Welcome to the TBI-HELP Live Chat

Today's topic is: "The Importance of Setting Goals in the Recovery Process after a Traumatic Brain Injury"

Our Guest is: Mr. Andrew Sikiric, Cognitive Rehabilitation Therapist

Tonight's Topic Summary: 
Many brain injury survivors face challenging roadblocks that involve physical, cognitive and psychological effects of brain injury. By taking a proactive stance and setting goals for oneself, an individual can experience a more fulfilling reintegration into the community.

[18:56:17] mod: Welcome! I hope that this new year brings all of you good health and happiness. The best in 2002 to all of you! Tonight it is our pleasure to have Mr. Andrew Sikiric, MA, cognitive Rehabilitation Therapist from Jamaica Hospital Medical Center as our guest speaker. Andrew will be discussing "The Importance of Setting Goals in the Recovery Process after a Traumatic Brain Injury". Welcome Andrew!
[18:56:38] Andrew: Hi, I'm very happy to be here.
[18:56:59] mod: Why is setting goals important?
[18:57:51] Andrew: By setting goals, individuals that have sustained a brain injury can begin to empower themselves and regain certain levels of independence in their lives. Often, individuals that experienced a brain injury feel that since they are not able to perform activities like they were before then they can not do much of anything. This type of irrational thinking can perpetuate depressive and anxious feelings. Setting goals helps individuals take a proactive stance, break cycles of negative thinking, and create meaningful changes in everyday life. Taking action helps to improve a person's self-esteem and demonstrates that they can have control over many segments in their lives.
[19:01:57] mod: Rail: How can a person with cognitive deficits set goals for themselves?
[19:02:46] Andrew: Significant cognitive deficits can include memory deficits, limited concentration, impaired perception and communication, and difficulties with planning, judgment, and initiation. All of these skills are important in the conceptualization of goals and the ability to put them into action. In order to help deal with this, individuals with brain injury are encouraged to participate in treatment where cognitive rehabilitation techniques are applied. Through cognitive rehabilitation an individual who has sustained a brain injury can learn to better understand the nature of his/her difficulties and methods of compensation. The level of integration of cognitive rehabilitation techniques and treatment vary according to specific patient needs and goals. However, the central goal is to facilitate the individual's ability to think about their own thinking (metacognition). Through this techniques, an individual is guided to think about their own cogntive limitations and effective compensatory strategies. Often various strategies are introduced and an individual and tehrapist can choose which techniques are most useful for the patient in helping them adjust to TBI. Through this type of guidance, a person with cognitive deficits can set approriate goals for themselves.
[19:10:02] mod: Susan: Happy New Year to you and yours, Hi Andrew. I just read below what you said about the expectations of the brain injured, that they are sometimes low. I see that many times but I also see that sometimes those who work with this group of people, especially those who are also very physically disabled often seem to give up before they start, sort of by making a quick visual assessment. How can we get them to look further?
[19:11:57] Andrew: It depends on each specific individual. Therapists, family members, and friends sometimes need to find unique and creative ways to help individuals with low expectations garner motivation. Some traditional methods are having the brain injured individual join a support group or even a recreation group of peers in similar situations. Often these experiences help raise self-esteem and motivation in an individual.
[19:13:43] mod: Nick: How can we help people to make appropriate goals for themselves?
[19:16:04] Andrew: It is important to help people develop awareness into their capabilities and limitations. Once this has occurred an individual with TBI can begin to set realistic goals. It is essential that this person does not confuse the means with the end. In most cases, people will focus on an object or event, without following through the next important step, which is identifying how that object or event would make them feel For example, an individual with brain injury may want to return to the job he had before his injury. The reason they want to return to the job is because of how it made them feel. They might have enjoyed performing those duties, they might have felt a sense of security, pride, accomplishment. In this case the TRUE goal was not the job in itself, but how that job made the person feel. When a person can make this distinction, that it is not the thing or the event that they want but instead the FEELING associated with it, then their goal shifts from the thing they want to the emotions that are connected with it. Once this is realized the chances of getting what you want are increased. Maybe there are ten different ways for the person to arrive at the same desired destination rather than limiting yourself to one. For example, prior to a brain injury an individual had aspirations of becoming a medical doctor. The reason he wanted to become a doctor is because this would have made him feel successful and accomplished. He wanted the feelings associated with helping others.. However, his brain injury caused cognitive deficits that made completion of medical school unrealistic. This individual decided to met his goals by becoming a counselor and helping other individuals adjust to brain injury. He was able to meet his same goals (feelings) through other means.
