Tag Archives: head injury

Quick Points on Wheelchair Safety in Parking Lots

Following their injuries, many brain injury survivors are left depending upon wheelchairs to meet basic mobility needs.  This change in mobility creates new safety considerations that must be taken into account on a daily basis.  One of these considerations surrounds strategies for safely navigating a parking lot while in a wheelchair.

Most adults are between 5 and 6.5 feet tall.  They are accustomed to being easily visible to drivers distractedly circling a parking lot and through rear windshields as drivers back up vehicles out of parking spaces.  When sitting in a wheelchair though, normal adults are often effectively no taller than  young children.  Even the most conscientious driver can struggle while exiting a parking space to see a pedestrian in a wheelchair.  These survivors are also often harder to see by a driver making the turn from one parking lot lane on to another.  Due to this change in baseline visibility, survivors in wheelchairs and their families must be more vigilant of vehicle activity and the abilities at every identifiable moment of drivers to see the survivors.  They must spend more time looking around to observe vehicle activity, just as they would when in the presence of a small child who may slip the notice of nearby drivers.

Another issue regarding parking lot safety is that survivors in wheelchairs are generally slower than the average person would be while moving across the same parking lot.  Since it takes more time to traverse any distance, survivors and their families must add extra time in their calculations as to whether there might be enough time to safely cross in front of an approaching vehicle.   If the result of such calculations inspire even the suggestion of doubt, erring on the side of patience is always the best policy.  Sometimes, family and friends may need to push the survivors’ wheelchairs to help move quickly enough to safely avoid traffic.  Additionally, typical adults generally can step up onto the curb from the parking lot at any location they choose.  Survivors in wheelchairs must use curb cut ramps which often means that they have to take a longer route to get onto the curb and consequently spend more time in the path of vehicles.  Again, survivors and their families must be aware of this additional urgency when choosing a path across any parking lot.

These are just a few quick points on wheelchair safety in the parking lot.  I hope everyone has a safe time in their travels, particularly in parking lots!

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

 

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Why Are We “Suddenly” Hearing About Brain Injuries

Brain injuries are a hot topic in today’s media.  Whether it be football players with lasting damage due to concussions, soldiers suffering from brain injuries due to overseas conflicts or the latest youth sports concussion protocols, it seems that there are suddenly many news stories on brain injury that simply were not around just five or ten years ago.  Some individuals may be cynical and wonder whether brain injuries are simply the “diagnosis of the moment”, one of the many diagnoses that are suddenly “hot” but will disappear over time.  To those individuals, I would like to offer several rational reasons why brain injury stories have become more prominent over the last few years.

First, many people are now living with brain injuries who would have died from their injuries in previous eras.  The medical world has advanced significantly over the years and now doctors are able to save the lives of people who would have otherwise died. However, just because their lives were saved does not mean they emerged from their health emergency unscathed.  These survivors often have brain injuries which require treatment.  Please allow me to give an example of this change over time.  I once was talking over lunch with an older rabbi about Transitional Learning Center.  He relayed a story about his time at a synagogue many decades ago in Indiana.  A young man in his community had a serious motorcycle accident and as his rabbi, he visited the young man in the hospital.  After conversing for a while and finishing his visit, the rabbi exited the room.  As he left, the doctor pulled him aside and said “You know he will be dead in three days”.  The rabbi was shocked, having just had a full conversation with the young man.  But the doctor was correct.  The hospital had no means to manage his brain injury.  Due to either brain swelling, bleeding or both (the rabbi did not know the details), the young man passed three days later.  Today, a person with a similar motorcycle accident would have a surgery and other potential procedures to manage his injury and would stand a good chance of living, albeit with a brain injury.  Similarly, improvements in military field medicine are allowing many soldiers to survive blasts and other dangers that would have killed them in previous battles.  Thankfully, these soldiers still have their lives, but often struggle with long-lasting brain injuries suffered in their military service.

Second, it is important to acknowledge the active suppression of information regarding brain injuries in certain circles that is only recently coming to light.  Most famously, the NFL actively denied and hid data on the long-term brain injury effects of concussions to former football players.  Through a series of lawsuits, the NFL opened up about brain injuries and is now acknowledging the long-term injuries that many former players have suffered.  This has led to a complex $1 billion settlement for players with long-term effects of brain injuries.  Following these court cases, many other lawsuits have been filed against other professional and amateur sports, leading to further agreements and new safety protocols.  The suppression in the past contributed to an artificial perception that brain injuries were less common than they actually were.

