- TOOL KITS
- A. The NEXT Step
- B. Promoting Independence
- C. Phone Apps
- D. Return to Work
- E. Motivational Interviewing
- F. Paediatric Brain Injury Rehabilitation Resources
- a) Introduction
- 0. Introduction
- 1. Working together promoting independence
- 2 . Using this kit
- b) Issues, goals, action
- 3. Identifying issues W
- 4. Setting goals W
- 5. Making goals happen W
- 6. Monitoring progress W
- c) Strategies Myself and my relationships
- 7. My behaviour's changed W
- 8. Thinking
- 9. Relationships W
- Managing memory, money and time
- 11. Remembering information and messages
- 12. Finances and handling money W
- 13. Managing time W
- Household tasks
- 14. Food and shopping W
- 15. Food and meals W
- 16. House keeping
- 17. Laundry
- Getting around
- 18. Public transport W
- 19. Accessing the community
- Life tasks
- 20. Self care
- 21. Fitness
- 22. Leisure
- 23. Employment
- 24. Continue learning
- 25. Health and well-being
- 26. Emergencies
- 9.2 W
to the injury
- 9.5 W
Why don't I seem to get on with people as I used to?
After a brain injury you may notice changes in how you relate to people and possibly how they relate to you. How people react and relate to each other is as individual as the type of injury you may have acquired. Here is some information that may be useful in helping you in the many different relationships we form throughout life. These may include:
9.1 People in established relationships
9.2 Establishing new relationships
9.3 Getting on with family
9.4 Adjusting to the injury
9.5 Working with others
It is difficult to keep some relationships going - ones I never thought would falter.
How can I maintain a loving relationship with my partner?
An established relationship is one that you were involved in before your accident.
After brain injury, it is often important to rebuild the affection shared between partners. With all the stress that occurs after one partner has an injury this can easily be lost.
Also, a high number of relationships break down after one partner has a brain injury. By building up the affection and romance in a relationship, there may be an improved chance of your relationship weathering the storm.
Some tips for building up the romance and affection in your relationship:
- Make sure you thank your partner for any help they provide you.
- Remember to compliment your partner on their appearance. Compliment your partner on clothes they wear that make them look attractive.
- Think of buying your partner a romantic gift from time to time to show your appreciation - flowers, chocolates etc.
- Make sure you remember your partner's birthday, your relationship anniversary Valentine's day or other important days in your relationship.
- If your partner likes physical affection, make sure you give your partner a hug or a kiss every day. Make sure you tell your partner how much you love them.
- If your partner is uncomfortable with too much physical affection, hugs and kisses, then back off. Reduce the number of times you try to give your partner a hug or a kiss.
- Take your partner out on a romantic date to dinner, dancing or whatever they like.
- Plan a romantic evening at home. Use candlelight if you both like it, play some romantic music. Share a nice meal together.
- Focus on doing the things listed in these tips for a while and don't focus too much on sex.
- Show consideration to your partner - notice when they are tired and stressed. Is there anything you can do to help them when they are feeling this way?
- Can you think of anything else that will rebuild the romance in your relationship?
In there anyone useful I can contact about my personal relationships?
If you and your partner are having relationship difficulties, you can ask to speak to the social worker or the clinical psychologist in the Brain Injury Rehabilitation Programs. They are experienced in working with and supporting couples having to adjust to a brain injury. They can also refer you to other experienced counselors if required.
I find it difficult to meet new people and make new friends.
Some people find that after a brain injury they are more socially isolated. They have lost friends from before the injury and have not made new friends after the injury. There are three parts to the following exercise. The first map will help us identify all those people that we have in our lives. This is called mapping our existing social networks. After we have done that, if we decide that we would like to develop some new relationships, there are two exercises that are part of creating new social networks. This involves feeling good about ourselves, and planning places to go where we could meet new people.
Part 1: Mapping our existing social networks
The following worksheet is called "Levels of Relationships". The four circles represent increasing levels of closeness as we move from the outer circle to the inner circle. Some definitions of the four levels are contained below.
