Valentine’s Day

Valentine’s Day is coming in just a few days so this is a good time to talk about a few ways that brain injuries may affect Valentine’s Day for injury survivors and ways in which a brain injury survivor can make his or her Valentine’s Day experience a more successful one.

For survivors with speech deficits (generally referred to as “aphasia”), Valentine’s Day can be particularly stressful.  On Valentine’s Day people say “I love you” to loved ones and survivors with aphasia may find it frustratingly difficult to reciprocate, as effecting this once simple vocalization is for them no longer simple in any way to achieve.  They know what they want to say but cannot get the words out.  Some survivors may feel let down that they are not able to adequately express this heartfelt sentiment.  Speech therapists often work with survivors struggling with aphasia in order to help them to say important phrases like “I love you” and it is generally a good idea for those survivors to practice repeating these useful phrases on a daily basis.  Many survivors with aphasia can say simple phrases if someone starts to say the phrase with them or just accompanies them through the entire vocalization.  For instance, the survivor may be able to say “I love you” if his or her loved one helps him or her to initiate by saying “I lo….”.  Even if it takes some help getting the words out, most brain injury survivors will feel good about the accomplishment of having said the full phrase correctly.  Even if the survivor cannot quite get the words out, he or she is clearly trying to express his or her love.  Loved ones should accept and acknowledge the emotion behind the attempt.  In the end, it is truly the emotion that counts.

Another big Valentine’s Day change possibly seen in a survivor’s post-injury life relates to the way in which the holiday may now be celebrated.  For example, many survivors are accustomed to arranging for loved ones extensive meals, large events or extravagant celebrations on Valentine’s Day.  They may be used to purchasing huge bouquets, pricey wines or expensive chocolates.  After a brain injury, survivors and their families are often forced to adapt to a considerable decrease in potential household income and just as often struggle with substantial medical debts.  Some survivors may feel guilty that their injuries cause this change in holiday celebrations.  Many survivors that are hospital-bound may feel like they have ruined the holiday with their injuries.  From the perspective of those family members though, the joy of simply being able to celebrate another holiday with the survivor after the survivor’s near-death experience is greater than any gift that could be purchased.  There are a number of helpful ways in which to approach these issues.  Survivors may need to be reminded that they did not ask for the brain injury to happen, so they should therefore not blame themselves inappropriately.  Instead of purchasing items, they may be encouraged to make a gift or a card for their loved ones.  Families often appreciate hand-made items at least as much as (if not even more than) purchased items.  In cases in which survivors  do purchase items, loved ones may wish to take special care to reassure those survivors that a small item purchased is appreciated just as much as a larger such item would be.  In some situations, such as when a survivor is spending time as a patient in an inpatient rehabilitation facility, that survivor may need a friend or family member to purchase on the survivor’s behalf an item the survivor intends to give as a gift.  Most importantly, loved ones may need to help the survivor focus on what everyone values the most.  Above all else, those involved should never lose sight of how precious the opportunity to celebrate their love together is.  That this opportunity for shared appreciation was very nearly permanently lost as a result of the injury suffered should only emphasize its incomparable value.

Sometimes there are dietary issues that may be brought to the fore when engaging in Valentine’s Day festivities.  Valentine’s Day gifts tend to involve copious amounts of chocolate and sweets.  For survivors with diabetes, eating large amounts of chocolate and sweets is invariably accompanied by significant risk of serious health complications.  Loved ones may want to give non-food gifts like flowers or other such items to diabetic patients.  Also, people tend to go out to eat for Valentine’s Day meals.  Any instructions by speech therapists such as using thickener to make drinking liquid less of a hazard or adhering to safe swallowing techniques need to be carried out in restaurants just as they would be at a home or at a rehabilitation facility.  It may not seem romantic to thicken a drink during a candlelit dinner at a white tablecloth dining establishment, but there is certainly nothing romantic about contending with an identified swallowing issue leading to a serious problem such as aspiration pneumonia.

