Tag Archives: acquired brain injuries

Traumatic Brain Injury vs. Acquired Brain Injury

One of the more confusing aspects of the brain injury world is that there are so many terms to learn. It can be difficult to differentiate between often similar terms. In this post, I would like to clarify the difference between two commonly used terms, “traumatic brain injury” and “acquired brain injury.” These terms (also known by their acronyms “TBI” and “ABI”) carry notably different connotations.

Traumatic brain injury is generally defined as any injury caused when an outside force is brought upon the brain. This can occur when an object strikes the brain, such as a bullet shot through a person’s skull. Alternatively, it can be when the brain itself strikes an object, such as when a person’s head hits a windshield in a car accident. This outside force can also be supplied by the shock wave of a bomb, which is to blame for many brain injuries suffered by soldiers. Though there is no “object” striking the head in that case, the force of the shock wave can cause considerable brain damage. Common causes of traumatic brain injury include motor vehicle accidents, falls, assaults, gun shot wounds and sports-related concussions.

Acquired brain injury is a broader term, covering all methods by which a brain can be injured (including traumatic brain injuries). This includes non-traumatic brain injuries due to stroke, anoxia (lack of oxygen caused by events such as heart attack or drowning), encephalitis and substance abuse. In short, acquired brain injury = traumatic brain injury + non-traumatic brain injury. Also, using the term acquired brain injury or traumatic brain injury does not denote differentiation between degrees of severity. All brain injuries have equal potential for low to high levels of severity.

I hope this helps clarify the difference between the terms “traumatic brain injury” and “acquired brain injury.” Feel free to ask questions in the comment section below!

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

The Saddest Story

I would like to tell you the saddest story of my professional career. I was working at a major city hospital and one of my jobs was consultation neuropsychological testing. When a patient was admitted to the general medical unit of the hospital but the attending physician suspected the patient also had cognitive deficits (such as memory problems) I was asked to conduct a neuropsychological evaluation. It was in this role that I experienced the saddest case of my career.

One day, I was contacted by a doctor to conduct neuropsychological testing on a patient. The doctor told me the patient’s room and bed number. Naturally, I asked for the patient’s name. The doctor responded that he didn’t have the patient’s name, as the patient had been too confused to give it. He had been found injured at the side of the road and his brain was still in the beginning stages of healing, and the hospital had yet to be contacted by anyone who could provide his name. As I had never encountered such a situation before, I asked how long the patient had been in the hospital. The doctor replied that he had been in the hospital for two weeks. Two weeks had passed without any kind of contact from anyone that might know the patient.

I met with the patient and conducted the neuropsychological evaluation. Although he could respond verbally with excellent clarity, he could not give his name. He was so confused that at one point during testing, his responses indicated that he thought he was in a television show. I completed my testing and wrote up the evaluation. A week later, I asked the referring doctor if we’d finally found out the patient’s name. Three weeks later, we still had no name for the patient. He could not remember his name and no one had come to find him.

The saddest part of this story is not the patient’s severe confusion. I have assessed plenty of patients who struggled with recalling and conveying basic personal information. That is a large part of my role as a professional. The saddest part is that for three weeks, not a single family member, friend or co-worker had come to look for him. It was as if he was a lone deserted island in the middle of an ocean, and no one knew he existed.

There are several important lessons that I take from this story. As an adult, no one has to support you after you are injured. Legally, in most cases everyone can walk away and leave you on your own. Whether it be a spouse, child, other family member or anyone else, no one has to stick around when you are down. For instance, a spouse can choose to file for divorce or a parent can choose not to take responsibility for an adult child. This means that every single person who has decided since your injury to remain in your life has made a personal decision to remain. Every single visit, call, text or even a “like” on social media is completely voluntary. No one is being forced to do this. These individuals are choosing to be a part of your life. This means it is incumbent upon you to appreciate that each individual who has taken the time and effort to be a part of your life has made this decision willingly. Whether it be out of romantic or familial love, a strong friendship connection or any other reason, they have chosen to remain in your life following your injury. That is a big deal and it is important to appreciate their choices.

It is also incumbent upon you to recognize that your relationship with that other person is something that they find valuable even after your injury. If there were no value in the relationship, it would be easy for the other person to leave. So, you still contribute to that valuable relationship. He or she finds something about your relationship exceptional, even though you may not be in the same state of health as before your injury. You are still special and it is vital to appreciate your importance in the relationship.

It has been approximately 15 years since I saw the patient with no name and no loved ones. I hope life has turned out better for him than it was those many years ago. When I see the amazing love and caring that TLC patients receive from family, friends and co-workers, I think back and remember with sadness that not everyone has such great support. This makes me appreciate the relationships between TLC patients, family, friends and co-workers that much more.

