1. A whistle stop tour of Acquired Brain Injury
Presented by Chris Knight

2. The Acquired Brain Injury Education Service A.B.I.E.S.
An organisation originally formed as a joint funded project between : a charitable trust (The Acquired Aphasia Trust), the LEA, Health and Social Services
Funding is now a joint project between Evesham College and The Acquired Aphasia Trust.
The service consists of a team of education and health professional with specialist experience in ABI – Educationalists, Occupational Therapists, and a Physiotherapist
The team manage and support to the ABI courses at Evesham College and work under contract to other local FE Colleges supporting their ABI Courses and students with an ABI accessing mainstream courses. Also provide training for professionals and services working with people with an ABI.
ABIES currently have contracts with Kidderminster College, NEW College (Redditch) and Worcester College of Technology

3. Support Provided by ABIES to Colleges
Receive and screen referrals
Undertake initial interviews with students usually in their own home
Arrange and facilitate visits to the college
Carry out initial assessments and regular re-assessments of students strengths, challenges and needs in regard to cognitive skills, physical skills, basic communication, behaviour and emotional issues and personal care skills.
Produce summary profiles on all new students including recommendations on meeting their needs for all Lecturers and LSA’s involved with the student
Carry out regular observations of students in the classroom situation with written feedback to the course coordinator
Liase with family and other services providing support to the student
Arrange and attend annual joint reviews with the student and their other service providers
Trouble shooting on an individual student or course level e.g. access issues, inappropriate behaviour, poor attendance
Training for college staff

4. What is an Acquired Brain Injury (ABI)
The UKABIF definition of acquired brain injury is :
An Injury to the brain including traumatic brain injuries - such as open or closed head injuries - or non-traumatic injuries such as those caused by strokes and other vascular accidents, tumours, infectious diseases, hypoxia, metabolic disorders (e.g. liver and kidney diseases or diabetic coma) and toxic products taken into the body through inhalation or ingestion. Does not include brain injuries that are congenital or produced by birth trauma or those of a degenerative nature
Or more simply!
Any injury to the brain occurring after birth and of a non-degenerative nature.

5. The Most Common Causes of an ABI
Accident
Assault
Fall
Stroke
Tumour / Cyst
Anoxia resulting from CVA, drowning, strangulation etc
Aneurysm
Encephalitis / Meningitis

6. The Human Brain Size – Approx 3 –3½lbs Texture – Soft Blancmange
Made up of two halves (hemispheres)
Right Hemisphere
Left Hemisphere
Front

7. Protections
Skull
Meninges
Subarachnoid Space

8. Basic Structure of the Brain

9. (carries information between the two hemispheres)
Anatomy and Functional areas of the Brain
Occipital Lobe – processing of vision
Parietal lobe - processing of sensory information
Temporal lobe – memory
Frontal lobe – executive skills, movement, language
Cerebellum – coordinated movement
Brain Stem – Breathing, heart rate
Parietal Lobe
Frontal Lobe
Occipital Lobe
Cerebral Cortex / Cerebrum
Lateral View
(side)
Corpus Callosum
(carries information between the two hemispheres)
Sagittal View
(down through middle)

10. Brain Cell (Neuron)Facts
Cell Body
Dendrites
Axon
The brain is made up of approximately 100 billion neurons
Each individual cell can make contact with up to 2,000 other neurons connecting to one another by synapses
Neurons pass information along their fibres in the form of electrical and chemical messages
A Synapse

11. Stages of Recovery Spontaneous recovery (first few weeks)
Neuroplasticity (usually quoted as up to 6mths but now acknowledged that can occur up to 2yrs and more)
Compensation (life long)
Will overlap and run concurrently

