Progress of a Brain Injury

Memory Loss and Frontal Lobe Injuries

2011-10-13T13:11:00.000-07:00

Many memory issues following a brain injury are never resolved. Damage to the brain's memory produce corresponding impairments in the brain's ability to remember conversations and events.

Various things, such as anxiety about the memory lapses, can interfere with the ability to remember. It takes a lot of effort and concentration to compensate for short-term memory loss. It drains energy levels and can often result in chronic fatigue. Intellectual functions may then deteriorate causing feelings of inadequacy, discouragement, irritability and possibly even depression.

There are strategies to help with short-term memory loss, other than the obvious ones of using a diary, calendar or day timer. They are to: live in the moment; learn to trust your instincts; focus on one thing at a time; use repetition; use a system of reminders; plan ahead and be prepared; be organized; avoid alcohol consumption; eliminate distractions and have a routine and stick to it.

There are different types of memory. They are the following:

- Sensory-motor which are things like remembering how to walk, tie a shoelace, get dressed or make a cup of coffee.
- Semantic memory is the ability to retain general knowledge like how to add numbers or how to read .
- Narrative or episodic memory is remembering experienced events in any sort of detail.
- Short-term memory loss is the inability to remember what one did the day before or even earlier in the day, recent conversations or appointments.

Short-term memory loss may cause difficulty in remembering faces of those met recently, reading for pleasure or in watching television or a movie. It can also interfere with educational and personal goals. It is the inability to store and recall current information. Current information is not being recorded. Conversations can be held based on long term memories as long as it doesn't relate to recent conversations or events. There may be difficulty in learning new material and remembering it or forming new memories. Some brain injury survivors may fill in the forgotten details with imagined events or memories. Others may only have difficulty remembering words and thoughts.

One brain injury survivor said that the benefit of having short term memory loss is that it is difficult to carry on an extended argument or to hold a grudge so they appear much more forgiving of others. As well, she won't need to rehash the argument and get upset about it over and over again.

To help improve short-term memory loss, besides the benefits of using memory aids such as diaries and calendars, increase mental activity and challenge your brain. Reading also helps with concentration and memory. Cognitive therapy is also necessary when someone is suffering from short-term memory loss.

There are things that can be done when someone who has suffered a brain injury experiences short-term memory loss. The difficulty sometimes is in motivating them to get into the habit of doing the things that will assist them.

Concussions, Brain Injuries and Personality Changes

2011-10-12T14:01:00.000-07:00

Personality changes will be dependent upon the location and severity of the injury. Prisons and mental hospitals sadly are full of people who have suffered brain injuries which resulting personality changes have made aggressive, violent and often unable to make good choices.

Being aggressive, violent and unable to make good choices can be some of the changes in a survivor of brain injury or someone with repetitive concussions. They may also suffer from mood swings, mental rigidity, impulsive behavior, be apathetic, lethargic, are unable to show emotion, have no interests, be bored and may feel intellectually dull. If they once liked to play games, they may no longer wish to do so because they are unable to concentrate as they once did. If memory is an issue, which it often is, playing games will be increasingly difficult.

They may feel a great sense of loss after suffering a brain injury because they will feel as if they have lost their personal identity and personal power. They will feel that they don't know who they are any longer. If this is the case, they should try to find a Neuro-Psych doctor and a speech therapist who, through therapy, will help them try to fill the holes in their personalities that survivors often feel they have in how they identify themselves.

Many survivors of brain injury feel there is a stigma to having such an injury and will deny and cover up or isolate themselves rather than own-up to a brain injury. They will blame their problems on other things that are physical such as chronic pain in legs that were broken or other health issues which may or may not have been sustained in their accident.

Besides their loss of personal identity, sense of power and self-awareness, they may also lack self-determination, be unable to keep and make friends, have lost some of their memories, be unable to socially interact with others, understand the needs and desires of others as well as be unable to feel compassion and empathy. Very often their likes and dislikes will have changed as well as their sense of humor. They may no longer have a sense of humor or be interested in anything at all.

With so many losses, it is little wonder that a brain injury survivor's personality is likely to change at least somewhat. Not only is it difficult for the survivor but it is difficult for his/her family and spouse. They have lost the person they once knew and will feel the loss themselves. They have to get to know that person again as he/she may be quite different from who he had previously been.

In the case of concussions, some damage, regardless of severity will be sustained so multiple concussions can cause more damage. Both concussions and brain injuries can leave the survivor with deficits. Personality changes are the result of deficits.

Sometimes personality changes may only be really evident to those closest to the brain injury survivor. Others may say, 'He just isn't the same.' or 'Something seems off.' without being able to pinpoint exactly what the difference may be. But often it is enough of a change for even those unsure of what the change is for friends to not visit as often as they once did.

The Story About Strokes - An Acquired Brain Injury

2011-10-05T09:23:00.000-07:00

An acquired brain injury is caused after birth and can contribute to cognitive, physical, emotional and behavioral impairments. A stroke is when blood flow to a part of the brain stops. Brain cells can die and the patient may be left with permanent damage.

There are two major types of strokes:

- The ischemic stroke is when a blood vessel that supplies blood to the brain is blocked by a blood clot. If a clot forms in a narrow artery, it is called a thrombotic stroke. If the clot breaks off and travels to the brain, it is called a cerebral embolism.
- A hemorrhagic stroke is when a blood vessel in part of the brain bursts open and blood leaks into the brain. This usually causes a severe headache.

The causes of a stroke are high blood pressure, atrial fibrillation, diabetes, high cholesterol, a family history of strokes, being over fifty-five years of age, living an unhealthy lifestyle, having heart disease, being overweight, drinking heavily, smoking, using illegal drugs, ethnicity, a previous history of strokes or TIA's and women over thirty-five who are on birth control pills, especially if they smoke.

Some of the symptoms are a severe headache, slurred speech, inability to speak or to understand, loss of balance or coordination, confusion, numbness or tingling on one side of the body, vision problems and muscle weakness.

For best prognosis, it is extremely important to get medical treatment within three hours of first symptoms but no later than four to five hours. At the first signs of a stroke, it will be imperative to call 911 in order to get immediate treatment. This reduces disability and can save lives. Medical staff will examine and possibly give a clot-dissolving drug, do tests with probably tests using all or some of the following - an Angiogram, a CT scan, an MRI, and an Echocardiogram. There will probably be lab tests done as well.

Treatment and prognosis will depend on the cause of the stroke, the severity of the stroke, what has been affected and how quickly treatment was begun. There may be bladder and bowel problems, muscle and nerve problems, speech, memory and thinking difficulties as well.

There are three coping strategies for emotional problems related to strokes:

- approach-oriented coping where the patient consciously works towards minimizing the emotional challenges of the acquired brain injury;
- passive coping which indicates a lack of motivation where patient chooses not to express his/her emotions;
- avoidance coping where the patient actively avoids coping with their emotions. With this type of coping, there is usually a high level of depression.

Patients who have suffered a stroke may possibly need physical therapy, occupational therapy, speech therapy and swallowing therapy. And because it is common for patients to at least initially experience memory loss, rehabilitation in this area may be required as well as using memory aids such as a diary, calendar or a daytimer.

To reduce your risk of of having a stroke, exercise at least thirty minutes each day, eat a nutritional died rich in fruits, vegetables and beans, low-fat dairy products and foods that are low in sodium and fats.

Because a stroke is loss of blood to the brain, the importance of early medical intervention can't be stressed strongly enough in order to reduce the likelihood of a more debilitating disability.

Brain Injuries Involving Military Personnel

2011-10-03T15:06:00.000-07:00

Most brain injuries are life-long, life-altering and will require life-style adjustments. And most will affect not only the victim of the injury but his/her family, friends and the community as well. This has been evidenced by the thousands of military personnel who have come home with brain injuries.

It is suspected that as many as 320,000, possibly more, military personnel have come home with brain injuries that have affected their lives. Brain injuries affect personalities, emotions and often their mobility. Some will have an inability to understand speech but will still possibly be able to read, some will no longer be able to laugh, they may suffer post-traumatic stress disorder and other psychological problems such as denial of any problems. Some may not be able to recognize faces, may be flat and robotic in his speech, be unable to retain information, unable to feed themselves or be unable to form complete sentences. Depression and aggression can also be the results of brain injury. The ability to maintain social relationships quite often is another consequence of a TBI. And one soldier who, although he could see, was only able to see to the left. These are only some of the consequences of their injuries.

Many services will be required for these fighters of their country. They will require speech therapists, life skills coaches, some will need to learn to walk again, and to talk again. Some will suffer the consequences of having problems with drug and alcohol, they will display reckless behavior without considering the consequences, will make poor choices, will behave in unacceptably appropriate ways socially, or will behave impulsively. It is estimated that approximately twenty per cent of all service men who have suffered a traumatic brain injury will drive dangerously, partly as a consequence of the brain injury and partly because of the necessary training they have had while fighting.

Many of the causes of concussion and brain injury is blast-induced neurotrauma caused by a sudden increase in air pressure or when their body has been propelled through the air and the sudden impact as they land. And fragment penetration is another large reason. Approximately 1,400 troops sustained concussions or mild traumatic brain injuries because of blasts during a ten month period in Afghanistan and Iraq. They suffered such symptoms as loss of motor control, dizziness, headaches and difficulty processing their thoughts. Many of these troops are now taking time out when involved in or have been near a blast situation until their symptoms dissipate. Those within one hundred and sixty-five feet of a blast are examined for signs of concussion or brain injury.

Blast-related injuries are the signature wound of the Afghanistan and Iraq wars with many of the troops having been exposed to multiple explosions. Military personnel often don't get the necessary treatment in a timely fashion which can possibly worsen their condition.

Work is now being done on advanced MRI-based methods in order to be able to make more accurate diagnoses so that treatment inventions can begin earlier for those with brain injury. It is also being evaluated whether, or when, those who have suffered from multiple exposures to blasts should return to active duty. These types of follow-up will help to determine the future health of returning military personnel.

Concussions and Chronic Traumatic Encephalopathy

2011-07-05T15:27:00.000-07:00

Chronic Traumatic Encephalopathy, or CTE, is a progressive degenerative disease found in those who have been subjected to multiple concussions and other forms of head injury. It is being found in professional athletes, i.e.: those who play football, hockey, wrestling and other contact sports.

With autopsy, there has been evidence found in many athletes since 2008. In the eleven professional football players who received autopsies, Chronic Traumatic Encephalopathy was discovered in each case. Studies have shown that with repetitive blows, the brain significantly alters permanently.

For those suffering from CTE, they will show symptoms of dementia, memory loss, aggression, confusion and depression. These symptoms can appear quite soon following injuries or may not appear until decades later. Behaviors may be similar to those who suffer from Alzheimer's Disease. It is a build-up of an abnormal protein call tau which clumps in and around the brain disrupting its function.

Some initial symptoms are: attention deterioration, disorientation, dizziness, headaches, slowed muscular movements, tremors and vertigo. As the disease progresses, individuals may display erratic behavior and possibly symptoms similar to those of Parkinson's disease. With CTE's further deterioration, overt symptoms of dementia will be evident, along with speech difficulties, gait abnormalities, difficulty swallowing, a drooping eyelid and lack of control of facial muscles.

Concussions therefore, must be taken extremely seriously. Three weeks should be the minimum time for recovery with a graduated level of activity constituting initially of only light activity progressing gradually to more physical contact. Parents and coaches need to be particularly diligent in watching for subtle changes in athlete's behavior following a concussion and especially when there has been more than one concussion. Children playing contact sports are running long-term risks as some concussions are not being diagnosed.

Studies are being done in an attempt to delay the onset of dementia following concussions. Some athletes are now leaving their brains to scientists so more studies can be done to determine how CTE can be prevented.

