Grounding Identity

Living through the brain injury experience can represent quite the assault on a survivor’s identity.  Previously athletic survivors may now struggle to walk.  Previously active and industrious survivors may now be unemployed.  Instead of being in charge at the workplace,  a survivor now is given a list of externally defined rules to follow essential to his or her rehabilitation.  All of this can cause notable emotional strain on a survivor.  Contending with the inevitable alterations wrought by such an injury to the perception of  one’s own identity is no small thing.  Sometimes rather than focusing on all of these changes, it is worthwhile to instead concentrate on those aspects of the survivor’s identity that have remained stable in spite of the injury.  It is often helpful to write down these stable aspects to help visualize and internalize the truth that many of the attributes that have always defined the survivor’s identity at core remain just as relevant post-injury.

Here are a few of these aspects with strong potential to remain stable following an injury:
1.  Family relationships – An injury does not change the fact that a survivor holds family roles as a parent, child or sibling.
2. Life Experiences/Memories – An injury does not negate the many life experiences that a survivor has accumulated.  These experiences can originate in work, school, family or any other facet of life.
3. Interests/Hobbies – An injury is unlikely to change a survivor’s interests and tastes in things like music, food and sports.
4. Knowledge – An injury will almost never fully erase a survivor’s knowledge acquired over years of life experiences.  As example, a survivor who is a truck driver will generally remember all of the quickest routes across town.
5. Personality – An injury may not change a survivor’s personality.  For instance, a survivor who was a hard worker prior to an injury will very likely be just as hard a worker after.
6. Physical Characteristics – An injury may not alter certain physical characteristics.  A brain injury will not change the color of a survivor’s eyes or hair.  For many survivors, overall facial appearance does not change at all (or sees only minor changes) following an injury.
7. Beliefs – An injury will generally have no effect at all upon a survivor’s belief system.  For example, a lifelong Democrat will almost never suddenly begin voting Republican post-injury.

By spending time identifying and shifting focus upon the stable facets of survivors identities, survivors can better emotionally ground themselves as they navigate the brain injury experience.

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

 

 

 

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Frankie Muniz and Strokes

Actor Frankie Muniz is best known for his work in the hit TV show Malcolm in the Middle and recently has been competing on Dancing With The Stars.  Few know of a far more private battle that he has been fighting, though.  Muniz estimates that he has suffered as many as 15 mini strokes in recent years.  Doctors have not been able to identify a definitive cause for the multiple stroke events Muniz has suffered, but he does not let this stop him from succeeding in life.  He shares about his strokes and other health issues in the following article:

http://people.com/tv/frankie-muniz-secret-health-battle/

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

 

Alcohol, Seizures and Brain Injury

A drunk driving accident.  A fight at a bar after a night of drinking.  A serious tumble at home after a few too many.  Many brain injury survivors received their brain injuries while under the influence of alcohol.  In fact, studies have shown that between 35% and 81% of traumatic brain injuries occur in individuals who had been drinking at the time of their injuries.  Doctors and therapists routinely recommend that survivors abstain from alcohol after a brain injury but some survivors choose to ignore this advice. Drinking after a brain injury though carries with it fresh and frighteningly dangerous risk.  Namely, such unwise behaviour invites the post-injury seizure.

In general, brain injury survivors are more prone to developing a seizure disorder than are people without brain injuries.  Depending on the severity and location of a traumatic brain injury, research shows post-traumatic brain injury seizure rates to sit somewhere between 2% and 50%.  Similarly, post-stroke seizure rates range between 5% and 20%.  Both of these are significantly higher than the seizure rate found in the general populace.

Unfortunately, alcohol can raise both the likelihood and frequency of post-injury seizures.  Alcohol lowers the threshold for seizures to occur, making a seizure more likely to happen.  Alcohol also interferes with the performance of anti-seizure medication, which of course increases the risk of seizure in those who depend on its assistance.  As a seizure is at base a potentially life-threatening medical issue, anything that might raise the likelihood of seizures should be avoided.

Overall, it is smart for many reasons to avoid consuming alcohol after an injury.  The enhanced risk of seizure stands alone among these reasons though in both gravity and consequence, and as such should be granted special consideration.

