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.

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

9. Appendix A

10. Peak experiences

11. What does dopamine feeeel like?

19. Ways of thinking about the brain
• Left to right
• Top to bottom
• Front to back

24. what IS…
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© 2011 David D. Nowell, Ph.D. All rights
reserved.
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25. …what COULD BE
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© 2011 David D. Nowell, Ph.D. All rights
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26. EXECUTIVE FUNCTIONING

27. The Executive Functions
• Making movies in your head
• Talking to yourself
• Being your own boss
• Thinking and creating “what could be”

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1. 1-step errands
2. Chores with cues
3. Basic inhibition
Preschool

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1. 2-3 step directions
2. 20-30 minute assignments
3. Follow rules/inhibit/no grabbing
Kindergarten -
2nd Grade

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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

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1. Complex chores
2. Organizing system
3. Time management
4. Self soothe
5. Manage conflict
6th – 8th Grade

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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

33. 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.

34. 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.

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© 2011 David D. Nowell, Ph.D. All rights
reserved.
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Lending Your Brain

36. Capacity
• Guardianship
• Conservatorship
• Representative payee

37. Meet with your ADHD employee for
regular ongoing feedback

38. UNDERSTANDING YOUR BRAIN’S
REWARD-AND-PLANNING SYSTEM

39. Image: wikimedia commons

41. Cortico-striatal loop

42. Cortico-striatal loop

43. The reward-and-planning system

44. The reward-and-planning system
Goal / State
Identify Tasks
Sequence/
Problem solve
Block Distractions

45. Ways the reward-and-planning system can
go wrong
• Dante: “My biggest problem is that I want to
do everything all at once!”

46. 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.”

47. 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. ”

48. The reward-and-planning system
Goal / State
Identify Tasks
Sequence/
Problem solve
Block Distractions

49. The reward-and-planning system
Goal / State

53. The reward-and-planning system
Goal / State
STRATEGIES
• Identify the goal-behind-
the-goal (what do you want
to feel?)

54. The reward-and-planning system
Goal / State
Identify Tasks

55. The reward-and-planning system
Identify Tasks
STRATEGIES
• Coaching
• Interview someone who’s
already done it
• Vocational counseling

56. The reward-and-planning system
Goal / State
Identify Tasks
Sequence/
Problem solve

57. 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?

60. 10 minute morning check-in

61. The best defense against the
manipulation of our attention is
to determine for ourselves – in
advance - how we want to
invest it.
- E. Goldberg

62. easy hard
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reserved.
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63. Let your non-TBI family member tackle
the detailed long-term projects while
you manage the time-limited projects

64. 60-Second
Bathroom Cleaning Routine

65. Shower coach

66. Walk me up

67. Clocky

68. Launching pad

69. Clear (see-through) storage

73. 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?

74. The reward-and-planning system
Goal / State
Identify Tasks
Sequence/
Problem solve
Block Distractions

75. The reward-and-planning system
Block Distractions

76. The reward-and-planning system
Block Distractions
Strategies
• The Body Double
• StayOnTask app
• Increase salience (what’s in it
for me?)

77. Increase salience

79. EZ-C Reader

80. StayOnTask app

82. The reward-and-planning system
Block Distractions
Strategies
• The Body Double
• StayOnTask app
• Increase salience (what’s in it
for me?)

85. The reward-and-planning system
Goal / State
Identify Tasks
Sequence/
Problem solve
Block Distractions

86. The reward-and-planning system
Goal / State

87. The reward-and-planning system
Goal / State
Strategies
• Get clear about your unique
motivations.
• Maintain boundaries
• Ask “what about this do I want?”

89. The reward-and-planning system
Goal / State
Identify Tasks
Sequence/
Problem solve
Block Distractions

90. What’s wrong with this brain model?

91. The “Big 5” Brain Supports
• Sleep
• Exercise
• Nutrition
• Daily calendar review
• Connection

94. Q & A & D

95. www.slideshare.net/dnowell

96. Let’s stay in touch!
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