Tag Archives: holidays

Holiday Adjustments-Part 3: Social Interactions and Attention

This is part 3 of a series on holiday adjustments.  As mentioned in parts 1 and 2, deficits suffered in the wake of a brain injury may impact brain injury survivors’ ability to participate in holiday celebrations to the degree that they had in previous years so adjustments may need to be made in order to provide a greater likelihood of those survivors enjoying a successful holiday.  Part 3 will be focusing on issues regarding social interactions and attention during holiday celebrations.

 
Our social skills are at the heart of what it means to be a connected person in our society, and holiday celebrations invariably present what can only be understood as key social situations.  It’s incredibly common for brain injury survivors’ proficiency in employing vital social skills to markedly suffer as they navigate post-injury life.  As a result, holiday celebrations can be tricky for brain injury survivors to negotiate.  In many cases, holiday celebrations are the first time that friends and family members have seen a survivor since his or her injury.  In other cases, holiday celebrations are the first time that friends and family members have seen the survivor since he or she was in the intensive care unit of the hospital since people are most likely to visit in that initial period immediately following an injury.  Often, holiday celebrations present dual areas of stress with which a brain injury survivor must contend.  The survivor is learning how to negotiate life with newly acquired often significant deficits commonly experienced in multiple distinct arenas.  At the same time, survivors must learn to accommodate an increase in the attention afforded them by friends and family as those loved ones understandably seek to spend extra time with survivors as an expression of concern felt.

 
Near death experiences catch our interest and spark our concern.  As such, friends and family often give survivors far more time and attention than they may have at previous holiday celebrations.  After a brain injury, many survivors are surprised to find that they are now the most popular person in the room.  Each family member comes by and asks what happened, how is the survivor doing, how is therapy, etc.  Even if one family member was standing right behind another while that member asked each of these questions, the second family member still may ask the exact same questions as the first.  These queries are generally made with the best of intentions.  Family and friends want to show their concern and caring for their injured loved ones.  However, many survivors find this to be a frustrating and annoying experience.  It is important for survivors to prepare for some version of this experience to occur at the holidays, particularly if many people have not seen a survivor since the initial injury.  And it’s just as important for survivors to remember that such a situation is just a reflection of the caring felt by those around them.  Family and friends are often searching for a way to show their feelings to the survivor.  Preparing a good deflection script can often be helpful (For example: “Thank you for asking about my health.  I appreciate the questions but it seems like that is all I have been talking about lately.  Can we please talk about something else?”)  Family and friends need to remember that constant questions can be stressful.  If the questioning goes well, the questions can be experienced as a friendly interview would.  If it goes poorly, it might start to resemble more a police interrogation.  Loved ones should put effort into talking about other issues as well, such as the Thanksgiving football games or favorite music.  Some survivors and/or their families may find a handy solution in sending an e-mail or some similar communication updating everyone on the latest information and requesting that brain injury questions be kept to a minimum.

 
A more positive aspect of this extra attention is that brain injury survivors may find that they receive more phone calls, cards and gifts at holiday times than in previous years.  Sometimes these come from people who are not very close to the survivor but are more distantly acquainted with the situation, such as a congregant at a family member’s church.  Again, though this may feel slightly strange to the survivor it still represents someone trying to reach out and show that he or she cares.

 
Changes in social skills can create big hurdles for survivors to overcome during social interactions at holidays.  Survivors and their families must keep in mind potential problems due to changes in social skills.  When a survivor has difficulties that impact social skills, it is important that friends and family members at holiday parties are informed of the best ways to interact with that survivor.  For survivors with language difficulties this may include giving extra time for the survivor to speak, having the survivor’s conversation partner slow his or her rate of speech, writing important words down for the survivor, pantomiming words or having the survivor use an augmentative communication device such as an Ipad equipped with a special speech program.  If survivors have problems with impulsivity issues, family and friends may need to pay extra attention to cueing those survivors to slowing down and maintaining the topic of conversation instead of going on tangents.  For survivors that have difficulty with nonverbal skills such as making eye contact or reading social situations accurately, family and friends may need to cue them to utilize proper nonverbal skills such as looking at the conversation partner’s face while speaking.  If a survivor now struggles with a newly intensified propensity to engage in clearly inappropriate behaviors, family and friends may need to cue that survivor in order to aid in avoiding such behaviors (obvious examples being cursing and sexual jokes).  It is important in all cases that family and friends who will be interacting with the survivor be given adequate information to best help the survivor succeed in his or her social interactions.  This information can be shared via e-mail, phone call or simple face-to-face personal discussion.  If a family member or friend is caught unawares in a situation in which a survivor’s social deficits are seeing expression, this can lead to a strain in relations.  For instance if a survivor’s friend does not know that the formerly soft-spoken survivor now needs help to reduce foul language, the foul language may be taken as a personal insult rather than as a function of the injury.
Survivors and their families should also consider the possibility of the survivor faring better in a smaller holiday celebration.  Some survivors find that larger parties lead to more stress, agitation and/or social errors.  Also, the noise and activity of larger parties can become overwhelming for some survivors.  Certain survivors find that young children, with their noise and activity, can be quite problematic.  Further, some survivors would rather have a small celebration, especially in the early stages of recovery when they are not yet sufficiently comfortable with their injury in public.  They may feel embarrassed by their deficits and would rather not have a large number of individuals learn so casually about the depth of their struggles.

