Tag Archives: therapist

The Rehabilitation Partnership

One of the most basic truths of successful rehabilitation is that it involves a partnership between the patient and therapists/doctors.  It is important to understand what this partnership entails, namely that without both parties’ investments in the process the patient will only see limited improvements.  This also means that each side has a responsibility to the other side to ensure success.  The job of rehabilitation is a shared job between the patient and rehabilitation professionals.

There are a number of implications to this basic truth of the rehabilitation partnership.  A therapist/doctor cannot make a patient improve.  A therapist/doctor can only work with a patient to help the patient improve.  Keeping this in mind should dissuade rehabilitation professionals from imagining themselves to be like Superman, swooping in to save the patient from the patient’s brain injury.  Brain injury rehabilitation simply does not function like a comic book story.  This realization should also empower the patient with the knowledge that his or her thoughts, feedback and effort are a vital part of rehabilitation (without which success cannot be fully achieved). Professionals need the patient’s thoughts and feedback to best plan and implement therapy.  Every patient is different, so a method that helps one patient may hinder or even harm another.  There is no way for a professional to know this without feedback.  This should also dissuade patients from being too passive when engaging the therapy process.  Rehabilitation professionals cannot help a patient improve if the patient will not try to help him or herself.   They cannot do the work for the patient.

When this partnership between patient, therapists and doctors truly comes together, everyone becomes a vital member of the rehabilitation team.  However, it is important to remember who needs be recognized as “team captain.”  The patient is the “team captain” in the sense that the process is ultimately focused on the patient.  The patient needs to share with the team any and all goals, expectations and dreams.  When the entire team has this information (which has to be updated on a regular basis), the team can best determine the direction therapy needs to take.  For instance, if a patient was formerly a chef and dreams of returning to that former occupation, a great deal of therapy will be focused on activities in the kitchen.  If the patient never went in the kitchen outside of opening the refrigerator door, then therapy will clearly be focused on other activities.

A successful partnership will generally allow the patient and rehabilitation professionals to have a mutual understanding and appreciation of one another.  It will also foster openness, honesty and trust between the patient and the rehabilitation professionals.
Remember, teamwork makes the dream work!

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

Grounding Identity

Living through the brain injury experience can represent quite the assault on a survivor’s identity.  Previously athletic survivors may now struggle to walk.  Previously active and industrious survivors may now be unemployed.  Instead of being in charge at the workplace,  a survivor now is given a list of externally defined rules to follow essential to his or her rehabilitation.  All of this can cause notable emotional strain on a survivor.  Contending with the inevitable alterations wrought by such an injury to the perception of  one’s own identity is no small thing.  Sometimes rather than focusing on all of these changes, it is worthwhile to instead concentrate on those aspects of the survivor’s identity that have remained stable in spite of the injury.  It is often helpful to write down these stable aspects to help visualize and internalize the truth that many of the attributes that have always defined the survivor’s identity at core remain just as relevant post-injury.

Here are a few of these aspects with strong potential to remain stable following an injury:
1.  Family relationships – An injury does not change the fact that a survivor holds family roles as a parent, child or sibling.
2. Life Experiences/Memories – An injury does not negate the many life experiences that a survivor has accumulated.  These experiences can originate in work, school, family or any other facet of life.
3. Interests/Hobbies – An injury is unlikely to change a survivor’s interests and tastes in things like music, food and sports.
4. Knowledge – An injury will almost never fully erase a survivor’s knowledge acquired over years of life experiences.  As example, a survivor who is a truck driver will generally remember all of the quickest routes across town.
5. Personality – An injury may not change a survivor’s personality.  For instance, a survivor who was a hard worker prior to an injury will very likely be just as hard a worker after.
6. Physical Characteristics – An injury may not alter certain physical characteristics.  A brain injury will not change the color of a survivor’s eyes or hair.  For many survivors, overall facial appearance does not change at all (or sees only minor changes) following an injury.
7. Beliefs – An injury will generally have no effect at all upon a survivor’s belief system.  For example, a lifelong Democrat will almost never suddenly begin voting Republican post-injury.

By spending time identifying and shifting focus upon the stable facets of survivors identities, survivors can better emotionally ground themselves as they navigate the brain injury experience.

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