Acquired Brain Injury after a Brain Tumor Removal - Case Study Example

Name: Tutor: Title: Acquired Brain Injury (Traumatic- 12 months post injury). Course: Date: Section A: Case study I am a 37 year old man living with my wife and two teenage sons in Barcaldine in Central Queensland. I sustained a traumatic brain injury after a brain tumor removal a year earlier leading to memory loss particularly short-term, lack of motivation, cognitive problems, behavioral change, inertia, occasional confusion, paranoia, incapacity to learn fresh things, and psychosocial problems. My home is basically low set with four steps, and it also has 2 levels inside with my bathroom and bedroom on the upper level. There are various challenges that I would face in relation to my current home. For instance, the fact that my home has stairs poses a challenge to me because of difficulty in mobility brought about by my current condition. Posing a great burden to my family is also a great challenge. In addition, poor accessibility to suitable community resources and services due to lack of wheelchair ramps is another challenge. Employment is also a great challenge at the moment. Section B: Disability Awareness Brief outline of effect of condition on bodily functions Acquired brain injury (ABI) is a catastrophic occurrence that affects every feature of a man’s life and the people special to them. ABI affects various bodily functions. The domains of the bodily functions affected include cognitive, behavioral, and psychosocial. The interference to cognitive functioning after brain injury is conclusively the main deficit following various forms of injury to the brain. These discrepancies are indicative of loss of concentration and focus, impaired executive performance, impaired skills of multitasking, distractibility, and impaired memory known to impede sequencing, successful planning, and organizational skills (Mahar & Fraser, 2012, pg 51). ABI has greatly affected my multitasking skills in the sense that I am not able to perform various tasks at the same time. This is greatly evident when I try to read a newspaper and eat at the same time. Occasional confusion and impaired reasoning are other cognitive aspects that have been evident in my life. According to (Rushworth, 2009, pg 3), the outcomes of an ABI are very complex, profound and multiple. Attention and concentration that are impaired have been considered the prominent features of ABI not considering the degree of injury. The ability to maintain concentration for a prolonged time frame is referred to as sustained attention. Attention that is divided enables someone to dispense the available resources to tackle more than one supply of information. Sadly, such difficulties are habitually undetected in the process of cognitive evaluation after brain injury (Mahar & Fraser, 2012, pg 52). People are expected to follow traditional social rules and certainly, peer recognition is realized through the behavior adjustment to meet the expectations of the society (Mahar & Fraser, 2012, pg 52). On the contrary, someone with an ABI will mostly show signs of behavioral changes that may entail; destructive actions, physical and verbal aggression, delusions, and sexual disinhibition. These behavioral changes have been greatly revealed in my life following the event of ABI. Research shows that psychosocial effects following ABI are massive and more incapacitating compared to cognitive and physical. Following ABI, I have experienced a lot of symptoms related to anxiety and depression. Personality change is another bodily function that has been affected by ABI. Personality change is amongst the major prevailing psychiatric disorders linked to brain injury and it indicates frontal lobe damage (Mahar & Fraser, 2012, pg 53). Insufficient motivation is another feature that is evident following my disability. This is shown by various factors such as disconnection, lethargy, disinterest, and lack of emotional reaction. Effects on Family Unit Family system of people with ABI as well as other disabilities that are chronic usually goes through long-term alteration difficulties. Various issues, not excluding family strain, emotional difficulties, depression, social isolation, burden, income loss, and difficulties adjusting to fresh roles are mostly reported (Boschen, et al, 2007, pg 19). A lot of these hardships have faced my family as they try to adjust to my new condition. Income loss has been the major hardship since my condition limits me to work a lot. As cognitive impairment are frequently increased by irritability, depression, and disinhibited performance, they disadvantage the person as well as their family. Generally, members of the family experience grief and shock in the primary stages after a sudden injury that is life-threatening (Watanabe, et al, 2001, pg 370). Families that cope with a brain injury pose a greater incidence of mood disorders, social adjustment hardship and anxiety disorders (Hanks, R, 2007, pg 43). Identification of international, national, state, local organizations There are various organizations that I can provide me with information and/or support. For instance, there is Australian Federation of Disability Organizations (AFDO) whose mission is to support the rights of individuals with disability in Australia and enable them take