Tag Archives: head injury

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

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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

Left Neglect vs. Field Cut

It is possible for multiple distinct symptoms of an acquired brain injury to present in remarkably similar fashions.  For instance, a brain-injured survivor’s failure to take medication could be due to a memory deficit leading that survivor to simply forget his or her medication or it could be due to an attention deficit leading the survivor to be too distracted to take the medication in question.  In each case the medication was missed, but for acutely separate reasons.  A similar issue comes to light in observation of post-injury visual deficits.  Did a survivor fail to notice information to his or her left due to left neglect or due to a field cut?

Let’s start off with outlining precisely what a field cut is, as it is the simpler of the two to understand.  Under the effects of a field cut, the survivor has actually permanently lost the ability to perceive a portion of the field of vision.  That area of the field formerly available has now been “cut” away.  Due to his or her injury, the survivor is now in effect partially blind.  In medical terms, this loss of vision is often called “hemianopsia.”  So a survivor contending with a field cut has had actual visual loss  in his or her left visual field and thereby misses seeing information on his or her left side.

Left neglect is an attention issue which often manifests in the visual attention domain.  It is associated with an injury to the right side of the brain.  With left neglect, the brain fails to pay attention to information to the left side of the survivor.  If you ask a survivor with left neglect to turn his or her head all the way to the right, he or she will generally turn until the chin reaches the right shoulder.  However if you ask the same survivor to turn to the left, he or she may only bring the chin half-way to the the left shoulder despite fully understanding the request and giving a best effort to fulfill it.  It is almost as if the survivor’s brain is saying, “the left side of the world does not exist.”  The survivor’s eyesight can be perfectly intact, yet his or her brain is ignoring information generated from the left side.  This ignoring is not voluntary; as far as the survivor is consciously aware, he or she did look all the way to the left even though an outside observer can clearly see that the survivor did not make it all the way over.  Again, though it appears functionally as if the survivor has lost vision, the underlying issue is one of attention.

In the case of a field cut, most survivors do reasonably well after becoming sufficiently aware of their field cuts.  They will after enough practice naturally turn and make that extra effort to look for the information in their blind spots.  For a survivor with left neglect, improvement requires not just awareness but also daily repetition of scanning exercises and consistent use of visual aids.  As example, a survivor with left neglect may practice scanning techniques by slowly looking for information on a piece of paper being sure to start all the way on the left of that page before scanning across.  It can also be helpful to put a brightly colored highlighter mark on the paper to identify the far left of the page.  Sadly, in some cases a survivor will suffer from both left neglect and a field cut.  This combination can of course make successful functioning especially difficult, but with appropriate dedication and determined effort most any such goal gains entrance into the realm of the attainable.

I hope this clarifies the differences between left neglect and a field cut.  Please leave me a comment below with any questions, thoughts or ideas!

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

When Can I Return To Work?

One of the main roles we fill in life, and subsequently one of the chief ways in which we define our identities, is through our jobs.  Work is also incredibly important as it provides the money needed to cover the expenses of daily life.  Further it is one of the primary ways we spend our time during the week, taking up at least 40 hours per week for most employed adults.  When a person receives a brain injury, he or she often struggles with being out of work.  Staff at TLC will commonly be asked by a patient “When can I return to work?”  However, this question is far more complex than it appears on the surface.  This post will address some of the issues involved in returning to work following a brain injury.

Jobs differ greatly one from another.  The skills necessary and education required to become a lawyer are completely different from benchmarks met on the journey to a career as a plumber.  Both are highly skilled positions, but each has a very different set of job demands.  For instance, if a plumber lost functioning of his hands he would not be able to return to his job as relying upon excellent hand coordination is an essential aspect of that job.  However as a lawyer’s job generally does not require much or any mandatory use of the hands, that job could be more easily modified to allow the injured lawyer to return to work.  As one example, the task of typing reports could be replaced with use of voice recognition computer software.  The first question that needs to be asked regarding such a return to work is whether the survivor’s current skills are sufficient to facilitate that return, and within that consideration it must be determined what level of modifications might be appropriate.  Does the survivor have the requisite skills to fulfill the demands of the job?  This is a different question than whether the survivor remembers how to do the job.  Most people who have worked the same job for a few years can recite their job requirements in perfectly accurate detail.  This is generally true for brain injury survivors as well.  Following a brain injury, a survivor will more often than not have a functionally intact memory of life prior to his or her injury and therefore be able to easily describe the job activities engaged in that pre-injury life.  The issue is not whether the survivor remembers the job, but whether he or she possesses the skills to do the job right now.

