Category Archives: Learning about Brain Injury

Michael Johnson is a Survivor!

Olympic gold medal sprinter Michael Johnson has always kept himself in great shape, even after retiring from professional racing.  However,  it is possible for even a healthy individual to have a stroke.  Michael Johnson had a transient ischemic attack (TIA), also known as a “mini stroke”.  Though he has recovered well from the TIA, the experience taught him a lesson about vulnerability and motivated him to educate others about the risks for stroke.  Click the link below to read more about Michael Johnson’s stroke experience:

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Bike Helmets Are Not Just For Kids

This post, as many of the posts on this blog, are motivated by everyday experiences I have at work or in my personal life.  This particular post was influenced by a conversation I had on Facebook.  Recently, a friend of mine posted a picture from 20 years ago.  The picture was taken after he had a serious bicycle accident.  He mentioned breaking several bones and having a concussion during the accident.  He said that the accident was proof that bicycle helmets work and that he needs to wear one all of the time.  After reading his Facebook post, I mentioned to him that I have seen several patients with severe brain injuries due to bicycle accidents and agreed that he needs to wear a helmet whenever bicycling.  He responded by telling me that the accident was so serious that it affected his memory.  He woke in the emergency room with a note taped to his chest, telling him what happened, as he had no idea how he ended up in the emergency room.

This brings us to a worrisome trend I have noticed.  While many more children are wearing bicycle helmets while out riding than in the past, many adults are not.  This is especially concerning when looking at accident data from the National Highway Traffic Safety Administration (NHTSA).  According to the NHTSA, the average age of bicycle accident fatalities as of 2016 (most recent data available) is 46.  Moreover, for children under the age of 14, there are on average approximately 1 death per million resident population while for adults between the ages of 50-65, the average is over 4.6 per million.  These findings should raise concern in all adult bicycle riders.  (For this data, and further information on bicycle safety from the NHTSA, click on this link

A prime reason that children are wearing helmets while adults are not is that many states and cities have laws mandating that children wear helmets while there are no similar laws for adults.  For instance, it is illegal in the city of Houston for anyone under the age of 18 to ride a bicycle without a helmet but there is no equivalent law for adults.  This law in Houston, and similar laws in other locales, ignore a basic medical reality.  An adult can just as easily get a brain injury as a child and, based on NHTSA data, are dying from bicycle accidents at a higher rate than children.  Just as children need to protect their brains from injury, so do adults.  Reaching the age of 18 does not magically make a bicycle rider immune to serious accidents.  Everyone, including adults, should always wear a helmet when riding a bicycle!

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Practice Makes Proficient

Neurorehabilitation from a brain injury involves learning and re-learning a long list of activities.  Patients work on skills such as naming items, transferring from a wheelchair and using adaptive equipment.  Therapy sessions often consist of countless repetitions of the same action, drilling skills over and over.  Further, therapists will usually send patients home with discharge plans to continue practicing these same skills at home.  Sometimes, patients will wonder why they have to practice activities.  After all, if they demonstrated the skill once, doesn’t that mean they possess the skill?  Why is this repeated practice necessary?

In reality, to truly become proficient at any skill, lots of practice is necessary.  Just because a patient has succeeded at a skill on one occasion does not mean that he or she will succeed in the future.  This is true for any activity or field.  For instance, imagine hearing the following overhead announcement prior to a flight taking off the runway: “Ladies and gentleman, welcome aboard our plane.  My name is Captain Mike and I will be your pilot today.  I have successfully flown a plane once.  I anticipate we will have a smooth flight.”  After hearing this announcement, most passengers would probably run toward the exit door as quickly as possible.  Who would trust a pilot to fly a plane with a history of only one successful attempt.  We inherently recognize that lots of practice is necessary to trust that a person can reliably complete a task.  This holds true for therapy as much as for flying a plane.  Repeated practice, both in therapy and at home, is necessary for a patient to gain the skills and competence to succeed in rehabilitation goals.  It is only through practice that patients can become proficient.

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Why Brain Injury Education is Important

Recently, I was speaking with an acquaintance about our jobs.  He is a young, bright family physician.  The young physician explained to me how those patients he treats with brain injuries have all suffered mild brain injuries.  He then proceeded to give a list of some of the more common symptoms that his patients experience.  His description of the symptoms of mild brain injuries was well-informed and accurate.  I mentioned how I treat patients with moderate to severe brain injuries.  The young physician stated that there is not much one can do for patients who have such serious brain injuries.  On this point, he was sadly misinformed.  I explained to him that the terms “mild,” “moderate” and “severe” simply refer to the initial status conferred by the seriousness of brain injury incurred and not to a persisting state of being;  having that injury as a starting point in no way condemns a patient to that as end result.  I told him about several TLC patients who were quite successful following rehabilitation, including patients who went on to graduate from college after completing treatment at TLC.  He clearly took in the information and hopefully has adjusted his outlook as a result of our brief interaction.