According to Boston University, the disease was first discovered in boxers as early as the 1920's. Researchers have noted a pattern of suicide and suicidal behavior in CTE victims. Professional football players, especially those playing in the positions of lineman and linebacker, typically receive multiple hits to the head during every game and practice. It is estimated that they could receive as many as 1,000 hits per season.

Researchers are expounding the importance of brain trauma guidelines being developed to protect athletes and those playing youth sports. They further state that brain trauma education should be mandatory for all coaches, athletes and parents.

Repetitive brain trauma, which includes concussive blows to the head has not, until recently, been treated seriously. With recent research, every indication shows that concussions must be treated with extreme caution and importance. It is urged that this must begin today because tomorrow is too late.

How to Keep Your Brain From Aging

2011-05-23T19:18:00.000-07:00

Most of what has been discovered about the brain has been learned in the last twenty years. It is known now that cognitive decline as we age does not have to be our future. There are many ways that we can slow down the process and keep our brains healthy and youthful.

There are signs to let you know when your brain is aging: memory loss, mental exhaustion and difficulty multitasking. What can we do about it? We can make personal choices to keep our brains younger in order to avoid what some people call senior moments. The following are some of the many choices we can make:

- Oxygen is very important to our brains. If we live a sedentary lifestyle, we don't get enough oxygen. It is important to get a lot of exercise and fresh air; deep breathe and yawn. Exercise grows brain cells.
- Our brains are comprised mostly of water so it is necessary to keep hydrated. Most people need at least eight glasses of water, tea, juice, etc. every day.
- Proper nutrition is very important for our brains. Protein especially means brain growth and makes our brains more focused. Some of the foods that are important to have in our diets are nuts, eggs, fish, white meat, whole grains, fruits and colorful vegetables. An example of a healthy breakfast is fruit, whole grain and a protein.
- Other healthy foods for the brain are: wheat germ, cauliflower, soybeans, brown rice, turkey, soy products, walnuts, pumpkin seeds, olive oil, peanut butter, beans and avocados.
- Foods high in antioxidants are especially helpful for keeping a youthful brain. These include carrots, yams, spinach, cranberries, apples, prunes, plums, tomatoes, grapes, strawberries and raspberries. Blueberries are the winner in the antioxidant category.
- Herbs such as garlic, mint, rosemary, thyme and barley are also good for the brain as is green tea.
- It is important to take supplements, or those foods rich in Omega 3's which include fish and flax seed. A general multivitamin supplement is recommended plus vitamin C, the B vitamins and particularly for seniors, vitamins D and E.
- Stress and sleep deprivation take a heavy toll on the brain. Other things are saturated fats and trans fatty acids also. White sugar is poison, not only for your health but for your brain too.
- Smoking is detrimental to the brain as it damages blood vessels and can cause blood clots. And too much caffeine reduces blood flow to the brain.
- Overuse of alcohol detrimentally affects the brain. Hangovers are brain damage.

Education should never stop. Learning is a safeguard against memory loss. It is important to take on mental challenges and do problem solving. Be curious. Ask questions. Unfamiliar activities are the brain's best friend. Be creative and spontaneous. Travel, learn a foreign language, go to a symphony or an opera, especially if you've never gone before. Try your hand at art, sew, build or knit. Do Sudoku and crossword puzzles.

Protect your brain from insults, i.e.: concussions or injuries by making wise choices, i.e.: wearing a helmet and using a seat belt.

But it's also important to take time to relax, have fun and enjoy nature; enjoy close support of family and friends. See the humor in life; worry less and laugh more. By doing so, while you are keeping your brain healthy and youthful, you are also helping yourself along the path of longevity.

Bipolar Disorder - Symptoms and Treatment

2011-05-17T09:02:00.000-07:00

Bipolar disorder, or manic depression, causes serious shifts in mood, thinking, behavior and energy, from the highs of mania to the lows of depression. These extremes of moods can last a day, weeks or even months.

These swings are often so intense that they can interfere with the ability to function causing difficulties with work performance, school and relationships. It will often run in families although there is no known cause. The first episode usually occurs in the teenage years or as a young adult. Although there are episodes of mania and depression, there is often more depressive episodes than manic.

There are four types of mood episodes within the bipolar disorder realm. These are mania, hypomania, depression and mixed emotions. With mania, there is high energy, creativity, euphoria, hyperactive behavior, excessive talking, little need for sleep, the feeling of being invincible, unrealistic expectations and ideas, acting recklessly without thinking about the consequences and, having grandiose ideas. Hypomania is similar but to a lesser degree than mania.

With depression, sufferers are irritable, unpredictable, experience mood swings, have feelings of restlessness, require more sleep, may gain weight, be fatigued, feel sad, lack energy, may develop psychotic depression where they lose contact with reality, may have feelings of hopelessness and guilt, or possibly harbor thoughts of suicide and death.

Those with mixed episodes will suffer from depression with agitation, irritability, anxiety, insomnia and racing thoughts. Their high energy and low moods increase their risk of suicide.

Other symptoms of bipolar are that those suffering from the disorder may find their judgment as well as memory, concentration, appetite, sleep, and sex drive may be affected. It has been discovered to be linked to anxiety, substance abuse, migraines and some health problems such as high blood pressure.

Diagnosing bipolar disorder early helps prevent further complications. Treatment is long-term because bipolar is a chronic condition. Treatment must continue even when the person feels better because when treatment is discontinued, episodes will likely resume.

Medication is important in the treatment of bipolar but therapy and self-help strategies play important roles also. Exercising regularly, getting enough sleep, eating well, keeping stress to a minimum and being surrounded by supportive people will help. These lifestyle changes may be necessary as well as keeping medication closely monitored. Treatment is more than relieving symptoms; it is an effort to control future episodes. It is important to learn relaxation techniques, i.e.: meditation and yoga can be helpful in this; joining a support group; making healthy choices, i.e.: avoiding overuse of alcohol and taking the required medication.

Over-the-counter cold medications, caffeine and thyroid medication can sometimes trigger mania. Sleep deprivation may trigger mania as well. Manic episodes are more common during the summer and depressive episodes during other seasons.

Being able to recognize the symptoms of bipolar disorder in yourself or someone close to you will help in getting early diagnosis and treatment to enable you to live a life that is not hampered by episodes of mania or depression.

Frontal Lobe Injuries and Their Resulting Damage

2011-05-16T14:34:00.000-07:00

The frontal lobe is often involved in traumatic brain injuries. When the head is struck, the frontal lobes will hit the inside of the skull which can cause considerable damage. This resulting damage can alter life following an injury especially if there has been no rehabilitation.

The frontal lobe is made up of the precentral cortex, prefrontal cortex, orbitofrontal cortex and the superior mesial and inferior mesial regions. Each area has a particular function. But the frontal lobe, in general, is the brain's emotional center and is responsible for higher functioning. Although this is true, no part of the brain works in isolation.

Frontal lobe injuries can affect motor functions, problem solving, memory, social and sexual behavior. It can also affect language skills, impulse control and make changes to the personality. The damage incurred affects feelings of empathy, sympathy, humor and whether appropriate judgments are made.

Functions of the frontal lobe areas involves the ability to recognize future consequences resulting from current actions, an ability to choose between good and bad actions and to recognize the similarity or differences between things.

The frontal lobe assists in retaining long term memories. When this area has been injured, mental flexibility will be impaired. Talking may increase or decrease dramatically. Also, there may be impaired perceptions, possible loss of taste or smell, potential attention difficulties which will make a person easily distracted. Thinking may be inflexible showing perseveration which is an inability to switch from one line of thinking to another. Those with frontal lobe injuries may also lack motivation, the ability to plan and organize and may have difficulty making decisions. Abstract and complex thinking may also be problematic.

Damages such as these often make holding a job more difficult because of the inability to perform work consistently and because problem solving and motor skills have usually been affected.

The hope of successfully returning to work is through rehabilitation. The multidisciplinary approach to rehabilitation is mostly favored which includes specialists from neurology, psychology, occupational therapy, physical therapy, speech therapy and cognitive therapy. Other rehabilitation is developing strategies to overcome deficits. It is important that rehabilitation encourage, motivate and empower.

Rehabilitation involves working on functions that can be restored and learning how to do things differently. Neuro-functional strengths and weaknesses are considered. After strengths are developed, more complex skills can be added. The large brain skills must be retrained or developed before the small skills can be developed. And this must happen before intellectual activity can be worked on and be successful.

When there has been an injury to the frontal lobes, rehabilitation is important and the goal is to help individuals progress to the most independent level of functioning possible.

Alzheimers and the Boomer Generation

2011-05-11T09:03:00.000-07:00

Beginning this year, 10,000 baby boomers a day will turn sixty-five. Alzheimer's Disease is a progressive, degenerative disease and generally develops in people over sixty-five years of age but can start earlier. The biggest factor is age which puts the aging baby boomer population at risk.

Other risk factors are a history of Alzheimer's in your family, environmental issues, high blood pressure, poor diet and lack of exercise. It is estimated that one out of every eight boomers will suffer from Alzheimer's in their lifetime. The average life expectancy of the disease is eight years but many can live as long as twenty years.

There are presently five million people living in the United States with Alzheimer's Disease and over 400,000 Canadians over sixty-five years of age diagnosed with the disease. Alzheimer's is devastating not only to the sufferer but to their families as well. As the condition escalates, people can forget where they live, the names of family members and friends and can become lost on their own street. They become isolated by how they think and by what they can't remember.

There is currently no proven way to cure Alzheimer's but there are ways to delay the onset of this vicious disease. Physical exercise can slow down the degeneration of the nervous system. Other things that depend on the healthy well-being of our brains are: adequate fluid intake, a balanced diet, sufficient sleep, a minimum of stress, maintaining a healthy weight and looking after your health.

The plasticity of the brain gives hope. We can all start building better brains by keeping them active. We can do this by continuous learning which stimulates our brain. Once we stop learning, our mental capacity declines, we lose brain power and our brain cells begin to shrink.

We're never too old to learn new things and our brain's capacity for learning is limitless. The more variety of learning we undertake, the less likely we will experience cognitive decline as we age.

The varieties of learning that are beneficial to our brain are many. Music is one excellent learning experience whether we sing, dance or learn to play a musical instrument. Music increases blood flow to the brain, stimulates creativity, improves memory as well as concentration. Reading, writing and math are also great for the brain. Reading improves not only our memory but our brain. Writing in a journal is excellent for improving the brain and the memory. And when solving math calculations, areas on both sides of the brain are activated. Art is also excellent for firing up the brain and allows us to build links between both sides of the brain.

It is important to begin increasing our brain power when we are young, but it is also never too late to start no matter our age. It is possible to grow new brain cells even as we age.

Generation Alheimers: The Defining Disease of the Baby Boomers http://www.alz-news.org
Alzheimers Society of Canada www.alzheimer.ca
Alzheimers Society of B.C. www.alzheimer.bc.org

Short Term Memory Loss Following a Traumatic Brain Injury

2011-05-10T08:48:00.000-07:00

Following a traumatic brain injury, short term memory loss will be affected, especially if it has been a frontal lobe injury. Short term memory is the ability to remember a piece of information in order to complete a task.

