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Holiday Adjustments-Part 3: Social Interactions and Attention

This is part 3 of a series on holiday adjustments.  As mentioned in parts 1 and 2, brain injury deficits may impact the ability for a brain injury survivor to participate as in previous years in holiday celebrations so adjustments may need to be made for the survivor to have a successful holiday.  Part 3 will focus on issues regarding social interactions and attention during holiday celebrations.

Our social skills are at the heart of what it means to be a connected person in our society and holiday celebrations tend to be key social situations.  Thus, holiday celebrations can be tricky for brain injury survivors to negotiate.  In many cases, holiday celebrations are the first time that friends and family members have seen the survivor since his/her injury.  In other cases, holiday celebrations are the first time that friends and family members have seen the survivor since he/she was in the intensive care unit of the hospital since people are most likely to visit in the initial period following the injury.  Often, holiday celebrations have dual areas of stress for a brain injury survivor.  The survivor is learning how to negotiate life with new deficits while family and friends are trying to spend extra time or give extra attention to the survivor.

Near death experiences catch our interest and spark our concern.  As such, friends and family often give survivors far more time and attention than previous holiday celebrations.  After a brain injury, many survivors are surprised that they are now the most popular person in the room.  Each family member comes by and asks what happened, how are they doing, how is therapy, etc.  Even one family member was standing right behind another family member who just asked these questions, the second family member may have the exact same questions as the first.  These queries are generally made with the best of intentions.  Family and friends want to show their concern and caring for their injured loved ones.  However, many survivors find this to be a frustrating and annoying experience.  For survivors, it is important to know that some version of this experience will occur at the holidays, particularly if many people have not seen the survivors since the initial injury and to remember that this is a reflection of caring.  Family and friends are often searching for a way to show their feelings to the survivor.  Having a good brushoff line can often be helpful (For example: “Thank you for asking about my health.  I appreciate the questions but it seems like that is all I have been talking about lately.  Can we talk about something else?”)  Family and friends need to remember that constant questions can be stressful.  If the questioning goes well, the questions can be experienced like an interview.  If it goes poorly, like a police interrogation.  They should consider talking about other issues as, such as the Thanksgiving football games or favorite music.  Some survivors and/or their families will send an e-mail or some similar communication updating everyone on the latest information and requesting that brain injury questions be kept to a minimum.

A more positive aspect of this extra attention is that brain injury survivors may find that they receive more phone calls, cards and gifts at holiday times than previously.  Sometimes these come from people who are not close to the survivor but are more distantly acquainted with the situation, such as a congregant at a family member’s church.  Again, though this may feel weird it still represents someone trying to reach out and show that he/she cares.

Changes in social skills can create big hurdles in social interactions at holidays.  Survivors and their families must keep in mind potential problems due to changes in social skills.  For survivors with difficulties that impact social skills, it is important that friends and family members at holiday parties know the best ways to interact with the survivor.  For survivors with language difficulties, this may include giving extra time for the survivor to speak, having the conversation partner slow their rate of speech, writing important words down for the survivor, pantomiming words or having the survivor use an augmentative communication device such as a speech program on an Ipad.  For survivors with impulsivity issues, family and friends may need to cue them to slow down and maintain the topic of conversation instead of going on tangents.  For survivors that have difficulty with nonverbal skills such as making eye contact or reading social situations accurately, family and friends may need to cue them for proper nonverbal skills such as looking at the conversation partner’s face while speaking.  For survivors with inappropriate behaviors, family and friends may need to cue them for issues such as cursing and sexual jokes.  It is important in all cases that family and friends who will be interacting with the survivor be given adequate information to best help the survivor succeed in their social interactions.  This can be via e-mail, phone call or personal discussion.  If a family or friend is caught unawares of social deficits, this can lead to a strain in relations.  For instance if a survivor’s friend does not know that the formerly soft-spoken survivor now needs help to reduce foul language, the foul language may be taken as a personal insult rather than a function of the injury.

Survivors and their families should also consider whether the survivor will do better in a smaller holiday celebration rather than a larger one.  Some survivors find that larger parties lead to more stress, agitation and/or social errors.  Also, the noise and activity of larger parties can become overwhelming for some survivors.  Certain survivors find that young children, with their noise and activity, can be quite problematic.  Further, some survivors would rather have a small celebration, especially in the early stages of recovery when they are not yet comfortable with their injury in public.  They may feel embarrassed by their deficits and would rather not have large number of individuals learn about the depth of their struggles.