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

Using the Open Chair Technique

Survivors with brain injuries push themselves to get better.  Staff members at TLC see this every day.  Survivors push themselves to walk better.  They push themselves to speak better.  They push themselves to improve their memory.  They push themselves in every aspect of the rehabilitation experience, but recovery from a serious brain injury can be quite slow.  It is almost always slower than the survivor would prefer it to be.  Unfortunately, this leads some survivors to speak poorly about themselves.  They say things such as “I am a failure because I am not 100% improved” or “I should be much better than I am now.  I am failing at therapy”.  This negative self-talk can lead to emotional difficulties such as stress, low mood and sometimes even to depression.

If looked at objectively, this negative self-talk is often due to unrealistic expectations that the survivors have regarding their recoveries.  The survivors may believe that the amount of time necessary to recover is in excess to that which they expected, even when the medical research shows that they are progressing at a normal rate.  By expecting faster or better results than are humanly possible, survivors can cause themselves unnecessary frustration.

Interestingly, these same survivors who hold unrealistic expectations of themselves generally do not hold these same expectations of others.  They are often more logical and understanding of other survivors than they are of themselves.  It is common at TLC for the same patients who have unrealistic personal expectations to support realistic expectations in other patients.  They will make supportive statements to other patients such as “Don’t worry and take it slow.  You will get better over time.  You are running a marathon not a sprint.”  When the patients with unrealistic expectations are asked if they believe the advice they are giving to others, they almost always answer in the affirmative.  They understand that the brain injury recovery process is a slow one which requires lots of work.  They understand it is a long-term process.  But they decide for whatever reason that their personal recoveries should take less time than those of others, holding themselves up to unfair (often impossible) standards.
One way to manage this negative self-talk is by using the “open chair” technique.  How this technique works is that patients are asked to imagine they are sitting next to themselves and that the person occupying their seat is someone else with the very same issues and deficits that they have.  The patients are then asked to give this “other person” honest feedback about how the “other person” is doing.  Often, patients find that this leads them to soften their tones and to make more supportive personal statements regarding their own progress.  Similarly to when they are actually talking to other patients, when they address themselves as that “other person”  patients demonstrate more realistic expectations and are less likely to attack themselves.  The “open chair” technique often helps patients treat themselves not only better, but also more fairly and honestly.  By being more fair and honest to themselves, survivors tend to have an improved mood.  And the better the mood that survivors can maintain, the easier it is to navigate the rehabilitation process.

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

Practice Makes Proficient

Neurorehabilitation from a brain injury involves learning and re-learning a long list of common activities.  Patients spend hours honing skills such as naming well-known items, transferring to and from a wheelchair and using adaptive equipment.  Therapy sessions often consist of countless repetitions of the same action, drilling these essential skills over and over (and over).  Further, therapists will usually send patients home with discharge plans outlining continued practicing of these same skills at home.  Sometimes, patients will wonder why they have to practice these activities to such a degree.  After all, if they demonstrated the skill once (or more likely a multitude of times throughout inpatient therapy) doesn’t that serve as proof positive that they now possess said skill?  Why is this repeated practice necessary?

In reality, to truly become proficient at any skill a great deal of of practice is necessary.  Just because a patient has succeeded at demonstrating a skill on one occasion does not mean that he or she will succeed in the future.  This is true for any life activity or field of endeavor.  For instance, imagine hearing the following overhead announcement while taxiing an airport runway prior to takeoff:  “Ladies and gentleman, welcome aboard flight 683 to Phoenix.  My name is Captain Mike and I will be your pilot today.  I have successfully flown a plane once.  I anticipate a smooth flight today.”  After hearing this announcement, most passengers would probably scream for the exits immediately.  Who would trust a pilot to fly a plane with a history of only one successful attempt?  We instinctively recognize that lots of practice is necessary to trust that a person can reliably and competently complete a given task.  This holds just as true for therapy as it does for the for flying of a plane.  Repeated practice, both in therapy and at home, is necessary for a patient to hone the skills and competencies necessary to successfully accomplish rehabilitation goals.  It is only through practice that patients can become proficient.

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

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!

http://www.fox26houston.com/news/new-robotic-arm-therapy-being-used-to-help-stroke-patients-recover

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

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.

http://www.vulture.com/2017/09/dylan-obrien-is-back-from-the-brink.html

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

 

Different Parts, Different Speeds

Brain injury survivors and their families often ask doctors and therapists about how long it will take for brain injuries to heal.  This would seem like a simple and straightforward question, but the answer to this question is actually quite complex.  One of the chief factors that makes any such answer so complex is that different parts of the brain may heal at different speeds.

We often talk about the brain as if it were one unitary body part, but in truth it is made up of many interconnected parts.  For instance, there are distinct left and right sides of the brain that are connected by a set of neurons known as the corpus callosum.  Each side of the brain can be split into many different component parts.  These parts function interdependently, but each part has its own unique purpose.

