Monthly Archives: July 2013

A Regular Routine

People are creatures of habit.  We operate at our best when life is predictable and structured.  Predictability and consistency allow us to organize our lives smoothly.  They invariably bring about greater effectiveness at work and at home and put us in a better position from which to allocate our time more intelligently and to accomplish more goals.

After a brain injury, the survivor’s life often loses the routine it had before.  He or she loses the daily rhythm that the survivor had grown accustomed to prior to the injury.  Rather than having a schedule based on school/work activities, social plans and home responsibilities, many survivors come home to a life without any set schedule.   This can be a big mistake.  A lack of a routine often increases disorientation and decreases the ability to track day-to-day activities.  Without a set routine, important activities may be pushed off to a later time or ignored altogether and forgotten.  Some survivors even become more agitated and aggressive when their days lacks predictability.  Further, a lack of a set schedule often causes greater stress on family and caregivers.  For instance, without a set schedule a survivor may argue with a spouse about when they should practice walking skills, since there is no agreed upon time to practice.

It is highly advisable for survivors and their family members to create a daily schedule to help incorporate routine back into the survivor’s life.  The daily schedule should be written and placed in a prominent location in the home, such as on a refrigerator door or on a dry erase board.  Creating the schedule should be a joint activity between the brain injury survivor and his or her family.  Mealtime, personal hygiene tasks, taking medication and wake/bedtimes should be at approximately the same time each day.  A set time each day should be created for activities such as physical exercises, cognitive exercises and recreational activities.  Doctor’s appointments, therapist visits and family events should be written on the schedule.  Schedules should be made for the entire week, including the weekend.  Although some brain injury survivors will initially try to rebel against a set schedule (“I am a grown man, how dare you tell me what to do!”), survivors generally get into the new schedule without too much difficulty.  Survivors with memory deficits or disorientation tend to take more time to get used to the new schedule.  Once the schedule is in place, survivors often show improved overall functioning.

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

Community Integration Experience

An integral part of the mission here at the Transitional Learning Center has always been facilitating brain injury survivors’ return to the greater community.  In today’s post, we go to TLC’s Community Integration Specialist Lauren Mitchell (CTRS, CBIS) for a detailed summary of some of the steps TLC takes specifically dedicated to aiding its patients in this vital aspect of the road to recovery:

TLC is a community re-entry rehabilitation program for brain injury survivors. Therefore, on any given day its patients and vehicles can be spotted all over Galveston Island. My role as a Community Integration Specialist is to work with the more independent patients at TLC and help them integrate back into the (Galveston) community during the course of their individual rehabilitation programs. I function as part of the Case Management department and solicit input from the clinical team regarding a patient’s current functional and cognitive appropriateness for a possible Community Integration Experience (CIE). In short, a CIE is when a TLC patient gets matched up with an outside site in the Galveston community in order to work on his or her therapy goals. The patient is asked to complete a questionnaire about the experience at the conclusion of each week and discuss any difficulties or problems that may have been encountered.  This input is then used to develop strategies to help improve future experiences. I serve as the person who coordinates between the patient, the site supervisor and the treatment team at TLC.

The following scenario gives an illustration of a potential Community Integration Experience for a hypothetical patient:

John has done very well during his first four weeks at TLC. He is walking safely around campus and has been observed doing same during supervised outings in the community.  He has graduated from highly monitored dorm-style residence at TLC into almost entirely independent living in one of the apartments that TLC keeps on-campus for just that purpose. John has shown that he handles himself in a responsible manner and his treatment team recommended that he be screened for a Community Integration Experience. Lauren, the Community Integration Specialist, sat with John and determined some of his interests.  She learned that his interests include cooking and working in the restaurant industry. John needed a Community Integration site that would give him opportunities to work on his higher level balance and problem solving skills as well as present occasions when he could implement memory strategies developed in therapy.  Lauren was able to arrange a meeting between John and a local café owner to see if John would be able to spend a few hours a week in a restaurant setting. John was excited to enter into a situation that would allow him to help people in the Galveston community while addressing therapy goals at the same time.

Over the next several weeks, John went to the café on Tuesday afternoons and helped with various tasks that addressed the cognitive and physical skills he was seeking to improve upon. He could be seen there greeting patrons, rolling silverware, filling beverage orders, sweeping floors, learning the menu, and even serving tables their food. John came to Lauren when he had difficulties at the café and they problem-solved through situations using suggestions from the therapy team. After his fourth week at the café, the owner asked John to take on a few more challenging tasks and gave him more responsibility.  John came back to campus on Tuesday afternoons feeling empowered and with a positive attitude about his future. Over the course of his Community Integration Experience, John met and exceeded his therapy goals related to balance, problem solving and memory.  After leaving TLC, John was able to return to working at his previous job as a server in a restaurant.

Not every patient will leave TLC to return to his or her previous place of employment, nor is this necessarily the primary focus of a Community Integration Experience. A CIE at TLC is a way to incorporate real life situations and scenarios into the patient’s therapy program. Thus far, several patients have been able to successfully enjoy a CIE in the Galveston community. The following businesses and institutions have welcomed TLC patients into their facilities:
Mosquito Café, Colonel Bubbies Stand Surplus Center, Chalmers Hardware & Embroidery, Galveston Island Humane Society, Galveston Wreath Company, Holy Family Parish, Galveston Railroad Museum, Island ETC, Our Daily Bread, Galveston College, Ronald McDonald House of Galveston, Gulf Health Care Center and Lighthouse Charity Team.


