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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/

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/

 

 

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/

 

 

 

Bubba Smith and CTE

The phrase “larger than life personality” could have been invented to describe Bubba Smith.  Looming at 6’7″ and almost 300 pounds, he was the first pick of the 1967 NFL draft and earned his ring at Superbowl V with the Baltimore Colts.  His extraordinary defensive skills on the football field left many a shell-shocked quarterback lying prostate in his wake.  Following his nine year professional football career, he parlayed his fame into a second career in film and television.  He is best known in the acting world as Captain Moses Hightower in the Police Academy movies and for his appearances in Miller Lite commercials.  After he passed in 2011, his estate allowed researchers to study his brain for evidence of Chronic Traumatic Encephalopathy (CTE).  It was discovered that he had been living under the effects of level three CTE (the scale runs from one to four).  Follow the link below to read more about these findings.

http://www.nytimes.com/2016/05/25/sports/football/bubba-smith-cte-nfl-concussion.html?_r=1

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

 

 

 

But Are You Getting Help?

Following a brain injury, family members will often spend every possible moment dedicated to efforts in support of an injured loved one and devote special attention to helping that survivor get the best care possible.  They with rare exception will spend countless hours on the phone battling insurance companies and filling out forms.  These family members must deal not only with stressors directly related to worrying over a  loved one’s health, but must make peace with planning for a suddenly very different future and must manage (sometimes alone) a freshly revealed terrifying financial mine field.

Brain  injury survivors themselves also face an enormous number of stressors as they struggle to regain command of basic skills and learn different ways to perform common tasks.  However there is a major difference in this regard between the brain injury survivors and their family members, particularly while the survivors are in rehabilitation.  The brain injury survivors are surrounded throughout the day by professionals trained in the treatment of brain injury who can help with mood, education and adjustment.  Survivors merely need look to their immediate surroundings to find an abundance of professional help to address any difficulties.  Family members generally do not have anything approaching such a level of support so readily available.  With all this in mind, it becomes clear just how thoroughly brain injuries are in fact a family affair.  All members of a family are affected, not just the brain injury survivor.  Likewise, all family members are part of the team necessary for managing long-term effects of the injury.  It is important that all members of the team (not just the survivor) are receiving the help and support that they need in order to adjust to these major life changes.

At TLC, staff commonly ask survivors’ families, “Are you getting help?” and “How can we help you through this process?”  It is important that family members do not neglect themselves while giving all they can to aid injured loved ones.  Such care taken is in the best interests of both the personal health of the family members in question and the optimal well-being of the survivors they support.  Caregivers with high stress levels often find themselves more susceptible to physical illnesses than the average person.  A family member side-lined by illness can offer only a fraction of the aid and support he or she would wish to.  Further, family members deserve to be allowed to live their lives to the most complete level of happiness possible (just like the survivors deserve to).  Put simply, if these family members are struggling themselves then they are placed in a severely disadvantaged position from which to help the survivors in their lives.

Family members of survivors should consider personal therapy and support groups as aids for their own psychological and spiritual adjustment (Both the Brain Injury Association of America and the American Stroke Association offer listings of local support groups).  These family members can often benefit from reaching out to friends and community resources in order to better address the management of difficulties.  Seeking help is not a sign of weakness but is instead a common sense step taken in the interest of maximizing both individual and family success and happiness.  Brain injuries are complex and stressful.  Family members should not pretend to be super-humans capable of handling anything and everything.  They should actively ask doctors and therapists for information on brain injury prognoses, education resources and proven strategies helpful in planning for the future.  Overall, one of the most important ways that family members can contribute to the advancing well-being of survivors in their lives is to remain sufficiently mindful of their own.

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

Using Unique Characteristics to Help Memory

Following a brain injury many survivors face great struggles in the realm of memory.  This can be especially embarrassing when a brain injury survivor has difficulty remembering the name of a person with whom he or she is already well acquainted.  Utilizing techniques that make use of unique characteristics can make it far easier for survivors to remember important names in their lives.

