Tag Archives: brain injuries

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/


What Language Do You Speak?


There is an interesting phenomenon often observed in brain injury survivors who were bilingual to the extent of fluency prior to their injuries.  In these survivors who have post-injury language deficits the first (native) languages tend to return more quickly and fully than do their second languages.  This is true even in survivors who were fully fluent in a second language and used that second language extensively in their everyday lives.  As TLC is located in Texas, our staff tends to observe this phenomenon most often in Spanish-English bilingual patients.  Many of these patients now contending with language difficulties who learned English later in life find it far easier to name objects or follow directions when Spanish is used, while prior to their injuries they would have been comfortable using either language.

This return of the first language sooner than a second language can have a number of practical consequences.  Many survivors understandably become frustrated at an inability to speak that second language with the same skill once demonstrated.  Being bilingual is often a point of pride and may have previously allowed the survivor to excel in activities (such as import-export business transactions) that the average person could not.  This sudden significant skill gap may even prevent these survivors from returning to jobs in which a second language was utilized as a vital portion of everyday business life.  Moreover, if the survivor was previously the primary translator for the family this may cause difficulties in the family’s ability to interact with the outside world.  For example, the survivor may have previously served as point person to get information from school regarding a child’s performance as that survivor could easily speak to school officials (and the rest of the family may struggle with casual exchanges in English).  If the survivor is now unable to converse fluently in English, the family may now face significant problems interacting with the school.

There are also practical therapy concerns when a survivor struggles with a second language if that second language is the primary language used in the larger community.  In America, English is obviously the dominant language.  As such, most pre-therapy evaluations are conducted in English.  There are a limited number of health care professionals who are comfortable conducting evaluations in another language.  However, if a survivor’s first language is not English and that survivor is significantly stronger in his or her first language, that first language will need to be the language used in evaluations so as to get the most accurate measurements of the survivor’s skills.  The same is true in therapy.  If a survivor understands therapy directions significantly better in a first language, then therapy should be conducted in the survivor’s first language.    Additionally, therapists should always inquire as to which language is used in the home.  If the survivor’s first language is different than the language used at home (seen when someone who speaks both Spanish and English marries a spouse who only speaks English), then that second language will need extra focus or alternative methods of communication (e.g. pictures or hand signals) may need to be introduced.  At TLC, we have a number of Spanish-English bilingual staff and have a contract with a translation service if other help is needed.  Overall, rehabilitation professionals must be aware of survivors’ language skills and adjust evaluations and therapy accordingly.

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/




Frankie Muniz and Strokes

Actor Frankie Muniz is best known for his work in the hit TV show Malcolm in the Middle and recently has been competing on Dancing With The Stars.  Few know of a far more private battle that he has been fighting, though.  Muniz estimates that he has suffered as many as 15 mini strokes in recent years.  Doctors have not been able to identify a definitive cause for the multiple stroke events Muniz has suffered, but he does not let this stop him from succeeding in life.  He shares about his strokes and other health issues in the following article:


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


Alcohol, Seizures and Brain Injury

A drunk driving accident.  A fight at a bar after a night of drinking.  A serious tumble at home after a few too many.  Many brain injury survivors received their brain injuries while under the influence of alcohol.  In fact, studies have shown that between 35% and 81% of traumatic brain injuries occur in individuals who had been drinking at the time of their injuries.  Doctors and therapists routinely recommend that survivors abstain from alcohol after a brain injury but some survivors choose to ignore this advice. Drinking after a brain injury though carries with it fresh and frighteningly dangerous risk.  Namely, such unwise behavior invites the post-injury seizure.

In general, brain injury survivors are more prone to developing a seizure disorder than are people without brain injuries.  Depending on the severity and location of a traumatic brain injury, research shows post-traumatic brain injury seizure rates to sit somewhere between 2% and 50%.  Similarly, post-stroke seizure rates range between 5% and 20%.  Both of these are significantly higher than the seizure rate found in the general populace.

Unfortunately, alcohol can increase the likelihood and frequency of post-injury seizures.  Clinical research has consistently shown alcohol to lower the threshold above which a seizure will occur.  Alcohol also interferes with the performance of anti-seizure medication, which of course increases the risk of seizure in those who depend on its assistance.  As a seizure is at base a potentially life-threatening medical issue, anything that might raise the likelihood of seizures should be avoided.

Overall, it is smart for many reasons to avoid consuming alcohol after an injury.  The enhanced risk of seizure stands alone among these reasons though in both gravity and consequence, and as such should be granted special consideration.

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


Signs of Left Neglect

Left neglect is one of the more curious symptoms of brain injury.  Briefly, left neglect is an attention deficit in which a patient’s brain essentially tells that patient to ignore the left side of his or her world.  For that individual, it is almost as if the left side of the world does not exist.  It is most commonly observed when a patient ignores items in the left visual field (even when visual acuity is perfect) but can also involve hearing and sensation on the left side.  Left neglect is due to an injury to the right side of the brain.  Different techniques (such as practicing scanning skills) are used to help manage left neglect.  For more general information on left neglect, please see these previous posts on the topic:

What is Left Neglect? https://tlcrehab.wordpress.com/2015/01/08/what-is-left-neglect/

Left Neglect vs. Field Cut https://tlcrehab.wordpress.com/2015/06/25/left-neglect-vs-field-cut/

What I would like to do with this post is to give a few signs that rehabilitation professionals commonly observe when diagnosing cases of left neglect.  Below is a list of these common indicators of left neglect.

1. The patient only eats food on the right side of plates and does not notice food on the left side.  Often the patient will complain that he or she is not being fed enough because the patient believes that he or she is only being offered half-sized portions (since food to the left is necessarily ignored).

