When you work with people who have brain damage

When you work with people who have brain damage, such as people with intellectual disabilities, it is useful to know more about the functioning of the brains. This time, therefore, a comprehensive report of Fienie Gere Kink. Fienie's accompanist and musical theater on the activity of Amstelrade, residential institution for people with physical and multiple disabilities in Amstelveen.

The brains are the "control room" of our work. Hit it to one or another reason, damaged or the information processing not more than can have major consequences, both physically and mentally. Below is an outline of what may have brain damage to affect the personality, function and behavior of a client and where you have to reckon with as counselor or therapist.

These are people with non-congenital brain damage, but some aspects are also applicable to people with acquired brain injury.

The brains consist of the following components:
- big brains
- Small brains (fine motor skills)
- Brainstem (automatic life functions)
- Between brains (selection, forward hormones)

Incentive transfer between all those billions of brain cells occurs via neurotransmitters. Consider them only if certain substances are the conduit for information. In disorders such as depression or ADHD have too little or too much of a particular substance.
You can also divide the brains of three "levels" with different functions:
1. automatic functions, reflexes
2. performing - as level 2 fails you get a client who wants to, but can not. Possibly leading to depression and
aggression. are an example Parkinson's patients
3. want - as level 3 fails you get a client who takes no initiative, no taste function anymore. this client
requires an external stimulus. This symptom you often see in clients with brain damage
anoxia (coma)
At a stroke can be both level 2 and 3 fall out.

The effects of a brain injury to function as a person
Most of our functions are realized by cooperation of various parts of the brain (systems). The more complex the function, the more co-operating parts of the brain are required. In a diffuse brain damage these so-called. "High" functions are disturbed (by accident, oxygen deficiency, or meningitis). These include: attention, concentration, thinking, memory, can form an idea of ​​the future. Egocentrie than common. Properties like "social behavior" (learned!), And "you can empathize with others" (empathy), we lose very quickly. The damaged brains often have to work so hard to function, the attention, but one thing can be addressed. That explains why one example. "Just for him nice things" or seemingly "random" can remember. The brains make a selection in order of importance.

It also happens that the person remains with brain damage "hang" at the age he is receiving at the time of his accident. E.g. a 19 year old going five years back in time is 14 and remains his whole life an adolescent. This is called "mental fixation".

When a stroke or cerebral hemorrhage is brain damage the more locally. Think of a left- or right-sided paralysis. A certain "control center" in the brains affected .. Damage to the left side of the brains, where the control center is for language, can lead to aphasia. Damage to the right side, which is the control center for spatial orientation, to "neglect". The client is no longer aware of the affected body part. In the frontal portion of the brains is the control center for the targeted action. Damage can lead to apraxia there.

Possible consequences of brain damage

neurological disorders

Cognitive disorders

Changes in personality, emotion and behavior

psychiatric disorders

obtundation
paralysis
incoordination
movement disorders
sensory disorders
Other sensory impairment
articulation disorder: dysarthria
disorders of bladder and intestines
disorders of sexual functions
memory disorders
of attention and concentration problems
apraxia
aphasia
slower pace information processing
inzicht- / restriction list
perception disorders / neglect
planning and organizational problems
limited problem solving skills
apathy
reduction initiative
irritability / aggression
mood changes
mood swings
tantrums
disinhibited behavior
eetontremming
libido changes
decorum decrease
risk-taking behavior
emotional numbness
coercion laugh / cry
egocentricity
empathy-taking
altered sense of humor
trouble with perspective
disturbed disease awareness / gaining insight
psychotic disorders
mood disorders
anxiety disorders
posttraumatic stress disorder


The behavior that a client is dependent on a number of factors:
A. The injury - which is fixed and immutable. If a certain behavior repeats itself is injury related.
B. The reaction - every client has their own way of responding to and processing the acquired injury. That can range from intense to left.
C. The personality - the personality that the client was before the injury, how he was in life.
D. The treatment - how the environment responds to the client but also the expectations and desires that can project the environment on the client.

It is important, taking into account the points A to C, to achieve a good treatment. There is a risk of excessive demands of the client (the client is overestimated, about its borders and could completely collapse) or just questioning (the client is stimulated enough or does not feel taken seriously and will show boredom behavior).

When dealing with people with brain injury you should consider the following basic needs:
- Need for freedom
- Need for autonomy
- Need for bonding
- Need for effectiveness
- Need for security

It is the task of the counselor or therapist to assist the client as much as possible in its efforts to function independently again (or as independently as possible). Wherein the constant tacking between those different needs, eg. Between the need for freedom and autonomy and the need for security. Due to limited insight into illness is the gap between what the client wants and can often be very large. The client wants eg. His old job picking up again, or return to play saxophone. Take the client seriously herein. Offers him the opportunity to familiarize themselves with work or a musical hobby. So that the client can experience what his capabilities.

When you start a program, the following are important:
- Do not go out of the inability of the client, but keep in mind!
- It is not exactly as the customer wants it, then there can follow an "explosion". Do not be instantly put off,
this can be done
- Look after three months how it goes: there is performance loss, fatigue and the like than it can
the client still overwhelmed or has overestimated himself. The client eg. Too much choice, then comes the need
safety at risk.
- Do not be patronizing, let the client go wrong. But make sure that you are there to support.

As you can see, it's hard to really map out a course of action. Besides knowing what's going on with your client, it is equally important that as a supervisor also dares to go by your feelings. Assume that someone calls you, but make sure you know in your mind what's going on with the client. So you can work on the one hand to the acceptance of a common (including the client himself) invisible, irreversible disability and also to explore and develop the opportunities that are there.

Fienie Gere Kink

Thanks to Hans van Dam, professor and consultant neurology / brain injury

Website
http://www.hersenletsel.net (on the website of the Foundation Brainstorm can help you with all your questions and find you
names and links to several organizations in the field of brain injury)

Literature
For a good overview:
"Changed life support after brain injury" Jenny H.W. Palm. Assen: Van Gorcum, 1997. ISBN 90 232 3301 8
For music continues:
"Music made to measure", under ed. By Madeleen de Bruijn. Nijkerk: Intro 1994. ISBN 905574011X