Level. People I don't know. These are people you've met for the first time. For example - bus drivers, shop attendants, a person at a nightclub.
Level 2. Acquaintances. These are people that you see on a regular basis at a group activity. You know each other's name and can have a general conversation. For example - TAFE teachers, gym instructors, residential staff, fellow students attending a course, people down at the pub.
Level 3. Friends. These are people that you do things with, can ask personal questions and share your own personal worries and experiences. For example - friends from school or work, friends from the local neighbourhood.
Level 4. People I am closest to. These are people who stick by you through thick and thin, people you can share the most private details of your life. For example - dose family members, spouses, and long term friends.
Using the worksheet, write down people you can identify that fit into any of the four levels. You may not be able to think of someone to include on all four levels.
- People I don't know
- People closest to me:
Part 2 Meeting new people - creating new social networks
Step1: Self-presentation and self-confidence
A lot of people report feeling they are not as attractive after a brain injury and have less confidence. It is important to identify ways of building up self-confidence. This will help us when we do meet new people.
How to feel good about ourselves
If we feel good about ourselves, when we meet people we are more likely to make a good impression. After a brain injury people can often focus on the negatives in their lives, for example, I've got no licence, no job, no relationship. I'm disabled. Here are two examples of exercises that if practised regularly can help us to start feeling better about ourselves. If we are feeling good about ourselves, we are more likely to be attractive to other people.
Practical exercise a) : Self-praise
Give yourself genuine praise wherever possible. For example:
- I did that well
- I am pleased with the way I said that.
- I didn't do so well at this, but it was a good try.
- I did the best I could.
Spend a few minutes each day recalling something you have done well, feel pleased about or like about yourself.
Strategies for action
1. At the end of each day think over what you have done during the day. Think about how you did each activity. Think about what you did well and what you achieved.
2. If you have difficulty remembering what you did during the day, you may need to write your activities down in a diary, journal or use a weekly timetable so you can reflect on what you have achieved over time.
3. Using a diary or journal write down beside each activity what you did well and why. This will enable you to see the successes in your life. It will help you to feel good about yourself.
4. If you look at your day and you find there is nothing to feel good about or you don't seem to be doing anything, you may need to seek some assistance from others.
Practical exercise b) : Being fair to yourself
Most of us highlight our weaknesses and take our strengths for granted. Spend a few minutes making a list of your negative points or weaknesses on a piece of paper. Then spend a few minutes making a list of your positive points or strengths.
Did you come up with more negatives than positives? How easy was it to find positives? Most people find that it is easier to identify their weaknesses than their strengths. To overcome this, practice acknowledging your 'strengths' in fair proportion to your 'weaknesses'.
Strategies for action
1. Divide a piece of paper into two columns.
2. At the top of one column write "weaknesses'.
3. At the top of the other column write "strengths'.
4. Spend five minutes writing down what you think are your weaknesses.
5. Spend five minutes writing down what you think are your strengths.
6. If you have difficulty thinking of strengths, ask other people whom you trust. If you have kept a diary or journal where you have written down how you have felt about what you have done during the day, this can help you identify your strengths.
7. With the weaknesses you have identified, look at them and see how you can turn these into strengths. These may be issues you can add to your issue sheet. You can then work on these weaknesses as goals. They too can become transformed into strengths. (Modified from T. Nove. A Training Manual on Assertiveness Skills for Community Educators and Health Professionals).
Step 2 Getting out
If we would like to go somewhere new where it is possible to meet people, there are a number of issues to think through. Where are places to go to meet people? What sort of activities provide good opportunities to meet people?
Which of these ways outlined below do you use to find out about activities/places to go?
- Staff member
- Another person with a brain injury
- Resource directory
Identifying where you can meet people through directories or by attending groups is only the first step. Following is a list of issues you may need to think through before heading off.
