Cognitive Benefits of Art Therapy for Individuals Who Have Sustained Traumatic Brain Injuries: A Resource Guide Laura A Cope Introduction + The purpose of this presentation is to share an art therapy-based resource guide aimed to treat individuals who have sustained traumatic brain injuries. + We will cover the following: + The purpose of this resource guide + What is TBI? + Why Art Therapy? + Who this resource guide benefits + How to use it + Special Considerations when using this guide + Nine Interventions for individuals whoa have sustained TBI Purpose Develop a resource guide for Masters level art therapists to utilize when working with clients that have sustained traumatic brain injuries. The interventions in this guide are geared to help in gaining or regaining various cognitive skills. Brain injuries can occur in anyone, but the highest prevalence of TBI occurs in children 14 years and younger and on the other end of the spectrum, 65 years and older (Roebuck-Spencer & Cernich, 2014). Justification The effects of traumatic brain injury can include massive disruptions to the individuals’ life-course, family, relationships, income, earning potential and costly expenses throughout their lifetimes. Art therapy can be used in many of the settings that treat TBI to help promote selfesteem, improve mental health, socialization, and stimulate different brain functions in a non-verbal way. Terms + Traumatic brain injury + Traumatic brain injury (TBI) is the term used to describe an injury to the brain acquired from an external force which results in some form of cognitive and/or behavioral alterations (Roebuck-Spencer & Cernich, 2014). + Cognitive Rehabilitation + Cognitive rehabilitation refers to a set of interventions used to help an individual regain previously learned skills or develop compensatory strategies to manage newly acquired cognitive deficits. Goals of neurorehabilitation include increasing cognitive ability, increasing independence and reintegration with the community. + Cognitive Skills + Executive functioning deficits are common in TBI. Executive functioning skills include a range of high order cognitive abilities that are mainly associated with the prefrontal cortex. These abilities include planning, judgement, memory acquisition and retrieval, attention and decision making. Executive functions also include emotional aspects of decision making, impulse control and motivation to initiate and execute tasks (Rabinowitz & Levin, 2014). Terms (cont.) + Art Therapy + Art therapy is a modality of therapy in which art making plays a central role in nonverbal self-expression. + Expressive Therapies Continuum + The Expressive Therapies Continuum is a theoretical model which guides the development of art-based assessments and art-based therapeutic interventions. The model can help assess the artist’s creative level based on media choice, interactions with the media, the imagery created and why they chose to create the imagery Brain Activity and Art Making + Lusebrink (1990) described images as a bridge between mind and body or “between the conscious levels of information processing and the physiological changes in the body” (p.218). As we increase our understanding of the hemispheres of the brain, we begin to understand what mental functions are involved in art making. + Research has also found connections between simple line drawings and language functions in the brain through positron emission tomography (PET) scans (Frith & Law, 1995). + In a study conducted by Walker, et al. (2018), 10 service member participants who had been diagnosed with chronic TBI received fMRI scans halfway through a four-week intensive outpatient program which included art therapy interventions. How to use this resource guide + This guide is intended for Master's level art therapists to use for those who have sustained traumatic brain injuries. The goal of these interventions is to gain or regain cognitive skills that have been impacted by TBI. The art therapist using this guide should also seek further training in TBI, neuroscience and cognitive therapy in order to best understand the unique needs of their client. This is not a step by step curriculum, but a collection of resources that can be implemented as needed. + Clients should be assessed prior to implementing any of the interventions to ensure that the directive is appropriate for the individual. Consider any adaptations or modifications that can be used to help the directive be as successful as possible. Art therapy can serve as a non verbal method of communication. Many who have TBI may also suffer with aphasia , among other speech deficits. While each intervention includes discussion prompts, they may not be appropriate for each individual. Special Considerations Physical deficits may also impact a client's ability to carry out some art making functions. Art therapists should use discretion in identifying when it is appropriate to adapt an intervention or act as a hand to the individual. A thorough assessment process should be conducted before choosing directives for the client. Intervention One: Still Life Drawing +Materials: + Paper, Drawing materials, Objects/Landscapes that will act as the subject Intervention One: Still Life Drawing Cognitive Benefits Considerations and Adaptations +Memory acquisition, increased attention, develops encoding strategies +If drawing detailed objects is too complex or the client's attention deficits are more severe, have the client draw three simple shapes at a time. You can also show them the shapes, have the study the shapes, then take them away. Have them draw what they remember. Intervention Two: Creating a Memory Box +Materials: +Container/Shoe Box, Personal Photos/Copies of photos, Personal items, Preferred materials to decorate the box Intervention Two: Creating a Memory Box +Cognitive Benefits +Considerations and Adaptations +Memory acquisition, Long term