2. The patient bumps against objects with the left side of the body or wheelchair.  For instance, the patient may catch the left side of a door frame as he or she attempts to enter or exit a room.  Typically, patients who are just beginning to understand their left neglect and have yet to become proficient in scanning techniques will have bruising visible along the left arm or leg.  Staff often have to monitor patients in wheelchairs who have left neglect to ensure that the patients’ left arms do not fall down and get caught in the wheels of their wheelchairs.

3. The patient does not face people to his or her left, even when talking with these people.  Many times the patient may begin a conversation face to face, but slowly during that conversation his or her gaze can be observed to drift to the right.

4. The patient only shaves the right side of the face, only washes the right side of the face or only puts make-up on the right side of the face.

5. The patient misses words on the left side of the page.  This can cause a patient to complain that the reading material he or she is given does not make sense because the patient does not realize that he or she is only reading words on the right side of the page.

6. The patient is unable to find rooms located on the left side of a hallway.  Sometimes a patient will claim that a room has “moved” or “disappeared” since the patient cannot find the room in question.

7. The patient will start all activities on the right side and not make it all the way to the left. As example, a patient may play Connect 4 and only place chips on the right half of the board.  The patient may also be seen squeezing all his or her writing onto the right side of a page while leaving the left side of the page entirely blank.  When drawing a picture, the patient may leave a similarly barren left side of the page upon completion.

8. The patient complains that he or she is losing hearing in a left ear even though audiological testing shows no hearing loss.

9. In extreme cases, a patient may not recognize a left arm or leg as being his or her own body part.  When the patient sees this limb but does not recognize it, he or she may even make a complaint such as that a stranger has joined him or her in bed.

I hope this post helps everyone understand some of the more common signs of left neglect that rehabilitation professionals often observe!

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/

Life, Brain Injury and Repairing with Gold

There is a fascinating art form originating from Japan called “kintsugi” (a name formed from the Japanese root words meaning “golden” and “joining”).  In this form of art, broken pottery is repaired by using lacquer mixed with gold, silver or platinum.  Rather than being hidden, these cracks are instead highlighted, enhanced and made to reveal an entirely separate and distinct beauty.  Kintsugi is connected to the philosophy of “wabi-sabi” which means “finding beauty in broken or old things”.  This is not really a philosophy of items but a deeper spiritual concept informing a healthy approach to the world around us.

This idea of making the cracks more beautiful rather than trying to hide the break is an amazing metaphor for post-injury growth.  Survivors should not feel the need to hide or be embarrassed by their injuries.  Survivors never asked to have brain injuries, the events simply happened.  But there is a great deal of opportunity to use an injury and the rehabilitation process to take beautiful steps forward in life.  Some TLC patients have taken their experiences and used them to educate others about brain injuries.  Rather than shying away, they put themselves out front and center so as to benefit others in a powerful way that typical rehabilitation professionals do not have access to.  These survivors can speak from the authority conferred by actually having lived through the injury experience, lending their words an innate credibility that similar statements from health care and rehabilitation professionals can sometimes lack.  Other TLC patients have used their injuries as impetus to reach out to family and rekindle strained relationships.  Relatives who had not spoken for years were able to be reunited through response to these injuries.  Still other TLC patients have used their injuries to take their lives in healthier directions, such as returning to school, getting better jobs or cultivating sobriety.  Each of these steps forward is a way of taking the breaks in life created by brain injuries and repairing them with a “golden joining”, so that the survivors engage the world in an undeniably changed but potentially more beautiful and impactful way than before those changes wrought by their injuries.

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


Utilizing Music For Mood

Music has the amazing power to touch our hearts and souls.  The right song at the right time can move us in powerful ways, eliciting emotions ranging from brightest joy to deepest sorrow.  Harnessing the power of music can also help brain injury survivors (along with the rest of us) make it through their days more successfully.

It is a common sight at a gym to see the majority of participants working out with music in the background to help keep them motivated and driven.  This music tends to be upbeat and intense.  This workout music highlights the ability of music to boost our performance.  Survivors may want to consider using similar energetic background music while they are working out, whether in a gym or in therapy, to help them when they might be feeling low in energy.  However, it is important to ensure that the music does not distract the survivor.  An example of this pitfall to be avoided can be observed in a survivor suffering from substantial deficits in the arena of attention.  A catchy song could cause this survivor to sing along and devote a disastrous lack of attention to foot placement while practicing walking.  Finding the balance (whenever possible) between drive and distraction is important.  Energetic music may also help mitigate general fatigue that can occur at any part of the day.

Music has the ability to lift us when we feel down.  Following a brain injury, many survivors will display acute symptoms of depression or at the very least be significantly (if understandably) sad about their situations.  Survivors should identify songs that lift their moods and listen to that music when they find themselves feeling low.  These songs often tend to incorporate themes of hope and joy.  Religious music is also a very popular and effective source of this helpful form of mood modulation.

Many survivors also face serious difficulties with stress and anger.  Certain music can help individuals to relax and stay calm.  Soft, classical music tends to be popular to ease stress and anger though other types of music can do this as well.  Some individuals prefer listening to sounds of nature (such as waves lapping upon a beach) to reach a more calm state.  Meditation music is a hot market and there is a huge amount of excellent music available both in stores and online.

Not every song will help with every mood and sometimes the music that is most helpful may not be the survivor’s favorite song or from a favorite band.  What is most important is that the music in question leads to the emotional experience that the survivor would like to cultivate.  Technology has advanced exponentially over the last few years, and survivors should take full advantage.  A survivor can keep a playlist of songs to help influence his or her emotions on a smartphone, Ipod or other similar device that can then be accessed throughout the day.  Remember that music can be an important part of any recovery process!

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