traumatic brain injury upload videoa

MANAGING OFFENDERS WITH TBI

Mental Health, Medical, and Behavioral Management of offenders with an Acquired traumatic Head Injury

Traumatic Brain Injury

Developing an understanding of the socio-cultural impact and implications for management of TBI survivors within the correctional setting.

Stephen W Ford PhD NCCSAP►Four years in child welfare► Three Years in Crisis Care► Two years in foster care► Seven years in community

mental health► Seven years as a mental

health consultant► Five years in Corrections

(Active)► Twelve years as a Pastor

(Active)► Four years in private

practice (Active)► Adjunct Professor for

Liberty University Online (Active)

Sue Carol-Lehman MeD LSW► Thirteen years as a Social

Work Supervisor in corrections (Active)

►Three years as a multi-systemic therapist with the Lawrence County Courts

► Seven years as a community support mental health/crisis care social worker

►Served on Domestic Violence task force

► Served with the Ohio Arts Council

Why this Subject is of Interest to Us!► We both have professional and personal reasons for interest

in this subject.

Ms. Lehman and my professional interest in this topic is relatedto the fact that we have several inmates that we currently workwith that have traumatic brain injury that have caused us somestress.

I have also worked with several individuals in my private practicethat have acquired a traumatic brain injury and are struggling toadjust.

&

Our personal interest relates to our friend and co-workerthat suffered a traumatic brain injury three years ago.

Introduction► Tell us who you are.

► The name of your institution.

► Your job title.

► Years of experience.

► Why you may be interested in this topic.

► One thing you like to do for fun that isn’t work related.

Where we got all our cool stuff!• All treatment and workbook materials are

copyrighted by and purchased from Lash and Associates. We were given verbal permission from the company to demonstrate and promote these materials

• All videos were public service videos and used with permission for this training.

• All case study handouts were created from real life events or from stories gathered through our research.

• All Visual aids were purchased by your instructors are distributed to you as part of this training.

What Should I Get From this Training?

You should gain a basic understanding of the

following:

1) Brain Anatomy and Function

2) Epidemiology of Traumatic Brain Injury

3) Neuropathology

4) Neuropsychological Disorders

5) Neuropsychiatric Symptoms

6) Social Issues

7) Treatment/Management

What Will the Impact of What I’ve Learned Be on How I perform My Job?

By understanding: the structure of the brain, the

sum of the factors controlling the presence of a TBI,

the structural and functional deviations from the

normal that constitute TBI, the psychological

disorders, the psychiatric symptoms, and the social

Issues that are a result of TBI you should be able to

develop or provide more comprehensive and

effective treatment and correctional management

strategies for this specialized population of inmates.

What is Traumatic Brain Injury (TBI)?

Studies regarding brain injury do not appear to

present a concise definition of traumatic Brain Injury

(TBI).

► Definitions reviewed throughout the literature within

the last twenty years make understanding TBI

difficult because some studies only include

neurological trauma whereas some studies include

non-neurological head injuries such as fractures of

the skull, fractures of bones in the face, and

damage to the soft tissues of the head and face.


For the purpose of understanding how to manage

incarcerated inmates and the problems they

present, we are only concerned with inmates that

have neurological damage as the result of a (TBI).


► Traumatic Brain Injuries (TBI) are insults to the brain by an external physical force, which cause either temporary or permanent impairments, partial or total functional disability, or psychosocial maladjustment.

TBI can be divided into primary injuries, which

occur immediately at the time of trauma, and secondary injuries, which begin immediately after the trauma and continue for an indefinite period of time.

The clinical manifestations of TBI can range from a concussion to profound coma and even death.


What we will be primarily concerned with today are

the cognitive, behavioral, physical and social

problems that are a direct result of traumatic brain

Injury and that directly impact our ability to manage

inmates in our institutions.

Anatomy and Function

The sum of the factors controlling the presence of a TBI.

Handout page oneHandout page one

Handout Page TwoHandout Page Two

Neuropsychological Assessment

Six essential areas of cognition must be assessed in Six essential areas of cognition must be assessed in patients who have sustained moderate to severe TBI.patients who have sustained moderate to severe TBI.

Attention-Attention- Deficits are associated with diffuse Deficits are associated with diffuse brain injuries that are particularly known to occur brain injuries that are particularly known to occur in patients with frontal lobe pathology. in patients with frontal lobe pathology.

Deficits in attention will significantly effect Deficits in attention will significantly effect cognitive performance in areas of memory and cognitive performance in areas of memory and language comprehensionlanguage comprehension

Open To Suggestions

• I have not been able to find something that suits my needs here.


Memory - Is the cornerstone of successful neuropsychological rehabilitation.

Declarative Memory – Facts that are directlyaccessible to conscious recollection (Phone andSocial Security Numbers).

Procedural Memory – Includes learned skills andhabits and modifiable cognitive operations (Ability todrive and performance of activities of dailyliving.).

