Monthly Archives: September 2012

Smoking and Strokes

There are many reasons to stop smoking, but new research from South Korea adds one more. A recent study conducted there focused on people with and without aneurysms.  An aneurysm is a form of stroke in which a blood vessel explodes in the brain, causing significant brain damage and often death.   The researchers involved in this study found that smoking more than doubled the likelihood that its subjects would suffer a burst aneurysm.  Considering the high fatality rate of this condition and the severe deficits faced by survivors, this study provides yet another strong reason to avoid smoking.

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Where Is It?

Brain injuries can be complex because different parts of the brain control different functions.  Learning which part of the brain controls which function can be quite confusing.  The Center of Excellence for Medical Multimedia, a program from the Office of the Air Force Surgeon General, has a great interactive brain map.  Click on the dots on the brain or the menu on the right to learn the names of the parts of the brain and their functions.

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Please. Don’t. Help.

Perhaps the hardest part of the rehabilitation process for family members is watching their loved one struggle.  It is often painful and heartbreaking.  You see your son working so hard trying to operate his wheelchair and your first instinct is to run over and help him.  You listen to your wife stumble over basic words and you want to speak for her.  It is a natural reaction to these difficulties; you want to help.  After all, you love that person who is struggling and who doesn’t want to help someone they love?  However in rehabilitation, that loving help can hinder improvement.

In rehabilitation, therapists are rebuilding patient skills and teaching patients new ways to accomplish goals.  By definition, this means that the patient is starting off with deficits in the domains being worked in.  The only way to improve skills or learn a new method with which to accomplish a goal is through practice.  Every time a family member pushes a wheelchair, a patient loses an opportunity to practice wheelchair mobility.  Every time a family member speaks for a patient, a patient loses an opportunity to practice speech.

In summary, please talk to your rehabilitation professionals to learn when it is appropriate to help and what type of help is appropriate to give.  Sometimes, helping too much can hurt the recovery process.  It is important that everyone understands what the patient needs to succeed.  After all, patients, families and rehabilitation professionals are all part of the same team – Team Recovery!

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NFL and Brain Injury

Somewhat quietly, the NFL is facing a monstrously large lawsuit.  Thousands of former NFL players are suing the league, claiming that the NFL hid information showing that the concussions suffered while playing football can lead to permanent brain injuries.  At present time the Associated Press reports that 3,377  former players are suing the NFL, including more than two dozen Hall of Fame players such as Eric Dickerson and Tony Dorsett.  This is approximately double the total number of players who are currently in the entire league!  Some estimate that the NFL could lose billions of dollars if it loses these cases.

Below are a few articles on this topic:

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Brain Injury as a Chronic Disease

There is a movement in the Brain Injury community to change the popular conceptualization of brain injuries.  Rather than a  brain injury being viewed as  a one-time event, this movement puts forth the assertion that it should be understood as a chronic disease.  The link below will take you to the position paper from the Brain Injury Association advocating for this change in public perception.  It was authored by the Medical Director of the Transitional Learning Center, Dr. Brent Masel.

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Confabulation Vs. Lies

Every so often a patient’s family will report to the Transitional Learning Center that since the patient’s injury, the patient makes up false stories all of the time.  They state that they correct the patient but that the patient will argue and insist that the story in question is true.  This often upsets the family as they feel that the patient is deliberately telling lies.  In most cases, the patient is not deliberately telling lies.  The patient has a difficulty called confabulation.

Confabulation  is a term describing the brain’s act of creating false memories after a brain injury.  These false memories feel completely real and there is no way for the survivor to easily discern the difference between a confabulation and an accurate memory.  There is no way for the survivor to stop the brain from confabulating.  This is quite different from a lie, in which the liar has full control over the information and total understanding of its context.  Most people are accustomed to the concept that the memory of an event having happened serves as evidence of its truth.  The idea that our memories can be false is a completely foreign, sometimes hostile concept.  When a patient has a confabulation, it will not occur to them to doubt the confabulation any more than it would to doubt any real memory.

Imagine if you started to talk about your personal life and someone told you that your recollections were completely wrong.  This would probably frustrate you.  After all, it is your life.  How could someone know your life better than you?   This is the conundrum faced by survivors with confabulation.  Other people are constantly telling them that they are incorrect regarding their personal memories of their own lives.

Keep in mind that they have clear memories of these false events.  Again, they are not deliberately fabricating these memories.  This is not a psychological issue but a brain injury issue.  Survivors with confabulation need to constantly check to ensure whether a memory is real or confabulation.  This may mean checking with significant others or a planner/memory book.  It may require that a lot more information needs to be written in their planner/memory book than is typical for other brain injury survivors.  They have to get used to the idea of not trusting their own memory.  How unnerving must it be when someone else knows your own life better than you?

Sometimes confabulations have a clear starting point while other times they seem to come out of the blue.  Some confabulations are more logical than others.  An example of a more logical confabulation is when a former church choir member thinks that they have a practice session at church in an hour, despite the fact they have not sung in church for many months.  As you can see, it is not terribly odd to confabulate a false choir practice when this has been part of the person’s history.  An example of a more bizarre confabulation is when a survivor thinks that their psychotherapist previously did brain surgery on them in a hospital, while the patient was awake.  It is much harder to make the connection on this second example.  In both cases, the patients believed their confabulations completely.

Confabulation cannot simply be cured by memory exercises or medication.  Often they will fade as the patient’s health improves.  However, persistent confabulations can be one of the most disabling conditions of a brain injury.  If a person has a persistent confabulation that there is a meeting on the other side of town and subsequently wanders from home due to the confabulation, then he or she will need constant supervision to ensure safety.

Hopefully this clarifies the experience of confabulation and how it is differs from the telling of a lie.

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