Just Be Grateful

“Just be grateful you are alive”

“Just be thankful you didn’t die”

“You should just focus on the fact you survived”

Brain injury survivors hear these types of well-meaning lines all the time.  They are used by family members and friends to help survivors see the “brighter side” during their recovery period.  And the statements are true; traumatic brain injuries, strokes and other forms of acquired brain injuries lead to death for millions of people worldwide every year.  It is worthwhile to be thankful for life.  But these lines can be double-edged swords.

Taking a step back for a moment, most survivors are truly thankful to be alive following their near-death experiences.  But that does not mean that they have not suffered real, painful losses.  At the same time as you want to encourage and support survivors, it is also important to allow them to mourn these losses.  There is nothing inherently wrong with lamenting loss of arm function or fluid speech, as long as this does not lead to a serious decline in mood or performance.  For instance, wouldn’t any person be upset if after decades of normal walking, he or she would have to learn how to walk all over again because of a stroke?  A balance has to be struck between fostering positive mood and allowing for reasonable mourning of loss.  “Just be grateful you are alive” is not an inherently bad statement as long as it is not being overused and preventing healthy adjustment to change.  However, using this line repeatedly often causes survivors to be frustrated and feel as if they cannot express their feelings.  Though it may be difficult for a family member or friend to see the survivors experience sadness or anger, this is often one of the steps necessary to make a successful transition to post-injury life.

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

 

Give Yourself Permission

Brain injury survivors and their loved ones often try to approach life after an injury as if it is a fight.  Battle hard, stay strong and never let your enemy see your weaknesses.  But in truth, though there are some similarities in this analogy that are appropriate, life after an injury is not an actual fight.  In fact, by treating it as a real fight, sometimes survivors and their loved ones hurt themselves but not allowing themselves to feel and process certain emotions in a healthy manner.  By not processing emotions, individuals may allow these emotions to fester inside and come out at the wrong time or in the wrong situation.  Not processing emotions can lead to difficulties such as depression, anxiety and relationship stress.  I would like to encourage you to give yourself permission to feel these emotions.

Give yourself permission to get angry at the injury.  It truly is a frustrating and unpleasant experience.

Give yourself permission to cry.  There is no weakness in crying.  This is an appropriate reaction to a painful situation.

Give yourself permission to mourn.  There may be parts of you from the past that will no longer be part of your post-injury future.  It is okay to mourn their passing.

Give yourself permission to laugh.  Laugh at the moments of oddity.  Laughter , in measured amounts, is a reasonable coping technique during times of distress.

Most of all, give yourself permission to experience and value the full range of your emotions.  After all, our emotions are important aspects of who we are as people.  They are a central part of simply being human.  So please, give yourself permission to be the complete person that you are, despite your injury.

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

 

 

 

 

Doing It Best

Jahvid Best appeared to be on the road to football stardom.  Drafted in the first round by the Detroit Lions, Best possessed blazing speed that was the envy of other running backs.  Unfortunately, his professional football career was ended prematurely during it’s second year due to the effects of concussions.  Best put forth great effort to get back into the NFL but doctors ruled against his return.  For many people, this would be the end of the story.  But for Jahvid Best, it was the start of something new.

One of the key tasks that brain injury survivors must navigate is to look at their retained abilities and identify what they can do best, in spite of their injury.  Best understood that his body was not ready to be tackled by 300 lb linemen, but he still had his speed.  Best worked tirelessly at his skills on the track.  The hard word paid off.  Best qualified for the Olympics in Rio.  He will be representing the island of nation of St. Lucia.  Best demonstrated how to thrive and succeed in spite of an injury!  Though he was not a TLC patient, we certainly think he is truly a hero for the brain injury community.  Identifying a survivor’s skills and choosing activities that match those skills is a key part of the rehabilitation process.  For more reading on Jahvid Best’s journey, click on the link below:

http://olympics.nbcsports.com/2016/07/16/jahvid-best-olympics-detroit-lions-nfl-football-track-and-field-st-lucia/

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

 

 

 

When Michael Jordan is Smarter than the Media

As a brain injury rehabilitation therapist, it is can be painful to read the news.  Sometimes, the media simply do not appreciate the seriousness of brain injuries and the need to take reasonable actions to prevent injuries.  Today was one of those days.  Michael Jordan, arguably the greatest player in the history of basketball, decided to go jet skiing.  Being a smart man, Jordan wore a protective helmet.  It was not worn for fashion but for function.  For some reason, Pete Blackburn of Uproxx, as posted on Yahoo, decided to make fun of Jordan for wearing the helmet.  This is the offending article:

https://www.yahoo.com/news/michael-jordan-giving-us-magnificent-175458823.html

The article is just silly and encourages poor safety awareness.  The fact is that that people do get brain injuries and even die in jet ski accidents.  Jordan is entirely correct for wearing the helmet.  To put this issue in perspective, I would like to provide a few examples of people who have suffered brain injuries while jet skiing.  Duke University football player Blair Holliday nearly died due to a traumatic brain injury suffered in a jet ski accident (http://www.dukechronicle.com/article/2016/05/definitely-a-miracle-former-duke-football-wide-receiver-blair-holliday-earns-degree-after-suffering-traumatic-brain-injury-in-july-2012).

