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The Crash Reel: a case study of acceptance and adaptation

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Amy Fleischer

on 12 May 2014

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Transcript of The Crash Reel: a case study of acceptance and adaptation

Kevin Pearce
former professional snowboarder
star of award winning HBO documentary “The Crash Reel”
motivational speaker & TBI advocate
learning to be with others, in difficult times,
emotionally charged family conversations
Despite admirable intentions
Anderson, V. & Beauchamp, M. (2012).
Developmental social neuroscience and childhood brain insult: theory and practice.
New York: Guilford Press.

Bird, J., & Parente, R. (2014). Recognition of nonverbal communication of emotion after traumatic brain injury.
NeuroRehabilitation, 34,

Davies, L. (Producer) & Franklin, R. (Writer). (2008).
Brain injury dialogues
[Motion picture]. United States: Bainneclaba.

Hoogerdijk, B., Runge, U., & Haugboelle, J. (2011). The adaptation process after traumatic brain injury an individual and ongoing occupational struggle to gain a new identity.
Scandinavian Journal of Occupational Therapy, 18
(2), 122-132.

Kelley, E., Sullivan, C. P., Loughlin, J. K., Hutson, L., Dahdah, M. N., Long, M. K., Schwab, K., & Poole, J. H. (2014). Self-awareness and neurobehavioral outcomes, 5 years or more after moderate to severe brain injury.
Journal of Head Trauma Rehabilitation, 29
(2), 147-152.

Klinger, L. (2005). Occupational adaptation: Perspectives of people with traumatic brain injury.
Journal of Occupational Science, 12
(1), 9-16.

Lehrer, J. (2011, May 5). Some Reassembly Required.
, Retrieved from http://www.outsideonline.com/outdoor-adventure/athletes/Some-Reassembly-Required.html.

Love Your Brain LLC, LoveYourBrain™ (n.d.).
Love your brain.
Retrieved from http://www.loveyourbrain.com.

McDonald, S., & Flanagan, S. (2004). Social perception deficits after traumatic brain injury: interaction between emotion recognition, mentalizing ability, and social communication.
Neuropsychology, 18
(3), 572.

Schmidt, A. T., Hanten, G., Li, X., Wilde, E. A., Ibarra, A. P., Chu, Z. D., Helbling, A., Shah, S., & Levin, H. S. (2013). Emotional prosody and diffusion tensor imaging in children after traumatic brain injury.
Brain Injury, 27
(13-14), 1528-1535.

Schmidt, A. T., Orsten, K. D., Hanten, G. R., Li, X., & Levin, H. S. (2010). Family environment influences emotion recognition following paediatric traumatic brain injury.
Brain injury, 24
(13-14), 1550-1560.

Spell, L. A., & Frank, E. (2000). Recognition of nonverbal communication of affect following traumatic brain injury.
Journal of Nonverbal Behavior, 24
(4), 285-300.

Tonks, J., Huw Williams, W., Frampton, I., Yates, P., Wall, S. E., & Slater, A. (2008). Reading emotions after childhood brain injury: Case series evidence of dissociation between cognitive abilities and emotional expression processing skills.
Brain Injury, 22
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Rosema, S., Crowe, L., & Anderson, V. (2012). Social function in children and adolescents after traumatic brain injury: A systematic review 1989–2011.
Journal of Neurotrauma, 29
(7), 1277-1291.

Walker, L. (Director). (2013).
The crash reel
[Motion picture]. United States: Tree Tree Tree.

Yim, J., Babbage, D. R., Zupan, B., Neumann, D., & Willer, B. (2013). The relationship between facial affect recognition and cognitive functioning after traumatic brain injury.
Brain Injury, 27
(10), 1155-1161.
Managing Risk
visible VS invisible disability

role of narrative in recovery process

Further Evidence:
Emphasize verbal content when speaking to person with TBI.
The Crash Reel:
a case study of acceptance and adaptation

Traumatic Brain Injury
each year 2.5 million TBIs occur in US
173,000+ cases of sports related TBIs
are treated in people 0-19 years of age
KP's symptoms

... many of which are invisible
"When I first met him, last November at the Pearce home, he brushed aside talk of improvement. Although he looked like his old self—his long brown hair had grown back—Kevin insisted that his normal appearance was an illusion.
"I'm still so messed up," he said. "People tell me I keep on getting better, but I don't really notice it. All I can think about is how far I still have to go."
"Kevin showed me an iPhone video of himself skateboarding the day before—"Don't tell my mom," he whispered—and pointed out all the problems with his attempted tricks. He wasn't just bothered by his lack of body control: he quickly rattled off a list of other complaints, such as the drowsiness triggered by his antiseizure meds..."

