ABI RECOVERY MAGAZINE
or
Publisher and Edit Deborah St. Jean
ABI Recovery Magazine (ARM) is published quarterly eZine. Address: 7436 Stave Lake Street, Ste. #103, Mission, BC V2V 5B9. Email: Deborah@abirecoverymagazine.ca for ad or call 604-788-7221 to reserve. ARM welcomes letters and relevant, original articles for publication, and we reserve the right to edit any accepted submissions for clarity and length. A signature, address, and telephone number are required. Contact Deborah St. Jean for copy deadlines. Call 604-788-7221 for more information.
Magazine & Subscription Information ABI Recovery Magazine (ARM) is an online ezine published quarterly. Full colour magazine 8 1/2 x 11 that addresses a wide range of topics for professionals and survivors with acquired traumatic brain injury, their families and caregivers. Published four times a year starting annually with the ‘Winter Issue’ and is free to all.
eSubscribe Click here to sign up for your electronic subscription to ABI Recovery Magazine. Thank you for your interest in ABI Recovery Magazine and for your support. eSUBSCRIBER CHANGE OF ADDRESS?
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is not a substitute for medical care, rehabilitation, educational consultation, or legal advice in any way. Information in this magazine is general as it cannot and will not address each individual’s situation and needs. This magazine contains general information which may or may not apply to individuals. This magazine cannot and does not address each individual’s situation and needs. We encourage all persons with brain injuries, their family members and concerned parties to seek professional advice for any specific questions and concerns. The Publisher has made every effort to insure that content is accurate, correct and current and are not liable for any unintentional errors. Links to websites and contacts have been carefully chosen, but do not imply endorsement and we are not responsible or liable for their information and contents. Under no circumstances, shall the authors, the Editorial Manager and Publisher be liable under any theory of recovery for any damages arising out of nor in any manner connected with the use of this information, services, or documents from this magazine. *
Article Submission for Publication Article Submission: 700 to 1000 words. MS Word format. 2 graphics (JPG) . (NO PDF’s please). Send to: Deborah@abirecoverymagazine.ca Acceptance and publication is not promised nor guaranteed. Subject must be on-topic in keeping with the positive spirit of this publication. (Press Releases and Success stories always welcome.)
Hope. Healing. Health. Serving The Brain Injury Community of Western Canada
If you have moved, please contact Deborah at: 604788-7221 or email: Deborah@abirecoverymagazine.ca (Please put ‘ARM Subscriber’ in subject line of email) and send us your new email address to continue receiving your issues of ABI Recovery Magazine.
Disclaimer ARM’s Publisher, Editor and other principal parties take no responsibility for, nor do we necessarily agree with opinions contained in provided articles, letters or advertising composed by second and third parties, nor do we guarantee the accuracy of such information nor medical claims contained in articles and other content submitted by outside parties. Your discretion is advised.
Health & Medical Disclaimers Material published in this magazine is provided for informational purposes only with the aim to stimulate thought arouse meaningful discussion. This publication
ABI RECOVERY MAGAZINE 2
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In This Issue Survivor Turns Adversity Into Triumph
Coaching Through Recovery
Pg 7
Pg 10
The Cridge Centre for the Family: Our Hot Breakfast Team Pg 12
Balancing the Brain with Rhythmical Poetry and Movement
Pg 15
The Road Back to Driving: Functional Driving Evaluation Pg 18
Optimizing Health Care and Empowering People with Concussion
Pg 17
eSubscription is Free! Like what you see? Then please pass the word!
SEND ‘Subscribe Me!’ to: Subscribe@abirecoverymagazine.ca (Pls remember to include your full name and phone number)
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A.R.M. Is about...