If you have chosen an activity / place to go, which of the following things do you need to think about?
- Do I have any physical limitations that could create problems? [E.g. getting up stairs, needing a disabled toilet]
- How will I get there?
- Will I feel safe?
- How much will it cost?
- Do I need a support person in order to take part? If so, how will this be arranged?
- Will I be the only person with a disability there? Will this feel okay?
- Will I need to remember things? How can I ensure this?
- Do I need to be able to write something down or use a mini-tape recorder?
- Will the activity / place I go be noisy?
- How will I avoid the problem of continually being distracted?
Once you have thought about these things, the next step is to practically plan how you will get there.
Is there anyone I can contact about getting out and meeting people?
If you are wanting to get out more, you can speak to:
- Brain Injury Rehabilitation Unit staff
- The Recreation Officer
- Residential Care Staff
- Occupational Therapists.
If you are not feeling confident about meeting people, or are having difficulty making new friends, then you can speak to:
- Brain Injury Rehabilitation Unit staff
- Social Worker or
- Clinical Psychologist
Other services that can provide you with opportunities to meet people include:
- the Brain Injury Association
- New South Wales Sports Council for the Disabled
I find it difficult to get on with my family.
Often people are either living at home or have returned to the family home after having had a brain injury: Families often stand by a person, even when good friends fall by the wayside.
The Brain Injury Rehabilitation Unit interviewed a number of families about what it was like when one family member had a brain injury.
Many families reported that the brain injury brought them closer together. Others said that it drove them further apart. Some said that they were having less conflict, other said there was more family conflict since the injury: Many families reported being stressed and having a worsened financial situation.
How can I get along with my family?
- Be appreciative of the love and support you receive. Saying thank you can make a big difference for the members of your family.
- Try to be flexible and fit in with people.
- Encourage your family to find out as much as possible about how the brain injury might have affected your life, and what things you are able to do.
- Don't expect miracles. If you had difficulties getting on with your family before the injury these difficulties are likely to still be there.
- Given that many families reported being worse off financially after someone had a brain injury, try to live within your budget, and pay a weekly amount for board.
- Try and have breaks from your family. Respite is one way of achieving this. You and your family will both probably feel better afterwards.
- Be as independent as possible, but let people help you.
- Try and control any frustration and anger you may feel. See Section 7 My Behaviour's changed, which has strategies to assist you with this.
- If you are moving back home, try to let bygones be bygones. If there were fights going back many years, try to put them away, to let them go, and start anew.
- If it is too noisy at home, and this gets on your nerves, it is good if you have a room or a place you can go to get peace and quiet.
Michael is a single man in his late thirties. At the time of the injury, Michael was working as an usher in a Sydney cinema and lived with a friend in Sydney. Michael sustained a traumatic brain injury when as a pedestrian he was knocked down by a car on his way home from work. He was crossing against a Don't Walk sign.
He spent many months in an inpatient rehabilitation unit near his family. His family visited him regularly at hospital. Michael's parents were willing to be his full-time carers and Michael was happy to return home with them. He had to learn to fit back in with his parents, as he hadn't lived at home for many years. When he got angry, Michael's parents had to learn to leave him alone and let him go into his bedroom and shut the door. Michael went out to a program during the day, so that both he and his parents had a break. He paid his parents board every fortnight when his cheque came in. Michael appreciated the company and support he received from his parents as he lost contact with most of his friends from before the injury.
Who can I talk to about getting on with my family?
If you are having difficulties getting on with your family, you can ask to speak to the
- Brain Injury Rehabilitation Unit
- Social Worker or the
- Clinical Psychologist
They are experienced in working with and supporting families when someone has had a brain injury.
I'm having problems adjusting to my injury.
After a brain injury, many people feel as if their world has been turned upside down. They want things to be back the way they were before the injury, but this does not always appear possible. People can feel anxious, depressed, angry or frustrated. But they also have a strong determination and hold onto the hope that things will get back to the way they were. Below are some strategies that people with brain injuries have identified that are helpful during the process of rehabilitation and long term adjustment to brain injury.
