Presented By: Amy Karas, MS, CCC-SLP Janet McBride-Roy, CTRS Community Rehab Care, Inc. March 27, 2014.

Use of Cognitive and Communication Strategies to

Maximize Function for Persons with Acquired Brain

InjuriesPresented By:

Amy Karas, MS, CCC-SLPJanet McBride-Roy, CTRS

Community Rehab Care, Inc.March 27, 2014

Definition Characteristics Types Co-Morbitities:

◦ Intellectual functioning◦ Past medical history◦ Learning style◦ Mental health◦ Substance abuse

Statistics

Acquired Brain Injury

• Cognitive• Communication• Social Pragmatics• Emotional• Behavioral• Physical

Types of Impairments

• Impulsivity• Poor decision making• Inability to advocate for self• Social isolation• Feelings of hopelessness or disinterest• Withdrawal from interests• Changes to relationships• Modifications or inability to work• Modifications or inability to drive

NEED FOR CASE MANAGEMENT!

Impact on Environment

◦ Ability to develop a therapeutic relationship◦ Understanding of client skills, challenges and

barriers to progress◦ Recognition of change and ability to adjust and

adapt to needs◦ Flexible thinking◦ Ability to advocate for client and with client/family

as needed◦ Knowledge of your limits and when to seek

assistance

What makes a good case manager?

• Trust • Honesty• Patience• Ability to listen• Compassion• Providing support documentation/literature• Integration of strategies • Determine best mode of communication• Follow through• Frequency of check-ins

Building the Therapeutic Relationship:

• Interview• Demographics• Diagnosis/ Present

illness• Past Medical History• Social/Vocational

History• Legal Status/Guardian• Medical Providers/

Insurance• Financial Resources

• Client/Family goals• Daily Structure• Behaviors/Mental

health• Physical Abilities/Safety

Risk• Cognitive Skills• Communication Skills• Recommendations

Assessment

• Family• Friends• Medical/ rehab providers • Case management - ongoing• Counseling• Support groups (Survivor, Care Giver, AA/ NA)• Local community resources/supports• Money/insurance/rep payees• PCA/home health aides/home makers

Types of Supports

Premobid living environment New apartment (elderly/disabled housing, subsidized) Rooming/boarding house Friend’s apartment Shelter/streets Sober house Skilled nursing facility Assisted living facility Adult Foster Care Rest Home Residential/group home Set back/modifications/improvements

Types of Transitions

• Refer back to assessment.• Create an open dialogue. • Request input from client caregivers, family and other

close providers.• Identify key team members and roles.• Create short and long term goals that are client –

centered. S.M.A.R.T. Goals: S = Specific M = Measurable

A = Attainable R = Realistic T = Timely / Tangible

10

Creating a Plan of Action:

Ongoing training and communication needs◦ Type of brain injury◦ Functions of the brain◦ Signs and symptoms ◦ Living with brain injury◦ Specific strengths and weaknesses◦ Accommodations/ modifications/ strategies◦ Identify “Red Flags”

Implementation of Plan

When and How to Use Strategies

• Calendar: track appointments, orient to day/date• Smart Phone: track appointments, set alarms, take

notes, memory log• Notebooks: track appointments, phone log,

transportation needs, things to do, medical timelines

• Establishing Routines: increase organization (sorting mail, filing paperwork), increase involvement (meal prep, ALDs, IADLs)

• Phone Log: expressing needs, recording information, for follow up, returning calls

• Internet: set up banking, explore resources, job hunt, self advocacy and collaboration on goals

Functional Strategies:

• Involve others to assist with sharing information• Offer opportunities to provide education and training• How to communicate and share information

accurately?• Establish best modality: verbal or written• Determine amount of assistance needed• Establish frequency of contact and how to maintain

Functional Communication and Promoting Self Advocacy:

Establish systems for medical appointments -Determine amount of assistance with preparing for appointments -Develop written template -Rehearse script prior to appointment -Identify what to bring (medical timeline, notebook, tape recorder, etc.) -Communicate with medical team prior to appointment -Attend together How feedback will be provided after

appointments -Who calls who after appointment (you, client, medical provider) -Establish systems for processing & fine tuning systems

Functional Communication & Promoting Self Advocacy Continued

Questions/Feedback

www.biama.org

www.biausa.org

www.ABIstafftraining.info

www.nursing.advanceweb.com

www.ntooc.org

Donald T. Stuss and Robert T. Knight. Principles of Frontal Lobe Function (Oxford University Press, 2002).

References: