What Is Prosopagnosia?

Prosopagnosia is a symptom of brain injury in which brain injury survivors face acute difficulty in recognizing the faces of people (even including the faces of loved ones closest to survivors).  A survivor with prosopagnosia may not even recognize his or her own mother’s face.  In spite of this lack of recognition, this same survivor may easily recognize his or her mother’s voice or a distinctive item of clothing worn.  Prosopagnosia is not a memory or visual deficit.  A survivor with prosopagnosia can have good vision and strong memory in spite of this deficit.  Survivors with prosopagnosia generally have little difficulty identifying various common objects.  The issue sees sole expression in the recognition of faces.

Prosopagnosia most typically results from an injury to the right fusiform gyrus, inferior occipital gyrus and/or the superior temporal sulcus of the brain.  These parts of the brain govern facial perception.  Among their functions is to connect the parts of the brain that store names with those that store information about people.  As such, a survivor may recognize parts of a person but have difficulty organizing those disparate parts into a single cohesive picture.  As example, a recent TLC patient could identify one of her therapists because he wears a yarmulke (a Jewish religious hat), but could not recognize the rest of his face as belonging to that therapist.  So if that therapist were to ever remove his hat, she would lose ability to visually recognize her therapist despite working with him several times per week.  This deficit can limit function and cause stress in many areas of survivors’ lives.  For example, it would be hard for a survivor to return to a job in sales if he or she could not recognize clients’ faces.  Similarly, going to church could prove significantly awkward if the survivor could not differentiate between the face of the pastor and that of the pastor’s wife.  Home life would suffer unique stress if a survivor could not differentiate between the faces of the survivor’s wife and the survivor’s mother.  Interestingly, there are some people who are born with a developmental form of prosopagnosia.  For instance, Jane Goodall the world famous researcher of chimpanzees had prosopagnosia.  One of the most famous neurologists in modern times, Oliver Sacks, had prosopagnosia as well.

Many survivors notice improvement in their prosopagnosia as symptoms of their overall brain injuries improve.  Progress of this nature tends to be more common in cases of a brain injury suffered on one side of the brain rather than on both sides of the brain.  Compensatory strategies such as mentally attaching semantic information (e.g. a person’s job) to a person’s face and verbally describing facial features when practicing with faces (e.g. John has a big nose) have shown some benefit.  Many survivors with prosopagnosia use other methods of identification (e.g. voice, unique gait, body type) instead of faces to identify others.

I hope this helped to explain some of the basics of prosopagnosia, a brain injury symptom that can cause significant problems in a survivor’s functioning.

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

Tell Me What You Can Do

While under our care here at TLC, it’s very common for patients to talk with staff about post-injury deficits and areas of recovery  that present those patients with particular difficulty.  The self-awareness of deficits that such dialogue promotes is crucial to successful navigation of the therapy landscape.  However, there is a specific aspect of this self-awareness that poses to our patients consistent and notable struggle.  Namely, patients all too often encounter real difficulty in cultivating a healthy self-awareness of what they CAN do in spite of their deficits.

What brain injury survivors can do after an injury is equally important to that which they cannot do.  For example, recognition of memory deficits is important but so is the recognition of functional hand use that allows a survivor to write memory notes.  Recognition of motor deficits that prevent driving is important but so is the recognition of speech skills that allow a survivor to call a cab.  Recognition of walking deficits is important but so is the recognition of upper extremity capabilities that allow for use of a wheelchair.

This topic often comes up in relation to patients’ desire to return to work.  Survivors will often be upset that deficits necessarily preclude a return to pre-injury employment.  It’s important to help these survivors realize that they still possess skills that can be utilized at a different job, and to then aid them in identifying these remaining marketable skills.  For instance, a survivor with balance issues may not be able to return to his or her previous position as a roofer but if he or she has adequate speech and hand use then that survivor could serve as an online customer service representative.  As one of our therapists is fond of telling patients, you work on your deficits but you get paid on your strengths.  Self-awareness of strengths is vital to successful work re-integration.

