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ADVANCED COMMUNITY REHABILITATION

ASSISTANT WORKBOOK

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TABLE OF CONTENTS

TABLE OF CONTENTS........................................................................................... 2 THE WORKBOOK ................................................................................................... 3 Background - COMMUNITY REHABILITATION WORKFORCE PROJECT ..... 4 THE ADVANCED COMMUNITY REHABILITATION ASSISTANT (ACRA) ROLE . 6 RESPONSIBILITIES .......................................................................................... 11 CHART DOCUMENTATION ............................................................................. 14 CONFIDENTIALITY ........................................................................................... 17 COMPUTER SKILLS ......................................................................................... 18 HOME OR COMMUNITY VISITS ...................................................................... 21 CULTURAL DIVERSITY AND AWARENESS ....................................................... 23 EQUIPMENT .......................................................................................................... 24 EQUIPMENT USED IN SCREENING TOOLS ....................................................... 26 COMMUNITY REHABILITATION COMPETENCY DOMAINS .............................. 27 MOTIVATING CLIENTS TO ACHIEVE THEIR GOALS......................................... 30 PRIORITISATION OF WORKLOAD ...................................................................... 32 ACQUIRED BRAIN INJURY AND STROKE ......................................................... 34 ACKNOWLEGEMENTS......................................................................................... 36 ATTACHMENT A – TRAINING SCHEDULE ......................................................... 38 ATTACHMENT B - ABBREVIATIONS .................................................................. 43 ATTACHMENT C- HOME VISIT POLICY OR PROCEDURE............................... 44 ATTACHMENT D – UNDERSTANDING BEHAVIOUR CHANGES (BY ABIOS).. 45 ATTACHMENT E –COMMUNICATION PROBLEMS FOLLOWING A STROKE (SPEECH PATHOLOGY AUSTRALIA FACT SHEET).......................................... 46 ATTACHMENT F – GLOSSARY ........................................................................... 47

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THE WORKBOOK

This workbook has been developed to help you develop and/or improve skills that you will need to function as an advanced assistant working in community rehabilitation (CR). The various sections give you an overview of the topic and in many instances direct you to where you can access further training. Some of the sections also contain an activity for you to complete to assist in your understanding of the topic. You should discuss your progress with on a regular basis with your supervisor, ideally at your weekly/fortnightly supervision sessions. Aim to cover one section of the workbook prior to each session. Your Performance, Appraisal and Development (PAD) sessions would provide further opportunities to discuss these activities with your supervisor. Whilst this workbook has been developed to meet your training needs as an advanced assistant in CR, much of the information will be relevant to your colleagues working as assistants in other areas. So feel free to share! The sections in the workbook that are marked with this symbol, , are priority sections and should be completed first.

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Background - COMMUNITY REHABILITATION WORKFORCE PROJECT

The Community Rehabilitation Workforce Project (CRWP) aims to optimise the capability of the current and future workforce to develop, implement and evaluate CR programs to meet the current and emerging health needs of the Queensland community. The key target group of the CRWP includes nursing, occupational therapy, speech pathology, physiotherapy and support level staff working in community rehabilitation or community based services in Queensland. The CRWP works with both government (eg. Queensland Health, Disability Services Queensland) and non-government organisations (eg. Blue Care, Spiritus, private practitioners). An audit of the training and education needs of staff working in CR in Queensland was conducted by Griffith University in February 2006. The audit revealed ten key competency domains that were relevant to good CR practice in Queensland. These are:

1. Frameworks of understanding 2. Consumer engagement 3. Holistic focus 4. Service continuity 5. Networks 6. Cultural Awareness 7. Community Engagement 8. Boundaries and Safety 9. Reflective Practice 10. Systems Advocacy

Community Rehabilitation Assistant Workforce Project The Community Rehabilitation Assistant Workforce Project (CRAWP), a major initiative of the CRWP, aims to develop, implement and evaluate new roles for assistant level health workers in community rehabilitation, including appropriate support, education and training. A literature review completed in 2006 by the University of South Australia showed that assistants are a critical part of current and future health service delivery, particularly in CR. However it also stated that work is required to develop clear roles, boundaries, scope of practice and training. The CRAWP has since identified the roles for assistants and advanced assistants working in CR and has outlined the scope and boundaries of these roles. The project is also looking at exactly what training is needed, including TAFE courses and in-house training. Training and Development Officers

CRWP Training and Development Officers work across Queensland to develop and deliver training that disseminates community rehabilitation principles and competencies to the Queensland workforce. Training is delivered by

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videoconference, face to face and online. You should attend as many of these sessions as possible. Look at the training schedule (Attachment A) with your supervisor and discuss the relevance of each session to you.

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THE ADVANCED COMMUNITY REHABILITATION ASSISTANT (ACRA) ROLE As the ACRA role has been developed as part of a project, and tasks and duties will modified to meet the needs of the team and clients as the project progresses. Below is a list of duties you will be required undertake.

ACRA TASK LIST- NORTHSIDE HEALTH SERVICE DISTRICT Task List Steps Involved Training Requirements/Professional Development

Clinical Participate in information gathering for assessment as directed by treating therapist, including administering screening tools

MMSE/MSQ • Ensure client wearing hearing aid or glasses where

appropriate • Ensure no distractions • Administer MMSE/MSQ as per guidelines • Score the MMSE/MSQ and record results

Grip Strength (Jamar Dynamometer)

• Instruct client on correct technique for using Jamar dynamometer

• Ensure client in correct position and monitor this position throughout the screening

• Conduct grip strength test using Jamar Dynamometer • Record information appropriately

Pinch Strength (Pinch Gauge)

• Instruct client on correct technique for using Pinch Gauge

• Ensure client in correct position and monitor this position throughout the screening

• Conduct pinch strength test using Pinch Gauge • Record information appropriately

MMSE training session Observation of an MMSE/MSQ being conducted Competence evident by direct observation and questioning of knowledge base Jamar Dynamometer practical training session Competence evident by direct observation of technique and queuing Pinch Gauge practical training session Competence evident by direct observation of technique and queuing

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Participate in the clients’ rehabilitation programme by conducting independent home visits to assist in monitoring the home program established by the treating health professional. Evaluate the ongoing effectiveness of the rehabilitation plans and feedback to the treating health professional/s Conduct home visit to supply, instruct and monitor client with the use of an aid/equipment prescribed by the treating health professional Work with client, their family and carers to support community access in accordance with goals in their rehabilitation plan developed by the treating Health Professional

6 Minute Walk Test • Instruct client on the process of the 6 minute walk test • Conduct the 6 minute walk test and record the required

data (ie. Heart rate, O2 sats, distance walked, rests breaks needed, Borg scale)

