Tag Archives: mind

Give Me Your Best 40%

Good days, bad days.  Everyone has them.  No one minds the good days, but those bad days can be such headaches.  Maybe you didn’t sleep well the previous night.  Perhaps your children were sick and were thoughtful enough to pass their germs on to you.  Those bad days pose a regular struggle that we can only push through.  However, sometimes bad days have potential to knock traumatic brain injury and stroke survivors to emotional low points markedly lower than anything experienced in their lives prior to the injury experience.

Often, patients will apologize to their therapists when they are having bad days, even though they would not feel the need to do so when going through a similar bad day at a job in their pre-injury lives.  In reality, no apology is truly necessary.  Having good days and bad days is not only a natural part of life, but is just as natural a component of the journey to recovery.  The progress of a healthy recovery can usually be observed to resemble that of a healthy stock market.  We can track plenty of ups and downs, but a general upward trend is just as persistently evident.

On rare occasions, a patient may ask a therapist if he or she can skip a session because he or she is having a bad day.  Unless the patient is deemed unable to participate in therapy by a facility nurse or doctor, the patient will be strongly encouraged to engage in therapy.  This can be a bit confusing for patients.  After all, why shouldn’t they be able to skip rehabilitation when having a particularly bad day?  I will explain some of the logic involved in having patients stay in therapy even on those bad days.

First, as stated earlier, bad days are a natural part of life.  Therapists know that on some days a patient will simply be unable to contribute that normal 100% effort.  This is fine.  Advances in therapy can be made even on bad days.  A therapist will always take a patient’s best effort, whether it be that patient’s best 80%, best 60% or even a 40% effort.  Every step forward in rehabilitation is a step in the right direction.  Second, it is important to remember that every activity in rehabilitation is aimed at facilitating success following discharge.  At home, just like in rehabilitation, there will be good and bad days.  Survivors need to be just as prepared to handle bad days at home as they are to handle the good ones.  For example, a patient may not want to work on hand skills necessary to use adaptive flatware on a bad day.  But what is that patient going to do when he or she is hungry at home on a bad day?  Will the patient not eat because he or she is having a bad day?  Good day or bad day, the same skills will be used to succeed at home and therefore they need to be practiced both on good days and bad days in therapy.

So don’t worry about having a bad day.  Just give therapy your best effort, even if on that day your best effort is only 40%!

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

Advertisements

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

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

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

New Year’s Disorientation

As 2014 comes to a close and 2015 is upon us, some brain injury survivors may find themselves facing greater than normal levels of disorientation.  Often brain injury survivors, particularly those with memory deficits or in the earlier stages of recovery, will have trouble keeping track of basic orientation information such as the month or the day of the week.  The change in year represents yet one more piece of new information they have to worry about remembering.  Survivors may seem confused or express doubt when told of the change in year.  Some survivors may even argue that therapists, staff and family are giving them false information.

 
Many patients with orientation difficulties can get stuck on the last date or location they remember and have trouble incorporating new information.  For example, a survivor may last remember living in Dallas and struggle with integrating into his or her life knowledge of moving in post-injury with his or her parents in Houston.  This same issue can occur with a change in year.  As the survivor last remembers the year being 2014, it takes considerable effort to make the switch to recognizing that it’s now 2015 (and to making realization of that switch stick).  To put it in perspective, people often temporarily forget the correct year during the first few days of January and will then write the wrong year on checks.  But imagine if instead of being stuck on the wrong year for a few moments, you continually find yourself stuck on the wrong year for weeks upon weeks.  This is what brain injury survivors with orientation deficits may experience when confronted by a change of year.

 
Brain injury survivors can be helped by keeping relevant orientation information presented in many easily accessible locations.  Families and survivors may want to place more calendars around the home.  If a survivor has considerable problems with disorientation, he or she will likely do best with a one page per day calendar, one that displays on each page the day, date and year.  This type of calendar can generally be found at teller stations in banks in order to help ensure that customers write the correct date on checks.  This is in contrast to the month at a glance calendar, in which the entire month is shown on a single page.  The date can also be written on a dry erase calendar in a bedroom or on a refrigerator so that the survivor can easily see the new year.

 
Families can also make extra effort to insert the correct year into daily conversation.  This can be done simply by saying more often than one might otherwise things like “Wow, 2015 has really started off well for us” or “I’m glad that 2015 has rolled around as last year was quite difficult.”  The more that a survivor is exposed to the correct information, the more quickly and permanently he or she will learn this new information.

 
Lastly, please make sure to dispose of old calendars and similar items displaying the old year as quickly as possible.  Some brain injury survivors will become confused or distressed when confronted by both an old calendar and a new calendar.  This can cause a temporary (and entirely avoidable) setback in efforts to properly align orientation.

 

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

 

NFL Settlement Battle

Lawyers representing the vast majority of National Football League retirees seeking legal recourse due to the deleterious effect upon their lives resulting from brain injuries suffered throughout the course of their careers will be in court on Wednesday to argue over the terms of the settlements between the NFL and those former players.  This may be the final settlement between the NFL and the former players, though some players have opted out of the settlement in order to pursue individual lawsuits.

http://www.reuters.com/article/2014/11/17/us-nfl-concussions-idUSKCN0J123S20141117

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

Processing Speed

One area of difficulty that many brain injury survivors experience is a decline in processing speed.  Processing speed is the length of time it takes for a person to understand, access or utilize information.  For instance, if someone asks me which restaurant I would like to go to, there’s a distinct internal protocol followed.  My brain has to understand the question that is being asked, review the relevant information and then generate an answer.  In this example, I first need to ensure that I understand the question.  Next, I may have to think about issues such as what my favorite types of foods might be, how recent restaurant experiences may come into play, where given restaurants are located, affordability of the restaurants under consideration and which restaurants that others involved may enjoy.  Finally, after reviewing this information I need to generate an answer.  As you can see from the example, even a simple question can involve a great deal of processing.  Most people take for granted that their brains can process all of this information quickly and efficiently.  However, after a brain injury many survivors find that this is a much slower, much more difficult enterprise in which to engage.