Not focusing, thinking of too many things at one time, not paying attention, not listening and becoming distracted all contribute to difficulties with short term memory. The following are some ways to help manage short term memory problems:

- to help with memory, repeat information received, i.e.: a telephone number, a person's name, an address, or remembering what you were planning to do, i.e.: going upstairs to get something, remembering the three things you were going to get at the store;
- make lists and follow them, have a daytimer or use a calendar with squares large enough to write notes on, use a message board or notebook. Try each method then decide which works best for you. These memory assistants will help you to remember appointments, shopping items or your to do list. They will also remind you about things you want to take somewhere or something you want to tell someone. Daytimers or calendars are also excellent for reminders of future commitments;
- be organized, i.e.: put medication in a daily pill container, put things in the same place so you don't have to look for them, i.e.: your slippers or your house and car keys. Also, do things at the same time each day, i.e.: feeding your dog or cat or watering your plants on a certain day each week, possibly every Monday;
- establish habits – once you are used to doing something it will come naturally rather than having to remember it, i.e.: put out all the things you will need for the following morning before you retire for the night so you won't forget things when you are rushing to leave in the morning;
- write everything down. The process of physically writing something down helps to remember it;
- keep things together so you don't have to look all over for things and won't forget something when you are in a hurry, i.e.: gym equipment such as shoes, work-out gear and a towel, school supplies and work items. Cloth or canvas bags are an excellent way to keep things together.

Outside stimulation such as the loud music played at some gyms, the chaos and noise of rush hour traffic and crowds of people can all have an affect on memory. Stress also will play a part. Try to limit this type of sensory input and find opportunities to take a few minutes to close your eyes and relax, or go for a walk in nature to eliminate stress.

Getting seven to eight hours of sleep each night will also help with short term memory loss. Also, attempt to get to bed at the same time each night. To help alleviate memory loss, before going to sleep each night think back over your whole day and maybe even the day before. This practice will help to improve memory. Avoiding alcohol will help with the problem of short term memory loss as well and doing brain exercises such as crossword puzzles can benefit the brain too.

A lot of our memory can be a belief in ourselves and a determination to remember by remaining focused and working towards the goal of improving our short term memory loss. This is especially true following a traumatic brain injury.

What Do You Know About ADHD?

2011-04-17T19:09:00.000-07:00

Attention Deficit Hyperactivity Disorder (ADHD) is a neurobehavioral developmental disorder dealing mainly with attention difficulties and hyperactivity. Although often considered to be chiefly a child related issue, adults also have it with many never having been diagnosed.

Symptoms usually become noticeable in a child before they are seven years old. The following are some of these symptoms:

- difficulties with impulse control and antisocial behaviors. Some may act out by exhibiting defiant behavior;
- easily distracted, problems with completing tasks and difficulty in following instructions;
- will have difficulty in focusing, will tend to daydream when they should be doing other things and are easily bored;
- has poor organizational abilities, will often talk non-stop and may be hyper;
forgets important things, sometimes losing them and is often impatient.

Attention Deficit Hyperactivity Disorder (ADHD) is a psychiatric disorder affecting three to five percent of young children and is diagnosed in two to sixteen percent of school aged children. About 4.7 percent of adults live with ADHD. For those children who were diagnosed with ADHD, it will continue into adulthood. However, there are many adults who have ADHD but who have never been diagnosed.

It is believed that genetics is a large factor in ADHD. But issues such as nutrition and social environment may have a bearing as well. Also, it is believed there may be a potential link between smoking and alcohol use during pregnancy, contact with high levels of lead or possible consumption of some food additives such as artificial colors or preservatives.

To help reduce symptoms, treatments may include medication, psychotherapy, educational training or a combination of all three. Some medications can have side effects such as a decrease in appetite, sleeping problems, anxiety, irritability, stomach aches or headaches. Medication does not cure ADHD, it will only help to control the symptoms while it is being taken.

Psychotherapy includes behavioral therapy and assistance with social skills. For adults who have never been diagnosed, this can be extremely challenging but they are also usually more highly motivated because they know that treatment for them will make a big difference. They already know how challenging their lives have been. For some adults, they may also be suffering from anxiety and depression.

When ADHD is being diagnosed, sleeping disorders, tic disorders and behavioral problems may be confused with, or appear with ADHD. Most children diagnosed with ADHD quite often have at least one other developmental or psychiatric problem such as depression or bipolar disorder. For diagnosis in children, they should have at least six attention symptoms or six hyperactivity/impulsivity symptoms presenting before the age of seven. These symptoms should be present for at least six months and be severe enough to cause difficulties with school, work and other areas of their life. Diagnosis of adult ADHD is somewhat more involved.

Many of those with ADHD have learned over time to adapt to the problems relating to this disorder.

What is the Difference Between a Traumatic Brain Injury and an Acquired Head Injury|?

2011-03-30T21:12:00.000-07:00

Although a traumatic brain injury and an acquired head injury are brought about by very different reasons, each affects a person's life in ways that change how they once lived. When you know and understand the difference between the two, it is easier to know what to do to begin the recovery process.

A traumatic brain injury is a sudden injury to the head causing damage to the brain. It can be a closed head injury or a penetrating one. It can affect one area of the brain or more than one area. When there is a penetration, the skull will be pierced and a piece of the bone from the skull may enter the brain tissue. With a closed head injury, there is no break in the skull. A skull fracture is when the skull cracks and broken pieces of bone cut into the brain.

The different types of traumatic brain injuries are:
- diffuse axonal injuries where damage occurs over a widespread area of the brain. It is a major cause of persistent vegetative state after head trauma;
- coup injuries occur under the site of impact with an object. With a coup injury, on collision with an object the head stops and the brain collides with the inside of the skull;
- contrecoup injuries usually occur on the opposite side from the area that has been impacted. Contrecoup injuries are a result of the shaken baby syndrome. It is usually associated with cerebral contusion;
- contusions are bruising of the brain;
- concussions are a jarring injury to the brain.

These types of injuries are generally caused by motor vehicle accidents, falls, sports injuries or physical violence. Most will result in cognitive disabilities and difficulties with physical and emotional functioning with contusions and concussions being possible exceptions.

Acquired brain injuries are acquired after birth and will change neuronal activity. They are caused by heart attacks, strokes, aneurysms, meningitis, loss of oxygen, neurosurgery, brain tumors, infections, poisoning, substance abuse, choking or near drownings. The most common cause of acquired brain injuries is a traumatic injury to the brain. It is not genetic or congenital and no one is born with an acquired head injury.

Acquired brain injuries will contribute to problems with cognitive abilities, thought coordination, communication difficulties, organizational skills and memory, physical problems, social difficulties and independent functioning.

Victims of ABI retain their intellectual abilities but because behavior and thinking can be altered, it may be necessary to make a life adjustment to accommodate their new circumstances. Adjustments are critical for recovery and rehabilitation.

Like traumatic brain injuries, for those who have suffered from an acquired brain injury, no two will be the same. Differences will depend on where the injury has been sustained, the areas affected, and upon the personality of the person both pre-injury and post-injury.

In both cases, attitude and effort will make a big difference in what a person will be able to accomplish when working towards recovery.

Acquired Head Injuries and Personality Changes

2011-03-17T16:03:00.000-07:00

Although there are many causes of acquired head injuries, strokes are the most common. And because strokes are usually followed by stress, anxiety, depression and physiological changes the stroke sufferer is experiencing, personality changes are quite often the result.

In many cases, the sufferer is having difficulty moving and speaking and will have lost their independence as a result of their stroke. Those who had pre-stroke tendencies towards handling stress well, coping with adversity and were optimistic by nature, are more likely to react better following a stroke. Those whose pre-stroke personalities made them prone to anger, anxiety or depression will find stroke rehabilitation discouraging. Lack of motivation is a common reaction with the latter group when recovery is slow and especially if there are many setbacks. And depression and apathy can follow quickly thereafter.

Personality changes are differences in behavior, thinking and interactions of someone from what their normal character has previously been. Personalities are vulnerable to changes following a stroke but these changes may not always be permanent. Once there is an improvement in their abilities, their personality may return to their pre-stroke behavior and way of looking at things.

Some stroke sufferers may have uncontrolled bouts of crying or laughing. Some may have reduced patience and increased frustration levels, be more impulsive, lack self-confidence, be self-centered, more emotional or behave inappropriately. Others may suffer from post-traumatic stress disorder which is a fear of helplessness. Some have difficulty functioning socially and many have symptoms of identity loss which can lead to changes in their personalities. Identity loss is the feeling that many stroke sufferers have because of how they see themselves following a stroke. Their lives have been altered, especially if there have been major changes in their functioning abilities.

The following are some of the ways to help a stroke victim:

- treat them with respect and listen to what is bothering them;
- offer praise when they make an effort to work towards recovery;
- allow them to make choices. It is often necessary, however, to ensure that their choices are not ones that will place them at risk;
- discuss their personality changes with them and determine if they can identify and understand the changes in themselves;
- if they have an awareness, help them towards developing compensatory strategies;
- express your feelings about the changes and encourage them to discuss how they feel about the changes;
- discuss with them how personality changes have impacted their relationships.

If they are uncomfortable discussing their personality changes with someone close to them, perhaps it would be easier for them to do it with a third party, unbiased person who is not closely involved with them. Being aware of their personality changes can help considerably towards being able to work on them.

Brain Injury Awareness

2011-03-11T19:46:00.000-08:00

March is the month set aside to remind all of us of the importance of increasing the quality of life for those suffering from both traumatic and acquired brain injuries. It is also a time to remember that there are things each of us can do to prevent brain injuries for ourselves and our families.

As the population ages, acquired brain injury in particular becomes a major concern. Acquired brain injuries are causes by internal forces such as strokes, tumors, infections, substance abuse, various illnesses and oxygen deprivation. Strokes are the leading cause of these types of brain injuries.

Symptoms of a stroke are:

- a sudden weakness or numbness of the face, arm or leg, particularly on one side of the body;
- a sudden dimness or loss of vision, usually in one eye;
- loss of speech or difficulty in understanding what others are saying;
- a sudden severe headache;
- unexplained dizziness or falling down, especially if experienced with one of the other symptoms.

Recovery from strokes varies largely depending upon the severity of it. Other things that contribute to recovery from a stroke depend on how quickly treatment was received and the type of treatment given, as well as the determination of the stroke sufferer to improve.

The following are some ways to reduce your risk of suffering from a stroke:

- control diabetes by watching your diet and monitoring your diabetes daily;
- control high blood pressure by monitoring and avoiding sodium or foods with high salt content;
- control your cholesterol level by watching your diet and exercising regularly;
- avoid smoking;
- limit alcohol intake;
- exercise regularly and avoid the risk of becoming overweight by eating a healthy diet;
- become active and avoid a sedentary lifestyle;
- avoid stress where possible;
- get regular check-ups and follow the advise of your doctor.

However, there are some things we do not have control over. Strokes do increase with age. Two-thirds of those who suffer from strokes are over sixty-five years of age. Gender also has a bearing. Twenty-five percent more men than women will have a stroke. For both men and women, having a family history of strokes or heart disease increases the risks of suffering from a stroke.

Each of us can do our part in eliminating the risk of stroke for ourselves and in those we care about by living a healthy lifestyle and encouraging others to do so also. Some of the ways we can do this is by getting out and walking, bicycling, swimming or joining a yoga group. And we can increase the amount of vegetables and fruit we eat and eliminate the foods that are not good for us.

March is a good time to get family and friends together to increase your activity and make the decision to live a more healthy lifestyle and have some fun as well.

Multiple Head Injuries and Dementia

2011-03-11T19:38:00.000-08:00

According to statistics, it is thought that repeated head injuries are the third most common cause of dementia. Repeated head injuries can be the result of concussions which are common with boxers in particular but with many other athletes as well.

Most in the medical field now agree that concussions are a mild head injury. Historically, concussions involved loss of consciousness but this does not always happen. However, when it does, it is considered to be a more serious brain injury than if there had been no loss of consciousness.

In the case of boxers, the onset of early dementia can begin about fifteen years following the first concussion. It is estimated that between fifteen and twenty percent of boxers can be affected but also hockey, soccer and football players who suffer multiple concussions can suffer the effects as well.

When concussions initially occur, sadly they may not be identified as such or may even be ignored. However, with rest, in time they will heal. Some of the possible initial symptoms of a concussion are headaches, dizziness, vomiting or nausea, blurred vision, confusion, slurred speech, tearfulness or irritability. There is no indication that someone who has suffered only one concussion is at risk for dementia.