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

Emergency Preparedness Post-Injury – Cognition and Emotion

This post is the fourth and final entry in a series on the unique challenges encountered when addressing emergency preparedness in the life of a brain injury survivor.  This final post will cover possible issues in this arena that can arise regarding the cognitive and emotional difficulties left in the wake of a traumatic brain injury.  Below is a list of some of those issues.
1.   Brain injury survivors generally become far more susceptible to stress and agitation in their lives post-injury.  It is therefore often helpful to have handy items that can be used to help the survivor maintain calm.  Music that the survivor finds to be particularly relaxing is an example of such a device.
2.   For survivors who have cognitive difficulties such as memory problems, the evacuation process can be very confusing.  They may forget why they are evacuating or where they are going to.  Calmly repeating the evacuation plan and/or having the evacuation plan in writing can help reduce this confusion.
3.  Most people, even without a brain injury, find extensive travel in a car to be stressful.  It is often helpful in reducing that stress to keep to a schedule of planned breaks when evacuating.
4.  If a survivor has issues with impulse control, he or she may be more likely to make hostile comments or rashly suggest an unwise course of action during the evacuation.  At these times, loved ones should calmly remind the survivor of the evacuation plan and that the loved one has the situation under control.  If the loved one reacts with anger at the survivor, this is likely to cause a further escalation of emotions.
5.  As many brain injury survivors have already experienced significant loss due to their injuries, an evacuation and concerns for potential losses resulting from a disaster may trigger memories of those losses previously suffered.  Some survivors may need extra emotional support at this time as memories of old  losses and new concerns for fresh ones coalesce into significant emotional struggles.
6.  All people, especially those with brain injuries that affect cognitive skills, do best when operating under a stable schedule.  Survivors and loved ones should attempt to create a daily schedule to reinsert such stability into the evacuation environment.
7.   The more an evacuation plan is practiced and reviewed, the less stress there will be when it is time for a real evacuation.  Regularly going through evacuation plans will make the process less stressful for a person with a brain injury.
Hopefully, this series of posts helped bring attention to the important issues that brain injury survivors and their loved ones need to consider regarding emergency preparedness post-injury.

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

Burnout for People with Disabilities in Athletics

Many survivors of brain injuries are involved in athletics or participate in some form of health/fitness routine.  In fact, many individuals with disabilities are quite physically active.  However, a frank discussion of athletic burnout in these individuals is all too rarely encountered.  Kerry Wiley, Program Research Specialist at the New York State Developmental Disabilities Planning Council, wrote an article for the National Center on Physical Activity and Disability blog discussing athletic burnout and how it relates to her life own experiences.

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

Emergency Preparedness Post-Injury – Medical/Health Issues

This post is the third in a series on the unique challenges encountered by those living in the aftermath of a brain injury when they’re required to address issues related to emergency preparedness.  There are many possible such issues that can arise regarding medical/health concerns.  Below is a list of some of those issues.

1.  When people are forced to evacuate from areas effected by a natural disaster, there is an immediate substantial population increase in those cities evacuated to.  This puts a remarkable strain on any local  medical system, particularly pharmacies.  Let’s look for example at a city which has pharmacies normally prepared to have enough medication on hand for a population of 50,000.  Following an evacuation, the actual population may increase to 70,000.  Pharmacies are not equipped to deal with this increase and medication shortages inevitably occur.  Most government agencies recommend that people bring a one to two weeks’ supply of medication with them when they evacuate.  You may want to err on the side of caution and bring enough for two weeks to one month.  This same rule of thumb should also be used when preparing a stock of disposable medical items such as syringes, incontinence supplies and testing strips.
2.  In general, medications are sensitive to heat.  Keeping them in the trunk of a car or a similar location on a warm day can cause medications to degrade.  Further, many medications such as insulin require refrigeration.  For these medications, consider mobile storage in an icebox with cold packs or in a portable refrigeration device.
3.  Medications should be kept in their original boxes/bottles and be transported in a container capable of being sealed and re-sealed, such as a plastic bag with a zipper.  Do not take medications and dump them all into one container.  This is a nightmare to sort through later and can lead to crucial delays and even errors in medication administered.
4.  Medical devices and equipment should be protected from water or other potential environmental hazards.
5 .  If a medical device or equipment operates on electricity, make sure to bring an emergency power source such as extra batteries or a car adapter power cord.
6.  Keep a list of all important medical information.  This includes information such as health history, medications (with dosages), doctors, allergies and immunizations.  The Center for Disease Control has an excellent example of such a list available for download from their website:
Another excellent example can be downloaded from the AARP website:
7.  Identify in the area that’s been evacuated to the medical and health facilities that would need to be relied upon were an emergency to occur, such as  hospitals and pharmacies.
8.  Following a brain injury many survivors require a special diet, such as a diabetic diet.  When purchasing food for an evacuation, it is important to keep this special diet in mind.  For instance it may be important to check boxed foods, such as crackers, for their sugar and sodium levels.
9.  If a survivor has an item that helps to communicate difficulties suffered, such as a medical bracelet or aphasia card, it is important not to forget such an item.  These items do not help the survivor if they are left at home.
10.  If a survivor has pain issues, it is a good idea to pre-plan breaks in the trip as long periods confined to a car tend to exacerbate existing pain issues.
Hopefully this post helped to raise awareness regarding medical/health issues that a brain injury survivor needs to consider in the context of emergency preparedness.  The next post will cover cognitive and stress issues as they relate to emergency preparedness in such a scenario.

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