The right to have a support person at an assessment

In New Zealand the Health and Disability Commission Code of Rights states that people have a right to support at any medical appointment. This is particularly important for those with brain injury who may forget what has happened during an appointment. It is also important for those who may misrepresent themselves as coping better than they actually are, either because of pride or because of a lack of insight. Finally and most importantly from the perspective of this writer, it is also important for this group because they are living in a system without the protection of common law. Those who live in NZ know that we gave away our right to sue, in exchange for a no-fault compensation system. It has now been in operation for over a generation and is part of the NZ psyche and a major contributor to social capital. However, some distortions have arisen whereby the rights of those who are disabled by injury are becoming eroded. I argue here that this has been able to happen because of an erosion of the integrity of health professionals and the consequent failure of health practitioner associations to deal with the ethical challenges that are implicit in a no-fault system.

The potential for corruption has been especially evident at times when ACC is making major cutbacks. Health professionals can begin to collude in a process that disadvantages claimants to the extent that they lose their entitlement. Therefore a second very good reason for having a support person is to ensure that the assessor knows that there is a witness to the process. Someone cares about this person enough to sit with them through an interview and assessment process.  However, recently some health professionals have been refusing access to support persons and they have been appealing to their professional associations for corroboration of this decision. There is a claim made that a support person is the equivalent of the third party observer (from the litigious US context), and that furthermore this threatens the integrity and validity of the assessment materials. The implication being that support people are able to coach the person they are supporting and that they will also be able to ‘spy’ on the assessment materials.

These arguments are a fundamental distortion of the reality and they breach the possibility of the most basic level of advocacy for people with brain injury. This is the group who are among those most likely to cut from ACC books and they require some kind of protection. The presence of a support person may be the only social capital that they can draw on. Furthermore, there simply is not the expertise among support people to begin to offer the kind of threat that is posited to the validity of assessment material.  The support person is generally a relative or a friend, or it can be a liaison officer from the Brain Injury Association. This is generally a non professional person, employed by the BIA because of their family experience of brain injury. This is the group who are especially being targeted for exclusion from interviews on the grounds of their capacity to be ‘third party observers’. They have no interest in learning how they can coach those they are supporting, rather they want to provide support to those who are justly terrified by the process of assessment.

The disability movement is increasingly highlighting the issues of power imbalance between health professionals and those they are supposedly serving. This has particular resonance in the situation that has arisen in NZ where some health professionals have a reputation for invariably denying the aetiology of the particular conditions, such as brain injury. This belief tends to improve their employment prospects with ACC. This has led to situations where brain injury has been denied in situations where a person has been repeatedly assessed as having this condition over a period of over 15 years. Effectively this becomes a statement about malingering, which is incredibly powerful in terms of its capacity to destroy the integrity of the injured person. Such statements would be actively challenged in a common law system, especially in situations where fault could have been demonstrated. One of the weaknesses of the NZ system is that is has never established a permanent pension for those with severe disability, which leaves open forever the possibility that a compliant health professional will assess them as being suddenly cured of brain injury.  It means that in New Zealand, no matter how disabled the person is, their disability can always be open to reassessment and reconfiguration.  In another country if they were fortunate enough to have their condition accepted in a court of law (and there was fault established) then they would not be expected to continue to prove that this condition existed every year for the rest of their lives. 

In these circumstances it is hardly surprising that the injured patient would ask for a support person to come to an assessment. Yet it seems that some health professionals are now threatened by anyone who acts as an advocate for their clients. One has to suspect their motivations, even if they are couched in seemingly impeccably professional terms.  In New Zealand, once one gets to the review process, the judgement of the ACC employed assessor has been held as sacrosanct (Ramsay 2002). There is very little subtlety about interpreting whether that health professional may have a particular bias in favour of their employer (ie ACC).  In a court of law it would be possible to tease out some of these distinctions, but one of the disadvantages of the New Zealand no-fault system is that major savings are made by avoiding what would happen in a court of law. This unintended development of the ACC system has placed injured people in a very vulnerable position and there is little evidence that professional groups have adequately (or at all) reflected on the consequences for patients of their members having power that is not regulated by legal processes. The injunction to “first do no harm” seems to be fundamentally flawed within such a regime and health professionals are implicated in processes whereby thousands of people have been ‘cut’ from ACC. In the late 1990s the numbers of long term disabled on ACC were reduced from 30,000 to 15,000. During 2010 there has been another programme of such cuts and I personally know of people who have been unjustly removed.

