New ABI Training: Module 5

Hello again. This is acquired brain injuries training module number five for Arcadia homecare. 

In this module we’re going to be learning both speech and language deficits and some examples of how to spot them. We’re also going to be looking at strategies to help clients with language difficulties. We’re also going to look at filtering speech and inappropriate speech. 

And lastly, we’re going to take a look at fatigue which is a very common symptoms in people with brain injuries. 

A very common speech and language problem that people with brain injuries have is word finding. 

I’m going to give you some examples of a client that has word finding issues so you can get a sense of what you’re looking for. I’m going to read two sentences for you. One sentence with no word finding issues. And then I’m going to repeat the sentence as though I were someone that had some word finding problems. So here we go. 

Yesterday we went to a bistro I had an egg salad sandwich, the bread was toasted and I had a really nice peach iced tea. The waiter was really good and made some great suggestions. 

Now with some word finding issues yesterday we were at we went to lunch at a place 

a cafe I had a sandwich with eggs on it. 

It was it was it was like scrambled, scrambled eggs and some other stuff on on bread on an on a bun. A bun. I had a drink it was it was like a tea. Like like a cold tea was like a like a peach. Peach drink. 

The person who brought us the food, the food server person. 

The waiter was really nice. 

He told us what to order. 

Suggestions he made some good suggestions of what to eat. 

So you can see the difference between the two sentences. There’s a lot of pausing. A lot of trying to find the right word that fits or using a word that doesn’t quite fit, but it still works. 

You notice that the person has a lot of verbal filters like 

they’re trying to think of the word they want to say. 

The sentence comes across as a little disjointed. It doesn’t flow smoothly, it doesn’t fit together very well. The person has to take a lot of time in between words to think of the words that they’re they want to use. 

When working with a client that has some speech and language deficits, they might have problems not only producing speech, but also understanding what has been said to them. So when you’re speaking to them, you want to speak slowly, clearly. Use short sentences. Try and ask just one question at a time and allow the client time to process what you’ve said. And to answer it. You want to try and avoid large, complex, obscure words and try and keep your sentences short. concise, to the point and remember, just go slowly. Don’t rush your words. Don’t try and be overcomplicated. Allow the client time to process what you’ve said to them. 

When you’re listening to the client, be patient with them. Give them time to finish. It might be difficult for them to think up what it is they want to say and be articulate about it. 

Don’t try and finish their sentence for them. 

At the client is really stuck trying to find the word that they’re looking for. Try and get them to give you some descriptions about it. Like you can ask what is the size or the shape or color or what are some things that go with it. For example, if a client is trying to think of the word reclining chair and they just can’t remember it they know it’s something you you sit on it’s in your living room. You might want to ask them questions like okay, it sounds like you’re trying to think of the word chair but it’s not specifically chair. Is this. A soft chair is a hard wooden chair is this a chair that two people could sit on? Is it a loveseat? Is it a large chair that multiple people can sit on like a couch? So you’re trying to sort of play 20 questions with them to try and help them think of the word they’re trying to say by triggering it by asking descriptive questions about the word. 

You know how we all have that one older relative in our family that says some pretty racist things. Every now and again. 

Yeah, having a lack of filter can do that to a person. 

So we all have a filter in our brain that tells us what’s appropriate to say around certain people in certain situations and what is not appropriate to say. 

Some people with NaVi have lost this filter, and they say whatever comes to mind, no matter how inappropriate. 

The problem is that you probably won’t know they’ve lost this filter until they say something inappropriate. 

Immediately after a client says something inappropriate, you have to let them know that that was not appropriate to say. 

The next time you take your client into a situation where they might say something inappropriate. You have to have a little talk with them before you go into the situation and remind them not to say the inappropriate things that they said the last time you were there. For example, if you take a client to the gym, and they say something sexually inappropriate to a woman on a treadmill, and you get kicked out of the gym, while the next time you go back to the gym, the client might not remember that this incident happened. So you’re going to have to tell them that the last time we were here You said something a little inappropriate to a woman on a treadmill. We’re going to go into the gym today and I really need you to not say anything to women working out. 

Because last time you did you said something inappropriate. And we were asked to leave the gym. So today, I only want you talking with me. 

Don’t say anything sexually. Don’t make any comments or remarks to any of the women in the gym. 

So you have to let the client know. This is what you did last time. This was the outcome. Please don’t do that thing again. This time when we go in. 

Some clients with ABI suffer from fatigue where they just don’t have a lot of energy throughout the day and doing very simple tasks. Not only physical tasks, but cognitive tasks as well. Can really tire them out. You might notice this in the form of like a brain fog. 

The client will sort of appear as though they’re like a deer in headlights. 

Like they just can’t concentrate. They can’t process information. 

They’re having trouble keeping their eyes open. They’re having trouble keeping their head up. 

So they’re a little slow, mentally. 

They’re a little tired looking in their face. 

And they might need a few hours or they might just 20 minutes of quiet time just to refresh themselves. 

You know in video games, your character will have a health meter or an energy meter that tells you how much help and energy your character has. 

Energy conservation is sort of like that. You want to teach your clients that they have so many units of energy per day. 

Every time they do something whether physically or mentally, it’s going to take up units of energy. So you only have 20 units of energy until you need to rest and doing your morning routine like a shower shave brushing your teeth. Getting dressed, that might cost you two units of energy, and then making breakfast doing the dishes. Getting ready for your day. takes five units of energy. 

Exercise takes eight units of energy walking the dog takes five units of energy. And now your energy is depleted and you need to take a rest. 

So getting your clients to think of how much energy they have before they need to take a rest. Get them to break down how much energy each task in their day is going to take. And to think of their energy like that video game, health meter or energy meter bar. And the more tasks they do the more that energy bar shrinks down. 

Chunking This is where we take large tasks and we break them down into smaller more manageable steps or chunks. 

So the example we have is a client wants to clean up their basement and there’s a lot of large heavy items that need to be put into boxes and then put into the garage and then furniture needs to be moved. The floor needs to be vacuumed and swept and mopped and then the furniture needs to be moved back. So this is a pretty big job that has some big components to it. 

So we want to break this down into smaller chunks and try not to do it all in one session. You can try to do a couple of chunks in one session. You might just have to take a break and rest in between some of these chunks. 

You want to start by thinking about how to manage this project first. Think about breaking it down into step one and step two and step three then step four and that alone is going to require some planning and problem solving. And that in itself might be a little bit much of a task for a client to take on all at once. So sometimes just even planning how to break down a large task into smaller steps is a step in itself that the client might need to restaurant. 

So anytime you have a large task to do with a client, try and break it down into more manageable chunks. 

Okay, we’ve reached the end of training module five. that means it’s time for a knowledge check. Show me what you’ve learned. As always, I want you to copy and paste these questions into an email, answer them in your own words and then send them off to your RSW manager. Have fun.