A whistle stop tour of A whistle stop tour of Acquired Brain InjuryAcquired Brain Injury

Presented by Chris KnightPresented by Chris Knight

The Acquired Brain Injury Education Service The Acquired Brain Injury Education Service A.B.I.E.S.A.B.I.E.S.

An organisation originally formed as a joint funded project between : a charitable trust (The Acquired Aphasia Trust), the LEA, Health and Social Services

Funding is now a joint project between Evesham College and The Acquired Aphasia Trust.

The service consists of a team of education and health professional with specialist experience in ABI – Educationalists, Occupational Therapists, and a Physiotherapist

The team manage and support to the ABI courses at Evesham College and work under contract to other local FE Colleges supporting their ABI Courses and students with an ABI accessing mainstream courses. Also provide training for professionals and services working with people with an ABI.

ABIES currently have contracts with Kidderminster College, NEW College (Redditch) and Worcester College of Technology

Support Provided by ABIES to CollegesSupport Provided by ABIES to Colleges Receive and screen referrals Undertake initial interviews with students usually in their own home Arrange and facilitate visits to the college Carry out initial assessments and regular re-assessments of students

strengths, challenges and needs in regard to cognitive skills, physical skills, basic communication, behaviour and emotional issues and personal care skills.

Produce summary profiles on all new students including recommendations on meeting their needs for all Lecturers and LSA’s involved with the student

Carry out regular observations of students in the classroom situation with written feedback to the course coordinator

Liase with family and other services providing support to the student Arrange and attend annual joint reviews with the student and their other

service providers Trouble shooting on an individual student or course level e.g. access issues,

inappropriate behaviour, poor attendance Training for college staff

What is an Acquired Brain Injury (ABI)What is an Acquired Brain Injury (ABI)

The UKABIF definition of acquired brain injury is :

An Injury to the brain including traumatic brain injuries - such as open or closed head injuries - or non-traumatic injuries such as those caused by strokes and other vascular accidents, tumours, infectious diseases, hypoxia, metabolic disorders (e.g. liver and kidney diseases or diabetic coma) and toxic products taken into the body through inhalation or ingestion. Does not include brain injuries that are congenital or produced by birth trauma or those of a degenerative nature

Or more simply!

Any injury to the brain occurring after birth and of a non-degenerative nature.

The Most Common Causes of an ABIThe Most Common Causes of an ABI

Accident

AssaultFallStrokeTumour / CystAnoxia resulting from CVA, drowning, strangulation etc AneurysmEncephalitis / Meningitis

The Human BrainThe Human Brain

Size – Approx 3 –3½lbs

Texture – Soft Blancmange

Made up of two halves (hemispheres)

Right Hemisphere

Left Hemisphere

Front

ProtectionsProtections

Skull

Meninges

Subarachnoid Space

Basic Structure of the BrainBasic Structure of the Brain

Anatomy and Functional areas of the Brain

Lateral View(side)

Parietal LobeFrontal Lobe Occipital Lobe

Sagittal View(down through middle)

Corpus Callosum(carries information

between the two hemispheres)

Cerebral Cortex / Cerebrum

Occipital Lobe – processing of vision

Parietal lobe - processing of sensory information

Temporal lobe – memory

Frontal lobe – executive skills, movement, language

Cerebellum – coordinated movement

Brain Stem – Breathing, heart rate

Brain Cell (Neuron)FactsBrain Cell (Neuron)Facts The brain is made up of

approximately 100 billion neurons

Each individual cell can make contact with up to 2,000 other neurons connecting to one another by synapses

Neurons pass information along their fibres in the form of electrical and chemical messages

Cell Body

Dendrites

Axon

A Synapse

Stages of RecoveryStages of Recovery

Spontaneous recovery (first few weeks)

Neuroplasticity (usually quoted as up to 6mths but now acknowledged that can occur up to 2yrs and more)

Compensation(life long)

Will overlap and run concurrently

NeuroplasticityNeuroplasticity

The lifelong ability of the brain to reorganize itself by by forming new neural connections. Neuroplasticity allows the neurons (nerve

cells) in the brain to compensate for injury and disease and to adjust their activities in response to new situations or to changes in

their environment

Neuroplasticity occurs in the brain under two primary conditions:

During normal brain development when the immature brain first begins to process sensory information through adulthood (developmental plasticity and plasticity of learning and memory).

