Trr stroke the next steps edmonton 010

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Here is the Power Point program of Trauma, Rehabilitation and Recovery -- The Next Steps, for the SRA Edmonton Stroke Workshop; Saturday, May 29, 2010

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Trr stroke the next steps edmonton 010

  1. 1. Val Lougheed Northern Lights Canada Trauma, Rehabilitation and Recovery -- The Next Steps ~ Keep Your Fork ~ 1-800-361-4642 * www.northernlightscanada.ca * vlougheed@northernlightscanada.ca
  2. 2. “ You don’t want your impairments to define you – you want them to inform you.” (Hanita Dagan, personal communication, 2005)
  3. 3. <ul><li>www.slideshare.com/vlougheed </li></ul>#NLCAN www.northernlightscanada.ca/about/about-val-lougheed/be-still
  4. 4. Agenda <ul><li>Beginning … </li></ul><ul><li>Middle … </li></ul><ul><li>End … </li></ul>
  5. 5. The Next Steps <ul><li>What does it mean to recover? </li></ul><ul><li>What can I do to recover and return to a life that includes work? </li></ul><ul><li>What can we do to facilitate recovery and a return to work? </li></ul>
  6. 6. Rated PG-113 People Strongly Cautioned! May contain bad language, brief nudity, sexual overtones, and drug usage.
  7. 7. Beginning My Story
  8. 11. Sept. 9, 2003 - morning
  9. 12. Sept. 9 – p.m.
  10. 13. Sept. 15 2003 – Jan. 19 2004 Journey Back to Life
  11. 18. February 2004 – Present Starting Point
  12. 19. Identity Disintegration and The Re-organization of Self March 2004
  13. 20. “ 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)
  14. 21. Sliding Down The Slope (Dalhousie, March 2005) 783,762 prescriptions for OxyContin ™ dispensed in Canada Nov. 2003 – Oct. 2004 OxyContin ™ is one of Canada’s 3 most-prescribed narcotic painkillers 2003 OxyContin ™ earns Purdue more than $1 billion U.S. 2002 Approved in Canada 1996 Purdue Pharmacy (USA) launches OxyContin ™ – controlled-release formula 1995 Oxycodone ™ developed in Germany Early 1900’s
  15. 23. A Foothold <ul><li>Mild – moderate ABI </li></ul><ul><li>Depressed (dysphoria) </li></ul><ul><li>Working memory problems </li></ul><ul><li>Hiding pain </li></ul>1 st Neuropsychological Assessment June 2004 -- Results
  16. 24. Losing My Grip My IWRP August 2004
  17. 26. Rescued in the Valley of Despair Head Injury Program Oct. – Dec. 2004
  18. 28. HIP Oct to Nov – Full-time December – Part-time
  19. 29. GRTW – The Plan Jan. 3 – Feb. 7, 2005 (5 weeks)
  20. 30. GRTW – The Reality
  21. 31. GRTW – The Reality
  22. 32. GRTW – The Reality
  23. 33. GRTW – The Reality
  24. 34. GRTW – The Reality
  25. 35. GRTW – The Reality
  26. 36. GRTW – The Reality
  27. 37. GRTW – The Reality
  28. 38. GRTW – The Reality
  29. 39. Rescue Attempts <ul><li>Case Manager </li></ul><ul><li>Job Coach </li></ul><ul><li>Colleagues/Friends/ Psychologist </li></ul>
  30. 40. Sliding Back Down Into The Abyss <ul><li>Non-compliance </li></ul><ul><li>Malingering </li></ul><ul><li>Trying too hard </li></ul><ul><li>Not trying hard enough </li></ul>2 nd Neuropsychological Assessment May 2005 -- Edmonton
  31. 41. Lesson ASSUMPTIONS REVEAL BIAS
  32. 42. <ul><li>Mild – moderate ABI </li></ul><ul><li>Good prognosis </li></ul><ul><li>Post-Traumatic amnesia </li></ul><ul><li>Pain? </li></ul><ul><li>Depression? </li></ul><ul><li>“ Adjustment Disorder with Anxiety and Depressed Mood” </li></ul>3rd Neuropsychological Assessment August 2005 -- Calgary
  33. 43. Symptom Overlap (co-morbidity) (Michael Sullivan, Centre for Research on Pain and Disability, McGill University, September, 2006) Pain, Trauma, Depression, ABI
  34. 45. Oct. 3 – Dec. 11
  35. 47. Pain Research 1600’s – Rene Descartes (philosopher)
  36. 48. Pain Research 1950’s – Wilder Penfield (brain surgeon)
  37. 50. Pain Research Patrick Wall (physiologist) Ronald Melzack (psychologist)
  38. 51. Pain Research <ul><li>Gate Control Theory </li></ul><ul><li>Acute and chronic pain </li></ul><ul><li>Pain sensation travels up the central nervous system to the brain through a “gate” </li></ul><ul><li>“ Gate” – triggered by cell changes – sends descending messages that alter sensory input </li></ul><ul><li>Pain isn’t pain until it reaches the brain </li></ul><ul><li>Emotions, context, etc. affect pain sensations </li></ul><ul><li>Pain is a negotiable, individual experience </li></ul><ul><li>Pain centres in the brain – they just keep moving around </li></ul><ul><li>(Jackson, 2002, p. 21) </li></ul>
  39. 52. Pain – The Future SCN9A (Globe and Mail, March 24, 2007) Glia Cells (Scientific American, November, 2009) Poppy Genes (U of Calgary -- Calgary Sun, March 15, 2010)