How do I deal with all the changes that have occurred since the brain injury?
- Be able to laugh
- Attend a support group with other people with brain injury
- Accept help, don't try to do it all on your own
- Be patient, things may take years to sort out, not weeks or months
- Try relaxation
- Try not to get stuck in ruts, be flexible
- Try to be as independent as possible
- Face the fear, don't run away. The further you run, the bigger the fear becomes
- Allow yourself to be angry or sad - these are usually signs of coping rather than non-coping
- Allow yourself to occasionally feel - Why me?
Susan was in her early twenties and worked as a sales assistant. She sustained a brain injury when she fell while rock climbing. After the injury, Susan was sure that she would be alright. She tried to return to her job and found that she was becoming rude to her customers and got headaches after standing for a couple of hours. Susan loved her job and was depressed at giving it up. She also felt that people were staring at her as if she was "stupid" because of the brain injury.
She was finding it hard to meet guys, and felt that she had lost her confidence. She was going through times when she felt she was stuck in the same groove and that she would die single. Her friends from before the injury had all got married.
Recently, things have started to change. Susan had been talking to another person with a brain injury who suggested she attend TAFE. She enrolled in a TAFE course on computers and for the first time spoke to a TAFE disability counselor about some of her negative feelings. She found that talking about everything that had happened since the injury made her feel better. She also enjoyed getting out to TAFE and meeting people. She was also doing well in her course and this gave her added confidence.
It is now two years since Susan's injury. She still feels sad, but now realises she will never get back the things that she has lost from her life because of the brain injury. However, she has started to enjoy life again, and is feeling hopeful that her life will continue to improve in the future.
Is there anyone I can contact to help me to adjust to my injury?
If you are having difficulties adjusting to the injury, you can ask to speak to the
- Brain Injury Rehabilitation Unit
- Social Worker
- Clinical Psychologist
- Rehabilitation Doctor
They are experienced in working with and supporting people adjusting to a brain injury. There are also brain injury support groups that people can attend.
How can I work with others?
By simply being alive you have to talk with someone else. It might be at home , or at the local supermarket, over the telephone, at work or study: most people have to work with others in some way or another to get by.
The way you behave is influenced by who it is you are interacting with and what the situation is. In all these different situations, you and the person you are communicating with have rights and responsibilities. You should be aware of these so you can:
- make informed decisions. This means to make a decision when you know what all the facts are
- communicate your intentions clearly
- not be influenced by others.
You should also be aware of the other person's rights and responsibilities
What are my rights and responsibilities?
When you decide to help yourself and you are interacting with others, you need to be aware of what your rights and responsibilities are in different situations and relationships.
You have the right to be:
- treated as an equal
- treated with respect
- able to access services and facilities
- provided with information to make an informed decision
- vocal in saying what you want or think is important
- able to live in the least restrictive environment
- refuse or withdraw from treatment (unless you are under a guardianship order)
It is your responsibility to:
- treat others as equals
- treat others with respect
- tell others what is important to you
- ask for more information if something is not clear
- ask for help
- listen to what other people have to say
- participate in your program to achieve your goals
Achieving your goals
To a very large extent, whether or not you achieve your goals is up to you. The role you play in doing this is crucial. To achieve your goals it means:
- practice and hard work
- working with people who are trying to support you
- listening to others so you can make an informed decision
- trying a new way of doing something, or thinking about something in a different way.
Sometimes it can take a long time to achieve goals.
What are the rights and responsibilities of those I work with?
To achieve some of your goals you may need to work with other people. For example, these people may be friends, a member of your family, a person from the Brain Injury Rehabilitation Unit or a paid support worker from a Service Provider.
These people may have assisted you to set your goals. These people may also assist you to achieve them. You might have to work with people only sometimes or you may have to work very closely with them. They may provide you with emotional support, practical assistance or both.