There is growing evidence that those health professionals who are prepared to work with ACC in this way are effectively able to earn salaries that are more in line with corporate executives than health professionals. For example, psychologists can earn up to $540,000 for undertaking assessments for ACC. A small number of psychologists are known to conduct between 1000-2000 assessments per year (which staggers the mind). Finally a single assessor was paid between $1.3 and $1.6million by ACC for services from 2005-9, all of which were undertaken in addition to a full time job in the public health service (Barraclough and Forster 2010).

There are always problems at the edges of every system and sometimes it is hard to raise interest in these issues because they are so particular to that system. However, the NZ experiment with no-fault compensation has the capacity to demonstrate that there is an alternative to tort law, which is based on fundamentally egalitarian principles.  In a world that seems to offer few real alternatives to the power of major insurance schemes this experiment is a treasure that is worth preserving. For this reason, it is important to tease out the issues that have begun to compromise the system in order to explore whether this means that there cannot be an alternative to tort law. The issue of advocacy for people with brain injury who are being denied the right to have a support person seems to be one of those issues that should be setting off alarm bells. The onus is on health professionals to prove that they are not dividing off people with disability and isolating them from any natural supports, in order to make them more vulnerable. The measure of a society is how it is prepared to care for its most vulnerable, and the worst indictment of a health professional should be that they would deliberately exploit the vulnerability of the group that they serve. If ACC has allowed this example of structural violence to corrupt the practice of individual health professionals, it is up to professional associations to put ethical measures in place that call such practices to account.

principles of brain injury

It strikes me that there can never be enough principles to guide us.  However, I have never found anything that satisfied what I understand about brain injury.  I have put together two sets of principles here.  The first is from the perspective of the person with brain injury, the second is from a rehabilitation professional’s perspective.  This is just a beginning.  Have you anything to add?

Principles of living with brain injury from the perspective of someone with a brain injury

  1. You will be alienated.  Don’t let anyone lay memory principles on you…..those memory conclusions just contribute to the alienation. 
  2. You will have to receive energy from others for the rest of your life.  You need to set up a situation where people are going to be responsive to you.  You make them morally obliged to you.  .  You do this by taking responsibility for giving out energy, which you will then get back. 
  3. You have no future with brain injury. 
  4. You will never belong.  You are on your own.  You need to learn to handle isolation.  You never receive the reassurance of being a member because that is a memory thing.  You cannot think of two things at once, of belonging and being here. 
  5. Go with the flow – because if you don’t go with the flow you get mood swings and all the classic things that go with it.  It is about accepting that you are buggered then you learn how to handle the new brain states.  At first you are angry, frustrated and in a state.  It is only when you have learned to live with a new brain state….you come to terms with. 

(from a conversation with William Fairbank)

Principles of brain injury from a rehabilitation perspective

1.The clinican must begin with patient’s subjective or phenomenological experience to reduce their frustrations and confusion in order to engage them in the rehabilitation process.

2. The Patient’s symptom picture is a mixture of premorbid cognitive and personality characteristics as well as neuropsychological changes directly associated with brain pathology. 

3.Rehabilitation focuses on both remedation and the social situation.

 4.Rehabilitation helps patients’ observe their behaviour and thereby teaches them about the direct and indirect effects of brain injury.  This may help patients avoid destructive choices and better manage their catastrophic reactions. 

5.Failure to study the intimate interaction of cognition and personality leads to an inadequate understanding of the issues

6.Little is known about how to retrain a brain dysfunctional patient cognitively, because the nature of higher cerebral functions is not fully understood.  General guidelines for cognitive remediation, however, can be specified

7.Psychotherapeutic interventions are often an important part of rehabilitation because they help patient and families deal with their personal losses. 

8. Working with brain dysfunctional patients produces affect reactions in both the patient’s family and the rehabilitation staff.  Appropriate management of these reactions facilitates the rehabilitation and adaptive process.

