Traumatic Brain Injury vs. Acquired Brain Injury

One of the more confusing aspects of the brain injury world is that there are so many terms to learn. It can be difficult to differentiate between often similar terms. In this post, I would like to clarify the difference between two commonly used terms, “traumatic brain injury” and “acquired brain injury.” These terms (also known by their acronyms “TBI” and “ABI”) carry notably different connotations.

Traumatic brain injury is generally defined as any injury caused when an outside force is brought upon the brain. This can occur when an object strikes the brain, such as a bullet shot through a person’s skull. Alternatively, it can be when the brain itself strikes an object, such as when a person’s head hits a windshield in a car accident. This outside force can also be supplied by the shock wave of a bomb, which is to blame for many brain injuries suffered by soldiers. Though there is no “object” striking the head in that case, the force of the shock wave can cause considerable brain damage. Common causes of traumatic brain injury include motor vehicle accidents, falls, assaults, gun shot wounds and sports-related concussions.

Acquired brain injury is a broader term, covering all methods by which a brain can be injured (including traumatic brain injuries). This includes non-traumatic brain injuries due to stroke, anoxia (lack of oxygen caused by events such as heart attack or drowning), encephalitis and substance abuse. In short, acquired brain injury = traumatic brain injury + non-traumatic brain injury. Also, using the term acquired brain injury or traumatic brain injury does not denote differentiation between degrees of severity. All brain injuries have equal potential for low to high levels of severity.

I hope this helps clarify the difference between the terms “traumatic brain injury” and “acquired brain injury.” Feel free to ask questions in the comment section below!

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

Talking About Your Injury

One of the more stressful aspects of the injury experience is deciding how to answer questions about the injury experience. This can be particularly stressful as many survivors find themselves receiving a barrage of questions every time they return to familiar situations. Friends at work have questions, customers have questions, old high school classmates have questions, etc. For many survivors, it seems that they have been suddenly placed in an unfamiliar spotlight. Let’s go over some general ideas and some specific suggestions when talking about your injury.

First, let’s review some general ideas. Many survivors initially think that few people know about their injury. After all, if the survivors did not tell others, how would they know? The reality is usually different. Sometimes, the injury event was on the news. For instance, if a survivor was in a major car accident or shooting, it generally made the news. Also, following an injury, family members may make prayer requests through social media or religious institutions. In this case, everyone who is connected via social media or anyone is part of the religions institution is aware of the injury event. Moreover, a brain injury is a big piece of news. Once one person hears about it, they are likely to “share the news” with friends from work, school or other social environments. Overall, information often makes the rounds to people you know quite quickly. However, the information is often piecemeal and occasionally, inaccurate.

With this in mind, the guiding principle when talking to others about your injury should that you give honest information in a manner that will engender others to have appropriate confidence in you. In some cases, people may be truly confused or concerned how you are doing and are using questions as a sort of gauge of health. The better you handle the situation, the more likely the other person will walk away with confidence in you.

Here are a few pieces of advice regarding talking about your injury:

1. Always keep in mind who the person is that you are speaking with. For instance, is this a friend or an acquaintance? Is this person trustworthy to keep information private or likely to share it with everyone? Do I have a personal relationship or a professional relationship with this person? These factors will influence what you will share (or not share) with the other person.
2. Whenever possible, keep information short and with limited detail. Remember, once you have said something, you cannot take back the information and the person you are speaking with may share that information with many others. Also, the less details you give, the less opportunity you are giving the other person to ask probing, sometimes uncomfortable, questions.
3. Be sure to have a good exit/”no thank you” line. Not everyone has a right to your information and there are times you will not want to talk about your injury. A good exit line usually involves saying something nice, making your request and ending with something nice. For example: “Thank you for your concern but I really don’t enjoy talking about my recent health issues. However, I really appreciate that you cared so much to check on me.”
4. Always tell the truth. If you tell a lie, there are two possible unpleasant outcomes. One, if the other person finds out that you deliberately lied, this can ruin the relationship. Second, if you tell a lie and the other person realizes the information is wrong but falsely thinks that you actually believe the lie, the other person will assume that you are quite confused.
5. Be aware that you know a lot of medical/health terms that other people will not know, will not understand or even misunderstand. The average person on the street does not know terms such as “hemiplegia” or ” homonymous hemianopsia .” Using terms that other people do not understand may overwhelm the other person. Also, there are some terms that others may misunderstand. For instance, if you say that you are in “rehabilitation”, other people may falsely assume that you have a substance abuse problem. It may be better to say, “I have been working on my recovery from my injury” or “I have been in injury rehabilitation” rather than saying “I have been in rehabilitation.”
6. Do not exaggerate or embellish your injury experience. Your story is already powerful and does not need any help. Also, exaggerating or embellishing may make the experience seem worse and cause other people to lose confidence in you.
7. Be careful about using humor. Many people will not find much humor in your injury experience and may take too much humor to mean that you do not appreciate the seriousness of your injury. Again this could lead to a loss in confidence in your skills.
8. Always ask questions of the other person. If the other person gets to ask all of the questions and you have to give all of the answers, eventually the friendly conversation may feel like an interrogation. The best way to balance the power is to ask questions of the other person, such as how are things going for their spouse, children or job.
9. Practice your responses. When you are asked questions, the way to engender confidence is to have great responses. The best method to ensure you have great responses is to practice, out loud, your responses. This way, you can hear how your answers actually sound when coming from your mouth (which often sound different than how you imagine them in your mind) and practice different potential responses. It is often helpful to practice with a trusted loved one and/or to record and review your responses. This will help you find the best and most natural responses to questions.

These were just a few ideas and suggestions when talking to other about your injury. Always remember the key principle of giving honest responses that engender confidence!

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

The Saddest Story

I would like to tell you the saddest story of my professional career. I was working at a major city hospital and one of my jobs was consultation neuropsychological testing. When a patient was admitted to the general medical unit of the hospital but the attending physician suspected the patient also had cognitive deficits (such as memory problems) I was asked to conduct a neuropsychological evaluation. It was in this role that I experienced the saddest case of my career.

One day, I was contacted by a doctor to conduct neuropsychological testing on a patient. The doctor told me the patient’s room and bed number. Naturally, I asked for the patient’s name. The doctor responded that he didn’t have the patient’s name, as the patient had been too confused to give it. He had been found injured at the side of the road and his brain was still in the beginning stages of healing, and the hospital had yet to be contacted by anyone who could provide his name. As I had never encountered such a situation before, I asked how long the patient had been in the hospital. The doctor replied that he had been in the hospital for two weeks. Two weeks had passed without any kind of contact from anyone that might know the patient.

I met with the patient and conducted the neuropsychological evaluation. Although he could respond verbally with excellent clarity, he could not give his name. He was so confused that at one point during testing, his responses indicated that he thought he was in a television show. I completed my testing and wrote up the evaluation. A week later, I asked the referring doctor if we’d finally found out the patient’s name. Three weeks later, we still had no name for the patient. He could not remember his name and no one had come to find him.

The saddest part of this story is not the patient’s severe confusion. I have assessed plenty of patients who struggled with recalling and conveying basic personal information. That is a large part of my role as a professional. The saddest part is that for three weeks, not a single family member, friend or co-worker had come to look for him. It was as if he was a lone deserted island in the middle of an ocean, and no one knew he existed.

There are several important lessons that I take from this story. As an adult, no one has to support you after you are injured. Legally, in most cases everyone can walk away and leave you on your own. Whether it be a spouse, child, other family member or anyone else, no one has to stick around when you are down. For instance, a spouse can choose to file for divorce or a parent can choose not to take responsibility for an adult child. This means that every single person who has decided since your injury to remain in your life has made a personal decision to remain. Every single visit, call, text or even a “like” on social media is completely voluntary. No one is being forced to do this. These individuals are choosing to be a part of your life. This means it is incumbent upon you to appreciate that each individual who has taken the time and effort to be a part of your life has made this decision willingly. Whether it be out of romantic or familial love, a strong friendship connection or any other reason, they have chosen to remain in your life following your injury. That is a big deal and it is important to appreciate their choices.