To help determine whether the survivor is capable of meeting the challenges posed by a given job, it is often helpful to make a list of job requirements to be set against a list of the survivor’s strengths and weaknesses.  Each task making up an essential part of the job should be listed.  Often, employers will make available job descriptions and/or task analyses that can help in this process.  Next, survivors should write down their current strengths and weaknesses.  During this activity many survivors tend to report what they excelled at in their lives pre-injury, as the injury itself will generally do little to change that innate understanding of one’s self.  Keep in mind though that the past is in the past; the pertinent question at hand regards what skills the survivor retains at present. Also, the survivor and his or her loved ones should not attempt to take into account how skills might soon improve when creating this list.  As the future is ultimately unknown, it is vital to complete this task listing only the skills the survivor has today.  As weaknesses that may affect job performance are identified, the survivor and loved ones should attempt to identify whether there are ways to remediate a given weakness. For instance, if a survivor’s wheelchair will not fit under a worktable, perhaps lifts can be placed under the legs of the table so as to raise the table and enable the front of the wheelchair to fit under.  In employment law parlance, these relatively minor remediations are generally called “reasonable accommodations.”  It is as a rule mandatory for employers to provide these reasonable accommodations to employees once notified of need.  (For those interested in learning more about these laws, please click on this link to Americans with Disabilities Act: Questions and Answers http://www.ada.gov/q&aeng02.htm)

Unfortunately, not every brain injury survivor can return to a former employment situation.  In some cases, the survivor’s injury deficits may provide simply too great an obstacle to achieving the level of success once enjoyed by that survivor in his or her pre-injury career.  In other cases, a survivor may have been let go by an employer post-injury.  Additionally, some survivors may have been unemployed at the time of their injuries.  To find a new job, the survivor and his or her loved ones need to consider the matching of the survivor’s strengths to possible employment positions.  An important part of this process is listing the survivor’s strengths.  One way of doing this is by creating an employment skills inventory.  It is helpful to break up the various skills into categories.  One such breakdown is as follows:

Cognitive/Physical/Sensory Skills (For example: Walking or Speaking)

Skills and Areas of Knowledge Gained at Previous Jobs (For example: Using a cash register)

Skills and Areas of Knowledge Gained through School/Training (For example: Algebra)

Skills and Areas of Knowledge Gained from Family Members and Friends (For example: Speaking Spanish)

When creating an inventory, it is important to identify each particular skill and area of knowledge as specifically as possible rather than writing them down as more broad statements.  For example, a survivor might want to add to the list skill as a salesperson.  However sales positions are often made up of many distinct component parts such as selling items, servicing customers, completing billing, collecting money and using computerized inventory software.  Each and every skill and area of knowledge should be listed independently regardless of how unimportant one may seem.  Once all of the skills and areas of knowledge are listed on the inventory, survivors and their families can see how these skills and areas of knowledge can combine to match different lines of work.  For instance, a survivor may list that he or she naturally has good speech and organizational skills, has well-developed managerial skills after having served as an officer in the military, has substantial inventory skills gained while working as a clerk in a factory and is fluent in Spanish due to growing up in a Spanish-language home.  In assembling these once disparate facts, it suddenly becomes clear that this survivor may be a strong candidate for a bilingual inventory manager position in a warehouse.

