The Overlooked Release

One of the most important factors in providing quality care is for a health care provider to have all information pertinent to a patient’s health.  For instance, knowing that a patient has a history of seizures may influence the type of attention medication that a doctor would prescribe.  Similarly, knowing that a patient has a history of learning disabilities will affect the interpretation of neuropsychological and speech pathology testing.  On the surface, it would seem pretty obvious that a health care provider would need all available information on a patient under his or her care.  In reality though, providers all too often have access to surprisingly limited information which makes assessment and treatment more difficult than it needs to be.

Many patients and their families simply assume that each health care provider they see knows what every other provider in the chain of care is doing or has done.  Unless the health care providers in question all work for the same facility, the providers do not have this full and free access to one another’s information.  Patients (or loved ones that have the legal right to do so) must request that the information from one health care provider be sent to any other health care provider.  This will always be done with a written form called a Release of Information or Release of Records.  This release allows the providers specified on the form to share information.  So if you want your family care physician to have a sufficiently comprehensive understanding of what happened to you in the hospital, you want to make sure that you have signed a release of information authorizing the hospital to send information to that physician.

There will often be check boxes on these forms specifying what information is being sent.  Certain information such as psychological records have added legal protections so they cannot simply get sent automatically with other records (consider, do you really want your insurance company to have the same access to session notes from marital therapy sessions as they do to those from physical therapy sessions?).  Moreover, doctors/facilities will only send the records from their own offices, and not the records from other offices.  For example, if you are requesting that notes from a rehabilitation facility be sent to your family doctor, the rehabilitation facility will only send their records to that doctor.  They will not send the notes from the hospital you were at prior to the rehabilitation facility even if the facility has those hospital records.  Each doctor/facility will require a release of information to be signed and often they will insist that it be on a release form from their office.  Though this may seem like a bit of an inconvenience, having a full set of records greatly improves the ability of health care providers to give the best possible treatment to their patients and reduces the likelihood of wasted time and costly errors.

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

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Recreation After An Injury

Following a brain injury, survivors often have a sudden surplus of time on their hands.  Many individuals are unable to return to work at their former jobs, and even those able to effect such a return will often spend some time between discharge from a rehabilitation facility and re-entering the workforce just getting used to living day to day with an injury.  To help fill this time, it is important that survivors and their families identify recreational activities that can be enjoyed in spite of the survivors’ injuries.  Here is a list of ten recreational activities, based on suggestions from TLC patients, that can be successfully engaged in even when a person is contending with significant deficits due to a brain injury:

1.  Reading – This may be a regular book, a large print book or an audiobook.
2. Art – Activities such as drawing or painting often are inexpensive and involve minimal physical demands.
3. Spending time with family and friends – This can be an in-person get together or even something as simple as a phone call.
4. Board and Card Games – Most require minimal physical skills though a card holder can prove useful if a survivor only has one good hand.
5. Going to the movies – There are usually a few theater spots reserved specifically for those in wheelchairs.
6. Attending concerts – By law, all public venues must be handicapped accessible but calling ahead with any accommodation requests often makes things easier.  TLC patients attend yearly a Houston Livestock Show & Rodeo concert.  The organization hosts special nights in which there are extra accommodations made for those with these deficits.
7. Watching athletic events (either in person or on TV) – When TLC went to an Astros game, stadium workers ran over to help as soon as they saw our patients in wheelchairs.  TLC staff actually had to ask these sweet workers to give the patients room to work on independence!
8. Video Games – For those with only one good hand, the Wii often works well.  In addition, certain companies make one-handed controllers.
9. Fishing – TLC once had a patient in a wheelchair and with limited hand use enter a fishing tournament.  He caught over twenty fish in just a few short hours!
10. Adaptive Sports – Many sports (such as bowling and golf) can be easily adapted to survivors’ needs.

These are just a few quick ideas for recreational activities that a brain injury survivor (even one with significant deficits) can engage in.  It is best to identify multiple recreational options in order to keep a healthy variety of life activities.

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

Open Communication

The brain injury experience is a remarkably complex one.  Overnight, so many things change and so many adjustments need to be made.  Throughout this experience, brain injury survivors have goals, concerns and aspirations.  Survivors’ loved ones will have their own goals, concerns and aspirations as well as they come to terms with their own roles in this new and dauntingly complex experience.  These two sets of expectations may or may not fully match up with one another.  Survivors and their loved ones will all try their best to achieve desired outcomes.  Sometimes  differences in respective desired outcomes can lead to conflict.  One of the most common contributing factors to such conflict is poor communication.

Family members, injury or no injury, tend to make assumptions about one another.  In fact, we all engage in some form of attempted “mind reading” in which we guess at what another person is thinking.  For instance, if one person pauses to look at a second person prior to walking through a doorway that second person may “mind read” and think, “The other person is looking at me because he wants me to enter the doorway first.”  There are no actual words spoken in this momentary exchange, only valid assumptions made.  This method will generally work well enough in simple situations, but problems  arise when we engage in such “mind reading” in place of actual open communication regarding more substantial and  important issues.  A simple look or smile does not say “I am hoping that a month or two after discharging from therapy I can return back to working and driving” or “I am worried that my son will want to return to mountain climbing where he could fall and suffer further brain injury”.