When a survivor received a brain injury, different areas of the brain may have been damaged at different levels of severity.  Which parts suffered damage at what levels of severity will differ from person to person and from injury to injury.   With so many parts of the brain being impacted differently by an injury, it is very common that a brain injury survivor will see improvements in some areas faster than in others.  For instance, if the part of the brain responsible for speech comprehension was less injured than the speech production part of the brain, that survivor will likely gain back the ability to understand verbal communication well before ability to convey information through speech returns.  If the part of the brain governing leg movement was less injured than the part of the brain controlling the arms, then that person is likely to see a return of the ability to walk through a doorway prior to being able to once again turn a door knob to open that door.  Ultimately, having different skills return at different rates of speed should be understood as a normal and expected part of the brain injury recovery process.

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

Joe Biden is a Survivor

As Vice President of the United States under Barack Obama, Joe Biden served 8 years as one of the most important politicians in America.  Prior to holding the Vice Presidency, Biden served several terms as a senator representing the State of Delaware.  It was during his time as a senator that he required surgery for not one, but two brain aneurysms.  The first aneurysm had ruptured, putting him in a life or death situation.  Doctors saved his life and the recovery from his brain surgeries is simply astonishing.  His ability to succeed at the highest levels of government after these aneurysms is truly inspirational.  Below are a few news articles documenting his surgeries:

http://articles.latimes.com/1988-02-14/news/mn-42679_1_biden-aide

http://www.nytimes.com/1988/05/04/us/biden-resting-after-surgery-for-second-brain-aneurysm.html

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

 

A Little Note Goes A Long Way

As Thanksgiving approaches, many brain injury survivors are preparing for large get-togethers with family and friends.  Many of these family and friends have not recently seen the survivors in their lives and can understandably be extremely excited to be reunited.  However, there are often a great many changes that survivors have weathered which directly impact their experiences of Thanksgiving with these family and friends.  Close family members may be aware of these changes but extended family and friends may not be.  Email or similar communications can help spread necessary awareness to help ensure successful holiday celebrations.

These communications can be sent by the survivors or by close family members prior to any get-together. The goal is for individuals who are not fully informed of the survivors’ deficits to be given relevant information in order to help holiday celebrations run smoothly.  For instance, if alcohol is typically served at a Thanksgiving meal, friends and family need to know if the survivor is prohibited by a doctor from drinking.  If the survivor becomes agitated when there are too many people surrounding him or her, family and friends need to know to approach the survivor one at a time.  If the survivor can only tolerate food of a certain consistency, family and friends need to know which foods can or cannot be served the survivor.  These are just a few examples of useful information that could be included in a message sent to help avoid problems during a survivor’s Thanksgiving celebration.  Remember, a little note can go a long way toward success!

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

Grounding Identity

Living through the brain injury experience can represent quite the assault on a survivor’s identity.  Previously athletic survivors may now struggle to walk.  Previously active and industrious survivors may now be unemployed.  Instead of being in charge at the workplace,  a survivor now is given a list of externally defined rules to follow essential to his or her rehabilitation.  All of this can cause notable emotional strain on a survivor.  Contending with the inevitable alterations wrought by such an injury to the perception of  one’s own identity is no small thing.  Sometimes rather than focusing on all of these changes, it is worthwhile to instead concentrate on those aspects of the survivor’s identity that have remained stable in spite of the injury.  It is often helpful to write down these stable aspects to help visualize and internalize the truth that many of the attributes that have always defined the survivor’s identity at core remain just as relevant post-injury.

Here are a few of these aspects with strong potential to remain stable following an injury:
1.  Family relationships – An injury does not change the fact that a survivor holds family roles as a parent, child or sibling.
2. Life Experiences/Memories – An injury does not negate the many life experiences that a survivor has accumulated.  These experiences can originate in work, school, family or any other facet of life.
3. Interests/Hobbies – An injury is unlikely to change a survivor’s interests and tastes in things like music, food and sports.
4. Knowledge – An injury will almost never fully erase a survivor’s knowledge acquired over years of life experiences.  As example, a survivor who is a truck driver will generally remember all of the quickest routes across town.
5. Personality – An injury may not change a survivor’s personality.  For instance, a survivor who was a hard worker prior to an injury will very likely be just as hard a worker after.
6. Physical Characteristics – An injury may not alter certain physical characteristics.  A brain injury will not change the color of a survivor’s eyes or hair.  For many survivors, overall facial appearance does not change at all (or sees only minor changes) following an injury.
7. Beliefs – An injury will generally have no effect at all upon a survivor’s belief system.  For example, a lifelong Democrat will almost never suddenly begin voting Republican post-injury.

By spending time identifying and shifting focus upon the stable facets of survivors identities, survivors can better emotionally ground themselves as they navigate the brain injury experience.

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