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Headway UK a registered charitable organisation in the UK supporting and providing information to people living with acquired brain injury and their relatives. We also provide information and training about acquired brain injury to health and social care professionals. We deliver this service through a network of 117 local support groups in all four countries of the UK. We are involved in bridging the gap between the excellent work done by acute medicine to save people following brain injury and cognitive rehabilitation services.
My role in Headway
I head the training services but also see people for psychotherapy who are having problems with the psychological adjustment to their brain injury. I also see partners and relatives of people living with brain injury. I have a specialised interest and training in psychosexual therapy and I am interested in sexuality and relationships as a rehabilitation concern following acquired brain injury (Baker, M and Shears, S 2010) I need to modify my therapeutic approach in order to engage clients with cognitive deficits.
Cognitive problems like those in our everyday lives but more frequent?
A quote
We do not lack cognitive rehabilitative strategies following brain injury. In the last few decades we have developed a lot of them. It is getting patients/clients to do them that is the challenge Rick Parente PhD His talk at a cognitive rehabilitation conference in Denver was subtitled stuff we tried in brain injury rehab over the past 25 years and it worked! A key factor was a person-centred approach of the client seeing it as something that solved a problem for them therefore they might be more motivated towards achieving their goals. Clear goals are an important part of treatment.
Ian (Continued)
Treatment (7 Sessions) Education and information about causes and effects of acquired brain injury. Videoing of sessions to reinforce points discussed in sessions - due to his attention and memory problems Ian had a copy of the sessions to review at home. Development of cognitive strategies to help Ian compensate for his memory problems at work. Anxiety management strategies to use at work. Self monitoring sheets for Ian to use regarding his anger management. Counselling for the emotional adjustment issues related to his awareness that he had a brain injury. Referral to neuropsychology and neurology.
Case 2 - Heather
Synopsis Sub-arachnoid haemorrhage Damage to frontal lobe and hypothalamus areas. Alteration in executive function and hypersexuality with behavioural problems and risk-taking behaviours due to poor insight and impulse control.
Heather (Continued)
Treatment (Over a five year period) Medication to lower libido and hormone replacement. Education for Heather about her brain injury. Behavioural therapy aimed at reducing incidences of inappropriate behaviour. Supervision Whole family/friendship networks educated to give consistent response to Heathers behaviour. Husband was very involved in co-ordinating this. Counselling for Heather to deal with her emotional adjustment to the loss of her preinjury self and status. Social Services have now involved Heather in a volunteer training programme and this is meeting her vocational needs. Her insight and behaviour are such improved now.
Conclusion
Holistic assessment and treatment incorporating cognitive rehabilitation therapy and counselling support can lead to better outcomes for clients following acquired brain injuries.
References
Baker, M and Shears, S (2010) Sexuality training for health and social care professionals working with people with an acquired brain injury. Social Care and Neurodisability Volume 1 Issue 3 November 2010 Pier Professional Ltd Parente, R (2007) Society of Cognitive Rehabilitation Conference, Westminster, Denver, Colorado Powell, T (2004) Head Injury A Practical Guide, Speechmark. What Do Patients Need Several Years After Brain Injury?(2002) Prigatano, G.P. Barrow Quarterly. Vol18 No2 Wilson, BA, Gracey, Evans, J, Bateman, A. (2009). Neuropsychological Rehabilitation: Theory, Therapy and Outcome. Cambridge University Press.
Web references
http://www.dh.gov.uk/en/Publicationsandstatistic s/Publications/PublicationsPolicyAndGuidance/D H_4105361 (2005 (NSF Long Term ConditionsUK Department of Health Website)