part entirely in Australian life (Hobson, 2012, pg 2). This organization can be reached physically, via web or by phone. Another organization where I can get information regarding disability is the World Health Organization (WHO) which is an international organization that formulated the International Classification of Functioning, Disability, and Health (ICF). This provides an international evaluation of disability and 7 scores that is domain specific (Garlin et al, 2010, pg 1). A lot of authors have supported the framework of ICF and its helpfulness for providing comparable information on health from numerous settings, across multiple applications, as well as across nations (Bruyeye et al, 2005, pg 3). I can also get information from the Disability Service Act, Queensland (Disability Service Act 2006, 2012). How organizations will help In my area, there are organizations that would help me to holistically manage my own daily activities of living, like domiciliary nursing, community nursing, day respite services and the likely frequency of services. Additionally, some organizations may offer psychological, spiritual or social support in my area. One such organization is the ‘Consultancy’, a professional clinical service that offers outreach management support of behavior for individuals with ABI (Kelly & Parry, 2008, pg 302). Section C: Daily Living Time/Activity Ease of doing an activity or participating (0-4) 0=no difficulty, 4=complete difficulty Barriers or Facilitators you have encountered Your solution/s to overcome the barriers Approximated financial cost to you 7am: Getting out of bed 3 No railing to use Electronic bed would help US $ 588.23 7.15 am: Going to the toilet 4 Unable to stand Required personal assistance US $ 117.64 7.30 am: Go up/down stairs 4 No railing to use Required personal assistance. Moving to another house where moving up/down the stairs is not required. US $ 235.29 7.45 am: Shower 1 Help from wife Continued support from my wife. n/a 8.00am: Dress 3 Very slow Personal assistance required US $ 235.29 8.15am: Meals 3 Very slow Personal assistance required e.g. wife or sons n/a 8.45am. Get on a bus in wheelchair 4 Poor accessibility due to immense population of people as well as lack of wheelchair accessibility. Wheelchair accessibility at bus stations. Personal car. US $ 5882.35. For the car. 9.00am. Work 4 Discrimination from colleagues. Poor participation due to reduced self-esteem. Low productivity due to incomplete tasks. Frequent fatigue. Increased self-esteem. Implementation of human rights for those living with disability at workplaces. Allocation of lighter duties at the work place. Allowed to work for lesser hours. Perpetual positive rehabilitation process for better health status outcome. US $ 3000.00. To start a personal business. 4.00pm. Going back home 4 Poor accessibility by use of wheelchair. Discrimination by other bus users. Improved accessibility of wheelchair Disability awareness campaign so that people should respect those living with disability. US $ 5882.35. For the car. 5.00pm. Arrives home 4 Body exhaustion Allowed to leave work a bit earlier. US $ 3000.00. To start a personal business. 5.15pm. Takes tea 2 Assisted by my sons Should spend a lot of time with them n/a 5.30pm Toilet 1 Unable to stand Require personal assistance e.g. wife. n/a 6.00pm. Shower 1 Help from my wife Continued support from wife n/a 7.00pm. Watching television with family 2 Poor concentration Attending therapy regularly US $ 58.82 per session. 8.00pm. Meals 3 Very slow Support from wife or sons n/a 9.00pm. Bed time 3 No railing to use Electronic bed would help US $ 588.23 Section D: Challenges The social restrictions faced as a result of my disability. Maintaining family and friend relationship Present developments argue that the community of disability supports disability conceptualization within numerous current ICF iteration. ICF utility as a better classification tool of conditions of health and resulting practical status can be seen in a rising number of clinical sectors both abroad and in United States, ranging across various disability regions and conditions. Research has indicated that current experiences with the ICF basically reveal passion concerning the ICF potential as a mechanism to grade the functional outcomes of health issues, to provide a vital indication for existing measures of health-status (Bruyeye et al, 2005, pg 10). A person with ABI might experience a number of communication, cognitive, psychological, physical, emotional, and social difficulties. These hardships are likely to bring about intense challenges and disruption for both the victims and their kin, causing return to autonomous living within the community a crucial focus. Successful community incorporation, or in effect a person’s life quality, mainly entails retrieving a sense of ‘self’, autonomous in a person’s living circumstance, relationships with people, and actions to fill a person’s time (Wiseman-Hakes, et al, 2010, pg 356). This objective has been mirrored in the rising number of publications like ICF focused particularly on life quality following brain injury. With this in mind, it can only be easy to maintain my family and friend relationship when proper intervention and counseling is provided so that people can acknowledge various factors