A good place to start open communication is with a family meeting explicitly organized to talk through the goals, concerns and aspirations of all involved.  The meeting should be planned in advance and all parties informed of its purpose.  This gives each family member time to organize his or her thoughts about pertinent issues.  Many survivors benefit from writing down a list of topics they’d wish to discuss at this meeting in order to ensure that they don’t forget to raise a given subject.  A meeting of this sort need not necessarily determine the final word on any topic.  In fact, it can be a good idea to state from the start of such a meeting that participants are in no way required to (and may not even be expected to) agree with what others are saying.  Particularly at the first meeting of this sort, it is not important to make decisions regarding the future.  Instead it is more important to open the lines of communication so each person can know what all others are thinking and “mind reading” can be avoided.  Opening the lines of communication in such a formal manner may seem awkward to some, but it helps ensure that the goals, concerns and aspirations of each family member will actually be discussed and addressed rather than being lost in any number of side conversations.  Once these lines of communication are opened and everyone has a chance to freely discuss thoughts and sufficiently convey perspectives, it is much easier in the future to re-visit these topics in a constructive manner.  Open communication will ultimately allow family members to walk hand-in-hand into the future with less conflict.

 

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

 

Free Continuing Education Credits on Brain Injury and Concussion

There is an increased awareness in health care professionals regarding the importance of learning about brain injuries and concussions. The Transitional Learning Center offers continuing education presentations by staff experts for no charge in order to educate professionals on important brain injury issues.  The following presentations are currently available:

Brain Injury Rehabilitation: Evaluating the Options for Achieving Functional Outcomes Along the Continuum of Care

Neuropsychological Strategies in Post-Acute Brain Injury Rehabilitation

Caregiver Burden and Traumatic Brain Injury

Fatigue and Traumatic Brain Injury

Mild Traumatic Brain Injury: The Silent Epidemic

Post-Acute Psychiatric Disease and Traumatic Brain Injury

To arrange a presentation, please contact Nicole McAllister at 1-800-852-4769 Ext. 459 or nmcallister@tlcgalveston.org

Moreover, there are a number of trustworthy organizations that provide free education online on these topics and which also grant professional continuing education credits.  Below are links to the training offered by these organizations.

CDC: Online Concussion Training for Health Care Providers:

https://www.cdc.gov/headsup/providers/training/index.html

HomeBase (a joint project between the Red Sox Foundation and Massachusetts General Hospital focused on treating military veterans):

http://homebasetraining.org/Users/HomeBaseDefault.aspx

Michigan Traumatic Brain Injury Online Training (co-sponsored by the Brain Injury Association of Michigan):

https://www.mitbitraining.org/

Remember – the better educated the health care professional, the better the treatment received by patients!

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

 

 

How Can I Support A Caregiver?

As modern medicine improves and our population ages, more individuals are able to live longer with serious health issues including permanent deficits resulting from a brain injury.  This notable demographic shift places more loved ones in the position of serving as long-term caregivers.  These caregivers need all available support from those around them but many of those capable of offering assistance are simply unaware of how best to help.  Here are a few quick suggestions on how to support caregivers:

1.     Call them and ask how you can help.  Caregivers may feel shy or embarrassed to initiate requests for help but are often far more receptive to assistance if it is offered.   This gives caregivers opportunity to request specific aspects of help most needed at a given juncture, and they will certainly be grateful for all help shared.

2.    Offer to have the caregiver and survivor over for a meal or to deliver a meal to them.  With all of the responsibilities that caregivers meet on a daily basis, having someone else take care of even a single meal can be a source of welcome relief.

3.    Be there to listen.  Many caregivers feel overwhelmed by their experiences.  A friendly phone call or visit with a supportive ear helps relieve some of this emotional burden.  Knowing that others care about their well-being is very important for caregivers in maintaining their own emotional health.

4.    Be a friend to the survivor.  After their injuries, many survivors find that their social circles quickly shrink.  Some caregivers can find themselves serving as the only social outlet for the survivors in their lives.  This can be a source of tremendous additional stress in the life of a caregiver.  Being a part of the survivor’s social circle reduces the need for the caregiver to fill all of these social roles.  Moreover, the survivor is sure to appreciate this as well!

5.    Offer to spend time with the survivor so the caregiver can spend a little time tending to his or her own needs.  As a result of devotion to meeting needs of a survivor, it’s all to easy for caregivers to end up neglecting their own.  A few brief hours just to cover an unhurried trip to the grocery store, hair salon or doctor’s office (or simply to enjoy a quiet cup of coffee on their own) can do wonders for a caregiver’s quality of life.

6.    Take a moment out of your day to send a card, e-mail or flowers.  Sometimes we don’t have a lot of time to spare for lengthy calls or visits but a quick note to say “hello” tells the caregiver that they are not forgotten.

Hopefully this list will give you ideas to start reaching out and supporting caregivers!

