RTA - [ TBI] Don - motorbike accident, working man, husband, father. Rob- 20 years, out clubbing, hit by fire engine. Both suffered frontal and cerebellar damage D was able to claim compensation R was not Causes and Case Studies
Dee, existing MH problems, jumped from a bridge. Scott, fell from bridge on a night out. Both suffered physical and cognitive damage. D’s pre-existing problems led to added stress for carers. Conflict for social work over who is responsible for after care. Falls
Mike – carbon monoxide poisoning Brian – heart attack, Global brain damage, diffuse difficulties. Memory badly affected. Families of both struggle to cope. M > compensation B > not applicable Anoxia
Gary – 23 years – haemorrhage. Jim – 25 years -stroke following IV drug use Both left with communication difficulties G > no speech and unable to read. J > pre existing drug dependency. Both > anger, frustration Both received inappropriate support following SSD assessment. Haemorrhage /Stroke
Steve, beaten with baseball bat by drug gang Pete - beaten by gang, mistaken identity Both > major frontal lobe damage, reduced insight. No physical damage. Both > very vulnerable and at risk. Pete had help to apply for Criminal Injuries Compensation Assault
N – RTA aged 3 L -- Swallowed adult medication aged 3 Children's brains have plasticity and can develop different neural pathways but often at the expense of other skills But often long term problems exist which may not be obviously associated. [ see research on prison population etc] ABI in childhood
Cognitive changes. Poor memory Poor concentration Slower information processing. Difficulty with writing, reading. Impaired understanding / ability to think logically. Fatigue What’s the damage? And how does this affect assessment?
The frontal lobes are the gatekeeper of the brain. Damage --- Lack of forethought / consequences. Altered behaviour,irritability, anxiety Lack of self restraint, disinhibition, inappropriate comments/ actions / humour Impulsive behaviour. Personality /Emotional changes
Unrealistic ideas of their own abilities and difficulties. Reduced understanding of the needs of others. “ Damage to the frontal lobes is similar to how an 11 year old might function.ie OK until there is a need to problem solve and live within boundaries” Reduced insight
Not reading notes and reports prior to assessment. Relying on account of person with ABI[ client] Not appreciating extent of impairment,especially if client lacks insight. Pretending to understand when communication is affected Assuming that when someone can’t speak that they can’t understand. Assessments - Common mistakes
Expecting to achieve full assessment in one or even two meetings [ many people with ABI can only concentrate for 10 – 20 minutes] Assuming that reasoning will bring about changes in behaviour. Expecting that 6 week programme of generic enabling will effect change. Someone with a brain injury may not be able to manage Direct Payments or to retain support staff. Common mistakes cont.
Check any notes [ not always easy with electronic recording] Involve family/ significant others if appropriate. Recognise that assessments could be more time consuming Brain injury is NOT the same as a learning disability Help ?
Many people with ABI have Case Managers, work with them to assess. Many pw ABI will have lawyers / legal support. These people have a wealth of knowledge and can assist with finances at all stages of Brain Injury. Consider encouraging clients/families to seek legal advice. [CICA]
The current climate brings added pressures to Social Services departments. Many authorities now prefer generic working instead of specialist. ABI can bring with it particular difficulties for the pw ABI and those around them. Many of these no longer meet the remit for help from SSD. Pressures
But there are people who can help and advise and support. Eg -Headway [ see website ] – excellent advice for professionals, see also their list of law firms BISWG see website UKABIF, see website INSWABI see www.tbistafftraining.info HELP !
And of course BIRT who have developed BINI a tool to assist with what is arguably the most important first step on the road to maximising potential for people with ABI. A GOOD ASSESSMENT !! Brain Injury Rehab Trust