• Record information appropriately

• Contact client and arrange home visit • Assist client with the established home programme • Monitor the clients’ progress in accordance with

guidelines/checklist established by the treating therapist • Progress clients’ home program in accordance with the

rehabilitation plan when client achieving benchmarks that have been determined by treating therapist

• Comply with District’s home visiting policy and procedure

• Feedback to treating health professional/s

• Take prescribed equipment to client’s home if delivered

to the hospital • Adjust equipment, if necessary, to fit client (eg. Height

of frame etc) • Instruct client in use of equipment • Ensure client can use equipment safely in their

home/community environment Accessing Public Transport

• Assist/teach client how to obtain information about the local public transport eg. Timetables

• Instruct client in preparing for using public transport eg. Time management, Having money ready, purchasing ticket, finding correct train platform or bus stop

• Assist client to actually make a trip on public transport

6 Minute Walk test training session, including training in the use of a pulse oximeter and the Borg Scale. Training in the identification of signs of fatigue. Competence evident by direct observation of skill and questioning of knowledge base On the job observation and training around the clients’ exercises Training session on home visits ACRA workbook On the job observation and training around equipment (correct use, maintenance of, and adjusting equipment to “fit” client) Training session on home visits ACRA workbook Training on using QHEPS and the Internet as research/resource tool if necessary On the job observation and training around coping strategies developed for the client by the Health Professional Reviewing current community resource materials

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Work with client, their family and carers to carry out functional daily activities in accordance with goals in their rehabilitation plan Advocate for client including assisting client to navigate the health care system Work as a member of a multi-disciplinary team

Access Local Shopping Centre • Assist client in researching what local shopping centres

are available • Assist client to prepare for trip eg. Develop shopping

list, ensure have money • Assist client in deciding how will get to shop • Accompany client on visit to shopping centre and ensure

they can navigate the area safely • Help client to implement strategies developed by Health

Professional (eg. Scanning) and possibly “grade” them Access and Participate in Leisure Activities

• Assist client in identifying local clubs/groups available in their area

• Assist client to contact group and arrange for visit • Assist client in determining how will get to club/group • Assist and train client in how to prepare for club/group

eg. money, appropriate dress, equipment • Assist client to attend group/club

Working towards independence in ADLs Assist client to complete forms, eg.

• Centrelink forms • Taxi subsidy forms • Pension application forms

• Work with all the Health Professionals in the team as needed

• Provide feedback to treating health professionals on clients’ progress

• Participate in case conferences and provide updates on clients you have been working with

Training on using QHEPS and the Internet as research/resource tool if necessary On the job observation and training around coping strategies developed for the client by the Health Professional On the job observation and training in grading Reviewing current community resource materials Training on using QHEPS and the Internet as research/resource tool if necessary On the job observation and training around coping strategies developed for the client by the Health Professional On the job observation and training in grading Reviewing current community resource materials On the job observation and training around the participation in case conferences Session with Health Professional to develop communication plan and discuss respective parties roles and expectations

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Document client interventions in the clients’ medical records Maintain an accurate record of programs undertaken by client Participate in administrative functions required by the department appropriate to an Advanced Community Rehabilitation Assistant Participate in the development of community rehabilitation services, including resource development Undertake continuing education activities

• Document home visits in client’s medical record on day the day of the visit, in accordance with District policies and procedures

• Record results of screening tests on appropriate forms or in medical chart

• Record telephone calls made to clients (other than those made to arrange appointments) in medical chart

• Update clients’ home program record when a change has been made, for example, if there has been an increase in the number of repetitions of an exercise or if the program has been progressed in accordance with the rehabilitation plan

• Record statistics as per organisational guidelines Resource Development

• Assist in co-ordination of CBRT’s community resource manual

• Access resource information eg. from QHEPS, ILC, catalogues, supplier websites, other community services, leisure groups

• Participate inservices, teleconferences, videoconferences and other education provided appropriate to the Advanced Community Rehabilitation Assistant role

• Read the Workbook developed for ACRAs and complete the included activities

Review of District’s policy and procedure on Documentation ACRA workbook Training session with HIU On the job observation and training around the recording of exercise programs and screening tools On the job observation and training around the recording of exercise programs On the job observation and training around the recording of statistics Computer training if needed Training provided by the Training & Development Officers as part of the Community Rehab Workforce Project A record of training and education undertaken Participation in the Performance Appraisal & Development process

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Assist with orientation and training of new staff, relievers and students with respect to the Advanced Community Rehabilitation Assistant role Participate in reflective practice and strive for excellence in service delivery Knowledge of and compliance with organisational and service specific policies and procedures Participate in quality assurance and quality management practices

• Orientate new staff and students to the role of the ACRA role and how it differs to the role of the Therapy Assistants

• Orientate and train relievers to the ACRA role and tasks/duties performed

• Orientate relievers to procedures applicable to the ACRA role

• Make daily entries in the electronic Daily Diary for ACRAs

• Independently reflect on your work and identify strengths, weaknesses and areas for improvement

• Participate in the Performance Appraisal and Development Process with your supervisor

Familiarise yourself and comply with District and departmental policies, procedures and practices. Pay particular attention to the following areas:

• Human Resource Management issues, including workplace health and safety, equal employment opportunity, anti-discrimination and ethical behaviour as applied in the working environment

• Home visiting • Documentation • Confidentiality • CBRT Orientation to service folder

• Understand QA processes and identify areas of improvement

Participate at an individual or team level in assessment, evaluation, monitoring and review processes

Review of relevant policies, procedures and work practices Attend District mandatory training sessions ACRA workbook On the job observation and training Attend District staff forums Attend District education activities relating to QA including inservices Access relevant training provided by the Training & Development Officers as part of the Community Rehab Workforce Project

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RESPONSIBILITIES

It is important that in your role as an ACRA you carry out your work in a manner that reflects well upon yourself and our service, and promotes a safe environment for clients. To assist in achieving this, the points below need to be considered. Supervision Due to the nature of the ACRA role, it is likely that you will have more than one supervisor. You should have one person assigned as your operational line manager, the person who approves leave application forms and so on. You will also have clinical supervisors, and as ACRAs work with multiple disciplines (eg. Occupational Therapy, Physiotherapy, Speech Therapy, Nursing), there will be multiple clinical supervisors. How often you meet with your supervisor/s will vary depending on your experience, geographical location and so on. You may meet with your line manager once a week, once a fortnight or once a month. This should be a regular meeting. Reporting back to your clinical supervisors should occur as needed after each task. This is very important for feedback. For the purpose of this section, we will look at clinical supervision. In order for supervision to be effective and beneficial, it is essential that everyone understands what their responsibilities are. It is the responsibility of your clinical supervisor/the treating Health Professional to ensure that the task they ask you to do is an appropriate one. For example, it would not be appropriate for a Speech Pathologist to ask you to create a program of swallowing exercises for a client to do at home, as this task clearly falls under the scope of a registered Speech Pathologist. However, it would be appropriate for you to implement a program once it has been developed by the Speech Pathologist. Your supervisor also needs to make sure you have the appropriate qualifications or training to carry out the task they are delegating. Good communication is essential for the supervisory relationship to work. Your supervisor needs to ensure the task and their expectations are clearly explained to you. It is you’re your supervisor’s and your responsibility to make sure that you understand what is being asked of you. By agreeing to carry out a task, you are accepting accountability for that duty. If you feel you do not have the appropriate skills or training to carry it out, it is important that you tell the Health Professional. It is okay to tell them that you would not feel comfortable in undertaking that task as you do not feel experienced enough, or that you don’t believe you have enough training in that area. Feedback is a very important part of the communication process that cannot be overlooked. Due to the nature of community rehabilitation, as an ACRA you will often be working with clients in their home independently. It is your responsibility to provide feedback to the treating health professional regarding the client’s progress.

