Passover is the central family holiday on the Jewish calendar. Families come together to celebrate the Exodus from Egypt at the Passover Seder. Tables are packed with guests and overflow with foods as everyone reads through the Passover Haggadah. Weeks of cooking, cleaning and preparation all come together on the Seder nights into a full blown celebration of freedom from Egyptian bondage. Unfortunately, brain injuries such as from a stroke or traumatic brain injury can impact the survivors’ holidays. There is a tremendous beauty in the Passover Seder but after a brain injury, there are new concerns that survivors and their families may need to consider. This post will identify some of those concerns and make a few suggestions to address these concerns.
There are a number of issues that may need to be addressed regarding the location of the Passover Seder. First, if the survivor is in a wheelchair or uses another assistive device to aid mobility and is going to someone else’s home, is that home accessible? Keep in mind that it is much easier to get a wheelchair across a hard floor than across carpeting. Even thin carpet can be hard to turn a wheelchair on. Also, is there enough room in the bathroom for a wheelchair? Should the survivor bring along a urinal if it is too hard to access the toilet? If the survivor has problems with incontinence, is there somewhere available that the survivor could be cleaned or change clothes if necessary? Some families of brain injury survivors may find that it is easier to host Seders at their own homes rather than travel to the homes of others since their homes have already been adapted to the needs of the survivors. Survivors and their families should also consider the physical layout of the rooms where a celebration will take place. For instance, it may help to move tables and chairs into a different configuration in order to make it easier for the survivor to move through. Often, seders take place around a large table. The survivor may find it easier to sit the end of the table, particularly if he or she is in a wheelchair, than at the side of the table. Als0, how close does the survivor need to be to bathroom or an exit? Some survivors have urinary urges that need to be attended to quickly or may need to make a quick exit if he or she is overly stimulated. There are many other practical issues to consider regarding set-up of the holiday meal. Can the survivor reach a given dish or will he or she need help? Has silverware been left on a counter that is too high for the survivor to reach? Can the front of the survivor’s wheelchair fit under the table or will the table need to be raised? If the survivor uses an augmentative speech device like a letter board, is there room at the table for it? Is a side table perhaps needed for the device to be placed upon? Small changes in room and furniture layouts can make a huge difference to both a survivor’s sense of inclusion and his or her overall enjoyment of the Passover celebration.
Survivors and their families want to think about how loud the seder may be. Some survivors find that they are more sensitive to noise than previously and loud noises may provide a catalyst for unwanted agitation and/or anger. These survivors may benefit from attending smaller seders or be sat away from loud children.
Another practical issue is the drinking of the four cups of wine on Passover. The cups of wine take center stage during much of the seder yet many survivors are unable to drink alcohol as it is a health risk. For instance, alcohol mixes poorly with many medications and can lead to serious health effects. This may lead survivors to feel conflicted about the four cups of wine. The first thing to keep in mind is to consult with a doctor and that if a doctor has identified consumption of alcohol as a serious health risk for the particular person, then by Jewish law that person cannot drink the alcohol. It is important to keep in mind that maintaining one’s health is one of the 613 commandment in the Torah and it cannot be violated for the four cups of wine. Many rabbis including Rabbi Soloveitchik, one of the great rabbinical minds of the 20th century, have ruled that grape juice can be used instead of wine. Families may wish to have grape juice for all seder attendees instead of wine so the survivor does not feel left out. For those that are unable to drink at all due to swallowing issues and may be worried that they violated Jewish law by not drinking the four cups, it may be helpful to remind them that the idea that everyone needs to drink four cups is a stricture instituted by Tosafos (a group of rabbis of the Middle Ages), and that technically only the seder leader needs to drink.
There are other considerations when it comes to the eating and drinking done on Passover. Some individuals cannot eat green, leafy vegetables because it interacts with medicines such as a blood thinner. This can be an issue as many families use items like parsley during their seder meal. Survivors and their families should consult with doctors to assess if the amount being eaten will interfere with the medication. If it will, rabbis and doctors can help identify alternatives. For instance, instead of using parsley as the Karpas vegetable, some people use potatoes. Consulting with your doctor and rabbi can help you make the best adjustments and still adhere to the requirements of the seder meal.
Some brain injury survivors take certain supplements after their injury, such as meal supplements and thickeners. Survivors and their families may have concerns about whether these items violate the laws of Passover due to being chametz (made from leavened items) and for Ashkenazim, if they are kitniyot (legumes). However, most major supplements and thickeners are kosher for Passover use by those who are sick or are in medical need. The Orthodox Union (OU) has a lengthy list of kosher for Passover options.
