Positive Interactions: After brain injury

Positive Interactions: After brain injury

Thomas Novack, Ph.D.
Behavior after brain injury is often viewed as negative, not positive. Interactions with survivors who have changes in cognition and behavior after a brain injury are often frustrating for caregivers, families and even therapists. Too often they lead to arguments, interruptions and disagreements. This tip card gives strategies to help build positive interactions with survivors of brain injury. It shows how to deal with refusals to participate in therapy or activities with tips on improving the survivor’s motivation.
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Full Description

It’s one thing to understand that the brain injury is causing the behavior, it’s another to know what to do about it. This tip card describes “rules of engagement” or guidelines for interacting with survivors of brain injury who have cognitive and behavioral challenges. Strategies for positive interactions include using short phrases, taking turns talking, avoiding repeated disagreements, explaining actions in advance, redirecting attention and mood, and “sandwiching” negative feedback.

How instructions and requests are given contributes to refusals to participate in therapy, take medications, or join activities. Tips for optimal ways of presenting requests will help increase the survivor’s participation in meaningful activities.

A final section addresses difficulty with initiative and motivation. This section for caregivers gives strategies that can be used at home and are easy to follow in a daily routine.

Details
Item PIBI
Pages 8
Year 2012

Authors

Thomas Novack, Ph.D.

Dr. Novack is a neuropsychologist and Professor of Physical Medicine and Rehabilitation at the University of Alabama at Birmingham. He is also Director of the Traumatic Brain Injury Model System. He is one of the co-authors of the new book, Living Life Fully after Brain Injury, with an entire chapter devoted to managing behavioral changes, and the author of Behavior Basics: The ABCs of behavior after brain injury tip card.

Contents

From Negative to Positive

  Tips on strategies for interacting…

                Speak clearly in short phrases

                Take turns talking

                Avoid repeated disagreements

                Explain what you intend to do

                Avoid sudden touching or grabbing

                Redirect attention and mood

                Sandwich negative feedback

 

Dealing with “NO!”

                Pick your time

                Determine what is being refused and why

                Explain what you intend to do

                Provide reasonable choices

                Introduce activities positively

                Bargain when possible

                Redirect attention

                Create written goals and a daily routine

                Make activities meaningful

                Give positive feedback

 

Hello? Is anybody home?

  Tips and strategies for dealing with poor motivation

                Rule out depression

                Examine sleep patterns

                Examine nutrition

                Examine medications

                Arrange a general physical examination

                Don’t ask, expect

                Develop a daily routine

                Focus on choices

                Be persistent

 

Conclusion

References

Excerpts

Too often, family, friends, caregivers and even educators, therapists or clinicians are frustrated when interacting with survivors with cognitive and behavioral challenges. It’s one thing to understand that the brain injury is causing the behavior; it’s another thing to know what to do about it. We have all heard about “rules of engagement” during military operations. Well, there are some simple rules of engagement when it comes to interacting with people who have cognitive and behavioral problems after brain injury that can minimize negative behavior.                    

 

Tips on strategies for interacting…

ü Speak clearly in short phrases.

Don’t mumble or express uncertainty. Look at the person and make your non-verbal communication (tone of voice, facial expression, posture) consistent with what you are saying. Don’t underestimate the effects of non-verbal communication! We often pay more attention to tone of voice and posture than to what a person is saying. Sarcasm is often confusing or misinterpreted when a person has a brain injury because it involves a discrepancy between what is being said and what you intend to communicate. Try to avoid using long sentences with a lot of ifs, ands, and buts.

 

ü Take turns talking!

Pause to allow the survivor to say something. If you dominate a conversation, the

Survivor may feel desperate to interrupt and become irritable. Remember that the   survivor may need a few moments to process what you say and think of a response. In doing this, you are also demonstrating how to take turns for the survivor. Sometimes survivors have a difficult time knowing when to stop and listen. You can demonstrate how to do this by saying 2-3 sentences and then pausing to allow others to speak.

 

ü Avoid repeated disagreements.

If you find yourself disagreeing or saying, “No” repeatedly, change the subject or leave the person alone for a few minutes. None of us like to be told we are wrong, and for it to happen repeatedly is very frustrating.

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