You may not necessarily be in contact with your supervisor everyday, so routine client updates may only occur every few days or even once a week. However if there was a safety issue or if an incident had occurred, this would

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need to be reported to the treating health professional as soon as possible. For example, if a client had a fall whilst you were working with them, the supervisor would need to be informed as soon as the client had been attended to. Whilst the supervisor will not always be physically there, you should always be able to contact them. If a supervisor is not going to be available, another health professional should be assigned as the contact person. It is therefore essential that you work with your supervisor to develop a communication plan that is going to work for both of you. Scope of the ACRA role As this is a new role, and an advanced one, there will be certain tasks and duties that you will undertake as an ACRA that other support level workers cannot. Having this advanced role is a wonderful opportunity as it will allow a better and more efficient service delivery. However it is essential that you have a clear understanding of the limits of your role so that you do not perform tasks outside your scope. In addition to your ACRA Role Description/Position Description, you should also have access to a task list. These two documents should clearly outline what tasks or duties are within the scope of your role. When starting in the ACRA role, it would be a good idea to go through these documents with your supervisor so that you are clear with what is expected. You can also always refer back to these documents if you are unsure about a task. Professional Conduct There are many behavioural aspects that contribute to working in a professional manner. Some of these include;

• Respect for your colleges and clients • Confidentiality- refer to the section in this workbook on confidentiality • Professional Boundaries- It is inappropriate to enter into a personal

relationship with a client. If you develop strong positive or negative feelings towards a client, this could impact upon the service you provide and could be detrimental to the client’s health care. If you find yourself in this situation you should discuss it with your supervisor as it may be in the client’s best interest if you cease working with them.

• A commitment to professional development- ACRAs have a responsibility to maintain their level of clinical competence and strive to continually improve their level of skill and knowledge.

Activity Consider the tasks listed below and whether you think they fall into the role of the Health Professional or the ACRA or both. Write the Health Professional tasks in the circle on the left and the ACRA tasks in the circle on the right. List the tasks that are within the scope of both Health Professionals and ACRAs, in the overlapping section. Discuss your responses with your supervisor.

Tasks:

• Initial Assessment of a client

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• Conducting screening test eg. 9 hole peg test • Home visits • Discharging a client • Referral to a Doctor • Monitoring of a home programme • Assisting client to access public transport • Writing discharge report • Documenting a client visit in the medical chart • Reporting on client progress at case conference • Work with client to achieve leisure goals

Health Professional ACRA

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CHART DOCUMENTATION

Documenting client interventions is an important part of our job. It allows all members of the team to keep up-to-date with the progress of a client and informs them of any important occurrences. A client’s medical record is a very important document and provides a basis for a number of purposes including:

• Effective communication within the health team • Evaluation of patient care • Research • Quality assurance • Risk management • Medico-legal defence • Administration • Best clinical practice.

It is therefore important to ensure that all chart entries are in accordance with the District’s standards. This document will help to familiarise you with these standards. The Format of a Chart Entry • Ensure every page/form you write on has a client ID sticker placed in the

allocated spot in the top right hand corner. • All entries and alterations are to be made in blue or black ball point pen. Do not

use ink, pencil or liquid. Writing must be clearly legible. • The date and time (24 hour time) of the chart entry is to be written in the left

hand margin provided, at the start of the entry. Your designation should be written at the start of the entry.

• At the end of the chart entry sign your name, followed by your surname printed in brackets

• If you make an error, draw a single line through each line of the entry, making sure the original inaccurate notation is still legible. Date and initial the change. In the margin state the reason why the entry has been replaced. Eg. Written in error, wrong/ different client.

• At the end of a paragraph, or where nothing else is to be written, a line should be drawn to the edge of the page.

What to Include • When and where the client intervention occurred. For example in the clients

home at 1430HRs on the 23/6/07; or a telephone conversation at 0945Hrs on the 06/06/07.

• The name of the treating therapist who asked you to see the client • Be sure to document any reaction a client may have and how you addressed it • Only standard, approved abbreviations and symbols from The Australian

Dictionary of Clinical Abbreviation, Acronyms and Symbols are to be used.

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What Not to Include • Any interpretation of clinical assessments (this is the role of the therapist) • Any subjective comments, entries are to be kept objective. For example, it

would be inappropriate to write “Mr Jones was grumpy today” but it is okay to write “Mr Jones told me he was irritable today”.

• Any derogatory or unprofessional comments **Did you know …?

Patients can access their medical chart under the Health Information Disclosure & Access Policy or the Freedom of Information Act. This means clients can read anything you write about them in the chart. Another important point to remember is that anything you write could potentially be read in court.

Activity Look up your District’s policy and procedure on clinical documentation

• Clinical Documentation Policy RCHSDPol0054 • Clinical Documentation Procedure RCHSDProc00110v2

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Sample Chart Entry

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CONFIDENTIALITY

As health care providers we are privy to a lot of personal and private information about our clients. It is very important that we respect our clients’ privacy and do not divulge any confidential information without their consent. Consider the following example:

You are conducting a home visit to a client, Mrs Hamilton. One of her neighbours, Mr Baker, is also a client of yours. Mr Baker has multiple sclerosis which has recently flared up and has required him to use a wheelchair. During Mrs Hamilton’s home visit, she appears to be very concerned about her neighbour and says to you, “I saw you visit Mr Baker yesterday and I noticed that he is in a wheelchair! He’s such a lovely man, I hope he’s okay. What happened to him?”