As mentioned above, many people like to go out for Valentine’s Day.  This may include going to restaurants, movies or plays.  As Valentine’s Day tends to be a busy day for these venues, there are a few issues that may need to be considered as regards a brain injury survivor’s participation.  If a survivor has physical mobility issues, that survivor and his or her loved ones need to hold accessibility as a key aspect of any venue selection.  Though all public buildings must by law meet a minimum threshold of accessibility, some venues are simply better suited to the needs of those with significant mobility issues than others.  One relevant question to consider would be which restaurants have wider spaces between tables allowing greater ease in wheelchair navigation.  Is there a separate accessible entrance that a survivor can use to make it easier to enter the venue?  As an example, many movie theaters have separate entrances for those with mobility deficits so as to make it easier to enter and leave while avoiding the normal crowd of movie-goers.  If a survivor would do best with a particular seating arrangement (such as being closer to the door to limit the distance he or she will be required to walk), venues will almost always assist in such a scenario as long as they are contacted in advance.  A simple phone call to a restaurant can often guarantee that the most appropriate seating will be reserved for the survivor and his or her loved ones.  Survivors and loved ones may also want to consider patronizing any of these establishments at off-peak hours.  This can not only mitigate challenges faced by those with mobility issues, but it is also usually the best choice for survivors that have a tendency to become easily agitated when in large crowds.  Some survivors may do best with a home-based or facility-based celebration rather than going out into the community if they have too significant a difficulty with mobility or managing agitation.  Others may do best by celebrating Valentine’s Day a day early or a day late so as to avoid the holiday rush and stress.

One oft-ignored issue is that many brain injury survivors simply do not feel attractive faced daily as they are by ever-evident knowledge of permanent changes their injuries have wrought.  They may look at themselves and see body parts that do not move, now necessary constantly present aid devices, prominent scars or other injury-related alterations to their physical appearance that make them feel ugly.  In almost all cases, loved ones will still feel  strong love for and a powerful sense of connection to the survivors.  Sometimes, contending with life in the aftermath of such an injury will have the effect of even increasing these feelings.  It is vital for loved ones to express their feelings to the survivors and to be sure that they let the survivors know how much the survivors are loved.   Survivors may need more encouragement and reassurance of their attractiveness than they needed in the past.  Further, survivors should be encouraged to dress as they normally would have (or as best as they can now manage given their needs).  For instance, if a survivor normally wore make-up prior to her injury, she should be encouraged to still wear make-up.  We tend to feel better when look better, even when we do not have an injury.  When we see ourselves in the mirror looking our best, we are more likely to feel our best.

I hope this post helped to explain a few of the issues that may accompany Valentine’s Day celebrations and offered some useful suggestions to aid brain injury survivors in maximizing their holiday experiences.

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

Holiday Adjustments-Part 2: Participation

This is part 2 of a series on holiday adjustments.  As mentioned in part 1, deficits suffered in the wake of a brain injury may impact brain injury survivors’ ability to participate in holiday celebrations to the degree that they had in previous years so adjustments may need to be made in order to provide a greater likelihood of those survivors enjoying a successful holiday.  Part 2 will be focusing on some thoughts regarding participation in holiday celebrations.
One of the most difficult aspects of having a brain injury at holiday time is changes in the ability to participate in the holiday celebrations.  For instance, a brain injury survivor may have been the main cook for Thanksgiving but can no longer do so due to memory deficits or newly acquired physical disabilities (such as losing use of the entire right side of the body).  This can serve a tremendous blow to the survivor’s self-esteem and pride.  Family members may try to be helpful by telling the survivor to “not worry” and that the family members will “take care of everything.”  Many survivors will appreciate this effort at mitigation, but unfortunately some survivors will receive such an effort as an even further attack to their self-esteem.  If we were to choose a single most important guideline governing brain injury survivors’ participation in holiday festivities, rehabilitation therapists and professionals would encourage brain injury survivors and their families to find tasks contributing to holiday celebrations in which the survivor can fully participate.