[19:23:54] mod: Welcome Anney! How can I help my family member to have more confidence in their ability to achieve a higher goal than they set for themselves?
[19:25:56] Andrew: Achieving goals is a step by step process. You could help your family member to have more confidence in their ability to achieve a higher goal by taking it step by step. Often individuals my be intimidated or scared of jumping into certain things. Family members should provide genuine support and guidance and help them work their way up in a step by step fashion until they are more comfortable performing certain activities.
[19:28:09] mod: Susan: How can you make an individual that is aware of the level of the retraining done, that even if it is slightly juvenile, is the basic steps needed to recovery and to further abilities, as doing simple puzzles, basic math, etc. It seems very hard for them to understand that they can walk before they crawl.
[19:31:33] Andrew: Individuals with brain injury should start therapy at appropriate levels depending on the level they are currently7 functioning at. It is important to have the individual participate in certain activities that appeals to their personality. For instance, if a person does not particularly like performing math problems, is there another way to help engage him in that activity. For instance , there are many games available that help improve various cognitive deficits and that include performing activities such as mathematical computations, reading, and/or writing.
[19:34:50] mod: Anney: How can you handle conflict in the family over what the goals for the patient should be?
[19:36:11] Andrew: The first step is to have family members educate themselves on the effects of brain injury and the origin of consequent behavior.
[19:38:10] mod: Hi Vern! Many times patients as well as family members get frustrated by the time and the work it takes to continue to attain a goal, how can we prevent this?
[19:42:18] Andrew: That is a very common experience by survivors of brain injury and their family members. Individuals with brain injury and their families often wish that things could be back the way they were before the brain injury once the patient leaves the rehab unit. Unfortunately, there as most clinicians and doctors would tell you-the recovery process after a brain injury can take some time. Often people treat the recovery process as a sprint. But in reality, the recovery process is more like a marathon. It takes patience, a positive attitude, guidance from health care professionals, and love and support from family members in order to adjust to the changes that often occur after a brain injury.
[19:46:35] mod: Susan: Since goals are like lessons to be achieved, shouldn't they be adjusted to fit the learning style of the client, whether visual, auditory, whatever and based on "readiness" for the skill. Many times, unfortunately goals are too set and either achieved quickly or forgotten dependant on the therapist. Teaching, or re-teaching styles should vary to fit the individual. What do you think?
[19:48:51] Andrew: Absolutely Susan! Great point. Lessons should be adjusted according to the learning style of the client and their current functional status. When someone associates strong emotional experiences to an activity they are far more likely to take i9n and remember the lesson.
[19:50:30] mod: What should caregivers keep in mind in an attempt to meet their own goals?
[19:51:37] Andrew: Caregivers typically experience a vast amount of emotions in their attenpt to care for a loved one that has experienced a TBI. Many caregivers have stated that it is absolutely essential that they take care of themselves first and foremost. At first many caregivers feel guilty about this concept and think they are being selfish. But they soon come to realize that when they take care of themselves they are able to perform their duties and strive for their personal goals with greater quality. People who take care of themselves as individuals realize that they are the most important resource they have in achieving their goals. They actively manage their mental, physical, emotional, and spiritual health. They maintain a balance that keeps the safe from burnout. They do not become so consumed by their passion for a particular goal that they forget about the rest of their life. Exercise, recreation, social activity, and family time are distributed according to what works fo each individual. By setting out to take care of oneself, caregivers are more readily prepared to get to where they want to go in a more satisfied fashion.
[19:56:30] mod: Well I see that our time is up for this evening. Thank you all for participating in tonight's session. I want to thank Andrew for a very interesting session and hope that he can join us again in the future. Good Night, take care and be safe! See all of you next week!
[19:56:50] Andrew: Thank you for the questions all.. Have a good night!