Third, we are in an age of information so it is much easier to learn about what is happening to people across the country, and even across the world.  Just think about how often you hear or read stories about a robbery or kidnapping occurring hundreds of miles from where you live.  Until the age of the internet, most of those stories would be confined to local media.  Now, stories can go “viral” and suddenly everyone knows the details.  This phenomenon is equally true in the realm of brain injuries.  A simple keyword search of “brain injury” will bring up a plethora of local stories that prior to the age of the internet would have been hidden from most of the world.  These local stories existed in the past but only now d0 we have so much access to them.

Fourth, we are now having a more honest conversation about brain injuries.  In the past, people generally did not talk about brain injuries.  Athletes and soldiers rarely mentioned their deficits due to fear of sounding “weak”.  Individuals with brain injury deficits from car accidents, strokes or other methods were often afraid of negative views and discrimination if others knew about their deficits.  We are now coming to an age of sharing without fear.  It may be hard to believe but the Americans With Disabilities Act (ADA), the civil rights legislation that has allowed for a greater involvement of people with disabilities in the workplace without fear of discrimination, was only passed in 1990.  In comparison, the Civil Rights Act, which blocked discrimination due to issues such as race, gender, and religion, was passed in 1964.

Fifth, we are much more able to diagnose and treat brain injuries than in the past.  Technology such as MRI and CT exams to scan the brain and locate injuries are relatively new.  Moreover until fairly recently many people, even health professionals, did not even know the right questions to ask to identify a potential brain injury.  For instance, if a high school athlete is concussed in a game today, the coach and athletic trainer often have a protocol to follow to ensure proper health management.  Twenty years ago, the player would likely have been just given smelling salts, asked if he or she felt “okay” and sent back into the game.  In fact, many states now have mandatory concussion training for coaches and athletic trainers.  This was unheard of just a few years ago.  In the past, people with brain injuries were forced to suffer in the silence of unrecognized deficits.  Now, these brain injuries and their concomitant deficits are more likely to be accurately diagnosed.

Overall, there are many rational reasons why we are “suddenly” hearing about brain injuries in the media, despite these injuries having been an issue in the past.

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

 

 

Just Be Grateful

“Just be grateful you are alive”

“Just be thankful you didn’t die”

“You should just focus on the fact you survived”

Brain injury survivors hear these types of well-meaning lines all the time.  They are used by family members and friends to help survivors see the “brighter side” during their recovery periods.  There is undeniable truth in each one of these statements; traumatic brain injuries, strokes and other forms of acquired brain injuries lead to death for millions of people worldwide every year.  It is worthwhile to be thankful for life.  But these well-intentioned statements can all too often serve as double-edged swords.

Taking a step back for a moment, most survivors are truly thankful to be alive following their near-death experiences.  But that does not mean that they have not suffered real, painful losses.  While one may feel the commendable impulse to encourage and support survivors, it is also important to allow them to mourn these losses.  There is nothing inherently wrong with lamenting loss of arm function or fluid speech, as long as this does not lead to a serious decline in mood or performance.  For instance, wouldn’t any person be upset if, after decades of normal walking, he or she would have to suddenly learn how to walk all over again because of a stroke?  A balance has to be struck between fostering positive mood and allowing for reasonable mourning of loss.  “Just be grateful you are alive” is clearly not an inherently harmful statement, but it can still nonetheless be overused and thus inhibit healthy adjustment to change.  Excessive  repetition of such a statement can often cause survivors to be frustrated and feel as if they are being discouraged from expressing their feelings.  Though it may be difficult for family members or friends to witness as survivors experience sadness or anger, this is often one of the steps necessary while making a successful transition into post-injury life.

 

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

 

Give Yourself Permission

Brain injury survivors and their loved ones often try to approach life after an injury as if it is a fight.  Battle hard, stay strong and never let your enemy see your weaknesses.  But in truth, though there are some similarities in this analogy that are appropriate, life after an injury is not an actual fight.  In fact, by treating it as a real fight survivors and their loved ones can sometimes hurt themselves by not allowing themselves to feel and process certain emotions in a healthy manner.  By not processing emotions, individuals may allow these emotions to fester inside and come out at the wrong time or in the wrong situation.  Not processing emotions can lead to difficulties such as depression, anxiety and relationship stress.  I would like to encourage you to give yourself permission to feel these emotions.

Give yourself permission to get angry at the injury.  It truly is a frustrating and unpleasant experience.

Give yourself permission to cry.  There is no weakness in crying.  This is an appropriate reaction to a painful situation.

