Val LougheedNorthern Lights Canada

Mental Health & Injury:Rehab, Recovery and

Return to Work

Trauma, Rehabilitation and Recovery –

~ Keep Your Fork ~

1-800-361-4642 * www.northernlightscanada.ca * vlougheed@northernlightscanada.ca

“You don’t want your impairments to define you – you want them to inform you.”

(Hanita Dagan, personal communication, 2005)

www.slideshare.com/vlougheed

#NLCAN

www.northernlightscanada.ca/about/about-

val-lougheed/be-still

Agenda

•Beginning …

•Middle …

•End …

Rehab, Recovery and Return to Work

1. What does it mean to recover?

2. What can I do to recover and return to a life that includes work?

3. What can we do to facilitate recovery and a return to work?

Rated PG-113

People Strongly Cautioned!

May contain bad language, brief nudity, sexual overtones, and drug usage.

Beginning

My Story

Sept. 9, 2003 - morning

Sept. 9 – p.m.

Sept. 15 2003 – Jan. 19 2004

Journey Back to Life

Research

Dominant Themes

• Narcotic Pain Killers

• ABI

• Pain

• Trauma

• Depression

• Methods of Helping• Return to Work

• Life

Foundation for Understanding

Experience

Body-Mind Connection

Psychoimmunoendocrine Network

The nervous, endocrine, and immune systems are functionally integrated – the brain is only one part of this non-hierarchical network Memories, emotions, behaviours and physiology are all connected at the molecular level

(Candace Pert, 1997, p. 171 – 179)

February 2004 – Present

Starting Point

Identity Disintegration

and

The Re-organization of Self

March 2004

“In the aftermath of traumatic life events … [the] sense of self has been shattered.”

(Herman, 1992, p. 61)

“An existential crisis …”

(Hanita Dagan, personal communication, 2005)

Sliding Down the Slope

Early 1900’s Oxycodone™ developed in Germany

1995 Purdue Pharmacy (USA) launches OxyContin™ – controlled-release formula

1996 Approved in Canada

2002 OxyContin™ earns Purdue more than $1 billion U.S.

2003 OxyContin™ is one of Canada’s 3 most-prescribed narcotic painkillers

Nov. 2003 – Oct. 2004

783,762 prescriptions for OxyContin™ dispensed in Canada

(Dalhousie, March 2005)

Sliding Down the Slope

A Foothold

• Mild – moderate ABI

• Depressed (dysphoria)

• Working memory problems

• Hiding pain

1st Neuropsychological Assessment

June 2004 -- Results

ABI – Measuring Loss

“Pre-morbid intelligence is a crucial variable …”

Subjective Report – difficulty retrieving words and communicating ideas

Objective Report – above-average performance on neuropsychological measures

(Prigatano, 1999, p. 59)

Losing My Grip

My IWRPAugust 2004

Rescued in the Valley of Despair

Head Injury ProgramOct. – Dec. 2004

HIPOct to Nov – Full-time

December – Part-time

GO TO WORK

GRTW – The Plan

Jan. 3 – Feb. 7, 2005

(5 weeks)

GRTW – The Reality

GRTW – The Reality

GRTW – The Reality

GRTW – The Reality

GRTW – The Reality

GRTW – The Reality

GRTW – The Reality

GRTW – The Reality

GRTW – The Reality

Rescue Attempts

• Case Manager

• Job Coach

• Colleagues/Friends/ Psychologist

Sliding Back Down Into The Abyss

• Non-compliance

• Malingering

• Trying too hard

• Not trying hard enough

2nd Neuropsychological Assessment

May 2005 -- Edmonton

Test Results• Mild to Moderate ABI

• Pain?

• Depression?

• Motivation?

• “a high flyer”

• “phobic avoidance”

• Future plans – “live off dividends” [from company]

Lesson

ASSUMPTIONS

REVEAL BIAS

• Mild – moderate ABI

• Good prognosis

• Post-Traumatic amnesia

• Pain?

• Depression?

• “Adjustment Disorder with Anxiety and Depressed Mood”

3rd Neuropsychological Assessment

August 2005 -- Calgary

Symptom Overlap

(co-morbidity)

(Michael Sullivan, Centre for Research on Pain and

Disability, McGill University, September, 2006)

Pain, Trauma, Depression, ABI

Oct. 3 – Dec. 11

Pain Research

1600’s – Rene Descartes (philosopher)

Pain Research

1950’s – Wilder Penfield (brain surgeon)

Pain Research

Patrick Wall (physiologist)Ronald Melzack (psychologist)

Pain ResearchGate Control Theory

• Acute and chronic pain

• Pain sensation travels up the central nervous system to the brain through a “gate”

• “Gate” – triggered by cell changes – sends descending messages that alter sensory input

• Pain isn’t pain until it reaches the brain

• Emotions, context, etc. affect pain sensations

• Pain is a negotiable, individual experience

• Pain centres in the brain – they just keep moving around

(Jackson, 2002, p. 21)

