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Brain trauma prevention programs

 
 
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Abstract

We are presenting three examples of good practice in preventive work of Centre Naprej, where we provide long-term psychosocial rehabilitation for persons with acquired brain injury.

The first example represents preventive workshops intended to different target groups. In these workshops professionals together with users of our services raise awareness about the consequences of brain injury and preventive measures against it.

Second example is the provision of mandatory community service, which is ordered to persons, who have committed an offense - it is an alternative to servicing prison sentence, to settlement or prosecution. Persons, who carry mandatory community service in Center Naprej, are mostly juvenile delinquents. In Center Naprej they come in contact with persons who suffer the consequences of brain injury. In that way they gain an experience what can their risky and reckless behaviour cause.

The third example is organizing and conducting various events and actions in wider social environment. The main goal of such actions is to raise awareness of wider public about the acquired brain injuries and possible prevention. Second aspect is to include people with special needs in nearby environment and thus reduce their feelings of social exclusion and discrimination.

In our paper we will highlight the effects of our preventive work on narrow and wide public; and last but not least, the impact on our users, who engage in a new role as active trainers and citizens.
 

1. Introduction

Acquired brain injuries (ABI) belong to the biggest problems in the majority of developed societies, and are a leading cause of death and disability in the world.

The Center Naprej provides a long-term rehabilitation to people and their relatives after the ABI, and at the same time it works precautionary in wider social environment. Users are active co-creators of all programs.

We are presenting three examples of good practice in prevention programes of Centre Naprej Centre.


2. Brain injury facts

Worldwide
- Of all types of injury, those to the brain are among the most likely to result in death or permanent disability (1).
- Brain injury is the leading cause of death and disability worldwide.
- Traumatic brain injury is the leading cause of seizure disorders.
- The World Health Organization (WHO) adopted standards for the surveillance of central nervous system injury in 1993.

European Union
Brain injury accounts for one million hospital admissions per year.

Causes of Traumatic Brain Injury:
- Motor Vehicle Crashes account for 50% of all TBIs. This includes autos, trucks, motorcycles, bicycles, and pedestrians hit by vehicles.
- The leading causes of TBI vary by age: falls are the leading cause of TBI among persons aged 65 years and older; transportation is the leading cause of TBI among persons under the age of 65 years.
- Estimates suggest that sports related brain injury accounts for close to 300,000 injuries each year, with winter sports such as skiing and ice-skating accounting for close to 20,000 brain injuries (2).

Slovenia
In emergency surgeries ambulances annually 4,400 injured persons with all forms of  head and brain injuries from mild to severe are  treated:
- Mild accidental brain injuries are one of the most common diagnoses in damage to the nervous system with a significant proportion of people who have long-term consequences and occupy from 70% to 90% of all registered brain injuries (3).
- 40% of the injuries account for an accident with a motor vehicle, 20% of injuries have non-motorized road users (cyclists and pedestrians), 35% of injuries resulting from a drop from various reasons (work accidents, sports injuries, leisure) and 5% of the injuries are result of an act of violence (4).
- Due to a stroke annually 4,400 persons are treated (5).

Who is at Greatest Risk?
- Males are more likely to sustain a TBI.
- Adults 65 years and older have the highest rate of TBI deaths.
- Children under the age of one and adults 65 years and older are most likely to sustain a TBI severe enough to require hospitalization; 15 to 19 year olds have the third highest rate.
- Children under the age of one, followed by 1 to 4 year olds, are the most likely to be treated in an emergency department for a TBI; 15 to 19 year olds have the third highest rate.
- In motor vehicle crashes, not wearing a seat belt, alcohol, and speed are all associated with high rates of TBI (6).

Occurrence of traffic accidents is influenced by several factors, but the main are participants in road traffic, road infrastructure, motor vehicle and traffic environment. Among all these factors, a human has the most important role, because as a driver is in the role of the user of the motor vehicle and the road, as a designer, it is very important link in the construction of roads.

Sistem human-environment-vehicle (12)
Occurrence of traffic accidents is influenced by several factors, but the main are participants in road traffic, road infrastructure, motor vehicle and traffic environment. Among all these factors, a human has the most important role, because as a driver is in the role of the user of the motor vehicle and the road, as a designer, it is very important link in the construction of roads.

Prevention
- The best protection against brain injury is prevention (7).
- TBI's can be life altering, yet many are preventable if the necessary precautions are taken (8, 9).
- Research has shown that approximately 85% of head injuries form bicycle accidents can be prevented with the use of helmets (10).
- WHO Regional Office for Europe reported, if all countries in Europe had the same death rate from injuries as the countries with the lowest rates, some 500,000 lives could be saved each year (11).


3. Brain Trauma Prevention Programs In Centre Naprej

Centre Naprej provides long-term psychosocial rehabilitation for persons with ABI and their relatives and at the same time it works precautionary in the wider social environment. Users are active co-creators of all programs.