This interaction led me to have other thoughts.  Here is a well-educated, skilled and obviously competent doctor who still lacked a sufficiently comprehensive understanding of brain injury.  How much more so then must such a deficiency in understanding persist in the general populace?  How many people in the general public harbor demonstrably false ideas about brain injuries?  The desire to educate the public on brain injury is one of the principal reasons this blog was created.  Moreover, every article, news story and conversation about brain injury which we share helps to educate individuals outside of the brain injury treatment world about brain injury.  We need to let the general public know that a brain injury is not the end of someone’s life but it is rather one more of myriad forks in the road encountered while navigating life’s path.  It is important for the general public to understand that despite significant difficulties, an individual with a brain injury can still lead a successful life.  All would benefit from the general public learning to see more clearly the human truth behind the facade of injury.

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Gary Busey is a Survivor!

Actor Gary Busey, the star of countless movies and television shows, is also a traumatic brain injury survivor.  On December 4, 1988 Busey suffered a serious motorcycle accident while riding without a helmet.  This accident caused a severe traumatic brain injury which nearly took his life.  Through a great deal of hard work and persistence, Busey achieved an effectively full recovery and has used his platform as a star to help advocate for the brain injury community.  Click the link below to learn more about his injury experience:

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Two Plans

While working on their recoveries at TLC, patients often tell staff about all of the activities they will engage in once they are “all better.”  They will share these plans regarding work, vacations, school and family clearly having spent significant time planning future activities assuming an identical skill level as that enjoyed pre-injury.  There is nothing inherently wrong with this kind of planning, but there is an important complementary plan that is missing.  The majority of the patients at TLC have suffered severe traumatic brain injuries and contend with multiple areas of deficits.  Moreover, insurance companies and other funding sources inevitably only fund rehabilitation for a finite span of time.  Those spans of time almost never cover the entirety of a patient’s incremental progress back to “100%,” and no such funding source can make allowances for an indefinite stay.   After a number months (the exact number differing among funding sources and insurance plans), sources will cut off funding and force discharges even if patients would benefit from further therapy.   This is why it is important for patients and their families to make at least two plans.  One of these plans can assume a full recovery, but another plan should recognize the very real likelihood of a less than full recovery.

The first plan, based on a full recovery, tends to be fairly straightforward.  Patients generally want to return back to the majority (if not all) of pre-injury daily activities.  The second plan, based on a less than full recovery, can be more difficult.  This plan is far more emotionally taxing, as it requires patients and families to confront the possibility that the journey of recovery will be longer and more complex than they originally hoped it might be.  It also means that patients and families will have to identify needs, resources and accommodations necessary to be successful incorporating effectively permanent deficits into any planning equation.  This takes a considerable amount of time and effort.  Neglecting to make these plans though can be very problematic, and in some cases quite dangerous.  For instance, if a patient has difficulties with balance and there is no plan in place to make accommodations for those difficulties, a patient may go home without necessary equipment such as grab bars and a shower chair to compensate for balance problems in the bathroom.  This would place the patient with balance deficits at a high risk for a fall, which could lead to a serious injury.  Similarly, if no secondary plan is made for a patient who is confused and experiences disorientation, that patient may be left at home alone.  This confused and disoriented patient may then leave home unaccompanied and become lost wandering the streets, which clearly places that patient in extreme personal danger.

The obvious question when making a plan for a less than full recovery is how does one best make such a plan when the patient is still actively recovering?  Does one guess that a patient will be 25, 50 or 75% better at eventual discharge?  Experience dictates that it is generally preferable to make this secondary plan based on the worst-case scenario (which makes it more likely that all contingencies will be covered) regardless of the rate of improvement a patient appears to exhibit.  So what is the worst-case scenario?  The worst-case scenario is the situation arising if a patient were to make no further improvements beyond current status.  After all, as long as a patient does not have some additional health issue arise (e.g. seizures), then overall recovery should not decline significantly.  This promotes the valid assumption that the current state is the worst possible state and should then be used to inform secondary planning.  So how does one talk about this thorny issue with a patient currently devoting so much of his or herself to the recovery process?  After introducing the topic and having the patient agree to a discussion, I usually start with a version of the following:  “I can see that you are working hard and getting better through rehabilitation.  However, no one has a crystal ball to predict the future.  All we know for certain is today.  Let’s pretend for a moment that you do not get any better than you are right now or that perhaps the insurance company decides to force your discharge tomorrow.  What would you need at home to be successful?  What activities could you take part in on your own or with help?  In addition, which activities might you be unable to take part in at your current recovery level?  By doing this, we can be better prepared for even the hardest post-discharge situation.”  With this type of introduction framing the discussion, patients are able to more comfortably explore these distressing potential eventualities.