It is important to understand that the person working with you also has rights and responsibilities. It is as important for you to be aware of their rights and responsibilities as it is theirs to know yours. Their responsibility might not only be to you.
Helpers rights include being:
- treated as an equal
- treated fairly
- able to speak about what they feel is important
- able to feel safe in performing their duties
Helpers responsibilities are to:
- treat you as an equal
- treat you fairly
- provide you with respect
- enable you to feel safe
- provide you with information to make decisions
- enable you to participate in your program to achieve your goals
- inform you of their responsibilities to others. For example, they may be responsible to an employer, the Insurance Company or the Brain Injury Rehabilitation Team.
It is important to remember your helpers will also have responsibilities to others. These responsibilities provide boundaries about how they relate to you as a person and what they can do with you.
The support worker, therapist and client relationship
A support worker or therapist may have the same leisure interests as you but cannot participate in these with you outside of work time. As a worker they may be required to enable you achieve this leisure interest. Worker-client relationships are based on the support worker or therapist enabling you to do something.
Although you may develop a friendship and rapport, it is within the working relationship. Understanding the worker-client relationship can be difficult. It can be difficult because you both spend a great amount of time together and you work so closely together you know each other very well.
It is important to try and keep the relationship as a working one. Workers move on and if you have become friendly with this worker and overstepped the worker-client boundary it is hard to say goodbye. It can be difficult to accept the change and move on with the replacement worker.
A support worker or therapist is employed by a Service Provider. The worker has responsibilities to their employer as well as to you. They have to report to another about what they do with you and how you are progressing toward achieving your goals. People work as a team and share information. This type of relationship is different to a friendship.
Keeping track of everyone you work with
It is difficult to keep track of everyone you may have contact with and why you have contact with them. It is also important to be aware of those people you may have to have contact with if there is an emergency. One way of knowing who to call and when, is to map out those people you deal with in everyday life.
Worksheet 5 allows you to identify all the different people you will have contact with to achieve your goals. It is common for people like yourself to be involved with a combination of people. The number of people depends upon your goals, needs, support and financial situation. Often different people are only concerned with helping you in one specific area. To help keep track of the different people you work with you can map those you are involved with, so you know who to contact and when. Worksheet 6 allows you to map all the different people you work with. It is important to know who is responsible for what part of your program.
You can then contact the right person the first time. You can record all the different people you have contact with on Worksheet 5. Keep this as a master copy in a safe place. Fill it in. The name refers to the person's whole name. Write down who they are underneath their name. For example, a volunteer or your employer. The address column is where you write down the person's work address. The telephone number is their work number. You can include a fax number or pager number if they have one. You might program your phone with important numbers too.
When Gemma moved out from home the number of people with whom she had to work increased. She was involved with the Brain Injury Rehabilitation Unit social worker, occupational therapist, physiotherapist, recreation officer, social worker and speech pathologist. This changed further down the track. She continued to be involved with the Brain Injury Rehabilitation Unit social worker, and changed to an occupational therapist from a private company and included a Service Provider who provides support worker assistance, the support workers themselves, the local Housing Co¬op, her solicitor, as she has an insurance claim pending, her local GP, bank, telecom, and family members to name a few.
Gemma has a large number of people she works with. She has developed a personal contact list and a contact map of others. These are included so you can see how it all fits together. Gemma keeps her contact list with her goals in a folder. She keeps her contact map on her fridge.
If Gemma has a concern with shopping, she asks her support worker. If Gemma has a concern with a support worker, she contacts the Service Provider. If Gemma has a concern with her program, she contacts the occupational therapist. If Gemma has a problem with her accommodation, she contacts the Housing Co-op. And the contact numbers go on!
While you can identify the people who are working with you and how they are helping you to achieve your goals, it is important for you to realise how important you are to ensuring the success of the program and the achievement of your goals. As your contact map shows, you are the centre of the program and you have responsibilities to others to be involved, honest and to participate.