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, favor certain styles of clothing or wear certain shades of lipstick. Catching sight of ourselves in a mirror presenting in our typical manner helps reinforce a sense of normalcy. Any change to our usual look or style has potential to cause us some level of 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, “Why dress to impress? I have no one to impress. 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 a constant reminder 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. In turn, 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 in mood.

As “dressing down” makes many survivors feel badly, dressing as they would have 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 experience of seeing themselves fully “put together” will often improve survivors’ 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/

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

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/

 

 

 

The Problem With the Word “Should”

The word “should” may be one of the most hazardous words in the life of a brain injury survivor.  It tends to appear in sentences such as “I should be walking already” or “I should have been back at my job by now.”  The word confers a tremendous degree of expectation on the survivor and implies that somehow the survivor is a failure if he or she has not achieved what he or she “should” have achieved.  Often, this word sparks a cascade of statements by which survivors verbally punish themselves.  “I should have been able to walk without a wheelchair but I instead I fell.  I should be doing better with my mobility.  I am letting down my whole family!”  These “should” statements can easily lead to depression, stress and damaged self-esteem.

The reality is that each brain injury heals at its own rate and as a result each survivor is left with his or her own unique set of challenges.  After a serious brain injury, it often takes a survivor considerably longer than he or she may expect to reach goals due to the severity of the injury suffered.  An injured brain is not like a broken arm.  You cannot put a brain in a cast as you would put an arm, expecting that in a relatively brief period of time the brain will be healed.  Brain injury rehabilitation is a process that takes time and patience.  The only applicable “should” enters into consideration in emphasizing that the survivor should dedicate full effort to his or her therapies.  That is all anyone, including the survivor, can reasonably ask for.  As long as the survivor is giving his or her best effort, the survivor is doing everything in his or her power to get better.  The rest of the process will depend on time, the practicing and learning of new skills and how the survivor’s individul brain heals following a specific injury.  Recovery cannot be rushed or forced.  “Should” statements that imply that somehow recovery ought to have gone differently are thus plainly revealed as emotional snares best avoided.

 

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

 

Fatigue

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

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

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

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

Mood and Awareness

It can be scary when a brain injury survivor lacks sufficient awareness of the full effect an injury has had upon his or her life.   It can be all too easy for a survivor in such a circumstance to engage in what could potentially be extremely risky behavior. For instance, if a survivor does not realize that he can no longer walk, he may attempt to get up from his wheelchair anyway to walk to the bathroom. This could lead to a terrible fall. Similarly, a survivor who is not aware that she now suffers from severe memory deficits may turn on a curling iron for her hair and forget to turn it off. This could lead to a fire. When survivors gain in awareness of their situations post-injury, families understandably feel much more at ease as these risky behaviors can only decline.

However, there is one downside to such improved awareness. When a survivor first becomes significantly aware of his or her deficits, he or she often experiences a marked decline in mood. The survivor is suddenly aware of the severity and implications of the injury. It is depressing to realize that life has changed, in some cases irrevocably, and that success over these new challenges can only come after many trials and tribulations. It is important that the loved ones of brain injury survivors understand that this decline in mood is natural and expected. This is the time when a psychologist, counselor or psychotherapist can step in and help the survivor adjust to his or her new situation. With therapy and support, most brain injury survivors will see an improvement in mood after this initial decline due to increased situational awareness.

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

What Is a “Flat Affect?”

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

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

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

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

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

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