9.Each rehabilitation program is a dynamic entity.  It is either in a state of development or decline.  Ongoing scientific investigation helps the team learn from their successes and failures and is needed to maintain a dynamic, creative rehabilitation effort.

 10.Failure to identity which patients can and cannot be helped by different rehabilitation approaches creates a lack of credibility of the field.

11.  Disturbances in self-awareness after brain injury is often poorly understood and mis- managed.

12.   Competent patient management and planning innovative rehab programs depend on understanding mechanisms of recovery and deterioration of direct and indirect symptoms after brain injury.

 13.  The rehab of patients with higher cerebral deficits requires both scientific and phenomenological approaches.  Both are necessary to maximise recovery and adaptation to the effects of brain injury. 

 Adapted from, Prigatano, G. P. (1999). Principles of neuropsychological rehabilitation. New York, Oxford University Press.

Message to the parents of the newly brain injured person.

There are times when infants are born when things have not turned out as a parent might have planned. Despite our best efforts, careful prenatal environments making use of the best available information, there are infants who come into the world with handicaps and disabilities that cannot be corrected. When handicapped children are born in hospitals, the best ones immediately provide counsellors to talk with parents about the educational possibilities that will be open to them, and give them hope regarding their children’s futures, provided they attend closely to them. Child psychologists have found that this makes a major difference in the bonding that takes place in the family, and ultimately in maximizing the child’s, and the family’s, potential.

So I wonder why we can’t make it a practice to provide counsellors to talk to families of people who have had to re-start life with a brain injury. This moment of catastrophic change brings with it the need for a new bonding. Parents need to know about the possibilities that are available to them, what they can hope for. Of course it is impossible to give an exact prognosis for this person, but there are some words that we could say that might give guidance and comfort. Can we begin to imagine what we would like to say if we were place in that position? Wouldn’t it be great to have a book filled with multiple scripts for the occasion? You could imagine saying some of these things…..

“Congratulations that Christian is still alive. I know you are exhausted after all you have been through in intensive care and rehabilitation! And, let me tell, so is he. It is the end of a long journey for both of you, and the beginning of another, one that I hope will bring both of you nothing but joy!”

“Christian has been damaged in this injury, but he is otherwise perfectly healthy. We can hope that he will have a long, happy, and fulfilling lifetime. You always need to remember this – Christian is absolutely unique, as he always was. There is not another person who has ever existed on this planet, short of cloning, who has the same biological makeup that he does, or ever will. Even if a clone of Christian had a similar brain injury the effects would be different, because that clone would be exposed to environmental influences – including you and the life you make for him – which are absolutely unique, and which awaken some of the latent possibilities built into whom he is, and will leave others sleeping.”

“Now there is something else I need to tell you. It is statistically unlikely that Christian will achieve all that he might if he had not had the brain injury. He is unlikely to win the Nobel Prize, invent the final cure for cancer, attend Harvard, compete in the Olympics, conduct the New York Philharmonic, or become President of the United States. All of these are always possible, of course. I’ve seen brain injured people go out and do amazing things. But even if you have had dreams and aspirations for Christian’s future, learn to pay attention to him in the here and now, attending to his particular gifts and aspirations.”

Every parent of someone with brain injury has fears for the future, fears of what they might miss in providing for their son or daughter, fears that they would be inadequate as a parent of this adult person. It takes awhile to feel that you really have everything under control, or at least enough control that you could relax, so that you can grow together. ”

“But, now let me also tell you that fantasies, and ideas, and anxieties are a big part of what love is all about. If you lack these, and I’m sure you don’t, you would be lacking in those very qualities that make you human, and which Christian needs now more than ever as he re-learns what it means to be human, including how to love.”

“Let me tell you also that there are some things you will not understand about your child…and never will. Christian is his own soul, and with any luck will outlive you, and visit places in space and time that you in this worldly sphere are simply prohibited from going. Indeed, this is one of the great secrets and paradoxes of parenting the person with brain injury – you are preparing your child for a future you yourself will never know. Having to re-invent life after a brain injury makes the future all the more unknown, but it is still his destiny.”

