Using the Open Chair Technique

Survivors with brain injuries push themselves to get better.  The staff at TLC see this every day.  Survivors push themselves to walk better.  They push themselves to speak better.  They push themselves to improve their memory.  They push themselves in every aspect of the rehabilitation experience.  But recovery from a serious brain injury can be quite slow.  It is almost always slower than the survivor would like it to be.  Unfortunately, this leads some survivors to talk badly about themselves.  They say things such as “I am a failure because I am not 100% improved” or “I should be much better than I am now.  I am doing poorly in therapy”.  This negative self-talk often leads emotional difficulties such as stress, low mood and sometimes even to depression.

If looked at objectively, this negative self-talk is often due to unrealistic expectations that the survivors have regarding their recoveries.  The survivors may believe that the amount of time necessary to recover is in excess of what they expected, even when the medical research shows that they are progressing at a normal rate.  By expecting faster or better results than is humanly possible, survivors can cause themselves unnecessary frustration.

Interestingly, these same survivors who hold unrealistic expectations of themselves generally do not hold these same expectations of others.  They are often more logical and understanding of other survivors than themselves.  It is common at TLC for the same patients who have unrealistic personal expectations to support realistic expectations in other patients.  They will make supportive statements to other patients such as “Don’t worry and take it slow.  You will get better over time.  You are running a marathon not a sprint.”  When the patients with unrealistic expectations are asked if they believe the advice they are giving to others, they always answer in the affirmative.  They understand that the brain injury recovery process is a slow process which requires lots of work.  They understand it is a long-term process.  But they tell themselves that their personal recovery should be quicker than everyone else, holding themselves up to unfair, often impossible, standards.

One way to manage this negative self-talk is by using the “open chair” technique.  How this technique works is that patients are asked to imagine they are sitting next to themselves and the person in their seat is someone else with the exact same issues and deficits that they have.  The patients are then asked to give this “other person” honest feedback about how the “other person” is doing.  Often, patients find that this leads them to soften their tone and make more supportive personal statements.  Similar to when they are actually talking to other patients, when they address themselves as the “other person”, patients demonstrate more realistic expectations and are less likely to attack themselves.  The “open chair” technique often helps patients treat themselves not only better, but also more fairly and honestly.  By being more fair and honest to themselves, survivors tend to have an improved mood.  And the better the mood that survivors have, the easier it is to go through the rehabilitation process.

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

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Michael Johnson is a Survivor!

Olympic gold medal sprinter Michael Johnson has always kept himself in great shape, even in retirement from his celebrated professional career.  However,  it is possible for even a healthy individual to have a stroke.  Michael Johnson recently suffered a transient ischemic attack (TIA), also known as a “mini stroke”.  Though he has recovered well from the TIA, the experience taught him a valuable lesson about vulnerability and motivated him to educate others regarding the risks for stroke.  Click the link below to read more about Michael Johnson’s stroke experience:

https://www.bbc.com/sport/athletics/46798931

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

 

Bike Helmets Are Not Just For Kids

This post, as many of the posts on this blog have been, was motivated by an everyday experience (had either at work or in my personal life).  This particular post was influenced by a conversation I had on Facebook.  Recently, a friend of mine posted a picture from 20 years ago.  The picture was taken after he had experienced a serious bicycle accident.  He mentioned breaking several bones and having a concussion.  He said that the accident was proof that bicycle helmets work and that he needs to wear one all of the time.  I mentioned that I have seen several patients with severe brain injuries due to bicycle accidents and agreed that he needs to wear a helmet whenever bicycling.  He responded by telling me that the accident was so serious that it affected his memory.  He woke in the emergency room with a note taped to his chest telling him what had happened.  Before reading that note,  he had no idea how he might have ended up in the emergency room.