How do you think you would respond to Mrs Hamilton? Even though you think she is a very kind and caring lady and appears genuinely concerned about Mr Baker, it would be a breach of confidentiality to tell Mrs Hamilton anything about Mr Baker’s situation. Write down what you think you would say to Mrs Hamilton. __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ Some other points that are important to remember with respect to patient confidentiality are:

• Ensure medical charts are not left in public areas where anyone could access them

• If discussing a client’s progress with another member of the team, ensure the discussion cannot be overheard by others

• Do not discuss any aspects of a client’s condition or rehabilitation plan with anyone outside the team without the client’s consent

• If you ever become concerned or suspicious that a client (or a child living with the client) is being abused, you should raise the matter with the treating health professional immediately

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COMPUTER SKILLS With technology and computer literacy an increasingly crucial aspect of everyday life, it's becoming more important to stay current with this essential technology. Having a basic understanding of a computer and electronic services can help you to work more efficiently and effectively. What sort of tasks would an Advanced ACRA use the computer for?

• Communicate and network via email • Accessing information about the district and Queensland Health eg. Policies

and procedures, district forms, complete PRIME Clinical Incidents forms etc • Create resources for clients eg. handouts • Participate in education by accessing or developing a power point

presentation • Record data on a spreadsheet

… the list could go on forever! However if you’re not very confident with your computer skills, there is no need to be concerned because training is available. What training is available? Queensland Health provides training sessions on the use of the electronic resources available to staff. Some of the courses available are:

• Computer Awareness o Differentiate between the different components of the computer/network

setup o Understand procedure to gain access to the network o Log in/out of the network o Understand data saving fundamentals o Demonstrate good posture while keyboarding o Understand the importance of regular rest breaks and exercises for

keyboard work o Identify the different keypads on the keyboard o Identify standard features on the desktop o Activate shortcut menus o Search on-line help o Basic file management

• Novell GroupWise

o Identify different components of Novell GroupWise o Understand and be able to send Electronic Email o Create and edit a Group o Receive and respond to information sent through GroupWise o Maintain received items

o Tracking items o Understand and send notes and tasks o Maintain a personal calendar

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o Set preferences for User Access o Proxy into other user’s calendar

• QHEPS (Queensland Health Intranet)

o Demonstrate search function o Demonstrate the use of ADOBE ACROBAT o Discuss favourite function o Create folders and items in favourites folder o Print information from the database o Discuss approved Internet sites o Overview of District Policies and Procedures o Overview of Industrial Relations manual

• Microsoft Word Basic

Getting to know your way around a document including – o Creating, opening, saving and closing a document o Modify page set-up and insert and modify tabs o Layout and design o Work in different views o Formatting/improving the presentation of a document o Open, work within and close multiple documents o Format characters, align, indent, bullet and number paragraphs o Border and shade paragraphs, use AutoCorrect and format Painter

features

• Microsoft Excel Basic o Getting started o Creating, opening, saving and closing your workbook o Working with multiple workbooks o Selecting cells and moving around your workbook o Creating and utilising Auto-fill features o Formatting your worksheet o Sizing, inserting and deleting rows, cells and columns o Constructing basic formulae o Layout o Viewing the work sheet and preparing your workbook to print o Customising the header and footer

• Microsoft PowerPoint

o Create presentation using the Auto Content Wizard o View your presentation in different ways o Create, open, save and close presentations o Format your presentation o Add, delete and copy slides o Customise individual elements

o Apply global changes to your presentation o Apply transitions and builds to your presentation o Work with pictures, drawing objects and colour schemes

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o Electronic presentation effects o Printing your presentation

Contact your District Library or local Facilitator for session details. Activity 1. The following websites, which are very relevant to the ACRA position, can be accessed either through QHEPS or via the internet. Access each of the websites and have a look at the information and services they provide;

• National Stroke Foundation • Disability Services Queensland • TransLink • Life Tec

2. Develop a short PowerPoint presentation (maximum of 5 slides) on your role (ie. an ACRA) and present it to the team you work with.

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HOME OR COMMUNITY VISITS Conducting home and community visits will be an important part of your role as an ACRA. When going on home visits it is important to remember that you are a guest in the client’s home and you need to respect their home and its contents. When conducting visits, safety must be given the highest priority for staff and clients. You will, at times, need to be particularly flexible, resourceful and self-sufficient. A lot of planning and organisation is involved when preparing for a home or community visit. The following checklist will help you ensure the visit runs smoothly. Preparing for the visit • Contact client to arrange a time for the visit and explain the purpose of the visit

to them • Request that any dogs be restrained for the visit • Book a car for the visit • Prepare any equipment and documentation required • Ensure you have a street directory or map of the area and a mobile phone • Take contact phone numbers for clients and emergency contact phone

numbers • Leave details of your travel destination your expected time of return at your

work base. Also ensure they have your mobile contact details When on a visit it is important to watch for hazards to your own and/or others’ health and safety. Appropriate action should be taken to control risk in accordance with your District’s policies and procedures. When returning from a visit, ensure that you notify your workplace of your return. You should then document all aspects of the home visit in line with organisational protocol. Be sure to promptly report any areas of concern to the treating Health Professional. Any arrangements for follow up visits should also be recorded. Important information, particularly for rural and remote visits You may be visiting clients where you will need to travel large distances away from your work base, and where there are few people. It is necessary, therefore, to be prepared before you leave your work base and have a good understanding of the area you are to travel. It would also be an advantage if you have some working knowledge of vehicle maintenance including how to change a tyre, and check the oil and water levels of your vehicle Below is a safety check list which should be covered prior to leaving for a home or community visit:

• Check distances to travel and expected time of travel • Take relevant road map/directory

• Check Mobile phone coverage or take satellite phone if necessary • Check UHF radio channels and channels for area ( if needed)

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• Know the type of roads that have to be traveled e.g. bitumen/dirt/gravel/all weather

• Contact client/family member and give them an estimated time of arrival • Check that you have all necessary equipment ( as it will be too far to go back

to get it, if forgotten) • Prior to leaving ,check safety of travel due to rain/other poor weather

conditions • Prior to leaving, check that your car is well serviced, has a good spare tyre

and full of fuel Always take with you:

• Road map/directory of area you are traveling in • List of Outreach towns/indigenous communities serviced (if applicable) • List of phone contacts in each town/community • List of relevant client phone contacts • Mobile/satellite phone • UHF radio (if necessary)

Activity Read your District’s policy on home and community visits (see attachment C)

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CULTURAL DIVERSITY AND AWARENESS

Australia has a diverse population with a wide range of needs. In the past Australians expected other people to conform to the dominant Anglo-Australian culture, but now cultural differences are celebrated. In Queensland in 2002 the population was made up of:

• people from 117 birthplaces • 3.1% indigenous peoples • 16% of people born overseas • 7.3% people from a Non English Speaking Background • 11.5% of people who spoke a language other than English at home • and 17.2% of Queenslanders had one or more parents born overseas

(http://www.health.qld.gov.au/sop/content/cultural_diversity.asp 2.10.2007) Culture and past experience can result in people viewing health and illness in varied ways and with different expectations. When providing a health care to a client, aspects to consider include the way a client is addressed, culturally significant events or situations and who is present during this intervention. Queensland Health has developed the Aboriginal and Torres Straight Islander Cultural Awareness Program, with training mandatory for all staff. The aim is to equip staff with the cultural knowledge required to provide appropriate health care to Indigenous clients. If you haven’t done this training you will need to do it as soon as possible. The website www.health.qld.gov.au/multicultural/ contains some useful links relevant to cultural diversity, including information about specific cultural groups.