This can also prove an important issue in successful family and home re-integration.   Upon returning home from TLC, many  patients struggle with significant necessary alterations to the roles they fill in aspects of family life.  Conventional wisdom dictates the confronting of some remarkably distressing questions.  How can one be a good spouse absent any capacity to serve as breadwinner?  How can one still be a good parent to children and never once drive them to school?  But there are so many wholly irreplaceable roles that the survivors can still fill in spite of any deficit.  They can still be loving and attentive partners to spouses.  They can still serve as the go-to parent for relationship advice.  They can still be just as enthusiastic cheerleaders  on the sidelines at sporting activities.  All of these things that they can do just as well post-injury are tremendously valuable to their loves ones.

Ultimately, thoroughly identifying what a survivor can do allows that survivor to more easily overcome obstacles, locate future opportunities and maintain a healthy self-image.  As a brain injury rehabilitation therapist, I do need to be told what it is that you can’t do.  But you’d better be prepared to also tell me what you can!

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

 

It’s Ok To Do It Differently

When I was a senior in high school, I had a physics teacher whose outlook differed from that of most science teachers.  Early in the year she told us that when we answered questions on her tests, she did not care about how we came to a given answer.  As long as that answer was correct, the method by which it was arrived upon did not matter.  Work did still have to be shown as in any other science class.  Even if that work bore no resemblance to that which she had prescribed though, a result was perfectly acceptable provided that the answers matched.

In many ways a healthy approach to rehabilitation is similar to this outlook championed by my former physics teacher.  Due to their injuries, rehabilitation patients are often unable to complete tasks in the same manner as they did before.  For instance, a patient with only one functioning hand will not be able to cut vegetables for a salad as he or she did prior to the injury but utilizing a one-handed rocker knife produces the same results.  A patient who has trouble speaking may not be able to verbally place an order at a restaurant but typing the order into an Ipad speech app produces the same results.  As you can see, there are often multiple methods by which to accomplish a given goal.  Effectiveness is the most important measure of a method’s worth, not whether it is identical to a previous method.

The idea of reaching the same goal through different methods sometimes bothers patients and their families.  In some cases, patients and their families refuse to use alternative methods because they are focused on doing things in exactly the same way as they have in the past.  A patient completing minor tasks just as he or she did prior to an injury holds strong appeal as a signifier of a return to normalcy.  However, due to the injuries this may not be realistic either at this stage of rehabilitation or for the foreseeable future.  Accepting alternative methods consistently allows patients to be far more functional in both work and home environments.  These alternative methods often allow patients to be more independent whereas insistence upon pre-injury methods can  bring with it a dependence on others.  It is important that patients and their families embrace alternative methods of accomplishing daily goals so that patients can achieve at their highest levels.  This open-minded attitude often yields the best long-term therapy results.

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

Quick Points on Wheelchair Safety in Parking Lots

Following their injuries, many brain injury survivors are left depending upon wheelchairs to meet basic mobility needs.  This change in mobility creates new safety considerations that must be taken into account on a daily basis.  One of these considerations surrounds strategies for safely navigating a parking lot while in a wheelchair.

Most adults are between 5 and 6.5 feet tall.  They are accustomed to being easily visible to drivers distractedly circling a parking lot and through rear windshields as drivers back up vehicles out of parking spaces.  When sitting in a wheelchair though, normal adults are often effectively no taller than  young children.  Even the most conscientious driver can struggle while exiting a parking space to see a pedestrian in a wheelchair.  These survivors are also often harder to see by a driver making the turn from one parking lot lane on to another.  Due to this change in baseline visibility, survivors in wheelchairs and their families must be more vigilant of vehicle activity and the abilities at every identifiable moment of drivers to see the survivors.  They must spend more time looking around to observe vehicle activity, just as they would when in the presence of a small child who may slip the notice of nearby drivers.

Another issue regarding parking lot safety is that survivors in wheelchairs are generally slower than the average person would be while moving across the same parking lot.  Since it takes more time to traverse any distance, survivors and their families must add extra time in their calculations as to whether there might be enough time to safely cross in front of an approaching vehicle.   If the result of such calculations inspire even the suggestion of doubt, erring on the side of patience is always the best policy.  Sometimes, family and friends may need to push the survivors’ wheelchairs to help move quickly enough to safely avoid traffic.  Additionally, typical adults generally can step up onto the curb from the parking lot at any location they choose.  Survivors in wheelchairs must use curb cut ramps which often means that they have to take a longer route to get onto the curb and consequently spend more time in the path of vehicles.  Again, survivors and their families must be aware of this additional urgency when choosing a path across any parking lot.