This brings us to a worrisome trend I have noticed.  While many more children are wearing bicycle helmets while out riding than in the past, many adults are not.  This is especially concerning when looking at accident data from the National Highway Traffic Safety Administration (NHTSA).  According to the NHTSA, the average age of citizens suffering bicycle accident fatalities as of 2016 (most recent data available) is 46.  Moreover, for children under the age of 14 there is on average approximately 1 death per million in the resident population while for adults between the ages of 50 and 65 that figure jumps to over 4.6 per million.  These findings should should raise concern in every adult bicycle rider. (For this data, and further information on bicycle safety from the NHTSA, click on this link) https://crashstats.nhtsa.dot.gov/Api/Public/ViewPublication/812507)

It is likely that a chief factor in this disparity is the fact that many states and cities have laws mandating that children wear helmets while there are no corresponding laws governing adult behavior.  For instance, it is illegal in the city of Houston, TX for anyone under the age of 18 to ride a bicycle without a helmet but there is no equivalent law for adults.  These laws ignore a basic medical reality.  Adults can just as easily suffer a brain injury as any child and, based on that NHTSA data, are dying from bicycle accidents at a distressingly higher rate than children.  Just as children need to protect their brains from injury, so do adults.  Reaching the age of 18 does not magically make a bicycle rider immune to serious accidents.  Everyone, including adults, should always wear a helmet when riding a bicycle!

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

Practice Makes Proficient

Neurorehabilitation from a brain injury involves learning and re-learning a long list of common activities.  Patients spend hours honing skills such as naming well-known items, transferring to and from a wheelchair and using adaptive equipment.  Therapy sessions often consist of countless repetitions of the same action, drilling these essential skills over and over (and over).  Further, therapists will usually send patients home with discharge plans outlining continued practicing of these same skills at home.  Sometimes, patients will wonder why they have to practice these activities to such a degree.  After all, if they demonstrated the skill once (or more likely a multitude of times throughout inpatient therapy) doesn’t that serve as proof positive that they now possess said skill?  Why is this repeated practice necessary?

In reality, to truly become proficient at any skill a great deal of of practice is necessary.  Just because a patient has succeeded at demonstrating a skill on one occasion does not mean that he or she will succeed in the future.  This is true for any life activity or field of endeavor.  For instance, imagine hearing the following overhead announcement while taxiing an airport runway prior to takeoff:  “Ladies and gentleman, welcome aboard flight 683 to Phoenix.  My name is Captain Mike and I will be your pilot today.  I have successfully flown a plane once.  I anticipate a smooth flight today.”  After hearing this announcement, most passengers would probably scream for the exits immediately.  Who would trust a pilot to fly a plane with a history of only one successful attempt?  We instinctively recognize that lots of practice is necessary to trust that a person can reliably and competently complete a given task.  This holds just as true for therapy as it does for the for flying of a plane.  Repeated practice, both in therapy and at home, is necessary for a patient to hone the skills and competencies necessary to successfully accomplish rehabilitation goals.  It is only through practice that patients can become proficient.

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

Why Brain Injury Education is Important

Recently, I was speaking with an acquaintance about our jobs.  He is a young, bright family physician.  The young physician explained to me how those patients he treats with brain injuries have all suffered mild brain injuries.  He then proceeded to give a list of some of the more common symptoms that his patients experience.  His description of the symptoms of mild brain injuries was well-informed and accurate.  I mentioned how I treat patients with moderate to severe brain injuries.  The young physician stated that there is not much one can do for patients who have such serious brain injuries.  On this point, he was sadly misinformed.  I explained to him that the terms “mild,” “moderate” and “severe” simply refer to the initial status conferred by the seriousness of brain injury incurred and not to a persisting state of being;  having that injury as a starting point in no way condemns a patient to that as end result.  I told him about several TLC patients who were quite successful following rehabilitation, including patients who went on to graduate from college after completing treatment at TLC.  He clearly took in the information and hopefully has adjusted his outlook as a result of our brief interaction.

