Module

Module 5

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5.0 Aims

5.1 Behaviour
      Changes

5.2 Strategies

5.3 Analysing
     behaviour

5.4 Behaviour
     management

     Case study A
     Case study B

5.5 Understanding
      anger

5.6 Managing
     escalating
     situations

5.8 Resources

5.9 Take the      Test

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5.2 Strategies for dealing with specific behaviour changes following TBI

If you have completed Module 4
Go direct to 5.3 Analysing problem behaviour with a view to management
as you will have already covered
5.1 Changes following TBI in Module 4.3 and
5.2 Strategies for dealing with cognitive changes in Module 4.4

Management strategies

As you saw in the brainstorm activities at the end of the previous section, each cognitive deficit (eg a deficit in flexibility) will result in a person facing particular problems (eg being unable to adapt to change). There are management strategies that you and others working with the person can use to assist in minimising the impact of these deficits.

The following table gives a comprehensive list of strategies you can use for each specific cognitive deficit (a printable version is available in the resources section at the end of this module).

Deficit Problems arising Management strategies
  The person may: You and others can:
Speed of information processing

- take longer to complete tasks

- take longer to get ideas together and answer someone

- be unable to keep track of lengthy conversations and instructions

- make allowances and give the person extra time

- speak clearly and evenly

- present only one thing at a time

- try not to interrupt or answer for the person

- check that the person is keeping up with the conversation

Fatigue - tire quickly during mental effort

- have reduced tolerance and ability to cope

- become irritable easily

- have their other problems exacerbated
- encourage the person to take rest breaks

- schedule more demanding or essential tasks when the person is at their best (often morning)

- arrange activities to be shorter where there is an achievable goal
Mental tracking - have difficulty following instructions

- lose track of what they are thinking/doing

- get information mixed up or become confused
- keep activities and instructions short and uncomplicated

- ask specific or direct questions

- provide reminders to the next step in a task
Attention

- appear not to listen

- miss details

- forget what people have said

- have difficulties concentrating

- be unable to cope with more than one thing at a time

- be easily distracted

- change the subject often

- not complete what they say

- get bored easily

- use short, simple sentences

- shorten activities so they can be completed

- ensure the person writes down important information

- assist the person to check what they are doing

- encourage the person to engage in only one activity at a time

- reduce external distractions (noise, other people)

- if the person has been distracted, interrupt and bring their focus back to task

- alternate activities to maintain interest
Memory - have difficulty learning new things

- be forgetful (what people say, names, appointments)

- lose things

- have difficulty recalling what they have learnt

- repeat information as necessary

- encourage rehearsal of new information

- encourage use of external memory aids; diaries, calendars, time tables

- maintain 'special places' for belongings

- give reminders and prompts to assist recall

Problem solving - have difficulty working out solutions to problems

- be unable to generate new ideas

- have a disordered approach to problem solving
- help identify an achievable outcome for the task, ensure there is a purpose

- avoid giving open-ended tasks

- help the person to approach tasks in a more systematic manner

- assist the person to break a task down into smaller components

- reduce the demands made upon the person (one thing at a time, start simple)
Flexibility - be unable to accommodate for, or adapt to change

- become 'stuck in a rut' unable to develop new strategies

- persist with erroneous methods despite feedback

- repeatedly refer to the same topic or return to that topic when doing something else (perseverate)
- assist the person to identify initial signs of frustration and recognise that is a time to stop what they are doing

- provide alternative ways of completing a task so a choice is available

- direct the person to another activity if they are continually making errors

- if they are talking off topic, direct the person back to task by asking specific questions
Planning and organising - difficulty preparing for a task

- be unable to work out the steps or sequence involved in a task

- not consider the consequences of their actions

- have problems with organising their own thoughts and explaining things to others
- encourage the person to consider what they are about to do before commencing an activity

- provide a written structure or guideline outlining the steps in order

- give prompts or steps

- help develop a timetable (weekly, daily) to establish a routine of activities

- keep the environment organised so items are always kept in the same place

- encourage the person to take time to think about what they want to say
Reasoning - have a rigid and concrete thinking style

- take statements literally

- fail to "put themselves in another's shoes"

- be resistant to change

- have a simplistic understanding of emotions

- show poor judgment and poor decision making skills

- use simple and direct language and avoid talking in abstract terms

- explain changes in routine in advance, giving reasons

- try not to get into arguments with the person

- avoid using emotional undertones

- provide real life examples (preferably the person's) when offering explanations

Self-monitoring - show poor adherence to rules

- not realise they have made errors because they have not checked their work

- 'hog' conversations

- be verbose and keep talking when others are no longer interested
- reinforce specific requirements of an activity

- encourage the person to check over their work

- immediately indicate, or provide feedback, when errors occur or when the person talks too much

- use signals, which have been agreed to in advance, to let them know they are talking too much

- encourage turn taking in conversations
Insight - be unaware of cognitive and physical limitations

- set unrealistic goals, plans and expectations

- be resistant to the effort of carers/staff
- provide explanation why proposed action (not the person's own plan) is useful, and reason through the steps (small steps, start gradually etc)

- help to identify realistic goals - these may be smaller components of a lager plan, but more achievable