Trauma, Rehab and Recovery; Putting the Pieces Together;Manitoba Brain Injury Association

Val LougheedNorthern Lights Canada

Real Work * Real People * Real Results

PUTTING THE PIECES TOGETHERTrauma, Rehabil i tation and Recovery

~ Keep your Fork ~

1-800-361-4642 * www.northernlightscanada.ca * [email protected]

“You don’t want your impairments to define you – you want them to inform you.”

(Hanita Dagan, personal communication, 2005)

www.slideshare.net/vlougheed

#NLCAN

www.northernl ightscanada.ca/our-company/our-

president/be-st i l l

Agenda

• Beginning …

• Middle …

• End …

Putting the Pieces Together

1. What does it mean to recover?

2. What can I do to recover and return to a l i fe that includes work?

3. What can we do to facil i tate recovery and a return to work?

Rated PG-113

People Strongly Cautioned!

May contain bad language, brief nudity, sexual overtones, and drug usage.

Beginning

1978

VIDEO CLIP Val being

interviewed in Minden

Sept. 9, 2003 - morning

Sept. 9 – p.m.

Sept. 15 2003 – Jan. 19 2004

Journey Back to Life

February 2004 – Present

Starting Point

The

Re-organization

of Self

March 2004

“In the aftermath of traumatic l i fe events … [the] sense of self has been shattered.”

(Herman, 1992, p. 61)

“An existential crisis …”(Hanita Dagan, personal communication, 2005)

Sliding Down the Slope

Sliding Down the Slope

A Foothold

• Mild – moderate ABI

• Depressed (dysphoria)

• Working memory problems

• Hiding pain

1st Neuropsychological Assessment

June 2004 -- Results

ABI – Measuring Loss

Subject ive Report – diff iculty retrieving words and communicating ideas

Objective Report – above-average performance on neuropsychological measures

(Prigatano, 1999; p. 59)

Losing My Grip

My IWRPAugust 2004

Video of Borg

Rescued in the Valley of Despair

Head Injury ProgramOct. – Dec. 2004

GRTW – The Plan

Jan. 3 – Feb. 7, 2005

(5 weeks)

GRTW – The Reality

GRTW – The Reality

GRTW – The Reality

GRTW – The Reality

GRTW – The Reality

GRTW – The Reality

GRTW – The Reality

GRTW – The Reality

GRTW – The Reality

Work-Site Performance Evaluation©

Sliding Back Down Into The Abyss

• Non-compliance

• Malingering

• Trying too hard

• Not trying hard enough

2nd Neuropsychological Assessment

May 2005 -- Edmonton

Test Results

• Mild to Moderate ABI

• Pain?

• Depression?

• Motivation?

• “a high flyer”

• “phobic avoidance”

• Future plans – “l ive off dividends” [from company]

Lesson

ASSUMPTIONS

REVEAL BIAS

• Mild – moderate ABI

• Good prognosis

• Post-Traumatic amnesia

• Pain?

• Depression?

• “Adjustment Disorder with Anxiety and Depressed Mood”

3rd Neuropsychological Assessment

August 2005 -- Calgary

Symptom Overlap

(co-morbidity)

(Michael Sullivan, Centre for Research on Pain and

Disability, McGill University, September, 2006)

Pain, Trauma, Depression, ABI

Oct. 3 – Dec. 11

Pain Research1600’s – Rene Descartes (philosopher)

Pain Research1950’s – Wilder Penfield (brain surgeon)

Pain ResearchPatrick Wall (physiologist)

Ronald Melzack (psychologist)

Pain – The Future

SCN9A(Globe and Mail , March 24, 2007)

Glia Cells(Scienti f ic American, November, 2009)

Poppy Genes(U of Calgary -- Calgary Sun, March 15, 2010)

“In every encounter, basic trust is in question.” ( Herman, 1992, p. 92)

“Survivors feel unsafe in their bodies – and in any relationship with other people.” (Herman, 1992, p. 160)

Rehab & Recovery

DISSO

CIA

TION

Trauma Research

VIDEO CLIP

Adrenal ine:

F l ight or F ight

Response

Trauma Research

Fight

Freeze

“Survival Central”(Rothschild, 2000, p. 46)

• Amygdala - Implicit memory• storage of emotions and sensory reactions

(Rothschild, 2000, p. 20)

• Hippocampus – Explicit memory• creates memories of actual sequence of

events(Rothschild, 2000; p. 28)