This interaction led me to have other thoughts.  Here is a well-educated, skilled and obviously competent doctor who still lacked a sufficiently comprehensive understanding of brain injury.  How much more so then must such a deficiency in understanding persist in the general populace?  How many people in the general public harbor demonstrably false ideas about brain injuries?  The desire to educate the public on brain injury is one of the principal reasons this blog was created.  Moreover, every article, news story and conversation about brain injury which we share helps to educate individuals outside of the brain injury treatment world about brain injury.  We need to let the general public know that a brain injury is not the end of someone’s life but it is rather one more of myriad forks in the road encountered while navigating life’s path.  It is important for the general public to understand that despite significant difficulties, an individual with a brain injury can still lead a successful life.  All would benefit from the general public learning to see more clearly the human truth behind the facade of injury.

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

Gary Busey is a Survivor!

Actor Gary Busey, the star of countless movies and television shows, is also a traumatic brain injury survivor.  On December 4, 1988 Busey suffered a serious motorcycle accident while riding without a helmet.  This accident caused a severe traumatic brain injury which nearly took his life.  Through a great deal of hard work and persistence, Busey achieved an effectively full recovery and has used his platform as a star to help advocate for the brain injury community.  Click the link below to learn more about his injury experience:

https://usatoday30.usatoday.com/news/health/spotlight/2001-07-05-busey-brain-injury.htm

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

Two Plans

While working on their recoveries at TLC, patients often tell staff about all of the activities they will engage in once they are “all better.”  They will share these plans regarding work, vacations, school and family clearly having spent significant time planning future activities assuming an identical skill level as that enjoyed pre-injury.  There is nothing inherently wrong with this kind of planning, but there is an important complementary plan that is missing.  The majority of the patients at TLC have suffered severe traumatic brain injuries and contend with multiple areas of deficits.  Moreover, insurance companies and other funding sources inevitably only fund rehabilitation for a finite span of time.  Those spans of time almost never cover the entirety of a patient’s incremental progress back to “100%,” and no such funding source can make allowances for an indefinite stay.   After a number months (the exact number differing among funding sources and insurance plans), sources will cut off funding and force discharges even if patients would benefit from further therapy.   This is why it is important for patients and their families to make at least two plans.  One of these plans can assume a full recovery, but another plan should recognize the very real likelihood of a less than full recovery.

The first plan, based on a full recovery, tends to be fairly straightforward.  Patients generally want to return back to the majority (if not all) of pre-injury daily activities.  The second plan, based on a less than full recovery, can be more difficult.  This plan is far more emotionally taxing, as it requires patients and families to confront the possibility that the journey of recovery will be longer and more complex than they originally hoped it might be.  It also means that patients and families will have to identify needs, resources and accommodations necessary to be successful incorporating effectively permanent deficits into any planning equation.  This takes a considerable amount of time and effort.  Neglecting to make these plans though can be very problematic, and in some cases quite dangerous.  For instance, if a patient has difficulties with balance and there is no plan in place to make accommodations for those difficulties, a patient may go home without necessary equipment such as grab bars and a shower chair to compensate for balance problems in the bathroom.  This would place the patient with balance deficits at a high risk for a fall, which could lead to a serious injury.  Similarly, if no secondary plan is made for a patient who is confused and experiences disorientation, that patient may be left at home alone.  This confused and disoriented patient may then leave home unaccompanied and become lost wandering the streets, which clearly places that patient in extreme personal danger.

