Posts Tagged Social Work
Brain Injury — Important Facts and Implications for Social Work Practice
By Jennifer Fleming, MA, LPC, CBIS; Natasha McVey, MSS, LCSW, CBIS; Madeleine Shusterman, LCSW, CBIS; and Eli DeHope, PhD, LCSW, BCD
Roberta is a bright, high-energy, fun-loving, career-oriented woman in her early 30s who worked as a pharmaceutical sales representative. Roberta’s ability to multitask and think quickly and her dedication to working long hours put her on the fast track to project leader of the sales team.
On one winter day while traveling to see a client, Roberta’s car slid on a patch of ice, went off the road, and crashed into a ditch. Roberta sustained minor physical injuries and a bad concussion. She did not lose consciousness. Her family and coworkers believed, as did Roberta, that while this was a serious accident, she would recover fully. The expectation was that she would be back to her usual, highly productive self in a matter of weeks.
After several months of ongoing headaches, fatigue, difficulty concentrating, and decreased motivation to return to work, her family started to wonder what was wrong with Roberta. Why didn’t she just get over the accident and go back to her life? Why was she so unmotivated? What her family didn’t understand was that Roberta’s symptoms were related to her concussion and that Roberta had actually sustained a brain injury.
Brain injury refers to the death of brain cells and the disruption of neural pathways that can change the way a person thinks, feels, and/or acts. A brain injury can be caused by an outside force, such as a bump, blow, or jolt to the head related to an accident, fall, or violence, or to a change in air pressure, such as a blast injury. Brain injuries can also result from neurologic diseases, lack of oxygen to the brain, or penetrating wounds like gunshots (Rutland-Brown, Langlois, Thomas, & Xi, 2006).
Brain injury is increasingly recognized as a health concern with lifelong implications; however, it continues to be referred to as the “silent epidemic,” perhaps because awareness about brain injury, although improving, continues to be limited. It is estimated that an average of 1.7 million individuals sustain brain injuries each year (Coronado et al., 2011), which translates to about one person every 23 seconds. Brain injuries are most likely to occur in the very young (under the age of 5), followed by adolescents (ages 15 to 19) and adults over the age of 75 (Coronado et al.). Brain injury has a higher prevalence than HIV, breast cancer, and multiple sclerosis combined. Brain injury is also frequently undiagnosed and underreported (Leibson et al., 2011).
Brain Injury Sequelae
Because the brain is responsible for many functions, once an individual experiences a brain injury, his or her life is often drastically affected. A person with a brain injury can have a range of medical, cognitive, emotional/behavioral, and psychosocial issues. The sequelae listed in this chart are common challenges associated with brain injury; however, this list is not exhaustive:
Clearly, brain injury can impact all aspects of a person’s life. An individual’s identity in his or her family, friendships, and workplace are often affected. Alarmingly, it is estimated that 60% of people with brain injuries are never able to return to their prior employment (van Velzen, van Bennekom, Edelaar, Sluiter, & Frings-Dresen, 2009). Many lose their friendships and spouse or partner. People with a brain injury often experience and report social isolation, feelings of loneliness, and loss of friendships as a primary problem (Temkin, Corrigan, Dikmen, & Machamer, 2009) as well as an inability to participate in their hobbies and leisure activities.
Similarly, family members of these patients often experience significant stress, including the development of significant psychological symptoms as well as the loss of social support (Vangel, Rapport, & Hanks, 2011). Social workers can play a vital role in helping individuals and their families to accept and learn how to adapt to the inevitable changes that result from brain injury.
Making an Impact
All social workers should be equipped to recognize and refer individuals who might be struggling with a brain injury. Knowing who is at risk and what to look for is an important first step.
Recognizing At-Risk Populations and Symptoms
Individuals who have been involved in violence, dangerous occupations or hobbies, or who were athletes, veterans, or substance abusers should be considered as possibly having suffered a brain injury. Via case review, social workers should look for a history of loss/alteration of consciousness or significant events such as falls, motor vehicle accidents, and hospitalizations.
While a history of coma indicates the likelihood of a brain injury and the potential for long-term impairment, short losses of consciousness, or alterations, can also indicate the presence of a brain injury.
There is no medical test that can predict a person’s prognosis based on a specific injury. It is important to understand that even if an MRI or CT scan does not reveal any physical brain changes, the injury may still affect the person. The social worker should take into consideration a client’s history, as there may have been instances of head trauma not documented in the person’s medical record, as well as look for possible symptoms of brain injury.
If a brain injury is suspected, social workers can ask several questions during an interview that may shed light on the person’s history of head trauma. These questions include the following:
• Have you ever been hit in the head?
• Have you ever lost consciousness?
• Have you ever had a concussion?
• Do you, or did you ever, play contact sports?
