1.  Understanding and Analysis relevant psychological theories and models  demonstrate your application of relevant psychological theory and models in the clinical or organisational context  respond appropriately to ethical issues  synthesise national policy and guidance with the clinical material

2. Bobbie, Caroline, Jason and Jo

3.  Complexity of traumatic brain injury – psychological, social, financial, behavioural, relational, yadiyadiyada

4. INTRODUCTORY AND DEFINITIONS

5.  Definition  ‘Complex needs refer to multiple interlocking needs that span health and social issues’. For the DCS component of this assessment, you will be required to demonstrate your application of relevant psychological theory and models in the clinical or organisational context, respond appropriately to ethical issues and synthesise national policy and guidance with the clinical material. Google books has latest edition of the Textbook of Traumatic Brain injury (APA, 2011) http://books.google.co.uk/books?id=N_lVQ7Z- YooC&printsec=frontcover&source=gbs_ge_summary_r&ca d=0#v=onepage&q&f=false Traumatic (acquired) brain injury and behavioural difficulties http://books.google.co.uk/books?id=N_lVQ7Z- YooC&printsec=frontcover&source=gbs_ge_summary_r&ca d=0#v=onepage&q&f=false

7.  Types of injury  Neuroanatomy  Associated difficulties

8.  Confusion over terminology  Complexity of neuro understanding

9. IMPACTS

10.  “Coping refers to the persons’ cognitive and behavioural efforts to manage (reduce, minimise, master or tolerate) the internal and external demands of the person-environment transaction that is appraised as taxing or exceeding the person’s resources.” ◦ Folkman, Lazarus, Gruen & DeLongis (1986, pg. 572)  Direct result of the structural lesion  Psychological reaction to the lesion ◦ Somatising  Evidence for both

12.  CBT for loss/grief ◦ Loss of future prospects, adjusting to irreversible nature of impairments etc.  Anxiety and depression  Theories of hopeless and helplessness depression  Adjustment disorders ◦ Many patients suffer poor psychosocial adjustment and experience a reduced quality of life  Wolters et al. (2010) ◦ Effectiveness of psychotherapy and adjustment  Ratzel-kurzdorfer, Franke & Wolfersdorf (2003)  Strain & Newcorn (2006)

13. ROLE OF PSYCHOLOGY (WHAT CAN BE DONE?)

14. “challenging behaviours exhibited by those with ABI are significant obstacles to achieving successful rehabilitative outcomes.” Rahman, Oliver & Alderman, (2010 pg. 213) “the neurorehabilitation field has been slow to embrace the practice of functional analyses prior to behavioural intervention.” Rahman, et al (2010, pg 212) STUDY (Rahman et al, 2010)  9 ABI survivors with challenging behaviours (physical aggression, property destruction, self-injury & verbal aggression.)  method -descriptive functional analysis.  Found –  1)all 9 participants exhibited at least one behaviour which was socially reinforced.  Across all 9, 88% of challenging behaviours showed a significant concurrent association with an environmental event.  Summary  Challenging behaviour by 9 ABI survivors adhered to a social model of reinforcement and were functional  Assessment using functional analysis in the field of neurorehabilitation may lead to better treatment outcomes.  Critique  Repp, Felce and Barton, (1988) “an accurate assessment of behavioural function is required to devise and effective programme of behaviour change.”  There were a variety of injury types and frontal lobe damage was not specified. Clinical interventions based on functional assessments are still limited (Ager & O’May, 2001)

15.  Rahman, Oliver and Alderman (2010) “such behaviours can be decreased and managed by adopting treatment approaches based on operant conditioning.” any combination of 3 contingencies (Carr,1977) o Social positive reinforcement. o Social attention, or tangible items /activities (Kodak, Northup and Kelley, 2007) o Social-negative reinforcement o Behaviours which remove postpone or reduce aspects e.g not needing to do tasks or engage in social contacts ( Iwata, Pace, Kalsher, Cowdery, & Cataldo,1990 ) o Automatic reinforcement o non environmental BUT internal e.g. perceptual feedback (Lovaas, Newsom & Hickman, 1987) Pain attenuation (Sandman & Hetrick, 1995) Behavioural treatment models have been successfully applied for ABI (Corrigan & Bach, 2005)