Trauma ResearchLimbic System and Memory

Stress Hormones

• Amygdala - Implicit memory• storage of emotions and sensory reactions

(Rothschild, 2000, p. 20)

• Hippocampus Explicit memory–• creates memories of actual sequence of

events(Gunnar & Barr, 1998)

Trauma ResearchLimbic System Under Threat

TraumaPersonal Experience

• Dissociation & Cocoon = Safety

• System on High Alert Always = Survival

• World is black & white = Trust

Trust (Safety) = Love

No Trust (Life Threatening) = Hate

TraumaPersonal Experience

• Listen to me

• Understand me

• Respect me

• Are competent

I trust ( love, feel safe with, wil l try hard for) people who:

“… depression [caused by trauma] is not the same as ordinary depression.”

( Herman, 1992, p. 118)

Depression

Candace Pert, 1997; pp. 171 -- 179

Psychoimmunoendocrine Network

Affects more than IQ ….

Touches core … of a person’s self-esteem

(Prigatano, 1999; p. 58)

ABI

Back to Wilder Penfield – 1950’s

ABI

Localizationist

VIDEO CLIP Story of Paul Bach-y-Rita’s dad

Paul Bach-y-rita Neuroplasticity Video Clip;

l ink to Neuroplasticity – YouTube; bren49764

00 – 2:20

Paul Bach-y-Rita – 1934 – 2006

Scientist and Rehab Doctor

Neuroplasticity - 1969

METHODS OF HELPING

“The words and att i tudes of others … are potent. They help or hex healing and recovery.”

“ Expectations are powerful.”

(Bolen, 1996; p. 94)

Body-Mind Connection

Cortisol and Immune Cells

Sternberg, 2001; p. 112

SCARF MODEL (Rock, 2008)

VIDEO CLIP Esther

SternbergDr. Esther Sternberg Demo

Reel – YouTube; 00 -- .36

• Hypothalamus

• Peptides

• Receptors

• Biochemical Events

Video clip Addicted to Love song

Quantum Connection The Living Matrix

(Braden, 2007; p. 45)

“Loss of identity can evoke a personal crisis, creating a need for change.”

(Ornelas, in Smith & Johnson (Eds), 1997; p. 172)

The Re-Organization of Self

Identity Research

Scaling the Canyon

Sept., 2005

Waskesiu

Breast Cancer Reconstructive Surgery

March 2006

Convocation M.Ed. -- June 2006

Back in “a” SaddleSeptember 2007

• Off icial ly change role/ t i t le

• Re-organize NL

• Home Office

Putting the Pieces TogetherResil ience

Abil ity to return to original form after being bent (bounce back)

Thriving in constant change, abil i ty to be:

• Flexible

• Creative

• Adaptable

• Learn from experiencehttp://www.resiliencycenter.com/articles/5levels.shtml

Putting the Pieces Together

Rehabil i tation (habiter – to live inside)

“Rehabil itation is the learning to l ive inside not only one’s body, however it is after an injury or i l lness, but inside one’s very being.”

(Kabat-Zinn, in Meili, 2003; p. 241)

Putt ing the Pieces Together

RecoveryCuring Focus on the i l lness/

impairment [outside]Healing Focus on the person

[inside](Crombez, October; 2003)

Be Sti l l

Putting the Pieces Together

1. What does it mean to recover?

2. What can I do to recover and return to a l i fe that includes work?

3. What can we do to facil i tate recovery and a return to work?

Keep Your Fork

Northern Lights Canada is a person-centred organization committed to providing innovative, responsive l inks to real work.

We offer 4 major divisions of service: • Vocational Rehabil itat ion Services • Employment Services • Employer Services• Corporate Training

For more information, please contact us: 1-800-361-4642

www.northernlightscanada.ca

Voc Rehab Canada (VRCAN) is a national consort ium of experienced regional vocational rehabil i tat ion companies. VRCAN provides customers with single-point access to VR services anywhere they are needed in Canada, whether on an individual service or contract basis.

Member companies include:

Argus Management Consultants, Inc. Sandra Preeper & Associates

Advantage Rehabil i tation Consultants Ltd.

Rehabil i tation Alternatives Limited / Vocational Alternatives Software

OPTIMA Rehabil i tation CVE Inc.

Northern Lights Canada Occupational Rehabil i tation Group of Canada (ORGOC)

Western Rehabil i tation Special ists Inc. Diversif ied Rehabil i tation Group

Genesis Rehabil i tation Ltd. Rehabil i tation Focus

For more information, please feel free to contact us at 1-800-361-4642