With all of this in mind, it is still not easy to return to work.  Many survivors have been out of work for months or even years prior to attempting a return to the workforce.  It is generally recommended that a survivor return to work on a part-time basis and then slowly move toward a fuller schedule.  There are a few very good reasons supporting this approach.  First, after being out of the employment scene for quite some time, most people lose to a certain degree their “work hardiness.”  Many survivors find that when they first return to work, they become tired far more easily than expected.  It is often necessary for them to build up their strength over time in order to enable them to physically and mentally stay on task for an extended period of time.  Second, by working a shorter day it is easier to identify and correct any possible areas of difficulty that a survivor may encounter due to his or her injury.  As example, if a survivor is working four hours a day and finds that attention deficits are negatively impacting performance, he or she can simply try different methods designed to assist in blocking distractions.  If the survivor is working ten hours a day, it is hard to discern if poor performance is due to injury deficits or is rather due to the unavoidable fatigue that comes with working long hours.  If the survivor is beginning a new line of work (particularly if that work earns the survivor less money or carries less prestige than the survivor’s former employment), it is important to encourage the survivor.  Just getting back to work after a serious brain injury is a tremendous accomplishment.  Further, the first job after a brain injury does not have to be the survivor’s “forever” job any more than a first job out of high school was necessarily his or her “forever” job.  These first jobs can be seen as stepping stones to greater employment success in the future.  Overall, patience is vital in its role central to any successful return to work.

Unfortunately, some brain injury survivors may simply never reach the point at which a return to paid employment becomes feasible.  However, there may be volunteer opportunities that the survivor could engage in which can both occupy his or her time and bring a missing sense of accomplishment and contribution to the larger community into his or her life.  Volunteers are the lifeblood of many charities, hospitals and religious organizations.  Volunteering also provides a useful opportunity to practice post-injury work skills in a safe environment in anticipation of future employment.

There are several organizations that can help a survivor through the post-injury employment process.  In the State of Texas, the Department of Assistive and Rehabilitative Services (DARS) has a Vocational Rehabilitation (VR) department that can help provide therapy and support for brain injury survivors who are strong candidates for employment (http://www.dars.state.tx.us/drs/vr.shtml). In fact, the Transitional Learning Center often works with VR candidates from DARS in order to help those individuals return to employment in their post-injury lives.  The Job Accommodation Network offers excellent information for both employment seekers and employers looking to facilitate the return-to-work process (http://askjan.org/).

Hopefully this post helped outline a few of the considerations important to a post-injury return to work.  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

Taxes and Medical Deductions

As Tax Day is upon us, it is important to remember that many of the expenses that brain injury survivors and their families incur as a result of injuries suffered can then be deducted when preparing a given year’s Federal tax return.  The link below leads to an official IRS overview of which medical expenses can be deducted for this year’s Federal taxes.

https://www.irs.gov/taxtopics/tc502.html

The IRS even has an interactive tax assistant to help you determine if you can deduct a particular expense.  It is fairly easy to use though it has a bit of weird feature in which there is a drop down menu of letters of the alphabet where you first identify the type of expense by the first letter of the word (e.g “B” for “Bandage”) and then there is a second drop down menu which follows for the actual name of the expense (e.g. “Bandage” and “Breast Reconstruction” are all under the “B” drop down).

https://www.irs.gov/uac/Can-I-Deduct-My-Medical-and-Dental-Expenses%3F

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

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

Caregiver Burden And the Initial Injury Event

Families of brain injury survivors are often the unsung heroes of the injury experience.  They are the individuals who insisted the doctors not give up on their loved ones.   They are the individuals who spent the sleepless nights on uncomfortable hospital chairs and stressful days trying to hold a chaotic home life together.  They battled the insurance companies for hospital and rehabilitation coverage.  They support the survivor in countless ways during rehabilitation and then beyond the point when formal rehabilitation services conclude.  However, many family members and friends fail to adequately appreciate the burden that a caregiver is under.  Even some of the primary caregivers themselves may not fully recognize the difficulties they are experiencing.  The stress and problems due to caregiver burden can lead to those caregivers experiencing a decline in both physical and mental health.

