trauma, rehab and recovery
DESCRIPTION
Brain Injury GPS: Navigating through Recovery, London, ON; June 18, 2010; Trauma Rehab and Recovery Power PointTRANSCRIPT
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Val LougheedNorthern Lights Canada
1-800-361-4642www.northernlightscanada.ca
Navigating Through Recovery
~ Keep Your Fork ~
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“You don’t want your impairments to define you – you want them to inform you.”
(Hanita Dagan, personal communication, 2005)
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www.slideshare.com/vlougheed
#NLCAN
www.northernlightscanada.ca/about/about-val-
lougheed/be-still
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Agenda
•Beginning …
•Middle …
•End …
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Navigating through Recovery
1. What does it mean to recover and return to work?
2. Why can I do to recover and return to work?
3. What can we do to facilitate recovery and a return to work?
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Rated PG-113
People Strongly Cautioned!
May contain bad language, brief nudity, sexual overtones, and drug usage.
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Beginning
My Story
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Sept. 9, 2003 - morning
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Sept. 9 – p.m.
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Sept. 15 2003 – Jan. 19 2004
Journey Back to Life
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February 2004 – Present
Starting Point
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Identity Disintegration
and
The Re-organization of Self
March 2004
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“In the aftermath of traumatic life events … [the] sense of self has been shattered.”
(Herman, 1992, p. 61)
“An existential crisis …”
(Hanita Dagan, personal communication, 2005)
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OxyContin™ Research
Early 1900’s Oxycodone™ developed in Germany
1995 Purdue Pharmacy (USA) launches OxyContin™ – controlled-release formula
1996 Approved in Canada
2002 OxyContin™ earns Purdue more than $1 billion U.S.
2003 OxyContin™ is one of Canada’s 3 most-prescribed narcotic painkillers
Nov. 2003 – Oct. 2004
783,762 prescriptions for OxyContin™ dispensed in Canada
(Dalhousie, March 2005)
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Sliding Down the Slope
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A Foothold
• Mild – moderate ABI
• Depressed (dysphoria)
• Working memory problems
• Hiding pain
1st Neuropsychological Assessment
June 2004 -- Results
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ABI – Measuring Loss
“Pre-morbid intelligence is a crucial variable …”
Subjective Report – difficulty retrieving words and communicating ideas
Objective Report – above-average performance on neuropsychological measures(Prigatano, 1999, p. 59)
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Losing My Grip
My IWRPAugust 2004
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Rescued in the Valley of Despair
Head Injury ProgramOct. – Dec. 2004
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GRTW – The Plan
Jan. 3 – Feb. 7, 2005
(5 weeks)
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GRTW – The Reality
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GRTW – The Reality
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GRTW – The Reality
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GRTW – The Reality
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GRTW – The Reality
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GRTW – The Reality
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GRTW – The Reality
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GRTW – The Reality
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GRTW – The Reality
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Rescue Attempts
• Case Manager
• Job Coach
• Colleagues/Friends/ Psychologist
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Sliding Back Down Into The Abyss
• Non-compliance
• Malingering
• Trying too hard
• Not trying hard enough
2nd Neuropsychological Assessment
May 2005 -- Edmonton
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Lesson
ASSUMPTIONS
REVEAL BIAS
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• Mild – moderate ABI
• Good prognosis
• Post-Traumatic amnesia
• Pain?
• Depression?
• “Adjustment Disorder with Anxiety and Depressed Mood”
3rd Neuropsychological Assessment
August 2005 -- Calgary
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Symptom Overlap
(co-morbidity)
(Michael Sullivan, Centre for Research on Pain and
Disability, McGill University, September, 2006)
Pain, Trauma, Depression, ABI
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Oct. 3 – Dec. 11
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Pain Research
1600’s – Rene Descartes (philosopher)
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Pain Research
1950’s – Wilder Penfield (brain surgeon)
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Pain Research
Patrick Wall (physiologist)Ronald Melzack (psychologist)
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Pain ResearchGate Control Theory
• Acute and chronic pain
• Pain sensation travels up the central nervous system to the brain through a “gate”
• “Gate” – triggered by cell changes – sends descending messages that alter sensory input
• Pain isn’t pain until it reaches the brain
• Emotions, context, etc. affect pain sensations
• Pain is a negotiable, individual experience
• Pain centres in the brain – they just keep moving around
(Jackson, 2002, p. 21)
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Pain – The Future
SCN9A(Globe and Mail, March 24, 2007)
Glia Cells(Scientific American, November, 2009)
Poppy Genes(U of Calgary -- Calgary Sun, March 15, 2010)
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Limbic SystemThe centre for emotional expression
(Prigatano, 1999, p. 132)
• Amygdala - attaches emotional tags to memories
(Dr. Suffield, personal communication, 2004)
• Hippocampus - controls the laying down of new memories
(Ramachandran & Blakeslee, 1998, p. 15)
• Hypothalamus – controls the outward expression of emotions
(Ramachandran & Blakeslee, 1998, p. 177)
Trauma Research
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“In every encounter, basic trust is in question.” ( Herman, 1992, p. 92)
“Survivors feel unsafe in their bodies – and in any relationship with other people.” (Herman, 1992, p. 160)
Rehab & Recovery
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TraumaPersonal Experience
• Dissociation & Cocoon = Safety
• System on High Alert Always = Survival
• World is black & white = Trust
Trust (Safety) = Love
No Trust (Life Threatening) = Hate
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TraumaPersonal Experience
• Listen to me
• Understand me
• Respect me
• Are competent
I trust (love, feel safe with, will try hard for) practitioners who:
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“… depression [caused by trauma] is not the same as ordinary depression.”
