Post on 01-Jan-2016
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Why are cases complicated?
What are the pitfalls and possibilities for assessment?
What is so special about brain injury?
Traumatic [TBI] or Acquired Brain Injury [ABI] can affect one specific area
But very often the whole brain is affected with diffuse damage across all areas
Brain injury can happen to anyone
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 !