Monthly Archives: August 2015

Oliver Sacks

Neurologist and author Dr. Oliver Sacks passed away this weekend.  Dr. Sacks was a skilled clinician who had a special talent for concisely and lucidly bringing the world of neurology to the mainstream through his many books and articles.  His writings influenced many in the field of medicine, particularly those in disciplines related to brain injury.  His wit, warmth and knowledge will be dearly missed.  Below is an obituary describing his life and accomplishments in more detail:

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

Four Types of Problems

People are fantastic at finding problems to worry over.  We worry about the weather, the economy, our children, our homes and a myriad of other problems.  Think about it – news and sports radio are businesses that are essentially built on a 24/7 discussion of problems!  Generally, this is not an impediment to success and most people can worry about a whole host of problems while still completing necessary tasks.  People can go to work, pay bills and effectively manage daily life, yet still find ample time to fret over whether a favorite baseball team should fire its manager or whether a reality television starlet should dump her boyfriend.  Sometimes, people spend so much time worrying about problems facing others that they do not focus enough on their own problems.  It’s also all too easy for people to find themselves caught needlessly worrying about problems that they have no ability to solve.  This can be especially burdensome following a brain injury or stroke, as survivors have many new problems to be concerned with yet almost always have diminished cognitive resources available to spend on solving such problems.  It is often helpful to place problems into categories and then to determine just how much time should be spent on a given problem based on the category it falls into.

It is often useful to categorize problems based on two general ideas.  First, can this be considered my problem or is it simply not my problem?  As an example, if I have diabetes then this is clearly my problem.  If a famous Hollywood actor has diabetes this is just as clearly not my problem.  That is not to say that we need to be heartless about said actor’s health difficulties, but ultimately we should be spending more time devoted to addressing our own problems than we spend on those of others.  An equally important second consideration is revealed in the answer to another question.  Do I have the power to change/affect a given problem or do I not have that power?  For instance, if I have memory problems I can do exercises to improve my memory.  If I have a terminal case of cancer, there is nothing I can do to change that fact.  We should be spending more time and energy on problems we have the ability to change and less  on those that we cannot.  If we combine these two ideas we come up with  four problem categories:

1.    My Problem-I Can Change/Affect

2.    My Problem-I Cannot Change/Affect

3.    Not My Problem-I Can Change/Affect

4.    Not My Problem-I Cannot Change/Affect

Let’s give a few examples to help clarify these four categories.  First, let’s look at the category of My Problem-I Can Change/Affect.  An example of this type of problem could be that I need money to pay my rent.  It is my problem (after all this is my apartment) and I can affect it by getting a job or asking a family member for money.  Another example could be recovery from my brain injury.  It is my injury so it is my problem.  I can affect or change it by going through rehabilitation.  Since this category involves personal problems that we can do something about, this is the category of problems we should spend the most time and effort working on.

Second, let’s give a few examples of My Problem-I Cannot Change/Affect.  As mentioned earlier, if I have terminal cancer then it is my problem but ultimately I cannot do anything to change this.  Another example could be if I am nervous about what my doctor will say following an upcoming CT or MRI scan.  It is my problem as the doctor will be talking about my health.  But frankly, all of the worrying and problem-solving in the world will not change the results of the scan or the doctor’s feedback.  Since these are my problems, spending some time thinking about them is fine.  I probably do not want to spend too much time/energy on them though, as there is ultimately nothing I can do to solve these problems.

Third, let’s give a few examples of Not My Problem-I Can Change/Affect.  This category is essentially where the idea of charity resides.  If my friend is out of a job, I can give him some money to help pay for food.  It is his problem and not mine, but I can help out if I choose.  If a child is too poor to afford notebooks for school, I can donate notebooks to meet that child’s need.  Again, this is not my problem but I’m free to do what I can to help solve the problem if I have the resources to do so.  Since I can change/affect the problem, it is fine to spend some time and energy thinking about it.  I want to be careful to limit my expenditure of time/energy here though, since it is in the end someone else’s problem.  Sometimes we tend to spend more time fixing other peoples’s problems than our own problems, which is not a healthy approach to life.