 
The first part of identifying holiday tasks that the survivor can participate in is to take a realistic assessment of the survivor’s skills and deficits.  Safety concerns should always be held in priority, but they should not be allowed to unnecessarily overshadow consideration of reasonable options.  If a survivor has ataxia (inability to fully control muscle movement) in his or her arms, the survivor should not be lighting menorah candles for Chanukah.  Similarly, a survivor with balance issues should not be climbing on to the roof of a home to put up Christmas lights.  With this in mind though, a survivor will always have some form of identifiable strengths.  In fact, it is incredibly rare that a survivor would be unable to contribute anything at all to holiday celebrations.  For instance, though a survivor in a wheelchair may not be able to put up all of the decorations on the Christmas tree, he or she may be able to put up the decorations on the lower part of the tree.  A survivor may not be able to be fully responsible for the cooking of a turkey, but perhaps he or she could cut some of the vegetables for a salad or help set the table.  Even if a survivor cannot use his or her arms or legs, perhaps a role can be found such as leading the family in a prayer before eating or giving recipe directions to family members that are cooking.  Survivors with aphasia can sometimes sing, with help, familiar songs as the songs are so familiar that the action of singing them can have become almost automatic.  For example, many aphasic survivors that struggle to name a common item like an apple can sing a holiday tune like “Jingle Bells” or “We Wish You a Merry Christmas” if given extra time and if someone sings with them.  If survivors and their family members look closely enough, there is almost always something the survivor can do or help with.  Even a small task will help boost the survivor’s pride and self-esteem.  Moreover, injury or no injury, working together on holiday celebrations brings family together for a joyful opportunity to bond.

 
Many survivors struggle with the tradition of giving gifts at certain holidays such as Christmas and Chanukah, since they often find themselves contending with greatly worsened financial status in the aftermath of the injury suffered.  They have often lost jobs and can have high medical expenses which dramatically sap their funds.  Many now rely on financial support from family members.  Usually, families and friends understand that the survivor is in a different financial state but the survivor may still feel significant guilt over the inability to purchase gifts as he or she once did.  Simply reassuring a survivor that the family members and friends understand the changes and are not worried about not receiving a gift or are perfectly fine with receiving a smaller gift can help alleviate concerns.   Alternatively, a survivor could always put together a handmade gift or card with the help of a family member as necessary.  Everyone appreciates a homemade gift or card.  Families may choose to switch to a gift exchange in which everyone buys just one gift, places that gift in a bag, and then randomly chooses a gift from those assembled.  One gift is far less costly than multiple gifts.  A limit on the cost of gifts purchased can also be placed so as to further make participation easier and to help make the survivor feel less left out due to costs.  If an effort is put into de-emphasizing the role finances play in holiday celebrations, the survivor is often better able to focus on those more essential and meaningful aspects of the holidays.

 
Another consideration regarding holiday celebration participation is fatigue.  Holiday celebrations often go quite long and brain injury survivors may find that they become fatigued more easily than they did previously.  This is a particularly common issue during New Year’s celebrations.  Survivors who have grown accustomed to staying up until midnight to celebrate the new year may find that they now are exhausted by 8 p.m.  Sometimes, shifting the length of time that the survivors will be attending the celebrations in question can increase opportunity for participation.  Three good hours of participation is better than five hours of exhaustion.  Moreover, some families change the time of the celebrations entirely to make it easier on the survivors.  “Early” New Year’s eve celebrations are relatively common.  After all, it’s midnight somewhere.  Instead of a late Thanksgiving dinner, a survivor’s family might find that a Thanksgiving lunch is more feasible.  Perhaps gift opening can be done prior to a holiday meal rather than after the meal, which would speed up the main parts of the holiday celebration considerably.  These are just a few of the ways in which post-injury fatigue can be better managed at a holiday celebration.

 
Hopefully this post was able to raise awareness of adjustments in participation that can be made in order to increase a brain injury survivor’s enjoyment of the holiday season.  The next part of this series will focus on holiday adjustments that may need be made related to social interactions and attention.

 

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