“Now having said that, relax. It really isn’t as hard as you think. Treat him as if, out of all the possibilities, he chose this particular path to learn what he needs in this life. Treat him as if, out of all the possible parents in the world, Christian chose you! Literally. There are, in fact, philosophers going as far back as Plato who have believed that children choose their parents. You’re it. Take it as an honor, and a responsibility, not that you are a parent (lots of folks can make that claim) but that you were specifically chosen to be the parent of Christian, at this particular and special moment in time. If you learn to listen and to watch and just to be present long enough, time will reveal you to why this was meant to be. It is the same now as it was at the beginning of his life.”

“And let me assure you, Christian wouldn’t have chosen you if you weren’t up to the task. His very uniqueness, the uniqueness that makes him Christian – call it the song of Christian – is calling to you, and you will know, know deeply, how to respond to it. Yes, you will learn plenty of techniques, tricks of parenting the person with brain injury trade, maybe even a little bit about education, as you go along. You’ll find a great library of books out there about brain injury; you will meet people with brain injury who inspire you, either through life or through books and films that tell of what can be achieved; you will find a walking library of other parents who have gone through the same thing and who will freely share their experiences and wisdom with you – sometimes, perhaps, more freely than you’d ever really desire. All that is well and good, but you only need take on board what will help both you and Christian to grow. . Ultimately, all this is really about is paying good attention. Your ability to be the right parent for Christian at this time is built into you just as securely as being Christian is still built into himself.”

“And just one more thing. Don’t neglect who you are just because he has had a brain injury. You are born with that same energy and potential as he is, and his brain injury is an invitation to you to maximize it. There is nothing you can do that is more important to Christian than your becoming, fully, the person the Great Creator meant you to be. You will find, if you look, parents and families who negotiate this transition to become stronger than they could have ever dreamed.”

“In Yiddish at any milestone or acknowledgment of an accomplishment or rite of passage, one says “Mazel Tov”. Having Christian alive with you today is an accomplishment and a new beginning. The tov in Mazel Tov simply means “good”. The word mazel derives from the Hebrew for the Zodiac mazalot, and is associated with an infusion of cosmic energy yet to be delivered. The Talmud cites three life issues directly affected by the mazalot – life, children, and livelihood. Wishing someone “Mazel Tov” is an expression of hope that the energy of the universe should only be for our, and the world’s, good.

Freely adapted from : Albert, D. H. (2004). nature/nurture debate.

Brain injury and prisoner health

This is something I have been thinking about since being asked for a submission about the health about people with brain injury who go to prison.  It strikes me that I have hardly scratched the surface.  It would be lovely to hear from anyone who has done work in the area. 

The outlook is not good for those people who do not make a good recovery from brain injury, and studies have consistently found high levels of traumatic brain injury among prisoner populations.  In an Australian study with 200 participants, Schofield, Butler, Hollis, Smith, Lee &  Kelso (2006) found that 82% had a history of at least one traumatic brain injury (TBI).  In New Zealand these figures would be approximately the same, at 86.4% (Barnfield & Leathem, 1998).  Two US studies of death row inmates found that 75% had a history of brain damage and 100% had a history of TBI (Freedman & Hemenway, 2000; Lewis, Pincus, & Bard, 1986).   Fifty per cent of individuals convicted for non-violent crimes had a past history of TBI compared with 5-15% in comparison samples (Sarapata, Herrman, Johnson, & Aycock, 1998).  Violent offenders have also been found to be more likely to have experienced TBI than non-violent offenders (Bach-y-rita & Veno, 1974).   

The lives of the adults with brain injury tend towards a vicious spiral unless they have the committed care of at least one other person.  This is not possible for everyone and so people with brain injury can end up in a variety of more or less unsuitable institutions. These include long stay wards, rest homes, forensic psychiatric units and prisons. Given that many people with brain injury go to prison there are many things that need to be taken into account, including the following:  

 Epidemiology of brain injury in prisons

The general epidemiology of brain injury is in its infancy.  Brain injury is clearly implicated in many of the crimes for which prisoners are incarcerated, although it is difficult to estimate in what way the prison statistics relate to the general community.  It seems clear that brain injury is a significant factor in crimes for which people are caught and sent to prison.  There is more work needed on the specific epidemiology of brain injury in the prison population. In particular studies are needed that differentiate the severity of the injury and relate this to types of crime and patterns of incarceration. 

