Own Your Journey AFTER BRAIN INJURY · and supportive training to align with an individuals needs /...

OWNING YOUR REHABILITATION

AFTER BRAIN INJURY

Maura English Silverman, MS, CCC/SLPFounder/Executive DirectorTriangle Aphasia Project UnlimitedOwn Your Journey

December 17, 2019BIANC

Silverman TAP Unlimited 2019

OWNERSHIP

• Belonging to oneself

• To have power or control over

• Involves exclusive and multiple rights


SERVICE DELIVERY MODEL

• The Traditional Programming model• Continuum of Care• Person Centered Care / Relationship Centered Care • Defining the “Expert”• Neuroplasticity as a Game Changer• Community (Re)Engagement (i.e. (Re)Integration• Transferring Ownership…

• to its rightful owner!


TRAUMATIC BRAIN INJURY PATHWAY

• Survival• Neuro Acute Care• Inpatient Rehabilitation• Day Programming • Outpatient Rehabilitation• School/Work Re-entry Options• Community Programming


CONTINUUM OF CARE

Acute Rehabilitation What’s Next?


TIMES THEY ARE A CHANGING

Medical Model Social Model Life Participation Model


WHEN THINGS WENT FROM THIS…

70 yr old femaleChronic afibMVR 1986Large left frontal bleeds/p evacuationRight hemiplegia / Global

AphasiaDysphagiaWidowedFamily in from out of state


TO THIS…

Mom / grandma /sister in law / friendVery Catholic / Fatima monthly /

women’s groupRetired nurseVolunteers at Cultural Center & reads

news to blindLoves shopping / classy dresser /Reads / cards / planning parties /

knitting funky scarfs / travel



Life Participation Approach to Aphasia (ASHA, 2001)LPAA Project GroupChapey, Duchan, Elman, Garcia, Kagan, Lyon and Simmons-Mackie

WORLD HEALTH ORGANIZATION (ICF) FRAMEWORK

o Impairmento Activity o Participation

Goal: Identification of, and attention to, life experiences that are valuable to the individual.


LIFE PARTICIPATION APPROACH TO APHASIA

The A-FROM model (Kagan et al)Supporting the World Health Organizations call to provide services in a ICF model…Adding Participation!


PERSON-CENTERED CARE

▹ Active participation in health care/rehabilitation by patients working collaboratively with the professionals throughout their journey.

Engagement in Preferred ActivitieS Scale (EPASS)Epass Toolkit: https://epasstoolkit.com/epass/Temple University: Victoria Crumbie, Aurora Crew & Rhonda Nelson

https://epasstoolkit.com/epass/

“INSTEAD OF TREATING THE PERSON AS A COLLECTION OF SYMPTOMS AND BEHAVIORS TO BE CONTROLLED, PERSON-CENTERED CARE CONSIDERS THE WHOLE PERSON, TAKING INTO ACCOUNT EACH

INDIVIDUAL’S UNIQUE QUALITIES, ABILITIES, INTERESTS, PREFERENCES AND NEEDS.”–ALZHEIMER’S SOCIETY

WHO IS THE EXPERT?


ADVANCES IN NEUROPLASTICITY!

• Experience Based Neuroplasticity• Need for Intensity, Repetition, Saliency• Life Participation Approaches

• Mirror Neurons • Thought / Mindset Role in NeuroRestoration


WE WERE GOING FROM THIS…


TO THIS!

Neuroplastic healing is truly one of the life changing breakthroughs of modern science- “mind bending, miracle-making, reality-busting stuff”

The New York Times re: Doidge’s first bookSilverman TAP Unlimited 2019

THAT MAKES US…TRAINERS OF CELLS!

Get down and give me 50, brain-cell!

Understanding that the brain circuitry can, and does, change based on the experiences it has AND that the cells get better at what they are asked to do…


http://images.google.com/imgres?imgurl=http://www.giantmicrobes.com/us/files/images/productdetails/brain-cell_01.jpg&imgrefurl=http://www.giantmicrobes.com/us/products/braincell.html&usg=__9K3JkSf-S17b9D9C65Nhp-yADrs=&h=350&w=334&sz=10&hl=en&start=3&itbs=1&tbnid=JNSYB8Ezxl66vM:&tbnh=120&tbnw=115&prev=/images?q=brain+cell&hl=en&sa=N&gbv=2&ndsp=18&tbs=isch:1

1.Use It or Lose It2.Use It and Improve It3.Specificity4.Repetition Matters5.Intensity matters6.Time Matters7.Salience Matters8.Age Matters9.Transference10.Interference

PRINCIPLES OF EXPERIENCE-DEPENDENT NEURAL PLASTICITY (KLEIM & JONES, 2008)


PUTTING THE INFORMATION IN THE HANDS OF THOSE WHO NEED IT…


How do we get there? • “Getting to know you”• Social Networks• Determination of goals … throughout the journey• Non-judgement of expectations, dreams and pursuits

• Believe in them• Look for ways to have them achieve them• Support habilitation and rehabilitation efforts


GETTING TO KNOW YOU…


SO WE LEARN THAT AN INDIVIDUAL WANTS…


WHAT COGNITIVE/COMMUNICATION CHALLENGES CAN BE ANTICIPATED?