It is important for athletes who are at risk for developing dementia in later life to do things to prevent or delay the onset of it. The following preventative measures should be taken:

- it is important to exercise consistently;
- eat a brain healthy diet;
- avoid smoking;
- avoid alcohol;
- challenge your brain by learning new things;
- get a lot of rest.

The nature of dementia depends on the type and location of the head injury and the person's characteristics previous to their injury. Dementia related symptoms are:

- memory difficulties;
- tremors and lack of coordination;
- speech and communication problems;
- difficulty walking;
- inappropriate behavior and paranoia;
- explosive anger;
- cognitive and emotional difficulties;
- personality changes;
- delusions and or hallucinations, confusion and disorientation;
- a decrease in problem solving abilities and judgment;
- depression and irritability;
- declining mental ability to think and concentrate;
- and possibly other prolonged and irreversible problems such as impaired recognition which will impact daily living and independence.

Rest is important during the healing process . A return to any sports' activities should be based on the severity of the concussion. Injured players should be symptom-free for one week following a concussion but if they become unconscious, all sports activities should be avoided for a month after all symptoms have cleared. It is important to avoid a second concussion until well after all symptoms have cleared. And if there is any swelling or bleeding of the brain, sports and the risk of another concussion, should be avoided for an indefinite period of time.

Improving Our Brain and Reducing Our Risk of Alzheimer's Disease in Later Life

2011-02-16T21:43:00.000-08:00

In an interview seen recently on television, Daniel Amen, M.D., clinical neuroscientist and adult and child psychologist was talking about his book 'Change Your Brain and Change Your Life'. His book is not only for those suffering from brain injury but apparently has information for everyone on how to increase the potential of our brains.

The following are some things that Dr. Amen claims can improve our brains now but will also lower our risk for Alzheimer's disease in later life:

- to exercise at least four times a week for a minimum of twenty minutes, preferably cardiocvascular exercises;
- to eat a diet high in vegetables (particularly the most colorful vegetables), fruit and fish but little or no red meat;
- to take omega 3 fish oil supplements;
- to take a daily multi-vitamin supplement;
- to eat blueberries (top of the list), cranberries and walnuts;
- to get a minimum of at least seven hours of sleep each night;
- to relax through meditation; and
-to drink a lot of water.

He also recommended that in order to be physically and mentally healthy throughout our lives drinking alcohol to excess and smoking also increases the risk of developing Alzheimer's disease down the road.

Not only will doing the above, according to Dr. Amen, reduce our risk of Alzheimer's disease, but it will also help those who suffer from Attention Deficit Disorder, who are obsessive-compulsive, who have negative thought patterns or inflexibility in their thinking.

Taken from another source is the suggestion that honey and cinnamon when taken together can increase alertness and vitality.

It is important to start looking after our brains as young as possible but as Dr. Amen points out, it is also never too late to start.

The Effects of Marijuana on the Brain

2011-02-10T21:28:00.000-08:00

Although there are a few positive aspects to the use of marijuana such as assisting and controlling pain and its use for cancer and AIDS patients, according to my research there are more negative than positive issues related to it. The following are some of the harmful, and not so harmful, effects of using marijuana:

- Marijuana can hinder the memory. While under the influence of marijuana, new information may not register and could be lost from memory.
- It can have a harmful affect on the central nervous system.
- It can affect the emotions causing depression, chronic anxiety or panic attacks in some people.
- Some users may be affected in such a way that one minute they will be laughing uncontrollably and in the next may be experiencing feelings of paranoia.
- It can trigger severe mental disturbances, particularly in the case where a brain has already been seriously hampered as in the case of someone who has suffered a brain injury, is schizophrenic or has a bipolar disorder.
- In some cases, and with repeated heavy usage, it can damage nerve cells.
- It could possibly contribute to cognitive impairment, while using, which will make learning difficult.
- It can cause psychotic reactions such as delusions or hallucinations.
- It may have an affect, on some users, on concentration abilities and distort perceptions, particularly as it relates to time.
- Usage of marijuana will slow the reflexes and reaction times thereby interfering with driving abilities.
- It can affect the release of dopamine which has the potential of creating medical problems.

Although some believe that those who use marijuana are more at risk for becoming addicted to harder drugs, in a 2006 United Kingdom government report, it was stated that they considered it to be less dangerous than tobacco, prescription drugs or alcohol.

Besides its ability to control pain, further research indicates that it can help to reduce stress, increase the libido and creativity, encourage philosophical thinking, enhance enjoyment of food and music and inhibit aggression, in some people.

But when looking at the issue of marijuana usage as a whole, the harmful effects to the brain seem to heavily outweigh any benefits there may be to the user.

The Long Road Ahead for Gabrielle Giffords

2011-02-05T12:41:00.000-08:00

No one knows how hard that road will be to travel better than Gabrielle Giffords. And even she doesn't know because it's an unfamiliar and uncharted road with no one, including herself, knowing what pitfalls there are going to be ahead or what the real extent of her brain injury will be.

Will her personality change? The Gabby Giffords that those who know her are familiar with would no doubt plunge fearlessly into the unknown territory of this challenge and fight to get better. But is she the same Gabby? Will she still have a smile on her face and an answer for the constituents she is representing? It will take time for that to be known by her medical team as well as by Gabby and her family.

One news source said she was recuperating from her traumatic brain injury. Anyone who has been involved with or has worked with someone who has suffered from a brain injury knows that no one 'recuperates' from one. They will improve, they will adapt and adjust and they will learn to cope but they don't recuperate. And at the very least, most will be left with some deficits. It is a tough road to walk and the hard work she is facing should not be forgotten or ignored when hearing news articles that appear to negate the extreme seriousness of her situation.

No two brain injuries are the same. Those with determination and the motivation to push themselves will definitely be ahead of the game. Also, if Gabby Giffords is fortunate enough to receive cognitive therapy and treatment as soon as possible, I feel very positive about her future outcome. I have seen first-hand the positive results of early therapy.

For more information about brain injuries go to:

- Lash & Associates Publishing/Training Inc. www.lapublishing.com
- The National Resource Center for Traumatic Brain Injury www.neuro.pmr.vcu.edu
- Brain Injury News and Information Blog www.BrainInjury.blogs.com
- Northeast Center for Special Care
- Brain Injury Association of North America www.biausa.org

I wish Gabrielle Giffords success as she faces her biggest challenge yet. She has a lot of things on her side though – her relatively young age, her strong personality (as evidenced by what she has already been able to accomplish in her life), and hopefully a determined spirit. Best wishes to Gabby and her family and to everyone who has suffered a traumatic brain injury.

Memory Loss - Some Important Things to Know

2010-10-27T20:47:00.000-07:00

When determining that someone is suffering from memory loss, it is necessary to know what the symptoms are and to discover the cause. The next important thing to know is how to prevent memory loss and to decide on the best avenue to take to slow down the symptoms.

Some of the symptoms of memory loss are:

- an inability to recall events over a short period of time;
- forgetting names, dates and appointments;
- getting lost even in a familiar neighbourhood;
- having difficulty comprehending and completing tasks previously familiar with;
- there may be some confusion relating to memory;
- will worsen as a person becomes tired.

Some of the possible causes of memory loss are:

- the aging process (in the normal aging process, a person will still continue to function normally);
- traumatic brain injuries or brain damage caused from strokes;
- Parkinson's or Huntington's disease, Lyme disease and HIV/AIDS;
- early dimentia or Alzheimers;
- some drugs such as statins, chemotherapy, or vitamin deficiencies;
- certain types of seizures;
- depression;
- alcohol abuse.

How someone suffering from memory loss can help themselves:

- it is important to spend time with people to help keep mind active;
- read the newspaper and keep up with current events;
- try to learn a new skill;
- it is necessary to get lots of rest;
- it is important to have a nutritional diet;
- focus on things that are important to remember;
- avoid drinking alcohol;
- make use of calendars, notes and to-do lists for appointments, etc.

Some of the ways to help those who are suffering from memory loss are:

- take sufferer for a complete physical examination to determine the reason for the memory loss so that proper treatment can be given depending on the cause;
- follow-up on what they are doing to ensure that they are helping themselves in the best way possible;
- give reminders regarding such things as diet, when necessary;
- make sure that the family member is not isolated, help them to stay involved;
be there to offer encouragement and support;
- take for regular medical check-ups.
Because memory loss is serious for both the person who is experiencing it and for family members, encourage everyone close to the family member who is having difficulty, to lend their assistance when they think help may be needed.

personality Changes - Lack of Motivation Following a Brain Injury

2010-10-25T21:13:00.000-07:00

Lack of motivation is a direct result of injury to the frontal lobe and can create a change in a person's personality. This deficit can lead to social isolation for the brain injured survivor as they are usually not interested in recreational activities.

It is often the case that the injured person is not even interested in activities that had been enjoyed previously. They may have no interest in events and complain that there is nothing to do. It is more that there is nothing they are interested in doing or have the energy to pursue because fatigue is also part of the personality changes. As a result they may prefer to sit on the couch all day.

Motivation requires persistence and determination in order to be able to follow through on something. It requires self-confidence and a degree of self-esteem to realize their potential for accomplishment. And it requires effort, even if something is started, to be able to sustain the activity through to completion.

The following are ways to assist someone who lacks motivation:

- make a list of activities they may be interested in doing;
- help them initiate an activity;
- encourage their continued effort;
- assist them, if necessary;
- check off the activity when it has been completed to support their feeling of accomplishment.

Sometimes if something can be found that really interests them, it will help towards motivation. Perhaps suggest a potentially interesting activity that may appeal to them; borrow a book on various hobbies from the library or have someone talk to them that has a particularly creative hobby which may be of some interest for them. Cognitive therapy can also help but it is difficult to get and is rarely covered under medical plans.

Lack of motivation or interest can also be a result of depression which is common following a brain injury. This in turn leads to feeling tired all of the time; a general feeling of fatigue, no energy and a complete unwillingness to do anything.

If depression is suspected, encourage a visit to the doctor to be properly assessed. There are medications which can help. Depression can be very serious if not properly treated. If lack of motivation is a result of depression, once the depression is treated then motivation could cease to be a problem.

Personality changes with lack of motivation being the root can cause problems in relationships and families. For those who are assisting anyone with this problem, continue to encourage and support as best as possible.

Personality Changes - Communication Difficulties Following a Brain Injury

2010-10-19T22:31:00.000-07:00

There are many deficits following a brain injury that can cause personality changes. One of these problematic changes is in how a person communicates with others. Communication, for many reasons, often becomes difficult particularly in group conversations.

Pragmatic communication impairment causes problems in relationship as well as in work environments. Because of this, if severe, it will determine their success in employment situations and possibly within their social networks. With lack of communication skills often these social networks will gradually fade into the background.

A high percentage of those with brain injuries have communication difficulties. They very often have problems initiating conversation or in continuing with one. They will disassociate and be unable to interact with others either verbally or non-verbally, even if they know the people well. These difficulties seem to be enhanced when in large groups.
Over time their communication skills can either increase or decrease depending on the positive or negative results they get from their efforts.

When in conversation with others, it is common that they will rarely ask questions. The reason for this may be that in many cases, those who have suffered from a brain injury will tend to be self-centered and as a result, they have little interest in what someone else is saying. Another reason is they often have memory problems so may hesitate to ask because they don't remember if they've already been told before.

Some of the reasons for communication difficulties are:

- too much background noise can be confusing;
- it can be difficult to concentrate if the person is tired or anxious;
- they may have difficulty explaining their thoughts;
- pain can make communication more difficult because it may limit concentration;
- moods and fatigue can affect communication;
- long sentences can sound confusing as can complex conversations;
- alcohol can increase communication problems;
- over-stimulation;
- large groups;
- inability to take cues from others when in conversations;
- inattentiveness to conversation and/or lack of interest.

