Tag Archives: cte

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/

 

 

 

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Bubba Smith and CTE

The phrase “larger than life personality” could have been invented to describe Bubba Smith.  Looming at 6’7″ and almost 300 pounds, he was the first pick of the 1967 NFL draft and earned his ring at Superbowl V with the Baltimore Colts.  His extraordinary defensive skills on the football field left many a shell-shocked quarterback lying prostate in his wake.  Following his nine year professional football career, he parlayed his fame into a second career in film and television.  He is best known in the acting world as Captain Moses Hightower in the Police Academy movies and for his appearances in Miller Lite commercials.  After he passed in 2011, his estate allowed researchers to study his brain for evidence of Chronic Traumatic Encephalopathy (CTE).  It was discovered that he had been living under the effects of level three CTE (the scale runs from one to four).  Follow the link below to read more about these findings.

http://www.nytimes.com/2016/05/25/sports/football/bubba-smith-cte-nfl-concussion.html?_r=1

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

 

 

 

Who Will Be There When I Am Gone?

Fields related to the treatment of brain injury have improved by leaps and bounds over the last twenty to thirty years.  People who have suffered severe traumatic brain injuries are today surviving from injuries that would have once been fatal.  Health care professionals are able to manage associated medical issues and injury deficits left in the wake of traumatic brain injury better than ever before.  This has led to brain injury survivors with serious impairments being able to live longer than could have been imagined just a short time ago.  This also then means that many of these survivors will have need for others to serve as caregivers for them many years into the future (in some cases even for decades).  These caregivers may be called upon not only to help with day-to-day activities but also may be legally responsible for making medical, legal and financial decisions.  This brings us to an important question for those caregivers to consider. If something decisively unfortunate were to befall such a caregiver, have contingency plans been made to ensure that those care and legal responsibilities would continue to be sufficiently addressed?  For example, let’s say that a forty year-old man survives an aneurysm which leaves him unable to make his own decisions and subsequently his sixty-five year-old mother takes over these responsibilities for him.  A man that young in reasonably good health could fairly be expected to live at least another twenty years under such a circumstance, which would then put his mother at eighty-five.  Can anyone guarantee that his then eighty-five year old mother would continue to have the ability to make such decisions for him?  What happens if she faces a health issue such as Alzheimer’s or cancer that would effectively dismantle her ability to make his decisions for him?  Can anyone even guarantee that she will survive all the way to eighty-five?  Clearly, a plan needs to be put in place to designate a replacement to step into the mother’s critical role in this man’s life should she suffer incapacitation or pass away.

Putting together such a plan is no simple task and in many cases families will need to consult an attorney in order to formulate a coherent, legally binding plan.  These plans will generally involve issues such as daily care, financial management and legal responsibilities.  Questions have to be answered such as where the survivor will live and who will monitor disability or like payments should a current caregiver be unable to continue in his or her role.  Also, plans may need to be updated over time to reflect changes.  Using the earlier example, let’s say that in the mother’s will she appoints the survivor’s uncle to take over the legal responsibilities in her son’s life after she’s gone.  If this uncle’s wife developed a serious illness that suddenly demanded all his time and energy, the mother would likely want to update her will and appoint a new person to be responsible in case she became incapacitated or passed away.  Sometimes multiple people are listed in the plan (often in descending order), identifying a line of succession regarding those responsible for seeing to the survivor’s well-being.  This even further bolsters guarantee of a survivor’s continued security.  Sometimes roles are also divided among different individuals.  As example, one person may be responsible for daily physical care while a different person might be assigned ultimate authority over medical decisions.  No matter what plan is put in place (for this or for any other issue), the brain injury survivor should take part in the planning to the best of his or her abilities.

Planning for the future is a serious issue and should be started as early as possible.  Most survivors’ brain injuries make entrance into life suddenly and without warning, and caregivers can just as abruptly have their own issues present that prevent them from maintaining their caregiver roles.  For those that do not have the financial means to hire an attorney to develop a plan, there are legal aid offices throughout the United States that provide free legal services.  Follow the link below to search for a legal aid office in the United States.