Lisa Votaw suffered a brain injury in Minnesota when the jet ski she was on flipped over (http://www.fergusfallsjournal.com/2016/06/fergus-falls-woman-injured-in-jet-ski-accident/).

Firefighter Mike Yurchak of Pennsylvania suffered a serious brain injury in a jet ski accident (http://www.readingeagle.com/news/article/mohnton-firefighter-in-coma-after-jet-ski-accident-in-maryland).

Similarly, this past January, a woman in Miami received a brain injury when she was involved in a collision of two jet skis (http://miami.cbslocal.com/2016/01/31/woman-hospitalized-after-jet-ski-accident-on-miami-beach/).

Jordan should be appreciated, not lambasted, for taking reasonable precautions by wearing a helmet on a jet ski.  There are already enough injuries out there.  We do not need to discourage anyone from being safe while having fun.

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

Citizen Science

One of the big changes for brain injury survivors need to adjust to is that they often have a great deal more time to fill in their day once they return home from rehabilitation.  Whereas they previously may have spent most of their pre-injury days involved in work or school, those that are unable to return to these activities now have large holes in their schedule.  For instance, if a survivor spent 40 hours a week at a job and cannot return to work, he or she now has 40 hours of time to fill in their post-injury life.  One way of filling this time in a meaningful way is through citizen science projects.

Citizen science projects are based on the idea that scientists do not have enough time or ability to collect and analyze all of the information that they would like in order to conduct their research.  For instance, if a scientist was collecting information on trout migration, he or she cannot be at every single stream and river to collect data.  However, these scientists could ask fisherman who are at these waterways to spend 30 minutes counting the trout in a particular location.  This way, the scientists can get data from many more locations.  A second example is identifying galaxies.  There are billions of galaxies in our universe but scientists do not have the time to categorize all the photographs of galaxies that they have .  However, they can put up these pictures for regular people to look at on the web and ask these people to categorize galaxies based on shape.  As you can see in both examples, much of the information for research projects can be gathered and analyzed by individuals with little or no training but have a large impact on the quality and quantity of science.  The work of citizen science projects are often used to help make policy decisions, find new discoveries and help understand our environment in a more complete manner.

Just like the examples given above, there are many different types of citizen science projects.  Some involve going out of the home, such as to a forest or lake, while some can be done at home.  They are run by universities, museums, nonprofits and government agencies.  You can easily locate many citizen science projects by entering the keywords “citizen science” into  the search box of any web browser.  Here are a few helpful links to locate projects:

Scientific American: http://www.scientificamerican.com/citizen-science/

Cornell University: http://www.birds.cornell.edu/citscitoolkit/projects/find

Scistarter: http://scistarter.com/page/Citizen%20Science.html

Hopefully, incorporating citizen science projects into a weekly activity schedule will help bring brain injury survivors enjoyment and meaning in their post-injury lives!

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

 

Bubba Smith and CTE

The phrase “larger than life personality” could have been invented to describe Bubba Smith.  Looming at 6’7″ and almost 300 pounds, he was the first pick of the 1967 NFL draft and earned his ring at Superbowl V with the Baltimore Colts.  His extraordinary defensive skills on the football field left many a shell-shocked quarterback lying prostate in his wake.  Following his nine year professional football career, he parlayed his fame into a second career in film and television.  He is best known in the acting world as Captain Moses Hightower in the Police Academy movies and for his appearances in Miller Lite commercials.  After he passed in 2011, his estate allowed researchers to study his brain for evidence of Chronic Traumatic Encephalopathy (CTE).  It was discovered that he had been living under the effects of level three CTE (the scale runs from one to four).  Follow the link below to read more about these findings.

http://www.nytimes.com/2016/05/25/sports/football/bubba-smith-cte-nfl-concussion.html?_r=1

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

 

 

 

But Are You Getting Help?