When a person is injured, families often get a sudden call from the hospital warning them that they must come as quickly as possible because their loved one is hurt and may die.   It is important to appreciate this terrifying experience.  Life is instantaneously turned upside-down.  Family members run off to the hospital not knowing what to expect.  Often they come to an emergency room to find their loved one hooked up by a number of tubes and hoses to a variety of machines.  In the case of an accident, the loved one may well be horribly bruised and bleeding with broken limbs.  Doctors likely will come over to advise the family of the terrible news and to inform them of the potential severity of the injury, often relaying death as a possible consequence.  Family members are thrust into the position of caregivers required to make life-and-death decisions.  They may be asked to consent in their loved one’s place for complex surgeries such as a craniotomy (in which part of the survivor’s skull is removed to counter swelling and bleeding in the brain).  Even with these life-saving procedures, families are warned that their loved one may not survive.  This may then leave families forced to wait on pins and needles for days on end.  Their loved one may be in a coma for days, weeks or even longer.  During such a period, family members may rightfully worry whether their loved one will ever wake up at all.  The newly injured person may suffer setbacks such as seizures or infections such as MRSA, each of which bringing with it new risks and fears.  At every step family members are forced into the role of caregivers, being updated by doctors and attempting to make the best of often unpleasant situations.  In some cases, family members are the first to find their injured loved one following the brain injury or actually even had the misfortune of watching the injury as it happened.  In these cases there is the added terror of having to summon an ambulance while helplessly watching as a loved one suffers.  This can be not only an incredibly scary moment but also an incredibly lonely moment as the family member stands alone, staring at the clock and hoping the ambulance will arrive in time.

These injury events are often the start of the caregiver burden experience.  The caregivers undergo a physically and mentally exhausting experience and though their loved one may survive, the injury event experience often leaves a permanent emotional scar.  This is a traumatic event, similar in some ways to the trauma someone may experience watching a fellow soldier get shot in battle.  There are feelings of fear and helplessness as little is left to do but watch as a loved one fights to survive.  Caregivers may have nightmares regarding their loved one’s injury.  They often go throughout the day worrying that their loved one will suffer subsequent injury and decline or even worse, die.  In some cases, caregivers blame themselves for their loved one’s injuries.  They may tell themselves, “If only I hadn’t let her have that last drink, she would have never been in that accident” or “If only I’d made more of an effort to ensure that he’d eaten better, he would have never had this stroke”.  For some caregivers the date of the injury becomes an anniversary of a new life.  For others it will forever be known as the anniversary of a death of life as they knew it, no matter how much their loved one improves.

With this in mind, it is vital for caregivers to acknowledge the enormity of the injury event and to allow themselves to work on the resultant emotional experience.  Caregivers need to give themselves permission to reach out for help and support.  It is important for those in the caregivers’ lives to help support these caregivers and provide a safe space for them to share their experiences (of course only up to the level with which the caregivers are comfortable).  Often, rehabilitation therapists are the first to notice the caregiver burden and to offer to help caregivers with these abundant concerns.  In many cases, caregivers benefit from counseling and/or psychotherapy in efforts to work through their emotional experiences.  A well-defined medication regimen appropriately tailored to an individual’s needs can also aid substantially in attaining emotional balance.  Some family members may benefit from meeting with clergy so as to aid in their spiritual recovery from this experience.  Also, brain injury and/or stroke support groups can be very useful in managing the emotional impact of this experience.

I hope this post shed some light on the caregiver burden as it specifically relates to the initial injury event.  Feel free to comment below with any questions.

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

What is Music Therapy?