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EQUIPMENT

You are going to come across a lot of equipment during your work as an Advanced Assistant. Below are some photos of some of the equipment you are likely to encounter frequently. Keep in mind that as there are many brands of equipment, the aids used by your team might look quite different to the photos below!

Walking Sticks/Canes

Wheelchairs

Wheeled Walker

Over toilet frame

Shower Chairs

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Toe Wiper Pick Up Frame

Bath Board Canadian Crutch

Activity Life Tec provides information and advice on Axillary Crutches assistive technology available to help individuals improve their quality of life and remain independent. If you are in Brisbane, a visit to the centre would be very informative. www.lifetec.org.au

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EQUIPMENT USED IN SCREENING TOOLS

Grip Strength Dynamometer Pinch Gauge

Pulse Oximeter with Finger Probe Activity Go to the equipment area in your department and identify what each piece of equipment is used for.

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COMMUNITY REHABILITATION COMPETENCY DOMAINS

Competency Domain

Descriptors

1 Frameworks of understanding

- Understanding, implementing and evaluating practice against recognised theoretical frameworks

that underpin CR e.g. The ICF - Understanding, implementing and evaluating practice using recognised models of delivery e.g.

case management/case coordination

2 Consumer Engagement

- Recognising the client as central to every process - Promoting client understanding, choice, control and engagement in their own health and

wellbeing - Incorporating consumer need and consumer preference

3 Holistic Focus

- Recognising that needs of individuals extend beyond immediate physical health issues and

incorporate social and emotional health - Recognise situational, environmental, family, Carer and community influences on Consumers - Incorporate clients’ physical, emotional and social needs in the specific context, environment or

situation

4 Service continuity

- Coordination of support for Clients through transition points e.g. discharge from hospital,

metropolitan back to rural community

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- Ability to identify and mitigate risks in transition - Ability to incorporate following-up and monitoring with recognition of long-term outcomes

5 Networks

- Ability to engage and work in a teams - Ability to build partnerships/establish networks - share information, and collaborate - Ability to practice in inter-disciplinary ways that capitalise on the strengths of other disciplines

and recognise the limitations of one’s own capacity. - Coordination of whole packages of service delivery and addressing gaps in service systems

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Cultural Awareness

- Demonstrating an awareness of cultural differences - Practicing in ways that accommodate culture and local knowledge - Adapting and accommodating to different knowledge-bases or perspectives - Accepting and valuing different styles of living.

7 Community Engagement:

- Engaging with local communities in a respectful and trusting way - Understanding and investing in the local community to become a trusted partner - Recognising how individuals live and function within a community - Appreciating a collective way of operating and investing in the community

8 Boundaries and Safety

- Maintaining professional boundaries and keeping a “separateness of self” within one’s practice of

CR (despite consumer and community engagement) - Ability to work safely and prevent injury or illness arising from work by applying good workplace

health and safety principles

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- Managing competing demands on one’s time, recognising constraints and limitations, monitoring and prioritising workload while maintaining the principles of CR

9 Reflective Practice

- Thinking creatively to solve problems, prioritise, and plan through difficult and diverse tasks by

using local solutions, a creative use of resources and a flexible approach to problems - Ability to manage complicated tasks such as supervising and training family members, Carers or

support personnel - Acquiring knowledge to support good practice, and disseminating knowledge meaningfully in the

community

10 Systems Advocacy

- Advocating to make changes that improve services for client - Recognising that community rehabilitation requires advocates who can lobby systems for

recognition, resources and respect

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MOTIVATING CLIENTS TO ACHIEVE THEIR GOALS Goal setting is an important part of any rehabilitation plan. Goals extend beyond physical health issues to social and emotional health needs. They also recognise environment, family and community influences. Research has shown that involving clients in the setting of goals for their rehabilitation program has many benefits. Some of these include:

• Creating a focus for the client

• Facilitating the communication between the health care provider and the client

• Providing a way to measure progress

• By involving the client in the goal setting process they are more likely to take ownership of the goal and have the motivation to work towards achieving it

• Giving clients some control and engagement in the management of their health

Being able to achieve goals after an injury is an important step towards independence. It is the responsibility of the treating Health Professionals to establish rehabilitation goals with the clients. As an ACRA, an important part of your role will be to motivate, encourage and work with clients to achieve these goals. Motivation can mean many things. It can be a desire to act on a goal and to have the energy to do it, or to have an attitude to do something and want to do it. It can be about commitment and drive, achievement, success and change. Levels of motivation can fluctuate and often depends on the importance of the issue or task at hand. Motivational interviewing is a specialised technique that can be use to help motivate people to change and might be effective with some clients who have behavioural barriers to achieving their potential in rehabilitation. It relies very much on the client coming to a commitment to change themselves. The therapist’s or health worker’s opinions are not made apparent and in fact they speak very little. It involves probing the client on an issue to bring about self –confrontation and then resolution to change. There are a number of other communication strategies that you should use when working with clients. Some of these include: 1. Listen to the client. In order for a client to open up to you, they need to know that

you are listening to them. Active listening and reflective listening are two very useful techniques that allow

you to convey to the client that you are listening as well as clarifying and checking the meaning of what the client has said. Active listening involves you repeating back in your own words what the client has said to ensure you

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understand them. This doesn’t mean you agree with them, just that you understand what was said. Unfortunately when working with clients, we can misinterpret what they say, or even just assume what they need. Reflective listening acknowledges that the client has a deep understanding of themselves allows you to convey empathy. In reflective listening you may use phrases such as “So you feel..”, “It sounds like…” or “You’re wondering if…” to check the meaning of what a client has said and to clarify their feelings.

2. Show acceptance and understanding. Whilst a client’s values and beliefs may differ to your own, it is important to respect and accept their decisions and not to judge them.

3. Refer to the goals. During sessions, reinforce the importance of what you are

doing by discussing how it will help to achieve the goals the client set with the health professional. Discuss the consequences of not doing the rehabilitation plan and give the responsibility back to the client.

4. Avoid arguments or resistance. In order to get the most out of your sessions with

a client, it is important to foster a positive relationship. Activity Book into one of the Goal Setting or Motivational Interviewing training sessions run by the Training and Development Officers – refer to Appendix A. Try to put reflective listening into practice in everyday conversations. Next time you find yourself in a conversation with someone where you have differing views, instead of arguing with them, pause for a moment and try reflecting back to them what they are saying. Whilst doing this, also ask a question or two until they are satisfied that you have heard them accurately. Hopefully you will find that two things have occurred, firstly, the person may be more willing to hear your point of view. Secondly, you will have a better understanding of theirs.

