Tag Archives: anger

Fatigue

It is common for brain injury survivors to suffer fatigue more acutely and to enter into states of fatigue more easily after their injuries.  For many survivors and their family members, this increase in fatigue comes as a bit of a surprise.  Why am I (or my loved one) exhausted by 6 p.m. when I (or my loved one) used to be active throughout the evening even after a long day of work?
Below are just a few of the reasons why brain injury survivors may be experiencing this greater post-injury fatigue:

 
1.  Survivors may still be healing from the injury.
2.  It often takes far more effort and concentration to engage in basic activities like walking and speaking than it did pre-injury.
3.  Survivors are almost always operating under far greater levels of stress than before.  This could be due to the inevitable stress of trying to get better or stress from other issues such as financial difficulties due to losing a job after an  injury.
4.  They may be experiencing significant post-injury pain and prolonged pain tends to contribute to fatigue.
5.  The survivors’ medications may be causing fatigue.
6.  The survivors may not be sleeping as well due to the injury.  Many brain injury survivors experience significant changes to sleep patterns post-injury.
7.  The survivors may be feeling depressed, anxious or angry. Any of these emotional states are conducive to greater fatigue.
8.  They might still be getting used to the “rehab” or “post-injury” schedule, which may be quite different from their pre-injury schedules.  For instance, a night shift worker may find that it takes some time to get used to the daytime hours of rehabilitation.
9.  The greater fatigue may simply be part of the brain injury itself.

 
Depending on the cause of the fatigue effecting each individual survivor, brain injury professionals may manage given circumstances in very different ways.  For instance, if it’s determined that a survivor is suffering fatigue due to depression, then the survivor would be encouraged to talk about those issues with a staff psychotherapist.  If fatigue is most likely attributable to medication being taken, a staff doctor may make adjustments to those medications.  If fatigue is due to to the added exertion of engaging in daily tasks, survivors may be encouraged to take appropriate rest breaks.  In all cases, patience and understanding go a long way to helping the survivor cope with fatigue.

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

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Book Recommendation For Working With Soldiers/Veterans

In recent years, public awareness has been growing of the increasing presence of brain injuries in combat soldiers and veterans. Many doctors and therapists are now working with these soldiers and veterans but often do not fully grasp how this population may differ from other patient populations.

 
The military is in no way simply a nine to five job. For many soldiers and veterans it encompasses much of their life and identity. Under combat deployment, there are no days off from work. The soldier is on duty 24-7 without a true break or rest. Due to the demands and risks of the military, soldiers are part of a culture that is very different from that of the civilian world. For instance, it’s relatively common for an employee at a store to question a supervisor’s directives and perhaps even lodge a complaint with management. This process may last for several days and either see action taken or not. In combat, a soldier is not in a position to question a direct order. Life and death decisions have to be made moment by moment. The immediacy of danger also leads soldiers to develop intense and special bonds with one another. The loss of a fellow solider in combat may be felt as strongly as the loss of a family member. Since being a soldier so often encompasses so much of the individual’s life and identity, being dismissed from the military due to an injury is not like being fired from a job. The effects of emotions such as grief and anger felt resulting from losses suffered in the course of a veteran’s service are often experienced on an entirely separate level of magnitude.

 

Below is a list of a few books that may help doctors and therapists to better understand this population:

Hidden Battles on Unseen Fronts: Stories of American Soldiers with Traumatic Brain Injury and PTSD by Patricia Driscoll and Celia Straus

On Combat: The Psychology and Physiology of Deadly Conflict in War and Peace and On Killing: The Psychological Risks of Learning To Kill in War and Society by Lt. Colonel Dave Grossman

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

What Is a “Flat Affect?”

There are so many terms that family and friends of brain injury survivors are exposed to that are simply not part of our day to day vocabulary.   Learning to understand all these new terms while attempting to cope with an already trying experience can be quite dizzying.  I would like to take a moment to explain one of those terms, “flat (or flattened) affect.”

 
A flat (or flattened) affect is when a person does not display or experience emotions with the same intensity that  he or she did before an injury so that the affect (mood) of the individual in question appears to be unchanging (flat).  This symptom is most common in right-sided brain injuries.  A survivor with a flat affect may be told that a friend has died and blandly state, “That is too bad.”  The same survivor could be told that he or she has won a huge contest and simply say, “That is nice.”  Instead of being distraught and tearful in the first example or excited and elated in the second, everything ends up feeling to the survivor similarly ordinary.  This is not to say that the person does not understand the importance of each situation.  It is simply that the person’s brain is no longer capable of experiencing the strong emotions we generally associate with having encountered such a situation.  Rather than traversing the hills and valleys of normal emotional fluctuation, the person’s emotional experience is more akin to that of an even surface or flattened plain.

 
As we are social beings, a flat affect can of course interfere with social relationships.  Other people may find it awkward or off-putting when the survivor does not display the emotions that would be normally expected in a given situation.  For instance, a friend might find it odd that a warm smile is not reciprocated with a similar smile by the survivor.  It may feel to the other person like the survivor is now almost robotic in most interactions.  Many survivors with a flat affect need to be retaught social skills so as to allow for improved social functioning.  This may include learning to show facial expressions appropriate to the emotion associated with a given social interaction, even if the person is not feeling said emotion or perhaps not feeling the emotion very strongly.  Sometimes, loved ones mistakenly assume that the flat affect implies depression or anger.

 
A further complication is that the lack of or decline in the experiencing of emotions can also impact motivation to engage in activities.  If a person feels strongly that he or she wants to accomplish a goal, then motivation there will clearly be high.  However if the person feels little emotion to begin with, it is often difficult to arouse more than minimal motivation.  Many survivors with flat affect report little desire to participate in activities that they previously enjoyed or weak motivation for therapy.

 
Survivors with flat or flattened affect often find that as their injury heals, they experience a wider range of emotions.  Unfortunately, there are also those survivors for whom this will prove a symptom that provides some level of struggle throughout the remainder of their lives.

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

Harry Carson Is a Survivor

New York Giants Hall of Fame linebacker Harry Carson was one of the most feared football players of his era.  However, behind that tough exterior he was terrified of the symptoms of brain injury which he experienced following many concussions on the playing field.  Harry was eventually able to confront his fears and is now a spokesman for the Brain Injury Association.

In this article from Sports Illustrated, Harry talks about his experiences with brain injury and how he made adjustments to his life in order to better manage his symptoms.  Though the article is almost 15 years old, it’s still just as relevant as a sincere and affecting portrait of the struggles faced by a brain injury survivor.

http://sportsillustrated.cnn.com/vault/article/magazine/MAG1013015

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