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

 

Signs of Left Neglect

Left neglect is one of the more curious symptoms of brain injury.  Briefly, left neglect is an attention deficit in which a patient’s brain essentially tells that patient to ignore the left side of his or her world.  For that individual, it is almost as if the left side of the world does not exist.  It is most commonly observed when a patient ignores items in the left visual field (even when visual acuity is perfect) but can also involve hearing and sensation on the left side.  Left neglect is due to an injury to the right side of the brain.  Different techniques (such as practicing scanning skills) are used to help manage left neglect.  For more general information on left neglect, please see these previous posts on the topic:

What is Left Neglect? https://tlcrehab.wordpress.com/2015/01/08/what-is-left-neglect/

Left Neglect vs. Field Cut https://tlcrehab.wordpress.com/2015/06/25/left-neglect-vs-field-cut/

What I would like to do with this post is to give a few signs that rehabilitation professionals commonly observe when diagnosing cases of left neglect.  Below is a list of these common indicators of left neglect.

1. The patient only eats food on the right side of plates and does not notice food on the left side.  Often the patient will complain that he or she is not being fed enough because the patient believes that he or she is only being offered half-sized portions (since food to the left is necessarily ignored).

2. The patient bumps against objects with the left side of the body or wheelchair.  For instance, the patient may catch the left side of a door frame as he or she attempts to enter or exit a room.  Typically, patients who are just beginning to understand their left neglect and have yet to become proficient in scanning techniques will have bruising visible along the left arm or leg.  Staff often have to monitor patients in wheelchairs who have left neglect to ensure that the patients’ left arms do not fall down and get caught in the wheels of their wheelchairs.

3. The patient does not face people to his or her left, even when talking with these people.  Many times the patient may begin a conversation face to face, but slowly during that conversation his or her gaze can be observed to drift to the right.

4. The patient only shaves the right side of the face, only washes the right side of the face or only puts make-up on the right side of the face.

5. The patient misses words on the left side of the page.  This can cause a patient to complain that the reading material he or she is given does not make sense because the patient does not realize that he or she is only reading words on the right side of the page.

6. The patient is unable to find rooms located on the left side of a hallway.  Sometimes a patient will claim that a room has “moved” or “disappeared” since the patient cannot find the room in question.

7. The patient will start all activities on the right side and not make it all the way to the left. As example, a patient may play Connect 4 and only place chips on the right half of the board.  The patient may also be seen squeezing all his or her writing onto the right side of a page while leaving the left side of the page entirely blank.  When drawing a picture, the patient may leave a similarly barren left side of the page upon completion.

8. The patient complains that he or she is losing hearing in a left ear even though audiological testing shows no hearing loss.

9. In extreme cases, a patient may not recognize a left arm or leg as being his or her own body part.  When the patient sees this limb but does not recognize it, he or she may even make a complaint such as that a stranger has joined him or her in bed.

I hope this post helps everyone understand some of the more common signs of left neglect that rehabilitation professionals often observe!

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

The Overlooked Release

One of the most important factors in providing quality care is for a health care provider to have all information pertinent to a patient’s health.  For instance, knowing that a patient has a history of seizures may influence the type of attention medication that a doctor would prescribe.  Similarly, knowing that a patient has a history of learning disabilities will affect the interpretation of neuropsychological and speech pathology testing.  On the surface, it would seem pretty obvious that a health care provider would need all available information on a patient under his or her care.  In reality though, providers all too often have access to surprisingly limited information which makes assessment and treatment more difficult than it needs to be.

Many patients and their families simply assume that each health care provider they see knows what every other provider in the chain of care is doing or has done.  Unless the health care providers in question all work for the same facility, the providers do not have this full and free access to one another’s information.  Patients (or loved ones that have the legal right to do so) must request that the information from one health care provider be sent to any other health care provider.  This will always be done with a written form called a Release of Information or Release of Records.  This release allows the providers specified on the form to share information.  So if you want your family care physician to have a sufficiently comprehensive understanding of what happened to you in the hospital, you want to make sure that you have signed a release of information authorizing the hospital to send information to that physician.

There will often be check boxes on these forms specifying what information is being sent.  Certain information such as psychological records have added legal protections so they cannot simply get sent automatically with other records (consider, do you really want your insurance company to have the same access to session notes from marital therapy sessions as they do to those from physical therapy sessions?).  Moreover, doctors/facilities will only send the records from their own offices, and not the records from other offices.  For example, if you are requesting that notes from a rehabilitation facility be sent to your family doctor, the rehabilitation facility will only send their records to that doctor.  They will not send the notes from the hospital you were at prior to the rehabilitation facility even if the facility has those hospital records.  Each doctor/facility will require a release of information to be signed and often they will insist that it be on a release form from their office.  Though this may seem like a bit of an inconvenience, having a full set of records greatly improves the ability of health care providers to give the best possible treatment to their patients and reduces the likelihood of wasted time and costly errors.