 

http://www.lsc.gov/what-legal-aid/find-legal-aid

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

Give Me Your Best 40%

Good days, bad days.  Everyone has them.  No one minds the good days, but those bad days can be such headaches.  Maybe you didn’t sleep well the previous night.  Perhaps your children were sick and were thoughtful enough to pass their germs on to you.  Those bad days pose a regular struggle that we can only push through.  However, sometimes bad days have potential to knock traumatic brain injury and stroke survivors to emotional low points markedly lower than anything experienced in their lives prior to the injury experience.

Often, patients will apologize to their therapists when they are having bad days, even though they would not feel the need to do so when going through a similar bad day at a job in their pre-injury lives.  In reality, no apology is truly necessary.  Having good days and bad days is not only a natural part of life, but is just as natural a component of the journey to recovery.  The progress of a healthy recovery can usually be observed to resemble that of a healthy stock market.  We can track plenty of ups and downs, but a general upward trend is just as persistently evident.

On rare occasions, a patient may ask a therapist if he or she can skip a session because he or she is having a bad day.  Unless the patient is deemed unable to participate in therapy by a facility nurse or doctor, the patient will be strongly encouraged to engage in therapy.  This can be a bit confusing for patients.  After all, why shouldn’t they be able to skip rehabilitation when having a particularly bad day?  I will explain some of the logic involved in having patients stay in therapy even on those bad days.

First, as stated earlier, bad days are a natural part of life.  Therapists know that on some days a patient will simply be unable to contribute that normal 100% effort.  This is fine.  Advances in therapy can be made even on bad days.  A therapist will always take a patient’s best effort, whether it be that patient’s best 80%, best 60% or even a 40% effort.  Every step forward in rehabilitation is a step in the right direction.  Second, it is important to remember that every activity in rehabilitation is aimed at facilitating success following discharge.  At home, just like in rehabilitation, there will be good and bad days.  Survivors need to be just as prepared to handle bad days at home as they are to handle the good ones.  For example, a patient may not want to work on hand skills necessary to use adaptive flatware on a bad day.  But what is that patient going to do when he or she is hungry at home on a bad day?  Will the patient not eat because he or she is having a bad day?  Good day or bad day, the same skills will be used to succeed at home and therefore they need to be practiced both on good days and bad days in therapy.

So don’t worry about having a bad day.  Just give therapy your best effort, even if on that day your best effort is only 40%!

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

Using Stories To Aid In List Memory

The human brain is fascinating for so many reasons.  One of these reasons can be seen in the expression of its preference for different styles of memory.  The brain generally has a preference for remembering stories as opposed to random lists of information, even though there are many more words in a story to remember than there are in a list.  It can be demonstrated though that this preference for stories can in fact be used to help bolster the memory for lists of items.

Individuals generally encounter lists of items in areas of daily life related to shopping, school, work, and other like activities.  You may have a list of items that you need to buy at a supermarket.  Your boss may ask you to pick up a list of items from the stockroom to place on shelves.  A teacher may ask you to bring in certain items for a class project.  Although it is of course advisable to write down or record in some manner any such list of items, you may not always have a pen and paper or other recording device available.  If you take such a list of items and turn it into a brief story though, you might be surprised by how much easier it becomes to remember.

Let’s say you have three items to remember to buy at the store: milk, cookies and napkins.  You can use to your advantage the brain’s natural preference for having these items organized as components of a story over simply having them listed one after the other.  It takes little effort to come up with a brief, one-line story that uses these words.  For example, the story in this instance could be “I like to dip my cookies and milk and then wipe my mouth with napkins.”  Most people will find it easier to remember this short story than to remember those same three words in list form.  A similar scenario could be encountered working at a large store like Wal-Mart or Target.  Your  boss may ask you to bring out light bulbs, toilet paper and paper cups.  This is a pretty random list of items which may be difficult to remember in its current form.  Turning this list into a short story may be beneficial.  For instance, the story here could be “There is no light bulb in the bathroom so he tripped over the toilet paper and knocked over the paper cups.”  Again, by putting the list of words into a brief story, the brain will find it easier to remember the information.

