Cognitive Rehabilitation Therapy – Companionship & Competition

Two Pronged Brain

Last month I talked of the two ways in which C.R.T. can be given – “Comprehensive” and “Modular”. My personal opinion is that a combination of both helps individuals most. This was following a conversation with someone wanting to help their family member directly.

I hope the link to Dr. Judd’s expertise was useful.

Nowthen, as it’s Christmas, I thought it might be an idea to look at some of the online resources available. There’s stuff out there, some even quite fun, that everyone can challenge each other at.

(“Restorative”)

It’s best to see this often used term as an intention, not a promise. It is used to describe exercises designed to improve precise areas of brain function. For an idea of the different options available online, click here for Phone Arena.Com’s view of their “Top 5” brain training sites. (Just under 4 minutes.) (As always, you may want to skip the ad’.)

(Neuronation)

Not saying it’s the best. Neuronation is the site I’ve most experience with. You can find your own favourite.

The first thing to do is register an email address and password to log on with. The first thing that will greet you will be three choices of subscription: 1. £11 for three months; 2. £5 for twelve months or 3. £299 for a lifetime access to all the games. But as with most things of this nature, you’ll get a free sample of tasters.

To gain access to these free samples, click the “Training” header at the top of the page. The next gives the options of “Daily Training” or “Exercises”.

On your first visit, I suggest you go straight to the exercises. These include a free exercise or two in the following catagories: “Numeracy”; “Language”; “Reasoning”; “Memory” and “Perception”.

Have a practice at each. You can time yourself, but I’d suggest building your confidence by having a go in “Learning Mode”. Pick a catagory; pick an exercise; choose the “Tutorial”; click the “Learning Mode”.

Neuronation monitors and charts your level of performance. At any time, when fatigue or boredom strike, you can come out of your chosen exercise.

Whether you’re wanting something to do yourself, or get to know and help your familiar-cum-new member of your family, these online products are a good way of doing it.

Wishing you progress throughout 2020. And a Christmas as best as best can be.

Sean

Xmas2020

Cognitive Rehabilitation Therapy – The Two Pronged Way

Two Pronged Brain

Here at last! I thought I was never going to get this uploaded. And still in November too.

Let’s turn our attention back to Cognitive Rehabilitation Therapy (C.R.T.)

Why?

  1. We haven’t talked about C.R.T. for a long time.
  2. Someone recently asked what they could do at home to help their loved-one themselves. (I’ve found a Youtube post that should help. See below.)
(Definition)

There are many. It seems every organisation the world over has its own description of what CRT is. Here’s my “in a nutshell” definition:-

Cognitive Rehabilitation Therapy is a collaborative series of tasks and discussions between therapist(s) and patient(s) / client(s) aimed at helping those patient(s) / client(s) cope with themselves and the wider world after a brain injury.

The implication for Cognitive Rehabilitation Therapists, be they grounded in classical Cognitive therapies or Person-centred therapies, is that C.R.T. involves both active listening and active thinking.

What do I mean by “active thinking”? I mean empathically thinking as the client thinks.

Art of cinversation

(Comprehensive)

Cognitive Rehab’ Therapy takes a two pronged approach. The Person-centred or “Multi-modal” (“Comprehensive”) prong takes account of emotions, behaviour and perceptions altogether.  Active listening flags up the patient’s / client’s motivation or lack of it – gauges what stimulates by whatever degree and how. A therapist can then intuit techniques and interventions to best aid the patient’s / client’s understanding and skills.

The relationship is one of observation – reflection or open question – reaction – observation – response. Such in-the-moment to-ing and fro’-ing between therapist and patient / client can result in unforeseen recognitions. I’m talking about immeasurable and surprising reconnections and new connections within the “neuro-person”, if I may call them that.

(Modular)

The Modular prong is more targeted. Its focus is on areas of damaged brain, not always the holistic person. Formulated exercises are aimed at improving attention, memory, visual and information processing, language or executive functions.