In Centre Naprej one of our primary goals is to act socially responsible. It is important and necessary that the society strives to develop social responsibility towards all of its members. As Berman argued in 1990 (13), “Social responsibility – that is a personal investment in the well-being of others and of the planet – doesn’t just happen.” The education for development of social consciousness is a lifelong process that must start in an early age. And society as a whole plays an important role in such education with its social norms and regulations of socially acceptable behaviour.

Preventive program at our centre isn’t intended only to public, it also plays an important part in rehabilitation of our users. The consequences of ABI increase the risk they are facing by engaging in everyday activities. And it’s our professional and moral duty to equip them with knowledge and experience to reduce that risk and have quality lifestyle after ABI. Thus the preventive program is an important part of our everyday work.

Brain Injury is a public health concern that demands ongoing epidemiological study, increased efforts to prevent injuries from occurring, and research to advance medical options and therapeutic interventions.

Goals:
- Developing of social consciousness.
- Acting socially responsible.
- Informing public about acquired brain injuries and their consequences.
- Reducing the rate of acquired brain injury in all age groups, especially reducing traumatic brain injuries among small children and teenagers.
- Encouraging people to choose a healthy/safe way of life.
- Raising awareness about the importance of protective equipment/means (helmets, safety belts ...).
- Providing a personal experience with a person with ABI.
- Increasing traffic safety.
- Involving persons with ABI in socially responsible and valuable activities.
- Mentally and emotionally connecting risky and reckless behaviour with its consequences.
- Directly connecting different target groups (drivers, offenders, drug users…) with persons with ABI and giving them personal experience.
- Setting a good example in participating in a great number of social and physical activities.
- Promoting a healthy lifestyle and sports activities.
- Reducing the prejudices towards the population that is different.

Methods:
- Lectures with practical demonstrations
- Role play
- Confrontation
- Use of audio-visual material
- Group discussion
- Analysis of media news
- Panel discussion
- The method of observation, perception, sensation
- Brainstorming
- The method of random clustering

PREVENTIVE WORKSHOPS
2011 - 2015

In Centre Naprej one of our primary goals is to act socially responsible. Thus we developed a program of preventive workshops intended to various target groups: pre-school children, schoolchildren, students, driving schools, companies and other. They are measures that we perform in an effort to prevent brain injuries. Our professionals perform these preventive workshops at schools or workplace and sometimes at our Center – how workshop is conducted depends very much on number and age of participants.  The theme of a workshop also depends on age of participants and their special interest. For example for small children, the emphasis is on safety at home, wearing helmets and protective clothes and shoes at sport activities and importance of fastening seat belts in cars. For children in school the emphasis is on safety in traffic (for groups that are intended to pass cycling license or driver’s license) – we highlight critical areas in traffic such as speeding, alcohol and drug abuse, use of a seat belt, helmet and encourage them to act responsible in any role they find themselves in engaging traffic. Other emphasis is to highlight the consequences of risky behaviour (drug and alcohol abuse, physical violence…). We also inform participants about functions of the brain, prevalence and consequences of acquired brain injuries. 

We use different methods, but the most important method is confronting participants with a person who suffered ABI and now has to live with the consequences. In that way they gain personal experience about how altering for life ABI can be.

PROVISION OF MANDATORY COMMUNITY SERVICE
2009 - 2015

The second example of good practise of preventive work in Center Naprej is the provision of mandatory community service, which is ordered to persons, who have committed an offense - it is an alternative to servicing prison sentence, to settlement or prosecution. Mandatory community service is socially useful work or work in the general interest. People, who carry out community service, are working for the benefit of local communities, humanitarian organizations and other organizations engaged in non-profit work.
A person, who is penalized for a foul and was fined, can propose to the court to replace the payment of the fine with performing of work in the general interest or for the benefit of local community. It is also possible for court to replace the prison sentence up to two years (except for an offense of a sexual nature), with the sentence of mandatory community service. Executions of mandatory community service are prepared, managed and supervised by Social work Centres. In the process of deciding which organisation is the best option for the punished person, the Social work Centre takes into account what kind of work would be most appropriate due to personal characteristics, personal circumstances, health, employment potential, skills and knowledge as well as permanent or temporary residence of the person. (14)

Persons, who carry out mandatory community service in Center Naprej, are mostly juvenile delinquents. In the last six years 28 persons have carried out mandatory community sentence in Center Naprej, and from those, 23 persons were juvenile. Most of them stated that the community work in Center Naprej gave them better understanding of what can their risky and reckless behaviour cause and that because of this experience they won’t repeat these kind of behaviour. Some of the persons who serve mandatory community work in Center Naprej have also stayed involved in Center Naprej as volunteers or they just visited users after their punishment was done. These facts led us to conclusion that mandatory community service in Center Naprej is beneficial for all involved parties. It directly links offenders with our users, persons with ABI, and so it gives them personal experience. On the basis of this experience they are able to link their risky and reckless behaviour with its consequences on cognitive and more importantly, on emotional level. This is especially important for youth.

