Positive Outcomes for Individuals with Severe Brain Injury

Overview of Presentation Research History ARBI s unique and successful model Outcomes Case examples

Research Neuroplasticity: With a brain injury, functions performed by damaged areas are lost. Over time, with rehabilitation, uninjured parts of the brain can take over lost functions. Dr. Richard Dyck, University of Calgary Professor and Associate of Hotchkiss Brain Institute Principles of Experience-Dependent Neural Plasticity : (Kleim and Jones Journal of Speech, Language, and Hearing Research: Vol. 51. S225-239, Feb. 2008) Use it or lose it Use it and improve it Task Specific Repetition Motivating, meaningful activities

Research Long-term Recovery Existing evidence indicates that severe brain injury survivors are capable of significant functional recovery years after injury. Rehabilitation may serve to further ameliorate disability and reduce long-term costs of care. Slow-to-recover severe traumatic brain injury: a review of outcomes and rehabilitation effectiveness Brain Injury: 2000, Vol. 14 No. 11 Dr. Shaun Gray, Director of Halvar Jonson Centre for Brain Injury, Ponoka, Alberta

ARBI s Co-Founders Alice Laine Audrey Morrice

Mel s Rehabilitation

Mel s Rehabilitation Meaningful, Task Specific Activities

In a Nurturing, Rich Environment Mel s Rehabilitation

Mel Today

ARBI Formed in 1978

ARBI Today ARBI is a critical asset to the organizations in Southern Alberta committed to improving the quality of life for those affected by neurological injury or disease. The care and commitment that ARBI demonstrates for those with severe brain injuries is an outstanding model for us all. Dr. Samuel Weiss, Director Hotchkiss Brain Institute

ARBI s Mission and Vision Mission ARBI is a community-based non-profit organization that strives to improve the lives of individuals with severe brain injury including stroke. We unite professionals, volunteers and caregivers throughout Alberta to provide personalized rehabilitation and community integration. Vision Creating a community where quality rehabilitation is accessible to all individuals with a severe brain injury including stroke, enabling them to live their best life possible.

Eligibility for Programs and Services Diagnosis Medical stability Rehab completed 16 to 75 years of age 24 hour care and/or supervision Behaviours Significantly compromised abilities

ARBI s Programs Only non-profit, community-based agency in Canada that provides intensive, long-term rehab for this population Three programs offered Fully accredited by Alberta Council of Disability Services

Our Team Physiotherapists, Occupational Therapists, Speech Language Pathologists and Recreation Therapists Rehabilitation Practitioners Neuropsychologist and Clinical Counsellor Volunteers Practicum Students

Rehabilitation Model COMMUNITY INTEGRATION PROGRAM ON-SITE Core rehab program 24 CLIENTS (A.M. TBI) (P.M. CVA) ACTIVE WAIT LIST POST DISCHARGE OUTREACH Calgary & Province wide 37 CLIENTS

On-site: Assessment to Program Implementation Assessment Client goals Personalized written program Demonstrated on DVD Chart developed Volunteers recruited Train the Trainer Intensive training and follow-up

On-Site Program Continued Program Coordinator s responsible for 8 clients and their team of volunteers/support workers Program Assistant provides direct client care Program Leader (PT) supervises program and supports team on daily basis 24 clients - Younger ABI: 5 am/wk Stroke: 3-5 pm/wk

On-Site Program Continued Reassessments: otbi - annual o Stroke 6 mo. Goals reviewed Team meeting No functional progress: transition planning Average Length of Stay: TBI: 4 yrs. Stroke: 3 yrs.

Volunteer Program KEY to success of program 2009-125 volunteers donated 8,000 hours 60+ volunteers weekly, 19 practicum placements Cost-savings of >$100,000/yr.

Outreach Program: Assessment to Program Implementation Modeled after On-site Program Assessment Written program Demonstrated on DVD Consistent person Place of residence or community setting 3-5x/wk.

Community Integration Assessment by RT Volunteer/leisure pursuits - Cesar volunteers once/wk. at SPCA caring for pets Group participation

CIP Group Programs Sensory Group: Psycho/social focus for clients who function at a lower response level

CIP Group Programs Not Too Serious Folk Group: Social and recreational activities for individuals with lower functional abilities

CIP Group Programs Music Therapy: Music therapist incorporates physical, vocal, cognitive and emotional aspects of therapy through music

CIP Groups Cont. Talking at your Leisure Group: Facilitated by RT and SLP Promotes development of communication and cognitive skills via recreational and social activities.

