Success Story: Helping a client gain insight following a TBI

  • by glarehab
  • May 30, 2014
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Success Story: Helping a client gain insight following a TBI

Lack of insight or “Anosognosia” in survivors of Traumatic Brain Injury (TBI) can result in significant rehabilitation challenges.  When a lack of insight is present, it can be difficult for the treatment team to help the survivor “buy-in” to the therapeutic process.

When a survivor is unaware of a problem there is no motivation to change the behaviour or situation. This can result in prolonged treatment that is less effective inhelping the survivor regain independence and participation in meaningful activities.

In this success story, we are providing a case study of how a treatment team including occupational therapy, physiotherapy and a rehab support worker from Galit Liffshiz & Associates successfully used a multidisciplinary, community based approach to treat an adult male, with a moderately-severe head injury and very limited insight into his cognitive deficits.

Like many GLA clients, the client participated in an intensive treatment program aimed at improving physical and cognitive deficits. During occupational therapy and rehab therapy treatment sessions, the client would participate in cognitive retraining exercises and was provided with instructions on compensatory cognitive strategies.

Due to the client’s brain injury, he lacked insight into his cognitive impairments which reduced the carry-over of learning between treatment sessions.

The client, did not fully “believe” that he required cognitive rehabilitation and did not regularly follow through with treatment suggestions and strategies between treatment sessions. He was complaining during treatment sessions.

As a result, each session was a bit like “starting over” and the therapists needed to repeat information and strategies over and over again.  The client was starting to become frustrated.

After a few initial treatment sessions the therapists met to develop a strategy to help him develop more insight. The main idea was that ALL OF THE THERAPISTS had to start using the same strategies and send the same message.

Here is what they came up with:

  • Specific and relevant therapeutic challenges in the community context: By practicing activities that used to be easy for the client before his injury, such as buying groceries or using a bank machine, the team was able to provide “evidence” to the client that some aspects of cognitive functioning were more difficult than they used to be.
  • Encouragement of mistake-making in a supportive environment: The purpose of highlighting difficulties was not to discourage or upset the client, but rather to help him understand how therapy would be helpful to him. This approach should only be used by rehabilitation professionals who are able to “frame the mistakes” in a positive way that is motivating to the client.
  • Consistent messaging between the treatment providers: The therapists stayed in close contact with each other and delivered the same messages to the client in a positive way that promoted increased insight and awareness.

Now, a few months later, the therapists agree that this approach has successfully helped the client gain insight into his cognitive deficits. His “buy-in” to treatment has increased and he is less frustrated.

While the client continues to require ongoing treatment to improve cognitive deficits, he has increased his insight into his cognitive limitations and carryover of learned cognitive strategies between sessions has improved.

The treatment team and the client are motivated to continue working toward his rehab goals!

For more information about Galit Liffshiz and Associates, visit our website.

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The Test Of Everyday Attention: A Useful Tool for Highly Targeted Cognitive Intervention

  • by glarehab
  • May 30, 2014
  • Blog
  • 0 comment
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Blog
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The Test Of Everyday Attention: A Useful Tool for Highly Targeted Cognitive Intervention

The ability to pay attention is perhaps the most essential component of human cognition. When we are able to pay attention, or “attend” we can accurately observe our environment. When we observe we can remember and when we can remember we can learn.

Without adequate attention skills, all other components of cognition will be negatively impacted.

For example, imagine you are studying for a test. If you aren’t able to adequately concentrate in order to really absorb the material you are studying, how will you ever remember it when it comes time to take the test? Will you have even “made” the memories in the first place?

Many individuals who experience a Traumatic Brain Injury (TBI) will have difficulty with attention skills. At GLA, many of our clients with TBI experience deficits in attention and our therapists understand that because of this other cognitive deficits such as memory or visual perceptual skills will become even more problematic.

The ability to pay attention is a complex process. There are many components of attention including auditory, visual, selective, divided and alternating attention. We switch between different types of attention without even realizing it and we often use more than one form of attention at a time. All aspects of attention are required for adequate performance in many of our daily activities of living.

Think of the task of driving. When you are driving your car you need to divide your attention to focus on the road while you use the indicator lever to signal that you are turning. You need selective attention skills in order to focus on the road and tune out the radio or other distractions and you need to use alternating attention to shift your focus while glancing at the side and rear-view mirrors.

As attention is such a crucial component of overall cognitive functioning, occupational therapists almost always include measures of attention in functional-cognitive assessments as well as to guide their interventions.

The Test Of Everyday Attention (TEA Test) is a reliable and valid standardized test used frequently by OTs at GLA. The TEA Test is used to assess a client’s attention abilities in various everyday activities. The 8 subtests measure specific attention systems, including selective attention, sustained attention, attentional switching, and divided attention.

The TEA Test is designed to be functional in nature by asking the client to imagine that they are going on a trip to Philadelphia. Each subtest asks the client to complete real-life activities such as locating restaurants on a map, searching through various phone numbers and listening for winning lottery numbers.

The results of the TEA Test provide scores for multiple areas of attention and compares the client’s scores with the norms for his or her age group.

The client’s performance on the TEA Test provides OTs with information about the specific areas of attention that may be problematic for the client. The OT is then able to design a highly targeted intervention program.

Using the TEA Test in conjunction with an OT’s unique ability to provide functional analysis and observation of the client in a natural context provides essential information for both assessing deficits in attention and providing targeted treatment.

To learn more about the TEA Test or other assessments used at GLA, please contact us. We will be happy to provide you with more information.

Written by: Kathryn Decker, MSc, OT, Reg. (Ont)

Registered Occupational Therapist

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