These are just a few quick points on wheelchair safety in the parking lot.  I hope everyone has a safe time in their travels, particularly in parking lots!

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

 

The Problem With the Word “Should”

The word “should” may be one of the most hazardous words in the life of a brain injury survivor.  It tends to appear in sentences such as “I should be walking already” or “I should have been back at my job by now.”  The word confers a tremendous degree of expectation on the survivor and implies that somehow the survivor is a failure if he or she has not achieved what he or she “should” have achieved.  Often, this word sparks a cascade of statements by which survivors verbally punish themselves.  “I should have been able to walk without a wheelchair but I instead I fell.  I should be doing better with my mobility.  I am letting down my whole family!”  These “should” statements can easily lead to depression, stress and damaged self-esteem.

The reality is that each brain injury heals at its own rate and as a result each survivor is left with his or her own unique set of challenges.  After a serious brain injury, it often takes a survivor considerably longer than he or she may expect to reach goals due to the severity of the injury suffered.  An injured brain is not like a broken arm.  You cannot put a brain in a cast as you would put an arm, expecting that in a relatively brief period of time the brain will be healed.  Brain injury rehabilitation is a process that takes time and patience.  The only applicable “should” enters into consideration in emphasizing that the survivor should dedicate full effort to his or her therapies.  That is all anyone, including the survivor, can reasonably ask for.  As long as the survivor is giving his or her best effort, the survivor is doing everything in his or her power to get better.  The rest of the process will depend on time, the practicing and learning of new skills and how the survivor’s individul brain heals following a specific injury.  Recovery cannot be rushed or forced.  “Should” statements that imply that somehow recovery ought to have gone differently are thus plainly revealed as emotional snares best avoided.

 

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

 

Why Are We “Suddenly” Hearing About Brain Injuries

Brain injuries are a hot topic in today’s media.  Whether it be football players with lasting damage due to concussions, soldiers suffering from brain injuries due to overseas conflicts or the latest youth sports concussion protocols, it seems that there are suddenly many news stories on brain injury that simply were not around just five or ten years ago.  Some individuals may be cynical and wonder whether brain injuries are simply the “diagnosis of the moment”, one of the many diagnoses that are suddenly “hot” but will disappear over time.  To those individuals, I would like to offer several rational reasons why brain injury stories have become more prominent over the last few years.

First, many people are now living with brain injuries who would have died from their injuries in previous eras.  The medical world has advanced significantly over the years and now doctors are able to save the lives of people who would have otherwise died. However, just because their lives were saved does not mean they emerged from their health emergency unscathed.  These survivors often have brain injuries which require treatment.  Please allow me to give an example of this change over time.  I once was talking over lunch with an older rabbi about Transitional Learning Center.  He relayed a story about his time at a synagogue many decades ago in Indiana.  A young man in his community had a serious motorcycle accident and as his rabbi, he visited the young man in the hospital.  After conversing for a while and finishing his visit, the rabbi exited the room.  As he left, the doctor pulled him aside and said “You know he will be dead in three days”.  The rabbi was shocked, having just had a full conversation with the young man.  But the doctor was correct.  The hospital had no means to manage his brain injury.  Due to either brain swelling, bleeding or both (the rabbi did not know the details), the young man passed three days later.  Today, a person with a similar motorcycle accident would have a surgery and other potential procedures to manage his injury and would stand a good chance of living, albeit with a brain injury.  Similarly, improvements in military field medicine are allowing many soldiers to survive blasts and other dangers that would have killed them in previous battles.  Thankfully, these soldiers still have their lives, but often struggle with long-lasting brain injuries suffered in their military service.

Second, it is important to acknowledge the active suppression of information regarding brain injuries in certain circles that is only recently coming to light.  Most famously, the NFL actively denied and hid data on the long-term brain injury effects of concussions to former football players.  Through a series of lawsuits, the NFL opened up about brain injuries and is now acknowledging the long-term injuries that many former players have suffered.  This has led to a complex $1 billion settlement for players with long-term effects of brain injuries.  Following these court cases, many other lawsuits have been filed against other professional and amateur sports, leading to further agreements and new safety protocols.  The suppression in the past contributed to an artificial perception that brain injuries were less common than they actually were.