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

Recreation After An Injury

Following a brain injury, survivors often have a sudden surplus of time on their hands.  Many individuals are unable to return to work at their former jobs, and even those able to effect such a return will often spend some time between discharge from a rehabilitation facility and re-entering the workforce just getting used to living day to day with an injury.  To help fill this time, it is important that survivors and their families identify recreational activities that can be enjoyed in spite of the survivors’ injuries.  Here is a list of ten recreational activities, based on suggestions from TLC patients, that can be successfully engaged in even when a person is contending with significant deficits due to a brain injury:

1.  Reading – This may be a regular book, a large print book or an audiobook.
2. Art – Activities such as drawing or painting often are inexpensive and involve minimal physical demands.
3. Spending time with family and friends – This can be an in-person get together or even something as simple as a phone call.
4. Board and Card Games – Most require minimal physical skills though a card holder can prove useful if a survivor only has one good hand.
5. Going to the movies – There are usually a few theater spots reserved specifically for those in wheelchairs.
6. Attending concerts – By law, all public venues must be handicapped accessible but calling ahead with any accommodation requests often makes things easier.  TLC patients attend yearly a Houston Livestock Show & Rodeo concert.  The organization hosts special nights in which there are extra accommodations made for those with these deficits.
7. Watching athletic events (either in person or on TV) – When TLC went to an Astros game, stadium workers ran over to help as soon as they saw our patients in wheelchairs.  TLC staff actually had to ask these sweet workers to give the patients room to work on independence!
8. Video Games – For those with only one good hand, the Wii often works well.  In addition, certain companies make one-handed controllers.
9. Fishing – TLC once had a patient in a wheelchair and with limited hand use enter a fishing tournament.  He caught over twenty fish in just a few short hours!
10. Adaptive Sports – Many sports (such as bowling and golf) can be easily adapted to survivors’ needs.

These are just a few quick ideas for recreational activities that a brain injury survivor (even one with significant deficits) can engage in.  It is best to identify multiple recreational options in order to keep a healthy variety of life activities.

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

Open Communication

The brain injury experience is a remarkably complex one.  Overnight, so many things change and so many adjustments need to be made.  Throughout this experience, brain injury survivors have goals, concerns and aspirations.  Survivors’ loved ones will have their own goals, concerns and aspirations as well as they come to terms with their own roles in this new and dauntingly complex experience.  These two sets of expectations may or may not fully match up with one another.  Survivors and their loved ones will all try their best to achieve desired outcomes.  Sometimes  differences in respective desired outcomes can lead to conflict.  One of the most common contributing factors to such conflict is poor communication.

Family members, injury or no injury, tend to make assumptions about one another.  In fact, we all engage in some form of attempted “mind reading” in which we guess at what another person is thinking.  For instance, if one person pauses to look at a second person prior to walking through a doorway that second person may “mind read” and think, “The other person is looking at me because he wants me to enter the doorway first.”  There are no actual words spoken in this momentary exchange, only valid assumptions made.  This method will generally work well enough in simple situations, but problems  arise when we engage in such “mind reading” in place of actual open communication regarding more substantial and  important issues.  A simple look or smile does not say “I am hoping that a month or two after discharging from therapy I can return back to working and driving” or “I am worried that my son will want to return to mountain climbing where he could fall and suffer further brain injury”.

A good place to start open communication is with a family meeting explicitly organized to talk through the goals, concerns and aspirations of all involved.  The meeting should be planned in advance and all parties informed of its purpose.  This gives each family member time to organize his or her thoughts about pertinent issues.  Many survivors benefit from writing down a list of topics they’d wish to discuss at this meeting in order to ensure that they don’t forget to raise a given subject.  A meeting of this sort need not necessarily determine the final word on any topic.  In fact, it can be a good idea to state from the start of such a meeting that participants are in no way required to (and may not even be expected to) agree with what others are saying.  Particularly at the first meeting of this sort, it is not important to make decisions regarding the future.  Instead it is more important to open the lines of communication so each person can know what all others are thinking and “mind reading” can be avoided.  Opening the lines of communication in such a formal manner may seem awkward to some, but it helps ensure that the goals, concerns and aspirations of each family member will actually be discussed and addressed rather than being lost in any number of side conversations.  Once these lines of communication are opened and everyone has a chance to freely discuss thoughts and sufficiently convey perspectives, it is much easier in the future to re-visit these topics in a constructive manner.  Open communication will ultimately allow family members to walk hand-in-hand into the future with less conflict.

