COMPENSATORY STRATEGIESFor Persons With

Traumatic Brain Injury

Successful completion of this training meets one hour of the four hour annual training requirement for Personal Attendant Services direct care staff as provided through the WV TBI

Waiver Program

• Information included in this presentation was current at the time it was developed

• Presentation materials are reviewed on an annual basis

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Disclaimer

Amanda M Wilson, M.A.

• Traumatic Brain Injury Services at the Center for Excellence in Disabilities

• Traumatic Brain Injury Information Specialist

• Ms. Wilson has been providing education and awareness about Traumatic Brain Injury with the state’s designated lead agency for coordination of services for West Virginia’s with TBI

• Contact information:www.cedwvu.org/programs/tbi

Toll Free: 1-877-724-8244

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Authors

Upon completion of this training participantswill be able to:

• Identify at least four symptoms that may appear as a result of a TBI

• Identify at least one compensatory strategy to use with each symptom of a Traumatic Brain Injury

• Understand the importance of compensatory strategies to Traumatic Brain Injury

• Identify four challenging behaviors/feelings as a result of a TBI

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Learning Objectives

Traumatic Brain Injury (TBI) isan insult to the brain not of a degenerative or congenital nature

caused by an external physical force, that may produce a diminished or altered state of consciousness resulting in an

impairment of cognitive abilities or physical functioning. It can also result in the disturbance of behavioral or emotional functioning,

may be temporary or permanent and cause partial or total functional disability or psychosocial maladjustment

National Head Injury Foundation(now the Brain Injury Association of America)

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Overview of Traumatic Brain Injury

Medicaid TBI Waiver Definition A non-degenerative, non-congenital insult to the

brain caused by an external physical force resulting in total or partial functional disability and/or

psychosocial impairment

WV TBI Waiver Manual 512.7.2.C. page 19

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• Every 23 seconds, one person in the United States sustains a traumatic brain injury

• Each year, an estimated 1.7 million people sustain a TBI

Centers for Disease Control and Prevention

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Overview of Traumatic Brain Injury

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“No head injury is too severe to despair of, nor too trivial to ignore.”-Hippocrates

Finding alternative methods to complete tasks that accommodate the needs of the person who has a Traumatic Brain Injury

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What Does Compensatory Mean ?

• It is important to remember that each person with a Traumatic Brain Injury (TBI) experiences life differently

• Compensatory Strategies can be used to help the person complete daily tasks

• Each strategy can be designed to meet the needs of the person

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Important Points about Compensatory Strategies

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DETERMINING WHAT STRATEGIES TO USE

• In order to execute appropriate compensatory strategies as a direct care staff it is important to understand some symptoms that may appear after a person has sustained a TBI

• When working with a member it is important to report any changes in behavior, mood, appearance to the case manager or appropriate contact person for your agency

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SYMPTOMS

• Shortened attention span• Lack of ability to concentrate• Difficulty organizing• Challenging Behavior/Feelings• Memory Problems• Initiation problems• Language problems• Slower processing speeds• Visual difficulties• Disorientation difficulties

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Symptoms After a TBI

• When someone has suffered a TBI attention, concentration, and organization can become very difficult to manage throughout the day

• As a direct care staff it is important to recognize that these difficulties may appear greater when the person is tired or stressed during the day

• Report any changes to the case manager or appropriate contact at the agency

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Attention, Concentration, and Organizational Difficulties

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Attention, Concentration, and Organizational Difficulties

The following are ways to assist the individual:

• Assist member in making predictable routines for everyday tasks such as:• Household chores (dishes, laundry)• Hygiene (shower/bath, brushing teeth)• Medication (morning, afternoon, evening)

*Assisting the member in completing these tasks at the same time, place, and day allows him/her to establish a routine*

• Assist member in making check lists and reminders for tasks such as:• Grocery Lists (milk, bread, eggs, toilet paper, paper towels)• Basic Living Skills (hygiene, laundry, cleaning)

*Encourage member to focus on one task at a time and take breaks when needed*

• As direct care staff you may need to use one of the following cues to assist with regaining focus:

• Visual : demonstrating how the task should be completed• picking up tooth brush and putting tooth paste on brush

• Auditory: using words to describe task at hand• “Johnny lets pick up your tooth brush”

• Physical : working with member side by side• Taking members hand and picking up tooth brush

• The member may have a tendency to become easily distracted after the TBI. Encourage the following:

Assist with rearranging furniture in the home to help minimize distractions Encourage member to hold conversations in quiet environments

Because attention, concentration, and organization may be more difficult when the member

is stressed or tired , it is important to schedule activities when the member has more energy

and will be the most productive

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Attention, Concentration, and Organizational Difficulties

As a direct care staff it is important to understand and recognize that the member may demonstrate some challenging behaviors as a result of the TBI

Take a minute to review the link listed below on Challenging Behaviors/Feelings:

Managing Intense Feelings(right click on above link and select open HyperLink)

• Some of your members may be on medications to help with these behaviors/feelings. It is important to notify the case manager or appropriate contact person of any changes in behaviors/feelings

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Challenging Behaviors/Feelings

Other strategies may be used when working with a member when challenging behaviors/feelings are present:

• Anger Management:• Identify the trigger • (what caused the behavior/feeling to occur)

• Encourage the use of “I” statements• “I feel sad when I have to write down my schedule”

• Identify Internal Cues• How is the body feeling ?

