Lend Me Your Brain: Supporting TBI
Survivors around
Executive Function Deficits
www.DrNowell.com
DavidNowell
DavidNowellSeminars
Overview
• Brain overview in 18 slides
• Executive functioning
• Understanding your brain’s
reward-and-planning system
• Q...
BRAIN OVERVIEW IN 18 SLIDES
Appendix A
Peak experiences
What does dopamine feeeel like?
Ways of thinking about the brain
• Left to right
• Top to bottom
• Front to back
what IS…
5/12/2014
© 2011 David D. Nowell, Ph.D. All rights
reserved.
24
…what COULD BE
5/12/2014
© 2011 David D. Nowell, Ph.D. All rights
reserved.
25
EXECUTIVE FUNCTIONING
The Executive Functions
• Making movies in your head
• Talking to yourself
• Being your own boss
• Thinking and creating “...
5/12/2014
© 2011 David D. Nowell, Ph.D. All rights
reserved.
28
1. 1-step errands
2. Chores with cues
3. Basic inhibition
...
5/12/2014
© 2011 David D. Nowell, Ph.D. All rights
reserved.
29
1. 2-3 step directions
2. 20-30 minute assignments
3. Foll...
5/12/2014
© 2011 David D. Nowell, Ph.D. All rights
reserved.
30
1. Simple shopping list
2. Keep track of variable daily sc...
5/12/2014
© 2011 David D. Nowell, Ph.D. All rights
reserved.
31
1. Complex chores
2. Organizing system
3. Time management
...
5/12/2014
© 2011 David D. Nowell, Ph.D. All rights
reserved.
32
1. Independent with assignments
2. Make adjustments based ...
Impact of Executive Dysfunction on
School and Work
• Problems initiating and completing work.
• Slowed work pace.
• Increa...
Impact of Executive Dysfunction on
Social Skills
• Loss of friends and social circles.
• Decreased affective regulation.
•...
5/12/2014
© 2011 David D. Nowell, Ph.D. All rights
reserved.
35
Lending Your Brain
Capacity
• Guardianship
• Conservatorship
• Representative payee
Meet with your ADHD employee for
regular ongoing feedback
UNDERSTANDING YOUR BRAIN’S
REWARD-AND-PLANNING SYSTEM
Image: wikimedia commons
Cortico-striatal loop
Cortico-striatal loop
The reward-and-planning system
The reward-and-planning system
Goal / State
Identify Tasks
Sequence/
Problem solve
Block Distractions
Ways the reward-and-planning system can
go wrong
• Dante: “My biggest problem is that I want to
do everything all at once!”
Ways the reward-and-planning system can
go wrong
• Inna: “I just get blank. I usually start sitting
more slouched, hold my...
Ways the reward-and-planning system can
go wrong
• Hank: “I have things I need to do to improve
my marriage, my health and...
The reward-and-planning system
Goal / State
Identify Tasks
Sequence/
Problem solve
Block Distractions
The reward-and-planning system
Goal / State
The reward-and-planning system
Goal / State
STRATEGIES
• Identify the goal-behind-
the-goal (what do you want
to feel?)
The reward-and-planning system
Goal / State
Identify Tasks
The reward-and-planning system
Identify Tasks
STRATEGIES
• Coaching
• Interview someone who’s
already done it
• Vocational...
The reward-and-planning system
Goal / State
Identify Tasks
Sequence/
Problem solve
The reward-and-planning system
Sequence/
Problem solve
Strategies
• Weekly planning session
• Morning 10-minute review
• R...
10 minute morning check-in
The best defense against the
manipulation of our attention is
to determine for ourselves – in
advance - how we want to
inv...
easy hard
5/12/2014
© 2011 David D. Nowell, Ph.D. All rights
reserved.
