Tag Archives: self

Roles

Perhaps the most emotionally difficult parts of the brain injury recovery process stem from the losses of and changes to life roles due to the injury.  For instance, a man who is used to being the breadwinner may now be in need of financial assistance.  Not only is this a financial change, but it involves a fundamental change in how this man interacts with his world.  He went from financially helping others to needing to ask for such help.  In many cases,  role changes can be experienced as an attack upon the very identity of the individual involved.  A brain injury survivor may have had a role as a Boy Scout Troop Leader for twenty years, but after the brain injury can no longer participate in Boy Scout activities.  After twenty years, this activity may have provided much of the foundation upon which the survivor considered his identity to rest.  Not only is he involved in Boy Scouts, he “is” a Scout.  For some brain injury survivors, it may feel like a piece of themselves died when a role important to them was necessarily lost.  Some roles that often change or may even be lost due to a brain injury are:

1. Parent

2.  Employee/Worker

3.  Volunteer

4.  Student

5.  Man or Woman of the House/Authority of the Home

6.  Athlete

7.  Driver of Vehicle

8.  Organizational Leader

9.  Musician

Since our roles are part of what defines our identity, the loss or changing of roles can be quite traumatic.  Here are a few methods that can help a survivor who has experienced these losses or changes.

1.  Identify roles in which the survivor still has sufficient ability to engage.  For example, a survivor may not be able to continue his work as an electrician but his children still need his love, support and advice in his role as their father.

2.  If a role has changed, identify the parts of the role in which the survivor can still become involved.  For instance, a survivor may not be able to balance her checkbook or pay bills but she can still sign her own checks once some else has filled them out.

3.  Help find new roles for the survivor that can take the place of roles that have been lost.  One example involves a survivor no longer able to continue at his job as a high school football coach.  Since he reads well and likes children though, he may enjoy volunteering to read books to children at the local library.  Volunteering is a great way to engage in new roles after an injury.  Similarly, a survivor may not be able to return to his or her former employment but may still be able to begin new employment.  For instance, a survivor who is unable to work as a truck driver due to loss of use of his or her legs may be able to work at a desk job such as a bank teller.  Joining organization, clubs or taking a class are other great ways to identify new roles.

By identifying roles in which survivors can engage, the emotional trauma of those roles that are lost can be notably reduced or sometimes even eliminated.

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