Two Plans

While working on their recoveries at TLC, patients often tell staff about all of the activities they will engage in when they get “all better.”  They will tell staff about plans regarding work, vacations, school and family, clearly having spent significant time planning their future activities for when they are at the identical skill level as before their injury.  There is nothing inherently wrong with this planning but there is a important plan that is missing.  The majority of the patients at TLC have suffered severe traumatic brain injuries and have multiple areas of deficits.  Moreover, insurance companies and other funding sources will only fund rehabilitation for a limited amount of time.  Funding sources will not allow patients to stay indefinitely in therapy until they are “100%”.  After a number months (the exact number differing between funding sources and insurance plans), even if the patients are not finished with their recoveries, the sources will cut off funding and force discharges.  This is why it is important for patients and their families to make at least two plans; one plan on the basis of a full recovery and one plan on the basis of a less than full recovery.

The first plan, based on a full recovery, tends to be fairly straight-forward.  Patients generally want to return back to the majority, if not all, of their pre-injury daily activities.  The second plan, based on a less than full recovery, is more difficult.  This is an emotionally more difficult plan to make, as it forces the patients and families to confront the possibility that, at least temporarily, this journey will be longer and more complex than they originally hoped for.  It also means that patients and families will have to identify needs, resources and accommodations necessary to be successful in spite of having deficits.  This takes a considerable amount of time and effort.  But not making these plans can be very problematic, and in some cases, very dangerous.  For instance, if a patient has difficulties with balance and there is no plan on how to accommodate the balance issues at home, 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 plan is made for a patient who is confused and experiences disorientation, the patient may be left at home alone.  The confused and disoriented patient may leave home and become lost or wander through neighborhoods, which could place the patient in extreme personal danger.

The obvious question when making a plan for a less than full recovery is how does one plan for this when the patient is still actively recovering?  Do you guess than someone will be 25, 50 or 75% better?  Experience dictates that it is generally preferable to plan based on the worst-case scenario, which makes it more likely that all contingencies will be covered, no matter what the level of improvement that the person will experience.  So what is the worst-case scenario?  The worst-case scenario is what would happen if the patient did not continue to get any better than where they are at right at this moment.  After all, as long as the patient does not have some other health issue arise (e.g. seizures), then their overall recovery should not decline significantly from it’s present state so right at this moment is the worst off he or she should be.  So how does one talk about this thorny issue?  After introducing the topic and having the patient agree to discuss the topic, I usually say to the patient, “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 I know for sure is today.  So, if let’s pretend for a moment that you did not get any better or maybe that the insurance company decided that you would have to discharge tomorrow, what would you need at home to be successful?  What activities could you take part in own your own, with help or perhaps cannot do at your current recovery level?  By doing this, we can be bettter prepared for even the hardest post-discharge situation.”  With this type of an introduction, patients more easily are able to discuss various potential future issues.

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

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

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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/

New Technology Can Lead To More Success

Technology plays an ever-increasing indelible role in our modern lives.  Just as our phones and televisions are enhanced by new technological advancements,  so does neurorehabilitation from brain injuries benefit in a similar fashion.

Technological advances and applications for that new technology in rehabilitation come from different sources.  There has been a steady improvement in proprietary technologies catering to therapists and doctors who treat individuals with brain injuries.  These new technologies aid in a wide range of therapies, from helping a patient to re-learn swallowing skills to improving gait training.  Two common such examples can be seen in a patient working on a task while wearing electrodes to stimulate particular muscle groups or one walking laps while a programmable hoist unloads a percentage of that patient’s body weight.

Separately but related, most patients now integrate smart phones, Ipads, tablets and other such technology into their daily lives.  These items can be very useful in compensating for certain deficits.  For instance, many patients use their smart phones to keep track of their schedules and to program reminder alarms for daily activities.  There are numerous speech apps that can be downloaded to Ipads which enable patients to engage in more effective communication with others.  The cameras now included as feature of virtually every cell phone and tablet PC prove useful in compensating for deficits in visual memory.

These new technological advances benefit patients in multiple ways.  Many of these technologies enhance the effectiveness of therapies.  This brings greater success in individual therapies and thus in overall rehabilitation.  Other technologies provide new ways to compensate for deficits.  This helps reduce the lasting impact of injuries on patients’ daily lives.  Additionally, patients enjoy certain technologies that can make the daily work of therapies feel more fun or interesting.  This helps keep patients motivated in those therapies.  The pertinent role of the therapist is to identify which technologies will benefit which particular patient as each patient is different both in therapy needs and in personal comfort level with new technologies.

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

Ronald Reagan’s Brain Injury

Ronald Reagan served as President of the United States from 1981 to 1989.  He passed away in 2004 from Alzheimer’s Disease, perhaps the most famous victim of this terrible affliction.  Most Americans are unaware that in 1989  (just months after he completed his second term as President) Reagan underwent neurosurgery to remove blood build-up between his brain and skull following a fall from a horse in Mexico.  Below is a link to an article on his surgery:

There is significant discussion in the field of medicine that a brain injury can increase the likelihood of developing Alzheimer’s Disease or cause the disease to occur earlier in an individual’s lifetime.  For example, recent research found that patients with Alzheimer’s who had suffered a traumatic brain injury earlier in life developed the disease 2.5 years earlier than those who had not suffered a brain injury.

http://www.utsouthwestern.edu/newsroom/articles/year-2018/tbi-alzheimers.html

It is impossible to generalize from large-scale studies to a particular individual such as Reagan but it is worthwhile to acknowledge the possibility that his traumatic brain injury influenced the course of his Alzheimer’s.