62
Let your non-TBI family member tackle
the detailed long-term projects while
you manage the time-limited projects
60-Second
Bathroom Cleaning Routine
Shower coach
Walk me up
Clocky
Launching pad
Clear (see-through) storage
The reward-and-planning system
Sequence/
Problem solve
Strategies
• Weekly planning session
• Morning 10-minute review
• R...
The reward-and-planning system
Goal / State
Identify Tasks
Sequence/
Problem solve
Block Distractions
The reward-and-planning system
Block Distractions
The reward-and-planning system
Block Distractions
Strategies
• The Body Double
• StayOnTask app
• Increase salience (what’...
Increase salience
EZ-C Reader
StayOnTask app
The reward-and-planning system
Block Distractions
Strategies
• The Body Double
• StayOnTask app
• Increase salience (what’...
The reward-and-planning system
Goal / State
Identify Tasks
Sequence/
Problem solve
Block Distractions
The reward-and-planning system
Goal / State
The reward-and-planning system
Goal / State
Strategies
• Get clear about your unique
motivations.
• Maintain boundaries
• ...
The reward-and-planning system
Goal / State
Identify Tasks
Sequence/
Problem solve
Block Distractions
What’s wrong with this brain model?
The “Big 5” Brain Supports
• Sleep
• Exercise
• Nutrition
• Daily calendar review
• Connection
Q & A & D
www.slideshare.net/dnowell
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 DNSE...
Lend Me Your Brain:  Supporting TBI Survivors around Executive Functioning
Lend Me Your Brain:  Supporting TBI Survivors around Executive Functioning
Lend Me Your Brain:  Supporting TBI Survivors around Executive Functioning
Lend Me Your Brain:  Supporting TBI Survivors around Executive Functioning
Lend Me Your Brain:  Supporting TBI Survivors around Executive Functioning
Lend Me Your Brain:  Supporting TBI Survivors around Executive Functioning
Lend Me Your Brain:  Supporting TBI Survivors around Executive Functioning
Lend Me Your Brain:  Supporting TBI Survivors around Executive Functioning
Lend Me Your Brain:  Supporting TBI Survivors around Executive Functioning
Lend Me Your Brain:  Supporting TBI Survivors around Executive Functioning
Lend Me Your Brain:  Supporting TBI Survivors around Executive Functioning
Lend Me Your Brain:  Supporting TBI Survivors around Executive Functioning
Lend Me Your Brain:  Supporting TBI Survivors around Executive Functioning
Lend Me Your Brain:  Supporting TBI Survivors around Executive Functioning
Lend Me Your Brain:  Supporting TBI Survivors around Executive Functioning
Lend Me Your Brain:  Supporting TBI Survivors around Executive Functioning
Lend Me Your Brain:  Supporting TBI Survivors around Executive Functioning
Lend Me Your Brain:  Supporting TBI Survivors around Executive Functioning
Lend Me Your Brain:  Supporting TBI Survivors around Executive Functioning
Lend Me Your Brain:  Supporting TBI Survivors around Executive Functioning
Lend Me Your Brain:  Supporting TBI Survivors around Executive Functioning
Lend Me Your Brain:  Supporting TBI Survivors around Executive Functioning
Lend Me Your Brain:  Supporting TBI Survivors around Executive Functioning
Lend Me Your Brain:  Supporting TBI Survivors around Executive Functioning
Lend Me Your Brain:  Supporting TBI Survivors around Executive Functioning
Lend Me Your Brain:  Supporting TBI Survivors around Executive Functioning
Lend Me Your Brain:  Supporting TBI Survivors around Executive Functioning
Lend Me Your Brain:  Supporting TBI Survivors around Executive Functioning
Lend Me Your Brain:  Supporting TBI Survivors around Executive Functioning
Lend Me Your Brain:  Supporting TBI Survivors around Executive Functioning
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 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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Lend Me Your Brain: Supporting TBI Survivors around Executive Functioning

  1. 1. Lend Me Your Brain: Supporting TBI Survivors around Executive Function Deficits
  2. 2. www.DrNowell.com DavidNowell DavidNowellSeminars
  3. 3. Overview • Brain overview in 18 slides • Executive functioning • Understanding your brain’s reward-and-planning system • Q&A&D
  4. 4. BRAIN OVERVIEW IN 18 SLIDES
  5. 5. Appendix A
  6. 6. Peak experiences
  7. 7. What does dopamine feeeel like?
