Fatigue

It is common for brain injury survivors to suffer fatigue more acutely and to enter into states of fatigue more easily after their injuries.  For many survivors and their family members, this increase in fatigue comes as a bit of a surprise.  Why am I (or my loved one) exhausted by 6 p.m. when I (or my loved one) used to be active throughout the evening even after a long day of work?
Below are just a few of the reasons why brain injury survivors may be experiencing this greater post-injury fatigue:

 
1.  Survivors may still be healing from the injury.
2.  It often takes far more effort and concentration to engage in basic activities like walking and speaking than it did pre-injury.
3.  Survivors are almost always operating under far greater levels of stress than before.  This could be due to the inevitable stress of trying to get better or stress from other issues such as financial difficulties due to losing a job after an  injury.
4.  They may be experiencing significant post-injury pain and prolonged pain tends to contribute to fatigue.
5.  The survivors’ medications may be causing fatigue.
6.  The survivors may not be sleeping as well due to the injury.  Many brain injury survivors experience significant changes to sleep patterns post-injury.
7.  The survivors may be feeling depressed, anxious or angry. Any of these emotional states are conducive to greater fatigue.
8.  They might still be getting used to the “rehab” or “post-injury” schedule, which may be quite different from their pre-injury schedules.  For instance, a night shift worker may find that it takes some time to get used to the daytime hours of rehabilitation.
9.  The greater fatigue may simply be part of the brain injury itself.

 
Depending on the cause of the fatigue effecting each individual survivor, brain injury professionals may manage given circumstances in very different ways.  For instance, if it’s determined that a survivor is suffering fatigue due to depression, then the survivor would be encouraged to talk about those issues with a staff psychotherapist.  If fatigue is most likely attributable to medication being taken, a staff doctor may make adjustments to those medications.  If fatigue is due to to the added exertion of engaging in daily tasks, survivors may be encouraged to take appropriate rest breaks.  In all cases, patience and understanding go a long way to helping the survivor cope with fatigue.

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

CARF Certification

The Commission on Accreditation of Rehabilitation Facilities, also known as CARF, is the primary certification body for brain injury treatment facilities.  CARF assesses the overall quality of rehabilitation facilities both in the United States and Canada.  The Transitional Learning Center recently went through a site evaluation by CARF and was re-certified for 3 years, the longest period for which CARF issues such certifications.   TLC is proud of CARF’s recognition of the excellence of our program!

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

Featured in the News!

The Galveston Daily News recently did an in-depth story on Transitional Learning Center therapist Lauren Mitchell’s extensive and tireless work in service of successful community integration of patients at TLC and residents of our sister-facility, Tideway.   Lauren has previously written for this blog about  the purpose and design of a community integration experience.

https://tlcrehab.wordpress.com/2013/07/15/community-integration-experience/

Below is a link to the article, which is available to subscribers to the Galveston Daily News:

http://www.galvestondailynews.com/lifestyle/health/article_b94cfaca-3230-11e4-9989-0017a43b2370.html

For those who are not subscribers, here is a photo of the article from the front page of the newspaper.

 

 

Great job, Lauren!

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

 

2014 Forum on Traumatic Brain Injuries

Attention Healthcare and Rehabilitation Professionals!  On September 19, the Transitional Learning Center in Lubbock will be hosting a special conference on traumatic brain injuries with experts covering topics such as managing spasticity, coping with visual impairments and the effects of mild traumatic brain injuries.  This is a unique opportunity to learn from clinical experts in the field of brain injury.  Free CEUs are available for nurses, case managers, social workers and counselors.  Click on the link below for more information on registering for this wonderful event.

conference

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

 

Visual Scanning with Telephone Books and Circulars

As I have talked about previously in this blog, many brain injury survivors recovering from traumatic brain injuries will experience visual scanning difficulties as a result of those injuries.  This can be due to a direct loss of visual ability (often called a visual field cut) or due to an attentional issue such as left neglect.  One convenient and practical way to work on scanning is for the survivor to practice with a telephone book or supermarket circular.

The idea is pretty straightforward:  the survivor is tasked with locating various items found in the advertisements of the telephone book’s yellow pages or in a supermarket circular.  You’ll want to pick items in a random order so as to prevent the survivor from figuring out where each correct item is without really working on the skills.  For example, if you are using restaurant ads in the yellow pages, you may first have the survivor find the hours of operation from an Arby’s ad in the top left corner, then the address of a Taco Bell advertised on the bottom left of the page, followed by the Domino’s Pizza fax number down at the bottom right. The supermarket circular can be used in the exact same manner.  As example, you could ask the survivor for the cost of the Oscar Meyer bologna in the top right corner of the page, then the size packaging of the Frosted Flakes cereal in the bottom left corner, followed by having the survivor point to the Hebrew National hot dogs back up towards the top right.

You do not want to tell the survivor where on the page each item is located, but allow the survivor to naturally search on his or her own.  All parts of the page, including the center, should be used during this activity.  If the survivor cannot find the material, the survivor (often with the help of a loved one) should be prompted to conduct a slow, organized search for the item in question.  If the survivor has left neglect, such a search should always begin on the left side, using a slow up-down search rather than side to side.  If the survivor has a visual field cut, the search should always begin on whichever side has suffered the cut, again using an up-down search.  If the survivor is missing the right visual field in both eyes, the search should always begin on the right side and if he or she is missing the left visual field in both eyes, the search should always begin on the left. Missing both the right or both the left visual fields is known as homonymous hemianopsia.

There are a few things you want to keep in mind to help this task go smoothly.  You will want to check and ensure that the information can be easily seen by the survivor.  Sometimes the writing in phone books and circulars may be quite small and the survivor may need to use reading glasses or perhaps need only to work with the bigger items on the page.  When working with the yellow pages, it is generally better to pick pages with lots of display ads rather than just listings.  I do not advise using the white pages since the writing is small, placed very close together and is always in an obvious alphabetical order.  Supermarket circulars are generally much better for this task than department store circulars since they will tend to list more items.  If the survivor has left neglect, it may be helpful to highlight the left side of the page or put a bright object (such as a strip of paper) on the left side.  Additionally, some survivors benefit from the use of a line reader (such as ruler) to help with their ability to focus on one section of information at a time.

Here are a few previous blog posts on home-based visual scanning activities:

https://tlcrehab.wordpress.com/2012/08/06/ispy/

https://tlcrehab.wordpress.com/2012/08/02/visual-scanning-practice-2/

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