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PRIORITISATION OF WORKLOAD In your role as an ACRA it is likely that you will be working with a number of clients as part of your case load, as well as carrying out other activities as part of your duties. Working with multiple health professionals means that you will often have several people requesting you to do tasks on the same day. In order to address this, priortising and planning your workload will be an important activity you will need to do every day. Prioritisation can assist with:

• managing your workload;

• time management; and

• ensuring clients with the greatest need are seen first. Without prioritisation, it is easy to feel stressed in the face of so many tasks that need to be done. When priortising your caseload and planning your day, there are a few questions you should ask yourself:

• Does this request/job fall within the scope of my role?

• Will the safety of this client be at risk if this task is put off until later?

• Did the health professional who asked me to do this task say it was urgent?

• Does the team use prioritisation categories and if so what is the category of this task?

Learning to prioritise is a skill that develops with education and experience. If you are unsure about the urgency of a task, discuss the job with the treating health professional or your supervisor, in relation to the rest of your workload. Communicating with your team about your workload is important as it enables them to see what tasks you have been given by other the other health professionals and helps them to avoid overloading you. If at any stage you are feeling overloaded or stressed due to your workload, be sure to raise the issue with your supervisor or line manager. Activity You work in a multidisciplinary team and each health professioal has given you a task to undertake (listed below). You realise that you will not be able to get to all of the tasks that day so you decide to prioritise your workload to help you plan your day. Prioritise the list and explain your reasoning.

• The Occupational Therapist has asked you to conduct a community access visit with a client, to assist them to access the local library.

• There is a weekly Assistants meeting where you discuss procedural matters. It is not a clinical meeting.

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• The Speech Therapist has asked you to research what communication groups exist in the local area and compile a list for the community resource folder.

• The Physiotherapist has asked you to conduct a home visit to deliver a mobility aid to a client who has had a number of falls, and instruct them on how to use it.

• The Team Leader has suggested you visit Life Tec to see what aids and supports are available to clients.

__________________________________________________________________

__________________________________________________________________________

__________________________________________________________________________

__________________________________________________________________________

__________________________________________________________________________

__________________________________________________________________________

__________________________________________________________________________

__________________________________________________________________________

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ACQUIRED BRAIN INJURY AND STROKE There are a number of medical conditions that you will encounter whilst working with clients in community rehabilitation. Acquried brain injury or ABI is a term used to describe all types of brain injuries that occur after birth. Some of the more common ABIs include stroke, brain tumours and traumatic brain injuries. A stroke, also now as a cerebrovascular accident (CVA), refers to a group of diseases that affect the arteries that supply blood to the brain. There are two main types of stroke:

1. Ischaemic stroke- when the artery supplying blood to the brain suddenly becomes blocked by a clot or plaque. This accounts for about 85% of all strokes

2. Haemorrhagic stroke- when the artery supplying blood to the brain suddenly suddenly breaks or bursts and starts bleeding. This makes up around 15% of all strokes.

When the blood supply to the brain is interrupted, brain cells begin to die and can result in permenant brain damage. This area of dead brain cells is referred to as an infarct. A stroke can have many effects. Some of the common ones include:

• Paralysis- A stroke will often cause weakness (hemiparesis) or paralysis (hemiplegia) on one side of the body, usually on the opposite side to the infarct. For example, if someone has a (L) CVA, it will usually be the right side of their body that is affected.

• Cognitive changes- changes in thinking skills/ memory/ concentration and attention

• Altered sensory awareness

• Continence problems

• Communication and swallowing difficulties – refer to Attachment D for a fact sheet on communication problems following a stroke.

• Balance and co-ordination difficulties

• Altered behaviour- refer to Attachment D for a fact sheet on behaviour changes following a head injury.

• Emotional changes- depression/ problems adjusting to changes in abilities

• Changes in personality

Recovery after a stroke can be a prolonged process however most of the brain’s natural recovery process occurs within the first three to six months. This can be

enhanced by commencing therapy as soon as possible.

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Following any form of ABI, a client may experience a number of changes and losses in their life due to the effects of the injury. For example their ability to drive or work may be affected. These changes further impact upon the client’s level of independence and will also affect those close to them such as family members. It is important to recognise that they are likely to experience a variety of emotions as a part of their grieving process. Infarcts due to stroke are often localised to one side of the brain, and may leave many parts of the brain undamaged. Injury to the brain due to trauma (TBI), such as that caused by a car accident or an assault, is often more widesread and can affect many different parts of the brain. Recovery after TBI is often slower than recovery after stroke. Most recovery still occurs in the first 6 months after injury, but recovery can still be expected for a further two years, or even more. Many people with even a severe TBI make a good physical recovery, but are left with ‘invisible impairments’, and in particular, permanent changes to thinking skills, personality and behaviour. This means that you should not assume that a person has had a ‘mild’ injury just because they look and sound fine. Activity

1. Read the Understanding Behaviour Changes fact sheet by ABIOS (Attachment D)

2. Read the Speech Pathology Australia Fact Sheet- Communication problems following a stroke (Attachment E).

3. Refer to Attachment F for a glossary of terms commonly used when discussing ABIs.

4. Explore the following websites

• http://braininjury.org.au

• http://www.health.qld.gov.au/abios/

• http://www.strokefoundation.com.au/

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ACKNOWLEGEMENTS

The Community Rehabilitation Workforce Project would like to acknowledge the following resources in the development of this workbook. Acquired Brain Injury Outreach Service (ABIOS) webite. http://www.health.qld.gov.au/abios/ Accessed 17/12/2007. Acquired Brain Injury Outreach Service (ABIOS). 2007. Goal Setting After Brain Injury. http://www.health.qld.gov.au/abios/documents/behaviour_mgt/goal_setting.pdf Accessed 30/10/2007. Ashton, L. and S. Myers. 2004. Serial Grip Strength Testing – Its Role in Assessment of Wrist and Hand Disability. The Internet Journal of Surgery. http://www.ispub.com/ostia/index.php?xmlFilePath=journals/ijs/vol5n2/strength.xml accessed 22/10/2007. Australian Physiotherapy Association Code of Conduct. 2007. Australian Physiotherapy Association. BrainLink website. http://www.brainlink.org.au/index.htm Accessed 17/12/2007. Brain Injury Association of Queensland website. http://braininjury.org.au Accessed 7/1/2008. Clinical Development Education Service website. http://cdes.learning.medeserv.com.au/products/HI4390/HI4390_enrolled.cfm accessed 1/10/2007. Clinical Documentation Procedure, Redcliffe-Caboolture Health Service District, 2005. Clinical Documentation Policy, Redcliffe-Caboolture Health Service District, 2005. Code of Ethics. 2001. Occupational Therapy Australia. Cultural Awareness Program website. http://hi.bns.health.qld.gov.au/rbh/community_health/cap/cap_cultural_awareness.htm#Indigenous%20Culture%20Fact%20Sheet accessed 30/10/2007. Cultural Diversity website. http://www.health.qld.gov.au/sop/content/cultural_diversity.asp accessed 30/10/2007.