• Have you ever been in a car accident?
• Have you ever been in a physical fight or a victim of violence?
• Are you a veteran? Were you ever injured in service?
If an event with the potential to cause head trauma is found, social workers should follow up with questions about the immediate effect of the trauma, including amnesia, disorientation, or confusion, and then with questions about its impact on functioning in the following weeks, months, and even years. The Ohio Valley Center for Brain Injury Prevention and Rehabilitation, in conjunction with BrainLine, has developed a screening tool available at www.brainline.org.
Brain injury rehabilitation services are highly specialized. Knowing where quality rehabilitation services are located in your community is most important for referring clients appropriately. The majority of physicians have little or no experience with brain injury and its short- and long-term impact. So identifying a physiatrist, a rehabilitation doctor, and a neurologist who do have experience treating those with brain injuries can greatly improve an individual’s overall medical care. Major trauma centers and rehabilitation facilities in urban areas are a good place to start.
Each state has a Brain Injury Association, organized by the umbrella organization Brain Injury Association of America (www.biausa.org). These organizations often have online resources that contain provider information, family support services, and general brain injury education.
Children with brain injuries can qualify for specialized services until the age of 21 through their school districts with an individualized education plan. This information is imperative for school social workers to know so they can educate parents, teachers, coaches, colleagues, and students. They can also advocate for needed services and make necessary referrals.
School social workers should also be aware of the special situation concussions can pose for students and schools. While a child can completely recover from a concussion, it is often recommended that a child’s return to school be gradual, following a period of complete rest at home. Social workers can play a critical role in gathering information from family and physicians and ensuring that all school staff are aware of medical recommendations about concussion management and restrictions (e.g., recess, physical education, sports). The Centers for Disease Control and Prevention has many valuable resources on concussion, including free tool kits and checklists (http://www.cdc.gov/concussion).
Finally, social workers should be aware of the adjunct resources in their community that clients may need to access, including assistance with transportation, housing, legal problems, education and/or employment, attendant care, assistive technology, and financial support.
Quick Tips for Working With Individuals With Brain Injury
• Provide simple written information, including summaries of what you are doing and what is next.
• Have a family member present in sessions.
• Speak simply and ask direct questions.
• Avoid long, complicated discussions.
• Check the client’s understanding of the information presented, making sure to allow time for processing.
• Offer breaks.
• Provide appointment reminders.
• Be careful with humor and your personal space.
Additional resources are provided in the table below:
|Resources on Brain Injury|
|BrainLine.org: provides resources for preventing, treating, and living with brain injury|
|Brain Injury Association of America: a website with links to state affiliates and their resources; also a great source of information on current advocacy efforts in this area|
|Centers for Disease Control and Prevention – Traumatic Brain Injury: extensive resource on brain injury (mild to severe), including fact sheets, tip cards, and other practical tools|
|Systematic Approach to Social Work Practice: Working With Clients With Traumatic Brain Injuries: a downloadable 132-page manual completed with support from the National Institute on Disability and Rehabilitation Research|
|Defense and Veterans Brain Injury Center: provides both information and resources on brain injury in the military for veterans, military families, and other interested parties|
With brain injury becoming more common, especially with more veterans returning home from war, it is important for social workers to understand this condition and know the best means for helping their clients get the treatment they need to successfully function from day to day. Doing so will prove beneficial not only for the client but for family and friends as well.
— Jennifer Fleming, MA, LPC, CBIS, is a day program specialist at ReMed in Paoli, PA.
— Natasha McVey, MSS, LCSW, CBIS,is a rehabilitation case manager atReMed.
— Madeleine Shusterman, LCSW, CBIS, is a clinical specialist at ReMed.
— Eli DeHope, PhD, LCSW, BCD, is a professor of undergraduate social work at West Chester University of Pennsylvania.
Coronado, V. G., Xu, L., Basavaraju, S. V., McGuire, L. C., Wald, M. W., Faul, M. D., et al. (2011). Surveillance for traumatic brain injury-related deaths—United States, 1997-2007. MMWR Surveill Summ, 60(5), 1-32.
Rutland-Brown, W., Langlois, J. A., Thomas, K. E., & Xi Y. L. (2006). Incident of traumatic brain injury in the United States, 2003. Journal of Head Trauma and Rehabilitiation, 21(6), 544-548.
Leibson, C. L., Brown, A.W., Ransom, J. E., Diehl, N. N., Perkins, P. K., Mandekar, J. et al. (2011). Incidence of traumatic brain injury across the full disease spectrum: A population-based medical record review study. Epidemiology, 22(6), 836-844.
Temkin, N. R., Corrigan, J. D., Dikmen, S. S., & Machamer, J. (2009). Social functioning after traumatic brain injury. Journal of Head Trauma Rehabilitation, 24(6), 460-467.
