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/

What Happened to Your Shoes?

We each have a way that we are used to visualizing ourselves. It is part of our identity. We may comb our hair in a certain way, favor certain styles of clothing or wear certain shades of lipstick. Catching sight of ourselves in a mirror presenting in our typical manner helps reinforce a sense of normalcy. Any change to our usual look or style has potential to cause us some level of discomfort or stress.

After a brain injury, survivors may change their normal looks or styles. Sometimes, this is done for safety or practicality. For instance, certain pairs of sneakers may not supply adequate ankle support for safe ambulation or certain shirts are too hard to put on independently. However, in other cases survivors fall into habits of “dressing down” on a daily basis. Survivors may say to themselves, “I am not going to same places that I used to go, so I will just wear my ugly jogging pants. Who cares, right?” Or, survivors may say to themselves, “Why dress to impress? I have no one to impress. I will just put on a t-shirt and sweatpants every day instead of my favorite shirt and pants.”

This “dressing down” can cause a negative emotional feedback loop. Dressing differently serves as a constant reminder that survivors are not living the same lives as before. Survivors see themselves dressed poorly, which may make them feel badly. Feeling badly causes survivors to be even less inclined to dress nicely so they continue to dress poorly. In turn, seeing themselves dressed poorly on a daily basis may make survivors feel even worse than before. For some survivors, this contributes to a downward spiral in mood.

As “dressing down” makes many survivors feel badly, dressing as they would have prior to their injuries often makes survivors feel better. Even if survivors are not going to the same jobs or activities as before, putting on nicer clothes on a regular basis may help them feel emotionally better. For ladies this often includes putting on make-up or jewelry (as they would have prior to their injuries). The experience of seeing themselves fully “put together” will often improve survivors’ moods. For many people, even without injuries, if they “look like a million dollars” then they “feel like a million dollars.” And when moods are improved, other facets of their lives are often easier and better. So break out your nice wardrobes and feel better!

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/

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

 

Practice Makes Proficient

Neurorehabilitation from a brain injury involves learning and re-learning a long list of common activities.  Patients spend hours honing skills such as naming well-known items, transferring to and from a wheelchair and using adaptive equipment.  Therapy sessions often consist of countless repetitions of the same action, drilling these essential skills over and over (and over).  Further, therapists will usually send patients home with discharge plans outlining continued practicing of these same skills at home.  Sometimes, patients will wonder why they have to practice these activities to such a degree.  After all, if they demonstrated the skill once (or more likely a multitude of times throughout inpatient therapy) doesn’t that serve as proof positive that they now possess said skill?  Why is this repeated practice necessary?

In reality, to truly become proficient at any skill a great deal of of practice is necessary.  Just because a patient has succeeded at demonstrating a skill on one occasion does not mean that he or she will succeed in the future.  This is true for any life activity or field of endeavor.  For instance, imagine hearing the following overhead announcement while taxiing an airport runway prior to takeoff:  “Ladies and gentleman, welcome aboard flight 683 to Phoenix.  My name is Captain Mike and I will be your pilot today.  I have successfully flown a plane once.  I anticipate a smooth flight today.”  After hearing this announcement, most passengers would probably scream for the exits immediately.  Who would trust a pilot to fly a plane with a history of only one successful attempt?  We instinctively recognize that lots of practice is necessary to trust that a person can reliably and competently complete a given task.  This holds just as true for therapy as it does for the for flying of a plane.  Repeated practice, both in therapy and at home, is necessary for a patient to hone the skills and competencies necessary to successfully accomplish rehabilitation goals.  It is only through practice that patients can become proficient.

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

TLC on TV!

TLC was on TV!  The TLC facilities in Galveston and Lubbock both recently acquired  innovative new robotic arm devices from Bionik Laboratories.  Our partnership with Bionik Laboratories will allow TLC patients to make use of this cutting edge technology in efforts to improve rehabilitation outcomes.  This new technology is so innovative that Fox 26 in Houston came to film a segment at TLC Galveston on the robotic arm and its potential.  Click the link below to see TLC on TV!

http://www.fox26houston.com/news/new-robotic-arm-therapy-being-used-to-help-stroke-patients-recover

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

Dylan O’Brien is a Survivor

Brain injury does not discriminate.  Even those most famous of Hollywood stars are not immune to being injured.  Maze Runner star Dylan O’Brien suffered a brain injury due to an accident while filming the third Maze Runner film.  He needed many months to recover from his injury before he could return to filming.  The most difficult part for Dylan was the emotional aspect of recovery.  The article below is an interesting read in which Dylan opens up about his experiences surrounding the accident.

http://www.vulture.com/2017/09/dylan-obrien-is-back-from-the-brink.html

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

 

Lessons from a Blind Man

We here at the Transitional Learning Center often host patients and family members that speak Spanish as a primary language.  Spanish-speaking TLC staff members are generally on-hand to translate during therapies and other necessary interactions, but on occasion TLC staff will have need to use a phone translation service (in a meeting updating family on progress, for example).  To utilize this service, a staff member will call the service phone number which connects directly to a translator.  The translator can then translate between all parties involved via speaker-phone.

When using such a translator, it is important to pause every few sentences so as to allow the translator to translate that which has just been stated.  On one memorable occasion a therapist spoke for too long without pause and upon realizing her error, stopped herself and apologized for not stopping sooner.  The translator agreed that to do his job effectively he would require more frequent pauses.  He then added that he cannot depend upon notes taken while someone is giving him information to translate because he is blind.  He was doing his job utilizing memory and language skills exclusively.

Reflecting upon this situation there is an important lesson to be learned for all individuals with disabilities, including brain injury survivors contending with long-term deficits.  A translator position is the perfect occupation for a bilingual blind person.  The job requires excellent speech and finely-honed cognitive skills, but in no way requires vision.  The job matches the person’s strengths to a central task while sidestepping the influence of any weaknesses.  After an injury, many brain injury survivors need to find new jobs because newly acquired deficits do not allow them to return to their previous occupations.  It is important during the job search process to honestly identify post-injury strengths and weaknesses in order to find jobs that rely on strengths while minimizing the impact of any weakness.  By taking this important step survivors are more likely to enjoy success in the working world, just like the blind translator from our story.

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