encompassed in disability rehabilitation. Following my sustained ABI, I experienced social isolation and placed a major burden on my family members as a result of challenging behaviors and impairments that prevents me from living an independent life. Various programs in the community provide help to caregivers. This entails connecting them to various community services and education on dealing with challenging behaviors. When my family and friends are well informed about the management of challenging behaviors brought about by my chronic condition, they are able to invent new measures and interventions of dealing with my situation regardless of it being a compromising event. Community or environmental challenges faced and how I have adjusted to them. There are a number of factors of disabilities faced by individuals with ABI and aspects that encounter them within the community. The consequences of ABI are complex, and people are differently affected. With the numerous impact of ABI on one’s life, environmental or community challenges may be experienced. The decisive objective for an individual with ABI is habitually to be a participating and appreciated member of their kin and the community at large. However, going back to the community might be a bit challenging. This is evident when I found myself disconnected from my social circle and unable to go back to work. Negative attitudes from the community and an extensive improper understanding of ABI enhance the difficulties that I faced. Individuals with ABI might require support to enable them construct relationships and institute social networks, attain autonomy and independence in daily life, access services and resources of community, build self-esteem and confidence, develop skills, and get work. Community incorporation that is successful is likely to rely on lasting access to suitable professional and generic services like provision of expert guides to both family and community (Duff, 2006, pg 9). If networks of support need to be successful in helping patients with ABI, they need to involve educators, therapists, decision-makers and funders in sufficient resourcing of fruitful management of behavior, not only in transitional or inpatient settings, but in the community and as needed all through an individual’s life (Kelly, G, et al, 2008, pg 467). Things that made it hard for individuals with ABI to get services entails: lack of suitable services; absence of resources and funding; improper awareness of suitable services; inaccessibility, as a result of physical issues or other issues like communication hindrances; and absence of understanding of ABI’s needs on the component of service staff. The named factors are still experienced by people with ABI. Several changes need to be made in order to fit in the community. For instance, use of wheelchairs due to the disability caused by ABI is among the changes that I had to adjust to in order to carry out my daily activities. With this change in place, I find it very hard to access essential services and resources within the community due to poor accessibility of wheelchairs. In an effort to enhance everyone’s participation in the community development, accessibility of wheelchair ramps should be implemented so that people with ABI can easily get the intended resources. How I may react to my disability from the perspective of self-concept, body image and self-esteem Disability in its own brings about mixed perspectives of one’s reaction. Some choose to react negatively while others react in a positive way. Although insufficient research has studied various changes within self-concept after ABI, available statistic argue that brain injury with successive cognitive, physical, and/or psychosocial restrictions can pose a significant negative effect on the victim’s perspective of self (Vickery & Gontkovsky, 2006, pg 32). One possible result of this self-concept impact might be the substantial frequency of emotional disturbance and depression seen in people following ABI experience or stroke. The self-concept amenability to enhance rehabilitation, the question in relation to intervention of self-concept turns out to be how the intervention enhances the victim’s quality of life in general. In my perspective, apart from contributing to the ABI victim’s psychological fitness by treating emotional interruptions indirectly through tackling self-concept, the possible contribution of progress in self-concept to the victim’s functional status and activity in the process of rehabilitation need to be explored. Self-concept is understood as an array of beliefs regarding a person’s own functioning in several dimensions of life like social and physical self-concept, and is regarded as equipment that allows self-reflection (Vickery & Gontkovsky, 2006, pg 30). From a personal perspective of self-concept regarding my disability, I am able to understand that positive self-concept will enhance my rehabilitation process thus bringing about a positive outcome of healing. To achieve this, I have to embrace the virtue of self-reflection and appreciate my own functioning. Self-esteem and body image are reported to be affected negatively after ABI (Howes, et al, 2005, pg 146). This is very true considering my situation since my physical and sexual functioning have been affected immensely. Self-esteem