It is often helpful for survivors, families and their therapists to try to problem-solve potential pitfalls and practice skills such as how best to talk to others about their injury experience.

Hopefully, this post provided insight on holiday adjustments due to attention and social interaction issues.

Learn about brain injury treatment services at the Transitional Learning Center: tlcrehab.org

Holiday Adjustments-Part 2: Participation

This is part 2 of a series on holiday adjustments.  As mentioned in part 1, brain injury deficits may impact the ability for a brain injury survivor to participate as in previous years in holiday celebrations so adjustments may need to be made for the survivor to have a successful holiday.  Part 2 will focus on some thoughts regarding participation in holiday celebrations.

One of the most difficult aspects of having a brain injury at holiday time is changes in the ability to participate in the holiday celebrations.  For instance, a brain injury survivor may have been the main cook for Thanksgiving but can no longer do so due to memory deficits or an inability to use the right side of the body.  This is a tremendous blow to the survivor’s self-esteem and pride.  Family members may try to be helpful by telling the survivor to “not worry” and that the family members will “take care of everything.”  Some survivors appreciate this but some find this to be a further attack to their self-esteem.  If there is one rule that rehabilitation therapists and professionals want brain injury survivors and their families to follow, it is to find tasks in the holiday celebrations that the survivor can participate in.

The first part of identifying holiday tasks that the survivor can participate in is to take a realistic assessment of the survivor’s skills and deficits.  Safety always has to be a priority but it should not overshadow reasonable options.  If a survivor has ataxia (inability to fully control muscle movement) in his or her arms, the survivor should not be lighting menorah candles for Chanukah.  Similarly, a survivor with balance issues should not be climbing on to the roof of a home to put up Christmas lights.  With this in mind, survivors almost always have strengths.  In fact, it is a rarity that a survivor cannot do anything to help with the holiday celebrations.  For instance, though a survivor in a wheelchair may not be able to put up all of the decorations on the Christmas tree, he or she may be able to put up the decorations on the lower part of the tree.  A survivor may not be able to cook a turkey but perhaps he or she could cut some of the vegetables for a salad or help set the table.  Even if a survivor cannot use his or her arms or legs, perhaps a role can be found such as leading the family in a prayer before eating or giving recipe directions to family members that are cooking.  Survivors with aphasia can sometimes sing, with help, familiar songs as the songs are so familiar that they can become automatic.  For instance, many aphasic survivors that struggle to name a common item like an apple can sing a holiday tune like “Jingle Bells” or “We Wish You a Merry Christmas” if given extra time and if someone sings with them.  If survivors and their family members look close enough, there is almost always something the survivor can do or help with.  Even a small task will help boost the survivor’s pride and self-esteem.  Moreover, injury or no injury, working together on holiday celebrations brings family together for a joyful opportunity to bond.

Many survivors struggle with the tradition of giving gifts at certain holidays such as Christmas and Chanukah, since they often have a much worse financial status due to their injury.  They have often lost jobs and have high medical expenses which sap their funds.  Many now rely on financial support from family members.  Usually, families and friends understand that the survivor is in a different financial state but the survivor may feel significant guilt over the inability to purchase gifts are previously.  Simply reassuring a survivor that the family members/friends understand the changes and are not worried about receiving a gift/smaller gift can help alleviate concerns.   Alternatively, a survivor can make a gift/card, with the help of a family member as necessary.  Everyone appreciates a homemade gift or card.  Families may choose to switch to a gift exchange in which everyone buys just one gift, places the gift in the bag, and everyone randomly chooses a gift.  One gift is far less costly than multiple gifts.  A limit on the cost of the gift can also be placed to further make participation easier and make the survivor feel less left out due to costs.  By de-emphasizing the focus on finances, the survivor is often better able to focus on the rest of the holiday celebrations.