ABI Awareness
Sub Heading
Eye on ABI News and Research
“Text”
Information Flow
By Peter Suciu, Detroit, MI
Advocacy
Continued Advocacy
Improving Supports
Improving Service Access
Continued Healing
Acceptance
Relearning
Quality of Life
The Possibilities
Loving the New You
(as published at bikeradar.com) *
And we are glad you’re here! ~ Comments, suggestions and submissions are welcome. Send to: Editor@abirecoverymagazine.ca
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Be Your Brainy Best! Do you have acquired brain injury symptoms? Do you have life stressors that impact your daily functioning? Are you interested in improving your cognitive skills? Crystal Willms, Certified Power CoachÂŽ and Reiki Master Practitioner, can provide: Coaching and consultation for brain injury management Brain GymÂŽ strategies for improved cognitive wellness, athletic and academic skills Reiki sessions to promote physical healing, relaxation and improved mental clarity Whole-life coaching to assist with improved skills in problem-solving, planning and followthrough (for individuals with or without injuries)
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Brain Injury Survivor Turns Adversity Into Triumph
Jan. 2017 ~ With Sergio Di Giovanni, Survivor’s Chronicle
How does an individual go from being at his lowest depths of struggle, frustration, and helplessness, and then transform his situation to the point where he is not only helping himself, but on the verge of transforming rehab tools for brain injury survivors. A special Traumatic Brain Injury (TBI) survivor has the story that shows us how. At the young age of 29, Sergio Di Giovanni had it all. A thriving web development business he had started out of college had clients from across the globe; he owned real estate in a booming early 2000s economy; and he was three months away from marrying his life partner, Maybelline. However, a lot changed when Sergio – affectionately called ‘Serg’ – stepped into his vehicle, on his way home after picking up wedding invitations. An oncoming van ran a red light and tboned him on the driver’s side, forcing his car into a concrete pole, and instantly knocked him unconscious. Sergio was soon admitted into the ABI program at Hamilton Health Sciences… to this day he has no recollection of this event. “In the beginning I kind of remember that everything felt fine, that I could get back and do what I was supposed to do and carry on with my life,” says Sergio. But I remember when I got back on the first day at work, I felt like I was in a tornado and I didn’t know what was going on; I had to leave. It was just unbearable.” Serg had been an exceptionally talented web designer and programmer. Growing up in an Italian-Canadian home, he had a natural ability to draw from a young age, and when he was introduced to his first computer at the age of 10, he immediately developed an interest in it. By the age of 12, he had taught himself how to write software and was coding games such as Hangman, Connect Four and 21.
“I always knew I was going to be in the computer field at some point of my life,” adds Sergio. So it was little surprise that after attending Mohawk College of Applied Arts and Technology, Di Giovanni married his passion for design and technology, and started his own web design company. The company became very successful in a short period of time. Not long after, he won awards for ‘best designed website in Canada’, acquired clients across North America, Italy and Hong Kong. At the age of 23, he purchased his first real estate investment, and a few short years later purchased his second, making him a landlord to over 20 units. One of his greatest achievements in life came at the age of 26, when he fulfilled his childhood dream of owing a Ferrari. His life was good. After the car crash, however, Sergio found it increasingly difficult to continue the work he had successfully achieved. His injury limited his ability to manage and keep-up with the multiple projects and responsibilities he was involved in. Frustrated, he closed his business, sold off his real estate interests and sold his Ferrari. Accustomed to being incredibly busy, Serg now was left with little to do. “I went from having a million and one things to do and managing it effortlessly, to having difficulty remembering to take the chicken out of the freezer for dinner, and that led to depression, anger and frustration and a whole stretch of dark years,” recalls the newly-minted father. It was during this rehab phase of his life that support workers taught him strategies to write things down in paper calendars, sticky notes, white boards and notepads as a memory aid and to help him stay on track. “I tried and I struggled with these traditional memory aids, but it came to a point where I simply gave up on it. I just couldn’t justify investing so much time and effort into a system that would fail me more often then not. What’s the point of writing something down and never seeing it again?” A few years later, the Apple iPhone was introduced and Serg immediately thought this device could be solution he’s been looking for. “What a perfect device I thought! I could carry all my reminders and appointments in one device, and since it’s my phone, I’m already accustomed to caring it with me everywhere I go so it’s one less thing to have to remember to bring!” Shortly after using his iPhone as his memory aid, he quickly discovered that all it really did was mimic traditional memory aids. He persistently looked for other ways to help complete ordinary
