Bridging Tangents: What is a Rehab Support Worker?

  • by Galit Liffshiz
  • Nov 30, 2012
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Bridging Tangents: What is a Rehab Support Worker?

Bridging Tangents is a forum for brain injury survivors and the people who support them. .

A Rehab Support Worker (RSW) is an unregulated hospital  and community care professional who follows rehab goals prescribed by a number of regulated professionals such as Physiotherapists, Occupational Therapists, Speech Language Pathologists, Social Workers, Psychologists, etc.,  when working with brain injury survivors.

RSWs implement functional activities designed from these goals and practice them with the ABI survivor in their natural, community-based setting.

One of the main goals of an RSW is to put the ‘fun’ in functional activity.  Why?  Because relearning a skill or a strategy following a brain injury often involves an incredible amount of repetition. You can imagine just how frustrating and time consuming this can be!  And when you’re having fun, it doesn’t really feel like you’re working.  This helps to pass the time needed to learn or re-learn the skill or task at hand.

Rehab Support Work has such a wide scope of practice I find it necessary to focus on what I believe should be its main function…bridging.

Like a damaged brain trying to repair itself, recovery is all about making connections.  RSWs help survivors identify bad connections, repair old connections and create new ones, by bridging different environments, activities and communication between all members of the treatment team.

Tangents do not intersect, they go off on a completely different line of thought or action.

The transition from hospital to home and the relationship changes that occur pre/post brain injury are common examples of rehab tangents.

Our RSWs at Galit Liffshiz & Associates hold degrees, diplomas and certifications in Kinesiology, Psychology, Behaviour Therapy, Occupational/Physiotherapy Assistant, Qqua Therapy, mindfulness and other health-related fields of study.

So fellow adventurers, please put on your safety belt and helmet (both literally and figuratively).  We are about to embark on a journey into the mysterious world of ABI Rehabilitation.

3-2-1. Let’s bridge some tangents!

Submitted by: Kris Mamaril

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Cognitive Rehabilitation’s Tremendous Potential

  • by Galit Liffshiz
  • Nov 30, 2012
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Cognitive Rehabilitation’s Tremendous Potential

I have worked as an Occupational Therapist with acquired brain injury clients for the last 20 years. And that’s why I get really discouraged when the doctors in the acute, and even rehabilitation hospitals, call cognitive rehabilitation mental stimulation and tell the clients to do random quizzes and Sudoku etc. to help in their cognitive recovery following a brain injury.Cognitive rehabilitation as we have seen in the recent literature is a science, just like physical rehabilitation. It takes a detailed assessment by a neuropsychologist and an occupational therapist to identify the impairment areas, followed by developing and implementing a well-defined plan of action to obtain the optimal results.

It uses some of the same principles as physical rehabilitation; namely, the use of the right challenge to progress the clients. For example, you would not expect a client who is disoriented to his/her surroundings and has a very limited attention span, and who just came out of a coma two days ago in an ICU, to do Sudoku or cross word puzzles. It would only lead to frustration and failed outcome for the therapist and the client.

Cognitive intervention has to be tailored to the specific client, their educational background, their cultural and social beliefs and their level of functioning. It’s not one-size-fits-all.

Another issue is the assessment tools being used for screening and assessing cognition. The MOCA and the MMSE for the acquired brain injury clients is being used as the first line of action by the occupational therapists in acute care hospitals. However, these are very simplistic ways of looking at and assessing a very complicated area i.e. cognitive functioning. I would suggest that clinicians execute caution in using and reporting the results from these screening tools.

Occupational Therapists have to be careful about the assessments/screening tools they use and the interventions they employ to obtain the optimal results for their acquired brain injury clients. The biggest piece of the puzzle is to educate the team members on the very complicated nature of brain injury and recovery and veer them away from oversimplification of assessment and intervention techniques!!

Submitted by:  Meeta Gugnani, BSc. OT, MSOT, OT Reg. (Ont.)

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Treating Executive Functioning Dysfunction with Occupational Therapy

  • by Galit Liffshiz
  • Nov 30, 2012
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Treating Executive Functioning Dysfunction with Occupational Therapy

Treating Executive Function Dysfunction with Occupational Therapy.

