1. Successful completion of this training meets one hour of the four hour annual training requirement
for Personal Attendant Services direct care staff as provided through the WV TBI Waiver Program

2. •
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2013
Information included in this presentation was current
at the time it was developed
Presentation materials are reviewed on an annual
basis
West Virginia TBI Waiver Program direct care staff annual training
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3. Amanda M Wilson, M.A.
•
Traumatic Brain Injury Services at the Center for Excellence in
Disabilities
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Traumatic Brain Injury Information Specialist
•
Ms. Wilson has been providing education and awareness about
Traumatic Brain Injury with the state’s designated lead agency
for coordination of services for West Virginia’s with TBI
•
Contact information:
www.cedwvu.org/programs/tbi
Toll Free: 1-877-724-8244
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West Virginia TBI Waiver Program direct care staff annual training
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4. Upon completion of this training participants
will be able to:
•
Identify at least four symptoms that may appear as a result of a
TBI
•
Identify at least one compensatory strategy to use with each
symptom of a Traumatic Brain Injury
•
•
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Understand the importance of compensatory strategies to
Traumatic Brain Injury
Identify four challenging behaviors/feelings as a result of a TBI
West Virginia TBI Waiver Program direct care staff annual training
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5. Traumatic Brain Injury (TBI) is
an insult to the brain not of a degenerative or congenital nature
caused by an external physical force, that may produce a
diminished or altered state of consciousness resulting in an
impairment of cognitive abilities or physical functioning. It can also
result in the disturbance of behavioral or emotional
functioning, may be temporary or permanent and cause partial or
total functional disability or psychosocial maladjustment
National Head Injury Foundation
(now the Brain Injury Association of America)
2013
West Virginia TBI Waiver Program direct care staff annual training
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6. A non-degenerative, non-congenital insult to the
brain caused by an external physical force resulting
in total or partial functional disability and/or
psychosocial impairment
WV TBI Waiver Manual 512.7.2.C. page 19
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West Virginia TBI Waiver Program direct care staff annual training
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7. •
•
Every 23 seconds, one person in the United
States sustains a traumatic brain injury
Each year, an estimated 1.7 million people
sustain a TBI
Centers for Disease Control and Prevention
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West Virginia TBI Waiver Program direct care staff annual training
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8. 2013
West Virginia TBI Waiver Program direct care staff annual training
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9. Finding alternative methods to complete tasks
that accommodate the needs of the person
who has a Traumatic Brain Injury
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West Virginia TBI Waiver Program direct care staff annual training
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10. •
•
•
2013
It is important to remember that each person
with a Traumatic Brain Injury (TBI)
experiences life differently
Compensatory Strategies can be used to help
the person complete daily tasks
Each strategy can be designed to meet the
needs of the person
West Virginia TBI Waiver Program direct care staff annual training
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11. 2013
West Virginia TBI Waiver Program direct care staff annual training
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12. •
•
In order to execute appropriate compensatory
strategies as a direct care staff it is important
to understand some symptoms that may
appear after a person has sustained a TBI
When working with a member it is important
to report any changes in
behavior, mood, appearance to the case
manager or appropriate contact person for
your agency
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West Virginia TBI Waiver Program direct care staff annual training
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13. •
•
•
•
•
•
•
•
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Shortened attention span
Lack of ability to concentrate
Difficulty organizing
Challenging Behavior/Feelings
Memory Problems
Initiation problems
Language problems
Slower processing speeds
Visual difficulties
Disorientation difficulties
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West Virginia TBI Waiver Program direct care staff annual training
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14. •
•
•
When someone has suffered a TBI
attention, concentration, and organization can become
very difficult to manage throughout the day