Ways of helping someone who is having difficulty with communication:

- keep sentences short;
- do not interrupt;
- be positive;
- have person avoid, when possible, large groups;
- when in groups encourage topics that the brain injured person may feel comfortable discussing;
- discourage, if possible, the use of alcohol;
- give emotional support.

Because of communication difficulties, especially in groups, many of those who have suffered from a brain injury tend to feel lonely. Over time it may be one of the most difficult deficits they will have to deal with.

Is Alcohol Bad for the Brain?

2010-03-13T21:28:00.000-08:00

I believe that excessive alcohol can contribute to dire consequences for the brain. Because of alcohol's effects on the brain, studies have shown that other areas can also be affected such as the central nervous system and the blood supply.

Alcohol will cause speech to be slurred, vision to be blurred, reaction times to be slower and memory to be impaired. Depending on whether a person is drinking on an empty stomach and how quickly they consume the alcohol, these affects can sometimes be apparent after only one or two drinks.

How often a person drinks, when they first began drinking, their gender and size and whether there is a family history of alcohol all will determine what the effects will be. Heavy drinking is one of the causes of acquired brain injury (Alcohol Related Brain Injury - ARBI). Alcohol can cause short-term memory loss, dehydration and can lead to falls and accidents. Alcohol can also increase the risk of seizures following brain injury.

Alcohol abuse can also lead to traumatic brain injuries because someone who is drinking may still drive without making reasonable judgments and may take more risks than a sober person would. Their chance of falling is increased as is the potential of getting into verbal altercations or fisticuffs. Alcoholics tend to have more head injuries; there is a high rate of alcohol abuse before TBI.

Those who continue to use alcohol after a traumatic brain injury have more difficulty with thinking abilities, cognitive function and memory problems. Cells are lost after a brain injury and other cells will have to work that much harder. If those cells are affected by alcohol, it makes it more difficult for them to work. Alcohol worsens problems already brought about by the brain injury.

People who use alcohol after a brain injury don't recover as quickly or as completely and in fact, can lose much of the progress they have made. They will lose what skills they had previous to the brain injury that they could possibly have regained.

For people who have alcohol related brain injury or have suffered a traumatic brain injury, because of their impaired insight they do not realize that their substance abuse is a problem. The problem is exacerbated for counselors working with survivors of brain injury and those with ARBI because when those with brain injuries report on their use of alcohol the figures are usually inaccurate because of their memory deficits.

For those who have brain injuries, the affects of alcohol will be more quickly apparent. After only two beers, my partner will have problems with speech and attitude and after only one glass of rye, (particularly the way he likes to pour them), he is slurring his words and having difficulty walking. Before his brain injury, although he drank several glasses every day, I saw no outward signs of inebriation.

These signs become readily apparent because of alcohol's effect on the brain. The only conclusion possible, therefore, is that alcohol is bad for the brain.

The Impact of Frontal Lobe Injuries

2010-03-11T20:52:00.000-08:00

Our frontal lobe is the emotional control center of our brain and is the director of our personalities. For this reason, when we receive brain trauma to the frontal lobe, many areas of our life will be affected.

Because of the size and location of the frontal lobe, this is the most common area to be injured. A traumatic injury to this part of our brain can affect problem solving, short term memory loss, motivation, judgment, impulsivity, behavior, perception, attention span difficulties, rationality, apathy, inhibition (possibly social or sexually inappropriate behavior), strategizing problems, and decision making.

A very common deficit of frontal lobe injury is perseveration which is non-compliance with rules. There may also be difficulty in interpreting cues to guide behavior. This can have a serious affect on interpersonal relationships; especially if perseveration is not acknowledged by the survivor.

A brain injured survivor is considered to be in denial when deficits are unacknowledged. Denial hinders rehabilitation and recovery. It also has a detrimental affect on relationships.

Personality changes can generally be significant with this type of injury. The changes will be dependent upon the survivor's deficits and upon his/her acceptance of the injury and willingness to work towards a new life through adaptations and adjustments.

Studies have found that some survivors with frontal lobe injuries have difficulty understanding some types of humor; many prefer the slapstick variety. In some cases however, the personality may become flat with no sense of humor and little facial expression.

Abstract thinking can also sometimes be affected. The ability to understand others allows us to feel empathy, sympathy, and to realize when others are being sarcastic or deceptive. Other areas of the brain can sometimes adapt to be able to take over the functions of the damaged area; this is more likely if the injured person is young. Additionally some sufferers of a frontal lobe injury may have problems consistently performing a task which may make job performance difficult.

Intensive therapy following this type of injury, according to some studies, is important towards achieving successful rehabilitation. Sadly, in many communities there are few resources available for brain injured survivors. And in some cases unfortunately, the injured person is reluctant to participate in programs that would assist him/her in recovery.

Frontal lobe injuries change the brain injured survivor's life; in most cases forever. This will be more evident in some people than in others because no two brain injuries are the same.

Brain Injury Awareness

2010-03-10T19:37:00.000-08:00

It is important to those who have sustained brain injuries that the public be made aware of the difficulties and challenges they encounter following such an injury. Few people are aware of the consequences of a brain injury until it happens to them or to a family member. In the United States, March is Brain Injury Awareness Month; in Canada it is June.

There has been much mentioned lately about the dangers of concussions and the risks involved when young people play sports. Concussions are now considered to be a mild brain injury and while initially may not appear to be serious, can result in later consequences if not looked after at the time of the injury. It is important therefore that coaches, teachers and parents who are involved in youth sports be made aware of concussion prevention, recognition and response.

Brain injury awareness campaigns attempt to educate the public in the prevention of traumatic brain injuries. In spite of the fact that many of these injuries can be prevented, the lack of awareness of the consequences of this type of injury means that prevention mesures are often not taken. Prevention can be accomplished in many ways, i.e.: by living a healthy lifestyle, and by wearing helmets when riding a motorcycle, biking, skiing, snowboarding, horseback riding, skating and skateboarding. Also, seatbelts should be worn at all times when in a motor vehicle; driving should be done defensively; and alcohol and illegal drugs should be avoided while in control of a motor vehicle.

Other reminders to help people become aware of, and prevent needless brain injuries are: to keep guns in locked cabinets; keep guns unloaded, and to store ammunition separately from guns.

Those most vulnerable for sustaining brain injuries are children under five, seniors seventy or over and those between fifteen and forty. Men are twice as likely as women to sustain traumatic brain injuries. The most likely causes of brain injury are vehicular accidents, falls and accidents. However, others at risk are those who are in contact or extreme sports, construction workers and, in more recent years, those who have served in the military.

Brain injury awareness information also attempts to reinforce the importance of support programs to assist survivors in working towards successful rehabilitation. And for this reason, a rehabilitation team is necessary for best results. This includes physiotherapists, occupational therapists and support groups.

Because social, physical and economic challenges are created as a result of brain damage and resulting cognitive problems, caregiver support is also necessary. Relationships are difficult to maintain when there are behavior and cognitive difficulties. This is especially true when friends no longer visit the survivor thereby relieving the caregiver.

Despite the staggering statistics of brain injuries suffered each year in both Canada and the United States, there is very little public awareness of the problem. Let 2010 be your year to learn more about this often preventable and devastating tragedy.

Relationship Break-downs Following a Brain Injury - The Reasons for Them

2010-02-26T23:15:00.000-08:00

In most relationships, it takes two people working together to make it a success. In the case where one has suffered a traumatic brain injury, this likely won't be the case because of cognitive impairments and deficits. When a relationship is unequal, it places an extra burden on the healthy partner.

Some of the problems that will have a bearing on the success or failure of the relationship will depend on the following:

- The length of the relationship at the time of the injury. Long-term relationships where a strong bond has already been firmly established, and one especially where they've raised children together, will have a better chance of survival.
- Whether it is a first or a second marriage. If it is a second marriage there may be other issues such as step-children and problems that have been brought into the relationship that could cause additional difficulties.
- The role of any step-children can make a very big difference. This is especially true if there has not been enough time to establish a good relationship between them and the caregiver or if they didn't have a good relationship with the parent.
- Whether or not there is friend and family support. If there is not, there is an additional burden on the caregiver which adds extra stress to the relationship. Often friends will not keep in contact after the initial injury.
- Is there community support? This is important to both the survivor and the caregiver. Brain injury survivors very often fall through the cracks in obtaining required support. Also in many communities, very little is offered for the survivors of brain injury.
- If outside social support is not available and leisure activities have become fewer, the family becomes isolated. This is hard on a relationship especially if the couple had originally been socially active. This may be even more difficult for the healthy partner than for the survivor.
- Role changes will be difficult for both partners but probably more difficult for the caregiver. In all liklihood the caregiver will carry most of the work load and responsibility that had previously been shared.
- If the relationship becomes a dependency/co-dependency one, it will make neither partner happy and eventually there will be resentment on both sides.
- Substance abuse can create severe problems in a relationship. It will be important to try to get help by possibly joining an Alcoholics Anonymous group and/or Al-Anon.
- Stress, as a result of changes in both the survivor and the caregiver's life, can cause many problems. As well, there may be stress as a result of depression.

If counseling is available in the area and both are agreeable to attending sessions, a counselor could help the brain injured survivor with cognitive impairments that may be impacting the relationship. Some of these might be denial issues; help with problems of self-awareness; lack of empathy; the inability to assess the difference between right and wrong, and to give encouragement to the injured person to work on his own behalf towards recovery.

Counseling can also help the caregiver understand the difficulties the survivor is experiencing and to learn strategies to help him/her with his rehabilitation. A good counselor can also help if there have been sexual problems since the injury.

However, even with knowledge, awareness and effort, relationship break-downs following a brain injury do happen.

Brain Injury Survivors - Learning to be in Control of their Own Lives

2010-02-21T21:36:00.000-08:00

For brain injury survivors to gain control over their own lives following a traumatic brain injury, they must learn ways of working towards becoming the person they want to be. If they want to realize their dreams, it will mean never giving up their fight to be that person.

In order to do this, they will have to learn specific tools and strategies to make their life more enjoyable and productive. One way to do this is to keep their brain active and involved. An active brain will grow and develop while a brain that is not used will lie dormant. It will be important for them to challenge their brain. One of the strategies is the use of lists to help them organize their life; and with organization comes planning. By becoming organized both mentally and physically it will help both their mental and physical wellbeing. Some of the ways to do this are to write down on a list exactly what they are going to do each day. By planning ahead in this way, if the unexpected happens, it can be handled more effectively because they can just go on to the next thing on the list. Having a secondary back-up plan in place will also help them to be in better control of their life.

Other areas where it will be important to practice learning to become their own masters are to work towards being calm and in developing a good attitude. Being positive is very important because it seems that things usually go wrong for the person who is consistently negative. Also, it will be necessary for them to stay focused and to be consistently determined to be the person they want to be. The big thing is to never give up.

When doing a large task, a good strategy is to break it into smaller components so that it is easier to focus and concentrate on one small part of the task in order to avoid the feeling of being overwhelmed.

Learn to communicate with others. If help is required, it is better to ask for help and admit that help may be reqired than to continue to a point where a situation may be made worse because help wasn't asked for.

It is also necessary for survivors to be able to shoulder the responsibility of their mistakes and admit to those mistakes without looking to blame others for them. Only in this way can they take control of their lives because then they can correct those mistakes and learn from them.

Joining a brain injury support group will help the brain injured survivor to become more independent because of the help he/she will receive from others who have had similar experiences. They will learn how to adapt and adjust to them while using specific tools and strategies. It will be a continuation of their rehabilitation. This is necessary for recovery because brain injuries do not go away. It will help them also to recognize and accept their limitations so that denial does not become their mantra.