Each person possesses many different characteristics.  These can include height, weight, eye color, tone of voice, expressed clothing preferences, etc.  Trying to remember a person’s name while matching it with all these disparate features can be a daunting task.  When meeting someone for the first time, it is often easier to find the one unique characteristic of the person that stands out most and pair that with the person’s name (e.g. “Paul is the tall guy” or “Susie has a rainbow tattoo on her neck”).  In this way the survivor only has to remember one characteristic in order to recall a person’s name rather than contend with the confusion that would accompany recalling many characteristics.  Unique characteristics can include aspects of physical appearance, dress, voice and behavior.  Let’s give a few examples in each category, using celebrities as examples, to demonstrate how one might execute this technique.

Physical appearance can include height, hair, size/shape of facial features, scars and tattoos.  For instance, former NBA player Shaquille O’Neal has brown eyes, a shaved head and a bright smile.  None of these features necessarily make him stand out.  However, if you were to meet him on the street and were picking one unique characteristic to match with his name, you would likely pick that he is over seven feet tall.  The pairing between height and name would clearly provide a more memorable association than anything involving those other  mentioned characteristics, and would make it far easier to recall Shaq’s name at a later time.  Similarly, comedian Carrot Top is of medium height with fair skin.  Again, these common features would not be useful to pair with his name as an aid to memory.  However, his striking red hair is quite unique and by pairing this unique characteristic with Carrot Top’s name, a survivor would be more likely to later recall his name.

Some people dress in a manner that is simply different from everyone else.  These differences in dress can also be paired with a person’s name in order to make it easier to recall that name.  Michael Jackson was known for wearing one white glove.  No one else was known for effecting that particular fashion choice.  If a survivor would have met Michael and wanted to remember his name, he or she could have paired Michael’s name with the one white glove.  Another example of this can be found in former United States Secretary of State Madeleine Albright.  Albright always wore pins on the upper left shoulders of her jackets.  A survivor could pair the pin with her name in order to better recall her name, rather than attempt to utilize any number of additional characteristics she possesses.

Just like a unique physical characteristic or a unique manner of dress, a unique voice can be paired with a person’s name to help remember him or her.  A voice might be recognized as unique due to a distinct tone, a particular accent or use of a singular delivery.  Actor James Earl Jones has a baritone voice which makes him a favorite choice for voice-over work in commercials and the like.  By pairing his deep voice with his name, a survivor could more easily identify him by name at a future meeting.  Similarly, actress Fran Drescher has an unmistakable New York accent which she played up in the television show “The Nanny.”  If a survivor was to meet her for the first time, the survivor could pair her accent with her name to help remember her at a later time rather than trying to remember any other likely more common of her features.

Sometimes, a new acquaintance may demonstrate a behavior that is so different from that of others that it can be used as one of these unique characteristics to aid in memory.  This can sometimes prove a little harder to use for memory unless the person in question demonstrates the identified behavior all of the time.  For instance, Elvis Presley often had a lip twitch/snarl when speaking which other people do not have.   In a different vein, John Wayne walked with his legs spread in a wide gait.  Both a constant lip twitch/snarl and idiosyncratic pattern of walking can be paired to names to more easily remember a person at a later time.

Survivors should not worry about whether the characteristic being used is complimentary to the other person.  If pairing the name “Julie” with “giant nose” helps the survivor remember Julie later, then this is fine.  There is no need to share with the other person that this technique is being used to aid memory.  The key is whether the characteristic is so memorable to the survivor that pairing the characteristic with the name will make it easier for the survivor to remember.  Further, this technique does not prevent the survivor from adding other, more mundane characteristics to his or her memory of the other person.  This technique is primarily designed for when a survivor is first trying to learn the other person’s name.

Hopefully this method will help survivors remember others’ names and be spared the embarrassment of forgetting!

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