Fourth, let’s give a few examples of Not My Problem-I Cannot Change/Affect.  This is the category that is sports radio and reality television’s bread and butter.  If my favorite team is playing poorly, this is not my problem.  Unless I work for the team, whether they win or lose does not meaningfully impact my life.  Moreover, unless I work for the team, there is nothing I can do to help it to play better.  Despite sports radio’s 24/7 pot-stirring regarding the performance of given players and managers, I’m fairly certain that the team never takes playing advice from the fans.  Similarly, if the latest reality television star is about to marry someone that I consider to be a poor match, it does not truly affect me.  After all, this is a stranger’s new spouse and not mine.  Further, no matter how much I worry or complain about that potential spouse, it can have no potential effect on the decision being made.  Let’s bring this category a bit closer to home.  Another example could be if my brother is dealing with a tough drill sergeant in Army Basic Training and this is making him notably upset.  This is my brother’s problem, not mine.  He is the individual in Basic Training, not me.  Moreover, the drill sergeant is not going to change his training methods because a family member is not happy with them.  I could complain all day but nothing will change about this situation.  Problems in this category should be given the lowest priority, especially in the life of a brain injury survivor.  They should only be afforded any time and effort at all if each and every item assigned to the other three categories of problem has already been completely resolved and the survivor has surplus time that he or she chooses to spend on them.

In review, when faced with problems it is often helpful to categorize those problems based upon their relevancy to our lives and then to determine according to those categorizations how much time and effort should be expended on solving each one.

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

What Is The Goal of Rehabilitation?

A few days ago I was looking through news articles on strokes and ran across a headline stating that the purpose of rehabilitation is to return lost abilities.  The first thought that went through my head was “kinda”, as in that is really only “kinda” the purpose of rehabilitation.  This reaction certainly has potential to strike those reading it as odd.  Because really, if regaining abilities lost due to injury isn’t the entire point of rehabilitation then just what might that point be? In a post-acute rehabilitation facility there are several other vitally important aspects of rehabilitation that prove equally essential in a patient’s journey to long-term success in his or her home environment.

To be sure, getting back lost abilities after a stroke or traumatic brain injury sees a majority of the focus directed by any therapy regimen.  After all, patients want to regain their skills and therapists are committed to helping those patients regain lost skills.  But there are other issues to keep in mind.  When patients come to a post-acute facility, as a general rule of thumb they have already concluded treatment at a hospital and an acute care facility yet continue to have multiple areas of need.  Many patients will have long-term (if not permanent) loss of certain skills due to the severity of injuries suffered.  These patients have usually spent several months, and sometimes even years, coming to terms with deficits acquired as the result of an injury or stroke event.  Post-acute rehabilitation is typically their last stay in an inpatient rehabilitation facility prior to returning home.  Therefore, therapists need to work with patients on how to live a successful life at home in spite of those acquired deficits.

The focus on successful life at home as an adaptation to deficits is sometimes hard for patients and their families to understand.  Many patients are perfectly content to do drills for hours and hours on end in an attempt to improve core skills.  However, planning realistic strategies with which to approach post-injury life is just as, if not arguably sometimes even more, important.  For instance, a patient may want to spend as much time as possible each day doing hand exercises to get back his or her fine motor skills.  But if the hand is clearly not coming back to full functionality quickly enough and the patient will likely be discharging with hand deficits, how will that patient put on his or her clothing at home with one good hand?  How will he or she cut foods without having a second hand to stabilize the food?  How will he or she open up jar lids with one hand or tie his or her shoes?  If a facility sends the patient home without having put focus on addressing necessary adjustments that need be made in the application of these practical life skills, then the facility has done a disservice to the patient.

This issue sees a comparable expression in the realms of cognitive and speech skills.  A patient may want to practice solely on exercises designed to improve memory or those similarly aimed at regaining speech and oral motor capacity.  But if a patient is likely to contend with long-term memory deficits, how will that patient ensure that bills are always paid and that doctors’ appointments are not forgotten?  What steps need to be taken in order to ensure that stoves or ovens are not left on?  If the patient is likely to have long-term speech deficits, how will he or she contact 911 in the event of an emergency?  Clearly, planning for the future while affording full consideration to post-injury deficits’ impact is necessary even for day to day safety and health.