Daily Living Products website. http://www.ca.com.au/daily/wheels.html accessed 22/10/2007.

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Dunbar-Jacob, J. 2007. Models for Changing Patient Behaviour. American Journal of Nursing. 107(6):20-25. Mobility Store website. http://www.mobilitystore.co.uk/catalogue/index.php?cPath=21_32 accessed22/10/2007. Multicultural Health site. http://www.health.qld.gov.au/multicultural/default.asp accessed 15/10/2007. National Stroke Foundation website. http://www.strokefoundation.com.au/ accessed 7/1/2008. Northside Health Service District Library site. http://qheps.health.qld.gov.au/redcab/SDETU_Courses/Computer-training.pdf accessed 10/9/2007. Respironics website. http://model512and513.respironics.com/ accessed 22/10/2007. Speech Pathology Australia fact sheet – Communication Problems Following A Stroke Wikipedia website. http://en.wikipedia.org/wiki/Pulse_oximeter accessed 22/10/2007.

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ATTACHMENT A – TRAINING SCHEDULE

VIDEOCONFERENCE DATES Expressions of Interest, including information about the course and how to enrol, will be circulated closer to the training dates. For further information on the training please feel free to email or call the contact person listed next to the training.

TOPIC DATE LOCATION CONTACT PERSON &

DETAILS Tuesday 13th November 2007

Videoconference 1pm – 3pm

Thursday 6 December 2007

Videoconference 1pm – 3pm

Wednesday 30 January 2007

Videoconference 1pm – 3pm

Thursday 14 February

Videoconference 10 am – 12pm

Tuesday 25 March 2007

Videoconference 10am – 12pm

Friday 18 April 2007

Videoconference 10am – 12pm

Preparing Written Material

Wednesday 14 May 2007

Videoconference 1pm – 3pm

Rachael Byrne Ph. 4920 7934 Rachael_Byrne@health.qld.gov.au

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TOPIC DATE LOCATION CONTACT PERSON & DETAILS

Wednesday 17th October 2007

Videoconference 10.30am- 12.30pm

Tuesday 11th December 2007

Videoconference 10.30am- 12.30pm

Wednesday 30th January 2008

Videoconference 10.30am- 12.30pm

Tuesday 19th February 2008

Videoconference 10.30am- 12.30pm

Wednesday 26th March 2008

Videoconference 10.30am- 12.30pm

Goal Setting & Motivation

Tuesday 29th April 2008

Videoconference 10.30am- 12.30pm

Faith Lucas Ph. 3360 4802 Faith_Lucas@health.qld.gov.au

TOPIC DATE LOCATION CONTACT PERSON &

DETAILS Monday 19th November 2007

Videoconference 10am – 12pm

Karen Bell Ph. 4616 5531 Karen_Bell@health.qld.gov.au

Wednesday 23rd January 2008

Videoconference 11.00 am – 1.00pm

Karen Bell Ph. 4616 5531 Karen_Bell@health.qld.gov.au

Wednesday 5th March 2008

Videoconference 9am – 11am

Karen Bell Ph. 4616 5531 Karen_Bell@health.qld.gov.au

Thursday 3rd April 2008

Videoconference 10.30 am – 12.30pm

Karen Bell Ph. 4616 5531 Karen_Bell@health.qld.gov.au

Demand Management

Friday 2nd May 2008

Videoconference 1.00pm – 3.00pm

Karen Bell Ph. 4616 5531 Karen_Bell@health.qld.gov.au

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TOPIC DATE LOCATION CONTACT PERSON & DETAILS

Friday 2nd November 2007

Videoconference Session 1

Friday 9th November 2007

Videoconference Session 2

Friday 7th December 2007

Videoconference Session 1

Community Rehab/Research and Evaluation

Friday 14th December 2007

Videoconference Session 2

Glenda Blackwell Ph. 4799 9538 Glenda_Blackwell@health.qld.gov.au

NB: There are two sessions within this topic; Session 1 – Introduction to Planning, Session 2 – Introduction to Methods. It is not necessary to attend both sessions if you are unable. The first session is not a prerequisite to attend the second.

TOPIC DATE LOCATION CONTACT PERSON & DETAILS

Monday 24th September 2007

Videoconference 10.30am – 12.30pm

Tuesday 30th October 2007

Videoconference 1.00pm – 3.00pm

Tuesday 5th February 2008

Videoconference 10.30am – 12.30pm

A guide to advocacy for community rehabilitation workers

Tuesday 18 March 2008

Videoconference 1.30pm – 3.30pm

Margaret MacDonald Ph. 4799 9535 Margaret_MacDonald@health.qld.gov.au

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TOPIC DATE LOCATION CONTACT PERSON & DETAILS

Monday 12 November 2007

Videoconference 10am – 12noon

Tuesday 29 January 2008

Videoconference 10.30am – 12.30pm

Monday 25 February 2008

Videoconference 1.30pm – 3.30pm

Friday 1 March 2008

Videoconference 10am – 12pm

Tuesday 1

April 2008 Videoconference 10.30am – 12.30pm

Influencing those who make policy decisions: A guide to systems advocacy

Tuesday 6 May 2008

Videoconference 1.30pm – 3.30pm

Madeline Avci Ph. 3360 4802 Madeline_Avci@health.qld.gov.au

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WORKSHOP DATES AND VENUES Expressions of Interest, including information about the course and how to enrol, will be circulated closer to the training dates. For further information on the training please feel free to email or call the contact person listed next to the training. TOPIC DATE LOCATION CONTACT PERSON &

DETAILS Tuesday 23rd October 2007

Cairns

Tuesday 6th November 2007

Mt Isa

Tuesday 20th November 2007

Toowoomba

Tuesday 12th February 2008

Rockhampton

Mental Health Awareness in the Physically Impaired + Mental Health Act

Tuesday 11th March 2008

Brisbane

Faith Lucas Ph. 3360 4802 Faith_Lucas@health.qld.gov.au Margaret Macdonald Ph. 4799 9535 Margaret_MacDonald@health.qld.gov.au

TOPIC DATE LOCATION CONTACT PERSON &

DETAILS Wednesday 17 October 2007

Brisbane

Wednesday 24 October 2007

Rockhampton

Wednesday 31 October 2007

Cairns

Networking & Peer Group Learning

Thursday 1 November 2007

Townsville

Karen Bell Ph. 4616 5531 Karen_Bell@health.qld.gov.au

ONLINE TRAINING The following package is available online for you to complete at your own pace, at a time that suits you. For information about the package and how to log on click on the link below. Clinical Education Training Package http://qheps.health.qld.gov.au/ahwac/content/cetp.htm UPCOMING WORKSHOPS/TRAINING SESSIONS The following sessions will be added to the training schedule once dates and venues and form of delivery have been decided upon.