 
It is often helpful for survivors, their families and their therapists to try to problem-solve in advance potential pitfalls and to practice skills such as how best to talk to others about an injury experience.
Hopefully, this post provided insight on a few holiday adjustments that can be made to mitigate attention and social interaction issues.

 

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

Holiday Adjustments-Part 1: Location

As Thanksgiving approaches, it is important to be aware of the potential need for adjustments to be made to holiday celebrations in order to accommodate a brain injury survivor’s injury-related deficits.  Having a brain injury does not stop a survivor from celebrating a holiday, but it may put a few wrinkles into holiday plans.  Part 1 in this series on holiday adjustments will focus on some thoughts regarding the location of celebrations.

 
There are a number of issues that need to be addressed regarding the location of holiday celebrations in such a scenario.  First, if the survivor is in a wheelchair or uses another assistive device to aid mobility and is going to someone else’s home, is that home accessible?  Keep in mind that it is much easier to get a wheelchair across a hard floor than across carpeting and that for some survivors, a large pile (a term used to denote length of carpet fibers) carpet can provide quite the inconvenience.  Also, is there enough room in the bathroom for a wheelchair?  Should the survivor bring along a urinal if it is too hard to access the toilet?  If the survivor has problems with incontinence, is there somewhere available that the survivor could  be cleaned or change clothes if necessary?  Some families of brain injury survivors find that it is easier to host holiday celebrations at their own homes rather than travel to the homes of others since their homes have already been adapted to the needs of the survivor.

 
Survivors and their families should also consider the physical layout of the rooms where a celebration will take place.  For instance, it may help to move tables and chairs into a different configuration in order to make it easier for the survivor to move through.  A big issue to look for in the consideration of a given room is trip hazards, particularly around Christmas.  It is important that toys and gifts not be left around on the floor as these can easily become trip hazards and could cause the survivor to suffer a bad fall.  Alternatively, most toys tend not to fair well when a wheelchair runs them over.  Cords from Christmas trees or lights can also become trip hazards and should be placed in a manner that will not pose danger to a mobile survivor.  There are many other practical issues to consider regarding the holiday meal.  Can the survivor reach a given dish or will he or she need help?  Has silverware been left on a counter that is too high for the survivor to reach?  Can the front of the survivor’s wheelchair fit under the table?  If the survivor uses an augmentative speech device like an Ipad, is there room at the table for it?  Is a side table perhaps needed for the device to be placed upon?  Small changes in room and furniture layouts can make a huge difference to both a survivor’s sense of inclusion and his or her overall enjoyment of a holiday celebration.

 
The weather can also play a notable role in adjustment to different locations.  Walking up an icy pathway can be quite difficult and possibly dangerous.  Some survivors who normally use a walker may be safer in a wheelchair over these icy surfaces.  Moreover, some survivors in wheelchairs may need more help getting across an icy or snowy surface.  In such a situation a loved one may need to aid in pushing more than would otherwise be required or just pay attention to helping keep the chair from sliding in the wrong direction.

 
Families of brain injury survivors may want to put some thought into how loud they allow holiday celebrations to be.  Some survivors find that they are more sensitive to noise than previously and loud noises may provide a catalyst for unwanted agitation and/or anger.  These survivors may benefit from attending smaller celebrations or spending their time in a quieter room away from the main celebrations.  This can also be a relevant issue when considering attendance of holiday religious services.  Some survivors may find busier houses of worship  or busier times at those houses of worship to be problematic and may do better at less busy times or benefit from selecting a less busy house of worship.

 
One more such consideration associated with location relates to how many celebrations a survivor and his or her family may be planning to attend.  Some families have the tradition of going from house to house to multiple holiday celebrations throughout the day.  However, survivors often become fatigued quite easily and holiday celebrations tend to be long and active events.  For many survivors, attending multiple celebrations in the same day may be very difficult.  Some survivors may benefit from spending a shorter amount of time at each such celebration.  Survivors and families must also consider the fatigue sure to accompany constant transferring to and from vehicles and the necessary related packing up and unpacking of equipment.  For instance, getting a wheelchair in and out of a car repeatedly throughout a day can be very taxing on the backs of survivors’ families.

 
These are some of the considerations regarding the location of holiday celebrations that survivors and their families may wish to think about when identifying adjustments that may need be made to holiday celebrations.  The next part of this series will focus more specifically on brain injury survivors’ participation in holiday celebrations.

 

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