Vangel, S. J., Rapport, L. J., & Hanks, R. A. (2011). Effects of family and caregiver psychosocial functioning on outcomes of persons with traumatic brain injury. Journal of Head Trauma Rehabilitation, 26(1), 20-29.
van Velzen, J. M., van Bennekom, C. A., Edelaar, M. J., Sluiter, J. K. & Frings-Dresen, M. H. (2009). How many people return to work after acquired brain injury?: A systematic review. Brain Injury, 23(6), 473-488.
- [BLOG POST] 14 Things You Need to Start Doing for Your Emotional Health
- [BLOG POST] How not to forget
- [Abstract + References] The impact of maternal epilepsy on delivery and neonatal outcomes
- [Abstract] Wrist flexion rehabilitation device using arm mbed microcontroller for post-stroke patient – Full Text PDF
- [TED Talks PLAYLIST] Overcoming depression
- [ARTICLE] Maternal complications in pregnancy and childbirth for women with epilepsy: Time trends in a nationwide cohort – Full Text
- [ARTICLE] Portable Motion-Analysis Device for Upper-Limb Research, Assessment, and Rehabilitation in Non-Laboratory Settings – Full Text
- [Systematic Review] Effects of Soft Robotic Gloves on Rehabilitation Outcomes in Individuals With Sensorimotor Hand Impairments: A Systematic Review
- [THESIS] The effectiveness of acupuncture in upper extremity motor function rehabilitation in post stroke patient–systematic literature review
- [ARTICLE] Brain oscillatory activity as a biomarker of motor recovery in chronic stroke – Full Text
- [Fact Sheet] Post-Stroke Rehabilitation Fact Sheet – National Institute of Neurological Disorders and Stroke
- [Webinars] Latest Reeve Foundation Webinar Series Focuses on Self-Care for Caregivers
- [Abstract] Robotic-assisted therapy with bilateral practice improves task and motor performance in the upper extremities of chronic stroke patients: A randomised controlled trial.
- [Abstract] Immediate effects of ankle eversion taping on gait ability of chronic stroke patients.
- [Abstract] Motor imagery as a complementary technique for functional recovery after stroke: a systematic review.
- Assistive Technology (16)
- Books (131)
- Caregivers (336)
- Depression (141)
- Educational (103)
- Epilepsy (396)
- Fatigue (77)
- Hemianopsia (171)
- Music/Music therapy (46)
- Neuroplasticity (329)
- Quotations (17)
- Recovery Plateau (23)
- REHABILITATION (3,899)
- Cognitive Rehabilitation (308)
- Constraint induced movement therapy CIMT (91)
- Functional Electrical Stimulation (FES) (299)
- Gait Rehabilitation – Foot Drop (533)
- Mirror therapy (117)
- Paretic Hand (1,353)
- Pharmacological (200)
- Rehabilitation robotics (758)
- tDCS/rTMS (291)
- Tele/Home Rehabilitation (361)
- Video Games/Exergames (353)
- Virtual reality rehabilitation (513)
- Vojta Therapy – DNS (9)
- Spasticity (235)
- TBI (74)
- Uncategorized (677)
- Video (198)
Category CloudAssistive Technology Books Caregivers Cognitive Rehabilitation Constraint induced movement therapy CIMT Depression Educational Epilepsy Fatigue Functional Electrical Stimulation (FES) Gait Rehabilitation - Foot Drop Hemianopsia Mirror therapy Music/Music therapy Neuroplasticity Paretic Hand Pharmacological Quotations Recovery Plateau REHABILITATION Rehabilitation robotics Spasticity TBI tDCS/rTMS Tele/Home Rehabilitation Uncategorized Video Video Games/Exergames Virtual reality rehabilitation Vojta Therapy - DNS
TagsABI Acquired Brain Injury Action observation Activities of daily living Acupuncture ADL AED AEDs Aerobic Exercise AFO Alcohol android ankle ankle-foot orthosis antiepileptic drugs anxiety aphasia App Apps Arm Artificial intelligence assessment Assistive Technology Attention augmented reality Balance BCI biofeedback biomechanics Bioness book Botox botulinum toxin brain Brain Computer Interface Brain Injuries brain injury Brain plasticity Brain stimulation Brain–machine interface Cannabidiol cannabis Caregiver Caregivers CBD CBT cerebral palsy Cerebrovascular accident Children chronic chronic stroke cognition cognitive Cognitive behavioral therapy cognitive function cognitive impairment Cognitive Rehabilitation Cognitive Rehabilitation Communication concussion constraint induced movement therapy Constraint Induced Movement Therapy (CIMT) dementia Depression dexterity disability driving drop foot Educational EEG elbow Electrical Stimulation Electric stimulation