There are a few handy pointers to keep in mind when turning a list of items into a story.  First, the story should be relatively brief.  If you are trying to remember three or four words, the story should not be much longer than a single complex sentence.  Five or six items may require a story to be two to three lines long.  A story cannot be so long that it becomes itself difficult to remember.  The story should also create a visual image in your mind.  If you can “see” the story in your mind, then chances are that you’ve succeeded in creating a story useful in achieving the objective of bolstering memory in this way.  Using one of the previous examples, you may be able to imagine someone in a dark room tripping over toilet paper and knocking over cups sitting by the sink.  If you can see this happening in your mind, then the story worked for you.  It is very important that the story be one that is functional for you.  You should not concern yourself about whether others would like your story or find your story odd.  Too often, brain injury survivors using this method will self-censor their stories because they feel that others might not like those stories as they initially occur to the survivors.  These stories exist only to aid our memories.  The opinions others might hold of them therefore are not truly relevant.

This method of improving memory takes practice but once you get comfortable with the method, it can be very useful!  Please leave me a comment below with any questions, thoughts or ideas!

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

Attention Process Training

Attention is a foundational skill that lays the groundwork for much of our cognitive functioning.  For instance, absent sufficient attention paid to your supervisor’s directions, it is impossible for you to remember and then follow those directions.  Similarly, without proper attention given to driving one cannot solve critical problems that may come up (such as avoiding a potential accident).  These examples of how attention affects other cognitive domains such as memory and problem-solving are just the tip of the iceberg when it comes to understanding the importance of attention.  One research-demonstrated method of improving attention after a brain injury is through Attention Process Training.

Attention Process Training (APT) is a multi-session exercise designed to help improve the brain injury survivor’s ability to focus on relevant material while ignoring irrelevant distractions.  Further, it helps improve the speed of processing information.  Speed of processing is a very important factor to success in areas such as driving, as the driver must pay attention to a myriad of information (even more so at high speeds).  The APT version used by the Transitional Learning Center consists primarily of the patient listening to audio tracks presenting a variety of information and then being asked to press a buzzer when information previously identified as relevant is given.  For instance, the audio track may consist of a long list of numbers and the patient must press the buzzer every time he or she hears the number 5.  These tracks are always first read slowly, and then repeated at an increased speed.  The therapist listens for errors of omission (missing the relevant information) as well as errors of commission (pressing the buzzer as an indication of having heard distractor information).  The APT tracks become steadily more difficult as the tasks progress.  After completing the tracks without any background noise, the tracks are repeated but this time including a different voice reading newspaper articles in the background.  Again, the patient must press the buzzer for the relevant information and ignore the distracting information (now including that background voice).  This skill is important since most life tasks involve some form of background distraction.  As example, a parent may cook a meal while his or her children are watching television.  If the parent is not able to sufficiently ignore the background noise of the children and the television, there may be a large kitchen disaster.  When a patient demonstrates good skill on these first tasks, he or she will be moved to a more difficult version of APT in which he or she must not only listen for relevant information but also alternate between sets of information to which he or she must pay attention.  For instance, a patient may have to alternate between listening for names of sports and names of animals.  This alternating attention is also important in our daily lives.  One common example of an alternating attention task would be found at a cookout, when a cook has to alternate between watching the meat grilling on the barbecue and cutting vegetables for condiments.  A failure to alternate attention adequately could lead to a charred dinner or a lost finger.

By working with Attention Process Training, patients can strengthen these vital attentional skills and thereby be more successful in their daily lives.  TLC has seen many patients improve in their overall functioning through this training program.

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

Tips for Improving Attention

Attention is an important skill. It plays an integral role in almost everything we do. Attention is vital when we engage in daily activities such as paying bills, driving a car and safely walking through a busy parking lot. After a brain injury, many survivors notice significant challenges in the realm of attention.  Their attention spans may be much shorter, they may find themselves now to be far more easily distracted than they once were, and multitasking may no longer be in any real way feasible. Here are a few tips to help improve attention:

1.  Find a quiet location to work on activities. The more quiet the surroundings, the less likely distraction is to present as a significant factor while completing those activities.