As alluded to earlier, this discussion can be very emotionally difficult for patients and family members.  It forces focus on a troubling “what if” and can provide a quite painful reality check resulting from a practical assessment of skills impacting needs.  It is important that everyone understands that this does not mean that it is assumed the patient will not get better or that rehabilitation is useless.  This planning is to raise the likelihood that the patient and family members will be prepared for all possibilities and to lower the likelihood of unexpected dangers and headaches later in the recovery journey.  Overall, the goal is to have a smooth, safe and successful transition to home life after inpatient rehabilitation.

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TLC on TV!

TLC was on TV!  The TLC facilities in Galveston and Lubbock both recently acquired  innovative new robotic arm devices from Bionik Laboratories.  Our partnership with Bionik Laboratories will allow TLC patients to make use of this cutting edge technology in efforts to improve rehabilitation outcomes.  This new technology is so innovative that Fox 26 in Houston came to film a segment at TLC Galveston on the robotic arm and its potential.  Click the link below to see TLC on TV!

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Dylan O’Brien is a Survivor

Brain injury does not discriminate.  Even those most famous of Hollywood stars are not immune to being injured.  Maze Runner star Dylan O’Brien suffered a brain injury due to an accident while filming the third Maze Runner film.  He needed many months to recover from his injury before he could return to filming.  The most difficult part for Dylan was the emotional aspect of recovery.  The article below is an interesting read in which Dylan opens up about his experiences surrounding the accident.

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Lessons from a Blind Man

We here at the Transitional Learning Center often host patients and family members that speak Spanish as a primary language.  Spanish-speaking TLC staff members are generally on-hand to translate during therapies and other necessary interactions, but on occasion TLC staff will have need to use a phone translation service (in a meeting updating family on progress, for example).  To utilize this service, a staff member will call the service phone number which connects directly to a translator.  The translator can then translate between all parties involved via speaker-phone.

When using such a translator, it is important to pause every few sentences so as to allow the translator to translate that which has just been stated.  On one memorable occasion a therapist spoke for too long without pause and upon realizing her error, stopped herself and apologized for not stopping sooner.  The translator agreed that to do his job effectively he would require more frequent pauses.  He then added that he cannot depend upon notes taken while someone is giving him information to translate because he is blind.  He was doing his job utilizing memory and language skills exclusively.

Reflecting upon this situation there is an important lesson to be learned for all individuals with disabilities, including brain injury survivors contending with long-term deficits.  A translator position is the perfect occupation for a bilingual blind person.  The job requires excellent speech and finely-honed cognitive skills, but in no way requires vision.  The job matches the person’s strengths to a central task while sidestepping the influence of any weaknesses.  After an injury, many brain injury survivors need to find new jobs because newly acquired deficits do not allow them to return to their previous occupations.  It is important during the job search process to honestly identify post-injury strengths and weaknesses in order to find jobs that rely on strengths while minimizing the impact of any weakness.  By taking this important step survivors are more likely to enjoy success in the working world, just like the blind translator from our story.

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New Technology Can Lead To More Success

Technology plays an ever-increasing indelible role in our modern lives.  Just as our phones and televisions are enhanced by new technological advancements,  so does neurorehabilitation from brain injuries benefit in a similar fashion.

Technological advances and applications for that new technology in rehabilitation come from different sources.  There has been a steady improvement in proprietary technologies catering to therapists and doctors who treat individuals with brain injuries.  These new technologies aid in a wide range of therapies, from helping a patient to re-learn swallowing skills to improving gait training.  Two common such examples can be seen in a patient working on a task while wearing electrodes to stimulate particular muscle groups or one walking laps while a programmable hoist unloads a percentage of that patient’s body weight.

Separately but related, most patients now integrate smart phones, Ipads, tablets and other such technology into their daily lives.  These items can be very useful in compensating for certain deficits.  For instance, many patients use their smart phones to keep track of their schedules and to program reminder alarms for daily activities.  There are numerous speech apps that can be downloaded to Ipads which enable patients to engage in more effective communication with others.  The cameras now included as feature of virtually every cell phone and tablet PC prove useful in compensating for deficits in visual memory.

These new technological advances benefit patients in multiple ways.  Many of these technologies enhance the effectiveness of therapies.  This brings greater success in individual therapies and thus in overall rehabilitation.  Other technologies provide new ways to compensate for deficits.  This helps reduce the lasting impact of injuries on patients’ daily lives.  Additionally, patients enjoy certain technologies that can make the daily work of therapies feel more fun or interesting.  This helps keep patients motivated in those therapies.  The pertinent role of the therapist is to identify which technologies will benefit which particular patient as each patient is different both in therapy needs and in personal comfort level with new technologies.

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