“Recovery is a process. It takes time. It takes patience. It takes friends.” ~ GirlFriendOlogy
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“Nothing really was annoying enough for me,” Serg joked, referring to the need of alerts that constantly badger and remind him of tasks to complete. “It just seemed like theses reminder apps were made for people who don’t need reminders because they all kept failing me too.” He compared the existing iPhone memory-aid applications as similar to the advice support workers would give him in suggesting he write down notes to remind himself of tasks and appointments. The problem with that, he says, is how does he remember he left the note in the first place? So his wife, who he married as originally planned only three months after his motor vehicle collision, suggested he create his own app. “He kept on complaining to me of things he wished his iPhone could do and things he wished it would stop doing. So I said to him one day, why don’t you make your own damn app.” And that was the day Qcard was born. While his injury prevented him from programming the software himself, he could still deliver his ideas, input and vision. “The next day I took out my pencil and started sketching screenshots, mockups and user interface flows for an app called Qcard” Sergio says proudly. Shortly after, having only his vision and ideas in hand, Sergio walked into the Ontario Brain Injury Association (OBIA) offices and made a presentation to OBIA Executive Director Ruth Wilcock. “Initially, before meeting Sergio I was admittedly a bit skeptical,” says Ruth Wilcock. “However, he presented his idea with such conviction and passion, and laid out a clear plan. Also, I thought his idea was very unique and had potential to better serve peopling living with TBI. So we wanted to provide him support, and help him reach his goal.” “Ruth and OBIA helped provide me the reassurance and encouragement that this was a worthwhile idea, and gave me the important direction to talk to the appropriate people,” Sergio attests. Serg applied to Mohawk College’s iDeaWORKS; a program designed to reward innovation in technology and entrepreneurship, and holds a contest similar to the popular ABC program “Shark Tank”. Sergio competed against a host of others and made a ten-minute presentation to the iDeaWORKS panel, and ultimately convinced them that his idea will work. His reward was funding for the development of the Qcard over 4 semesters, which included a team of programmers, designers and students dedicated to his project. But how does it differ from other task-oriented applications already in existence? “There’s a whole list of features that make Qcard very different from other reminder apps.
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My sole focus and goal was to create a tool, a memory crutch, I could lean on and trust it wouldn’t fail me.” Serg explains. “Qcard will never let me forget, keeps reminding me and guides me to completion… even through prolonged tasks like doing laundry. It’s my life management app… anything I put into Qcard, gets done - and to feel like that again, is invaluable.” In addition, Serg adds, “It’s really my intimate insight of the challenges I live with that gives me the perspective into problems most others can not see or understand. I used my lived experiences, common pitfalls and frustrations to design an app tailored to my personal needs.” “Best of all”, Sergio says “Qcard gives us the ability to send & receive Reminders, Guided Tasks and Appointments! Families can now manage, organize and delegate life together with ease, reducing tension and stress. Occupational Therapists can arm themselves with a catalogue of commonly used Gudied Tasks and Reminders and simply share them with their clients” “This is an application that can aid not only TBI survivors, but even those with ADHD, Alzheimer’s, dementia, as well as the elderly,” he adds. Sergio’s story is inspiring because it symbolizes a man who was once at his peak before falling to a low, only to climb back up despite facing very real adversity. He recalls close friendships he lost after his injury, blamed at least partially on a lack of knowledge regarding brain injuries and the effects it has on those who have it. Serg admits he has changed significantly himself in that time, and has become more aware. His new project is clearly indicative of that. “My proudest aspect of Qcard is it gives us our independence back. ” says Sergio. “We need a tool that does that, and that’s what Qcard is. I’m excited to help others living with brain injuries improve their quality of life too.” He is clearly on his way towards achieving that.
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Qcard is an officially recognized product of the Canadian Association of Occupational Therapists (CAOT)
~ Qcard is available for download on the Apple App store. f you would like more information you can contact Sergio at sergio@qcard.ca or visit www.Qcard.ca.