Following a brain injury, family members will often spend every possible moment dedicated to efforts in support of an injured loved one and devote special attention to helping that survivor get the best care possible.  They with rare exception will spend countless hours on the phone battling insurance companies and filling out forms.  These family members must deal not only with stressors directly related to worrying over a  loved one’s health, but must make peace with planning for a suddenly very different future and must manage (sometimes alone) a freshly revealed terrifying financial mine field.

Brain  injury survivors themselves also face an enormous number of stressors as they struggle to regain command of basic skills and learn different ways to perform common tasks.  However there is a major difference in this regard between the brain injury survivors and their family members, particularly while the survivors are in rehabilitation.  The brain injury survivors are surrounded throughout the day by professionals trained in the treatment of brain injury who can help with mood, education and adjustment.  Survivors merely need look to their immediate surroundings to find an abundance of professional help to address any difficulties.  Family members generally do not have anything approaching such a level of support so readily available.  With all this in mind, it becomes clear just how thoroughly brain injuries are in fact a family affair.  All members of a family are affected, not just the brain injury survivor.  Likewise, all family members are part of the team necessary for managing long-term effects of the injury.  It is important that all members of the team (not just the survivor) are receiving the help and support that they need in order to adjust to these major life changes.

At TLC, staff commonly ask survivors’ families, “Are you getting help?” and “How can we help you through this process?”  It is important that family members do not neglect themselves while giving all they can to aid injured loved ones.  Such care taken is in the best interests of both the personal health of the family members in question and the optimal well-being of the survivors they support.  Caregivers with high stress levels often find themselves more susceptible to physical illnesses than the average person.  A family member side-lined by illness can offer only a fraction of the aid and support he or she would wish to.  Further, family members deserve to be allowed to live their lives to the most complete level of happiness possible (just like the survivors deserve to).  Put simply, if these family members are struggling themselves then they are placed in a severely disadvantaged position from which to help the survivors in their lives.

Family members of survivors should consider personal therapy and support groups as aids for their own psychological and spiritual adjustment (Both the Brain Injury Association of America and the American Stroke Association offer listings of local support groups).  These family members can often benefit from reaching out to friends and community resources in order to better address the management of difficulties.  Seeking help is not a sign of weakness but is instead a common sense step taken in the interest of maximizing both individual and family success and happiness.  Brain injuries are complex and stressful.  Family members should not pretend to be super-humans capable of handling anything and everything.  They should actively ask doctors and therapists for information on brain injury prognoses, education resources and proven strategies helpful in planning for the future.  Overall, one of the most important ways that family members can contribute to the advancing well-being of survivors in their lives is to remain sufficiently mindful of their own.

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

A Story About Adjustment and Meaning

I would like to tell a brief story about adjustment and meaning that I often share with our patients at TLC.  I believe it highlights many important aspects of healthy post-injury adjustment.  Many years ago, TLC had a patient who had suffered a severe stroke.  He had been hard-working in his life as a truck driver, and his dedication to determined effort did not decline after being injured.  This patient worked incredibly hard to get better and in fact, he did improve.  However, his injury was too severe to allow him to return to his job.  He had an arm that did not work, weakness in one leg which caused walking to be more difficult and he had left neglect (a condition which causes the brain to ignore items on the left side).  He simply could no longer safely fulfill all the requirements of his job due the effects of the stroke.  It was apparent pretty early on in his rehabilitation that he would not be able to return to work at his former job in the foreseeable future and his psychotherapist attempted to help him plan for a different but still meaningful life after discharge.  The patient initially insisted that he was going to be able to get back to work, but after several months he began to understand and accept the reality of his situation.  After this acceptance, the conversations he’d had with his psychotherapist really began to sink in.  What happened next was truly special.

One day, the patient walked into his psychotherapist’s office and stated that he had come to a decision.  He was not a young man but he had two young children.  He said that prior to his injury, he woke up before his children arose and came home after they had gone to sleep.  He never really saw his children except on Sundays.  Prior to his injury, he was a truck driver who was a good breadwinner for his family.  But now, his new job was going to be as a full-time dad who would be present for all of his children’s events and activities.  He was happy with his decision and found great meaning in being an active father.  By making this mental switch, his mood was brightened and he was excited for the future.  Seeing another potential opportunity, the therapist encouraged him to contact an adult daughter with whom he had not spoken in a long time (even prior to his stroke).  With a little encouragement, he made the call and was able to rekindle the relationship with his daughter.  She had two children, so he also was able to renew his relationship with his grandchildren.  He was truly happy.