 Brain injury as a (legal) defence

Generally disability (with the exception of mental health conditions) is not considered a defence in our criminal justice system.  However, in recent years we have come to a greater understanding of the relationship between executive dysfunction and brain injury.  It seems that the judgment of some people with severe brain injury is compromised to the extent that their responsibility for actions must seriously be called into question.  There is an argument that brain injury should be a legal defence in these cases.  However, at present there is a lack of credible expertise that could provide an assessment in these cases.  There are few qualified neuropsychologists and it is outside the area of training of psychiatrists.  It is clear from anecdotal evidence that people with severe brain injury are being incarcerated in situations where they are neither realistically defended, nor are they able to advocate for themselves. 

 There are two subsets of the brain injured population who do not make it into the prison system:

a) those whose families are effective advocates and more research needs to be done on how such families succeed;  and

b) those who have a visible disability accompanying the brain injury, which highlights the problematic nature of the invisibility of brain injury. 

 Those with an invisible brain injury are the “walking wounded” and their behaviour is often labelled “bad”, because this is how it is experienced by others.  The brain injured person is perfectly capable of being dominating, browbeating, overtalking, abusive and uninhibited among other things. They can also be gullible, slow thinking, forgetful, lacking in judgment and communication skills, none of which are admirable traits but all of which can be directly caused by brain injury and can lead to hefty judgments on the part of others.  The person with a physical disability accompanying the brain injury is often exonerated for similar behaviour because people have a way of understanding the cause.

 Executive function disorder makes the person with brain injury particularly vulnerable to being the ‘fall guy’.  This is often the reason why they end up in prison and there are stories that circulate in the brain injury community of people who are known for their naivety who get put away for extended periods of time. These are often people who are incapable of lying and cannot comprehend the concept of plea bargaining. 

The executive function disorder that makes the person with brain injury vulnerable in the community does not leave them when they enter prison.  There is anecdotal evidence of the ways in which this particular group is identified and victimized by other prisoners.  The vulnerability of this group needs to be recognized within the prison as well as in the community. They cannot be made completely safe, but a degree of understanding is called for. 

 The rehabilitative capacity of prison

There are many people with less serious injury, for whom prison can be a way of learning about consequences of actions when everything else has failed.  A well planned prison, which has rehabilitation as well as incarceration as a focus, can provide the kind of structured environment that is ideal for the person with brain injury to learn to deal with rules. One of the effects of brain injury is difficulty dealing with rules and a truism of brain injury rehabilitation is that it is easier to change the environment than the person. Further research is needed to establish trajectories of adults with severe brain injury who find themselves in prison. As a first step communication needs to be established between the prison system and ACC. 

 Anecdotal evidence suggests the structured workshop can be very useful for the person with severe brain injury, who may struggle with the greater freedoms that are given to prisoners at a later stage in their sentence.  Rehabilitation efforts should therefore not only focus on the years prior to release, but should also address the early stages of the sentence when the person with brain injury may have become ready to make gains.  This may go some way to alleviating the familiar vicious cycle brought about by brain injured types of behaviour. 

 Management of medication

Medication has an important, but poorly understood, role following brain injury and it requires strict monitoring.  A variety of drugs may be used in non conventional ways for pain relief (e.g. methadone) or irregularities in sleep (e.g. anti depressants). 

Mismanagement of medication is a human rights issue and there is anecdotal evidence that medication is arbitrarily adjusted on admission to prison and thereafter.  These adjustments may happen if the person is labelled as “drug seeking” or because 4.30pm lockup means that night medication has worn off in the early hours of the morning.  There is also evidence that medication prescription is not being monitored and people can leave prison with multiple drugs all of which are doing the same thing.

Service capture, human rights and family carers

This is a story that I have heard in several different ways over the last few years and so I have fictionalised a version of it here to highlight some of the issues that arise around “service capture” for people who are severely brain injured.   I connect this to the outcome of a recent Human Rights Review Tribunal in favour of family carers. 