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

Different Parts, Different Speeds

Brain injury survivors and their families often ask doctors and therapists about how long it will take for brain injuries to heal.  This would seem like a simple and straightforward question, but the answer to this question is actually quite complex.  One of the chief factors that makes any such answer so complex is that different parts of the brain may heal at different speeds.

We often talk about the brain as if it were one unitary body part, but in truth it is made up of many interconnected parts.  For instance, there are distinct left and right sides of the brain that are connected by a set of neurons known as the corpus callosum.  Each side of the brain can be split into many different component parts.  These parts function interdependently, but each part has its own unique purpose.

When a survivor received a brain injury, different areas of the brain may have been damaged at different levels of severity.  Which parts suffered damage at what levels of severity will differ from person to person and from injury to injury.   With so many parts of the brain being impacted differently by an injury, it is very common that a brain injury survivor will see improvements in some areas faster than in others.  For instance, if the part of the brain responsible for speech comprehension was less injured than the speech production part of the brain, that survivor will likely gain back the ability to understand verbal communication well before ability to convey information through speech returns.  If the part of the brain governing leg movement was less injured than the part of the brain controlling the arms, then that person is likely to see a return of the ability to walk through a doorway prior to being able to once again turn a door knob to open that door.  Ultimately, having different skills return at different rates of speed should be understood as a normal and expected part of the brain injury recovery process.

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

What Language Do You Speak?

 

There is an interesting phenomenon often observed in brain injury survivors who were bilingual to the extent of fluency prior to their injuries.  In these survivors who have post-injury language deficits the first (native) languages tend to return more quickly and fully than do their second languages.  This is true even in survivors who were fully fluent in a second language and used that second language extensively in their everyday lives.  As TLC is located in Texas, our staff tends to observe this phenomenon most often in Spanish-English bilingual patients.  Many of these patients now contending with language difficulties who learned English later in life find it far easier to name objects or follow directions when Spanish is used, while prior to their injuries they would have been comfortable using either language.

This return of the first language sooner than a second language can have a number of practical consequences.  Many survivors understandably become frustrated at an inability to speak that second language with the same skill once demonstrated.  Being bilingual is often a point of pride and may have previously allowed the survivor to excel in activities (such as import-export business transactions) that the average person could not.  This sudden significant skill gap may even prevent these survivors from returning to jobs in which a second language was utilized as a vital portion of everyday business life.  Moreover, if the survivor was previously the primary translator for the family this may cause difficulties in the family’s ability to interact with the outside world.  For example, the survivor may have previously served as point person to get information from school regarding a child’s performance as that survivor could easily speak to school officials (and the rest of the family may struggle with casual exchanges in English).  If the survivor is now unable to converse fluently in English, the family may now face significant problems interacting with the school.

There are also practical therapy concerns when a survivor struggles with a second language if that second language is the primary language used in the larger community.  In America, English is obviously the dominant language.  As such, most pre-therapy evaluations are conducted in English.  There are a limited number of health care professionals who are comfortable conducting evaluations in another language.  However, if a survivor’s first language is not English and that survivor is significantly stronger in his or her first language, that first language will need to be the language used in evaluations so as to get the most accurate measurements of the survivor’s skills.  The same is true in therapy.  If a survivor understands therapy directions significantly better in a first language, then therapy should be conducted in the survivor’s first language.    Additionally, therapists should always inquire as to which language is used in the home.  If the survivor’s first language is different than the language used at home (seen when someone who speaks both Spanish and English marries a spouse who only speaks English), then that second language will need extra focus or alternative methods of communication (e.g. pictures or hand signals) may need to be introduced.  At TLC, we have a number of Spanish-English bilingual staff and have a contract with a translation service if other help is needed.  Overall, rehabilitation professionals must be aware of survivors’ language skills and adjust evaluations and therapy accordingly.

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

 

Joe Biden is a Survivor

As Vice President of the United States under Barack Obama, Joe Biden served 8 years as one of the most important politicians in America.  Prior to holding the Vice Presidency, Biden served several terms as a senator representing the State of Delaware.  It was during his time as a senator that he required surgery for not one, but two brain aneurysms.  The first aneurysm had ruptured, putting him in a life or death situation.  Doctors saved his life and the recovery from his brain surgeries is simply astonishing.  His ability to succeed at the highest levels of government after these aneurysms is truly inspirational.  Below are a few news articles documenting his surgeries:

http://articles.latimes.com/1988-02-14/news/mn-42679_1_biden-aide

http://www.nytimes.com/1988/05/04/us/biden-resting-after-surgery-for-second-brain-aneurysm.html

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

 

A Little Note Goes A Long Way

As Thanksgiving approaches, many brain injury survivors are preparing for large get-togethers with family and friends.  Many of these family and friends have not recently seen the survivors in their lives and can understandably be extremely excited to be reunited.  However, there are often a great many changes that survivors have weathered which directly impact their experiences of Thanksgiving with these family and friends.  Close family members may be aware of these changes but extended family and friends may not be.  Email or similar communications can help spread necessary awareness to help ensure successful holiday celebrations.

These communications can be sent by the survivors or by close family members prior to any get-together. The goal is for individuals who are not fully informed of the survivors’ deficits to be given relevant information in order to help holiday celebrations run smoothly.  For instance, if alcohol is typically served at a Thanksgiving meal, friends and family need to know if the survivor is prohibited by a doctor from drinking.  If the survivor becomes agitated when there are too many people surrounding him or her, family and friends need to know to approach the survivor one at a time.  If the survivor can only tolerate food of a certain consistency, family and friends need to know which foods can or cannot be served the survivor.  These are just a few examples of useful information that could be included in a message sent to help avoid problems during a survivor’s Thanksgiving celebration.  Remember, a little note can go a long way toward success!

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