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Coaching Through Recovery By Crystal Willms of The Crystal Factor
I am Crystal Willms, Certified Power Coach®, Usui Reiki Master Practitioner, speaker and author. My company, The Crystal Factor, is based out of Calgary, Alberta, Canada. In order to simply describe the majority of my work, I often use the title Brain Injury Management Expert. I was a caregiver for nearly three years to a former common -law partner who sustained a severe brain injury in a motorcycle accident. This life changing experience lead to my involvement in the brain injury field, in which I've been coaching since 2002. I really enjoy variety in my work, so about 35% of my business also includes vocational transition consultation, whole-life coaching for youth and adults (unrelated to brain injury), public speaking, Reiki and nutrition education to support brain health and enhance physical wellness. I do work with individuals on a long distance basis. 1. What is coaching? Coaching defined by the International Coach Federation (ICF): The ICF defines coaching as partnering with clients in a thought-provoking and creative process that inspires them to maximize their personal and professional potential. Coaching honors the client as the expert in his/her life and work and believes that every client is creative, resourceful, and whole. Standing on this foundation, the coach's responsibility is to: Discover, clarify, and align with what the client wants to achieve; Encourage client self-discovery; Elicit client-generated solutions and strategies; and Hold the client responsible and accountable. Coaches are trained to listen, to observe and to customize their approach to individual client needs. They seek to elicit solutions and strategies from the client; they believe the client is naturally creative and resourceful. The coach's job is to provide support to enhance the skills, resources, and creativity that the client already has. It is important that an individual interested in coaching ensures they hire a coach that is a good fit for them (i.e. chemistry, similarities and differences that are beneficial to the working partnership). There is a variety of coaching styles used by professional coaches and it is helpful to understand them. It is beneficial to hire a coach that has specific knowledge related to one’s current challenges and the areas of life in which they are seeking change. Researching websites, reviewing coach profiles, reading testimonials and speaking directly to coaches about their services and expertise are ways to help someone fully understand coach-
ing and its benefits. A coach maintains neutrality and if mentoring is included in their coaching model, it is offered when appropriate. 2. How can coaching help a caregiver? A caregiver can receive support from a coach with: Confronting urgent matters and overcoming negative emotions Closing a gap in knowledge, skills, confidence and/or resources Enhancing clarity, making choices and accelerating results Improving life balance Identifying core strengths and how to best use them. 3. How can coaching help a person with a brain injury and at what stage in recovery is coaching most helpful? Coaching is helpful to an individual with acquired brain injury because they can receive support with: Accepting current circumstances Creating realistic ways to manage short and/ or long-term deficits as well as the overall impact of the injury in all areas of life Confronting urgent matters and overcoming negative emotions Closing a gap in knowledge, skills, confidence and/or resources Enhancing clarity, making choices and accelerating results Improving life balance Identifying core strengths and how to best use them There is no definitive time that coaching is most helpful because it is based on the individual. Coaching is a partnership, so one must be able to find it valuable to collaborate, have another viewpoint and to be asked to consider new perspectives. If a person is ready to devote the time and the energy to making actual changes, then it is worth exploring. If an individual’s brain injury has had a mild to moderate impact on their functioning, they may be ready for a coach within one to three months. The support of a coach might help to avoid or reduce the development of dysfunctional coping tactics and emotional challenges that can slow down recovery. However, some individuals are not ready for a coach this soon and may not work with a coach for one year or many years after their brain injury. 4. How might coaching be different from that of an Occupational Therapist, Social Worker or Psychologist? How might they work together? The ICF acknowledges that professional coaching is a distinct service which focuses on an individual's life as it relates to goal setting, outcome creation and managing personal change. In an effort to understand what a coach is, it can be helpful to distinguish coaching from other professions that provide personal or organizational support.
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 Therapy: Coaching can be distinguished from therapy in a number of ways. First, coaching is a profession that supports personal and professional growth and development based on individual-initiated change in pursuit of specific actionable outcomes. These outcomes are linked to personal or professional success. Coaching is forward moving and future focused. Therapy, on the other hand, deals with healing pain, dysfunction and conflict within an individual or a relationship between two or more individuals. The focus is often on resolving difficulties arising from the past which hamper an individual's emotional functioning in the present, improving overall psychological functioning, and dealing with present life and work circumstances in more emotionally healthy ways. Therapy outcomes often include improved emotional/feeling states. While positive feelings/ emotions may be a natural outcome of coaching, the primary focus is on creating actionable strategies for achieving specific goals in one's work or personal life. The emphasis in a coaching relationship is on action, accountability and follow through.  Training: Training programs are based on the acquisition of certain learning objectives as set out by the trainer or instructor. Though objectives are clarified in the coaching process, they are set by the individual or team being coached with guidance provided by the coach. Training also assumes a linear learning path which coincides with an established curriculum. Coaching is less linear without a set curriculum plan. A coach can work with an individual on a long-term basis, meet them in their environment of choice and consult with their support system (if this is the chosen service model of the coach). If a coach were to collaborate with other rehabilitation
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professionals, the brain injured person would provide permission for the coach to offer insight to these professionals that they may not have access to, as the coach can frequently see the individual in their natural environment. Rehabilitation professionals can also educate a coach regarding strategies/treatment recommendations. When this occurs, the brain injured person can be regularly accountable to their coach if they choose to follow such recommendations. The coach can support the individual by helping them address obstacles to recovery, therefore increasing the likelihood of success. Many professionals working in the same industry have some shared knowledge and skills, but each has specific tools that may be more effective in certain situations than others. Anyone in need of services is encouraged to research accessible professional support and determine what best meets their needs at the time. A coach will refer an individual to an alternate service provider if they do not have the required expertise to address a need or challenge. * For more information about Crystal Willms and her work, visit TheCrystalFactor.com.