The main thing for those with brain injuries wanting the abilities to be in control of their own lives to remember is to stay focused, always be determined and to never give up. If they do this, they will in all likelihood be successful.

Beware of Concussions - They Are Brain Injuries

2010-02-11T20:25:00.000-08:00

Concussions are mild head injuries and are the most common of traumatic brain injuries. Most people do not think of concussions as being serious but there is the possibility that later life symptoms can occur because of scar tissue build-up.

Concussions can cause physical, cognitive and emotional symptoms. These symptoms will usually disappear in about three weeks when there has been sufficient rest following the injury. With this type of injury there can be loss of consciousness of minutes or more and possibly post-amnesia which could last twenty-four hours or less. Loss of consciousness indicates a more severe blow to the head than if there was none. Concussions are usually caused from falls, sports injuries or car accidents.

Headaches are one of the most common symptoms. Other symptoms can include dizziness, nausea, difficulty with balancing, light sensitivity, blurred vision, confusion, focusing difficulties, disorientation, reasoning problems, concentration, crankiness, tearfulness, inappropriate emotional displays and possibly, but not likely, convulsions.

It is advised that following an injury such as this that individuals get a lot of sleep at night with rest during the day before gradually returning to normal activities. It is also advised that sufferers don't drink alcohol or take drugs that have not been authorized by their doctors.

It is rare that resultant problems from concussions will be permanent but for those over fifty-five years old, it may take longer to heal or they may have more persistent problems. Occasionally those with concussions may suffer from post-concussion syndromes for weeks or possibly even years after. These symptoms may include headaches, dizziness, attention, memory or sleep problems as well as irritability. Symptoms may be more severe with subsequent concussions.

When doing research, I heard that one concussion sufferer experienced headaches for many years following her injury. There had been no follow-up after her injury even though she had lost consciousness. At the time of her injury, little was known about concussions and very little attention paid to them. People are now becoming more aware of the seriousness of these injuries and most now realize that they are a mild head injury.

In the case of students playing high school sports, concussions are very common. Very often after only a brief period of sitting out, most will return to finish the game. It is serious when they do this as follow-up care is important after this type of injury.

It is important that these injuries be taken seriously not only for today but for future health and wellbeing also.

What Are the Possibilities of Developing a Seizure Disorder Following a Brain Injury?

2010-02-10T20:04:00.001-08:00

Seizures may occur immediately after an injury or they may not show up until months or years later. Eighty percent of seizures occur within the twenty-four month period after an injury. In general, the greater the injury, the higher the risk of developing seizures will be. In some cases brain injury survivors may develop epilepsy.

Many problems can result with seizures such as injuries caused when falling, a risk of choking or injuries sustained if an individual suffers a seizure while driving a motor vehicle and has an accident. In some cases individuals experience warning signs prior to a seizure such as a tingling sensation, a change in lights or an odor. However, in many cases there are no warning signals. Following a seizure there is usually a feeling of extreme fatigue.

In one situation that I know of the survivor didn't have any evidence of seizures until about fifteen years post-injury. His injuries at the time were quite severe. Initially the seizures were mild and were not diagnosed immediately. They gradually became Tonic-Clonic seizures and now more than ten years after the onset he is unable to drive as medication has not yet stabilized their impact.

In another situation, the individual suffered a concussion when she was sixteen years old. It wasn't until she was thirty-five years old before she experienced her first complex partial seizure. She didn't have another one for several years and only periodically after that. It wasn't until she was in her late fifties that the episodes became consistent and often and she was eventually diagnosed as having seizures. In this case, the seizures are completely controlled with medication. My partner at three and a half years post-injury has had no indication of being likely to experience a seizure disorder. This is fortunate because his injury was serious and he's also in the higher-risk group because he is a drinker.

There are many different kinds of seizures. The Partial Seizure disorder is subtle causing perception changes, visual abnormalities, hearing distortions and unusual sensations. Alteration of memory or consciousness is not associated with this type of seizure.

The Complex Partial Seizure is preceded by an aura. The individual may appear to be dazed or confused and then it passes. This is the most common type of seizure.

Generalized Seizures usually involve a loss of consciousness but may not be convulsive. The Generalized Absence Seizure will usually accompany a complete loss of awareness where the individual may stare into space and appear to be dazed. It will not be preceded by a warning and may go unnoticed by others because it is usully followed by normal activity. It is similar to the Complex Partial Seizure but quicker in duration. It is more common in children.

The Tonic-Clonic Seizure has a convulsion phase with muscle stiffening; the person may lose consciousness and the body will become rigid possibly jerking and twitching in the second phase. After consciousness returns the person will be confused and disoriented. It is not one of the most common types of seizures although it is the type that one thinks of when thinking of seizures.

Status Epilepticus is the most serious of the various kinds of seizures. It is potentially life-threatening and can lead to brain damage. This type of seizure can last longer than thirty minutes or will be a recurrent seizure without regaining consciousness. An ambulance should be called for seizures that last longer than five minutes. Treatment must be initiated quickly. This is the least common of all the various types of seizures.

The good news is that although some survivors of a brain injury will possibly get seizures, the majority will not develop this disorder. However, if they do, most can be easily controlled with medication.

How to Deal With Learned Dependencies and Co-Dependency Following a Brain Injury

2010-02-05T20:22:00.000-08:00

Learned dependency and co-dependency will often go hand-in-hand when a loved one has sustained a traumatic brain injury. It usually begins innocently enough but will end up being healthy for neither the brain injured survivor or the caregiver.

Brain injury survivors can, over time become dependent on their caregiver so that even when they are able to do things for themselves, they won't. As a result they will continue to become more and more reliant on their caregiver instead of calling on their own resources. It will affect their emotional and physical wellbeing which will then affect their recovery process. A survivor of traumatic brain injury will learn to become dependent as a result of receiving help when it wasn't required.

A co-dependent becomes overly involved in the patient's care. When this happens they don't allow the patient to be responsible for doing things even if they are capable of doing them. Caregivers initially become co-dependents because of love; they are trying to do the right thing by helping their loved one. With co-dependency and patient dependency, each person is robbed of their own identity. Co-dependency can create too much control over the patient leading to disempowerment. This can hinder the brain injured person's ability to take control of their own lives. Unfortunately, over time many who have learned dependency will be resistant to unlearning it and will not wish to do things for themselves.

Independence should be encouraged even if it means stepping away and leaving the situation. It may be a case of having to exercise tough love in order to force the patient to do things for himself/herself. This will be difficult to do for many reasons. It will be hard for the caregiver because they may feel that by not doing things for the patient, they are not doing what they should be doing. The brain injured survivor may also attempt to emotionally manipulate the caregiver to feel guilt for not continuing to do what they've been doing.

Other people may also negatively judge a caregiver who does not behave co-dependently when someone appears to need the help. But because others do not walk in the shoes of the caregiver they are unable to see that often the patient is more capable than he may appear to be to outsiders.

Learned dependencies and co-dependency becomes a vicious circle. Once the cycle begins, it is difficult to get out of but it is as important for the brain injured survivor as it is for the caregiver to attempt to do so. Looking after someone who is emotionally dependent is very tiring; and feeling dependent on another thwarts any possible progress towards healthy living.

If the brain injured survivor is capable, encouraging independence and backing off is the most positive thing that can be done to assist your loved one in getting better.

How To Achieve a More Successful Recovery Following a Brain Injury

2010-02-05T14:18:00.001-08:00

The degree of success with the progress of recovery will be dependent upon many things. It is rare, however, that there is ever complete recovery from brain injury because the brain injured survivor is usually left with some deficits. These deficits generally are permanent and cannot be overcome like one would with a case of the flu. However the deficits can be adapted to and adjustments can be made for them.

The most important element of recovery is that expectations must change so that limitations can be accepted. Learning to cope and accept will be vital in the challenge to improve progress. If this is not done, disappointment and frustration with abilities that aren't the same as those pre-injury will definitely hold back the process.

Additionally, it is important that expectations be realistic. The severity and the location of the injury, what the pre-injury characteristics and personality were, and awareness and acceptance of limitations will all have a bearing on this progress. What is most associated with a more successful recovery is pre-injury intelligence, cognitive abilities and willingness to establish new life goals and a new life with different abilities.

Both overly optimistic attitudes as well as pessimistic expectations are harmful. Recovery may be slow but can continue sometimes for years, with changes possibly being in stops and starts. At times, after a lull with what seems like little progress there can suddenly be a spurt of improvement which could possibly be caused by a change in circumstances in the life of the survivor.

The fact remains is that the more time that has passed since the injury, the less likelihood there will be of many further changes. However, each individual is different but in most cases there is usually more recovery made in the earlier years following an injury than later.

As people age, some recovery may be reversed because of cognitive decline due to the lack of exercise or mental stimulation. Exercise stimulates the brain so it is very important for those who have sustained a brain injury to remain physically active. Reading, doing crossword puzzles and Suduko can help to keep the brain stimulated.

Quality and enjoyment of life as well as the opportunity for the best recovery possible for the brain injured survivor will also depend upon his/her effort to be involved with others, to eat a nutritional diet, to avoid alcohol or illegal drugs and to continually strive for improvement in all aspects of his/her life.

Although family and community can assist the brain injured survivor towards recovery, the majority of the effort towards this goal will need to be made by the patient through his attitude and his effort to work towards progress.

How Brain Injuries Affect Personalities

2010-02-04T21:41:00.000-08:00

Brain injuries affect our personalities in many ways but severity of injury and pre-injury personality will have a bearing on the changes. Because our brains control who we are, when our brains are affected, so shall our personalities be. Because no two brain injuries are the same and no two people are the same, no one will experience the same personality changes. However, most brain injury survivors, and certainly those who are closest to them, will acknowledge that there most often are some changes.

Changes will be based on the deficits that a survivor is left with; some people will be left with many deficits while someone else may be left with only a few. These deficits will contribute to various behaviors which will change a person. Some of these deficits may be involving memory, concentration, anger problems, frustration, lack of motivation, feelings of detachment and anxiety.

Brain injuries can cause impairments to how we think and act which will cause changes in personality. Our brain is what gives us our reasoning abilities, helps us to interact socially and tells us how to live morally; it makes us who we are.

Personality changes can happen one, five or even fifteen years after the injury. Some personality disorders can be managed by the avoidance of caffeine and alcohol or by avoiding becoming overtired. Maintaining a regular exercise program could also help lessen the degree of change there may be.

Many of the changes that brain injured patients have experienced cannot be attributed directly to deficits. While doing research, I discovered that many brain injury survivors mention changes to their sense of humor, i.e.: they may no longer have one; or where they were once creative, they may no longer be; their interests may have changed or they don't have any, and many say they feel dull.

A bigger change, and one that is more likely to affect relationships, is that they may no longer have the same likes and desires; their feelings may have changed. It is possible that they no longer have the same interests they shared with their partner or enjoy doing the things they once did together. They may no longer make any effort to be affectionate but instead may be more focused on themselves.

The sexual part of their relationship may also have changed. Often there is less interest in sex after a brain injury. This change may become a problem in the relationship.

Personality changes such as these are difficult for family members but are not easy for the brain injured survivor as well. Survivors know they have changed; they know they no longer feel the same way and most often they don't know what to do about it.

Chronic Pain and Brain Injuries

2010-01-28T21:42:00.000-08:00

Brain injuries, according to some studies, appear to have a correlation to chronic pain. In most cases it is related to headaches but it can also be related to other injured areas as well. Most physicians agree that chronic and acute pain is a further complication of traumatic brain injuries and is difficult to deal with.

According to the Mayo Clinic, your brain sends messages that influence your perception of pain. It's believed that how our pain is tolerated depends upon our emotional and psychological states, what our past pain experiences have been, what our childhood pain memories and experiences were, and our expectations of the pain we will have. Also, quite simply some people experience pain to a greater degree than others do.