is greatly linked with functional actions and satisfaction in life together with mental and physical well being (Cooper-Evans, et al, 2008, pg 609). Taking this in account, I can appreciate that self esteem that is high will have positive results in my social relationships as well as general outcome of health. On the other hand, low esteem in highly associated with poor outcome of coping with life issues such as sickness. A significant component of self-concept is considered the subjective perspective of one’s body, health status, skills, physical appearance as well as sexuality; which literature terms it as body image (Howes, et al, 2005, pg 135). In some situations, body image alterations after injury to the brain are as a result of perceptual disturbance; on the other hand, it is argued that even the people who do not have neurological disturbance need to adjust to body image alteration after any disability or residual illness (Howes, et al, 2005, pg 135). This is why in my perspective I feel I should quickly adjust to my situation and know that I am still worthy since my family still needs me around. Additionally, employment following ABI is linked with decreased risk of drug abuse and improved mood (Niemeier, et al, 2010, pg 167). The concepts of pity, paternalism, self efficacy and independence in relation to rehabilitation and health care professionals treating people with a disability There are various approaches which apply to rehabilitation of brain injury. One of the approaches is the Compassion Focused Therapy (CFT), an approach which argues that the system of soothing-contentment may be activated in several methods, by other’s actions as well as through practiced imagery, particularly the ones that are compassion and affiliation focused (Ashworth, 2011, pg 130). It is suggested that when human beings are understanding, validating and kind all of which entail pity, it can assist to calm those in disability that they feel wanted and valued. While individuals with ABI may go through constant feelings of disappointment, anger and criticism, moving to validation, support and kindness could greatly provide a different way for regulation of affect. Usually, medical paternalism is viewed as unconstructive and unjustified. The reason being that paternalism definition usually entails the preferences and actions of an individual being overruled by another with no apparent consent (Zomorodi & Foley, 2009, pg 1748). It is somehow tricky for paternalism to be justified because to some extent it denies the individual’s autonomy, however, in situations where a person’s cognitive status is put on a compromising state, it can be easily argued that paternalism is definitely ethical, for instance in a case of a confused patient who has ABI. With respect to self-efficacy which is an individual’s belief in ability to successfully go through a particular situation, self-awareness that is impaired which also termed as poor insight has been linked empirically to decreased participation in rehabilitation, and follows naturally to the degree that people who cannot identify their impairments are not able to feel motivated in respect to treatment (Medley & Powell, 2010, pg 483). In support of self-efficacy, patient’s belief in the likelihood of change is a very significant motivator. Additionally, health care professionals should seek to improve patient’s self-determination and confidence in order to cope with disability obstacles. Autonomy, also referred to as independence, is one’s capacity to think, make a decision and take action on the decision made, with no fear of retaliation. Healthcare professionals mostly make decisions with respect to their personal fundamental experiences as well as situation’s knowledge. In the end, the client and family lack the ability to make decisions that are informed, thus displacement of autonomy. However, it is vital that nurses need not to forget that technical and medical competence should not take the place of knowing a client’s personal life values and experiences (Zomorodi & Foley, 2009, pg 1750). In such situations then, the nurse may explain the distinguishing line by educating the patient’s family concerning alternatives of decision-making, together with the outcomes of every decision in a manner that they can comprehend. On the other hand though, in a scenario of a person declining medical treatment, professionals of health care often consider a moral duty to treat that person for their own benefit. Professionals of health care might attack the competence of the client since it appears un-understandable that any person who is competent would deny treatment that is life-sustaining (Zomorodi & Foley, 2009, pg 1749). Bibliography Ashworth, F, et al, 2011, Compassion Focused Therapy After Traumatic Brain Injury: Theoretical Foundations and a Case Illustration, Brain Impairment, Vol. 12, Issue 2, pp 128-139. 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Wiseman-Hakes, C, et al, 2010, Perspectives on evidence based practice in ABI rehabilitation. “Relevant Research”: Who decides?, NeuroRehabilitation, Vol 26, pp 355-368. Zomorodi, M., & Foley, B., 2009, Concept Analysis, The nature of advocacy vs. paternalism in nursing: clarifying the ‘thin line’, Journal of Advanced Nursing, Vol. 65, Issue 8, pp 1746-1752. Read More