CIP Groups Cont. Leisure Skills Group: Leisure awareness, education/planning Facilitate independence and community re-integration

CIP Groups Cont. Horticulture Group: Clients take ownership for ARBI s outdoor garden from planning, planting (herbs, vegetables and, perennials) and harvesting the produce in the fall.

CIP Groups Cont. Wheelchair Curling Group: Four clients participate weekly in this fun, community based program.

CIP Groups Cont. Aquatics Group: Community pool provides an active, social and relaxing experience for participants

CIP Groups Cont. Stroke Group: Focused on developing leisure-related knowledge, attitudes and skills for stroke survivors Offers plenty of opportunity for practice in community settings

CIP Groups Cont. Sports Sampler: Provides clients the opportunity to sample several modified sports over the summer months

Funding Fundraising, events and restricted donations 48% United Way 18% GIK Prov. of AB 10% AB Seniors and Community Supports 23% Fee for Service 1%

Referrals - 2009 8% Health Care Professionals Families 92%

On-site TBI Demographics - 2009 Average Age: Brain Injury: 33 Average Age Range: Brain Injury: 20-57 Males: 25 Females: 8 At Admission At Discharge 13% 13% 13% 13% PCH Own Home LTC 27% Hospital 60% PCH Own Home LTC 61%

Traumatic Injury Origin 2000-2010 7% 7% 7% MVA Fall 13% 53% Sports Pellet Gun 13% Industrial Military

Changing Level of Disability Rappaport Disability Rating Scale at Admission to ARBI 14 12 10 8 6 4 2 0 12.00 11.00 10.00 8.50 8.00 1995-1997 1998-2000 2001-2003 2003-2007 2008-2009 Date of admission

Our Outcomes

Outcomes At ARBI we help clients to regain quality of life and self-worth through: Increased physical mobility Increased and effective means of communication Increased ability to think clearly and make decisions Increased ability to contribute to their own health and well being through participation in stimulating, meaningful activities with family, friends and the community at large *** Individual outcomes vary depending on severity of injury

Outcome Measures Standardized Discipline Specific Assessments Outcome measures: Rappaport Disability Rating Scale Rancho Los Amigos Scale of Cognitive Functioning Chedoke McMaster Activity Inventory (Austoms, COPM) Satisfaction Survey

Rancho Los Amigos Score Admission to Discharge 2000-2010 6.6 Rancho Los Amigos Scale (I-10) 6.4 6.2 6 5.8 5.6 6.36 5.4 5.2 5.53 5 ADMISSION DISCHARGE

Rappaport Disability Rating Score Admission to Discharge 2000 2010 14 12 10 Rappaport Disability Rating Scale (30-0) 12.3 10 8 6 4 2 0 ADMISSION DISCHARGE

Chedoke-McMaster Activity Inventory - Admission to Discharge 2000-2010 Chedoke McMaster Activity Inventory Score (0-100) 50 45 45.6 40 37.2 35 30 25 20 15 10 5 0 ADMISSION DISCHARGE

Transitioning traumatic brain injury clients from Care Facility to Community 2000-2010 Place of Residence on Admission to ARBI Place of Residence Currently 25% 12% 75% 88% Care Facility Home in Community

Community Participation Admission to Discharge 2000-2010 4 Community Participation- Average Times per Week 3.5 3 2.5 2 1.5 1 0.5 0 ADMISSION DISCHARGE

Our Report Card Progress Towards Goal Achievement, Summary Average Scores On-site Clients Satisfaction Survey 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Category: 84% My physical goals 72% My cognitive goals 76% 76% My communication goals My social interaction goals

What Our Clients Say - Satisfaction Survey

Impact ARBI has on Quality of life 1 Low Impact 4.8 5 Significant Impact

New Initiatives CAMMRI - Comprehensive Assessment Measure for Minimally Responsive Individuals SaeboFlex Pilot Project Mirror Therapy Pilot Project

Grade 11 Honour roll Athlete Lots of friends Dave s Story

MVA 2005 Dave s life changed in an instant

Dave s Rehab at ARBI The best thing about ARBI is the people! They help me work to become more independent.

Dave Today

Carla s Story

Rehab at ARBI On-site program 2007-2010 Carla s Goal: To walk without her walker

Carla Today The grand essentials of happiness are: something to do, something to love, and something to hope for. Allan K. Chalmers

Kylan - A Survivor s Story On ARBI s website: www.arbi.ca

THANK YOU! Contact Information ARBI: (403)242-7116 www.arbi.ca