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What’s Initiation Deficit? Dr. Celeste Campbell, BrainLine

What’s Initiation Deficit?
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    Transcript of this video. Welcome to the first in a series of webcasts on traumatic brain injury, hosted by Doris McMillon. Concussion: Understanding Mild Traumatic Brain Injury will help you understand what a concussion is and what to expect during recovery. We are pleased to feature the following distinguished guests:
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    James P. Kelly, MA, MD, FAANJames P. Kelly, MA, MD, FAAN
    Dr. Kelly is Professor of Neurosurgery and Physical Medicine and Rehabilitation at the University of Colorado Denver School of Medicine and Associate Director of the Colorado Area Health Education Center System. He graduated cum laude with a BA from Western Michigan University, with a major in Psychology and minor in Chemistry before obtaining his MA, also at WMU, in Clinical Psychology. He earned his medical degree from Northwestern University. Kelly specializes in all aspects of traumatic brain injury research and clinical care. His scientific publications and editorials have appeared in numerous medical journals, and he is invited to speak on a variety of neurological topics across the United States and abroad. Among countless other affiliations, positions, and publications, he was lead author of the Colorado and American Academy of Neurology Guidelines for the Management of Sports Concussion, and a co-author of the Standardized Assessment of Concussion (SAC), which is the most widely used sideline mental status test in sports. Dr. Kelly is a member of the Colorado State Boxing Commission and is the consulting neurologist to the National Hockey League Players Association, to the Aspen Skiing Company, and to the US Department of Defense for blast injury and concussion. He is Chairman of the Defense Health Board's Traumatic Brain Injury External Advisory Subcommittee for military clinical care, research, and education. He maintains an active outpatient and inpatient practice at the University of Colorado Hospital. Aditya A. Bhagwat, PhD, ABPP-CNAditya A. Bhagwat, PhD, ABPP-CN
    Dr. Bhagwat is a board certified Clinical Neuropsychologist currently working in the Defense and Veterans Brain Injury Center (DVBIC) at Walter Reed Army Medical Center in Washington, DC. He completed his undergraduate studies in Psychology at McGill University, his doctoral work in Counseling Psychology at The Ohio State University, and a postdoctoral fellowship in Clinical Neuropsychology through the National Rehabilitation Hospital in Washington, DC, and Walter Reed Army Medical Center. Dr. Bhagwat served as a commissioned officer in the United States Air Force for seven years before joining the DVBIC, where he is privileged to be able to continue serving military service members who have suffered brain injuries. Aditya A. Bhagwat, PhD, ABPP-CNLesley LeMasurier
    A senior at University of Colorado at Boulder (CU), Lesley LeMasurier grew up skiing in Virginia until age twelve, when she moved north to attend Burke Mountain Academy, a ski racing school in Vermont. In the spring of 2003, she earned a spot on the United States Alpine Development Ski Team. Over the course of the two years (2001 – 2003) prior to joining the US Team, she suffered four concussions, and began struggling with poor balance, coordination, and strength on the left side of her body. She also began suffering from migraines and insomnia. Despite these symptoms, she accepted the spot on the team. But after many crashes resulting in a fifth concussion, a broken right leg, and torn ligaments in her left knee in early 2005, she left the development team to focus on her health. An English major with a minor in Ethnic Studies, she is also a member of the CU Varsity Ski Team, but given her history of mild TBI, she is medically ineligible to compete. However, she continues her relationship with athletics by assisting with ski team training sessions, mentoring freshman student-athletes in the athletic department at CU, and serving as a board member and the athlete representative for the Shelley Glover Ski Education Foundation. She plans to pursue an MFA in writing upon completion of her undergraduate studies. About BrainLine Webcasts We've launched BrainLine's webcast series to keep you informed — on an ongoing basis — about preventing, treating, and living with traumatic brain injury. Listen, watch, and learn from top experts in the field — from neurosurgeons and speech pathologists to long-time caregivers and individuals living with TBI.
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More Information
 

What exactly is “initiation deficit” and are there coaches or specialists who can help with this problem after a brain injury?

 

Initiation deficit refers to difficulty getting started in doing something. This appears to be a frontal lobe function and is not uncommon following a traumatic brain injury. The individual may have every intention of doing something, and may even have a plan, but just does not seem to be able to get started. This may be particularly difficult with tasks that have a vague starting or ending point such as “sometime next week I need to call the bank.” It may also affect immediate actions like “I need to go upstairs and get my glasses” as the individual just sits there. It as if somebody needs to push the “go” button.

Fortunately, there are strategies — and specialists — to help with this problem. A cognitive rehabilitation specialist (a neuropsychologist, speech-language therapist, or even an occupational therapist) will be able to teach these strategies and provide proper supports for implementation. Some of the strategies include different cuing techniques, scheduling specific times to get things done, auditory alarms, visual cues, and specific routines.

The strategies used will vary from person to person — depending on things like learning style, temperament, environment, interpersonal supports, and cognitive strengths and weaknesses — and will often take some trial-and-error and practice to perfect. Some of these techniques certainly can be used at home, and a cognitive rehabilitation specialist can help streamline and focus the process. As always, be sure the specialists you choose have expertise in brain injury.

 

Click here to go to About Ask the Expert.

Celeste Campbell, PsyDCeleste Campbell, PsyD, Dr. Campbell is a neuropsychologist in the Polytrauma Program at the Washington, DC Veterans Administration Medical Center. She completed a postdoctoral fellowship in Rehabilitation Neuropsychology at National Rehabilitation Hospital and has served as adjunct faculty for the George Washington University Graduate Certificate Program in Special Education and Traumatic Brain Injury. Dr. Campbell has a long history of providing cognitive psychotherapy and developing residential behavioral management programs for children and adults with a variety of cognitive deficits, including learning disability, developmental disability and traumatic brain injury. She has served as adjunct faculty for the George Washington University Graduate Certificate Program in Special Education and Traumatic Brain Injury. In addition she has been a frequent presenter and workshop facilitator, addressing psychological, neuropsychological and cognitive issues following brain injury to survivors and their families and friends, rehabilitation and vocational specialists, special education teachers, and case managers. She has appeared on The Donahue Show, Taking the ‘Dis’ out of Disability, and PBS’ Exploring the Brain with Garrick Utley.


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 Comments [1]

Hello Dr. Campbell, Wonderful article. Too bad, however, few windows are opened for the frontal/diffuse injury sufferers. I did it! I'm doing it! Small victories are most often the best. Take good care Paul Scott

Dec 17th, 2010 8:53am