Single modules can be used for an isolated or overriding impairment. Selected modules can be used in group settings or tailored to individual patients / clients. Though less precise in delivery, modular, task orientated group therapy helps in the following ways:-

  • By facilitating peer support.
  • Problem solving by discussion gives greater chance to strengthen confidence, co-operation, as well as some empathy.
  • Less rigid, more flexible problem solving skills – “thinking sideways” also has greater chances to develop.
(Family Involvement)

How about that Youtube link? Clinical neuropsychologist, Tedd Judd, PhD. offers family members advice on how to approach helping a brain injured loved-one. (8.5 minutes.) Click here to watch. (Skip the advert.)

There is every reason to include family members in therapy when and where appropriate and possible.

When couple counselling I find it helps the couple best if we view their relationship as the client. Thinking sideways, it’s not difficult to shift this way of working to a wider family context. After all, it’s the relationship with and around a loved one with the acquired brain injury that needs to readjustment as much as A.B.I. survivor themselves.

More next month. Take care for now.

The Power of Zen (Part Two)

Spaceballs02

Hello all. I hope you’re as well as can be.

Thank you to the couple of you who’ve emailed and commented on last month’s post.

To answer the question posed by one of you (What is “The Power of Zen” about?) it is about that thing we have that says: “I am”. It’s about that sense we have of being ourselves whatever the state of our brain.

In Part One I explain Zen is an interface – not the whole computer. Those of you who clicked on Zen’s picture may have noted that it gives a running commentry for its / the ship’s systems as they happen. And it is in this way, the ship acquires an ego-like quality.

Here’s a favourite “Blake’s 7” quote:-

BlakeBlake:  Seven of us can run this ship properly.Vila

Vila:  Six, surely.

Blake:  You forgot Zen.

Avon:  You’re not counting that machine as a member of the crew.Avon

Blake:  Oh, what do you say to that, Zen?

Zen:  Please state course and speed.

Blake:  Very diplomatic. Set a course for Centero, speed standard by two.

Zen:  Confirmed.

We have our identity and we know we exist. But how much power over our brain injury does our identity give us if our identity is influenced by that injury?

When we actively own our personality as something more than our brain injury,  to whatever measure possible, we can increase the likelihood of change. Zen’s power is will power.

Existing with a Brain Injury

Another thing I did in Part One of this article is put us in the passenger seat of our spaceship. Why? I’m going to answer with a case example. The clent is fictional. The circumstances are real. Some of you might relate to this example straight-away.

(Justine)

Justine takes medication for her epilepsy. She often needs reminding to drink fluids because when she forgets, she gets really bad headaches. She easilly gets fatigued and doesn’t show much emotion. Although she can hold a conversation much of the time, she gets frustrated when her voice doesn’t produce the words she tells it to. Also, she has difficulty reading and writing.

She says: “I know what I want to write but it’s frustrating. I know where I want to put my pencil’s lines – how to do them – but my brain changes them while I’m writing.”

She goes on to describe both sides of her brain arguing. Justine finds it “fascinating”, “scary…” and “…not really scary… more frustrating”. She is eager to improve.

The extent to which this is possible for Justine is unknown. Coping with the unknown is hard. What Justine is showing us for sure is that she is able to make real-time observations of what she perceieves her brain to be doing. She is frustrated by her lack of control over how her writing looks.

In other words, getting back to the good ship Personality, she is eager to move from her passenger seat to her pilot seat.

How Existential Therapy (E.T.) Might Help

How about we look at Justine’s case in light of the E.T. goals I ended with last month?

(Understand Unconscious Conflict)

Justine has a sense of one half of her brain arguing with the other half. Given the opportunity via therapy, her strength of personality – that bit of her that’s feeling frustrated might get to the bottom of what it is those halves are arguing about.

(Identify Unhelful Defensive / Coping Mechanisms & Discover their Destructive Influence)

I’m unsure how this goal applies to Justine. Perhaps a more applicable goal would be to focus on something practical. With her therapist’s support, she could experiment with aids and techniques to improve letter and word recognition and hand-eye co-ordination for writing.

(Diminish Secondary Anxiety)

If and as her communication skills improve – more and more of her intended words coming out right, her confidence might grow. Getting anxious about being anxious (panicking) could happen less often.

(Righten Restrictive Ways of Dealing with Self & Others)

With better communication and her own creative ways of getting around problems, Justine might help others wanting to help her improve.

