Galveston Brain Injury Conference

This week, the Transitional Learning Center and the University of Texas Medical Branch have the pleasure of co-hosting the Galveston Brain Injury Conference (GBIC).  GBIC is a unique invite-only conference focusing each year on a single specific topic.  Only a select few top researchers in their respective fields are invited each year to attend.  As each year focuses on a different topic, the list of invitees will also differ substantially from year to year.  This year’s topic is “Brain Injury as a Chronic Disease.”

At the culmination of each GBIC is the awarding of the Robert L. Moody Prize for Distinguished Initiatives in Brain Injury Research and Rehabilitation.  The prize, which comes with a $10,000 honorarium, is one of the top accolades a researcher can earn in this arena.  Robert L. Moody is the visionary behind and founder of the Transitional Learning Center.  Mr. Moody was influenced by the tragic injury of his son to create a facility to bridge the gap in care between acute care rehabilitation and discharge to a home environment.  Thanks to Mr. Moody’s generosity and innovation, the Transitional Learning Center has helped brain injury survivors in optimizing their journey to recovery for over 30 years.

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

Anosognosia – Part I

Anosognosia is a scientific term meaning “lack of self-awareness.”  Many brain injury survivors suffer some form of anosognosia after their injuries.  Anosognosia will often find expression in a survivor’s inability to comprehend the full extent of the deficits he or she has been left with in the wake of an injury.  Part I of this series will explain about some of the common manifestations of and difficulties encountered due to anosognosia.

Anosognosia can cause many problems for brain injury survivors.  They may put themselves into risky situations because they do not realize how extensively their injuries have affected them.  For instance, prior to his admission to the Transitional Learning Center one of our patients with severe visual deficits attempted to drive his car.  This attempt resulted in the outcome of him flipping that car in a ditch.  If he’d had full awareness of and complete understanding regarding his deficits, he never would have gone through with such an obviously risky proposition.  His anosognosia therefore led to a very scary situation.

Wheelchair-bound survivors with anosognosia may endure falls because they will try to get up from their wheelchairs when a loved one or caretaker leaves them for a moment.  Were they fully aware of their deficits in this arena, they would remain in their wheelchairs in such situations.  Speech-impeded survivors with anosognosia may grow inappropriately angry that other people cannot understand their speech.  The survivor will often think that he or she sounds for the most part normal while in reality his or her speech is almost completely unintelligible.

Survivors with anosognosia tend to question or reject evaluations which show their deficits.  Since the survivor does not recognize their own deficits, the negative evaluation results appear confusing and bizarre.   For instance, a survivor with memory deficits may dismiss memory assessments as “stupid” or “useless.”  He or she may say “I could never do that test even before my injury” or “the doctor thinks he is smart but he is just a dummy.”  In truth, the assessments are not “stupid.”  The survivor is simply unable to detect the blind spots anosognosia has left obscuring perception of his or her own deficits.

Anosognosia can also lead brain injury survivors to question the very need for rehabilitation and medication.  Since he or she does not recognize the existence of any notable deficits, the patient can have a hard time seeing value in any treatment.  This will often frustrate family members who can easily observe the survivor’s deficits and understand how treatment will be of great benefit.  Sometimes in the absence of this recognition of a need for treatment, brain injury survivors with anosognosia will think that their family members or loved ones have sent them to treatment in order to simply get rid of them.

In many ways, anosognosia will magnify the impact of other brain injury deficits.  The survivor not only has to learn to manage life under the limits to capabilities that come with those more direct deficits,  but due to their lack of awareness it is hard for them to initiate methods by which to moderate those difficulties and avoid risks.  A survivor with poor memory already has enough difficulty remembering to take necessary medication.  If that survivor also suffers from anosognosia, he or she may also feel justified in refusing to write down medication times on a schedule in order to help bolster memory.

Hopefully this introduction gave the reader a basic understanding of anosognosia.  The next part of this series will address methods of improving anosognosia.

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

Who Needs To Know

Brain injuries do not solely affect the brain injury survivor but will also impact the survivor’s family life, circle of friends and workplace environment.  Moreover, post-injury changes may influence areas of life as diverse as church involvement and health care treatment.  It is important for the survivor and his or her loved ones to identify exactly who needs to know about the survivor’s injury and what specifically those individuals need to know.  Not every person will need to know the same amount of information regarding the injury.  For instance, a spouse will generally need to know all details involved in the injury, subsequent deficits suffered and resultant treatments engaged.  A co-worker would not need nearly as much information.  The co-worker would only need to be privy to any information about changes relevant to the job or workplace interactions.  Each brain injury survivor will differ as to which people in his or her life will need to know about the injury suffered and the types of information to which those individuals should have access.

It is often useful to make a list of all the people that might need to know about the survivor’s brain injury and what information each person should need.  Let us take a look at the theoretical case of Ronny, a 22 year-old brain injury survivor who is living with his parents and planning to return to college.  Here is a brief list of some of the people who may need to know about his brain injury and what they may need to know:

Parents:  Need to know everything about Ronny’s injury, subsequent deficits and treatment

Extended Relatives: Need to know the cause of the injury and how the injury will affect their future interactions with Ronny.

College Professors:  Need to know how the injury affects Ronny in the classroom and any accommodations he might require be made.

Personal Physician: Similar to parents due to the physician’s necessary role in long-term care.

Friends: Need to know how the injury might affect Ronny in their personal interactions and any lifestyle changes due to the injury that should be respected.  For example, Ronny’s friends need to know that he can no longer consume alcohol at a party.

Clerk at the Store: If the injury affects Ronny’s ability to make a purchase, the clerk may need to know that Ronny has difficulties but not necessarily the cause of those difficulties.  For example, if Ronny struggles with speech he may hand the clerk a card from his speech therapist indicating that he needs extra time in order to pronounce his words accurately.

Obviously, this is an abbreviated list of people that may need to know about Ronny’s injury as there are many other people that may be affected by interactions with him after his injury.  It is important that brain injury survivors and their families take the time to identify who needs to know about the survivor’s injury and what those individuals need to know in order to ensure that survivors are able to attain the smoothest transition possible into post-injury life.

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