Monthly Archives: December 2014

New Year’s Disorientation

As 2014 comes to a close and 2015 is upon us, some brain injury survivors may find themselves facing greater than normal levels of disorientation.  Often brain injury survivors, particularly those with memory deficits or in the earlier stages of recovery, will have trouble keeping track of basic orientation information such as the month or the day of the week.  The change in year represents yet one more piece of new information they have to worry about remembering.  Survivors may seem confused or express doubt when told of the change in year.  Some survivors may even argue that therapists, staff and family are giving them false information.

 
Many patients with orientation difficulties can get stuck on the last date or location they remember and have trouble incorporating new information.  For example, a survivor may last remember living in Dallas and struggle with integrating into his or her life knowledge of moving in post-injury with his or her parents in Houston.  This same issue can occur with a change in year.  As the survivor last remembers the year being 2014, it takes considerable effort to make the switch to recognizing that it’s now 2015 (and to making realization of that switch stick).  To put it in perspective, people often temporarily forget the correct year during the first few days of January and will then write the wrong year on checks.  But imagine if instead of being stuck on the wrong year for a few moments, you continually find yourself stuck on the wrong year for weeks upon weeks.  This is what brain injury survivors with orientation deficits may experience when confronted by a change of year.

 
Brain injury survivors can be helped by keeping relevant orientation information presented in many easily accessible locations.  Families and survivors may want to place more calendars around the home.  If a survivor has considerable problems with disorientation, he or she will likely do best with a one page per day calendar, one that displays on each page the day, date and year.  This type of calendar can generally be found at teller stations in banks in order to help ensure that customers write the correct date on checks.  This is in contrast to the month at a glance calendar, in which the entire month is shown on a single page.  The date can also be written on a dry erase calendar in a bedroom or on a refrigerator so that the survivor can easily see the new year.

 
Families can also make extra effort to insert the correct year into daily conversation.  This can be done simply by saying more often than one might otherwise things like “Wow, 2015 has really started off well for us” or “I’m glad that 2015 has rolled around as last year was quite difficult.”  The more that a survivor is exposed to the correct information, the more quickly and permanently he or she will learn this new information.

 
Lastly, please make sure to dispose of old calendars and similar items displaying the old year as quickly as possible.  Some brain injury survivors will become confused or distressed when confronted by both an old calendar and a new calendar.  This can cause a temporary (and entirely avoidable) setback in efforts to properly align orientation.

 

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

 

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Holiday Adjustments-Part 4: Drinking

This is part 4 of a series on holiday adjustments.  As mentioned in the previous blog posts in this series,  deficits suffered in the wake of a brain injury may impact brain injury survivors’ ability to participate in holiday celebrations to the degree that they had in previous years so adjustments may need to be made in order to provide a greater likelihood of those survivors enjoying a successful holiday.  Part 4 will be focusing on issues related to drinking alcohol during holiday celebrations.

 
Alcohol consumption is associated with several holidays.  A champagne toast is often at the center of New Year’s Eve celebrations.  Eggnog with an alcohol such as rum or brandy added is featured at many Christmas parties.  However, alcohol can be highly problematic for a brain injury survivor.  Anyone who has suffered a brain injury should always consult with a physician prior to drinking alcohol.

 
There are a number of reasons why a brain injury survivor should avoid alcohol absent a physician’s approval.  First, for many survivors alcohol played an integral role in the circumstance that led to the survivor sustaining a brain injury in the first place.  For instance, if a survivor suffered a motorcycle accident because he or she was driving drunk home from a bar, clearly he or she faced difficulty managing alcohol safely prior to the injury.  There may be any number of issues underlying such a problem that need to be addressed with a substance abuse counselor, a psychiatrist or a psychotherapist.  Suffering a brain injury does nothing to remove or address a pre-existing problem with alcohol or life issues that may have set the stage for the injury.  Far too often a brain injury survivor will return in his or her post-injury life to old habits with regards to alcohol and consequently suffer yet another injury.