According to research, there may be some influence in how we tolerate pain if we were raised to be brave when confronted with pain or other difficulties versus if we were catered to for the slightest discomfort. Fear and anxiety can also increase the intensity of the pain we feel.

Although headaches are quite often the main cause of chronic pain in cases where there has been a traumatic brain injury, but there are often other severe injuries as well that can cause prolonged and severe pain.

Chronic pain can be a result of nerve damage resulting from an accident but in some cases there may be no evidence of anything that doctors can link pain to and the pain will still be felt long after the injury has healed.

Malingering may also be considered as a possibility in instances where there is the incentive of financial remuneration where there is a lawsuit pending. Most doctors, however, believe that when a patient says they are in pain, they must be feeling pain and are not exaggerating the degree of pain they feel.

There is also a theory that chronic pain could be a symptom of a neurotic personality type who hopes to acquire nurturing through chronic pain complaints so as to receive more attention and sympathy from family and friends. Those with neurotic tendencies tend to be dissatisfied with their lives in general and will often complain to others. People who are survivors of a traumatic brain injury quite often are not happy with their lives, the changes in themselves or with their limitations. This may possibly cause them to focus more on their pain level than otherwise may be the case if they were leading a more active and contented lifestyle.

Unfortunately, there is very little understanding of chronic pain and there are a variety of theories as to its causes. As a result, little seems to be able to be done about it.

Rehabilitation and Brain Injuries

2010-01-28T21:21:00.000-08:00

There is no limit to the degree that a survivor of a traumatic brain injury can be rehabilitated. However, the secret of this success will depend upon the determination and perseverance of the survivor and his family because rehabilitation is hard work.

Following a brain injury, cognitive impairment can leave brain injury survivors with concentration, focus and confusion difficulties. Memory issues also are a problem. There may also be difficulties with problem solving abilities, making decisions, reading and writing, the ability to logically solve puzzles, fatigue, denial, mathematical skills and they may suffer from lack of motivation. Basic abilities such as perceptual skills and those dealing with attention will need to be strengthened before more advanced skills can be added to what they can already do. In some cases other areas of the brain will take over the function of the damaged area. This is particularly true in the case of children and young people.

Initially assessments will be done regarding speech, cognitive and behavioral difficulties and the ability to perform daily living chores. Many cognitive and communication problems will be treated while the patient is still in the hospital but may continue for some time after. Longer term therapy may be performed either on an individual basis or in groups, often at a rehabilitation facility. Other rehabilitation may be done at home by a visiting therapist or as an outpatient. It is usually considered best to be done in a setting that is familiar to the patient.

Rehabilitation is designed to assist brain injured patients in relearning lost skills or in learning different ways to do things. When possible, it is important if family members can be involved in the process. In some cases, this includes the availability of caregiver support services.

As part of the process, patients may receive physical therapy, occupational therapy, speech and language therapy and task-specific training of cognitive deficits depending on the requirements of each individual.

Structure is a very important element in the life of a brain injured survivor; with structure their capabilities can be increased. It is important also, where bad behavior is a problem, that the patient be corrected. If poor behavior is allowed, it doesn't help the brain injured survivor and the end result could be that it may drive people away who might otherwise be able to help.

I believe that what gives the most liklihood of a more successful recovery is the survivor's ability to persevere and work hard.

Brain Injuries and Total Denial

2010-01-27T13:00:00.000-08:00

Denial is common with brain injury survivors. They want to maintain a positive image of themselves and therefore will often deny that they have even had a brain injury. They may instead insist that any problems they have will go away. Denial is the enemy of all survivors and to their relationships.

When survivors are threatened with exposure such as when smoking in an unauthorized area, i.e.: the washroom at a restaurant, or becoming so drunk that they fall down, they may deny that this had happened even when confronted with the truth. These two situations have happened with my partner. It appears to be lying but in actual fact is denial not only to themselves but to others. There can be no progress as long as denial exists.

Often, rather than admit that they have suffered a brain injury, they will focus on other things such as pain from arthritis in their legs or they will blame other people or things for their problems. It is a self-defense mechanism. But it is one that will get them nowhere. It will in fact, sabotage any future progress they may have.

For those who have not accepted their limitations, they feel that denial of them will draw attention away from their problems. Their hope is that others won't suspect there are things they are unable to do. If they refuse to believe that they have a problem, it gives them the excuse of not having to be accountable for their actions.

In order to combat the problems that being in denial cause them, it will be necessary for the survivor to understand and realize what the effects of their injury have on their life. If they can admit that they can and do make mistakes, they will be able to learn from those mistakes and they will not repeat the same ones again.

In order to be able to accept that their abilities are not the same as they once were and that they are not the same person, it will be necessary for them to face their fears. When one is consumed with fear, it increases feelings of loss of power. When this is the case, it is almost impossible for someone to be able to succeed at anything they try to do or to make any progress towards living a satisfying and fulfilled life.

By accepting their limitations, they can acknowledge that they cannot, for example, do the same job they once did. But perhaps there is another way of doing it or there is another job they can do while still working with the same company or a similar one. Or they can acknowledge other talents they have and pursue those. It will just be a different way of living.

Acceptance of their brain injury and of their limitations will increase their enjoyment in living. Denial, avoidance and making excuses are hard work when instead that effort could go into making positive changes in their lives.

Brain Injuries and Amnesia

2010-01-27T12:35:00.000-08:00

For someone who has sustained a traumatic brain injury, there is the risk of amnesia or loss of memory. Following my partner's motorcycle accident and subsequent injury, he lost all memory of the ten years preceding his accident.

This type of memory loss is called retrograde amnesia which eliminates any memory of events prior to the accident. It may only be for the preceding few minutes, hours or days rather than the more unusual extensive period that my partner experienced. When he became more aware, after ten days in a medically induced coma, he thought it was ten years in the past. He had no recollection at all of his accident and had lost ten years of his memory.

This was a traumatic experience for me, as I'm sure it was for him because during this ten year amnesia period, his wife had died and we met each other three years prior to his accident. When I visited him, there were times that he knew my name and other times when I asked him if he knew who I was that he avoided the question. But even when he seemed to know my name, I don't think he had any real understanding of what our relationship meant to him. Even after he had been out of the hospital for several months and appeared to have recovered most of his memory of that ten year period, he admitted that he had no accurate realization of what our relationship had been like prior to his accident. This was very disconcerting. We were virtually strangers.

This period was a learning experience for him. When I asked him how old he was, he gave me the age he would've been ten years previously. There were many friends who visited that he didn't recognize including some he had known for twenty plus years. He had no memory of the new home we had moved into, still thinking he lived where he had for many years. He also had no memory of the year or make of car that he drove instead telling me about one he had driven years before.

He talked about people in his past I had never heard of as if they were current friends. I began an experiement of asking him to help me make up a list of our 'welcome to our new home' party. All of his first suggestions were people who were mostly unknown to me. The second time we did the experiment a couple of weeks later, the list was comprised of some people that I knew and others that I didn't. On the third try, the list was pretty much who would normally have been on it.

During the six to eight week period before he gradually began to remember some of that lost period of time, I brought pictures into the hospital of family and friends, pictures of our new home, things from our home that I hoped might jog his memory and albums showing different trips we had taken together.

As he began remembering a few things, it seemed that he was making up stories. In actual fact, when someone has suffered retrograde amnesia, they will often fill in the blanks in stories when they can't quite remember the whole story.

It is difficult to say whether my partner does remember everything from that ten year period or not since I can't verify all of it. Even he is not sure whether he does or not. Some of his memory may, in fact, be made up to replace what he can't remember.

My partner also suffered from anterograde amnesia which is memory loss immediately following an injury. Even now after three and a half years post injury, he has no memory of his accident. He also has very little memory of any of his four month hospital stay. Survivors of brain injury will often have difficulty remembering anything new. In this case new events or learning new things will often not go into the long-term memory bank. For this reason they may become discouraged from doing anything that they aren't already familiar with.

For those people suffering from these types of memory losses, it must be like living in a fog - they know it's there but it's just beyond their grasp.

Adult Step-Children Relationships and Brain Injuries

2010-01-11T15:55:00.000-08:00

It is difficult being in the position of caregiver to a spouse with a brain injury and also dealing with problematic grown step-children. This is particularly true if the situation had not been good to begin with. However, the degree of difficulty will depend upon a number of factors.

Some of the things that will have a bearing on the situation with grown step-children will depend on how long the couple has been together before the injury; what the relationship with the step-children was like before the injury and probably more important, what the relationship was like between the survivor and his/her children.

In our situation, we knew each other about three and a half years before my partner sustained his brain injury. At the time of his accident he wasn't speaking to his oldest son and still doesn't; there was little interaction between him and his second son, and he saw and talked to his daughter only occasionally. This had been the case both before his accident as well as being the situation before I met him.

After his accident, there had been no offers of help of any kind from any of his children and admittedly I was upset with the poor treatment of their father. But then when he was doing up his Will, they suddenly wanted to bond with him; they wanted to take him for dinner - a dinner I was excluded from. He has since done up his Will and has given his daughter his Power of Attorney. Needless to say, there has been no more effort at bonding since or anything more than the occasional phone call from his daughter.

There has never once been a "We appreciate all you've done for our father. Is there anything we can do to help?" But this is not a surprise. How could I expect that they would treat me any other way when they treat their father so badly?

In circumstances such as this, where does that leave the partner/caregiver? The answer is - in a very vulnerable position; particularly when the stepchild has the Power of Attorney but the spousal/caregiver is doing the caring for their brain injured partner. For anyone who finds themselves in this position, I would recommend talking to a lawyer in order to get advice on how best to protect themselves and their own families. Your partner very likely is not well enough to protect you if he/she has not already taken steps to do so before their injury.

This is not an uncommon scenario with grown step-children but is made especially more difficult when brain injury is involved. It is a time for the spousal/caregiver to be proactive in order to safeguard their home and their own children,.

Brain Injuries - The Difficult First Year Following a Brain Injury

2009-09-29T22:28:00.000-07:00

During that first year after a family member has sustained a brain injury, it can be an extremely stressful and lonely time. But we are not alone; the incidence of brain injury is higher than one would expect.

After my partner’s serious motorcycle accident, I realized how difficult it was to get information on brain injuries or on how family members can help their brain-injured loved one. Following a brain injury it is necessary for those close to the injured person to know what to do when dealing with the monumental changes in both of their lives.

Often during the first few months when talking to medical staff, I felt it was difficult to get answers; partly because at the beginning very little was known about the severity of his injury or what the results of the injury would be. I also suspected that some of the information I was given may have been designed to not build up any hopes on my part. Further, I became aware that the more questions I asked, the more variety of answers I received with each person appearing to have a different opinion on both his injury as well as his prognosis. This may possibly have been because no two head injuries are the same.

The hospital library, I discovered, was a good place to start to initially look for information; the librarian I approached gave me some very good websites to check out. There are also many other sources available on internet. Brain Injury Associations are also excellent avenues for obtaining information, as well as brain injury support groups. And don’t forget the social worker at the hospital – she will have a lot of useful information for after the injured person returns home. But you must ask the questions because no one will come to you with answers to questions you have not voiced. It is absolutely necessary to be proactive in your loved one’s health care. This includes making sure that your injured family member will receive cognitive exercises as soon after their injury as possible even if it means doing them yourself.

At the beginning there may seem to be little progress; with a brain injury it is often two steps forward and one step back. The steps are small and sometimes may only be noticed after a big change has taken place. I was told that the majority of change takes place in the first year with possibly some improvement up to two years post-injury but in my partner’s case, there was some progress even after the two year time period.