• Community/Consumer Engagement • Cultural Awareness

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ATTACHMENT B - ABBREVIATIONS Abbreviations can often be found in medical charts for frequently used words. Whilst they can save time, it is very important that only approved and accurate abbreviations are used, so that chart entries can be correctly understood. Below is a list of approved abbreviations that you may frequently come across in Community Rehabilitation. (Abbreviations obtained from The Australian Dictionary of Clinical Abbreviation, Acronyms and Symbols). Rx Treatment PT Physiotherapy/Physiotherapist OT Occupational Therapy/Therapist CVA Cerebrovascular Accident (Stroke) MI Myocardial Infarct (Heart Attack) ABI Acquired Brain Injury HI Head Injury SCI Spinal Cord Injury W/C Wheelchair PUF Pick Up Frame SPS Single Point Stick ROM Range of motion/movement Dx Diagnosis DVA Department of Veterans Affairs R; (R); Rt; rt Right L; (L); lt Left R/V; RV Review Mx Management Hx History pt Patient HV Home Visit ↑ Increase/Increasing ↓ Decrease/Decreasing 1/52 One week 1/12 One month 12/12 One year +ve Positive -ve Negative F; ♀ Female M; ♂ Male **NOTE: Neither CR for Community Rehabilitation, nor HEP for Home Exercise Program are listed in The Australian Dictionary of Clinical Abbreviation, Acronyms and Symbols and therefore CANNOT be used**.

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ATTACHMENT C- HOME VISIT POLICY OR PROCEDURE

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ATTACHMENT D – UNDERSTANDING BEHAVIOUR CHANGES (ABIOS)

http://www.health.qld.gov.au/abios/documents/behaviour_mgt/understand_changes.pdf

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ATTACHMENT E –COMMUNICATION PROBLEMS FOLLOWING A STROKE (SPEECH PATHOLOGY AUSTRALIA FACT SHEET)

http://www.speechpathologyaustralia.org.au/library/31_FactSheet.pdf

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ATTACHMENT F – GLOSSARY (Definitions obtained from http://braininjury.org.au/portal/component/option,com_glossary/Itemid,363/ on 7/1/2008).

Agnosia - A disorder of recognition from injury to higher order information processing cells which can result in an inability to recognise or distinguish faces or objects.

Agraphia - Inability to write that can arise from trauma to areas of brain responsible for cognitive or motor skills necessary to write.

Akinesia - Inability to move ("freezing") due to problems selecting and activating muscle programs in the brain.

Aphasia - Difficulty understanding or expressing language as a result of damage to the brain.

Apraxia - Inability to voluntarily perform skilled movements. Ataxia - Abnormal movements due to the loss of coordination of the muscles. Bradykinesia - The slowing down and loss of voluntary movement and speech. Brain Stem - The lower extension of the brain where it extends to the spinal cord.

Neurological functions located in the brain stem include those necessary for survival (breathing, heart rate) and for arousal (being awake and alert).

Cerebral Cortex - The outer layer of the brain, responsible for cognitive processes including reasoning, mood, perception of stimuli and other thought processes.

Diffuse Brain Injury- Injury to cells in many areas of the brain rather than in one specific location. Disinhibition - Lack of control over impulses due to frontal lobe trauma. Anti social behaviours that arise usually lead to social isolation. Dysarthria - Speech impairment resulting from damage to the nerves and areas of the brain that control the muscles used in forming words. Dyskinesia - An impaired ability to make voluntary movements, resulting in

uncoordinated or involuntary movements. Dysphagia - Difficulty with swallowing. Dysphasia - Difficulty understanding or expressing language as a result of damage

to the brain. Dyspraxia - Difficulty performing voluntary movements not due to weakness but

because of motor coordinating problems. Emotional Lability - Repeated, rapid, abrupt shifts in emotion that are not related to

external stimuli. Focal Brain Injury - Injury restricted to one region (as opposed to diffuse).

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Frontal Lobe - The region of the brain directly behind the forehead. Responsible for planning, organising, problem solving, selective attention, personality and a variety of “higher cognitive functions”. Damage can cause changes to personality, problems with spoken language and impaired social skills.

Haematoma - A collection of blood in an organ, space or tissue, due to a break in the wall of a blood vessel.

Hemianopia - Blindness in the same sides of both eyes which can follow damage to the brain. This can cause an inability to see on the left or right side.

Hemiparesis - Weakness, partial paralysis or loss of movement that only affects one side of the body.

Hemiplegia - Paralysis of one side of the body. May be associated with spasticity -

increased muscle tension and spasms. Hypoxia - An insufficient supply of oxygen to cells of the body. May result in cell

death if severe. ICP - Intracranial Pressure: A measure of the amount of pressure inside the

skull from brain tissue, blood and cerebrospinal fluid. Increased pressure is a sign of intracranial hemorrhage or cerebral swelling that can lead to secondary brain injury.

Impulsivity - A tendency to rush into something without thinking or reflecting first. Occipital Lobe - Region in the back of the brain which processes visual information.

Damage to this lobe can cause visual deficits. Parietal Lobes - Left and right lobes located in the middle and top of the brain.

Responsible for visual attention and processing, spatial awareness, touch perception and manipulation, voluntary movements, and the integration of different senses. Damage can cause difficulty with identifying or naming objects, difficulty with writing or mathematics and difficulty with motor coordination or being aware of space and distance.

Proprioception - The sensory awareness of the position of body parts with or without movement.

Shunt - An apparatus designed to remove excessive fluid from the brain. A surgically placed tube which transfers fluid into either the abdominal cavity, heart or large veins of the neck.

Spasticity - An involuntary increase in muscle tone (tension). An involuntary increase in muscle tone (tension).

Temporal Lobes - Two lobes, one on each side of the brain located at about the level of the ears. Responsible for interpreting and understanding

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sounds, categorisation of objects, some visual processing and short and long term memory. Damage can result in impaired memory, hearing and recognition of objects.

Tracheostomy - This is a breathing tube inserted through the middle of the neck just below the voice box. Through this tube an adequate air passage can be maintained. It may be necessary to leave the tube in the windpipe for a prolonged period.

Brain Map

(accessed from http://www.health.qld.gov.au/abios/asp/brain.asp on 7/1/2008).