen O'Connor, Psy.D.; Charles Drebing, Ph.D.

Ch 12 Re-connecting with Relationships and Community Activities by Angelle Sander, Ph.D.; Allison Clark, Ph.D.

Excerpts

Managing Behavioral Changes

Introduction

This chapter helps the caregiver who is trying to manage difficult behavior by a survivor with a severe traumatic brain injury. If you are a survivor, you may not have these types of issues or you may have them and be unaware of them. In addition to your personal efforts to control your behavior, it is your caregiver and significant others who can help you by using some of the “tips” presented in this chapter. By working together, a survivor and caregiver/significant other can often make substantial behavioral gains.

Why do they behave that way?

The frustration is enough to pull out your hair at times! People spending time with a person with a traumatic brain injury sometimes have to deal with irritability, inappropriate comments, unpredictable responses, poor self-awareness, impulsive behavior, lack of motivation, or refusing to do things, among other issues. The person's behavior is so different from what he/she was like before the brain injury! It is like “throwback” behavior to a younger age or even more extreme. These concerns are more common with more severe injuries. How does a caregiver deal with while still helping with recovery and maintaining sanity? First, understand why this is happening and, second, learn what you can do to improve the situation.

There's a reason.

Those ol' frontal lobes. Areas of the brain that are often injured can affect behavior directly. This is particularly evident with trauma to the frontal part of the brain. Damage to this area, which controls what are often called "executive skills," can lead to the difficult behaviors that occur after a brain injury. Like an executive of a company, the frontal areas of the brain establish goals, patterns of behavior to achieve those goals, and inhibition (stopping) of behavior that is not consistent with those goals. For example, when a student has a test coming up, the goal is to perform well on the test. The pattern of behavior consistent with that goal is studying, meaning there will be an inhibition of inappropriate behavior such as watching television.

A frontal area disorder due to a brain injury causes a breakdown in establishing and maintaining goals. This means that the person will have difficulty establishing an appropriate goal, sticking to a goal, and stopping behavior that is not essential to the goal.

Can we talk?

In addition, people with a substantial brain injury often have difficulty communicating clearly and understanding clearly what is said to them. An injured person may have difficulty attending to longer instructions or conversations, particularly complex ones. Staying on topic may be difficult.

What are you really saying?

The ability to read and generate social cues may also be diminished. People with a brain injury may not pick up on “body language,” tone of voice, or facial expression during conversation. For instance, a survivor may not pick up on the body language typically used to say, “I am done with this conversation,” or, “I do not have a romantic interest in you.” Self and interpersonal awareness may be quite limited.

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