(sweating, feeling hot, cold, shaking)• Relaxation Techniques• Deep Breathing Deep Breathing Exercise (watch this short technique video)

(right click on link above and select Open Hyperlink )

• PMR Progressive Muscle Relaxation Technique (watch this short technique video)

(right click on link above and select Open Hyperlink)

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Challenging Behaviors/Feelings

It is very common after a TBI that a person may have difficulty with memory Many of the techniques that are used to help a person with memory are those that we use in our own everyday living

The following are techniques that can help with memory:

• Help the member to create a memory/organizational notebook• Write down important dates, times, events for the day/week/year

• Encourage the member to use:• Alarms on Cell Phones or Electronic Devices• Contact Lists (Cell Phones, I PAD, Phone Books, Tablets)• To Do List (daily, weekly, monthly)

Take a minute to read the article below on Managing MemoryManaging Memory

(Right Click on Above Link and Select Open Hyperlink)

Never ask a member if “they remember” something. The best would be to redirect to the memory/organizational notebook

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Memory Problems

People who have sustained a TBI often have difficulty getting started on tasks. This is known as initiation (starting). As direct care staff your role will be to assist with initiation

The following will help with initiation of the task at hand:• Use Environmental Cues (signs in the environment)

• When going outside and it is snowing, ask Johnny what would be needed to go outside Snow=Coat/Gloves

• Link behaviors that naturally go together• When getting in the car you : get keys, unlock door, get into car, put seat belt

on, check mirrors, etc.

• Encourage member to use some of the same techniques used for memory:• Sticky notes• Alarms (cell phones, kitchen timers)• Calendars (cell phones, tablets, small pocket calendar)• Check lists

• Assist member into breaking tasks down into smaller parts• Assist member in making signs with daily activities:

• “Stop! Check Keys” Place this on door or steering wheel to avoid locking self out of the house or car

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Initiation Problems

As direct care staff you may encounter a member that has trouble speaking (language difficulties) and/or understanding what is being said or task given (slowed processing speed)

The following are ways that you as staff can assist the member when experiencing language difficulties and/or slowed processing speed:

• Encourage member to make and carry a card that lists emergency contacts

• If necessary reformat questions to multiple choice or yes/no

• Some members may benefit from using a written template to communicate needs and wants:

• “ I want a _______ _______to ________________.” (item) (activity)

• Encourage member to ask people to repeat information until they understand it

• Encourage member if able to restate what was said to them in their own words

• Assist member in developing a Communication Notebook (allows member to point to picture to express needs)

• Includes pictures of favorite activities, foods, daily tasks, medication , etc.

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Language Difficulties and Slowed Processing Speed

Often times after a member has sustained a TBI there is difficulties with vision. This may also include but not be

limited to difficulties determining space/distances

The following maybe used to assist member:• Magnifying lenses• These allow printed items or objects to be enlarged for vision difficulties

• Computers and Copiers • Can be used to enlarge or decrease print based on need of member

• Proper lighting• Adjust according to need of member (brighter or lighter)

• Assist member in removing clutter from areas of travel• Global Positioning Systems (GPS)• Can assist member in determining distance when traveling

Some members may use a cane/walker for balancing and stability. Assist member in remaining aware of

surroundings to avoid injury

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Vision Difficulties

As a direct care staff you play an important role in the continued recovery and

rehabilitation of your member

The following are things to keep in mind when working with your member and using compensatory strategies:

• Constantly observe member• Report any changes in mood, behavior, activities to the case manager or appropriate

contact person for the agency

• Encourage your member even though they or yourself may become frustrated

• Remember that this is an ongoing process

• This is a person-centered approach . Offer guidance and direction when needed

• Not every compensatory strategy will work every time. Keep trying until one is

found that works and allows the member to complete tasks

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Direct Care Staff Role

Leonhardt,Debbie A.- Survival Kit: A planner and organizer for survivors of brain injury and their families. Lash & Associates Publishing/Training Inc. (2011)

Messenger,Barbara & Ziarnek,Niki.-Family Rehabilitation Activity Manual. Lash & Associates Publishing/Training Inc. (2008)

Sullivan, Cheryle-Brain Injury Survival Kit: 365 Tips, Tools, and Tricks to Deal with Cognitive Function Loss. Demos Medical Publishing (2008)

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References and Resources

Here are some additional resources that you may want to explore:

(To view site, right click on link and select Open Hyperlink)

• TBI Survivors View• External Aids for Memory• Centers for Disease Control and Prevention: TBI• Center for Excellence in Disabilities at West Virginia University

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Additional Resources and Readings

• To receive your certificate of successful completion you must first pass the test and complete an online evaluation

• A score of 80% or higher is required

• Once you have successfully completed this training module you will receive an email with your certificate of completion

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Next Steps

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