Tag Archives: safety

Quick Points on Wheelchair Safety in Parking Lots

Following their injuries, many brain injury survivors are left depending upon wheelchairs to meet basic mobility needs.  This change in mobility creates new safety considerations that must be taken into account on a daily basis.  One of these considerations surrounds strategies for safely navigating a parking lot while in a wheelchair.

Most adults are between 5 and 6.5 feet tall.  They are accustomed to being easily visible to drivers distractedly circling a parking lot and through rear windshields as drivers back up vehicles out of parking spaces.  When sitting in a wheelchair though, normal adults are often effectively no taller than  young children.  Even the most conscientious driver can struggle while exiting a parking space to see a pedestrian in a wheelchair.  These survivors are also often harder to see by a driver making the turn from one parking lot lane on to another.  Due to this change in baseline visibility, survivors in wheelchairs and their families must be more vigilant of vehicle activity and the abilities at every identifiable moment of drivers to see the survivors.  They must spend more time looking around to observe vehicle activity, just as they would when in the presence of a small child who may slip the notice of nearby drivers.

Another issue regarding parking lot safety is that survivors in wheelchairs are generally slower than the average person would be while moving across the same parking lot.  Since it takes more time to traverse any distance, survivors and their families must add extra time in their calculations as to whether there might be enough time to safely cross in front of an approaching vehicle.   If the result of such calculations inspire even the suggestion of doubt, erring on the side of patience is always the best policy.  Sometimes, family and friends may need to push the survivors’ wheelchairs to help move quickly enough to safely avoid traffic.  Additionally, typical adults generally can step up onto the curb from the parking lot at any location they choose.  Survivors in wheelchairs must use curb cut ramps which often means that they have to take a longer route to get onto the curb and consequently spend more time in the path of vehicles.  Again, survivors and their families must be aware of this additional urgency when choosing a path across any parking lot.

These are just a few quick points on wheelchair safety in the parking lot.  I hope everyone has a safe time in their travels, particularly in parking lots!

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

 

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Anosognosia – Part II

In Part I of this series I gave an introduction to anosognosia, a lack of awareness experienced regarding deficits which occur following a brain injury (https://tlcrehab.wordpress.com/2013/04/17/anosognosia-part-i/).  This lack of sufficient awareness of injury-caused deficits can be frustrating for both the brain injury survivor and the survivor’s family and can often lead the survivor to make poor decisions.  In this installment, I will address strategies by which a survivor can effect improvement of that awareness.

Anosognosia is particularly common when individuals who have suffered moderate to severe brain injuries are first coming out of their comas.  These individuals often suffer from Post-Traumatic Amnesia (PTA).  At this early stage, brain injury survivors are just beginning to heal.  They may walk or talk but will tend to say and do things stridently out of character, such as physically assaulting health care professionals and caretakers or making wild accusations (“You’ve poisoned my food”, etc.).  They also have a very poor understanding of the world around them and new memories established tend not to be very strong ones.  It can be argued that during PTA most brain injury survivors lack a full awareness of their injury.  After all, they are not really well enough connected to reality to allow for a full understanding of all that has happened and often cannot hold on to new memories for a long enough time in order to remember things they have been told.  Many brain injury survivors’ anosognosia simply improves as they gradually emerge out of PTA and attain a better understanding of their situation.

Anosognosia is improved by successfully teaching the brain injury survivor about his or her deficits.  Many people take it for granted that a patient in a wheelchair will automatically understand that he or she is unable to walk.  This is often not the case, particularly in the immediate aftermath of an injury.  Sometimes family and friends can forget that the brain injury survivor may not have all of the information about the injury to which they’ve been exposed.  After all, the survivor may have been unconscious or in PTA while doctors shared such information with the family and friends.  It is important that the brain injury survivor be taught, with rigorous repetition, about his or her brain injury and subsequent deficits.  It often helps to review medical records with the brain injury survivor so the survivor is able to see what happened laid out in an “official” form.  Since many survivors have deficits in memory and comprehension, it is generally helpful to review the information with the survivor on an excessively regular basis until he or she demonstrates a strong understanding of the injury and its consequences.