therapy Electrodes electroencephalography Electromyography EMG emotional Epilepsy Exercise Exergames Exoskeleton exoskeletons fatigue Feedback FES finger Fingers fMRI foot drop Force Functional electrical stimulation Functional electrical stimulation (FES) functional magnetic resonance imaging functional recovery gait Gait Analysis gait rehabilitation Gait Rehabilitation - Foot Drop gait speed Game games Gamification gaming Gloreha glove Google books grasping Hand Hand exoskeleton hand function hand rehabilitation healthcare. Hemianopia Hemianopsia hemiparesis Hemiparetic hemiplegia hemiplegic hippocampus home home-based home-based rehabilitation home rehabilitation homonymous hemianopia ICF infographic iOS iPad IPhone Kinect Kinematics. Levetiracetam locomotion Lokomat lower extremity lower limb Lower Limp marijuana mCIMT Medical treatment memory mental health mental practice meta-analysis Microsoft Kinect Mild traumatic Brain Injury Mirror therapy mobility Motivation Motor motor control motor cortex Motor function motor imagery motor impairment motor learning Motor recovery motor rehabilitation motor skills Motor training Movement MRI multiple sclerosis Muscles Muscle spasticity music Music/Music therapy Nervous system neural plasticity neuro-rehabilitation Neurofeedback Neurogenesis neuroimaging Neurological neurological disorders neurology neuromodulation Neuromuscular electrical stimulation Neuron neurons Neuroplasticity Neurorehabilitation neuroscience NIBS Nintendo Wii NMES Non-invasive Non Invasive brain stimulation Noninvasive brain stimulation Occupational therapy onabotulinumtoxinA orthosis orthotics Outcomes pain Paralysis paresis paretic hand pharmacological physical activity physical rehabilitation physical therapy physiotherapy plasticity plateau post stroke Post traumatic Epilepsy pregnancy Prognosis proprioception PTSD QoL quality of life Randomized controlled trial range of motion. recovery rehabilitation REHABILITATION rehabilitation robot Rehabilitation robotics repetitive transcranial magnetic stimulation review robot robot-assisted rehabilitation Robot-assisted therapy Robotic robotic glove robotic rehabilitation robotics robots Robot sensing systems rTMS saebo Safety SCI seizure seizures self-management sEMG sensorimotor Sensors Serious games serotonin sex sleep smartphone Spasticity spinal cord injury stem cells strength Stress Stroke stroke recovery stroke rehabilitation systematic review Tablet Task-Specific Training TASK ANALYSIS TBI tDCS technology TED Tele-rehabilitation Telehealth Telemedicine telerehabilitation therapy thumb TMS Training Transcranial Direct Current Stimulation Transcranial magnetic stimulation Traumatic Brain Injury treadmill treatment UE UL Upper Extremity upper limb Upper limb rehabilitation Vagus nerve Vagus Nerve Stimulation Video Video game Video games virtual reality Virtual reality exposure therapy Virtual Reality Rehabilitation Virtual rehabilitation visual field VNS VR Walk walking walking ability wearable Wii Wrist youtube
- December 2019 (23)
- November 2019 (86)
- October 2019 (101)
- September 2019 (97)
- August 2019 (79)
- July 2019 (70)
- June 2019 (78)
- May 2019 (57)
- April 2019 (60)
- March 2019 (48)
- February 2019 (64)
- January 2019 (109)
- December 2018 (78)
- November 2018 (70)
- October 2018 (75)
- September 2018 (87)
- August 2018 (100)
- July 2018 (112)
- June 2018 (64)
- May 2018 (55)
- April 2018 (45)
- March 2018 (83)
- February 2018 (129)
- January 2018 (106)
- December 2017 (98)
- November 2017 (60)
- October 2017 (72)
- September 2017 (68)
- August 2017 (132)
- July 2017 (93)
- June 2017 (98)
- May 2017 (82)
- April 2017 (60)
- March 2017 (142)
- February 2017 (80)
- January 2017 (91)
- December 2016 (123)
- November 2016 (85)
- October 2016 (149)
- September 2016 (65)
- August 2016 (68)
- July 2016 (91)
- June 2016 (72)
- May 2016 (50)
- April 2016 (44)
- March 2016 (82)
- February 2016 (66)
- January 2016 (36)
- December 2015 (68)
- November 2015 (86)
- October 2015 (99)
- September 2015 (85)
- August 2015 (70)
- July 2015 (113)
- June 2015 (83)
- May 2015 (69)
- April 2015 (77)
- March 2015 (91)
- February 2015 (64)
- January 2015 (111)
- December 2014 (112)
- November 2014 (165)
- October 2014 (159)
- September 2014 (228)
- August 2014 (108)
- July 2014 (8)