Test of Memory and Learning 2nd Edition

• A standard battery of eight core subtests, six supplementary subtests, and two delayed recall tasks

• TOMAL-2 subtests include Memory for Stories, Facial Memory, Word Selective Reminding, Visual Selective Reminding, Object Recall, Abstract Visual Memory, Digits Forward, Visual Sequential Memory, Paired Recall, Memory for Location, Manual Imitation, Letters Forward, Digits Backward, and Letters Backward, plus two verbal delayed recall tasks and cued recall procedures.

• TOMAL-2 core indexes consist of the Verbal Memory Index, Nonverbal Memory Index, and Composite Memory Index.

• TOMAL-2 supplementary indexes are composed of the new Verbal Delayed Recall Index, Learning Index, Attention and Concentration Index, Sequential Memory Index, Free Recall Index, and the Associative Recall Index.

• Reliability estimates are uniformly high—all composite and some subtest reliability values are in the .90s, with the balance exceeding .85. Test-retest reliability coefficients are all greater than .70 for the

• subtests, with most greater than .80. For the composite indexes, all but one value exceeds .80.


Language – Language – Deals with changes in language Deals with changes in language comprehension, expression, and repetition.comprehension, expression, and repetition.

This involves the ability to follow verbal and written This involves the ability to follow verbal and written commands.commands.

Naming common items as well as written and verbal Naming common items as well as written and verbal expression.expression.

Repetition of common words mixed with less common Repetition of common words mixed with less common words that occur with less frequency in everyday words that occur with less frequency in everyday use.use.

Wide Range Achievement Test 4th Edition

• This is best assessed if you have a baseline of functioning before the traumatic head injury, but this assessment instrument will assist you in knowing where their current level of functioning is in reading comprehension, spelling and arithmetic


Visual-Spatial Abilities – Is the ability to manually

arrange objects in patterns or copy drawings after

seeing them.

Executive Functioning – A person’s ability to

organize, plan, and execute purposeful behaviors.

Multiple Assessment Instruments are Useful

For Executive Functioning• Wisconsin Card Sort Test• Delis-Kaplan Executive Functioning Assessment

System

For Assesment of Visual-Spatial Abilities• Bender Gestalt• Hooper Visual Organizational Test

Brain Injury EffectsTBI effects can be mild moderate or severe. We are TBI effects can be mild moderate or severe. We are focusing on the chronic effects seen in Moderate to focusing on the chronic effects seen in Moderate to Severe Cases of TBI.Severe Cases of TBI.

Brain Injury Effects

Functional Changes

► Short term memory loss

► Long Term memory loss

► Slowed ability to process information

► Trouble concentrating

► Trouble paying attention

► Difficulty keeping up with conversation

► Word finding problems

► problems understanding language

► loss of a second (acquired language)

► spatial disorientation

► driving difficulties

► Impulsivity

►Inflexibility

Functional Changes

►Time Disorientation

► Organizational Problems

► Impaired Judgment

►Problems Multi-tasking

► Seizures

► Muscle Spasticity

► Double Vision

► Impaired Visual Fields

► Loss of Smell or Taste

► Slow or Slurred Speech

► Headaches or Migraines

► Fatigue

► Lack of Initiating Activities

Functional Changes

► Difficulty Completing Tasks without Reminders

► Increased Depression, Anxiety, and Mood Swings

► Denial of Deficits

► Impulsive Behavior

► Lack of Insight

► Agitation

► Egocentricity

► Explosive or Erratic Behavior

► Sensory Losses

► Inability to Deal with Novel or New material

► Impairment in reading Writing and Arithmetic

Assessing areas of Cognition Affected and Observable Assessing areas of Cognition Affected and Observable Effects of InjuryEffects of Injury

Group Activity Directions

1) Identify area (s) of cognition that are effected by

traumatic brain injury.

2) Identify psychosocial changes that presented

after a traumatic brain injury.

3) Identify what area (s) of the brain have been

Injured to create the example depicted.

Disorders that Share Symptomatology with (TBI)

Amnesia – often occurs in patients who have sustained head trauma, cerebral anoxia, brain tumors, cerebrovascular accidents (strokes), history of cariopulmonary arrest, electroconvulsive therapy, insulin overdose, surgical removal of the temporal lobes, and excessive drinking that results in Wenicke-Korsakoff’s syndrome will typically exhibit severe Amnesia.


Dissociative Disorders – Disturbance in an

individual’s sense of identity, memory, and

consciousness.

Delirium – A global disturbance in cognitive

functioning with associated clouding of

consciousness, impaired attention, disorientation,

increased sympathetic nervous system activity,

altered sleep-wake cycle, and psychomotor activity.


Dementia - is characterized by the development of multiple cognitive deficits that are due to the direct physiological effects of a general medical condition, the persistent use of a substance, or to multiple etiologies.

The essential feature of this disorder is the

development of memory impairment and at least

one other cognitive disturbance such as Aphasia,

Apraxia, or Agnosia.

Two main types of Dementia are Alzheimer’s type

and Vascular Dementia


Attention Deficit Disorder - The essential feature is a persistent pattern of inattention and hyperactivity/impulsivity that is more frequently displayed and more severe than is typically observed in individuals at a comparable level of development.