Brain injury survivors with anosognosia often benefit greatly from feedback on their performance during tasks.  This can aid in a very specific manner in efforts to teach them about their deficits.  For instance, a survivor with reading deficits may not believe he has a deficit until he attempts a reading test and learns that he got half the comprehension questions wrong.  Therapists may employ a method termed “guided failure.”  In this method, the patient is allowed to attempt a task (with safety precautions in place, as necessary) that the patient believes he or she is capable of completing but which the therapist knows will serve as a substantial obstacle.  This gives the patient an opportunity to try the task and learn from his or her struggles.  In some cases, the survivor may benefit from seeing a video which documents the attempted task and resultant poor performance.  Some survivors who minimize their difficulties quickly gain appreciation for their deficits when they see their difficulties on video.   The video provides objective evidence of performance.  Another method that therapists often use is asking patients to rate how they will do on a task prior to starting it and then comparing that rating with the actual results of the attempt.  This method allows the therapist to show patients the difference in performance between what those patients believe they are capable of achieving and what actually occurs.  As an example, a patient may estimate that he can walk 5 miles but when he tries to walk he is only able to accomplish 10 feet.  The therapist will then review with him the difference between his estimated performance and his actual performance.

Improvement in anosognosia, particularly for survivors with more serious injuries, can be a long, slow process.  Most survivors do show improvement over time.  Unfortunately, there are some cases in which a survivor does not make appreciable improvement in their anosognosia despite considerable effort.  In these cases, it is vital that the survivor’s family and treatment team develop a safety plan in order to minimize the impact anosognosia is allowed to have on the survivor’s general welfare and overall quality of life.

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

Can I Drive Yet?

One of the most common questions a patient will ask the Transitional Learning Center staff is when that patient will be able to resume driving.  This is an understandable concern as most Americans use their cars as their primary means of travel.  Additionally, a car is often viewed as a symbol of freedom and independence and not being able to drive is often felt as an acute personal loss.

Of all the activities of daily living, driving is one of the most complex and as such is uniquely susceptible to being effected adversely by deficits left in the wake of a brain injury.  Driving requires such skills as good vision to be able to adequately see traffic and other surroundings, solid motor coordination to operate the vehicle safely, strong attention skills to enable sufficient observation and anticipation of traffic and excellent reasoning skills to make safe decisions.  It requires strong memory skills in order to recall new directions as given and strong processing skills to analyze all of the various forms of information the driver receives in the course of a trip.

If all this were not difficult enough, driving requires all of these activities to be done while travelling at incredibly high rates of speed.  For instance, 60 miles per hour (a pretty typical speed limit for highways) is the equivalent of 88 feet per second!  Brain injury deficits are typically magnified by the speed with which a person is trying to do a given task, so the chance of making an error when driving is much greater than the chance of error while walking.  Moreover, making a mistake in a vehicle can be a much bigger problem because a  vehicle can weigh from between around 3000 pounds for a small compact car  to the neighborhood of 12,000 pounds for a larger truck.  If you are driving a midsize sedan at the highway speed limit, you are driving a vehicle weighing approximately 5500 pounds at 88 feet per second.  Any accident may be a major accident.

One of the statements we often hear from patients when discussing driving is, “But I haven’t forgotten how to drive.”  This may well be the case.  Unfortunately, this fact does little to lessen the gravity of the central issue at question.  Remembering or not remembering how to drive is not the problem.  Most patients in the post-acute stage of traumatic brain injury retain their pre-injury memories for how to engage in a number of activities, particularly those activities which have been done repeatedly like driving.   The issue is not whether or not a patient remembers how to drive, but to what extent that patient can safely drive today in spite of any deficits that may have been incurred due to his or her injury.

It is recommended that any person who has suffered a serious brain injury be evaluated by a driving rehabilitation professional prior to resuming driving.  Some brain injury survivors are able to return to driving but many cannot.  A professional evaluation will assess a patient’s driving skills to ensure both the safety of the survivor and of the public.  They also can and do recommend devices that may compensate for deficits.

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

Helmet Safety

As a therapist at a post-acute brain injury treatment facility, I often find myself cringing when driving down the highway.  I see so many motorcyclists without helmets and it brings to mind the many patients at our facility who were injured in motorcycle accidents and were not wearing helmets at the time of their injury.  Riding a motorcycle without a helmet is just a bad idea.

According to a 2009 report from the National Highway Traffic Safety Administration, helmets were 41% effective in preventing traumatic brain injuries in single vehicle accidents and 25% effective in multi-vehicle accidents.

http://www-nrd.nhtsa.dot.gov/Pubs/811208.pdf

Similarly, a study from Johns Hopkins University found a 65% reduction in brain injuries  resulting from motorcycle accidents when riders wore helmets.

http://archive.gazette.jhu.edu/2011/02/28/motorcycle-helmet-myth-debunked-use-decreases-cervical-spine-injury/

A study from the University of Wisconsin-Madison found that motorcyclists without helmets were almost two and a half times more likely to receive brain injuries than those with helmets.

http://www.chsra.wisc.edu/codes/special-cost/motorcycle-helmet-use-and-crash-outcomes-2010.pdf

The numbers do not lie.  Motorcycle helmets truly do help prevent brain injuries.

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