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.

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

 

Panic Buttons for A.B.I.

This month I’ve been asked to write about panic attacks. Wow! I thought. Why haven’t I covered it before? When any of us are unable to think straight, our biology, our emotions carry us along.

Where they carry us, we don’t know until we stop, draw breath and take in what we can of our situation. Up until that point, we don’t know which direction we’re taking ourselves. We become proverbial “headless chickens”.

Before any compensatory therapy or strategy can prove useful, Step One has to be a willingness to face fears. This is most true of clients whose cognitive functioning can be problematic, even on the happier days.

TV Static

The clouding of consciousness (brain fog) is for ABI clients / patients, physical. In a lot of cases it does not go away. Emotions determine the degree of cloud cover, but it’s always there to be lived with.

Another way to describe an injured brain might be as a faulty TV set. I am reminded of Sunday mornings I spent many, many years ago – playing around with the aerial of my parents’ gogglebox – trying to get an undistorted picture of the BBC test card before “Mr. Benn” started.

As therapists, the most we can do is reduce the amount of static and suggest positions the aerial might work better. The aerial’s actual positioning to stabilise their picture behind their static is our clients’ job.

There is no real, by the book, “how to…” with this. In my view, it has to be person-centred. Here‘s a link to Part One of a counselling session (not one of mine) with a head injured client. It lasts 9 or so minutes.

N.B. The client reports being “snappy”, NOT “panicky”.

Panic Button Controls
  • DON’T FIGHT, TAKE FLIGHT. Remove yourself from the environment / situation causing your panic.
  • Find somewhere you can be safe and quiet.
  • Begin listening to your own breathing, taking slow, deep breathsABI and Panic
  • Close your eyes and, if possible, imagine you’re in your favourite surroundings, doing a favourite thing.
  • If imagining you are somewhere else is impossible for you, hold an object in both hands and look at it. Keep listening to your breathing as you notice each of the object’s details – shape, colour, texture, markings…
  • Keep practicing. Set a special time andplace aside for yourself.

Reading what to do might be easy. Remembering and doing it, as we all know, is hard. It helps most to be with someone while you practice.

Click here for Part Two of the counselling session. Again, not a counselling session of mine. Part Two also lasts around 9 minutes.

Patchy Reception & Counselling

If you are perhaps wanting counselling, the following points may help you decide.

  1. It offers you a room clear of clutter and distraction – space to breathe and relax.
  2. Regular time slots (50-60 minutes) that can be used to off load – kind of scatter thoughts, feelings, experiences into and around that room.
  3. It provides someone who will support, not judge. Part of that support is in helping take control of the panic. Part is in helping you get organised.

If I was to counsel you, I’d combine listening with breathing techniques and other Mindfulness exercises. A new sense of self can grow. Because as your new self becomes less patchy, you could begin to identify your gut instincts – which situations cause panic more than others and how to deal with them yourself.

Take care for now.

Sean

 

SMART Pacing

 

pacingHappy New Year Everyone!

Here we are at the start of another twelve month cycle. If you’re anyone like me, this thought will have crossed your mind: “Is making a New Year resolution good for me?”

The Problem With Me

My neurologist once told me: “Sean, you can do most things most people can do. The difference is that they only need fuel themselves on one Mars bar. You need two.”

I’ve come to the conclusion, having a brain injury myself, that eagerness and enthusiasm to achieve works against me. I set myself too many ambitions. And those ambitions have been too big. I try to run before I can walk. I get fatigued and burn myself out.

I also set myself one year in which to achieve my goals. I’ve already said: “Here we are at the start of another twelve month cycle.” BIG mistake! Next Christmas becomes a Finishing Line. A Finishing Line that’s only half way down my imaginary racecourseeaster bunny.

When I get to Christmas, I feel a failure. My ambitious project still has a lot of time to be spent on it. In any case, the truth is I’d be out of puff before I’d got to Easter.

SMART Eggs

Specific   Measurable   Actionable   Relevant   Time-boundaried

That’s what S.M.A.R.T. stands for. It’s a way of working out the best goals to set. No one needs to be an egghead to use it, either… (Sorry. I couldn’t resist.)

Rather than have a New Year resolution, why not start smartly at Easter? Easter’s about new beginnings too. Better prepare yourself. Give yourself the best step forward. Consider your current experience and go on from where you are.

For example, the need for memory aids etc. Knowing who to talk through your hopes and wishes with might be your first step. Collaboration can help everyone involved be more aware and focused.