  8. 8. Ways of thinking about the brain • Left to right • Top to bottom • Front to back
  9. 9. what IS… 5/12/2014 © 2011 David D. Nowell, Ph.D. All rights reserved. 24
  10. 10. …what COULD BE 5/12/2014 © 2011 David D. Nowell, Ph.D. All rights reserved. 25
  11. 11. EXECUTIVE FUNCTIONING
  12. 12. The Executive Functions • Making movies in your head • Talking to yourself • Being your own boss • Thinking and creating “what could be”
  13. 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. 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. 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. 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. 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. 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. 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. 20. 5/12/2014 © 2011 David D. Nowell, Ph.D. All rights reserved. 35 Lending Your Brain
  21. 21. Capacity • Guardianship • Conservatorship • Representative payee
  22. 22. Meet with your ADHD employee for regular ongoing feedback
  23. 23. UNDERSTANDING YOUR BRAIN’S REWARD-AND-PLANNING SYSTEM
  24. 24. Image: wikimedia commons
  25. 25. Cortico-striatal loop
  26. 26. Cortico-striatal loop
  27. 27. The reward-and-planning system
  28. 28. The reward-and-planning system Goal / State Identify Tasks Sequence/ Problem solve Block Distractions
  29. 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. 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. 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. 32. The reward-and-planning system Goal / State Identify Tasks Sequence/ Problem solve Block Distractions
  33. 33. The reward-and-planning system Goal / State
  34. 34. The reward-and-planning system Goal / State STRATEGIES • Identify the goal-behind- the-goal (what do you want to feel?)
  35. 35. The reward-and-planning system Goal / State Identify Tasks
  36. 36. The reward-and-planning system Identify Tasks STRATEGIES • Coaching • Interview someone who’s already done it • Vocational counseling
  37. 37. The reward-and-planning system Goal / State Identify Tasks Sequence/ Problem solve
  38. 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. 39. 10 minute morning check-in
  40. 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. 41. easy hard 5/12/2014 © 2011 David D. Nowell, Ph.D. All rights reserved. 62
  42. 42. Let your non-TBI family member tackle the detailed long-term projects while you manage the time-limited projects
  43. 43. 60-Second Bathroom Cleaning Routine
  44. 44. Shower coach
  45. 45. Walk me up
  46. 46. Clocky
  47. 47. Launching pad
  48. 48. Clear (see-through) storage
  49. 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. 50. The reward-and-planning system Goal / State Identify Tasks Sequence/ Problem solve Block Distractions
  51. 51. The reward-and-planning system Block Distractions
  52. 52. The reward-and-planning system Block Distractions Strategies • The Body Double • StayOnTask app • Increase salience (what’s in it for me?)
  53. 53. Increase salience
  54. 54. EZ-C Reader
  55. 55. StayOnTask app
  56. 56. The reward-and-planning system Block Distractions Strategies • The Body Double • StayOnTask app • Increase salience (what’s in it for me?)
  57. 57. The reward-and-planning system Goal / State Identify Tasks Sequence/ Problem solve Block Distractions
  58. 58. The reward-and-planning system Goal / State
  59. 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. 60. The reward-and-planning system Goal / State Identify Tasks Sequence/ Problem solve Block Distractions
  61. 61. What’s wrong with this brain model?
  62. 62. The “Big 5” Brain Supports • Sleep • Exercise • Nutrition • Daily calendar review • Connection
  63. 63. Q & A & D
  64. 64. www.slideshare.net/dnowell
  65. 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

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