( Herman, 1992, p. 118)
Depression
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“Emotions are not in the head – they are in every cell in the body.”
(Pert (1995), in Bolen, 1996, p. 7)
Pscyhoimmunoendocrine Network
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Affects more than IQ ….
• We are sensitive to changes in higher cerebral functioning
• Very important to a person’s sense of self
• Touches core … of a person’s self-esteem
(Prigatano, 1999, p. 58)
ABI
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Back to Wilder Penfield – 1950’s
ABI
Localizationist
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Paul Bach-y-Rita – 1934 – 2006
Scientist and Rehab Doctor
Neuroplasticity - 1969
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Michael Merzenich
Neuroplastician
Neuroplasticity
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Harnessing the Power
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“The words and attitudes of others … are potent. They help or hex healing and recovery.”
“ Expectations are powerful.”
“Neutrality can be deadly.”
(Bolen, 1996, p. 94)
Body-Mind Connection
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Quantum Connection
The Living Matrix -- 1995• A type of energy exists that has previously gone unnoticed.
• Cells/DNA influence matter through this form of energy.
• DNA Phantom effect. Braden, 2007, p. 45
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“Loss of identity can evoke a personal crisis, creating a need for change.”
(Ornelas, in Smith & Johnson (Eds), 1997, p. 172)
The Re-Organization of Self
Identity Research
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Scaling the Canyon
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Sept., 2005
Waskesiu
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Breast Cancer Reconstructive Surgery
March 2006
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Convocation M.Ed. -- June 2006
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Back in “a” SaddleSeptember 2007
• Officially change role/ title
• Re-organize NL
• Work part-time
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Navigating Through Recovery
Resilience Ability to return to original form after
being bent (bounce back)
Thriving in constant change, ability to be:
• Flexible
• Creative
• Adaptable
• Learn from experiencehttp://www.resiliencycenter.com/articles/5levels.shtml
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Navigating Through Recovery
Rehabilitation (habiter – to live inside)
“Rehabilitation is the learning to live inside not only one’s body, however it is after an injury or illness, but inside one’s very being.”
(Kabat-Zinn, in Meili, 2003, p. 241)
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Navigating Through Recovery
RecoveryCuring Focus on the illness/
impairment [outside]
Healing Focus on the person [inside]
Crombez, October, 2003
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Be Still
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Navigating through Recovery
1. What does it mean to recover and return to work?
2. Why can I do to recover and return to work?
3. What can we do to facilitate recovery and a return to work?
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Keep Your Fork
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Northern Lights Canada is a person-centred organization committed to providing innovative, responsive links to real work.
We offer 4 major divisions of service: • Vocational Rehabilitation Services • Employment Services • Employer Services• Corporate Training
For more information, please contact us: 1-800-361-4642
www.northernlightscanada.ca
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Voc Rehab Canada (VRCAN) is a national consortium of experienced regional vocational rehabilitation companies. VRCAN provides customers with single-point access to VR services anywhere they are needed in Canada, whether on an individual service or contract basis.
Member companies include:Argus Management Consultants,
Inc. Sandra Preeper & Associates
Advantage Rehabilitation Consultants Ltd.
Rehabilitation Alternatives Limited / Vocational Alternatives Software
OPTIMA Rehabilitation CVE Inc.
Northern Lights Canada Occupational Rehabilitation Group of Canada (ORGOC)
Western Rehabilitation Specialists Inc.
Diversified Rehabilitation Group
Genesis Rehabilitation Ltd. Rehabilitation FocusFor more information, please feel free to contact us at 1-800-361-
4642
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