  40. 57. <ul><li>Limbic System </li></ul><ul><li>The centre for emotional expression </li></ul><ul><li>(Prigatano, 1999, p. 132) </li></ul><ul><li>Amygdala - attaches emotional tags to memories </li></ul><ul><li>(Dr. Suffield, personal communication, 2004) </li></ul><ul><li>Hippocampus - controls the laying down of new memories </li></ul><ul><li>(Ramachandran & Blakeslee, 1998, p. 15) </li></ul><ul><li>Hypothalamus – controls the outward expression of emotions </li></ul><ul><li>(Ramachandran & Blakeslee, 1998, p. 177) </li></ul>Trauma Research
  41. 58. “ 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
  42. 59. Trauma Personal Experience <ul><li>Dissociation & Cocoon = Safety </li></ul><ul><li>System on High Alert Always = Survival </li></ul><ul><li>World is black & white = Trust </li></ul>Trust (Safety) = Love No Trust (Life Threatening) = Hate
  43. 60. Trauma Personal Experience <ul><li>Listen to me </li></ul><ul><li>Understand me </li></ul><ul><li>Respect me </li></ul><ul><li>Are competent </li></ul>I trust (love, feel safe with, will try hard for) practitioners who:
  44. 63. “… depression [caused by trauma] is not the same as ordinary depression.” ( Herman, 1992, p. 118) Depression
  45. 64. “ Emotions are not in the head – they are in every cell in the body.” (Pert (1995), in Bolen, 1996, p. 7) Pscyhoimmunoendocrine Network
  46. 67. <ul><li>Affects more than IQ …. </li></ul><ul><li>We are sensitive to changes in higher cerebral functioning </li></ul><ul><li>Very important to a person’s sense of self </li></ul><ul><li>Touches core … of a person’s self-esteem </li></ul><ul><li>(Prigatano, 1999, p. 58) </li></ul>ABI
  47. 68. Back to Wilder Penfield – 1950’s ABI Localizationist
  48. 69. Paul Bach-y-Rita – 1934 – 2006 Scientist and Rehab Doctor Neuroplasticity - 1969
  49. 70. Michael Merzenich Neuroplastician Neuroplasticity
  50. 71. Harnessing the Power
  51. 73. “ 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
  52. 74. “ 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
  53. 75. Scaling the Canyon
  54. 76. Sept., 2005 Waskesiu
  55. 81. Breast Cancer Reconstructive Surgery March 2006
  56. 82. Convocation M.Ed. -- June 2006
  57. 83. Back in “a” Saddle September 2007 <ul><li>Officially change role/ title </li></ul><ul><li>Re-organize NL </li></ul><ul><li>Work part-time </li></ul>
  58. 84. The Next Steps
  59. 85. The Next Steps - 1 Resilience <ul><li>Ability to return to original form after being bent (bounce back) </li></ul><ul><li>Thriving in constant change, ability to be: </li></ul><ul><ul><ul><li>Flexible </li></ul></ul></ul><ul><ul><ul><li>Creative </li></ul></ul></ul><ul><ul><ul><li>Adaptable </li></ul></ul></ul><ul><ul><ul><li>Learn from experience </li></ul></ul></ul><ul><li>http://www.resiliencycenter.com/articles/5levels.shtml </li></ul>
  60. 86. The Next Steps -- 2 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)
  61. 87. The Next Steps - 3 Recovery Crombez, October, 2003 Focus on the person [inside] Healing Focus on the illness/ impairment [outside] Curing
  62. 88. Be Still
  63. 89. The Next Steps <ul><li>What does it mean to recover? </li></ul><ul><li>What can I do to recover and return to a life that includes work? </li></ul><ul><li>What can we do to facilitate recovery and a return to work? </li></ul>
  64. 90. Keep Your Fork
  65. 91. <ul><li>Northern Lights Canada is a person-centred organization committed to providing innovative, responsive links to real work. </li></ul><ul><li>We offer 4 major divisions of service: </li></ul><ul><ul><li>Vocational Rehabilitation Services </li></ul></ul><ul><ul><li>Employment Services </li></ul></ul><ul><ul><li>Employer Services </li></ul></ul><ul><ul><li>Corporate Training </li></ul></ul><ul><li>For more information, please contact us: </li></ul><ul><li>1-800-361-4642 </li></ul><ul><li>www.northernlightscanada.ca </li></ul>
  66. 92. 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: For more information, please feel free to contact us at 1-800-361-4642 Rehabilitation Focus Genesis Rehabilitation Ltd. Diversified Rehabilitation Group Western Rehabilitation Specialists Inc. Occupational Rehabilitation Group of Canada (ORGOC) Northern Lights Canada CVE Inc. OPTIMA Rehabilitation Rehabilitation Alternatives Limited / Vocational Alternatives Software Advantage Rehabilitation Consultants Ltd. Sandra Preeper & Associates Argus Management Consultants, Inc.

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