By Amanda Gilbert MT-BC, CBIS Staff Music Therapist at the Transitional Learning Center

Many people know of someone in their lives who has received music therapy services, and many have encountered videos or some like representation documenting music therapy methods and techniques. Music therapists can be found working with infants, children, adolescents, adults and elderly persons and may be called upon to assist those facing neurological conditions, specific psychiatric needs, developmental or learning disabilities, aging-related conditions, acute or chronic pain, the consequences of struggles with substance abuse, or the effects of more typical physical disabilities. Despite its rapid growth and wide application in the healthcare field, one of the most common questions any music therapist still receives is “What is music therapy?” The American Music Therapy Association tells us:

 

“Music therapy is the clinical and evidence-based use of music interventions to accomplish goals within a therapeutic relationship by a credentialed professional who has completed an approved music therapy program. Music therapy interventions can be designed to promote wellness, manage stress, alleviate pain, express feelings, enhance memory, improve communication and promote physical rehabilitation (American Music Therapy Association, 2013).”

 

So, what then does THAT mean? Let’s break this definition down:

 

“Music therapy is the clinical and evidence-based use of music…”

 

During the last 30 years, brain imaging has improved to the extent that it is now capable of showing us exactly what is happening when we are involved in listening to, creating, playing, or even reading music. These studies have found that the reactions generated in areas of the brain activated when we are engaged in these activities are not unique to musical stimuli, and that these areas therefore are not devoted exclusively to processing music-related information. They are used for other functions, too. When we complete musical tasks, we are helping our brain practice skills that are inevitably carried over into more classically functional areas (like moving, talking, and thinking). Research has shown that music participation drives plasticity in the human brain, which makes its auditory, learning, and motor areas interact more efficiently. Music therapists are charged with keeping up to date with current evidence supporting the clinical use of music and of incorporating the sources of that evidence into their practices.

 

“…use of musical interventions…”

 

During a typical music therapy session, you may see patients singing, drumming, listening to music, learning new instruments, or writing songs. There is no need for a person to have had a history of being involved in music in order for that person to benefit from MT. The music therapist will take all of a patient’s relevant strengths, barriers, and goals into consideration when designing these interventions.

 

“…to accomplish goals…”

 

While music therapy definitely can be fun, there is always an underlying goal to any activity. Music therapists create music interventions so as to address goals that can translate into beneficial changes seen in everyday life. They communicate with  patients and their loved ones as well as with therapists from other disciplines currently treating those patients in order to determine which skills are most important to address, and to assign priority to the addressing of each one. Obtainable and measurable goals are then created with objectives acting as stepping stones to each subsequent accomplishment.

 

“…within a therapeutic relationship by a credentialed professional who has completed an approved music therapy program.”

 

Board certified music therapists, holding the credential MT-BC, are qualified to practice anywhere in the United States. They have completed an approved college curricula (including an internship) and have passed the national examination offered by the Certification Board for Music Therapists. Therapists can complete additional training in order to earn specializations in other areas including but not limited to Neurologic Music Therapy (NMT), Neonatal Intensive Care (NICU), Bonny Method of Guided Imagery (GIM), and Nordoff-Robbins Music Therapy (NRMT). At the Transitional Learning Center, music therapy treatment is provided from an NMT-based perspective, focusing on the relationship between music and the brain.


“Music therapy interventions can be designed to promote wellness, manage stress, alleviate pain, express feelings, enhance memory, improve communication and promote physical rehabilitation.”

 

Music therapists address goals designed to promote a healthy lifestyle, to decrease pain, to provide a much-needed emotional outlet, to assist in memory, to improve verbal and nonverbal communication, and to augment rehabilitation of physical ailments in specific muscle groups. Neurologic Music Therapists address motor, cognitive, and sensory goals engaged in efforts to combat neurological disease. These therapists are trained specifically in the science of music perception and production and in the effects of same on the non-musical brain. Because music engages multiple areas on both sides of our brains, NMTs can assist those who have difficulty with speech, walking, and in the moving of their hands or arms.  This fact also leaves NMTs in an exceptional position to aid individuals in need when working to improve their attention, speed of processing, memory, and other like thinking skills.

Music therapy is a unique, evidence-based medium through which hundreds of thousands of people accomplish incredible goals each year. While the field is in its relative infancy, the future of MT looks bright as more individuals and facilities begin to learn the benefits it can provide.