As a direct care staff it is important to recognize that
these difficulties may appear greater when the person is
tired or stressed during the day
Report any changes to the case manager or appropriate
contact at the agency
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West Virginia TBI Waiver Program direct care staff annual training
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15. The following are ways to assist the individual:
•Assist member in making predictable routines for everyday tasks such as:
•Household chores (dishes, laundry)
•Hygiene (shower/bath, brushing teeth)
•Medication (morning, afternoon, evening)
*Assisting the member in completing these tasks at the same time, place, and day
allows him/her to establish a routine*
• Assist member in making check lists and reminders for tasks such as:
•Grocery Lists (milk, bread, eggs, toilet paper, paper towels)
•Basic Living Skills (hygiene, laundry, cleaning)
*Encourage member to focus on one task at a time and take breaks when needed*
2013
West Virginia TBI Waiver Program direct care staff annual training
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16. •
As direct care staff you may need to use one of the following cues to assist with regaining
focus:
• Visual : demonstrating how the task should be completed
• picking up tooth brush and putting tooth paste on brush
• Auditory: using words to describe task at hand
• “Johnny lets pick up your tooth brush”
• Physical : working with member side by side
• Taking members hand and picking up tooth brush
•
The member may have a tendency to become easily distracted after the TBI. Encourage the
following:
 Assist with rearranging furniture in the home to help minimize distractions
 Encourage member to hold conversations in quiet environments
Because attention, concentration, and organization may be more difficult when the member
is stressed or tired , it is important to schedule activities when the member has more energy
and will be the most productive
2013
West Virginia TBI Waiver Program direct care staff annual training
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17. As a direct care staff it is important to understand and recognize
that the member may demonstrate some challenging behaviors
as a result of the TBI
Take a minute to review the link listed below on Challenging
Behaviors/Feelings:
Managing Intense Feelings
(right click on above link and select open HyperLink)
•
Some of your members may be on medications to help with these
behaviors/feelings. It is important to notify the case manager or appropriate
contact person of any changes in behaviors/feelings
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West Virginia TBI Waiver Program direct care staff annual training
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18. Other strategies may be used when working with a member when
challenging behaviors/feelings are present:
•
Anger Management:
• Identify the trigger
• (what caused the behavior/feeling to occur)
• Encourage the use of “I” statements
• “I feel sad when I have to write down my schedule”
•
Identify Internal Cues
• How is the body feeling ?
 (sweating, feeling hot, cold, shaking)
•
Relaxation Techniques
• Deep Breathing Deep Breathing Exercise (watch this short technique video)
(right click on link above and select Open Hyperlink )
• PMR Progressive Muscle Relaxation Technique (watch this short technique video)
(right click on link above and select Open Hyperlink)
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West Virginia TBI Waiver Program direct care staff annual training
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19. It is very common after a TBI that a person may have difficulty with memory
Many of the techniques that are used to help a person with memory are
those that we use in our own everyday living
The following are techniques that can help with memory:
•
Help the member to create a memory/organizational notebook
•
Encourage the member to use:
• Alarms on Cell Phones or Electronic Devices
• Write down important dates, times, events for the day/week/year
• Contact Lists (Cell Phones, I PAD, Phone Books, Tablets)
• To Do List (daily, weekly, monthly)
Take a minute to read the article below on Managing Memory
Managing Memory
(Right Click on Above Link and Select Open Hyperlink)
Never ask a member if “they remember” something. The best would be to
redirect to the memory/organizational notebook
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West Virginia TBI Waiver Program direct care staff annual training
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20. People who have sustained a TBI often have difficulty getting started on
tasks. This is known as initiation (starting). As direct care staff your
role will be to assist with initiation
The following will help with initiation of the task at hand:
•
Use Environmental Cues (signs in the environment)
• When going outside and it is snowing, ask Johnny what would be needed to go
outside Snow=Coat/Gloves
•
•
Link behaviors that naturally go together
• When getting in the car you : get keys, unlock door, get into car, put seat belt
on, check mirrors, etc.