There are also emotional and behavioral areas that need to be explored and sufficiently appreciated.  For example, what kind of state is the patient’s self-image in following his or her injury?  How does he or she feel about interacting with old friends, family or the general public given the inevitable shift in perspective that accompanies a dramatic change in health status?  If the patient has anger or impulsivity issues, how can these best be managed in his or her discharge environment?  Again, efforts to adequately understand these emotional and behavioral areas are extremely important in setting the stage for long-term patient well-being and successful, healthy relationships with others.

Preparing for a life operating under the constraints of long-term effects of an injury is comprised of multiple facets which are often worked on simultaneously.  The following is not an exhaustive list but does highlight many of the prime targets for a sufficiently comprehensive therapy regimen:

1.    Learning new methods to engage activities perhaps previously taken for granted, such as learning how to tie a shoe with one hand or learning a new method to transfer into a car.

2.    Identifying and practicing with equipment to make up for deficits, such as using a daily planner to help remember a schedule or a sock-aid to help put on socks.

3.    Discussing thoughts and feelings about the real and concrete effects of having injury deficits, such as mourning the loss felt due to an inability to return to a previous job.

4.    Identifying potential problem areas in a discharge environment and problem-solving through those areas, such as pre-recording a message for a survivor suffering from aphasia to play on the phone for a 911 operator in case of a fire.

5.    Learning and practicing mood and behavioral management techniques such as relaxed breathing.

6.    Creating a daily schedule that honestly reflects real-life changes experienced in post-injury life.

7.    Identifying and planning activities that can still realistically support participation by a survivor in spite of injury deficits and recognizing those activities that should no longer be engaged in, such as identifying a trip to a ball game as an activity that can still be enjoyed just as capably.

8.    Articulating all aspects of a long-term health regimen necessary to satisfactorily maintain health, such as taking medication for seizures or chopping food into smaller-sized bites so as to avoid choking.

9.    Identifying and locating specific people/resources needed to promote success, such as deciding which family member is most able to help with managing finances or submitting an application for accessible busing.

In summary, since post-acute rehabilitation will generally be a patient’s last opportunity to experience inpatient rehabilitation and many patients face long-term deficits, it is crucial during post-acute rehabilitation to focus not only on rehabilitating lost skills but also to focus on how to manage life at home while affording sufficient consideration to those inevitable deficits wrought by a traumatic brain injury or stroke.


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

Purchasing a New Car

Purchasing a new car can be an incredibly challenging and stressful experience.  Adding to this potentially unpleasant experience, many brain injury and stroke survivors also need to purchase special modifications (such as a wheelchair lift) to enable their new cars  to meet minimum required levels of accessibility.  Thankfully, many car manufacturers provide reimbursement for these modifications on new car purchases (and in many cases for new car leases).  Each manufacturer has its own program, so it is important to read through all pertinent details.  Below are links to the reimbursement information for many major car manufacturers along with applicable reimbursement limits where available.  In those cases in which the main manufacturer page did not have a link to the desired information, I have provided a link to a local dealer that does provide the relevant information:

Acura: Up to $1000

Audi: Up  to $1500

BMW: Up to $2500 (for new or certified pre-owned vehicles)

Chrysler (Chrysler, Jeep, Dodge, Ram, Fiat): Up to $1000

Ford: Up to $1000

Honda: Up to $1000

Hyundai: Up to $1000

General Motors (Chevrolet, GMC, Buick): Up to $1000

Jaguar: Up to $1000 (I was not able to find an official link to sought information but many modification companies cited this program)

Lexus: Up to $1000

Mazda: Up to $1000

Mercedes Benz: Up to $1000

Nissan: Up to $1000

Scion: Up to $1000

Subaru: Up to $500

Toyota: Up to $1000

Volkswagen: Up to $1000

Volvo: Up to $1000

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