Give yourself permission to mourn.  There may be parts of you from the past that will no longer be part of your post-injury future.  It is okay to mourn their passing.

Give yourself permission to laugh.  Laugh at the moments of oddity.  Laughter, in measured amounts, is a reasonable coping technique during times of distress.

Most of all, give yourself permission to experience and value the full range of your emotions.  After all, our emotions are important aspects of who we are as people.  They are a central part of simply being human.  So please give yourself permission to be the complete person that you are, despite your injury.

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

 

 

 

 

Doing It Best

Jahvid Best appeared to be on the road to football stardom.  Drafted in the first round by the Detroit Lions, Best possessed blazing speed that was the envy of other running backs.  Unfortunately, his professional football career met a premature end during it’s second year due to the effects of concussions.  Best put forth great effort to get back into the NFL but ultimately doctors ruled against his return.  For many people, this would be the end of the story.  For Jahvid Best though it was the start of something new.

One of the key tasks that brain injury survivors must navigate is assessing their retained abilities so as to identify what they can still do best in spite of their injuries.  Best understood that though his body was not ready to be tackled by 300 lb linemen, he still had his speed.  Best worked tirelessly at his skills on the track.  The hard word paid off.  Best qualified for the 2016 Olympics in Rio, where he will be representing the island nation of St. Lucia.  Best demonstrated how to thrive and succeed in spite of an injury!  Though he was not a TLC patient, we certainly think he is a true hero for the brain injury community.  Identifying a survivor’s skills and choosing activities that match those skills is a key part of the rehabilitation process.  For more reading on Jahvid Best’s journey, click on the link below:

 

http://olympics.nbcsports.com/2016/07/16/jahvid-best-olympics-detroit-lions-nfl-football-track-and-field-st-lucia/

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

 

 

 

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/

 

 

 

But Are You Getting Help?

Following a brain injury, family members will often spend every possible moment dedicated to efforts in support of an injured loved one and devote special attention to helping that survivor get the best care possible.  They with rare exception will spend countless hours on the phone battling insurance companies and filling out forms.  These family members must deal not only with stressors directly related to worrying over a  loved one’s health, but must make peace with planning for a suddenly very different future and must manage (sometimes alone) a freshly revealed terrifying financial mine field.

Brain  injury survivors themselves also face an enormous number of stressors as they struggle to regain command of basic skills and learn different ways to perform common tasks.  However there is a major difference in this regard between the brain injury survivors and their family members, particularly while the survivors are in rehabilitation.  The brain injury survivors are surrounded throughout the day by professionals trained in the treatment of brain injury who can help with mood, education and adjustment.  Survivors merely need look to their immediate surroundings to find an abundance of professional help to address any difficulties.  Family members generally do not have anything approaching such a level of support so readily available.  With all this in mind, it becomes clear just how thoroughly brain injuries are in fact a family affair.  All members of a family are affected, not just the brain injury survivor.  Likewise, all family members are part of the team necessary for managing long-term effects of the injury.  It is important that all members of the team (not just the survivor) are receiving the help and support that they need in order to adjust to these major life changes.

At TLC, staff commonly ask survivors’ families, “Are you getting help?” and “How can we help you through this process?”  It is important that family members do not neglect themselves while giving all they can to aid injured loved ones.  Such care taken is in the best interests of both the personal health of the family members in question and the optimal well-being of the survivors they support.  Caregivers with high stress levels often find themselves more susceptible to physical illnesses than the average person.  A family member side-lined by illness can offer only a fraction of the aid and support he or she would wish to.  Further, family members deserve to be allowed to live their lives to the most complete level of happiness possible (just like the survivors deserve to).  Put simply, if these family members are struggling themselves then they are placed in a severely disadvantaged position from which to help the survivors in their lives.

Family members of survivors should consider personal therapy and support groups as aids for their own psychological and spiritual adjustment (Both the Brain Injury Association of America and the American Stroke Association offer listings of local support groups).  These family members can often benefit from reaching out to friends and community resources in order to better address the management of difficulties.  Seeking help is not a sign of weakness but is instead a common sense step taken in the interest of maximizing both individual and family success and happiness.  Brain injuries are complex and stressful.  Family members should not pretend to be super-humans capable of handling anything and everything.  They should actively ask doctors and therapists for information on brain injury prognoses, education resources and proven strategies helpful in planning for the future.  Overall, one of the most important ways that family members can contribute to the advancing well-being of survivors in their lives is to remain sufficiently mindful of their own.

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