Pain – The Future

SCN9A(Globe and Mail, March 24, 2007)

Glia Cells(Scientific American, November, 2009)

Poppy Genes(U of Calgary -- Calgary Sun, March 15,

2010)

Limbic SystemThe centre for emotional expression

(Prigatano, 1999, p. 132)

• Amygdala - attaches emotional tags to memories

(Dr. Suffield, personal communication, 2004)

• Hippocampus - controls the laying down of new memories

(Ramachandran & Blakeslee, 1998, p. 15)

• Hypothalamus – controls the outward expression of emotions

(Ramachandran & Blakeslee, 1998, p. 177)

Trauma Research

“In every encounter, basic trust is in question.” ( Herman, 1992, p. 92)

“Survivors feel unsafe in their bodies – and in any relationship with other people.” (Herman, 1992, p. 160)

Rehab & Recovery

TraumaPersonal Experience

• Dissociation & Cocoon = Safety

• System on High Alert Always = Survival

• World is black & white = Trust

Trust (Safety) = Love

No Trust (Life Threatening) = Hate

TraumaPersonal Experience

• Listen to me

• Understand me

• Respect me

• Are competent

I trust (love, feel safe with, will try hard for) practitioners who:

“… depression [caused by trauma] is not the same as ordinary depression.”

( Herman, 1992, p. 118)

Depression

“Emotions are not in the head – they are in every cell in the body.”

(Pert (1995), in Bolen, 1996, p. 7)

Pscyhoimmunoendocrine Network

Affects more than IQ ….

• We are sensitive to changes in higher cerebral functioning

• Very important to a person’s sense of self

• Touches core … of a person’s self-esteem

(Prigatano, 1999, p. 58)

ABI

Back to Wilder Penfield – 1950’s

ABI

Localizationist

Paul Bach-y-Rita – 1934 – 2006

Scientist and Rehab Doctor

Neuroplasticity - 1969

Michael Merzenich

Neuroplastician

Neuroplasticity

Harnessing the Power

“The words and attitudes of others … are potent. They help or hex healing and recovery.”

“ Expectations are powerful.”

“Neutrality can be deadly.”

(Bolen, 1996, p. 94)

Body-Mind Connection

•Hypothalamus

•Peptides

•Receptors

•Biochemical Events

Quantum Connection

The Living Matrix -- 1995• A type of energy exists that has previously gone unnoticed.

• Cells/DNA influence matter through this form of energy.

• DNA Phantom effect. Braden, 2007, p. 45

“Loss of identity can evoke a personal crisis, creating a need for change.”

(Ornelas, in Smith & Johnson (Eds), 1997, p. 172)

The Re-Organization of Self

Identity Research

Scaling the Canyon

Sept., 2005

Waskesiu

Breast Cancer Reconstructive Surgery

March 2006

Convocation M.Ed. -- June 2006

Back in “a” SaddleSeptember 2007

• Officially change role/ title

• Re-organize NL

• Work part-time

Rehab, Recovery and Return to Work

Resilience Ability to return to original form after

being bent (bounce back)

Thriving in constant change, ability to be:

• Flexible

• Creative

• Adaptable

• Learn from experiencehttp://www.resiliencycenter.com/articles/5levels.shtml

Rehab, Recovery and Return to Work

Rehabilitation (habiter – to live inside)

“Rehabilitation is the learning to live inside not only one’s body, however it is after an injury or illness, but inside one’s very being.”

(Kabat-Zinn, in Meili, 2003, p. 241)

Rehab, Recovery and Return to Work

RecoveryCuring Focus on the illness/

impairment [outside]

Healing Focus on the person [inside]

Crombez, October, 2003

Be Still

Rehab, Recovery and Return to Work

1. What does it mean to recover?

2. What can I do to recover and return to a life that includes work?

3. What can we do to facilitate recovery and a return to work?

Keep Your Fork

Northern Lights Canada is a person-centred organization committed to providing innovative, responsive links to real work.

We offer 4 major divisions of service: • Vocational Rehabilitation Services • Employment Services • Employer Services• Corporate Training

For more information, please contact us: 1-800-361-4642

www.northernlightscanada.ca

Voc Rehab Canada (VRCAN) is a national consortium of experienced regional vocational rehabilitation companies. VRCAN provides customers with single-point access to VR services anywhere they are needed in Canada, whether on an individual service or contract basis.

Member companies include:Argus Management Consultants,

Inc. Sandra Preeper & Associates

Advantage Rehabilitation Consultants Ltd.

Rehabilitation Alternatives Limited / Vocational Alternatives Software

OPTIMA Rehabilitation CVE Inc.

Northern Lights Canada Occupational Rehabilitation Group of Canada (ORGOC)

Western Rehabilitation Specialists Inc.

Diversified Rehabilitation Group

Genesis Rehabilitation Ltd. Rehabilitation FocusFor more information, please feel free to contact us at 1-800-361-

4642