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Our Hot Breakfast Team day being accountable for his time and arriving at work on time and ready to work is an important part of building his I’d like to introduce you to Kevin. He is 34 and has been daily routine. Kevin finds it challenging to schedule his time living with a brain injury for the past 7 years. Kevin started and to ensure that he takes care of the essentials of life (eating especially). Having the responsibility of a job gives him a volunteering at Macdonald House – our home for brain injury reason to manage his routine and strive to be productive with survivors – and last fall he moved into our supportive housing. is time. Kevin has been participating in the Bluesheet Clubhouse (a Kevin has also benefitsupport group for survited from the program by vors), Kale Kings (a social giving his natural leadership enterprise for survivors) skills a wonderful outlet. He and most recently with our feels acceptance and admiHot Breakfast Program. ration from the children and Kevin completed our food enjoys the connection he has services training and has with them. This has been a been serving breakfast real boost to his self-esteem twice a week at The Cridge and confidence. Alongside Child Care program as part this, the protected work enof the team involved with vironment has allowed the Hot Breakfast Program. Kevin to work productively Kevin is a character! He and still be supported to deal is a very outgoing and with the challenges resulting friendly guy – when he was Kevin, Romina and Emily: Our Hot Breakfast Team selling chocolate fudge kale with 2 hungry children from his brain injury. cookies at the markets, he We are super proud of was unquestionably our best salesman. Kevin knows how to Kevin and the great strides he has taken to make positive engage people and to draw them in. We knew he would be a choices in his life and in dealing with the effects of a brain terrific fit to work in the Hot Breakfast Program as he also injury. We believe that his work with us is merely a stepping loves kids. Kevin has benefitted from this program in several stone as he continues to grow and learn new ways of living ways. with a brain injury. * First of all, it has given him structure and purpose for his By Joanne Specht, Cridge Centre for the Family, Victoria, BC
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s ing i l a e H ing. heal d spee r u o Y n't does ter. Mat rd is a w r Fo ard. forw
Get involved! Volunteer Centres are your local leaders in community engagement Find one near you
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Balancing The Brain ...With Rhythmical Poetry and Movement
One, Two, Three
By Kimberly Burnham, Wash. USA
Here we go with the flow step one step two
Known as the Nerve Whisperer, Kimberly Burnham, PhD (Integrative Medicine) helps people with brain health issues, chronic pain, and vision improvement goals through health coaching (phone) and hands-on healing (craniosacral therapy, Reiki, acupressure) in her private practice in Spokane, Washington. The beat of my heart energy cycling through the day alert wakefulness and deep restful sleep a breath, a pause and out it flows the sound of my foot fall as I walk on crisp snow Music blaring from a radio boom boom boom words in a song a poem carrying cadence there are many rhythms in my life A recent study looked at the effects of rhythmic auditory stimulation on gait or walking behavior in 14 adolescents with acquired brain injury. Data collected included the dynamic motions of joints on three-dimensional planes during a gait cycle and the range of motion in each joint. Researchers noted, "Significant group differences were observed in cadence, walking velocity, and step time, indicating that there were greater improvements in those parameters in the rhythmic auditory stimulation group compared with the control group. Significant increases in hip and knee motions in the sagittal plane [hip flexion and extension] were also observed in the rhythmic auditory stimulation group." (Kim, S. J., Y. K. Shin, et al. (2016). "Changes in gait patterns induced by rhythmic auditory stimulation for adolescents with acquired brain injury." Ann N Y Acad Sci 1385(1): 53-62). The research indicates that attention to the rhythmical nature of our lives may help improve our ability to walk as well as the range of motion of joints. Many people with brain health issues find walking more successful when they count out loud or to themselves. This is a way to pay attention to the rhythm or cadence of walking. Think about your own walking does it improve if you sing a song or count or listen to music?
