Tag Archives: mood

Utilizing Music For Mood

Music has the amazing power to touch our hearts and souls.  The right song at the right time can move us in powerful ways, eliciting emotions ranging from brightest joy to deepest sorrow.  Harnessing the power of music can also help brain injury survivors (along with the rest of us) make it through their days more successfully.

It is a common sight at a gym to see the majority of participants working out with music in the background to help keep them motivated and driven.  This music tends to be upbeat and intense.  This workout music highlights the ability of music to boost our performance.  Survivors may want to consider using similar energetic background music while they are working out, whether in a gym or in therapy, to help them when they might be feeling low in energy.  However, it is important to ensure that the music does not distract the survivor.  An example of this pitfall to be avoided can be observed in a survivor suffering from substantial deficits in the arena of attention.  A catchy song could cause this survivor to sing along and devote a disastrous lack of attention to foot placement while practicing walking.  Finding the balance (whenever possible) between drive and distraction is important.  Energetic music may also help mitigate general fatigue that can occur at any part of the day.

Music has the ability to lift us when we feel down.  Following a brain injury, many survivors will display acute symptoms of depression or at the very least be significantly (if understandably) sad about their situations.  Survivors should identify songs that lift their moods and listen to that music when they find themselves feeling low.  These songs often tend to incorporate themes of hope and joy.  Religious music is also a very popular and effective source of this helpful form of mood modulation.

Many survivors also face serious difficulties with stress and anger.  Certain music can help individuals to relax and stay calm.  Soft, classical music tends to be popular to ease stress and anger though other types of music can do this as well.  Some individuals prefer listening to sounds of nature (such as waves lapping upon a beach) to reach a more calm state.  Meditation music is a hot market and there is a huge amount of excellent music available both in stores and online.

Not every song will help with every mood and sometimes the music that is most helpful may not be the survivor’s favorite song or from a favorite band.  What is most important is that the music in question leads to the emotional experience that the survivor would like to cultivate.  Technology has advanced exponentially over the last few years, and survivors should take full advantage.  A survivor can keep a playlist of songs to help influence his or her emotions on a smartphone, Ipod or other similar device that can then be accessed throughout the day.  Remember that music can be an important part of any recovery process!

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

 

 

 

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The Problem With the Word “Should”

The word “should” may be one of the most hazardous words in the life of a brain injury survivor.  It tends to appear in sentences such as “I should be walking already” or “I should have been back at my job by now.”  The word confers a tremendous degree of expectation on the survivor and implies that somehow the survivor is a failure if he or she has not achieved what he or she “should” have achieved.  Often, this word sparks a cascade of statements by which survivors verbally punish themselves.  “I should have been able to walk without a wheelchair but I instead I fell.  I should be doing better with my mobility.  I am letting down my whole family!”  These “should” statements can easily lead to depression, stress and damaged self-esteem.

The reality is that each brain injury heals at its own rate and as a result each survivor is left with his or her own unique set of challenges.  After a serious brain injury, it often takes a survivor considerably longer than he or she may expect to reach goals due to the severity of the injury suffered.  An injured brain is not like a broken arm.  You cannot put a brain in a cast as you would put an arm, expecting that in a relatively brief period of time the brain will be healed.  Brain injury rehabilitation is a process that takes time and patience.  The only applicable “should” enters into consideration in emphasizing that the survivor should dedicate full effort to his or her therapies.  That is all anyone, including the survivor, can reasonably ask for.  As long as the survivor is giving his or her best effort, the survivor is doing everything in his or her power to get better.  The rest of the process will depend on time, the practicing and learning of new skills and how the survivor’s individul brain heals following a specific injury.  Recovery cannot be rushed or forced.  “Should” statements that imply that somehow recovery ought to have gone differently are thus plainly revealed as emotional snares best avoided.

 

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

 

Just Be Grateful

“Just be grateful you are alive”

“Just be thankful you didn’t die”

“You should just focus on the fact you survived”

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

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

 

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

 

Give 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/

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

Mood and Awareness

It can be scary when a brain injury survivor lacks sufficient awareness of the full effect an injury has had upon his or her life.   It can be all too easy for a survivor in such a circumstance to engage in what could potentially be extremely risky behavior. For instance, if a survivor does not realize that he can no longer walk, he may attempt to get up from his wheelchair anyway to walk to the bathroom. This could lead to a terrible fall. Similarly, a survivor who is not aware that she now suffers from severe memory deficits may turn on a curling iron for her hair and forget to turn it off. This could lead to a fire. When survivors gain in awareness of their situations post-injury, families understandably feel much more at ease as these risky behaviors can only decline.

However, there is one downside to such improved awareness. When a survivor first becomes significantly aware of his or her deficits, he or she often experiences a marked decline in mood. The survivor is suddenly aware of the severity and implications of the injury. It is depressing to realize that life has changed, in some cases irrevocably, and that success over these new challenges can only come after many trials and tribulations. It is important that the loved ones of brain injury survivors understand that this decline in mood is natural and expected. This is the time when a psychologist, counselor or psychotherapist can step in and help the survivor adjust to his or her new situation. With therapy and support, most brain injury survivors will see an improvement in mood after this initial decline due to increased situational awareness.

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

What Is a “Flat Affect?”

There are so many terms that family and friends of brain injury survivors are exposed to that are simply not part of our day to day vocabulary.   Learning to understand all these new terms while attempting to cope with an already trying experience can be quite dizzying.  I would like to take a moment to explain one of those terms, “flat (or flattened) affect.”

