What Happened to Your Shoes?

We each have a way that we are used to visualizing ourselves. It is part of our identity. We may comb our hair in a certain way, wear certain brands of clothes or wear certain shades of lipstick. For each of us, when we see ourselves in the mirror in our typical manner, we feel normal. Any change to our usual look or style may cause us discomfort or stress.

After a brain injury, survivors may change their normal looks or styles. Sometimes, this is done for safety or practicality. For instance, certain pairs of sneakers may not supply adequate ankle support for safe ambulation or certain shirts are too hard to put on independently. However, in other cases survivors fall into habits of “dressing down” on a daily basis. Survivors may say to themselves, “I am not going to same places that I used to go, so I will just wear my ugly jogging pants. Who cares, right?” Or, survivors may say to themselves, “Since I am not doing anything important, I am not going to dress importantly. I will just put on a t-shirt and sweatpants every day instead of my favorite shirt and pants.”

This “dressing down” can cause a negative emotional feedback loop. Dressing differently serves as constant reminders that survivors are not living the same lives as before. Survivors see themselves dressed poorly, which may make them feel badly. Feeling badly causes survivors to be even less inclined to dress nicely so they continue to dress poorly. Seeing themselves dressed poorly on a daily basis may make survivors feel even worse than before. For some survivors, this contributes to a downward spiral of moods.

As “dressing down” makes many survivors feel badly, dressing as they would prior to their injuries often makes survivors feel better. Even if survivors are not going to the same jobs or activities as before, putting on nicer clothes on a regular basis may help them feel emotionally better. For ladies, this often includes putting on make-up or jewelry, as they would have prior to their injuries. The experiences for survivors of seeing themselves fully “put together” will often improve their moods. For many people, even without injuries, if they “look like a million dollars” then they “feel like a million dollars.” And when moods are improved, other facets of their lives are often easier and better. So break out your nice wardrobes and feel better!

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

Advertisements

Beware Slippery Sidewalks

Slips and falls due to slippery sidewalks and other similar surfaces are a concern, whether an individual does or does not have a brain injury. However, the risks are often more frequent and more serious after an injury.

Many brain injury survivors are able to walk after their injury but find that their balance is not as good as it was prior to their injury. Since these survivors can lose their balance more easily, this puts them at a greater risk for a slip and fall on wet, slippery surfaces. Similarly, many survivors do not have the same quick reaction times as they did prior to their injuries, so they have more difficulty catching their balance if they have a slip. Additionally, many survivor have one side of their bodies that is weaker than the other. When they fall, they tend to fall to the weaker side so there is little opportunity to brace themselves for falls. This potentially makes falls far more serious than prior to their brain injuries.

Survivors in wheelchairs are also at risk for accidents due to slippery sidewalks and other surfaces. The wheels on wheelchairs easily slip on wet surfaces. Wheelchairs pick up speed very quickly on wet sidewalk ramps, leading to potential accidents and injuries, due to an inability of survivors to control their wheelchairs at these higher speeds. Wet leaves and other slippery items on ramps often exacerbate these risks.

Keep the following tips in mind to reduce slip and falls on wet sidewalks and similar surfaces:

1. Always check the weather before you head out to your daily activities.
2. Make sure leaves are regularly swept up in locations where they tend to accumulate on sidewalks. Don’t be shy about mentioning to companies you may not be able to enter their businesses if there are wet leaves by entrances and exits.
3. Be extra careful when walking or traveling in a wheelchair both during and after a rainstorm.
4. When possible, use sidewalk ramps that are covered by an overhang which can repel the rain.

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

Give. It. A. Minute.

One of the most common mistakes that brain injury survivors’ loved ones make after an injury is not giving the survivors enough time to respond or take an action.  For instance, a survivor and his family may be at a restaurant for dinner.  When the survivor is struggling to place his order, a family member may jump in to place the order for him.  If given enough time, the survivor may have been perfectly able to place the order but the family member did not give him enough time to respond.

There are a few reasons why survivors’ loved ones tend to not give enough time to the survivor to respond or take an action.   One reason is that silence is uncomfortable.  For instance, if a survivor is needing extra time to respond, the silence may be so uncomfortable that the loved one will jump in and speak “for” the survivor.  A second reason is that is uncomfortable to watch someone struggle.  As an example, a survivor may be slowly, and with great effort, reach toward an item on a table.  The loved one may be so uncomfortable watching the survivor’s struggle that they reach over to get the item for the survivor.  A third reason is the feeling that the survivor and loved ones are in a rush or feel like they are causing someone else to slow down.  For instance, a survivor in a wheelchair may be pedaling down a hospital hallway but family members, concerned that the wheelchair is blocking the nurses, decide to push the survivor’s wheelchair to more quickly reach their destination.

