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Introduction

A Unique Method

A brain injury* affects not only the individual, but the entire family as well. The person with a brain injury may need help from caregivers over time. Caregivers will have many questions that need answers:

· How can I help the person with a brain injury to sort out his life again?

· What does she hope to achieve in the future and are her goals realistic?

· How do I talk about these things with him?

· How can I help care for her without taking over her life?

This workbook presents a unique program to help answer these questions. It describes an approach where the person with a brain injury works together with a caregiver to map out the past, present and future. The aim of this process is to help the person with a brain injury regain control over his life again.

This program has been applied in the Netherlands and Belgium by many healthcare and social service organizations. It has been used for people with mental and/or physical limitations. Staff in psychiatric hospitals, nursing homes and volunteer home caregivers have used this program successfully. Research reveals that people with brain injury and their caregivers respond very positively to this method.

Is there a need for a method specifically for people with brain injury?

There are many support models for people with mental or physical limitations or with psychiatric disorders. However, they do not answer the questions that people with acquired brain injury raise. The behavioral and cognitive changes that can occur after a brain injury are fundamentally different than those caused by other illnesses or disorders.

Brain injury requires a unique approach. People with brain injury have two lives: their pre-injury life and post-injury life. The challenge they face is how to connect both lives. With help from people with brain injury, their family and caregivers, we set out on a journey to develop a unique support method specifically for people with acquired brain injury. SABI* (known in the Netherlands and Belgium by the Dutch title ‘Hooi op je vork') is the distinctive result of our journey.

The SABI method considers…

· the change that the brain has undergone

· the change in perspective for the person with a brain injury

· the change in the social network

· a new way of looking at life with brain injury

· striving to the individual's maximum quality of life.

*Note: The term brain injury is used in this workbook to include all types of acquired brain injuries including those caused by trauma, blasts, tumors, infections, stroke, cardiac arrest and anoxia.

Sabi is also a Japanese word, which is used in the combination wabi sabi.

The two words together mean...live your life in knowing that everything will pass away, so accept the beauty that comes with age, when life is touched by time and is not perfect anymore.

Excerpt from

Chapter 3 Exploration Phase: Life in Perspective

The Exploration phase has two components: the person with a brain injury and his life. In this chapter, we will concentrate on the person with a brain injury's life. We will introduce twelve Life Themes that serve as a platform for discussion and provide a systematic approach for eliciting information about the person's life before and after the brain injury.

The working method with these Life Themes and the person's goals are explained within the context of the Exploration phase. To illustrate the theories of this phase, we will once again draw on case studies based on two people with a brain injury, Jane and Peter. We will explain possible ways of interrelating the information that has been elicited, with the aim of gaining a better understanding of the person's behavior in order to establish agreements and conventions.

Appendix 1 contains supplementary information on the twelve Life Themes and example questions and observations.

Life Themes

Why explore the different themes in the life of the person with a brain injury?

In this phase, the person with a brain injury and the caregiver explore together which aspects play a major role in the person's life. This is done by talking about a range of Life Themes and recording the information that surfaces. We work with Life Themes as a platform for discussion. They help us organize the information and elicit any aspirations of the person with a brain injury. This puts the person's life into perspective. The SABI method distinguishes twelve Life Themes:

· Appearance

· Health

· Family/Relationships

· Sexuality

· Social Contacts

· Work

· Finances

· Recreation

· Housing and Housekeeping

· Certainty about the Future

· Independence

· Meaning in Life

By exploring each Life Theme before and after the brain injury occurred and comparing the past with the present, what has changed in the person's life becomes clearer. This helps give the individual a perspective about the future. This also helps the person's social network understand him better. Information about the past can provide a fundamental key to understanding the present, as the following example illustrates.

Who provides information?

Information on the various Life Themes is provided by the person with a brain injury. Only if the person consents is information gathered from someone in the social network. Information from others can contribute to putting the person with a brain injury's life into clearer perspective. The information exchange allows all parties concerned to gain new insights. The other person providing information can be the person with a brain injury's partner or parent, a professional caregiver, or both if they both play a role in the person's life. Whoever the person is, it is important that the person with a brain injury trusts who is providing information. The person's file can also provide valuable information, particularly about the person's past.

Monique says that she used to be good with money. She was very proud of never being in the red. She adds that never being in the red is still important to her.

Her caregivers observe that Monique wants to buy expensive things, which they find awkward because they regularly have to tell her that she cannot buy things because she doesn't have the money.

Based on pre-injury information, Monique and her caregiver discuss the current situation and learn that because of her brain injury, Monique no longer understands the value of money. Because Monique considers it important to manage her finances properly, she and her caregiver make an overview of Monique's financial situation in a way that Monique is able to understand. With support from her caregiver, she is able to keep her financial situation in perspective and manage her own finances.