The OU also provides a brief guideline on caring for the infirm on Passover:
For those who are Sephardic, as long as the items do not have chametz, they are kosher for Passover as the issue of kitniyot is just an Ashkenazic issue.
Again, as each survivor’s case differs from the next, it is important to check with both the survivor’s doctor and rabbi prior to deciding if something can or cannot be taken. For instance, many times people believe that something is prohibited and their rabbi rules that it is in fact allowed.
Another issue that can arise is that seder meals tend to be very large with lots of food and this may impact a survivor’s blood sugar levels if he or she has diabetes. It is important to plan meal choices around this health issue. Survivors and families should tailor their Passover menu to reduce the chance of dangerous fluctuations in blood sugar. Also, it should be kept in mind that seder meals tend to be eaten later than is typical of a normal dinner. If you have diabetes, it is vital to discuss with your doctor what type of adjustments to medication schedules may be necessary for the seder nights. The Jewish Diabetes Association, via the Star-K Kosher organization, has a Passover guide for diabetics:
Passover cleaning and meal preparation can be almost as big (and sometimes bigger) than the seder itself. Individuals spend many hours cooking and cleaning in preparation for the holiday. This may be difficult for many survivors who are used to doing the cooking and/or cleaning themselves. This may make survivors feel useless or worthless and represents a large change in roles. It is important that the survivor be allowed to participate in any way they can in this process. The survivor may not be able to cook the chicken that will be eaten as the main course but perhaps he or she could chop some of the vegetables for the meal or the nuts used for the charoset. The survivor may not be able to handle a vacuum to clean the carpet but perhaps he or she could help with sweeping the floors. The survivor may also be able to help set the table or put out the haggadahs. There is almost always something the survivor can help out with if everyone just put their minds to it. If a survivor is living on their own and unable to do Passover cleaning, he or she may want to ask friends or family to clean for them. Also, many synagogues and Jewish organizations have contacts for people that are willing to volunteer to clean or will do it for a reasonable cost.
Another issue that can come up involves the structure of the Passover Seder. For instance, many brain injury survivors have shorter attention spans than previously and many seders tend to be quite lengthy. However, in recent years there have been a number of haggadahs published designed to make seders shorter. For those with extreme difficulties with attention, Rabbi Yonah Bookstein of the Pico Shul states that he has the shortest kosher haggadah available which allows one to complete the seder in 10 minutes:
The 30minute Seder is another haggadah option for a briefer service. This haggadah was edited by Rabbi Bonnie Kappel of Temple Chai and the US Army Reserves:
The seder is a very language heavy service which may be difficult for brain injury survivors with aphasia. Gateways has published a haggadah which is more picture-oriented and includes the use of Boardmaker symbols that many survivors with aphasia already use with their augmentative speech devices. The haggadah was written by Rebecca Redner and reviewed by a number of rabbis including Rabbi Neal Gold of Temple Shir Tikvah. It was created more to aid youth with special needs but may be more appropriate than other haggadahs for adult survivors with aphasia.
Matan, an organization serving Jewish youth with disabilities, has a number of Passover resources that turn verbal parts of the Seder into visual pictures. Though made for children, adults with aphasia my benefit from their use.
As it is common for family and friends to take turns reading the sections of the haggadah during the seder, survivors with aphasia may feel especially left out of during the seder service. But just as with the Passover preparation and cleaning, there is almost always a role the survivor can take in the seder. For instance, it could be the responsibility of the survivor to dip the green vegetables into the salt water and/or hand pieces of matzah for everyone at the seder. The survivor could have the job of pointing to the shankbone, matzah and bitter herb during the section regarding Rabbi Gamliel. Survivors with aphasia also tend to do better with familiar songs. Though the survivor may struggle with reading, he or she may still be able to sing the refrain “Dayenu”, as this is a common line that survivors have generally sung for many years.
Lastly, at some seders, there is a general desire to rush through the haggadah to reach the meal or to finish the second half of the haggadah quickly. For survivors with slower processing speed, they will require that the seder is done at a slower pace than previously.
These are just a few suggestions of areas in the Passover Seder that may need to be adjusted after a brain injury. Wishing you a wonderful and meaningful post-injury Passover!
Thank you to Rabbi Joel Levinson of Temple Beth El of Patchogue for reviewing the content of this post and Rabbi Daniel Masri of Beth Rambam of Houston for providing information on Sephardic practice.
Learn about brain injury treatment services at the Transitional Learning Center: tlcrehab.org