 
Difficulty with processing speed has the potential to negatively impact almost any situation.  A survivor may take more time to answer seemingly simple questions such as in the example given above.  The survivor may take more time to react to all manner of situations.  For instance, a survivor may have difficulty avoiding cars in a parking lot because he or she is unable to react quickly to the stimulus provided by arriving and departing vehicles.  The survivor may also have more difficulty following conversations.  Each word, each statement, each exchange in a conversation needs to be processed.  As a result,  the survivor may struggle to keep up with the other participant in a conversation (especially if that other person is speaking rapidly).  This often becomes most problematic in heated, emotional discussions.  When we are in these types of conversations, we tend to speak faster.  Many survivors complain that they are not given enough time to process and respond in conversations.  A survivor will all too often leave such a situation feeling frustrated, ignored or even bullied.
Additionally, many survivors with processing speed difficulties struggle with or are completely unable to engage in multi-tasking.  Each individual task requires so much processing effort that attempting to add even a single concurrent extra task becomes a huge burden.

 
Here are a few ways to help a survivor with processing speed difficulties:
1.  Allow the survivor extra time to think, act and respond
2.  Only give the survivor one task at a time to complete
3.  Allot extra time for tasks, so the survivor does not feel rushed
4.  Remember to ask often if the survivor needs more time to think, respond or act
5.  Stay on one topic at a time during conversation and be careful not to talk more quickly than the survivor can process
6.  If the survivor seems unable to process information at a given moment, if possible put the current conversation or activity on hold until a later time when the survivor might feel better equipped
7.  Ask the survivor if he or she has any new ideas or thoughts that may have been generated after the initial iteration of a conversation or activity was completed.  For instance, many times a survivor will report that he or she thought of a great response a few minutes after a conversation was over and would appreciate an opportunity to share that response with others.

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

 

 

Post Injury Humor

Many brain injury survivors struggle with humor after their injuries.  Survivors who were quite socially skilled prior to their injuries will often find that they now make jokes which are deemed inappropriate or insulting by others, even though these jokes were made with the best of intentions in mind.  These difficulties tend to be accompanied by social skill or interpersonal relation deficits in other domains.

Following is a list of suggestions to help ensure that jokes are made in appropriate situations and in a proper manner so as to minimize the likelihood of jokes backfiring.

1.    Prior to telling a joke, assess whether or not it’s a good time to tell a joke in the first place. For example, if someone is in a good mood and is smiling then it is probably a good time to tell a joke. If someone has just returned from a funeral or is currently clearly contending with a like source of emotional stress, then an attempt to add joking to the situation is unlikely to be appreciated.

2.    Pick a subject that you know your audience will find funny. For instance, if your friends usually joke about traffic, it’s a pretty safe bet that making additional jokes about traffic will be welcomed. If you’re in a group that you know enjoys joking about sports, an obvious choice would be to tailor any jokes made to sports.

3.    It is always better to make a joke about a situation than it is to make a joke about a person. A person can be insulted by being made the subject of a joke even if he or she is not present when the joke is made. After all, a third party could always repeat that joke to the person later. Situations (traffic, long lines, bad weather) have no emotions, so situations cannot get insulted. If you do make a joke about a person, it is always safest to joke about yourself.

4.    Keeps jokes short. The longer the joke, the more possibilities for mistakes to occur and someone to get hurt or offended.

5.    Never make jokes that involve sex or someone’s physical appearance (“you look really beautiful”).  Such jokes all too often tend to be taken badly.

6.    Never make jokes about safety (“someone ran away”), danger (“this car is unsafe”), health (“someone had a heart attack”) or important personal issues (“your friend’s struggling marriage”). These issues are more often than not so important that people are uncomfortable with any jokes made about them.

7.    Do not embarrass someone else with a joke. The audience who heard the joke may only remember it for a short time, but the person who was embarrassed will remember the resultant humiliation much longer and consequently may be upset with you for a good long while.

8.    Look for nonverbal signs that indicate whether a person found a joke funny or not. For example, if a person is laughing then a joke probably went well. If  a person is frowning, then it is important to check on how that person received the joke.

9.    If you make an error or upset someone with a joke, always remember to apologize. You are the one who made the offending joke, therefore the resulting consequences are  solely your fault and responsibility. Never try to make excuses (“You need to have a better sense of humor”). Such excuses attempt to deflect blame onto the other person and may make him or her even more upset.

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

Free Webinar on Social Security Disability

The Brain Injury Association of America will be hosting a free webinar titled “Understanding Social Security Disability” on Thursday, October 9th at 2 pm CDT.  As a great many brain injury survivors face temporary or even permanent loss of the ability to work following an injury, it’s extremely common for survivors to apply for Disability.  The Social Security Disability process can be long and confusing, so this webinar is a great opportunity to learn about the rules and expectations encountered when navigating this process.

https://attendee.gotowebinar.com/register/2720859529141907201

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

Fatigue

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

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

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

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