It is also incumbent upon you to recognize that your relationship with that other person is something that they find valuable even after your injury. If there were no value in the relationship, it would be easy for the other person to leave. So, you still contribute to that valuable relationship. He or she finds something about your relationship exceptional, even though you may not be in the same state of health as before your injury. You are still special and it is vital to appreciate your importance in the relationship.

It has been approximately 15 years since I saw the patient with no name and no loved ones. I hope life has turned out better for him than it was those many years ago. When I see the amazing love and caring that TLC patients receive from family, friends and co-workers, I think back and remember with sadness that not everyone has such great support. This makes me appreciate the relationships between TLC patients, family, friends and co-workers that much more.

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

Beware Slippery Sidewalks

Slips and falls due to slippery sidewalks and other similar surfaces pose a real concern, whether an individual does or does not have a brain injury. However, the risks of injuring oneself in this way after a brain injury are often more frequent and more serious.

Many brain injury survivors are able to walk after their injuries but find that their balance is not as good as it was prior to an injury. Since these survivors can lose their balance more easily, this puts them at a greater risk to slip and fall on wet, slippery surfaces. Similarly, many survivors do not have reaction times quite as sharp as they did prior to their injuries, so they have more difficulty regaining their balance after a slip. Additionally, many survivor have one side of their bodies that is weaker than the other. When they fall, they tend to fall to the weaker side so there is little useful opportunity to brace themselves for falls. This potentially makes falls far more serious than they would have been prior to brain injuries.

Survivors in wheelchairs are also at risk for accidents due to slippery sidewalks and other surfaces. The wheels on wheelchairs easily slip on wet surfaces. Wheelchairs pick up speed very quickly on wet sidewalk ramps. This contributes to potential accidents and injuries, as it’s difficult for survivors to control their wheelchairs at these higher speeds. Wet leaves and other slippery items on ramps often exacerbate these risks.

Keep the following tips in mind to reduce slips and falls on wet sidewalks and similar surfaces:

1. Always check the weather before heading out for daily activities.
2. Make sure leaves are regularly swept up in locations where they tend to accumulate on sidewalks. Don’t be shy about mentioning to businesses that you may not be able to enter an establishment if there are wet leaves by entrances and exits.
3. Be extra careful while traveling in a wheelchair or even simply walking both during and after a rainstorm.
4. When possible, use sidewalk ramps that are covered by an overhang which shields from rain.

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

Emilia Clarke is a Survivor!

On Game of Thrones, Emilia Clarke’s character Daenerys Targaryen is tough as nails and always up for a battle. But perhaps Clarke’s toughest personal battle was when she had brain aneurysms, which included multiple surgeries to save her life. Click the link below to read her personal account of her brain aneurysm experience, including surgery and aphasia:

https://www.newyorker.com/culture/personal-history/emilia-clarke-a-battle-for-my-life-brain-aneurysm-surgery-game-of-thrones

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

The Rehabilitation Partnership

One of the most basic truths of successful rehabilitation is that it involves a partnership between the patient and therapists/doctors.  It is important to understand what this partnership entails, namely that without both parties’ investments in the process the patient will only see limited improvements.  This also means that each side has a responsibility to the other side to ensure success.  The job of rehabilitation is a shared job between the patient and rehabilitation professionals.