The obvious question when making a plan for a less than full recovery is how does one best make such a plan when the patient is still actively recovering?  Does one guess that a patient will be 25, 50 or 75% better at eventual discharge?  Experience dictates that it is generally preferable to make this secondary plan based on the worst-case scenario (which makes it more likely that all contingencies will be covered) regardless of the rate of improvement a patient appears to exhibit.  So what is the worst-case scenario?  The worst-case scenario is the situation arising if a patient were to make no further improvements beyond current status.  After all, as long as a patient does not have some additional health issue arise (e.g. seizures), then overall recovery should not decline significantly.  This promotes the valid assumption that the current state is the worst possible state and should then be used to inform secondary planning.  So how does one talk about this thorny issue with a patient currently devoting so much of his or herself to the recovery process?  After introducing the topic and having the patient agree to a discussion, I usually start with a version of the following:  “I can see that you are working hard and getting better through rehabilitation.  However, no one has a crystal ball to predict the future.  All we know for certain is today.  Let’s pretend for a moment that you do not get any better than you are right now or that perhaps the insurance company decides to force your discharge tomorrow.  What would you need at home to be successful?  What activities could you take part in on your own or with help?  In addition, which activities might you be unable to take part in at your current recovery level?  By doing this, we can be better prepared for even the hardest post-discharge situation.”  With this type of introduction framing the discussion, patients are able to more comfortably explore these distressing potential eventualities.

As alluded to earlier, this discussion can be very emotionally difficult for patients and family members.  It forces focus on a troubling “what if” and can provide a quite painful reality check resulting from a practical assessment of skills impacting needs.  It is important that everyone understands that this does not mean that it is assumed the patient will not get better or that rehabilitation is useless.  This planning is to raise the likelihood that the patient and family members will be prepared for all possibilities and to lower the likelihood of unexpected dangers and headaches later in the recovery journey.  Overall, the goal is to have a smooth, safe and successful transition to home life after inpatient rehabilitation.

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

TLC on TV!

TLC was on TV!  The TLC facilities in Galveston and Lubbock both recently acquired  innovative new robotic arm devices from Bionik Laboratories.  Our partnership with Bionik Laboratories will allow TLC patients to make use of this cutting edge technology in efforts to improve rehabilitation outcomes.  This new technology is so innovative that Fox 26 in Houston came to film a segment at TLC Galveston on the robotic arm and its potential.  Click the link below to see TLC on TV!

http://www.fox26houston.com/news/new-robotic-arm-therapy-being-used-to-help-stroke-patients-recover

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

Dylan O’Brien is a Survivor

Brain injury does not discriminate.  Even those most famous of Hollywood stars are not immune to being injured.  Maze Runner star Dylan O’Brien suffered a brain injury due to an accident while filming the third Maze Runner film.  He needed many months to recover from his injury before he could return to filming.  The most difficult part for Dylan was the emotional aspect of recovery.  The article below is an interesting read in which Dylan opens up about his experiences surrounding the accident.

http://www.vulture.com/2017/09/dylan-obrien-is-back-from-the-brink.html

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

 

Lessons from a Blind Man

We here at the Transitional Learning Center often host patients and family members that speak Spanish as a primary language.  Spanish-speaking TLC staff members are generally on-hand to translate during therapies and other necessary interactions, but on occasion TLC staff will have need to use a phone translation service (in a meeting updating family on progress, for example).  To utilize this service, a staff member will call the service phone number which connects directly to a translator.  The translator can then translate between all parties involved via speaker-phone.

When using such a translator, it is important to pause every few sentences so as to allow the translator to translate that which has just been stated.  On one memorable occasion a therapist spoke for too long without pause and upon realizing her error, stopped herself and apologized for not stopping sooner.  The translator agreed that to do his job effectively he would require more frequent pauses.  He then added that he cannot depend upon notes taken while someone is giving him information to translate because he is blind.  He was doing his job utilizing memory and language skills exclusively.

Reflecting upon this situation there is an important lesson to be learned for all individuals with disabilities, including brain injury survivors contending with long-term deficits.  A translator position is the perfect occupation for a bilingual blind person.  The job requires excellent speech and finely-honed cognitive skills, but in no way requires vision.  The job matches the person’s strengths to a central task while sidestepping the influence of any weaknesses.  After an injury, many brain injury survivors need to find new jobs because newly acquired deficits do not allow them to return to their previous occupations.  It is important during the job search process to honestly identify post-injury strengths and weaknesses in order to find jobs that rely on strengths while minimizing the impact of any weakness.  By taking this important step survivors are more likely to enjoy success in the working world, just like the blind translator from our story.

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