Encourage member to use some of the same techniques used for memory:
•
•
•
•
•
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Sticky notes
Alarms (cell phones, kitchen timers)
Calendars (cell phones, tablets, small pocket calendar)
Check lists
Assist member into breaking tasks down into smaller parts
Assist member in making signs with daily activities:
• “Stop! Check Keys” Place this on door or steering wheel to avoid locking self out of
the house or car
West Virginia TBI Waiver Program direct care staff annual training
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21. As direct care staff you may encounter a member that has trouble speaking (language difficulties)
and/or understanding what is being said or task given (slowed processing speed)
The following are ways that you as staff can assist the member when experiencing
language difficulties and/or slowed processing speed:
•
Encourage member to make and carry a card that lists emergency contacts
•
If necessary reformat questions to multiple choice or yes/no
•
Some members may benefit from using a written template to communicate needs and wants:
• “ I want a _______ _______to ________________.”
(item)
(activity)
•
Encourage member to ask people to repeat information until they understand it
•
Encourage member if able to restate what was said to them in their own words
•
Assist member in developing a Communication Notebook
(allows member to point to picture to express needs)
• Includes pictures of favorite activities, foods, daily tasks, medication , etc.
2013
West Virginia TBI Waiver Program direct care staff annual training
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22. Often times after a member has sustained a TBI there is difficulties
with vision. This may also include but not be limited to difficulties
determining space/distances
The following maybe used to assist member:
• Magnifying lenses
• These allow printed items or objects to be enlarged for vision difficulties
•
Computers and Copiers
• Can be used to enlarge or decrease print based on need of member
•
Proper lighting
• Adjust according to need of member (brighter or lighter)
•
•
Assist member in removing clutter from areas of travel
Global Positioning Systems (GPS)
• Can assist member in determining distance when traveling
Some members may use a cane/walker for balancing and
stability. Assist member in remaining aware of surroundings
to avoid injury
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West Virginia TBI Waiver Program direct care staff annual training
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23. As a direct care staff you play an important role in the continued recovery and
rehabilitation of your member
The following are things to keep in mind when working with your member and
using compensatory strategies:
•
Constantly observe member
•
•
Report any changes in mood, behavior, activities to the case manager or appropriate
contact person for the agency
Encourage your member even though they or yourself may become frustrated
•
Remember that this is an ongoing process
•
This is a person-centered approach . Offer guidance and direction when needed
•
Not every compensatory strategy will work every time. Keep trying until one is
found that works and allows the member to complete tasks
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West Virginia TBI Waiver Program direct care staff annual training
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24. Leonhardt,Debbie A.- Survival Kit: A planner and organizer for
survivors of brain injury and their families. Lash & Associates
Publishing/Training Inc. (2011)
Messenger,Barbara & Ziarnek,Niki.-Family Rehabilitation
Activity Manual. Lash & Associates Publishing/Training Inc.
(2008)
Sullivan, Cheryle-Brain Injury Survival Kit: 365 Tips, Tools, and
Tricks to Deal with Cognitive Function Loss. Demos Medical
Publishing (2008)
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West Virginia TBI Waiver Program direct care staff annual training
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25. Here are some additional resources that you may want to explore:
(To view site, right click on link and select Open Hyperlink)
•
•
•
•
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TBI Survivors View
External Aids for Memory
Centers for Disease Control and Prevention: TBI
Center for Excellence in Disabilities at West Virginia University
West Virginia TBI Waiver Program direct care staff annual training
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26. •
•
•
To receive your certificate of successful completion
you must first pass the test and complete an online
evaluation
A score of 80% or higher is required
Once you have successfully completed this training
module you will receive an email with your
certificate of completion
2013
West Virginia TBI Waiver Program direct care staff annual training
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27. •
Please scroll down and take the test below.
•
Your thoughts and comments are very
important to us. You may submit your
comments here: TBI Training Survey
Thank You!
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West Virginia TBI Waiver Program direct care staff annual training
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