Another consideration regarding holiday celebration participation is fatigue.  Holiday celebrations often go quite long and brain injury survivors may find that they become fatigued more easily than previously.  This is a particularly common issue during New Year’s celebrations.  Many survivors who are used to staying up until midnight to celebrate the new year find that they are exhausted by 8 p.m.  Sometimes, shifting the length of time that the survivors will be attending the celebrations can increase participation.  Three good hours of participation is better than five hours of exhaustion.  Moreover, some families change the time of the celebrations to make it easier on the survivors.  “Early” New Year’s eve celebrations are relatively common; after all, it is midnight somewhere.  Instead of a late Thanksgiving dinner, perhaps a Thanksgiving lunch is more feasible.  Perhaps gift opening can be done prior to a holiday meal rather than after the meal, which would speed up the main parts of the holiday celebration.  These are just a few of the ways in which post-injury fatigue can be better managed at a holiday celebration.

Hopefully this post raises more awareness on holiday adjustments in participation due to a brain injury.  The next part of this series will focus on holiday adjustments in social interactions and attention.

Learn about brain injury treatment services at the Transitional Learning Center: tlcrehab.org

Holiday Adjustments-Part 1: Location

As Thanksgiving approaches, it is important to be aware of potential adjustments to holiday celebrations due to a brain injury survivor’s deficits.  Having a brain injury does not stop a survivor from celebrating a holiday but it may put a few wrinkles in the plans.  Part 1 of this series on holiday adjustments will focus on some thoughts regarding the location of celebrations.

There are a number of issues that need to be addressed regarding the location of the holiday celebrations.  First, if the survivor is in a wheelchair or uses an assistive device for mobility and is going to someone else’s home, is the home accessible?  Keep in mind that it is much easier to get a wheelchair across a hard floor than carpeting and for some survivors, a large pile (length of carpet fibers) carpet can be quite the inconvenience.  Also, is there enough room in the bathroom for the wheelchair?  Should the survivor bring a urinal if it is hard to access the toilet?  If the survivor has problems with incontinence, is there somewhere the survivor can be cleaned or change?  Some families find that it is easier to have holiday celebrations at their home versus going to another person’s home since their home has already been adapted to the needs of the brain injury survivor.

Survivors and their families should also consider the physical layout of the rooms where the celebration will take place.  For instance, it may help to move around tables and chairs into a different configuration to make it easier for the survivor to move through.  A big issue regarding rooms are trip hazards, particularly on Christmas.  It is important that toys/gifts not be left around on the floor as these can easily become trip hazards and the survivor can have a bad fall.  Alternatively, most toys tend not to fair well when a wheelchair runs them over.  Cords from Christmas trees or lights can also become a trip hazard and should be placed in a manner that will not encumber the survivor.  There are many other practical issues to consider regarding the holiday meal.  Can the survivor reach the turkey or will then need help?  Is silverware be left on a counter that is to high for the survivor?  Can the survivor’s wheelchair fit under the table?  If the survivor used an augmentative speech device like an Ipad, is there room at the table for it?  Do they need a side table for the device?  Small changes in room and furniture layouts can make a huge difference for the survivor.

The weather also plays a role in adjustment to different locations.  Walking up an icy pathway can be quite difficult and possibly dangerous.  Some survivors who normally use a walker may be safer in a wheelchair over these icy surfaces.  Moreover, some survivors in wheelchairs may need more help getting across an icy/snowy surface such as a push or help keeping the chair from sliding in the wrong direction.

Brain injury survivors and their families may want to consider how loud the celebrations will be.  Some survivors find that they are more sensitive to noise than previously and loud noises may cause agitation and/or anger.  For these survivors, they may benefit from attending smaller celebrations or spending their time in a quieter room away from the main celebrations.  This can also be a relevant issue in attendance of holiday religious services.  Some survivors may find busier houses of worship  or busier times at the house of worship to be problematic and may do better at less busy times or at a different house of worship.

One more location-related consideration is how many celebrations are the survivors and their families planning to attend.  Some families have the tradition of going from house to house to multiple holiday celebrations throughout the day.  However some survivors become fatigued quite easily and holiday celebrations tend to be long, active events.  For many survivors, attending multiple celebrations in the same day may be very difficult.  For others, they may benefit from spending a shorter amount of time at each celebration.  Survivors and families must also consider the fatigue from constantly transferring from vehicles and packing up equipment.  For instance, getting a wheelchair in and out of a car repeatedly can be very taxing on the backs of survivors’ families.

These are some of the considerations regarding the location of holiday celebrations that survivors and their families may wish to think about when identifying adjustments to holiday celebrations.  The next part of this series will focus on participation in holiday celebrations.