 

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

 

Free Continuing Education Credits on Brain Injury and Concussion

There is an increased awareness in health care professionals regarding the importance of learning about brain injuries and concussions. The Transitional Learning Center offers continuing education presentations by staff experts for no charge in order to educate professionals on important brain injury issues.  The following presentations are currently available:

Brain Injury Rehabilitation: Evaluating the Options for Achieving Functional Outcomes Along the Continuum of Care

Neuropsychological Strategies in Post-Acute Brain Injury Rehabilitation

Caregiver Burden and Traumatic Brain Injury

Fatigue and Traumatic Brain Injury

Mild Traumatic Brain Injury: The Silent Epidemic

Post-Acute Psychiatric Disease and Traumatic Brain Injury

To arrange a presentation, please contact Nicole McAllister at 1-800-852-4769 Ext. 459 or nmcallister@tlcgalveston.org

Moreover, there are a number of trustworthy organizations that provide free education online on these topics and which also grant professional continuing education credits.  Below are links to the training offered by these organizations.

CDC: Online Concussion Training for Health Care Providers:

https://www.cdc.gov/headsup/providers/training/index.html

HomeBase (a joint project between the Red Sox Foundation and Massachusetts General Hospital focused on treating military veterans):

http://homebasetraining.org/Users/HomeBaseDefault.aspx

Michigan Traumatic Brain Injury Online Training (co-sponsored by the Brain Injury Association of Michigan):

https://www.mitbitraining.org/

Remember – the better educated the health care professional, the better the treatment received by patients!

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

 

 

How Can I Support A Caregiver?

As modern medicine improves and our population ages, more individuals are able to live longer with serious health issues including permanent deficits resulting from a brain injury.  This notable demographic shift places more loved ones in the position of serving as long-term caregivers.  These caregivers need all available support from those around them but many of those capable of offering assistance are simply unaware of how best to help.  Here are a few quick suggestions on how to support caregivers:

1.     Call them and ask how you can help.  Caregivers may feel shy or embarrassed to initiate requests for help but are often far more receptive to assistance if it is offered.   This gives caregivers opportunity to request specific aspects of help most needed at a given juncture, and they will certainly be grateful for all help shared.

2.    Offer to have the caregiver and survivor over for a meal or to deliver a meal to them.  With all of the responsibilities that caregivers meet on a daily basis, having someone else take care of even a single meal can be a source of welcome relief.

3.    Be there to listen.  Many caregivers feel overwhelmed by their experiences.  A friendly phone call or visit with a supportive ear helps relieve some of this emotional burden.  Knowing that others care about their well-being is very important for caregivers in maintaining their own emotional health.

4.    Be a friend to the survivor.  After their injuries, many survivors find that their social circles quickly shrink.  Some caregivers can find themselves serving as the only social outlet for the survivors in their lives.  This can be a source of tremendous additional stress in the life of a caregiver.  Being a part of the survivor’s social circle reduces the need for the caregiver to fill all of these social roles.  Moreover, the survivor is sure to appreciate this as well!

5.    Offer to spend time with the survivor so the caregiver can spend a little time tending to his or her own needs.  As a result of devotion to meeting needs of a survivor, it’s all to easy for caregivers to end up neglecting their own.  A few brief hours just to cover an unhurried trip to the grocery store, hair salon or doctor’s office (or simply to enjoy a quiet cup of coffee on their own) can do wonders for a caregiver’s quality of life.

6.    Take a moment out of your day to send a card, e-mail or flowers.  Sometimes we don’t have a lot of time to spare for lengthy calls or visits but a quick note to say “hello” tells the caregiver that they are not forgotten.

Hopefully this list will give you ideas to start reaching out and supporting caregivers!

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

Education Loan Forgiveness

With the continuing rise of college costs, more and more students are taking out Federal loans to pay for higher education.  These loans can often total in the tens of thousands of dollars.  Following a severe brain injury, many survivors will of course see ability to pay back such loans severely diminished.  These loan payments can be an incredible financial burden at a time when survivors are already stretched perilously thin financially.  However, the United States Department of Education has a loan cancellation/forgiveness program for those survivors unable to work (or not expected to be able to work) for at least a five year period of time.  This type of loan forgiveness is known as Total and Permanent Discharge.  Qualifying individuals are able to get forgiveness of William D. Ford Federal Direct Loan Program (Direct Loan) loans, Federal Family Education Loan Program (FEEL) loans, Federal Perkins Loan  Program (Perkins Loan) loans and TEACH Grant service obligations.  If you are interested in more information, the link below will bring you to the official US Department of Education webpage for Total and Permanent Discharge.  Please be sure to read the information fully as there are important tax implications accompanying participation in this program.

https://www.disabilitydischarge.com/

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