(Lehrer, 2011)
how to effectively communicate caring & concern if a
person has experienced a traumatic, life-altering event
a process of
film about post-injury struggle, endured by entire family
Unaware of the true extent of his impairment after the accident, KP is determined to return to snowboarding; but for his family, this possibility is very painful to imagine. In the film, they must find a loving way to both honor his capabilities and convince him to respect his limitations.
body as medium of social relationships
how do we “seem like ourselves”?
what if self-awareness is impaired?
is an ideal quality in this process
what if disability is not apparent, so as to inspire understanding from others?
...but what if the most motivating activity poses significant risk?
disability & wellness
occupational adaptation
Impaired recognition of nonverbal communication of affect has also been documented in TBI literature
The widely recognized lack of community integration following brain injury speaks to the especially social nature of this disability.
Using a “wellness” perspective may help to prevent disability and dysfunction due to TBI.
Social isolation is one of the most commonly reported consequences of TBI
In order to improve social and emotional outcomes of treatment with this population, it is important to explore aspects of nonverbal communication.
"As the effects of the trauma recede,
[KP is] becoming increasingly aware of his persistent shortcomings, those problems that rehab can't fix. Studies of severe TBIs demonstrate that not all white matter can regenerate, even after years of therapy."
... KP is becoming
"increasingly mindful
of what he can't do."
(Lehrer, 2011)
Without glorifying risk, "The Crash Reel" is an honest portrayal of one family's experience of disability and adaptation
interaction with clinicians
KP's brother "calls a spade a spade"
Social environments within families set the stage for emotion recognition or perception in young children with TBI
An emerging field of developmental social neuroscience seems promising

(Bird & Parente, 2013).
(Spell & Frank, 2000; Rosema, Crowe, & Anderson, 2012).
(Anderson & Beauchamp, 2012; Schmidt et al., 2013).
Family functioning variables, in particular financial resources, can influence performance on emotional processing following TBI.
Cognition and emotion processing may be affected separately by TBI
comparing interactive styles
"I can't snowboard so I need to stay occupied in some way."
questions of epistemology

"how do we know" what we know and
"how do we understand" what we are capable of doing?
how did we used to know? how can we know again?
Making sense of individual, ongoing adaptation process after TBI
(Hoogerdijk, Runge, & Haugboelle, 2011; Klinger, 2005)
(Tonks et al., 2008; Yim, Babbage, Zupan, Neumann, & Willer, 2013).
focus: targeting a prospective client's experience of their own environment
Therapeutic outcomes may be improved by highlighting the power of family dynamics and self-acceptance.
"I needed to hear all the things that were going to be good, not for people to feel sorry for us."
Pia Pearce (KP's mother) on the experience of raising David and adapting to Kevin's brain injury (Walker, 2013)
Emotion is commonly revealed in tone of voice, but what if this is difficult to
and a wonderful family dynamic,
David's direct approach may be most effective in reaching KP after his brain injury.
The Pearce family conversations focus on feelings, not advice.
(Walker, 2013)
"I spent my whole life on this sport, working so hard at it, and now it's all finished," Kevin says. "But I'm realizing now that other stuff makes me happy, too. There's more to life than landing a trick."
(Lehrer, 2011)
"The only lesson of my crash is that riders should wear helmets"
KP (Lehrer, 2011)
... but maybe there's another lesson in the film?
The Crash Reel illustrates the
and diversity.
power of narrative,
(Walker, 2013)
(Walker, 2013)
(Walker, 2013)
(Walker, 2013)
(Walker, 2013).
(Bird & Parente, 2013; McDonald & Flanagan, 2004)
Constructions of disability are culturally, socially and historically situated in society. As such, they serve as lenses within the field of rehabilitation.

Love Your Brain
is a social movement that brings people together to connect, educate and empower. Everything we do is about improving lives through a mindful approach that focuses on brain injury prevention, rehabilitation and brain health.
(LoveYourBrain, n.d.)
(Davies & Franklin, 2008)
(Walker, 2013)
"You have to remember, riding is all I've ever done," Kevin says. "It's what I know. It's the only thing I'm good at. So yeah, I miss it an insane amount. When I close my eyes, I can still remember what it feels like, that feeling of coming down [a slope] by myself. There are no words for it."

(Lehrer, 2011)
Lower self-awareness can lead to maladaptive behaviors and cause caregivers considerable distress (Kelley et al., 2014).
(Lehrer, 2011)
"you can't go back to who you were before"

"love it"
KP in conversation with another TBI survivor (Walker, 2013)
you have a totally different brain.
Amy Fleischer

(Davies & Franklin, 2008)
(Davies & Franklin, 2008)
when words fall short
(Anderson & Beauchamp, 2012).
OTS 239: Nonverbal Communication and Disability
(Schmidt, Orsten, Hanten, Li, & Levin, 2010)
a necessary struggle to gain a new identity:
through engagement in occupation:
Full transcript