Lend Me Your Brain:  Supporting TBI Survivors around Executive Functioning
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Lend Me Your Brain: Supporting TBI Survivors around Executive Functioning

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Parents, counselors, case managers, and physicians are frequently called upon to support TBI survivors as they navigate decision-making, planning, and self-regulation. These key features of......

Parents, counselors, case managers, and physicians are frequently called upon to support TBI survivors as they navigate decision-making, planning, and self-regulation. These key features of executive functioning are often areas of weakness for brain injury survivors, because of frontal lobe involvement. This workshop provides professionals and non-professionals alike with a model for thinking about executive functioning and strategies for providing the best supports – at the right points – for their clients and loved ones who have survived a brain injury.

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  • 1. Lend Me Your Brain: Supporting TBI Survivors around Executive Function Deficits
  • 2. www.DrNowell.com DavidNowell DavidNowellSeminars
  • 3. Overview • Brain overview in 18 slides • Executive functioning • Understanding your brain’s reward-and-planning system • Q&A&D
  • 4. BRAIN OVERVIEW IN 18 SLIDES
  • 5. Appendix A
  • 6. Peak experiences
  • 7. What does dopamine feeeel like?
  • 8. Ways of thinking about the brain • Left to right • Top to bottom • Front to back
  • 9. what IS… 5/12/2014 © 2011 David D. Nowell, Ph.D. All rights reserved. 24
  • 10. …what COULD BE 5/12/2014 © 2011 David D. Nowell, Ph.D. All rights reserved. 25
  • 11. EXECUTIVE FUNCTIONING
  • 12. The Executive Functions • Making movies in your head • Talking to yourself • Being your own boss • Thinking and creating “what could be”
  • 13. 5/12/2014 © 2011 David D. Nowell, Ph.D. All rights reserved. 28 1. 1-step errands 2. Chores with cues 3. Basic inhibition Preschool
  • 14. 5/12/2014 © 2011 David D. Nowell, Ph.D. All rights reserved. 29 1. 2-3 step directions 2. 20-30 minute assignments 3. Follow rules/inhibit/no grabbing Kindergarten - 2nd Grade
  • 15. 5/12/2014 © 2011 David D. Nowell, Ph.D. All rights reserved. 30 1. Simple shopping list 2. Keep track of variable daily schedule 3. Inhibit and regulate even without teacher present 4. Simple delayed gratification (phone) 3rd-5th Grade
  • 16. 5/12/2014 © 2011 David D. Nowell, Ph.D. All rights reserved. 31 1. Complex chores 2. Organizing system 3. Time management 4. Self soothe 5. Manage conflict 6th – 8th Grade
  • 17. 5/12/2014 © 2011 David D. Nowell, Ph.D. All rights reserved. 32 1. Independent with assignments 2. Make adjustments based on feedback 3. Inhibit reckless behavior 4. Say “no” to fun activity if other plans already made 5. Take others’ perspective Teenage-mid 20’s
  • 18. Impact of Executive Dysfunction on School and Work • Problems initiating and completing work. • Slowed work pace. • Increased impulsivity. • Decreased productivity. • Confusion and increased stress. • Trouble with generalization of new learning. • Distractible.
  • 19. Impact of Executive Dysfunction on Social Skills • Loss of friends and social circles. • Decreased affective regulation. • Increased impulsivity. • Increased agitation. • Decreased perspective-taking. • Premature return to school/work.
  • 20. 5/12/2014 © 2011 David D. Nowell, Ph.D. All rights reserved. 35 Lending Your Brain
  • 21. Capacity • Guardianship • Conservatorship • Representative payee
  • 22. Meet with your ADHD employee for regular ongoing feedback
  • 23. UNDERSTANDING YOUR BRAIN’S REWARD-AND-PLANNING SYSTEM
  • 24. Image: wikimedia commons
  • 25. Cortico-striatal loop
  • 26. Cortico-striatal loop
  • 27. The reward-and-planning system
  • 28. The reward-and-planning system Goal / State Identify Tasks Sequence/ Problem solve Block Distractions
  • 29. Ways the reward-and-planning system can go wrong • Dante: “My biggest problem is that I want to do everything all at once!”
  • 30. Ways the reward-and-planning system can go wrong • Inna: “I just get blank. I usually start sitting more slouched, hold my head with my left hand, ….you freeze and instead of being able to think of alternatives, you start thinking to yourself that you cannot find a logical answer and you are tempted to avoid it as if it poses a threat somehow to you.”
  • 31. Ways the reward-and-planning system can go wrong • Hank: “I have things I need to do to improve my marriage, my health and my financial situation, but I honestly believe that I have zero chance of actually making any of those three things actually get better. ”
  • 32. The reward-and-planning system Goal / State Identify Tasks Sequence/ Problem solve Block Distractions
  • 33. The reward-and-planning system Goal / State
  • 34. The reward-and-planning system Goal / State STRATEGIES • Identify the goal-behind- the-goal (what do you want to feel?)
  • 35. The reward-and-planning system Goal / State Identify Tasks
  • 36. The reward-and-planning system Identify Tasks STRATEGIES • Coaching • Interview someone who’s already done it • Vocational counseling
  • 37. The reward-and-planning system Goal / State Identify Tasks Sequence/ Problem solve
  • 38. The reward-and-planning system Sequence/ Problem solve Strategies • Weekly planning session • Morning 10-minute review • Review your successes and strengths: What evidence do you have that you CAN do this?
  • 39. 10 minute morning check-in
  • 40. The best defense against the manipulation of our attention is to determine for ourselves – in advance - how we want to invest it. - E. Goldberg
  • 41. easy hard 5/12/2014 © 2011 David D. Nowell, Ph.D. All rights reserved. 62
  • 42. Let your non-TBI family member tackle the detailed long-term projects while you manage the time-limited projects
  • 43. 60-Second Bathroom Cleaning Routine
  • 44. Shower coach
  • 45. Walk me up
  • 46. Clocky
  • 47. Launching pad
  • 48. Clear (see-through) storage
  • 49. The reward-and-planning system Sequence/ Problem solve Strategies • Weekly planning session • Morning 10-minute review • Review your successes and strengths: What evidence do you have that you CAN do this?
  • 50. The reward-and-planning system Goal / State Identify Tasks Sequence/ Problem solve Block Distractions
  • 51. The reward-and-planning system Block Distractions
  • 52. The reward-and-planning system Block Distractions Strategies • The Body Double • StayOnTask app • Increase salience (what’s in it for me?)
  • 53. Increase salience
  • 54. EZ-C Reader
  • 55. StayOnTask app
  • 56. The reward-and-planning system Block Distractions Strategies • The Body Double • StayOnTask app • Increase salience (what’s in it for me?)
  • 57. The reward-and-planning system Goal / State Identify Tasks Sequence/ Problem solve Block Distractions
  • 58. The reward-and-planning system Goal / State
  • 59. The reward-and-planning system Goal / State Strategies • Get clear about your unique motivations. • Maintain boundaries • Ask “what about this do I want?”
  • 60. The reward-and-planning system Goal / State Identify Tasks Sequence/ Problem solve Block Distractions
  • 61. What’s wrong with this brain model?
  • 62. The “Big 5” Brain Supports • Sleep • Exercise • Nutrition • Daily calendar review • Connection
  • 63. Q & A & D
  • 64. www.slideshare.net/dnowell
  • 65. Let’s stay in touch! Join my e-newsletter list:  Fill out a card today and drop it in the box.  Text to join: text DNSEMINARS to 22828  Sign up on my web site or Facebook page Visit us on the web: www.DrNowell.com davidnowell David Nowell Seminars