(Develop other ways of coping with primary anxiety)

Always, each new achievement raises new unknowns, new possibilities. Fearing the unknown is healthy. Quality “me time” helps. Justine might later develop a new passtime that helps her chill out when she needs to. Who knows?

 

Now for a demonstration. For a quarter hour example of an E.T. session with an ABI client, click here. N.B: You’ll probably want to turn the volume up a tad; the sound quality is rubbish.

That’s all for now. Cheery-oh.

Sean

The Power of Zen (Part One)

Spaceballs01Hello there. Welcome back for what I hope is another entertaining and helpful read.

Imagine you and me in a spaceship. Neither of us know exactly where we are going, but we’re happy to just head out into the galactic lanes and follow a scenic route to the closest picnic planet to lunchtime. Our  ship’s name is “Personality”.

“Who am I?” is one of the most difficult questions we ask ourselves. Here’s another, maybe an even more difficult one to answer: “Where am I coming from?”

Some of us human beings display no e-motion after a brain injury. Some of us even become unaware that we are unaware; we don’t know that we don’t know. (In the second case it’s unlikely we would have the curiosity to ask the “where from?” question at all. Importantly, we would not have the choice to not choose something.)

But let’s assume you and I are still curious. Having a brain injury, we’re blissfully looking out into the depths of Space in our passenger seats on the good ship, “Personality”. Sharing the piloting are Vilayanur Ramachandran and Rollo May.

Neurology

World famous neurologist, Dr. Vilayanur Ramachandran is one of my inspirations. He begins his Ted Talk (“3 Clues to Understanding Your Brain” (approx. 23 min’s) with the following…

He says: “Here is this mass of jelly – this three pound mass of jelly. You can hold it in the palm of your hand and it can contemplate the vastness of intersellar Space. It can contemplate the meaning of infinity. And it can contemplate itself contemplating the meaning of infinity. And there is this peculiar recursive quality that we call self awareness, which I think is the Holy Grail of neuroscience…”

(Already I hear in my mind’s ear, a chorus of 2 1/2 year-olds chanting “But why?!”)

Zen

Anyone remember “Blake’s 7”? Basically, it was kind of Robin Hood / Dirty Dozen in outer space.One of the seven outlaws was a computer expert called Avon. In a remake of the series, he gives an alien computer an “interface” called Zen which allows him and the computer to exchange information; Zen becomes the computer’s personality.

Personality is our awareness and voice in action.  It allows us the chance to know each other.

Existential Therapy

Okay, having stopped off for a bite, or dare I say “byte”, on planet Neurology, back on board our spaceship, psychologist, Rollo May decides to take us for afternoon tea on his homeworld – Existential.

But let’s not go there straight away. Let’s visit next month in Part Two. I’m pooped and I’m guessing you are too. For now, let’s have a quick flick through our metaphorical tour guide.

In it we see the goals of Existential Therapy are:-

  • To understand unconscious conflict
  • Identify unhelful defencive / coping mechanisms
  • Discover their destructive influence
  • Diminish secondary anxiety
  • Righten restrictive ways of dealing with self & others
  • Develop other ways of coping with primary anxiety

Bye for now,

Sean

More Than Words – Expressive Art Therapy and Brain Injury

Art Therapy

Hello, all. Hoping you’re okay.

A few months back, I posted a piece about Writing Therapy. But writing is not the only creative form to be used as therapy. Drama, dance, drawing and painting, all can come under the title of Expressive Art Therapy.

I was introduced to it in my third year of training via Natalie Rogers. She’s the daughter of Carl Rogers, and a pioneer in her own right. If you’d like to see her explain her contribution to the Person-Centred approach to counselling, click here.

But the  U.K’s so-called “Father of Art Therapy” was Edward Adamson. Between 1946 and 1981 he worked at Netherne Hospital in Surrey.  It was there he encouraged patients to paint, draw and even sculpt.  He also extended his work througjh the British Red Cross.

Watching Paint Dry

Very academic readers and viewers might like to watch a conference presentation published on Youtube by the Edward Adamson Collection. (Or some of it.) It’s in two parts and called: “Art in the Assylum – Edward Adamson’s Life & Work”. Part 1 (Approx. 30 minutes long) and Part 2 (Just over 30 minutes long.) Those of you less academic WON’T.

