New ABI Training: Module 2

Welcome back. This is Module Two for acquired brain injuries here at Arcadia Homecare.

Okay, we’ve got a lot to go over in this module. We’re going to be looking at executive functioning, what it is, and what it controls. We’re also going to be understanding some of the common ABI behavioral deficits. Deficit is when there is a lack of something so if someone has a vision deficit, it means they don’t see very well. And we’re also going to be looking at strategies of how to support clients that have certain deficits.

Executive functioning, this is a really important function of the brain and you’re going to hear this term a lot in the ABI world. The area that controls executive functioning is called the frontal lobe. It’s located right behind the eyes and forehead. This area of the brain is used a lot in our daily lives. It helps us remember things regulate emotions, plan, predict problems all stay organized, and help controlling impulses and help with motivation. You can see by looking at this lovely colorful little slide, just how much of our lives this area of the brain deals with. 

Now we’re going to look at what happens when there’s damage to this area, and how that brain damage will manifest itself. What will the behaviors look like? 

A client with lack of impulse control or impulsivity lives in the now they live in the moment. They’re not thinking ahead. They often buy things that they don’t need. They seem to make poor life choices. They do what feels good. Right then right there in the moment. 

Here are five ways to help support impulse appliance. Number one redirect, you just want to redirect their attention. You’re just asking them to pay attention to the task at hand. Hey, don’t look over there. Look at this redirect number two. First, then this is a really great tool that you can use to help keep your client on track and let the client know that first we have to complete the task at hand. Then you can go do the thing you want to do. Do your home exercises. first. Then we’ll go on to YouTube first. 

Number three. You can also just let the client know politely that they’re being impulsive. Don’t be judgmental when you tell them this just inform them that they’re being a little impulsive. Teach them what their impulsive behavior looks like to you. Chances are they don’t even realize they’re being impulsive. Number four, the 1010 10 strategy. Ask the client how will this decision make them feel in 10 minutes from now? 10 hours from now 10 days from now. 

Number five when shopping use a shopping list and a budget. Remind the client that they need to stick to the list and keep their spending under certain amount. 

You’re trying to help the client see that sometimes an impulsive purchase or impulsive decision might feel really good right now. But by tomorrow, they probably won’t even care that they bought that thing or made some decision and they might even feel bad for spending money on it or regret the decision. That they made. 

However, when it comes to purchasing things, a client is an adult and they can spend their money however they like. Your job is to help them understand that they’re making impulsive choices. But if they really want to buy something, they’re going to buy it. At this point you would just write in your notes that the client made an impulsive purchase, even after you tried to redirect them or inform them of their impulsivity or do the 1010 10 strategy with them. Sometimes an impulsive client is just going to do what they want to do. 

Knowledge Check time. Okay, what I want you to do is write down these questions in an email, answer them in your own words, and then send them off to your RA SW manager. 

Lack of emotional control can present itself as sudden mood swings. You might see a client go from sad to angry to laughing within a short amount of time, or their emotional reactions to things are a little over the top. For example, they might cry hysterically for hours when they see a commercial with sad puppies in it or they get really really angry because the mail didn’t show up today. There are emotional reactions to things can seem a little extreme. 

To help clients with a lack of emotional control, you want to validate their feelings. Let them know it’s okay to feel what they’re feeling. Practice your active listening skills. reiterate back to them what you’re seeing and feeling from the client. It sounds like you’re really upset or I hear that you’re feeling sad 

some clients who have lost their emotional and impulse control can get really angry really quickly. There’s usually a series of steps or stages through the aggression continuum. People don’t just go from calm to violent. It usually starts with a little verbal agitation they get a little hostile they start making some threats. They start making some physically threatening postures and then the first punch is thrown. 

So keeping in mind the aggression continuum we just saw in the last slide. You can see here, two graphs one of the normal person one of an aggressive API client, and we see the normal person. They’re perfectly calm, and then something triggers them and they get a little aggressive. Maybe they get a little hostile and then they calm down. 