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

Education Loan Forgiveness

With the continuing rise of college costs, more and more students are taking out Federal loans to pay for higher education.  These loans can often total in the tens of thousands of dollars.  Following a severe brain injury, many survivors will of course see ability to pay back such loans severely diminished.  These loan payments can be an incredible financial burden at a time when survivors are already stretched perilously thin financially.  However, the United States Department of Education has a loan cancellation/forgiveness program for those survivors unable to work (or not expected to be able to work) for at least a five year period of time.  This type of loan forgiveness is known as Total and Permanent Discharge.  Qualifying individuals are able to get forgiveness of William D. Ford Federal Direct Loan Program (Direct Loan) loans, Federal Family Education Loan Program (FEEL) loans, Federal Perkins Loan  Program (Perkins Loan) loans and TEACH Grant service obligations.  If you are interested in more information, the link below will bring you to the official US Department of Education webpage for Total and Permanent Discharge.  Please be sure to read the information fully as there are important tax implications accompanying participation in this program.

https://www.disabilitydischarge.com/

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

Life, Brain Injury and Repairing with Gold

There is a fascinating art form originating from Japan called “kintsugi” (a name formed from the Japanese root words meaning “golden” and “joining”).  In this form of art, broken pottery is repaired by using lacquer mixed with gold, silver or platinum.  Rather than being hidden, these cracks are instead highlighted, enhanced and made to reveal an entirely separate and distinct beauty.  Kintsugi is connected to the philosophy of “wabi-sabi” which means “finding beauty in broken or old things”.  This is not really a philosophy of items but a deeper spiritual concept informing a healthy approach to the world around us.

This idea of making the cracks more beautiful rather than trying to hide the break is an amazing metaphor for post-injury growth.  Survivors should not feel the need to hide or be embarrassed by their injuries.  Survivors never asked to have brain injuries, the events simply happened.  But there is a great deal of opportunity to use an injury and the rehabilitation process to take beautiful steps forward in life.  Some TLC patients have taken their experiences and used them to educate others about brain injuries.  Rather than shying away, they put themselves out front and center so as to benefit others in a powerful way that typical rehabilitation professionals do not have access to.  These survivors can speak from the authority conferred by actually having lived through the injury experience, lending their words an innate credibility that similar statements from health care and rehabilitation professionals can sometimes lack.  Other TLC patients have used their injuries as impetus to reach out to family and rekindle strained relationships.  Relatives who had not spoken for years were able to be reunited through response to these injuries.  Still other TLC patients have used their injuries to take their lives in healthier directions, such as returning to school, getting better jobs or cultivating sobriety.  Each of these steps forward is a way of taking the breaks in life created by brain injuries and repairing them with a “golden joining”, so that the survivors engage the world in an undeniably changed but potentially more beautiful and impactful way than before those changes wrought by their injuries.

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

 

Utilizing Music For Mood

Music has the amazing power to touch our hearts and souls.  The right song at the right time can move us in powerful ways, eliciting emotions ranging from brightest joy to deepest sorrow.  Harnessing the power of music can also help brain injury survivors (along with the rest of us) make it through their days more successfully.

It is a common sight at a gym to see the majority of participants working out with music in the background to help keep them motivated and driven.  This music tends to be upbeat and intense.  This workout music highlights the ability of music to boost our performance.  Survivors may want to consider using similar energetic background music while they are working out, whether in a gym or in therapy, to help them when they might be feeling low in energy.  However, it is important to ensure that the music does not distract the survivor.  An example of this pitfall to be avoided can be observed in a survivor suffering from substantial deficits in the arena of attention.  A catchy song could cause this survivor to sing along and devote a disastrous lack of attention to foot placement while practicing walking.  Finding the balance (whenever possible) between drive and distraction is important.  Energetic music may also help mitigate general fatigue that can occur at any part of the day.

Music has the ability to lift us when we feel down.  Following a brain injury, many survivors will display acute symptoms of depression or at the very least be significantly (if understandably) sad about their situations.  Survivors should identify songs that lift their moods and listen to that music when they find themselves feeling low.  These songs often tend to incorporate themes of hope and joy.  Religious music is also a very popular and effective source of this helpful form of mood modulation.

Many survivors also face serious difficulties with stress and anger.  Certain music can help individuals to relax and stay calm.  Soft, classical music tends to be popular to ease stress and anger though other types of music can do this as well.  Some individuals prefer listening to sounds of nature (such as waves lapping upon a beach) to reach a more calm state.  Meditation music is a hot market and there is a huge amount of excellent music available both in stores and online.

Not every song will help with every mood and sometimes the music that is most helpful may not be the survivor’s favorite song or from a favorite band.  What is most important is that the music in question leads to the emotional experience that the survivor would like to cultivate.  Technology has advanced exponentially over the last few years, and survivors should take full advantage.  A survivor can keep a playlist of songs to help influence his or her emotions on a smartphone, Ipod or other similar device that can then be accessed throughout the day.  Remember that music can be an important part of any recovery process!

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

 

 

 

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/