In early October 2012, a number of therapists from Galit Liffshiz & Associates attended a three-day workshop on cognitive perceptual deficits and cognitive rehabilitation. The course was presented by Dr. Joan Toglia, PhD, OTR, who is an Occupational Therapist and educator at Mercy College in New York. She has over 20 years of clinical experience in acquired brain injury awareness and specialization in issues related to cognitive rehabilitation.

The focus of the workshop was on assessment and treatment of Executive Functioning (EF) dysfunction.

Generally, EF is an umbrella term for cognitive/brain processes which regulate, control and manage other brain processes. The five domains of EF include:

  • Initiation and Inhibition
  • Cognitive Flexibility
  • Working Memory
  • Planning and Organization
  • Self-regulatory/Monitoring

EF symptoms can be seen in a number of populations, including stroke, head injury, Multiple Sclerosis, schizophrenia and peripheral vascular disease. These deficits can be either prominent or subtle and can influence balance, motor function and one’s ability to complete daily activities.

Of the five domains, one of the most commonly referenced is working memory (WM). WM allows us to hold and manipulate information in our mind and keep track of all aspects of an activity as it is being performed (for example, following a recipe while cooking). Symptoms of poor WM can include losing track of what was just done or said, difficulty remembering what the next step of an activity is or the inability to process a large amount of information simultaneously.

There are two main approaches to treating working memory deficits: compensatory strategies and remediation.

Remediation is based on neuroplasticity;  the brains ability to reorganize itself by forming new neural connections. It allows parts of the brain to compensate for the injured areas.

Cognitive remediation is becoming mainstream and is often referred to as “brain training”. Internet and computerized programs encouraging ‘healthy brains’ have quickly gained popularity. An example of this type of program is Luminosity. iPhone applications and other electronic devices allow you to access games that promote mental stimulation. Combining periods of mental exercise with regular physical activity is recommended for positive outcomes.

Compensatory strategies are required when recovery of lost brain function is unlikely. Individuals with poor WM can become easily overwhelmed when too many steps or instructions are provided simultaneously. Compensatory strategies for poor WM include grouping similar information together (e.g. grocery items by department), rehearsal/repetition (e.g. a phone number or address) and association (e.g. linking a name to a well known person).

Resources for online Brain Fitness Exercises:

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Caregiving after Brain Injury: Preventing Burnout

  • by Galit Liffshiz
  • Nov 29, 2012
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Caregiving after Brain Injury: Preventing Burnout

Few illnesses or injuries result in the overwhelming changes which can accompany severe brain injury.

Your loved one that has sustained a brain injury may seem to to be a different person. They may behave differently, think differently and/or interact with their environment differently.

When a family member suffers a Traumatic Brain Injury (TBI), the entire family is affected. Caring for a loved one can be very rewarding, but it also involves many stressors: changes in the family dynamic, financial pressure, routine disruption, and of course, the added workload.

Caregivers of people who have suffered a brain injury may experience feelings of grief, guilt, burden, distress, anxiety, anger, depression and even embarrassment. Caregiver stress can be particularly damaging for caregivers of a person who has suffered a TBI, since their challenges are typically long-term and chronic.

If you are caring for a family member, spouse, child, relative, or a close friend with TBI, it is important to recognize how stressful the situation can be and to seek proper support.

One of the ways to prevent burnout may be to develop a circle of care and ask your support system of family, friends and community members for help with your loved one’s care.

In addition, services that would be helpful include in-home assistance (personal support workers or home health aides); respite care to provide breaks from caregiving; brain injury support groups and ongoing or short-term counseling for caregivers to adjust to the changes in the family dynamics as a result of the injury.

Keep in mind that it is not selfish to focus on your own needs when you are a caregiver.  In fact, it is an important part of your role to prevent the burnout of yourself, as you are responsible for your own self-care in order to continue and take care of others.

Focus on the following self-care practices:

  • To avoid compassion fatigue, take time for yourself without feeling guilty. You will not be able to take care of your loved one if you are physically or emotionally exhausted.
  • Learn and apply stress-reduction techniques (An Occupational Therapist or a social worker can assist you with this).
  • Attend to your own healthcare needs include keeping your own doctor’s appointments and, if you are on medications, keeping your own medication schedule.
  • Get proper rest and nutrition.
  • Exercise regularly.
  • Participate in enjoyable and nurturing activities.
  • Be assertive in getting the support and help you need. Accept the support from others when it is offered.
  • Find a caregiver support group. Educate yourself about available resources.
  • Identify and acknowledge your feelings. Do not ignore intense feelings of depression or anxiety. Seek professional help if you need it.
  • Try to identify and change the negative ways you view the situation.
  • Set SMART (Specific, Measurable, Attainable, Realistic, Timely) goals.