 
A flat (or flattened) affect is when a person does not display or experience emotions with the same intensity that  he or she did before an injury so that the affect (mood) of the individual in question appears to be unchanging (flat).  This symptom is most common in right-sided brain injuries.  A survivor with a flat affect may be told that a friend has died and blandly state, “That is too bad.”  The same survivor could be told that he or she has won a huge contest and simply say, “That is nice.”  Instead of being distraught and tearful in the first example or excited and elated in the second, everything ends up feeling to the survivor similarly ordinary.  This is not to say that the person does not understand the importance of each situation.  It is simply that the person’s brain is no longer capable of experiencing the strong emotions we generally associate with having encountered such a situation.  Rather than traversing the hills and valleys of normal emotional fluctuation, the person’s emotional experience is more akin to that of an even surface or flattened plain.

 
As we are social beings, a flat affect can of course interfere with social relationships.  Other people may find it awkward or off-putting when the survivor does not display the emotions that would be normally expected in a given situation.  For instance, a friend might find it odd that a warm smile is not reciprocated with a similar smile by the survivor.  It may feel to the other person like the survivor is now almost robotic in most interactions.  Many survivors with a flat affect need to be retaught social skills so as to allow for improved social functioning.  This may include learning to show facial expressions appropriate to the emotion associated with a given social interaction, even if the person is not feeling said emotion or perhaps not feeling the emotion very strongly.  Sometimes, loved ones mistakenly assume that the flat affect implies depression or anger.

 
A further complication is that the lack of or decline in the experiencing of emotions can also impact motivation to engage in activities.  If a person feels strongly that he or she wants to accomplish a goal, then motivation there will clearly be high.  However if the person feels little emotion to begin with, it is often difficult to arouse more than minimal motivation.  Many survivors with flat affect report little desire to participate in activities that they previously enjoyed or weak motivation for therapy.

 
Survivors with flat or flattened affect often find that as their injury heals, they experience a wider range of emotions.  Unfortunately, there are also those survivors for whom this will prove a symptom that provides some level of struggle throughout the remainder of their lives.

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

Tony Dorsett

Tony Dorsett was one of the greatest players in football history.  Over the years he began to experience memory loss, mood swings and thoughts of suicide.  He took the initiative to be tested for Chronic Traumatic Encephalopathy (CTE), which is a brain damage experienced secondary to multiple traumas to the brain.  In Dorsett’s case, these traumas occurred as a result of the thousands upon thousands of hits he endured  over the course of his playing career.  Dorsett was found to have signs of CTE.  The link below will bring you to a video in which he discusses his experience learning to cope with the symptoms of brain injury. In addition to providing further detail on Dorsett’s story, the article beneath the video relates the similar experiences of Hall of Fame lineman Joe DeLamielleure and All Pro linebacker Leonard Marshall as they also have experienced brain injury symptoms and received the CTE diagnosis.

http://espn.go.com/espn/otl/story/_/id/9931754/former-nfl-stars-tony-dorsett-leonard-marshall-joe-delameilleure-show-indicators-cte-resulting-football-concussions

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

Focusing on the Positive – Part 1

All people are inherently programmed to notice and immediately form lasting and indelible memories from having negative experiences more so than they will from having positive experiences.  For instance, if someone cuts you off in traffic, you are more likely to remember that event than if someone allowed you to merge into traffic.

Generally, our lives are filled with considerably more positive than negative events so our moods tend to be good.  However,  a brain injury invariably brings about a noticeable increase in the number of negative events in a survivor’s life.  These negative events can include such things as the loss of a job, physical pain or a decline in mobility.  As the ratio of positive to negative events shifts, many survivors see a decline in their emotional well-being.

One of the methods that can help improve mood is to deliberately focus on positive events.  A simple way of accomplishing this is by writing down at least five positive things that happened during the day.  This should be done on a daily basis.

Positive events do not have to be large accomplishments such as walking for the first time post-injury.  They can be (and usually are)  smaller events such as having a nice conversation with a spouse or working hard in speech therapy.  Moreover, if the same positive events happen each day, they can be written down each day.  You do not want to ignore positive events just because they happen regularly. The events should  be documented and kept in a format that can be easily accessed and reviewed.  A clear and concise diary-style list is suggested, and survivors with visual deficits may benefit from making a voice recording of events.  This activity should not be done only in one’s head.  When we leave the positive events in our head, it is all too easy to forget or discount them.  As such, it is preferable to have them available in a concrete visual or auditory format.

Here are some sample entries of daily positive events:
11/25

1.  Went out to eat for breakfast

2.  Enjoyed reading a book

3.  Transferred from my wheelchair without help

4.  Showered with only 25% assistance

5.  Had a nice conversation with my mother

11/26

1.  Was complimented by my physical therapist for giving great effort

2.  Was able to share my feelings with my counselor

3.  Conducted a cash transaction without assistance

4.  Told a joke that made everyone laugh

5.  My wife served my favorite dish for dinner

11/27

1.  Woke up without needing my alarm clock

2.  Followed my daily schedule without errors

3.  Received a card from a friend

4.  Found out that I gained 5% range of movement in my right arm

5.  Finished reading my book

By doing this activity every day, it is easier to notice and focus on positive events.  Consequently, many people who engage in this activity experience an improved mood and an expanded appreciation of daily life.

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