Trauma, Rehabilitation and Recovery; OBIA Conference 2009

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Power Point program presented at the 2009 Provincial Acquired Brain Injury Conference in Niagara Falls; October 29, 2009

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Trauma, Rehabilitation and Recovery; OBIA Conference 2009

  1. 1. Val Lougheed Northern Lights Canada 1-800-361-4642 www.northernlightscanada.ca vlougheed@northernlightscanada.ca Trauma, Rehab, and Recovery Harnessing the Power after Brian Injury ~ Keep Your Fork ~
  2. 2. “You don’t want your impairments to define you – you want them to inform you.” (Hanita Dagan, personal communication, 2005)
  3. 3. Agenda • Beginning … • Middle … • End …
  4. 4. Harnessing Our Power 1. What does it mean to recover and return to work? 2. Why can some people return to work and others can’t? 3. What can I do to facilitate recovery and a return to work?
  5. 5. Rated PG-113 People Strongly Cautioned! May contain bad language, brief nudity, sexual overtones, and drug usage.
  6. 6. Sept. 9, 2003 - morning
  7. 7. Sept. 9 – p.m.
  8. 8. Sept. 15 2003 – Jan. 19 2004 Journey Back to Life
  9. 9. Research
  10. 10. Dominant Themes • Narcotic Pain Killers • ABI • Pain • Trauma • Depression • Methods of Helping • Return to Work • Life
  11. 11. Foundation for Understanding Experience
  12. 12. Body-Mind Connection Psychoimmunoendocrine Network  The nervous, endocrine, and immune systems are functionally integrated – the brain is only one part of this non- hierarchical network  Memories, emotions, behaviours and physiology are all connected at the molecular level (Candace Pert, 1997, p. 171 – 179)
  13. 13. February 2004 – Present Starting Point
  14. 14. Identity Disintegration and The Re-organization of Self March 2004
  15. 15. “In the aftermath of traumatic life events … [the] sense of self has been shattered.” (Herman, 1992, p. 61) “An existential crisis …” (Hanita Dagan, personal communication, 2005)
  16. 16. OxyContin™ Research Early 1900’s Oxycodone™ developed in Germany 1995 Purdue Pharmacy (USA) launches OxyContin™ – controlled-release formula 1996 Approved in Canada 2002 OxyContin™ earns Purdue more than $1 billion U.S. 2003 OxyContin™ is one of Canada’s 3 most-prescribed narcotic painkillers Nov. 2003 – Oct. 2004 783,762 prescriptions for OxyContin™ dispensed in Canada (Dalhousie, March 2005)
  17. 17. A Foothold • Mild – moderate ABI • Depressed (dysphoria) • Working memory problems • Hiding pain 1st Neuropsychological Assessment June 2004 -- Results
  18. 18. ABI – Measuring Loss “Pre-morbid intelligence is a crucial variable …” Subjective Report – difficulty retrieving words and communicating ideas Objective Report – above-average performance on neuropsychological measures (Prigatano, 1999, p. 59)
  19. 19. Losing My Grip My IWRP August 2004
  20. 20. Rescued in the Valley of Despair Head Injury Program Oct. – Dec. 2004
  21. 21. GO TO WORK
  22. 22. GRTW – The Plan Jan. 3 – Feb. 7, 2005 (5 weeks)
  23. 23. GRTW – The Reality
  24. 24. GRTW – The Reality
  25. 25. GRTW – The Reality
  26. 26. GRTW – The Reality
  27. 27. GRTW – The Reality
  28. 28. GRTW – The Reality
  29. 29. GRTW – The Reality
  30. 30. GRTW – The Reality
  31. 31. GRTW – The Reality
  32. 32. Rescue Attempts • Case Manager • Job Coach • Colleagues/Friends/ Psychologist
  33. 33. Sliding Back Down Into The Abyss • Non-compliance • Malingering • Trying too hard • Not trying hard enough 2nd Neuropsychological Assessment May 2005 -- Edmonton
  34. 34. Test Results • Mild to Moderate ABI • Pain? • Depression? • Motivation? • “a high flyer” • “phobic avoidance” • Future plans – “live off dividends” [from company]
  35. 35. Lesson ASSUMPTION S REVEAL BIAS
  36. 36. • Mild – moderate ABI • Good prognosis • Post-Traumatic amnesia • Pain? • Depression? • “Adjustment Disorder with Anxiety and Depressed Mood” 3rd Neuropsychological Assessment August 2005 -- Calgary
  37. 37. Symptom Overlap (co-morbidity) (Michael Sullivan, Centre for Research on Pain and Disability, McGill University, September, 2006) Pain, Trauma, Depression, ABI
  38. 38. Oct. 3 – Dec. 11
  39. 39. Pain Research 1600’s – Rene Descartes (philosopher)
  40. 40. Pain Research 1950’s – Wilder Penfield (brain surgeon)
  41. 41. Pain Research Patrick Wall (physiologist) Ronald Melzack (psychologist)
  42. 42. Pain Research Gate Control Theory • Acute and chronic pain • Pain sensation travels up the central nervous system to the brain through a “gate” • “Gate” – triggered by cell changes – sends descending messages that alter sensory input • Pain isn’t pain until it reaches the brain • Emotions, context, etc. affect pain sensations • Pain is a negotiable, individual experience • Pain centres in the brain – they just keep moving around (Jackson, 2002, p. 21)