Submitted by: Miranda Mo, OT Reg. (Ont)

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The Benefit of Behaviour Therapy & Neuro Rehabilitation

  • by Galit Liffshiz
  • Nov 29, 2012
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The Benefit of Behaviour Therapy & Neuro Rehabilitation

The Benefit of Behaviour Therapy & Neuro Rehabilitation

How does a stressful environment affect health? Why do we remember some things and others we forget? How do some people overcome trauma while others struggle? Curiosity about these and other “big” questions attracted me to study psychology.

In university I was intrigued about various disorders and corresponding theories. While studying the different schools of thought, I gravitated towards behavioural psychology.

Studies in behavioural sciences (commonly called Applied Behaviour Analysis) provided a solid method of addressing such questions. I was excited to learn that by employing the scientific method and the basic principles of behaviour, strategies can be used to help improve people’s lives.

Extensive literature describes the important contributions that Applied Behaviour Analysis has made in rehabilitation, mental health, counseling, education, business and various other fields.

An appealing feature of behaviour therapy is that it is individually tailored to the specific strengths and deficits of the individual. By outlining a treatment goal a behaviour therapist can operationally define behaviours of concern. Then the therapist can conduct a functional analysis of behaviour and identifying possible triggers. This method increases the likelihood of a success.

Behaviour therapy is used successfully in the area of Acquired Brain Injury. The nature of brain injury can often bring about new and unwanted behaviours in an individual.Examples of these new behaviours can be: low initiation, memory loss, frustration, agitation, aggression, perseveration and impulsivity.

Often these behaviours will prevent progress in rehab.

For instance, if initiation is an issue for person with a brain injury, he may have difficulty completing a morning routine and attending therapy. Getting out of bed, having a shower or eating breakfast can be overwhelming. A behavioural approach to initiation may involve completing a task analysis, providing visual prompting and incorporating a known reinforcer.

In other words, breaking down the morning routine into small steps and posting it to the bedroom wall will help the person stay on task and serve as a reminder.  A reinforcer could be a special breakfast food or tea while watching a favourite morning TV show.   These small changes in the environment can help increase an individual’s ability to complete routines and thus attend therapy.

In future posts, I will explore specific behaviour change programs which have been used to promote rehabilitation. It is with great pleasure that I am now able to use my knowledge of Applied Behaviour Analysis to assist the clients of Galit Liffshiz & Associates reach their rehabilitation goals.

Submitted by : Jennifer Phyper BSc, BST, Behaviour Therapist

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Staying connected during COVID-19

  • by Galit Liffshiz
  • Apr 08, 1920
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Staying connected during COVID-19

Hi All

As we continue to care for our clients, we have started an informational blog to tell you all about it, which we named:

WHAT I DID TODAY FOR MY CLIENT

We ensured that our client could stay connected with her family and her treatment team.

By Lisa Hung, Occupational Therapist & Case Manager

Our client has been isolated in her home, which acts as a potential risk of a decline in her overall health status.

In order to continue working towards her goals and to minimize a decline in her health status, we requested an iPad for this client so that she can stay connected with her support system, including her family and her treatment team.

The insurance adjuster was very understanding and allowed the treatment team to provide the client with an iPad, so that she can continue her treatment virtually.

Today, we helped a client receive access to an iPad in order to avoid a disruption of treatment and stay connected virtually with her treatment team.

By Clementine Werdan, Rehab Therapist

A client of mine had been reluctant to use technology for virtual therapy sessions, as this was somewhat new to her.

During an outdoors therapy session with the client last week, she became more open to it as I explained to her the benefits of being connected to all therapy providers, her friends and to her family in the US.

Her ultimate acceptance came when I received a FaceTime call from my granddaughter (which I don’t usually take if I’m with a client) and she saw how easy it was to talk to others and see their faces.

I ensured the client that step-by-step instruction on how to set up and use the iPad and various applications would be provided and that her team of therapists would be working together to assist her.

With the client’s agreement to participate in virtual sessions, the Case Manager ordered an iPad for the client that should be received in the coming weeks.

The client is very excited for the opportunity to continue the care and to stay connected with both the treatment team and family members.

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