memory, Sequencing, Emotional regulation +This directive may be conducted in two sessions due to cognitive and physical limitations.. Having the clients discuss the items or photos in the box may be an emotional experience. Many living with TBI grieve their lives before their injury. Ensure this directive is conducted in a safe space for the individual. Intervention Three: Collaging my Life +Materials: +Paper, Scissors/adaptive scissors, Glue/glue sticks, Personal photos, Magazine/newspaper clippings Intervention Three: Collaging my Life +Cognitive Benefits +Considerations and Adaptations +Memory acquisition, Long term memory, Sequencing, Emotional regulation +It may be beneficial for this directive to be facilitated in a family session with the individual. This is especially true if the client decides to create a timeline of events. Family can assist in ordering events in chronological order. This activity can also facilitate reminiscing which aids in LTM retention. Intervention Four: Mindful Clay +Materials: +Air dry clay, Clay tools, clay knives if appropriate, sponges, needle tools, rolling pins, etc. Intervention Four: Mindful Clay +Cognitive Benefits +Motor skill development, Sensory memory, Build self efficacy +Considerations and Adaptations +It may be beneficial for this directive to be facilitated with an art therapist and occupational therapist present due to possible assistance needed when clients are manipulating the clay. Intervention Five: Origami +Materials: +paper squares, step by step instructions (optional) Intervention Five: Origami +Cognitive Benefits +Motor skill development, following directions, cognitive flexibility +Considerations and Adaptations +It may be beneficial for this directive to be facilitated with an art therapist and occupational therapist present due to possible assistance needed with fine motor skills. Intervention Six: Paint by Numbers +Materials: +paints (acrylic or tempera may be best), paint brushes, Canvas/Acrylic Paper with an unfinished images which the client will fill with paint colors. Intervention Six: Paint by Numbers +Cognitive Benefits +Considerations and Adaptations +Improves attention, following directions, sequencing, promotes mindfullness +This directive may not be appropriate for clients who have vision impairments due to their brain injuries. Some client's who suffer with aphasia may have difficulty identifying numbers and words. This could be a beneficial intervention to work on those skills, but may require one on one assistance. Intervention Seven: Jewelry Making +Materials: +Beads of various shapes and colors, String to hold the beads together, (optional) clasps or other jewelry findings. Intervention Seven: Jewelry Making +Cognitive Benefits +Sequencing, Pattern making, Improves attention, Promotes Self efficacy +Considerations and Adaptations +Clients that struggle with shakiness or other motor functioning impairments may benefit from occupational therapy support or the art therapist acting as a hand to the individual. Intervention Eight: Scribble Drawing +Materials: +-Resistive mark making tools (pens, markers, colored pencils, crayons, etc.), Paint (optional), Paper Intervention Eight: Scribble Drawing +Cognitive Benefits +Cognitive flexibility, remote memory, visual memory +Considerations and Adaptations +As with most of these directives, consider any potential physical limitations including poor motor skill function or vision impairments. Intervention Nine: Print Making +Materials: +Styrofoam (plates, trays, etc. as long as you have a flat surface) I used foam pads in my example, pens, Printing ink (speedball is affordable) or ink pads, (optional) printing brayer (looks like a roller), Paper Intervention Nine: Print Making +Cognitive Benefits +Considerations and Adaptations +Cognitive flexibility, Executing multistep tasks, Skill building +This project required many higher executive functioning skills and could be frustrating for some clients who struggle with initiating multi step tasks. If a client would benefit from this task, but requires additional assistance, it may be best to use this intervention in an individual setting rather than a group session. Limitations of Research + Has not been formally evaluated for effectiveness in improving cognitive abilities. + Interventions may require adaptations to meet the unique needs of each individual. + While each directive includes a list of processing questions, some individuals may live with speech impairments that affect their ability to verbally communicate. + Building rapport and assessing clients on cognitive functioning will help the interventions be more successful. + These interventions are meant to be utilized by master's level art therapists who have also acquired additional training in cognitive therapy and in traumatic brain injuries. Discussion Conclusion +There is a significant lack of research on the benefits of art therapy with the TBI population. +This curriculum serves as a flexible guide of directives that can be utilized individually or in group settings. +The target population would be individuals who have sustained traumatic brain injuries and are in treatment to gain or regain certain cognitive functions. +These directives should be carried out by licensed art therapists who have also had extensive training in the TBI population. +These directives can be used in residential, hospital, or outpatient settings. Q&A References: +Frith, C., & Law, J. (1995). Cognitive and physiological processes underlying drawing skills.Leonardo, 28(3), 203–205. +Roebuck-Spencer, T., & Cernich, A. (2014). Epidemiology and societal impact of traumatic brain injury. Handbook on the neuropsychology of traumatic brain injury, 3-23.c +Walker, M. S., Stamper, A. M., Nathan, D. E., & Riedy, G. (2018). Art therapy and underlying fMRI brain patterns in military TBI: A case series. International Journal of Art Therapy, 23(4), 180-187.