12. Neuroplasticity
The lifelong ability of the brain to reorganize itself by by forming new neural connections. Neuroplasticity allows the neurons (nerve cells) in the brain to compensate for injury and disease and to adjust their activities in response to new situations or to changes in their environment
Neuroplasticity occurs in the brain under two primary conditions:
During normal brain development when the immature brain first begins to process sensory information through adulthood (developmental plasticity and plasticity of learning and memory).
As an adaptive mechanism to compensate for lost function and/or to maximize remaining functions in the event of brain injury.
Theories first established within rehabilitation by Bobath in the 1970’s????
Still quite a contentious area and subject of much debate but the principle underpins most acute and post acute rehab approaches ie In-patient and out-patient OT
Will not be dealt with in detail today as we will be concentration on the area of long term rehab incorporating a compensatory approach.
However will just look briefly at current theories at a very basic level
Potential for plasticity appears to be age related falling off after 40. Seems reasonable theory when we consider that all new learning requires this ability of the brain to re-organise and we are aware that new learning becomes more difficult the older we get.
For the remoulding reshaping to take place the individual most be exposed to the desired behaviour/ action/learning required so it is important that the brain is exposed to desirable process ie the correct gait if it is to learn the correct rather than the incorrect way of doing things.
So what is neuroplasticity – next slide

13. Compensation
Education
Adjustments in lifestyle
Strategies

14. A model of potential difficulties post ABI
Physical Difficulties
Cognitive Deficits
Communication Problems
Emotional & Behaviour changes
Behaviour Problems
Aggression / Withdrawal / Inflexibility / Poor cooperation / Disinhibition
Psychosocial Problems
Loss of role / Loss of friends/ Changed family Dynamics / Loss of confidence / Low self-esteem
Decrease in : Productivity, Intimacy, Quality of Life
Deterioration Cycle

15. The effect of an ABI on an individual
Symptoms and related deficits fall into five major groups: Cognitive, Perceptual, Physical, Communicative and Behavioural/Emotional. Because of the uniqueness of each injury, some survivors may or may not face or exhibit some or all of the symptoms.
Cognitive Symptoms:
Difficulty in processing information (decreased speed, accuracy and consistency)
Shortened attention span, distractibility, difficulty screening out irrelevant info
Memory loss or impairment
Inability to understand abstract concepts
Impaired decision-making ability
Inability to shift mental tasks or to follow multi-step directions
Physical Symptoms:
Full or partial paralysis of one side of the body affecting the arm trunk and leg
Disorders of movement - ataxia, spasticity, dyspraxia and tremors
Persistent headache
Extreme mental and/or physical fatigue
Seizure activity (traumatic epilepsy)
Photosensitivity (sensitivity to light)
Sleep disorders

16. The effect of an ABI on an individual cont.
Perceptual Symptoms:
Disturbance in the ability to make sense of information coming in from the senses
Unilateral inattention
Topographical disorientation
Behavioural/Emotional Symptoms:
Irritability and impatience, poor anger management
Reduced tolerance for stress
Lack of initiative, apathy
Dependence (failure to assume responsibility for one's actions )
Denial of disability
Lack of inhibition (aggression, cursing and inappropriate sexual behaviour)
Inflexibility
Flattened or heightened emotional responses/reactions
Communication Difficulties
Word finding difficulty ranging from mild to severe
Difficulty understanding spoken or written language
Unclear speech due to poor control of the muscles in the lips, tongue and jaw and/or poor breathing patterns

17. Challenges for Teaching and Learning
Physically Accessing the Environment
Difficulty with practical tasks due to reduced mobility and upper limb functioning
Difficulty in Personal care ie managing cups and cutlery or using the toilet
Difficulty learning and retaining new information / skills
Difficulty planning or following through multi-step or more complex tasks
Difficulty making use of normal education resources e.g. chalk & talk, handouts, computers, front of the class demonstration

18. Challenges for Teaching and Learning cont.
Difficulty remembering arrangements, timetables, routes around the college
Difficulty tolerating full sessions or a full day programme because of increased fatigue
Difficulty understanding spoken information and expressing themselves through language
Difficulty with reading and writing
Difficulty socialising with other students

19. Meeting Students needs
Accessible environments
Pre-entry and ongoing assessment
Informed Lecturers
Adequate Support
Individual Learning Plans
Liaison with other service providers – a coordinated approach
Appropriate accreditation

20. What Can be Achieved ?
Rebuilding of some lost skills eg communication skills
Acquisition of new skills eg becoming computer literate
Alternative interests
Preparation for mainstream courses
Preparation for voluntary work
Preparation for a vocational training scheme
Return to work in a new capacity
Re-training for a new job via appropriate support on mainstream courses

21. Influencing challenges to the learning process presented by the ABI
Read assessments so you have some idea of the difficulties a student may have
Adapt support, teaching methods and materials appropriately
Encourage the development and use of strategies

22. Any Questions?