2.  Remove all distracting items such as cell phones, Ipads and radios while involved in activities.  One should also silence ringer/alarms on phones and watches.

3.  Let other people in the vicinity know that silence is needed when working on an activity so as to minimize likely instances of disruption.  Often, a “Do Not Disturb” sign works well to notify others to be quieter.

4.  Break down activities into smaller, simpler tasks. It is much easier to pay attention to smaller, simpler tasks than it is to contend with larger, more complex activities.

5.  Do one activity at a time.  All people, whether they have a brain injury or not, are better at focusing on a task if they tackle just one activity at a time rather than make an attempt to multitask.

6.  Organize activities before starting them. It is far easier to focus on organized activities than it is to grapple with disorganized ones.  Good organization also provides a road map for how one can most successfully approach a task.

7.  Schedule regular breaks during activities. Most people can only pay attention effectively for a limited period of time until they need a rest and that already limited period may be significantly diminished following a brain injury.

8.  Set up a reward to accompany completion of an activity so as to help with motivation and focus.  For instance,  watching a favorite movie or eating a favorite snack could be arranged as a reward to be enjoyed upon conclusion of a task.

9.  Make sure to eat well, stay hydrated and get plenty of rest. If a body is not functioning at its top level, attention skills will often be the first cognitive skills to suffer.  Many brain injury survivors find that strictly adhering to a well-considered health regimen is far more important to success after an injury than it was before.

10.  Ask people to speak slowly or repeat themselves if paying attention when they are speaking proves difficult.  People get far more upset if their audience misses what they are saying than if they have to repeat themselves in order to ensure that they are fully understood.

11.  If in a group of people, be sure to stay facing the person who is speaking.  If there are too many people around to effectively attend to, ask the person speaking if he or she could step away from the group to make focus more attainable.

12.  If in a classroom or meeting, make sure to sit in the front of the room so as to be closer to the speaker.  This not only removes as a factor distracting people and noise along the pathway to the speaker, but it also demonstrates interest in what the speaker has to say.

13.  Place a fan or a white noise machine by doors to help eliminate distracting noise coming from the outside of rooms.

14.  Place a bright colored piece of paper under a book being read.  This helps the eyes to stay focused on the book instead of on outside distractors since our eyes are naturally attracted to the bright color. Also, one can place a brightly colored ruler, index card or piece of paper under the line being read so as to help keep eyes focused on that line.

Hopefully this provided a few ideas on how to help improve attention!

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

NFL Settlement Battle

Lawyers representing the vast majority of National Football League retirees seeking legal recourse due to the deleterious effect upon their lives resulting from brain injuries suffered throughout the course of their careers will be in court on Wednesday to argue over the terms of the settlements between the NFL and those former players.  This may be the final settlement between the NFL and the former players, though some players have opted out of the settlement in order to pursue individual lawsuits.

http://www.reuters.com/article/2014/11/17/us-nfl-concussions-idUSKCN0J123S20141117

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

Tony Dorsett

Tony Dorsett was one of the greatest players in football history.  Over the years he began to experience memory loss, mood swings and thoughts of suicide.  He took the initiative to be tested for Chronic Traumatic Encephalopathy (CTE), which is a brain damage experienced secondary to multiple traumas to the brain.  In Dorsett’s case, these traumas occurred as a result of the thousands upon thousands of hits he endured  over the course of his playing career.  Dorsett was found to have signs of CTE.  The link below will bring you to a video in which he discusses his experience learning to cope with the symptoms of brain injury. In addition to providing further detail on Dorsett’s story, the article beneath the video relates the similar experiences of Hall of Fame lineman Joe DeLamielleure and All Pro linebacker Leonard Marshall as they also have experienced brain injury symptoms and received the CTE diagnosis.

http://espn.go.com/espn/otl/story/_/id/9931754/former-nfl-stars-tony-dorsett-leonard-marshall-joe-delameilleure-show-indicators-cte-resulting-football-concussions

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