WHAT’S STOPPING THEM?

Compensation/Habilitation: What will get you around the problem? Stimulation/Rehabilitation:What do I need to do to get better?


SOME IMPORTANT CONSIDERATIONS…

LIFE IS THERAPY…

THERAPY IS NOTLIFE!!!


ANOTHER CONSIDERATION…

NeuroplasticityCognitive & Communicative Opportunities:

EVERY opportunity is a reinforcing a neural connection…every MISSED opportunity denies that connection, and thus limits full and timely skill development!


AND EVEN MORE…Mirror Neurons:

• Neurons that fire both during execution and during observation

• Stimulation of the prefrontal cortex / Setting up motor plans for action

• Power of Observation and Imitation


“Those who are able to improve will benefit most from the dignity of struggle!”

THE DIGNITY OF STRUGGLE

Top Stroke Rehabil. 2011 Mar-Apr;18(2):134-8. doi: 10.1310/tsr1802-134 The dignity of struggle.Silverman ME1.Silverman TAP Unlimited 2019

http://www.ncbi.nlm.nih.gov/pubmed/21447461

http://www.ncbi.nlm.nih.gov/pubmed/?term=Silverman%20ME%5bAuthor%5d&cauthor=true&cauthor_uid=21447461

CHANGING THE PARADIGM…

“I can’t” “I will do this” “I can do this”

“This is so hard” “I can make this work” “I love a challenge”

“I’m never going to be able to ________” “I am strong and capable and I will persevere!”


IS THIS NEUROPLASTICITY BUSINESS ALL IN YOUR HEAD? IN YOUR MIND?


IMPRINTING POWERFUL IMAGES


THE ROLE OF THE REHABILITATION PROFESSIONAL

• Motivate to Achieve Potential

• Empower • Encourage• Relate practice to Life• Plan / Suggest

Modifications


WHAT IS A COMMUNICATION SUPPORT TEAM / CST© ?

A program designed to:▹ recruit the individual’s (own or borrowed)

community to support, build and extend engagement. (Eliminating RE- from the term Reengagement/Reintegration)

▹ Utilize Volunteers as Communicative Partners, Tutors, Supports and / or Buddies.

▹ Focus on communication and language skills while addressing barriers to full life participation.

▹ Offer a system of comprehensive, ongoing and supportive training to align with an individuals needs / goals / etc. along the entire recovery path.

Friends (childhood, work, kids,

etc.)

Colleagues

Civic OrganizationSocial groups

Club or Team Members

Family

Faith Based Congregation

Neighbors

Individual with

Aphasia

CST’S IN ACTION…

CST EXAMPLE• 18 years old / recent HS graduate

expected to go to University • Large LMCA CVA; Inpatient rehab (3

months) returned to home for outpatient rehab. Started CST within a month of being home.

• Goals: • Engagement in prestroke activities (soccer,

running, church involvement); maintain friendships (i.e. conversation goals)

• College! • Employment, Independence, etc.


AUSTIN’S TEAM

▹ Activities (Supported by CST): ￭ Volunteering at Soccer program for kids with

developmental disabilities￭ Volunteering at Food Pantry￭ Gym / Working out￭ Reading / Discussion￭ Conversational Practice and support of all

SLP 1:1 goals (KEY: Collaboration)￭ RETURN to College with online coursework!!

ON HIS 5th Online Class! (check out our FB page for Communication Class project!!)

https://www.facebook.com/AustinBlakeHarrellMedicalExpenses/videos/1462169057222925/

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2014 2015 2016 2017

Communication Support Team Professional Speech

COMMUNICATION PROGRAMMING HOURS

COMMUNICATION BASED PROGRAM HOURS

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2014 2015 2016 2017Communication Support Team Professional Speech Total Speech

THINK ABOUT THIS…

Total of 1711 hours of functional, directed, supported communication programming vs 486 with only professional speech therapy

Averaged 2.5 hours with Communication Support Team for every 1 hour of professional speech therapy

Accomplished a little over 11 years of additional programming with Communication Support Team.

“

”

YOU ARE A CHANGE MAKER…YOU WILL MAKE AN IMPACT…BELIEVE IN YOUR CLIENTS AND LISTEN TO THEIR GOALS

Now who is ready to go change some lives???


THANK YOU!

• Maura English Silverman, MS, CCC/SLP

• Triangle Aphasia Project, Unlimited

• [email protected]• www.aphasiaproject.org


mailto:[email protected]

http://www.aphasiaproject.org/

Own Your Journey AFTER BRAIN INJURY · and supportive training to align with an individuals needs /...

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