 
Second, alcohol chemically alters functioning in certain parts of the brain responsible for controlling skills with which survivors often already face substantial struggles.  For instance, alcohol depresses functionality in the prefrontal cortex, the part of the brain involved in decision-making and planning.  It also affects the cerebellum, which coordinates muscle movements for skills like walking.  If you think of a stereotypical drunk individual, the image that usually comes to mind is that of a person who has trouble walking, talking, coordinating body parts and effectively remembering  activities in which they are engaged.  In many cases, these are precisely the areas that the survivor is working to improve following his or her injury.  Alcohol is ostensibly a voluntarily induced temporary chemical brain injury and the last thing a brain injury survivor needs is that voluntary chemical brain injury on top of the current brain injury which was most certainly not chosen.

 
Third, alcohol interacts poorly with medication.  One compelling illustration of this dynamic can be found in brain injury survivors who take Dilantin (Generic name: Phenytoin) to prevent post-injury seizures.  Alcohol can change Dilantin levels in the blood, which then leads to an  increased risk of seizures.  Other brain injury survivors, particularly stroke survivors, may take the blood thinner Coumadin (Generic name: Warfarin).  Alcohol can magnify the effect of Coumadin, which then leaves those survivors at risk of excessive bleeding.  Anti-anxiety medications such as Ativan (Generic name: Lorazepam) and Xanax (Generic name: Alprazolam) may have interaction effects with alcohol that can range from increased dizziness to serious respiratory problems.  These are just a few of the many medications that when mixed with alcohol can threaten terribly dangerous consequences.  The National Institute of Alcohol Abuse and Alcoholism has a more complete list of medications and the negative effects of mixing those medications with alcohol:

 
http://pubs.niaaa.nih.gov/publications/Medicine/medicine.htm

 
Fourth, alcohol often affects the survivor far more strongly post-injury than experiences prior to the injury would tend to indicate.  As example, a patient at TLC once tried a beer while with his family when out on pass.  He reported to staff that he had not even finished drinking enough beer to empty the neck of the bottle before feeling potent symptoms of inebriation.  This scared him so much that he handed the bottle back to his family and swore off drinking then and there.

 
Now that the risks associated with drinking alcohol after a brain injury have been made more clear, here are a few suggestions as to how survivors and their families can make maintaining sobriety easier during the holidays.  First, survivors, families and friends can simply have a party without alcohol.  If no one is drinking alcohol because there is none available, then there is obviously no risk that the survivor will drink.  Holiday celebrations are ultimately about spending valued time together and celebrating as a community, not drinking.  Second, sparkling juices and imitation non-alcoholic beers can easily be substituted for alcoholic beverages.  Sparkling juices look like champagne or wine but are non-alcoholic.  TLC has a “Sparkling Juice Taster” twice a year and patients often find brands and flavors that they enjoy as a substitute for alcohol.  Sparkling juices and imitation beers can be purchased at low cost at most supermarkets.  Third, most people understand that someone on medication cannot consume alcohol.  In many cases, survivors need only point out that they are taking medication and other party-goers will understand why the survivors are not drinking (and then refrain from offering alcohol and/or insisting that those survivors partake).

 
Hopefully this post has been helpful in its elucidation of the specific and substantial risks to brain injury survivors contemplating alcohol consumption and has offered a few effective ways to approach managing those risks during holiday celebrations.

 

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

TLC Success Story: Tony Strueby

Since opening in 1982, the Transitional Learning Center has enjoyed many successes with our patients.  Tony Strueby is one of those success stories.   Tony’s traumatic brain injury caused him to suffer significant deficits in speech and mobility which impacted many areas of his life.  With the help of the TLC staff, Tony was able to improve and adapt.  He has done so well that he has returned to working and driving.  Read more about Tony’s journey in this linked story from the Texas Department of Assistive and Rehabilitative Services (DARS):
http://www.dars.state.tx.us/news/stories/drs_tony.shtml

 
For those unfamiliar with DARS, it is a Texas state agency which provides funding for treatment and medical devices for Texas residents who have suffered traumatic brain injuries.  DARS has enabled many of our patients to receive treatment who would not otherwise have been able to do so due to a lack of insurance or having insurance that would not fund treatment.  As receiving treatment is vital for post-injury improvement, please click on the link below to see if you or a loved one would qualify for services through DARS:

http://www.dars.state.tx.us/drs/crs.shtml

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