Three subtypes:

1.) ADHD Combined Type

2.) ADHD predominately inattentive type

3.) ADHD predominately hyperactive type


Mental Retardation – is a significantly sub-average general intellectual functioning that is accompanied by significant limitations in adaptive functioning in at least two of the following areas.

Communication, self-care, home-living, social

interpersonal skills, use of community resources,

self-direction, functional academic skills, work

leisure, health or safety.


Complex PTSD - The DSM IV presents criteria to

diagnose PTSD based on contact with a single or

discreet stressor rather than frequent or numerous

exposures to stressors.

Complex PTSD is a syndrome with varied and

divergent symptoms such as alteration in attention

and consciousness, amnesia, dissociative episodes,

and depersonalization

What is involved in Treatment?

Traditional Treatment

Cognitive therapy

• Speech/language therapy• Physical therapy• Occupational therapy• Neurobehavioral therapy• Vocational rehabilitation• Neuropsychological

testing• Family Support

Counseling

Alternative Treatments

• Craniosacral therapy

• Hyperbaric oxygen treatment

• Biofield therapies

• Meditation/mindfulness

• Highlighted in Yellow Showing what we are able to functionally do in corrections

Who is typically Involved in Treatment?

• Neuropsychologists• Behavioral analysts• Speech/language pathologists• Cognitive therapists• Physiatrists• Physical therapists• Recreational therapists• Occupational therapists• Neurologists• Neuropsychiatrists

SOCF Newly Acquired Resources

SR-Cognition Tool Kit: Cognitive Rehabilitation Program

• Joanna Boyer, M.A., CCC-SLP and Terri Tarnoff Snyder, M.A. CCC-SLP• SR-Cognition is a complete therapeutic multi-sensory tool kit targeting

cognitive rehabilitation in adults and adolescents with acquired brain injury, neurological impairments, or developmental delays. The comprehensive kit contains two workbooks (one with easel option and one with re-useable reproducible pages) featuring hundreds of therapeutic activities; 85 photo cards; 20 picture cards, and a dry erase marker all in a portable tote box. Activities and exercises feature realistic every day scenarios, in real world environments using current cues for memory and language building, daily living and life skills development and reinforcement

APT Attention Process Training and Cognitive Rehabilitation

• The APT-3 includes an extensive range of attention exercises appropriate for people with mild to severe attention deficits due to acquired brain injuries. Target populations include adolescents, adults and veterans. Unlike the APT-1 and APT-2 programs, the APT-3 is a computer based program promoting efficient data collection and analyses and treatment planning. The Kit includes a USB drive with customized software that can be used on either a Mac or PC. It includes 2 practice drives for clients. The program runs from the USB drive and does not stay on the user's computer. The set of 2 manuals contains a clinical overview, research evidence, discussion of therapy principles, detailed instructions and guidelines for assessment and treatment, as well as sample score sheets for all therapeutic activities and tasks.

Functional Rehabilitation Activity KitKathryn Kilpatrick, M.A., CCC-SLP, Barbara Messenger, M.Ed. and Niki Ziarnek, M.S., CCC, SLP/L

• There are five manuals in this Kit. They are Functional Rehabilitation Activities on Behavior, Cognition, Cognitive Communication, Activities of Daily Living and Leisure. Using a therapeutic style of interaction with a step-by-step format, someone with little or no experience in working with persons with disabilities can pick up these manuals and immediately be able to interact in a therapeutic manner while facilitating independence.

• The functional activity manuals can be used by any caregiver including direct care staff, nurses, therapists, family, teachers, and aides. They can be used with children or adults with any type of neurological condition involving social, cognitive, communicative and behavioral challenges. They are designed for use in inpatient and outpatient rehabilitation programs, community programs, residential settings, schools and at home.

• Each manual features worksheets and data forms for tracking performance and outcomes, with full instructions for administration. Each activity has a documentation form for easy inclusion in clinical records.

Additional Resources Available From Lash and Associates

• Cognitive Rehabilitation Tool Kit after Brain Injury• Concussion Tool Kit for Schools• Instructional Tool Kit on Brain Injury for Educators• PTSD Tool Kit for Veterans and Families• Sports Concussion Tool Kit for Athletic Trainers

and Coaches• Living with Blast Injuries, PTSD and TBI• The Post Traumatic Insomnia Workbook; A Step-

by-Step Program for Overcoming Sleep Problems after Trauma

Would you Like More Training on TBI• Institute for Natural Resources

http://www.inrseminars.com/seminars.aspx

• Nebraska Brain Injury Conference April 4th and 5th

• “Brain Injury Throughout the Lifespan” April 5, 2013, Delaware

• Brain Injury Alliance of Colorado 2013 Regional Brain Injury Conferences: Pueblo – April 25th, Grand Junction – May 4th, Durango – June 26th, Summit County – July 12th

• Williamsburg Brain Injury Rehabilitation Conference May 2nd and 3rd , Williamsburg VA

• Biannual Conference on Brain Injury in Children July 9-11, 2013 – Toronto, Canada

http://www.inrseminars.com/seminars.aspx

traumatic brain injury upload videoa

Documents

socialfour years

years of experience

brain anatomy

result of tbi

social issues

foster care

basic understanding

crisis care corrections