For more information about music therapy or to find a music therapist, please look to the following websites:

 

American Music Therapy Association

http://www.musictherapy.org

 

The Certification Board for Music Therapists

http://www.cbmt.org

 

The Center for Biomedical Research in Music

cbrm.colostate.edu

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

 

The Role of Support Groups

Going through life with a brain injury can be a remarkably difficult experience for a brain injury survivor.  Life has changed, often in many dramatic ways.  Sometimes utilizing the most basic of skills, such as using the restroom or remembering to turn off an oven, can present the most complex of challenges.  Life is often just as hard (and in some aspects can be even harder) for the survivor’s family.  Everything has changed for them, too.  Family members often find that new roles are now required of them and that new stressors now confront them at every turn.  A wife may now find herself serving as her husband’s primary caregiver.  A brother may now necessarily be conscripted as his sibling’s chauffeur to constant doctor’s appointments.  On top of all this, there is so much to learn in a field with which both survivors and family members almost always have little to no previous familiarity.  This can make for an incredibly lonely experience.  Survivors and family members may ask themselves, “Is there anyone else in the world who knows what this feels like?”  While the brain injury survivor is a patient in an inpatient rehabilitation program (a very common experience in post-injury life), the survivor can often rely upon the camaraderie of fellow patients.  Family members may become friendly with the family members of other survivors and chat on a regular basis.  Both survivors and their families will have regular contact with staff who are able to provide support and knowledge.  However once the survivor discharges from that inpatient facility, he or she suddenly has little to no contact with other brain injury survivors.  Families lose contact with each other and no longer have available as an option just popping in to a therapist’s office for a quick question.  This is when the brain injury experience can be its most lonely.

 
Support groups can help fill this gap.  Support groups are groups of individuals with similar experiences that meet on a regular basis to discuss those experiences.  Individuals may offer suggestions and advice or just provide a shoulder to lean on.  Support groups exist for a wide selection of health-related issues ranging from living with cancer and diabetes to coping with grief, struggling with substance abuse, and of course, rebuilding one’s life in the aftermath of a brain injury.

 
There are two primary types of support groups that are most relevant to brain injury survivors, namely stroke support groups and brain injury support groups.  Stroke groups tend to be more common than brain injury support groups, though in most larger population areas one will be able to find a brain injury support group in addition to stroke support groups.  Among stroke support groups, there is a small subset that are specific to aneurysms (though survivors of aneurysms and their families are of course welcomed in a general stroke support group).  Support groups are often run out of hospitals, rehabilitation facilities, community centers and houses of worship.  If a group’s meetings take place in a hospital, usually the survivor does not have to be a patient (past or present) of that particular hospital in order to attend.  In addition to the aforementioned support groups, there are support groups designed to address certain specific symptoms of brain injuries.  For example, there are aphasia support groups, apraxia support groups and memory support groups.

 
Each support group tends to have its own individual program and essential dynamic.  Some provide more educational content while others tend to offer more of an emotional/social support program.  Some are survivor oriented, others family oriented and still others are oriented to both survivors and their families.  If you do not feel suitably comfortable at one group, you can always attend another group.  Also, there are available some online support groups necessarily better suited to those who have difficulty leaving their homes.  Some survivors and families will even create their own groups when confronted by a lack of groups tailored to their specific needs in their vicinity.

 
Below are a few links that may aid in finding a support group:

 

For brain injury support groups, click on your state affiliate of the Brain Injury Association of America and scroll to the Support Groups section:

http://www.biausa.org/state-affiliates.htm

Stroke support groups:

http://www.strokeassociation.org/STROKEORG/strokegroup/public/zipFinder.jsp

http://www.stroke.org/stroke-resources/stroke-support-groups

In addition, the American Stroke Association has a family support phone program called the Stroke Family Warmline.  The Warmline phone number is 1-888-478-7653.

Aneurysm support groups:

http://www.bafound.org/support

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