As an adaptive mechanism to compensate for lost function and/or to maximize remaining functions in the event of brain injury.

CompensationCompensation

•Education

•Adjustments in lifestyle

•Strategies

A model of potential difficulties post ABIA model of potential difficulties post ABI

Physical Difficulties

Cognitive Deficits

Communication Problems

Emotional & Behaviour changes

Behaviour ProblemsAggression / Withdrawal / Inflexibility / Poor cooperation /

Disinhibition

Psychosocial ProblemsLoss of role / Loss of friends/ Changed family

Dynamics / Loss of confidence / Low self-esteem

Decrease in : Productivity, Intimacy, Quality of Life

Deterioration Cycle

The effect of an ABI on an individualThe effect of an ABI on an individualSymptoms and related deficits fall into five major groups: Cognitive,

Perceptual, Physical, Communicative and Behavioural/Emotional. Because of the uniqueness of each injury, some survivors may or may not face or exhibit

some or all of the symptoms.

Cognitive Symptoms: Difficulty in processing information (decreased speed, accuracy and consistency) Shortened attention span, distractibility, difficulty screening out irrelevant infoMemory loss or impairmentInability to understand abstract concepts Impaired decision-making ability Inability to shift mental tasks or to follow multi-step directions

Physical Symptoms: Full or partial paralysis of one side of the body affecting the arm trunk and legDisorders of movement - ataxia, spasticity, dyspraxia and tremors Persistent headache Extreme mental and/or physical fatigue Seizure activity (traumatic epilepsy) Photosensitivity (sensitivity to light)Sleep disorders

The effect of an ABI on an individual cont.The effect of an ABI on an individual cont.

Communication Difficulties•Word finding difficulty ranging from mild to severe •Difficulty understanding spoken or written language•Unclear speech due to poor control of the muscles in the lips, tongue and jaw and/or poor breathing patterns

Behavioural/Emotional Symptoms: •Irritability and impatience, poor anger management•Reduced tolerance for stress•Lack of initiative, apathy•Dependence (failure to assume responsibility for one's actions )•Denial of disability•Lack of inhibition (aggression, cursing and inappropriate sexual behaviour) •Inflexibility •Flattened or heightened emotional responses/reactions

Perceptual Symptoms: •Disturbance in the ability to make sense of information coming in from the senses •Unilateral inattention•Topographical disorientation

Challenges for Teaching and LearningChallenges for Teaching and Learning

Physically Accessing the Environment

Difficulty with practical tasks due to reduced mobility and upper limb functioning

Difficulty in Personal care ie managing cups and cutlery or using the toilet Difficulty learning and retaining new information / skills

Difficulty planning or following through multi-step or more complex tasks

Difficulty making use of normal education resources e.g. chalk & talk, handouts, computers, front of the class demonstration

Challenges for Teaching and Learning Challenges for Teaching and Learning cont.cont.

Difficulty remembering arrangements, timetables, routes around the college

Difficulty tolerating full sessions or a full day programme because of increased fatigue

Difficulty understanding spoken information and expressing themselves through language

Difficulty with reading and writing

Difficulty socialising with other students

Meeting Students needsMeeting Students needs

Accessible environments

Pre-entry and ongoing assessment

Informed Lecturers

Adequate Support

Individual Learning Plans

Liaison with other service providers – a coordinated approach

Appropriate accreditation

What Can be Achieved ?What Can be Achieved ?

Rebuilding of some lost skills eg communication skills

Acquisition of new skills eg becoming computer literate

Alternative interests

Preparation for mainstream courses

Preparation for voluntary work

Preparation for a vocational training scheme

Return to work in a new capacity

Re-training for a new job via appropriate support on mainstream courses

Influencing challenges to the learning Influencing challenges to the learning process presented by the ABIprocess presented by the ABI

Read assessments so you have some idea of the difficulties a student may have

Adapt support, teaching methods and materials appropriately

Encourage the development and use of strategies

Any Questions?Any Questions?