Learn about brain injury treatment services at the Transitional Learning Center: tlcrehab.org


NFL Settlement Battle

Lawyers representing the vast majority of National Football League retirees will be in court on Wednesday to argue over the terms of the settlements between the NFL and the former players over the effects of brain injuries.  This may be the final settlement between the NFL and the former players though some players have opted out of the settlement to pursue individual lawsuits.


Learn about brain injury treatment services at the Transitional Learning Center: tlcrehab.org

Processing Speed

One area of difficulty that many brain injury survivors experience is a decline in processing speed.  Processing speed is the length of time it takes for a person to  understand, access or utilize information.  For instance, if someone asks me which restaurant I would like to go to, my brain has to understand the question that is being asked, review the relevant information and generate the answer.  In this example, I first need to understand the question.  Next, I may have to think about issues such as what are my favorite types of foods, recent restaurant experiences, where the restaurants are located, affordability of the restaurants and which restaurants the others guests may enjoy.  Finally, after reviewing this information I need to generate an answer.  As you can see from the example, even a simple question can involve a great deal of processing.  Most people take for granted that their brain can process all of this information quickly and efficiently.  However, after a brain injury many survivors find that this is a slower, more difficult activity.

Difficulty with processing speed may negatively impact almost any situation.  A survivor may take more time to answer questions such as in the example above.  The survivor may take more time to react to situation.  For instance, a survivor may have difficulty avoiding cars in a parking lot because he or she is unable to react as quickly to arriving and departing vehicles.  The survivor may have more difficulty following conversations.  Each word, each statement needs to be processed in a conversation and especially if the other person is speaking rapidly, the survivor may struggle to keep up with the conversation.  This can become most problematic in a heated, emotional discussion.  When we are in these types of conversations, we tend to speak faster.  Many survivors complain that they are not given enough time to process and respond in conversations, leaving them feeling ignored and bullied.

Additionally, many survivors with processing speed difficulties struggle or are unable to multi-task.  Each individual task requires so much of their processing efforts that adding an extra task becomes a huge burden.

Here are a few ways to help a survivor with processing speed difficulties:

1.  Allow the survivor extra time to think, act and respond

2.  Only give the survivor one task at a time to complete

3.  Allot extra time for tasks, so the survivor does not feel rushed

4.  Ask the survivor if he/she needs more time to think, respond or act

5.  Stay on one topic at a time during conversation and do not talk more quickly than the survivor can process

6.  If the survivor is unable to process the information at that moment, if possible, put the conversation/activity off until a later time when the survivor feels better equipped to process

7.  Ask the survivor if he or she has any new ideas or thoughts that may have been generated after the initial conversation/activity was completed.  For instance, many times a survivor will report that he or she thought of a great response a few minutes after the conversation was over and would have liked to share the response with others.

Learn about brain injury treatment services at the Transitional Learning Center: tlcrehab.org



NHL Concussion Lawsuit

H0ckey can be a tough sport in which players receive concussions from checks, falls and fights.  In fact, many great hockey players have retired due to concussions.  Hall of Famers Pat LaFontaine and Scott Stevens are just a few of the best known players who retired due to a concussion.  Sports Illustrated has a gallery of some of the best known players whose careers ended due to concussions.


Of course, concussion is just another name of a brain injury.  Pat LaFontaine has been particularly active in educating others about brain injuries.  Below is a video on Brainline in which he described his brain injury experience due to his hockey career.


A number of retired hockey players are following the example provided by former NFL football players and are filing a lawsuit against the National Hockey League.  These players have accused the NHL of not doing enough to prevent brain injuries, not telling the players of the risk of brain injuries and encouraging fights which lead to injuries.


If the NHL lawsuit has similar results to the NFL lawsuit, the NHL may lose millions of dollars.

Learn about brain injury treatment services at the Transitional Learning Center: tlcrehab.org



Elections 2014

Voting is a fundamental right for all adult American citizens.  By Federal law, having a disability such as a brain injury does not alter this right in any election.  This includes national, state and local elections.  All election polling locations must be accessible or provide an alternate means for a brain injury survivor to vote.  Moreover, having a brain injury does not stop a survivor from registering to vote if they were not registered pre-injury.  For more information, follow this link to the US Department of Justice’s Civil Right’s Division.

This year, election day is Tuesday, November 4.  Go out and vote!


Learn about brain injury treatment services at the Transitional Learning Center: tlcrehab.org