Most of our patients at TLC are driven to return to their previous lives, and their visions for these restorations often include resuming previous occupations.  There is nothing wrong with this and our therapists work diligently to help patients reach these goals.  However, a brain injury may be too severe to allow a brain injury survivor to return to his or her old job.  Though this is sad, it does not mean an end to happiness and meaningfulness in the survivor’s life.  The survivor need only find a new or adjusted role that he or she can then embrace.  This adjusted role does not have to look the same for each survivor, it just has to bestow upon a given survivor’s life the sense of value that accompanies that recognized significance.

 

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

Lessons From a Former TLC Patient

Recently, we had a guest speaker in our 4 p.m. Community group.  A former TLC patient  gave a wonderful presentation to our current patients.  The former patient is a stroke survivor who had done well in therapy at TLC and continued to work to improve himself after discharge.  The current TLC patients in attendance warmly received his wise words.  I would like to share a few pieces of advice he gave in hope that they might benefit others.

1.     Work as hard as you can to get better.  It may seem obvious that you need to work hard, but some days are rougher than others.  On those rough days give the best that you can, even if that best doesn’t quite produce the same quality of work produced on your good days.

2.    Take advantage of the therapy you have now.  Once you leave inpatient therapy, your access to trained therapists will significantly decline.  You may still have access to outpatient therapists but this will by its nature almost always be for far fewer hours per week than in an inpatient setting.

3.    Set goals.  Goals reliably encourage motivation and allow you to check objectively to see if you are doing what is needed in order to take steps forward in your recovery.

4.    You have to be self-motivated.  No one can make you do anything, even if that thing is clearly in your own best interest.  This is especially true after you have discharged to home and the brunt of the work falls on you and you alone.

5.    Don’t get caught in the trap of saying “I’ll  do it after discharge.”  It is vital to set healthy habits there in a therapeutic environment specifically designed to be conducive to just that.  Carrying over those healthy habits to life at home then becomes that much more attainable an objective.  It is much harder to try to set healthy habits on your own without that support.

I hope all would take his sagely advice to heart for use in improving rehabilitation experiences!

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

Visual Scanning Using Menus

Previously, I have discussed the use of circulars and telephone books in scanning exercises for brain injury survivors with left neglect and/or a field cut.  Another practical option for scanning exercises can be found in restaurant menus.  Almost everyone will go to a restaurant at some point in a given year, so working with menus presents as a pretty straightforward opportunity to many survivors.  Most people have menus sitting around at home, making them easily available to employ as tools.  If one does not have a menu handy, many can be downloaded online.  Also, most any restaurant will be more than happy to give out extra copies of menus.  It can be helpful to have menus of different sizes and complexities since this allows for adjustments to task difficulty over time.

Once the survivor has agreed to the task, simply place the menu in front of the survivor.  Ask the survivor to point to various items on the menu (e.g. “Point to the Pastrami Sandwich” or “Point to the appetizer that costs $7.99″).  Be sure to vary the location of the items the survivor is asked to find.  For instance, you may first ask that he or she find an item in the upper left corner, then next request something closer to the middle, followed by an item in the lower right corner.  If the survivor is having difficulty finding an item, have the survivor begin a slow and organized scanning search.  As a rule, the survivor should start the search on whichever side is the most difficult for him or her.  As example, if the survivor has left neglect then he or she should start on the left side of the menu.  If the survivor has a right field cut, he or she should start on the right side.  The survivor should start at the top of the menu with the column furthest to the chosen side, slowly bringing the search to the bottom of the page.  Once he or she has reached the bottom of the page, the survivor should start back from the top moving one column over and searching slowly from the top to the bottom as before.  This should continue until the survivor has found the item.  This method works best if the survivor uses his or her finger as a guide.  If the survivor cannot find the item, the helper working with the survivor should aid the survivor by re-starting the search as a more active participant (this time using the helper’s finger as guide instead).  If the survivor continues to struggle with the task, the helper may wish to demonstrate how to use the organized search method to find the item as if the helper is the survivor.

Always make sure that the material is not too small for the survivor to see and that if the survivor uses reading glasses, he or she is wearing them.  It is usually a good idea to start off with simple, one page menus with fewer items listed and to then move on to more complex menus only after the survivor has first mastered the simpler ones.  Remember that colors and pictures can be very distracting to many survivors.  Patience is key, as it may take a significant amount of time for the survivor to find an item even with help.  Although these items may seem easy to find to the helper, the survivor is having to learn an entirely new way to engage with visual material.  A little teamwork will go a long way to ensure success in this vitally important endeavor.  As in all new learning, mastering a scanning technique can be a slow and laborious process requiring much support, goodwill and encouragement!

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