  43. 43. Limbic System The centre for emotional expression (Prigatano, 1999, p. 132) • Amygdala - attaches emotional tags to memories (Dr. Suffield, personal communication, 2004) • Hippocampus - controls the laying down of new memories (Ramachandran & Blakeslee, 1998, p. 15) • Hypothalamus – controls the outward expression of emotions (Ramachandran & Blakeslee, 1998, p. 177) Trauma Research
  44. 44. “In every encounter, basic trust is in question.” ( Herman, 1992, p. 92) “Survivors feel unsafe in their bodies – and in any relationship with other people.” (Herman, 1992, p. 160) Rehab & Recovery
  45. 45. Trauma Personal Experience • Dissociation & Cocoon = Safety • System on High Alert Always = Survival • World is black & white = Trust Trust (Safety) = Love No Trust (Life Threatening) = Hate
  46. 46. Trauma Personal Experience • Listen to me • Understand me • Respect me • Are competent I trust (love, feel safe with, will try hard for) practitioners who:
  47. 47. “… depression [caused by trauma] is not the same as ordinary depression.” ( Herman, 1992, p. 118) Depression
  48. 48. “Emotions are not in the head – they are in every cell in the body.” (Pert (1995), in Bolen, 1996, p. 7) Pscyhoimmunoendocrine Network
  49. 49. Affects more than IQ …. • We are sensitive to changes in higher cerebral functioning • Very important to a person’s sense of self • Touches core … of a person’s self- esteem (Prigatano, 1999, p. 58) ABI
  50. 50. Back to Wilder Penfield – 1950’s ABI Localizationist
  51. 51. Paul Bach-y-Rita – 1934 – 2006 Scientist and Rehab Doctor Neuroplasticity - 1969
  52. 52. Michael Merzenich Neuroplastician Neuroplasticity
  53. 53. Harnessing the Power
  54. 54. “The words and attitudes of others … are potent. They help or hex healing and recovery.” “ Expectations are powerful.” “Neutrality can be deadly.” (Bolen, 1996, p. 94) Body-Mind Connection
  55. 55. • Hypothalamus • Peptides • Receptors • Biochemical Events
  56. 56. Quantum Connection “There is something essential about the Now which is just outside the realm of science.” Albert Einstein, 1963, in Oschman, 2003, p. 43 The Living Matrix -- 1995 • A type of energy exists that has previously gone unnoticed. • Cells/DNA influence matter through this form of energy. • DNA Phantom effect. Braden, 2007, p. 45
  57. 57. “Loss of identity can evoke a personal crisis, creating a need for change.” (Ornelas, in Smith & Johnson (Eds), 1997, p. 172) The Re-Organization of Self Identity Research
  58. 58. Scaling the Canyon
  59. 59. Sept., 2005 Waskesiu
  60. 60. Breast Cancer Reconstructive Surgery March 2006
  61. 61. Convocation M.Ed. -- June 2006
  62. 62. Back in “a” Saddle September 2007 • Officially change role/ title • Re-organize NL • Work part-time
  63. 63. Harnessing the Power - 101 Resilience  Ability to return to original form after being bent (bounce back) Thriving in constant change, ability to be: • Flexible • Creative • Adaptable • Learn from experience http://www.resiliencycenter.com/articles/5levels.shtml
  64. 64. Harnessing the Power -- 201 Rehabilitation (habiter – to live inside) “Rehabilitation is the learning to live inside not only one’s body, however it is after an injury or illness, but inside one’s very being.” (Kabat-Zinn, in Meili, 2003, p. 241)
  65. 65. Harnessing the Power - 301 Recovery Curing Focus on the illness/ impairment [outside] Healing Focus on the person [inside] Crombez, October, 2003
  66. 66. Be Still
  67. 67. Harnessing Our Power 1. What does it mean to recover and return to work? 2. Why can some people return to work and others can’t? 3. What can I do to facilitate recovery and a return to work?
  68. 68. Keep Your Fork
  69. 69. Northern Lights Canada is a person-centred organization committed to providing innovative, responsive links to real work. We offer 4 major divisions of service: • Vocational Rehabilitation Services • Employment Services • Employer Services • Corporate Training For more information, please contact us: 1-800-361-4642 www.northernlightscanada.ca
  70. 70. Voc Rehab Canada (VRCAN) is a national consortium of experienced regional vocational rehabilitation companies. VRCAN provides customers with single-point access to VR services anywhere they are needed in Canada, whether on an individual service or contract basis. Member companies include: Argus Management Consultants, Inc. Sandra Preeper & Associates Advantage Rehabilitation Consultants Ltd. Rehabilitation Alternatives Limited / Vocational Alternatives Software OPTIMA Rehabilitation CVE Inc. Northern Lights Canada Occupational Rehabilitation Group of Canada (ORGOC) Western Rehabilitation Specialists Inc. Diversified Rehabilitation Group Genesis Rehabilitation Ltd. Rehabilitation Focus For more information, please feel free to contact us at 1-800-361-4642

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