However, it is important to give the survivor more time.  First, and most importantly, if the survivor is able to make a response or take an appropriate action when given extra time, they should be allowed the independence and respect to do so.  By unnecessarily jumping in, loved ones are taking away the power and the dignity of the survivor to take care of their own needs.  Second, although a survivor may need extra time and effort to complete a task, they are more likely to get faster and more efficient over time with practice.  By doing the task for them, the loved one is taking away vital practice from the survivor who is trying to master a task.  Third, the survivor may need extra time to safely complete an activity.  After an injury, certain tasks may have concrete steps which take time or require more processing time to successfully finish without risk.  For example, most uninjured individuals simply stand up when they are ready to leave a room.  A survivor may have to go through multiple steps to safely transfer from sitting to standing.  These steps require extra time so the survivor can safely transfer.

When wondering about the survivor’s need for extra time and if they should jump in, loved ones should ask themselves the following questions:

1.  Is the task truly out of the survivor’s skill range or do I just need to be more patient to allow them to complete the task?
2. Are we actually in a rush or is a little extra time a reasonable request?  For example, if a survivor needs an extra ten seconds to place an order at a restaurant, keep in mind that the waitstaff is getting paid to serve you.  Ten extra seconds is not an unreasonable request.
3. What message am I giving to the survivor if I do not allow them to do for themselves when they are able to so?
4. Is the issue really about the survivor needing extra time or my personal discomfort in this situation?
5. By going faster, have I compromised my or the survivor’s safety?

In most cases, a little extra time will help a brain injury survivor be more successful and allow everyone to have a better experience!

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

Lessons from a Blind Man

We here at the Transitional Learning Center often host patients and family members that speak Spanish as a primary language.  Spanish-speaking TLC staff members are generally on-hand to translate during therapies and other necessary interactions, but on occasion TLC staff will have need to use a phone translation service (in a meeting updating family on progress, for example).  To utilize this service, a staff member will call the service phone number which connects directly to a translator.  The translator can then translate between all parties involved via speaker-phone.

When using such a translator, it is important to pause every few sentences so as to allow the translator to translate that which has just been stated.  On one memorable occasion a therapist spoke for too long without pause and upon realizing her error, stopped herself and apologized for not stopping sooner.  The translator agreed that to do his job effectively he would require more frequent pauses.  He then added that he cannot depend upon notes taken while someone is giving him information to translate because he is blind.  He was doing his job utilizing memory and language skills exclusively.

Reflecting upon this situation there is an important lesson to be learned for all individuals with disabilities, including brain injury survivors contending with long-term deficits.  A translator position is the perfect occupation for a bilingual blind person.  The job requires excellent speech and finely-honed cognitive skills, but in no way requires vision.  The job matches the person’s strengths to a central task while sidestepping the influence of any weaknesses.  After an injury, many brain injury survivors need to find new jobs because newly acquired deficits do not allow them to return to their previous occupations.  It is important during the job search process to honestly identify post-injury strengths and weaknesses in order to find jobs that rely on strengths while minimizing the impact of any weakness.  By taking this important step survivors are more likely to enjoy success in the working world, just like the blind translator from our story.

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

New Technology Can Lead To More Success

Technology plays an ever-increasing indelible role in our modern lives.  Just as our phones and televisions are enhanced by new technological advancements,  so does neurorehabilitation from brain injuries benefit in a similar fashion.

Technological advances and applications for that new technology in rehabilitation come from different sources.  There has been a steady improvement in proprietary technologies catering to therapists and doctors who treat individuals with brain injuries.  These new technologies aid in a wide range of therapies, from helping a patient to re-learn swallowing skills to improving gait training.  Two common such examples can be seen in a patient working on a task while wearing electrodes to stimulate particular muscle groups or one walking laps while a programmable hoist unloads a percentage of that patient’s body weight.

Separately but related, most patients now integrate smart phones, Ipads, tablets and other such technology into their daily lives.  These items can be very useful in compensating for certain deficits.  For instance, many patients use their smart phones to keep track of their schedules and to program reminder alarms for daily activities.  There are numerous speech apps that can be downloaded to Ipads which enable patients to engage in more effective communication with others.  The cameras now included as feature of virtually every cell phone and tablet PC prove useful in compensating for deficits in visual memory.

These new technological advances benefit patients in multiple ways.  Many of these technologies enhance the effectiveness of therapies.  This brings greater success in individual therapies and thus in overall rehabilitation.  Other technologies provide new ways to compensate for deficits.  This helps reduce the lasting impact of injuries on patients’ daily lives.  Additionally, patients enjoy certain technologies that can make the daily work of therapies feel more fun or interesting.  This helps keep patients motivated in those therapies.  The pertinent role of the therapist is to identify which technologies will benefit which particular patient as each patient is different both in therapy needs and in personal comfort level with new technologies.

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/

 

 

 

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/

 

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/