There are a number of implications to this basic truth of the rehabilitation partnership.  A therapist/doctor cannot make a patient improve.  A therapist/doctor can only work with a patient to help the patient improve.  Keeping this in mind should dissuade rehabilitation professionals from imagining themselves to be like Superman, swooping in to save the patient from the patient’s brain injury.  Brain injury rehabilitation simply does not function like a comic book story.  This realization should also empower the patient with the knowledge that his or her thoughts, feedback and effort are a vital part of rehabilitation (without which success cannot be fully achieved). Professionals need the patient’s thoughts and feedback to best plan and implement therapy.  Every patient is different, so a method that helps one patient may hinder or even harm another.  There is no way for a professional to know this without feedback.  This should also dissuade patients from being too passive when engaging the therapy process.  Rehabilitation professionals cannot help a patient improve if the patient will not try to help him or herself.   They cannot do the work for the patient.

When this partnership between patient, therapists and doctors truly comes together, everyone becomes a vital member of the rehabilitation team.  However, it is important to remember who needs be recognized as “team captain.”  The patient is the “team captain” in the sense that the process is ultimately focused on the patient.  The patient needs to share with the team any and all goals, expectations and dreams.  When the entire team has this information (which has to be updated on a regular basis), the team can best determine the direction therapy needs to take.  For instance, if a patient was formerly a chef and dreams of returning to that former occupation, a great deal of therapy will be focused on activities in the kitchen.  If the patient never went in the kitchen outside of opening the refrigerator door, then therapy will clearly be focused on other activities.

A successful partnership will generally allow the patient and rehabilitation professionals to have a mutual understanding and appreciation of one another.  It will also foster openness, honesty and trust between the patient and the rehabilitation professionals.
Remember, teamwork makes the dream work!

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

Bret Hart is a Survivor!

Bret “The Hitman” Hart is a wrestling legend.  For years he traveled the globe as one of the biggest stars in the world of wrestling.  But even a tremendous athlete like Hart can have a stroke.  Hart had that stroke in 2001.  He spent three months in a wheelchair and countless hours in rehabilitation.  His hard work paid off in an excellent recovery.  Today he represents the March of Dimes Canada’s Stroke Recovery Program, inspiring other stroke survivors!  Click on the link below to watch a video of Bret Hart speaking about his stroke experience:

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

Give. It. A. Minute.

One of the most common mistakes that brain injury survivors’ loved ones make after an injury is not giving the survivors enough time to respond or take an action.  For instance, a survivor and his family may be at a restaurant for dinner.  When the survivor is struggling to place his order, a family member may jump in to place the order for him.  If given enough time, the survivor may have been perfectly able to place the order but the family member did not give him enough time to respond.

There are a few reasons why survivors’ loved ones tend to not give enough time to the survivor to respond or take an action.   One reason is that silence is uncomfortable.  For instance, if a survivor is needing extra time to respond, the silence may be so uncomfortable that the loved one will jump in and speak “for” the survivor.  A second reason is that is uncomfortable to watch someone struggle.  As an example, a survivor may be slowly, and with great effort, reach toward an item on a table.  The loved one may be so uncomfortable watching the survivor’s struggle that they reach over to get the item for the survivor.  A third reason is the feeling that the survivor and loved ones are in a rush or feel like they are causing someone else to slow down.  For instance, a survivor in a wheelchair may be pedaling down a hospital hallway but family members, concerned that the wheelchair is blocking the nurses, decide to push the survivor’s wheelchair to more quickly reach their destination.

However, it is important to give the survivor more time.  First, and most importantly, if the survivor is able to make a response or take an appropriate action when given extra time, they should be allowed the independence and respect to do so.  By unnecessarily jumping in, loved ones are taking away the power and the dignity of the survivor to take care of their own needs.  Second, although a survivor may need extra time and effort to complete a task, they are more likely to get faster and more efficient over time with practice.  By doing the task for them, the loved one is taking away vital practice from the survivor who is trying to master a task.  Third, the survivor may need extra time to safely complete an activity.  After an injury, certain tasks may have concrete steps which take time or require more processing time to successfully finish without risk.  For example, most uninjured individuals simply stand up when they are ready to leave a room.  A survivor may have to go through multiple steps to safely transfer from sitting to standing.  These steps require extra time so the survivor can safely transfer.