“Service capture” describes a situation where there is funding attached to an individual with severe brain injury and a residential facility moves to exclude the family.  They do this because famlies tend to advocate for good care and this is labour intensive.  For example, learning to communicate following brain injury is time consuming and therefore more expensive in terms of staff.    The “service capture” argument is usually based around some version of a story where there family is seen as interfering/not grounded in reality/ not really advocating for the person with brain injury.  This kind of “care” will eventually and inevitably break the spirit of both the brain injured person and their family unless they can find some support.  Incidentally it is also extremely bad training and supp0rt for the paid staff in these facilities, who often get their greatest job satisfaction from just this kind of work.

 In 2008 I was an expert witness in a Human Rights Tribunal (in NZ) about the issue of paying family carers, in situations where there was funding allocated and no paid carers available to do the skilled work necessary.  The Ministry of Health argued very hard against paying families on various grounds that revealed a deep prejudice that was never substantiated by written policy.  One of their arguments was about “equality of outcome for the disabled person”, by which they meant that the residential units were able to provide a better outcome than the families were.  It an example of “service capture”, where services want to keep the funding even though a much better job could be done by families if they had control of the funding. This may seem to be different to the arguments used to stop families from interfering once the person has been admitted to a residential facility.  However, the reasoning is essentially the same – families cannot be trusted to provide good outcomes for the person with severe brain injury. 

My witness, based on doctoral research was able to give empirical support for the concept that families, especially those who are supported, actually do an excellent job. I was also able to demonstrate that people with severe brain injury are capable of making major improvements in their lives many years after the injury and long after they would be expected to plateau.  The improvements were a direct result of sensitive flexible care on the part of the families.  The importance of this witness was acknowledged recently by Rosslyn Noonan (Chief Human Rights Commissioner) at a disability colloquium in Dunedin.  She said that this was a good example of empirical research that was used to form case law. 

 Amazingly, on 8th January the judges came out in favour of the families. This is an astounding finding, because it challenges the arguments for “service capture” at many different levels.   It may be one small step to beginning to accept families as equal partners in work with brain injured adults. 

The story:

 “Anthony is 22 years old and had a severe diffuse axonal traumatic brain injury from a motorcycle accident in 2007. He is trapped within ‘a broken body’, cannot speak yet, but his mother recognises that he has all his thoughts, memories and personality.  This is what he wrote recently: “please help, I am trapped”.

When he was transferred to the long term residential care the house manager indicated that her staff was not trained to communicate with patients by writing (Anthony’s only effective mode of communication, though he can indicate yes and no).  The policy of refusing to communicate in this way seems to be corroborated by a report that indicates that Anthony cannot reason or process thoughts.  Yet his written messages make sense and it seems highly likely that he is wants to communicate something of his dislike for the place that he is in. 

There is  a deliberate and sustained policy of excluding his mother from meetings, although she attends him daily.  His therapists are in favour of any mode of communication that will foster his growth, but their voice is also being ignored.  Anthony is understandably furious and depressed that no one asks him whether he wants to write. 

 Angela, his mother is very concerned that Anthony’s “guardians” are not acting in his best interest and that they are financially motivated (they receive around $x/day for Anthony – you can fill in the amount here, the family feel they could do a better job for the dollars being paid).  She has been to a liaison officer who advises her that she needs some credible authorities behind her to speak to the fact that such treatment of Anthony is contra-indicated.  Through all of this she is sustaining a daily connection with her son as well as working full time.”

William Fairbank: art and brain injury

I am sitting in my office waiting to hear a radio NZ  inteview with William Fairbank.  I met William six years ago, during a visit to NZ shortly after he made the film “Head On” about brain injury. He had his brain injury about 23 years ago and he is a great advocate for occupational therapy.  In the early years after his injury he made a series of sculptures on the stations of the cross, which are on permanent exhibition in Lincoln cathedral, England.  He calls this his occupational therapy and he is in the business of using his art to educate medical professionals and the rest of the world about what it is like to live with a brain injury. 

His latest project is to make another film about the experience of brain states after brain injury.  Historical knowledge about brain injury has in the main been produced and known by people without brain injury.  William’s work is part of a movement where brain injured people produce their own ways of knowing in order to negotiate the kind of knowledge that is held about them.  This project is about gathering together the experiences of talented people with brain injury and putting them on film. 