Third, we are in an age of information so it is much easier to learn about what is happening to people across the country, and even across the world.  Just think about how often you hear or read stories about a robbery or kidnapping occurring hundreds of miles from where you live.  Until the age of the internet, most of those stories would be confined to local media.  Now, stories can go “viral” and suddenly everyone knows the details.  This phenomenon is equally true in the realm of brain injuries.  A simple keyword search of “brain injury” will bring up a plethora of local stories that prior to the age of the internet would have been hidden from most of the world.  These local stories existed in the past but only now d0 we have so much access to them.

Fourth, we are now having a more honest conversation about brain injuries.  In the past, people generally did not talk about brain injuries.  Athletes and soldiers rarely mentioned their deficits due to fear of sounding “weak”.  Individuals with brain injury deficits from car accidents, strokes or other methods were often afraid of negative views and discrimination if others knew about their deficits.  We are now coming to an age of sharing without fear.  It may be hard to believe but the Americans With Disabilities Act (ADA), the civil rights legislation that has allowed for a greater involvement of people with disabilities in the workplace without fear of discrimination, was only passed in 1990.  In comparison, the Civil Rights Act, which blocked discrimination due to issues such as race, gender, and religion, was passed in 1964.

Fifth, we are much more able to diagnose and treat brain injuries than in the past.  Technology such as MRI and CT exams to scan the brain and locate injuries are relatively new.  Moreover until fairly recently many people, even health professionals, did not even know the right questions to ask to identify a potential brain injury.  For instance, if a high school athlete is concussed in a game today, the coach and athletic trainer often have a protocol to follow to ensure proper health management.  Twenty years ago, the player would likely have been just given smelling salts, asked if he or she felt “okay” and sent back into the game.  In fact, many states now have mandatory concussion training for coaches and athletic trainers.  This was unheard of just a few years ago.  In the past, people with brain injuries were forced to suffer in the silence of unrecognized deficits.  Now, these brain injuries and their concomitant deficits are more likely to be accurately diagnosed.

Overall, there are many rational reasons why we are “suddenly” hearing about brain injuries in the media, despite these injuries having been an issue in the past.

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

 

 

Just Be Grateful

“Just be grateful you are alive”

“Just be thankful you didn’t die”

“You should just focus on the fact you survived”

Brain injury survivors hear these types of well-meaning lines all the time.  They are used by family members and friends to help survivors see the “brighter side” during their recovery periods.  There is undeniable truth in each one of these statements; traumatic brain injuries, strokes and other forms of acquired brain injuries lead to death for millions of people worldwide every year.  It is worthwhile to be thankful for life.  But these well-intentioned statements can all too often serve as double-edged swords.

Taking a step back for a moment, most survivors are truly thankful to be alive following their near-death experiences.  But that does not mean that they have not suffered real, painful losses.  While one may feel the commendable impulse to encourage and support survivors, it is also important to allow them to mourn these losses.  There is nothing inherently wrong with lamenting loss of arm function or fluid speech, as long as this does not lead to a serious decline in mood or performance.  For instance, wouldn’t any person be upset if, after decades of normal walking, he or she would have to suddenly learn how to walk all over again because of a stroke?  A balance has to be struck between fostering positive mood and allowing for reasonable mourning of loss.  “Just be grateful you are alive” is clearly not an inherently harmful statement, but it can still nonetheless be overused and thus inhibit healthy adjustment to change.  Excessive  repetition of such a statement can often cause survivors to be frustrated and feel as if they are being discouraged from expressing their feelings.  Though it may be difficult for family members or friends to witness as survivors experience sadness or anger, this is often one of the steps necessary while making a successful transition into post-injury life.

 

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

 

Give Yourself Permission

Brain injury survivors and their loved ones often try to approach life after an injury as if it is a fight.  Battle hard, stay strong and never let your enemy see your weaknesses.  But in truth, though there are some similarities in this analogy that are appropriate, life after an injury is not an actual fight.  In fact, by treating it as a real fight survivors and their loved ones can sometimes hurt themselves by not allowing themselves to feel and process certain emotions in a healthy manner.  By not processing emotions, individuals may allow these emotions to fester inside and come out at the wrong time or in the wrong situation.  Not processing emotions can lead to difficulties such as depression, anxiety and relationship stress.  I would like to encourage you to give yourself permission to feel these emotions.