When wondering about the survivor’s need for extra time and if they should jump in, loved ones should ask themselves the following questions:

1.  Is the task truly out of the survivor’s skill range or do I just need to be more patient to allow them to complete the task?
2. Are we actually in a rush or is a little extra time a reasonable request?  For example, if a survivor needs an extra ten seconds to place an order at a restaurant, keep in mind that the waitstaff is getting paid to serve you.  Ten extra seconds is not an unreasonable request.
3. What message am I giving to the survivor if I do not allow them to do for themselves when they are able to so?
4. Is the issue really about the survivor needing extra time or my personal discomfort in this situation?
5. By going faster, have I compromised my or the survivor’s safety?

In most cases, a little extra time will help a brain injury survivor be more successful and allow everyone to have a better experience!

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

Using the Open Chair Technique

Survivors with brain injuries push themselves to get better.  Staff members at TLC see this every day.  Survivors push themselves to walk better.  They push themselves to speak better.  They push themselves to improve their memory.  They push themselves in every aspect of the rehabilitation experience, but recovery from a serious brain injury can be quite slow.  It is almost always slower than the survivor would prefer it to be.  Unfortunately, this leads some survivors to speak poorly about themselves.  They say things such as “I am a failure because I am not 100% improved” or “I should be much better than I am now.  I am failing at therapy”.  This negative self-talk can lead to emotional difficulties such as stress, low mood and sometimes even to depression.

If looked at objectively, this negative self-talk is often due to unrealistic expectations that the survivors have regarding their recoveries.  The survivors may believe that the amount of time necessary to recover is in excess to that which they expected, even when the medical research shows that they are progressing at a normal rate.  By expecting faster or better results than are humanly possible, survivors can cause themselves unnecessary frustration.

Interestingly, these same survivors who hold unrealistic expectations of themselves generally do not hold these same expectations of others.  They are often more logical and understanding of other survivors than they are of themselves.  It is common at TLC for the same patients who have unrealistic personal expectations to support realistic expectations in other patients.  They will make supportive statements to other patients such as “Don’t worry and take it slow.  You will get better over time.  You are running a marathon not a sprint.”  When the patients with unrealistic expectations are asked if they believe the advice they are giving to others, they almost always answer in the affirmative.  They understand that the brain injury recovery process is a slow one which requires lots of work.  They understand it is a long-term process.  But they decide for whatever reason that their personal recoveries should take less time than those of others, holding themselves up to unfair (often impossible) standards.
One way to manage this negative self-talk is by using the “open chair” technique.  How this technique works is that patients are asked to imagine they are sitting next to themselves and that the person occupying their seat is someone else with the very same issues and deficits that they have.  The patients are then asked to give this “other person” honest feedback about how the “other person” is doing.  Often, patients find that this leads them to soften their tones and to make more supportive personal statements regarding their own progress.  Similarly to when they are actually talking to other patients, when they address themselves as that “other person”  patients demonstrate more realistic expectations and are less likely to attack themselves.  The “open chair” technique often helps patients treat themselves not only better, but also more fairly and honestly.  By being more fair and honest to themselves, survivors tend to have an improved mood.  And the better the mood that survivors can maintain, the easier it is to navigate the rehabilitation process.

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

Michael Johnson is a Survivor!

Olympic gold medal sprinter Michael Johnson has always kept himself in great shape, even in retirement from his celebrated professional career.  However,  it is possible for even a healthy individual to have a stroke.  Michael Johnson recently suffered a transient ischemic attack (TIA), also known as a “mini stroke”.  Though he has recovered well from the TIA, the experience taught him a valuable lesson about vulnerability and motivated him to educate others regarding the risks for stroke.  Click the link below to read more about Michael Johnson’s stroke experience:

https://www.bbc.com/sport/athletics/46798931

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