General Principles of Expressive Art Therapy
  • Therapy is process focused, rather than systematic
  • The therapist, though qualified and professional, offers support, not authority
  • The client is their own expert
  • Creativity, expression and reflection can lead to positive wellbeing

What do these principles mean?

One, that therapy looks to the client’s experience more than goals and strategies. Two, the therapist does not believe their opinion is more important than the client’s. Three, the therapist trusts the client’s motivation, openness and self realisation. Four, the client’s own way forward is shown through their art.

Art Therapy2

How Expressive Art Therapy Works with Brain Injury

Thinking of the symptoms of brain injury – poor short-term memory, lack of concentration, aphasia or dysphasia, difficulties specifying goals, how can Expressive Art Therapy help?

  1. As the saying goes, “one picture can paint a thousand words” – there is no pressure to mean things with words
  2. The focus is on what’s going on for the client in the moment, so that there is less reliance on memory
  3. Both therapist and client have something tangible to refer to as therapy takes place
  4. The activity of being creative has the potential to increase concentration, planning and other cognitive skills.

But don’t just take my word for it, here are a couple of shorter links:

“Art Therapy Helps Patients with Traumatic Brain Injury” published by NJTV News (3 minutes long)

“Art Therapy Activities: Art Therapy and Brain Injury” published by eHowArtsAndCrafts (2 minutes long)

This is it for July. Take care for now.

 

Someone Walks into a Bank – Brain Injury, Modern Technology and Isolation

This month I’d like to highlight isolation. To help, I’ve the story of Mike. Mike is not a real person, but he is inspired by several real people – people living with the social effects of brain injury as well as cognitive.

What is Isolation?

The state of being separated from someone and/or something else. A “something” might be our community, which means being separated from lots of people. “Community” also implies, by its own definition, that those lots of people are helpful to each other.

So isolation can also mean ending up without help.

Chains of Isolation
  • Invisible cognitive problems
  • Communication difficulties
  • Emotional difficulties
  • Poor access to work
  • Reduced daily living skills
  • Relationship strains
  • Feeling sidelined
Modern Life

On the theme of computers and social skills, here‘s a “Little Britain” sketch I thought you might like before reading about “Mike”. Enjoy!

(Mike’s Story)

One Saturday morning, Mike decided to visit his bank. He had to cancel a direct debit. Not feeling confident, he had it in his head that a staff member would help from across the counter or in one of the side offices.

A reminder on his mobile three hours before the bank closed prompted him why he needed to get up in good time. (Being a Saturday Mike’s bank closed early.)

He arrived at the bank and stood in line to be seen. As he waited, a member of staff approached him. She had an ipad in one hand and a cheerful greeting for him. Before he could answer she asked if Mike banked on line. She told him that if he did, he need not have made the journey into town.

Mike felt awkward. He heard himself say: “I’m not interested. I’m just here to cancel a direct debit. Sorry.”Bank2

She carried on regardless. Mike tried to concentrate, but panic rose and her words began to wash over his mind. Anger began to take over from panic. The level of his voice matched the level of his emotion. “Stop!” Embarrassed he apologised. He tried humouring her. “I’m a dinosaur. I don’t get on with technology. I prefer to speak face to face with someone.”

Eventually, Mike felt telling her he had a brain injury was the lesser of evils. He coped better when not having to think about PIN and customer reference numbers, and yet another password. Telling her was his only way out of this situation. He did not like doing it; he worried who else might be listening.

The lady accompanied him to a desk and another member of staff. And even though that member of staff tried to help, her computer would not allow her to authorise the cancellation. In the end, Mike was led into a cubicle with a phone and given a number to ring.

Eventually Mike and the voice at the other end cancelled the direct debit. It had taken the voice several ways to answer Mike’s one last question, but the voice did not mind. The voice belonged to a human whose relative had had a stroke.

Mike was grateful but eager to get home. He felt drained and in no hurry to talk to anyone else that day.

As the “Little Britain” sketch shows, you don’t need to have a brain injury to be frustrated with modern technology. But for those with ABI, the problems can double.

Take care for now.

Sean