But aggressive API client you can see they go from calm to almost violent, really quickly, something triggers them it sets them off and they go through all five or six steps of the aggression continuum very quickly. And you can see it escalates to the point of violence and then eventually they’ll calm down but you can see the difference here and the two graphs. 

A lot of how to work with angry clients will be covered in your crisis prevention and intervention training or CPI. But I feel it’s really important. To go over this quite a bit. 

With angry clients, it’s important that you stay calm. You want to model calm, appropriate behavior. Don’t start shouting demands and don’t escalate things. Start by removing the client from the situation. Go somewhere quiet with no audience with help people around. 

Get the client to just sit and breathe, encourage them to breaths.

At a later date when the client is calm. You can talk about their anger and what triggers them. Teach them the signs of their anger. What physical signs are there that they’re starting to get really angry? Do they clench their fists and jaw? Do they start to get really loud and swear a lot? Do they pace back and forth then shake their fist? Show them what their escalation of anger looks like so they can start to understand when they’re getting angry. Remind them that when this happens, they need to remove themselves from the situation. Go somewhere quiet and just sit and breathe. 

I want to go over some of these strategies again. 

When the client is angry you want to speak calmly and slowly. You want to be a model of good calm behavior. Don’t place any demands on the client don’t start barking orders at them. 

You want to try and remove the client from the situation and the audience. If the client has an audience of people are cheering them on to fight someone is probably going to fight someone. Keep your distance from them. Don’t try to physically restrain them. You want to try and stay about arm’s length away from a client. That way if they do decide to lash out and strike you, you’ve got a little bit of distance and you can see it coming.

Don’t get yourself cornered. Always know where your exits are. If you are working with a client that has some anger issues, it might be a good idea to always stand in the doorway of a room in case you need to make a quick exit and most important, keep your calm. If you start panicking or raising your voice is just going to make things worse. Remember you want to model calm appropriate behavior. 

Clients who have difficulty with flexible thinking have difficulty with problem solving. They often have trouble coming up with a way to solve a problem and it’s almost impossible for them to generate multiple ways to solve a problem. They also tend to get stuck on one idea. This is called per separating.

When working with a client who has trouble generating multiple solutions to a problem, you as Dr. SW can give them hints, clues, and suggestions of other possible solutions to try. You don’t want to just give them the answer as this would be you doing something for the client and we want you to do things with the client. If the client gets really stuck, you may have to step in and solve the problem for them. But the next time this problem comes up, see if they can manage the problem independently.

Okay, just like you did with the last Knowledge Check. I want you to write these questions down in an email and answer them in your own words and send them off to your Rs W manager. Ready go. 

clients that have short term memory deficits might not remember what happened a few days ago. They might not remember what happened this morning. Some might not even remember what happened just a few minutes ago. You can see how this is going to present problems in their daily lives. They aren’t going to remember important details that their doctor or their lawyer told them they aren’t going to remember to turn the stove off when they’re done cooking. They don’t remember the location of their doctor’s office. They don’t remember where they left their keys or their phone they don’t remember what happened in your last session. 

Here are a few simple strategies to help with memory issues. 

The problem with a lot of memory age strategies is the client might forget to use them as an AR SW. It’s your job to help reinforce the strategies and remind the client over and over again to use these memory aids. When they do remember to use the strategies give them lots of praise and reinforcement. It may take a long time before a client is using a memory aid independently, so be patient with them. Remember, when short term memory is impaired, it means their ability to learn new things is also impaired. 

Here are some more simple strategies that you can use to help a client that has some short term memory problems. You can see they’re pretty simple sometimes all it takes is putting a sign on the door or putting a note on the stove reminding them to turn it off using a large whiteboard or a wall calendar in a common area of their house. So somewhere everyone is going to see it. I’d have the client write down important information and appointments on this calendar is a very simple, easy strategy. There’s also lots of apps out there to help with memory issues. 

All right, we’ve made it to the final knowledge check for this training module. Just like you did with the last ones. I want you to write these questions down in an email, answer them in your own words, and then send them off to your Rs W manager.