16.  Assessment  Formulation  Intervention etc……………..

17.  Brain Injury Association of America Brain Injury Association of America  National Institute of Neurological Disorders and Stroke (NINDS) National Institute of Neurological Disorders and Stroke (NINDS)  Brain Injury Association of Canada Brain Injury Association of Canada  Brain Injury Association of Queensland Australia Brain Injury Association of Queensland Australia  Headway - the brain injury association Headway - the brain injury association  Ontario Shores Centre for Mental Health Sciences Ontario Shores Centre for Mental Health Sciences  Ontario Brain Injury Association Ontario Brain Injury Association  NICE guidelines, but only for Triage, assessment, investigation and early management of head injury in infants, children and adults Head injury (CG56  It does not address the rehabilitation or long-term care of patients with a head injury  http://www.nice.org.uk/nicemedia/live/11836/36260/36260.pdf http://www.nice.org.uk/nicemedia/live/11836/36260/36260.pdf  Rehabilitation following acquired brain injury National clinical guidelines - by Royal College of physicians http://bookshop.rcplondon.ac.uk/contents/43986815-4109-4d28-8ce5-ad647dbdbd38.pdf http://bookshop.rcplondon.ac.uk/contents/43986815-4109-4d28-8ce5-ad647dbdbd38.pdf ◦ Included recommendation for clinical psychology provision! per 500000 of population (pg18)  More British ones - found Headway http://www.headway.org.uk/home.aspx http://www.headway.org.uk/home.aspx

18.  Teaching the patient and family to adapt their lifestyle  Taking into account the severity of cognitive and behavioural problems  Patient being stimulated to learn new skills and compensatory strategies  To return to activities of daily life and participate in society ◦ Wilson (2000)

19.  Jo

21.  Increase in traumatic brain injuries in veterans returning from war ◦ America, rehab, v pricey

23.  Who has overall clinical responsibility?

25.  What would be different if it was an organically caused brain injury?  Impact on client, carer, wider system, CP  What issues would be unique to TBI?  How would impact of CP differ?

26. Questions

27. Ager, A., & O’May, F. (2001). Issues in the definition and implementation of “best practice” for staff delivery of interventions for challenging behaviour. Journal of Intellectual & Developmental Disability, 26, 243–256. Carr, E. G. (1977). Motivation of self-injurious behavior: A review of some hypotheses. Psychological Bulletin, 84, 800–816. Folkman, S. Lazarus, R. S., Gruen, R. J. & DeLongis, A. (1986) Appraisal, coping, health status and psychological symptoms Journal of Personality and Social Psychology, 50, 571-579. Guess, D., & Carr, E. (1991). Emergence and maintenance of stereotypy and self-injury.American Journal on Mental Retardation, 96, 299– 319.  Iwata, B. A., Pace, G. M., Kalsher, M. J., Cowdery, G. E., & Cataldo, M. F. (1990). Experimental  analysis and extinction of self-injurious escape behavior. Journal of Applied Behavior  Analysis, 23, 11–27. Kodak, T., Northup, J., & Kelley, M. E. (2007). An evaluation of the types of attention that maintain problem behavior. Journal of Applied Behavior Analysis, 40, 167–171. Lovaas, I., Newsom, C., & Hickman, C. (1987). Self–stimulatory behavior and perceptual reinforcement. Journal of Applied Behavior Analysis, 20, 45–68. Rahman,B., Oliver,C.& Alderman,N.(2010) Descriptive analysis of challenging behaviours shown by adults with acquired brain injury. Neuropsychological Rehabilitation,20 (2), 212–238 Repp, A. C., Felce, D., & Barton, L. E. (1988). Basing the treatment of stereotypic and selfinjurious behaviors on hypotheses of their causes. Journal of Applied Behavior Analysis, 21, 281–289. Sandman, C. A., & Hetrick, W. P. (1995). Opiate mechanisms in self-injury. Mental Retardation and Developmental Disabilities Research Reviews, 1, 130–136. Wolters, G., Stapert, S., Brands, I. & Van Heugten, C. (2010) Coping styles in relation to cognitive rehabilitation and quality of life after brain injury. Neuropsychological Rehabilitation 20(4), 587-600.