EVENTS AND ACTIONS IN WIDER SOCIAL ENVIRONMENT 
2014 — 2015

The Centre Naprej implements numerous activities in the context of the program of sports rehabilitation for people with ABI, of which the main goal is to improve or preserve physical condition, improve and stimulate a healthy lifestyle, increase a sense of self-worth when tasks performed, acquire new knowledges and skills. Achieving these goals, we stimulate the improvement of flexibility, mobility, increase of general motivation due to activation and reaching sports success, implementation of sports activities in domestic environment and therefore beneficial and healthy free-time activities; consequently the quality of life and self-activation of users increases.

To raise general awareness about the importance of sports rehabilitation in a long-term rehabilitation of people with ABI, to set a good example and to participate in a great number in physical activities, we decided to join the activities in the context of the Move week. Move week (http://slovenia.moveweek.eu, 26.1.2015) is a Pan-European project and a part of the campaign NowWeMove.

The hiking section of the Center Naprej Maribor thus became one of the agents of exercise and organized two events in last years intended for people with disabilities and their active involvement in the wider social environment.

These activities enable gathering and meeting new people in a wider social environment for users besides primary goals of the development of a healthy lifestyle and sports activities. This gathering has positive impacts on reduction of prejudices towards population that is different and has special needs; it has also preventive effects.

User’s Point Of View

We have been including our users in prevention activities from the very beginning. Based on their statements this is very important to them. They come in contact with other social groups; they get to share their stories and their experiences so they feel useful again. Through telling their stories they re-evaluate their life and their brain injury. But let them speak for themselves:

A. M. (38 years): I think it is wise to raise awareness of young people with our own experiences and thus contribute to traffic safety. I feel very good about that and I would be very happy if my experience could help young drivers. Based on what I have experienced in these workshops, I think young people are touched and that they think about our stories when they go to the road. I think that we must live our lives to the fullest, but with caution and common sense. And this is what I want to pass to them.

B. L. (48 years): It seems to me wise and right that adolescents, who go astray, see what awaits them if they continue with their risky and irresponsible behavior. I think this is very educational. All in the center shared with them our life stories while they worked together with us, helped us.

L. Š. (50 years): I love it when there are a lot of people at events and I have an opportunity to get to know them. I like hanging out and experience new things. I like that we were in the city of Maribor, where I attended high school. After many years, I could walk through the streets where I once lived. Many people have asked me who we are, what is going on. I told them what led me to the Centre Naprej and what I'm doing there.


4. Conclusion

Acquired brain injuries are a growing social problem as they result in many traumas at personal and social level. Thus education about risks and consequences, prevention activities and support to the affected is very important and necessary. With our preventive workshops we raise awareness about the problem of brain injuries, increase understanding of wider public about specific problems that persons with ABI face and thus promote their social inclusion.


5. References

1) Centers for Disease Control and Prevention. (2016, February 13).
2) Thurman DJ, Branche CM, Sniezek JE. The Epidemioogy of Sports-Related Brain Injuries in the United States: Recent Developments. Journal of Head Trauma Rehabilitation 1998. (2016, February 13).
3) Grabljevec K, Klinične smernice za rehabilitacijo odraslih oseb po nezgodni poškodbi. Rehabilitacija. Ljubljana: Univerzitetni rehabilitacijski inštitut Republike Slovenije – Soča; 2014; 1: 53-68.
4) Šešok S, Grabljevec K, Nezgodne možganske poškodbe - tiha epidemija z dolgosežnimi pos¬ledicami. JAMA—SI.  Radovljica: Didakta d.o.o.; 2010; 5, 199-201.
5) Klanjšček G, Obravnava bolnika z akutno možgansko kapjo. Farmacevtski  vestnik. Ljubljana: Slovensko farmacevtsko društvo; 2015; 66: 49–55.
6) Traumatic Brain Injury: Prevention is the Only Cure. (2016, February 18). 
7) Brain Injury Can be Prevented!!  (2016, February 18). 
(8, 10) Traumatic Brain Injury. (2016, February 18).
9) Tips for preventing brain injury. (2016, February 18).
11) Falavigna A et al. How can we teach them about neurotrauma prevention? Prospective and randomized "Pense Bem-Caxias do Sul" study with multiple interventions in preteens and adolescents. J Neurosurg Pediatr; 2014 Jul; 14(1):94-100.
12) Obdobni načrt za zagotavljanje varnosti cestnega prometa v letih 2015 in 2016. (2016, February 18).
13) Berman S, Educating for Social Responsibility, Service Learning, General Paper 43. (2016, February 18).
14) Družbeno koristno delo. (2016, February 22).

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