In the disability movement the brain states after brain injury are one of the myriad expressions of  ‘Ouch! moments’.  These are the moments when a disabled person feels out of place and is made aware of the discordance between their experience and the rest of the world.  For the brain injured it is those moments when you put your car keys in the freezer; when the shop assistant gives you very strange looks; when you have told your best friend you don’t want to see them because you are too tired from thinking about making a simple choice; worse, it is the explosion of frustration when you have gone too far past your afternoon nap.  “Ouch! moments” are an exploration of the awkwardness brought about by having a brain that is out of synch with the rest of the world.  It is about having senses that are somehow not in tune with the common sense of everyone else.  It is about living in a different rhythm.  For William Fairbank it is about ‘living in the present’.  He describes the sense of being on a stage, or having things arrive to his attention and losing all else for that time. 

This living in the present sounds very pleasant, and William has learned ways of making it so -though the reality is not always easy.  He has learned to invite you into his presence/present as though you are coming into his living room.  It is all comfortable and full of lovely small things that delight.  He comes to visit in his “Little Puffer” caravan and brings his whole world with him: there are pictures on the wall and books on the bookshelves; repair kits and a sound system.  You only realise how caught he is in the present when you want to change the subject and find that William is still caught in this moment, which is also a self absorbed one.  This is one of the “Ouch! moments”, but William succeeds in sharing this brain state and making it fascinating, so that there is no wish to escape.  Maybe what he manifests is the same self absorption that is supposed to be so pathological in brain injury, but it is the Ouch!, without the ‘Oh dear!’. 

Brain injury can be profoundly alienating.  It can lead to experiences that are at the boundaries and the edges of what it is to be human.  Yet people like William have learned to map out the secret adventures of living with this brain state so that it reflects the secrets and aspirations of everyone; it reflects both pain and the search for a way of living that can mould an identity that feels worth living with.  It is not easy to understand, but it is our humanity and all the potential within it that makes us beautiful.  William’s work helps us to celebrate those heartbreaking strengths and those glorious disabilities that we all have.

It will be interesting to see what happens following William’s invitation to artists with brain injury to participate in the film he is making.  He hopes to include those who can craft their quirkiness into words, phrases and jokes.  There are so many ways of expressing the experience of brain states after brain injury: through photos, poems, paintings, jokes, quirky phrases.  If you are someone who has learned to do this….or if you know of someone who has the capacity to share a sense of reality that is mediated by a brain injury (and you live in NZ), don’t hesitate to get in touch.  I will use this blog to keep you posted on William’s progress.

Where To Find A Personal Injury Lawyer?

A victim of an accident must get the legal representation of a personal injury lawyer in order to help him or her file the appropriate personal injury lawsuit against the person who caused the accident. If you have been victimized by the negligent conduct of another, getting the services of a personal injury lawyer must be one of your primary concerns. For one, a personal injury lawyer knows very well the intricacies pertaining to a personal injury lawsuit. He or she, through long years of study, knows what to do, what to file, & what you are legally entitled to under our laws.

But you may ask, where can I get a competent personal injury lawyer that will help me in my personal injury lawsuit? Isn’t getting one a hard thing to do? How can I find a personal injury lawyer who is reliable, trustworthy & intelligent?

Well, be not wary anymore. You can easily find a personal injury lawyer through the use of the Internet. Aside from seeing so many of them by using this modern technology, you can actually make a background check on their qualifications, experience & expertise. There are indeed no hassles. Just by browsing, you can see that a lot of personal injury lawyers offer their legal services through this medium. You can even select your area or jurisdiction to see the law firms available to represent you in your personal injury claims. So, if ever you suffered personal injuries & you want to file a personal injury lawsuit, just take hold of your computer & browse the Internet to get the legal services of a personal injury lawyer. You will also be surprised 😮 to find out the number of lawyers offering their services on a contingency basis wherein the attorney’s fees will greatly depend upon the personal injury lawyer’s successful litigation of the personal injury case.

“Our Professional Los Angeles Lawyers specialize in all fields of Personal Injury

Cash for Personal Injury Settlements

Your pain & suffering damages will most likely be minimized if you involve insurance companies in your personal injury settlement. Insurance companies give lower compensation because they intend to keep as much money as possible for themselves. There is more. To you, personal injury settlements are personal, but to them they are purely business.