(Specific)

Be clear and certain. Set your sight on something simple. Very often, brain injury lets in all sorts of clutter – too much info’ from too many places – facts, opinions, advice. The more specific your target, the greater your chance of staying on track.

Let’s use the example of changing weight. “Changing weight” is an unclear statement. “I’d like to be 10 stone” leaves no-one uncertain about what’s wanted.

(Measurable)

For the purpose of demonstration here, let’s say “One pound difference a fortnight”. Weight can be measured every two weeks and a record kept.

(Actionable)

Again, stay specific. What treat can you not do without? Are medication and special dietary needs important factors? What is realistically achievable?

Memory and organisational problems can be reduced by dicussing meals for each day of the week. If need be, ask someone to add them to your diary, or tablet, or on something stuck to your fridge’s door.

It doesn’t have to be as strict as keeping count of how many calories per plate. Once a sensible menu has been agreed, just keep to that day’s meal.

Exercise, however possible is also something to be discussed.

(Relevant)

How relevant is weighing 10 stone to health and happiness? Maybe our existing weights are already ideal for us. Maybe something else is in more urgent need of attention.

(Time-boundaried)

Let’s say the difference between our start weight and the desired 10 stone is 3 stone. There are 14 pounds in 1 stone. 14 (pounds) x 3 (stone) = 42 (pounds). Pacing, targeting and measuring one pound difference every two weeks sets the target time 84 weeks… So we may as well, allowing a bit of leaway for celebrations and lapses, set a time boundary of two years.

And hey, if the 10 stone weight is arrived at sooner, what the heck?

Take care. I’ll be back in February.

Writing Therapy (Part Two)

Hello everyone.

How many of you, I wonder, challenged yourselves to put something into words? If you did I hope it freed you and was a help to you in some way.

Last month I promised to show how story writing can help organisational skills. Here’s how:

Beginning, Middle and End

Diaries and journals have a “yesterday – today – tomorrow” flow to them. It’s natural. Stories, on the other hand, need to have their beginning chosen. Even if we want to retell something true as fiction, the question has to be asked: “Where did it all start?” Answering and getting our story going therefore requires memory (long-term, usually) and thought.

From then on the questions come in a mix-up that needs sorting: “What happened then?” “What led this person to behave that way?” “Could it have gone differently?” “If something had happened earlier, would it have changed the outcome?” Answering and sorting out the order of all the events and explanations forms the middle.

Endings almost write themselves in a way. Some plots within our stories will have a one way conclusion. And this can also be true of some of our characters. Those who we find reasons to change their minds, become tougher or more relaxed about things, may resolve their adventures in ways they (and we as writers) would not have thought of at the beginning.

All the above is about a true story, even if it’s told as though it’s fiction. What if it’s all a fiction and we are making it up from scratch? It can be as complicated and as much fun as you like.

Creative Writing (2)
Themes, Characters and Genres

By “theme”, I mean topic – an emotional or philosophical one. For example, our story might be our way of figuring out what makes people brave. Or exploring what the world might be like without money.

Obviously, we all know what characters are. But who do we want our characters to be? A few months ago, I introduced you to the Drama Triangle. The Perils of Penelope Pitstop is a good example of this. It has a persecutor (the Hooded Claw), victim (Penelope),  and rescuers (the Ant Hill Mob). And then there are our lesser characters playing their part.

Characters can represent things too. For example, in mythology, the Viking god of storms, Thor, is often shown as quick-tempered and sometimes moody and unpredictable – just like lightening and thunder.

“Genre” is just a posh word for story type – Romance, Comedy, Adventure… Genres can be helpful. If we are exploring bravery, Fantasy might be a really good choice. Think about it. Game of Thrones, The Hobbit, even The Wizzard of Oz all explore bravery. If we think of imagining a world with no money, how about making our story a futuristic Science Fiction story? Or maybe a satirical farce?

Conclusion

Having said all the above, it might be that all we really want to do is tell a good yarn. We have no need to write anything complicated. We just want to tell a simple joke with a few added descriptions about the places and people involved to make it more interesting, more memorable, perhaps.

Perfect. The joke becomes a story. But complicated or simple, there is always a structure and our thinking behind it. And on that note, I’ll leave you with a link to two of my comedy heroes. Haurel & Hardy in “County Hospital”.

Until next month. Take care,

Sean