We move get into the groove right side left side The brain responds go flow move groove Notice the rhythms of life as you walk. Can you feel your heart beating as you put one foot ahead of the other? If you try to step forward with the right foot as you breathe in and step onto your left foot on the out breath, do you breathe too fast or walk too slow? Try breathing in as you step forward with the right foot and then in the same in breathe swing the left foot forward. Then breathe out as you take another complete right foot then left foot step forward. One way to feel the rhythmical flow of air in your body is to stand tall and straight as you breathe in and relax into the normal curves of the spine as you breathe out. This kind of rhythmical breathing with spinal movement creates a pumping action that can facilitate blood and fluid flow in the brain and spinal cord. Another study looked at the effect of rhythmical weight shifting exercises (standing and shifting the weight from one foot to the other) on overall balance and brain plasticity. They found that an 8-week balance training program had a significant impact on young patients with moderate to severe ABI. Researcher noted, "Following training, TBI [ABI] patients showed significant improvements on all EquiTest protocols, as well as a significant increase in mean diffusivity in the inferior cerebellar peduncle [part of the brain related to balance]. This suggests that training-induced plastic changes in balance control are associated with alterations in the cerebellar white matter microstructure in TBI patients." (Drijkoningen, D., K. Caeyenberghs, et al. (2015). "Training-induced improvements in postural control are accompanied by alterations in cerebellar white matter in brain injured patients." Neuroimage Clin 7: 240-251). Try This At Home Stand tall safely within reach of a friend or a chair close your eyes feel how the balance flows 15
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this is the before test Open your eyes shift your weight right then to the left foot back and forth you go shift one shift two lean right lean left Feel the weight on the bottom of the right foot then feel the left foot sole flowing back and forth the rhythm goes
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“Brain injuries are like snowflakes. No two are the same” OnWithLife
Now test again safely close your eyes note your sense of balance What has changed in the flow of time spent noticing feeling the rhythms of life Shifting from here to there *
Want Better Vision, Memory, Balance, and Walking? ‘Free eBook Offer ‘ Kimberly Burnham Walk better and see more clearly with a phone or Skype consultation with Kimberly Burnham, PhD (Integrative Medicine). An award winning poet and medical writer, Kimberly works with clients with brain health issues, such as acquired brain injuries, spinal cord injuries, Parkinson's disease, Huntington's ataxia, seizure disorders, diabetic neuropathy, macular degeneration, double vision, and more. Contact her and get a free eBook through her website or email Kimberly at NerveWhisperer@gmail.com Kimberly Burnham’s books are available on Amazon 16
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Optimizing Health Care Empowering People with Concussion By Rose Kristiansen, Occupational Therapist
Awareness and concern about concussion and its' long term affect are on the rise. Medical professionals and scientists are working to better understand, define, and outline the best treatment for this injury. Unfortunately, as the incidence and seriousness of this condition comes to light, the community infrastructure to support people with this condition has not yet caught up. When there is physical evidence of brain injury, people receive acknowledgement, clear treatment guidelines, support (formal and informal), financial assistance is identified and arranged where possible and a rehabilitation path is established to assist the client to return to their maximum level of functioning. In the case of concussion, the person with fluctuating cognitive and physical abilities may appear to be normal. They are often left without acknowledgment of the seriousness of the injury, without
pensatory strategies that prolong recovery. The P.A.C.E. Concussion application was developed in response to these issues by providing an accessible affordable recovery plan to those who need it no matter where they live. P.A.C.E. stands for Progressive Activation and Concussion Education The PACE app provides the “how to” for concussion recovery. It provides information and a recovery pathway that promotes access and has the potential to unify the recovery process. This tool provides information, and resources to help clients, health care providers, case managers and therapists Improving the effectiveness and efficiency of treatment. This guide helps people with concussion understand their symptoms, learn what they can do to feel better (YouTube links) and who they should see for help. It helps people monitor their recovery, learn how to pace themselves as well as provides step by step instructions on how to return to learn, work and play. * The P.A.C.E. Concussion Application is now available on iTunes. The P.A.C.E. Concussion website is now available with a short video to demonstrate its use. *
“Brain injury is like thinking with speed bumps...