Before insurance companies offer compensation, they will attempt to evaluate how serious the injury is. Usually, the less serious & costly the injury is, the better compensation offer you will receive. On the other hand, if the injury is more severe & costly, the insurance company will have to take the following information into account first: present & future medical needs, permanent disability benefits, physical impairment and/or disfigurement, lost income, loss of family member(s), loss of social or educational experiences, & pain & suffering such as post-traumatic stress disorder, loss of marital relations, depression, anxiety, embarrassment, stress, & property damage.

Knowing the cost of compensation

Insurance companies formulate your compensation cost by adding up many items in a formula which includes all the injury-related medical expenses. There is more. These are then multiplied by a number between 1.5 (for less severe injuries) & 5 (for more serious damage), & then added to the lost income due to the injury. Being aware of this information will often help you negotiate your case & not actually be deceived by anyone.

Personal injury compensation also depends on which part of the country you live in. If you are in a low cost-of-living area where wages & expenses are basically lower than that of a high cost area, then your compensation will also be low.

Injury Settlements gives detailed information on Back Injury Settlements, Burn Injury Settlements, Hydrocodone Injury Settlements, Injury Settlements & more. Injury Settlements is affiliated with Life Settlement Funding.

Personal Injury 101

Have you been injured in an accident that was caused by a negligent or reckless person? If yes, Personal Injury 101 is definitely made for your consumption. When you got injured in an accident, our civil & tort laws gives you the remedy of making a demand & filing a claim for damages against the negligent person who made you suffer personal injuries. In such a situation, the law allows you to recover the expenses that you have incurred, among other things, against such negligent person.

If you finally decide to make a personal injury claim against the negligent person who caused you the personal injuries, you should right away get the legal services of a personal injury lawyer. With the expertise of a personal injury lawyer, you will have more chances of obtaining positive results for your claim. But wait a minute, do you think that there is a problem? How can you get immediate help from a personal injury lawyer & where? Well, if this is one of your major concerns, you should not worry anymore. If you consider this a problem, consider it solved.

By using the internet, you can find lots of personal injury lawyers that offer competent, efficient & effective legal services. You will also find out that these lawyers have their respective areas of expertise. There is a general negligence lawyer, a vehicular accident lawyer, a slip & fall lawyer, a medical malpractice lawyer, a construction site accident lawyer, a spinal cord injury lawyer, a brain injury lawyer, & even a work related accident lawyer. You can always select from any of them depending upon the type of accident you got involved in. So do not waste anymore time. Personal injury 101 dictates you to immediately hire a lawyer for your case. You must remember that in a personal injury case, time is always of the essence.

“Our Professional Los Angeles Lawyers specialize in all fields of Personal Injury , Employment , & Disability Laws

A New Medical Malpractice Website

Personal injury law takes into account many different practice areas, one of those being medical malpractice. This branch of law deals with personal injury laws where a physician or other medical professional is at fault, from misdiagnosis to wrongful death. Pharmacy error & nursing home abuse are also included in medical malpractice. The unfortunate circumstances under which such errors occur cause grief & suffering for the victims & families. Eric Nielson is here to fight for your right & any compensation you deserve.

This website,, includes pages outlining the company’s policies, introducing the staff, & reviewing recent cases. There is more. The firm overview page describes the types of cases they work with, what you should expect from the company, & what types of organizations they are involved with. The attorneys & staff page explains how the staff strives to help to achieve the company’s goals… The recent cases page has links to the stories from previous clients, all victims of medical malpractice. The website is concise & easy to navigate, making it simple to find what you need in your medical malpractice case.

G. Eric Nielson works with other experienced attorneys. His staff utilizes over 20 years of experience when dealing with these delicate cases. Eric Nielson graduated with his BA from the University of Utah in 1982, Magna Cum Laude. He then continued on to Brigham Young University for his law education, graduating in 1986. He has passed the bar examination in both Utah & Arizona. He is a member of the American Bar Association, the Utah State Bar, & the Salt Lake County Bar Association. He is also bilingual, speaking Spanish & English.
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Click here to learn more about personal injury law in the Salt Lake City, Utah area.