Give yourself permission to get angry at the injury.  It truly is a frustrating and unpleasant experience.

Give yourself permission to cry.  There is no weakness in crying.  This is an appropriate reaction to a painful situation.

Give yourself permission to mourn.  There may be parts of you from the past that will no longer be part of your post-injury future.  It is okay to mourn their passing.

Give yourself permission to laugh.  Laugh at the moments of oddity.  Laughter, in measured amounts, is a reasonable coping technique during times of distress.

Most of all, give yourself permission to experience and value the full range of your emotions.  After all, our emotions are important aspects of who we are as people.  They are a central part of simply being human.  So please give yourself permission to be the complete person that you are, despite your injury.

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

 

 

 

 

Doing It Best

Jahvid Best appeared to be on the road to football stardom.  Drafted in the first round by the Detroit Lions, Best possessed blazing speed that was the envy of other running backs.  Unfortunately, his professional football career met a premature end during it’s second year due to the effects of concussions.  Best put forth great effort to get back into the NFL but ultimately doctors ruled against his return.  For many people, this would be the end of the story.  For Jahvid Best though it was the start of something new.

One of the key tasks that brain injury survivors must navigate is assessing their retained abilities so as to identify what they can still do best in spite of their injuries.  Best understood that though his body was not ready to be tackled by 300 lb linemen, he still had his speed.  Best worked tirelessly at his skills on the track.  The hard word paid off.  Best qualified for the 2016 Olympics in Rio, where he will be representing the island nation of St. Lucia.  Best demonstrated how to thrive and succeed in spite of an injury!  Though he was not a TLC patient, we certainly think he is a true hero for the brain injury community.  Identifying a survivor’s skills and choosing activities that match those skills is a key part of the rehabilitation process.  For more reading on Jahvid Best’s journey, click on the link below:

 

http://olympics.nbcsports.com/2016/07/16/jahvid-best-olympics-detroit-lions-nfl-football-track-and-field-st-lucia/

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

 

 

 

When Michael Jordan is Smarter than the Media

As a brain injury rehabilitation therapist, some days it can be simply painful to read the news.  Today was one of those days.  Sometimes, the media seems incapable of appreciating the seriousness of brain injuries and willful in its disregard for the importance of conveying  to the public the reasonable actions necessary to prevent those injuries.  Michael Jordan, arguably the greatest player in the history of basketball, decided to go jet skiing.  Being a smart man, Jordan wore a protective helmet.  It was not worn for fashion but for function.  For some reason, Pete Blackburn of Uproxx (as posted on Yahoo), decided to make fun of Jordan for wearing the helmet.  This is the offending article:

https://www.yahoo.com/news/michael-jordan-giving-us-magnificent-175458823.html

The article is just silly and encourages poor safety awareness.  The fact is that people do get brain injuries and even die in jet ski accidents.   Jordan was entirely correct in his decision to wear a helmet.  To put this issue in perspective, I would like to provide a few examples of people who have suffered brain injuries while jet skiing.

Duke University football player Blair Holliday nearly died due to a traumatic brain injury sustained in a jet ski accident (http://www.dukechronicle.com/article/2016/05/definitely-a-miracle-former-duke-football-wide-receiver-blair-holliday-earns-degree-after-suffering-traumatic-brain-injury-in-july-2012).

Lisa Votaw suffered a brain injury in Minnesota when the jet ski she was riding flipped over (http://www.fergusfallsjournal.com/2016/06/fergus-falls-woman-injured-in-jet-ski-accident/).

Firefighter Mike Yurchak of Pennsylvania also suffered a serious brain injury in a jet ski accident (http://www.readingeagle.com/news/article/mohnton-firefighter-in-coma-after-jet-ski-accident-in-maryland).

Similarly, this past January a woman in Miami received a brain injury when she was involved in a collision of two jet skis (http://miami.cbslocal.com/2016/01/31/woman-hospitalized-after-jet-ski-accident-on-miami-beach/).

Jordan should be appreciated, not lambasted, for taking reasonable precautions by wearing a helmet on a jet ski.  There are already enough injuries out there.  We do not need to discourage anyone from being safe while having fun.

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