clear treatment guidelines, without financial aid, limited formal and informal support and depending on where they live limited access to professionals experienced in the area who can help them with a rehabilitation plan to help them regain function. This leaves the injured person with concussion symptoms (thinking impairment) to try to meet their obligations or fight for help in regards to accessing treatment, recovery information, finances, insurance coverage, accommodations at work/ school, for their relationships and general understanding. Medical management is in a stage of development as well, where an inconsistent approach is contributing to poor outcomes. Long term rest is contributing to people’s general deconditioning, depression and the development of physical com17
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The Road Back to Driving Functional Driving Evaluation By Sue Reil, Director of Clinical Services, Community Therapists, BC
The ability to drive is an essential life skill that facilitates independence and freedom and is often required for clients to attend vocational activities. When the ability to drive is affected by illness or injury, the effects can be devastating. For individuals who experience, visual, cognitive, or physical limitations arising from TBI or stroke, determining fitness to drive is not a ‘black or white’ matter…. it’s a grey matter. Functional Driving Evaluations (FDE) are conducted by occupational therapists with specialized training in driver rehabilitation and they provide an assessment of a client’s driving abilities and rehabilitation potential to return to driving. By focusing on a client’s ability to compensate for skill deficits, OTs conducting driving evaluations can identify those drivers that can return to this vital activity using on or off-road training, vehicle modifications and specific occupational therapy intervention. Driving is a Complex Task Driving is a complex task that requires a variety of abilities. Visual acuity, visual scanning, information processing, visual attention, visual-perception, peripheral vision and the physical capacity to operate the vehicle are just some of the abilities that one needs for safe driving. Testing these abilities individually in a clinic setting or perhaps behind a computer screen is entirely different from observing whether driver’s can integrate those skills in a timely manner when driving on-road. Driving is a constantly changing task so client’s that have the potential to compensate must also be tested on road to obtain a valid assessment of their Functional Driving Skills. How do I know a Functional Driving Evaluation is required? Limitations in the following performance areas may be referral indicators for a Functional Driving Evaluation: Vision – acuity and peripheral vision Visual-perception Physical ability to drive Slowed sensory processing and reaction times Cognitive ability including attention, judgement, impulse control and other limitations What’s involved in a Functional Driving Evaluation Occupational therapists evaluate cognitive, perceptual, behavioural, visual and physical core skills to determine impact on operational, tactical and strategic driving. A battery of validated tests is used to assess skill deficits prior to proceeding to an on road evaluation. A typical evaluation takes
anywhere from 3-4 hours and usually starts in the therapist’s clinic or hospital outpatient department. Most providers complete the on road portion of the evaluation where the therapist observes the impact of the functional deficits on driving and records if the client can compensate as the client proceeds through a structured set of driving tasks. A driving instructor and dual controlled vehicle are features which ensure the on road evaluation remains safe by assisting the client to follow the rules of the road. After the formal assessment, the therapist reviews the test, analyzes results and prepares a report outlining whether the client has functional driving skills and provides recommendations for rehabilitation or driving cessation. Driver Rehabilitation Stakeholders Functional Driving Evaluations are conducted in active partnership with the client (driver), the primary care physician, a licenced driving instructor and the Office of the Superintendent of Motor Vehicles – Medical Fitness Program.. It’s important to remember that the occupational therapist is not the licencing authority and provides an objective opinion on functional driving ability and rehabilitation potential related to medical fitness to drive. Additionally, the OT requires information from the client’s doctor about their medical conditions and any specialist reports to better understand what driving related abilities may be affected. Helping Drivers Get on the Road Again For individuals who do not pass their Functional Driving Evaluation but who show potential to demonstrate functional driving skills, a driver rehabilitation program is recommended. This may include on-road lessons, vehicle modifications and OT intervention for the client to learn compensatory strategies to compensate for any skill deficits. A simple example of a compensatory strategy is slowing ones approach to an intersection – this compensates for reduced information processing time. Another example of a simple vehicle modification is a large rear view mirror to help compensate for a diminished visual field Where can I find Providers of Driver Rehabilitation If you or your client need to be referred for a Functional Driving Evaluation service, please visit this community resource webpage that includes a list of providers: * Author: Sue Reil, Director of Clinical Services, Community Therapists. Sue Reil has practiced OT for more than 20 years and has practiced in driver rehabilitation for over 10 years. She has served as an Expert Witness in the Supreme Court of BC on driving-related human rights cases and provides consultation to the ICBC Driver Training & Certification program and Regulated Driver Programs. Her past experience also includes teaching Driver Rehabilitation to UBC Occupational Therapy students (2005-2011)
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ABI Recovery Magazine
s aregiver C y l i m Fa Rock!
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ABI Recovery Magazine 7436 Stave Lake Street, Ste. 103 Mission BC Canada V2V 5B9
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