During the first year the survivor will often experience confusion, short-term memory difficulties, anger, sometimes violence and possibly depression. I discovered that the extreme confusion lessened after about two months but after three years, my partner’s short-term memory problems have not improved. Often medication can assist with some of the other issues. There will sometimes be other deficits as well that will need to be dealt with such as lack of motivation problems, reasoning abilities, rigidity of thinking and anger.

It is very important also, when you are the caregiver, to remember that although what has happened is a tragedy for the injured person, it is a tragedy for his loved ones too. You must remember that you are important also and as such, you must set boundaries. Do not allow yourself to be verbally or physically abused. It is important that we take time for ourselves and not feel guilty about it.

Joining a brain injury support group, if there is not a strong network of supportive family and friends, will be helpful to the caregiver during the first year following their injured loved one’s accident. And remember, eventually that first difficult year will become history.

Barriers to Returning to Work Following A Brain Injury

2009-08-30T22:05:00.000-07:00

The severity of the injury – whether it is mild, moderate or severe - will have a large bearing on when and if someone is able to return to work following a traumatic brain injury. But that is only one of the many things that will determine a survivor’s ability to return to the work force. There will be many things also that will determine their ability to hold a job if they do manage to secure one.

Those with fewer memory problems or personality changes are better able to successfully obtain employment. The amount of cognitive deficits they are left with and whether they have adapted to them will play a large part in their re-entry into the job market.

Other things that will be a consideration are their attention skills; ability to respond to the needs of their work environment; ability to focus; memory; reasoning; problem-solving; anger management difficulties; inability to take initiative; problems in sustaining their behaviour, and poor inter-personal relationships.

Age also can be a barrier to successfully returning to work. Employers often prefer hiring a younger person rather than someone who is possibly considered past their ‘prime’ especially one who has a disability.

Also many times employers are nervous about hiring someone who has sustained a traumatic brain injury. Most people do not understand brain injuries and the worry is they don’t know what they’re getting and don’t wish to take a ‘chance’ on potential problems.

Some survivors don’t have the self-esteem, or they lack the initiative to apply for positions of employment. The fall-out for a young person especially of not working further harms their feelings of self-esteem. This is particularly true if they have few leisure time interests, lack outside social contacts or are completely dependent on their family, spouse or caregiver.

Studies show that those who have a higher education or an advanced level of training, are more successful in their ability to find work – and to be able to keep it. This also includes those who have had access to rehabilitation and especially if it was available as soon after the injury as possible.

Unfortunately many brain injury survivors are unable to return to work for various reasons and are left floundering – jobless and with few financial, emotional and physical resources.

Brain Injuries and Apathy

2009-08-21T23:05:00.000-07:00

Apathy is very common following a traumatic brain injury and may often occur in conjunction with depression, but not always. It may become apparent shortly after a brain injury or may not be evident until a few years later.

There are many indications of this deficit – a decrease in goal-oriented activities and no interest in making goals of any kind; no interest in working towards rehabilitation; no effort towards becoming independent; no effort made towards any work-related activities; no interest in achievements of any kind; an emotional indifference; little effort at communication; little concern for their own health; loss of interest in daily activities; reduced interaction in personal relationships; few emotional reactions to situations and circumstances; unable to initiate, take action or make any plans; no interest in the future; little appreciation or notice of recovery made to date, and withdrawal creating social isolation. Their feelings of self-worth may plummet and they could possibly experience a sense of hopelessness. When survivors of brain injury are living with this deficit, they are often considered to be ‘lazy’ or possibly ‘couch potatoes’.

Following a brain injury, 61.4% of adults will exhibit signs of apathy. They will feel they have lost their role in life. For most of us, our role is defined by relationships we have established with others. But often after an injury friends don’t come by as often and eventually may stop coming altogether and sometime family relationships will become strained as well. Survivors often no longer seem to be the same person they once were.

Although apathy can be associated with depression, the latter is more common – found in 83% of traumatic brain injury survivors. There can however, be other factors associated with apathy. i.e.: health issues such as hypothyroidism or other illnesses; personality changes; difficult factors existing in their life; poverty or even the beginnings of dementia. Apathy is associated with a faster cognitive decline. There are, however, medications available for the treatment of this deficit.

From a recent study it has been suggested that there is a correlation with coping strategies and adapting – an active way of adapting to problems and managing stress versus a passive (avoidance) method which results in doing nothing and which often leads to substance abuse.

If someone is currently taking an anti-depression medication and still appears to be suffering from ‘depression-like’ symptoms, they may instead be suffering from the deficit of apathy; particularly if they continue to show a general lack of interest in most things in their life. If this is the case, it is important for them to see a medical practitioner.

Brain Injuries and Dependencies

2009-08-14T22:22:00.000-07:00

Following a traumatic brain injury, the survivor may be left with various dependencies. They may be emotional in nature or based on a substance abuse. Whatever dependency is involved, it can lead to difficulties in recovering from the injury.

Some of the emotional problems that can lead to dependency are a result of lack of initiative; lack of motivation; planning and problem solving difficulties and lack of self-esteem. All of these things can lead to feelings of powerlessness. And for this reason they will often become emotionally dependent upon someone close to them. There is another type of dependency called learned helplessness or learned dependency which will sometimes come about when someone helps beyond the point where help is actually needed.

With frontal lobe injuries there may also be a difference in emotional intelligence post-injury versus pre-injury. This is quite different from intellectual intelligence. Emotional intelligence relates to emotional self-awareness, the ability to recognize others’ emotions, taking responsibility for their own feelings, empathy, self-confidence, self-control, feelings of independence, and getting along with others. Difficulty in these areas can lead to dependency on others, particularly a caregiver.

Another dependency may be that of substance abuse. Sixty-seven percent of those with brain injuries have a history of substance abuse pre-injury and fifty percent of those will return to using alcohol following their injury. However, substance abuse can often be a result of boredom and loneliness also. With the use of alcohol and drugs after a brain injury, there is an increased risk of seizures as well as the risk of sustaining further brain injuries.

But there are many others who will fight for their independence. i.e.: they will drive before they have been given the ‘go ahead’ to drive; will refuse to go to therapy appointments; will feel increased anger if they are personally, socially or financially limited, as well as if they are deprived of privacy. Also those who need help physically may resent the help they receive if they think they should be able to do it themselves.

Regardless of whether they have become dependent or are fighting for their independence, it is important to remember that there are no two brain injuries that are the same and each person will react differently to their circumstances.

Brain Injuries and Attitude

2009-08-07T22:09:00.000-07:00

For most of us, attitude is one hundred percent within our control. It is our choice whether or not to be in a good or a bad mood. But for those who are survivors of a brain injury, the choice has become much more difficult.

The majority of people prefer to be with someone who has a good attitude rather than with someone who grumbles constantly about little things; who looks for problems instead of accepting the challenges; who becomes depressed easily, or who rarely smiles. Those with poor attitudes usually go through life reacting to situations and problems instead of taking control of their lives.

Unfortunately, for those with brain injuries, the effort required to have a good attitude is particularly challenging. Because they are often left with the deficit of lack of motivation and lack of initiative, mustering up the energy required to work at it may prove to be more difficult for them than for others.

For those wishing to have a better attitude in order to assist themselves with the difficulties of recovering from a brain injury, it will be necessary for them to remember that it is important to look for the good in every situation instead of only the negative; to be willing to face any challenge; to believe that with persistence and perseverance most problems can be overcome; to have an optimistic outlook; and to see humour in most situations. While striving towards having an optimistic outlook, and therefore a good attitude, they will be working towards making themselves happier and as a result will become more contented and positive.

Happiness and good attitude will not only be important for themselves but will be valued by those who surround them. With the time and effort of working towards having a good attitude, it will eventually become a choice to live happily and to enjoy the important things in life such as family, friends and health.

For brain injury survivors, those who are positive and optimistic are better able to motivate themselves to accept the challenges facing them. And those with good attitudes are generally positive people who make things happen instead of blaming others because nothing has happened. As with most things in life, nothing happens unless we make it happen.

Brain Injuries and Poor Judgment

2009-08-05T22:25:00.000-07:00

Poor judgment is one of the results of inadequate cognitive functioning following an injury to the frontal lobe. This deficit can involve many aspects of a person's life, including the situations mentioned below:

- When handling a motor vehicle of any kind, someone exhibiting poor judgment may place themselves, and others, in a dangerous situation because of their cognitive deficits. Those with frontal lobe injuries may not drive defensively or anticipate the actions of other drivers. They may tailgate, and possibly not realize the importance of signaling in an appropriate time to be able to safely make turns, particularly when turning left. Other potential problems could be not coming to a complete stop at stop signs, weaving in and out of traffic or going faster than the posted speed limits. Some may drive aggressively and as a result become rude as well as a dangerous driver. They may also decide that it is not necessary to wear appropriate seat belts or helmets thereby placing themselves at risk.

- Poor judgment may also involve excessive use of alcohol or non-prescription drugs. While using these substances they may become impulsive, place themselves and others at risk, act before thinking, perceive and interpret their surroundings in a different way than reality indicates, and not understand the possible consequences of their actions.

- Other examples of this deficit may be indicated by improper behaviour which may include inappropriate touching or sexual innuendoes. Some survivors may have difficulty understanding cause and effect and may have problems with their reasoning abilities. And many will have problems learning from their past mistakes.

- Social situations may also be difficult for some brain injury survivors. Some may possibly behave in an inappropriate manner by being rude, disrespectful of another's personal space, make inappropriate comments, or dominate a conversation. They may also have poor social skills and problems with communication.

There are other ways where poor judgment may become a problem following a brain injury but the ones listed above are quite often the main concerns.

Caregiving Your Spouse Following A Brain Injury

2009-06-27T22:27:00.000-07:00

It is a challenging and difficult task to be a caregiver for a spouse. The caregiver will often have to be in the role of being parent to their spouse. This is not a comfortable situation for either the brain injured survivor or for the ‘healthy’ partner but may very often be necessary – particularly if there is no one else to act in the ‘caregiver’ capacity.

With a brain injury and possibly physical injuries, the injured person may be a shell of who he/she once was. Because of this, caregivers often become ‘married widows’ because of the loss of the relationship they had prior to the injury. They may no longer have an equal partner. With the many changes in their spouse, social occasions with friends and family may also gradually become fewer and fewer. This places the ‘healthy’ partner in a ‘social limbo’ situation.

Caregivers very often receive little sympathy or support from family and friends because the injured person will often be on their best behaviour when they occasionally do see those outside of immediate family members. Survivors usually save their worst behaviour for their spouses.

And for this reason, occasionally parents or grown children, (particularly if they are not the caregiver’s children), of an adult survivor may attempt to intervene to the detriment of the attempts of the spousal caregiver to give support and stability. The intervention sometimes may not be in the form of help but rather of criticism or attempts to dissuade the brain-injured survivor to cooperate. i.e.: not attending support groups or therapy sessions, etc. if he/she doesn’t want to or the parents or children don’t think there is a need for them to go. This makes the role of a spousal caregiver even more difficult.

For the non-injured person, although the spouse they once knew may no longer exist, he/she is still alive. How do they mourn the loss of what is gone but is actually there? For many there will be a process of mourning for the relationship that once existed but few friends and family members will understand or have sympathy for those feelings of grief that will likely be experienced by the non-injured spouse.

It is important for caregivers to look after themselves so that they remain healthy and are able to make better decisions. It is also important that they stay connected with others – their friends and family, as well as possibly joining a support group. It will be equally important for them to occasionally get respite and take time for themselves, and if necessary, they must ask for help. No one knows if help is needed unless it is asked for.

Because of the difficulties of being a caregiver, many relationships dissolve following the injury. Those who make the decision to leave the relationship usually do so with feelings of guilt and certainly with feelings of failure. Friends and family will sometimes not understand this choice and may fault the caregiver for ‘giving up’ especially if it appears to others that things are going well.

For those who would criticize, it is best to remember that none of us know what goes on behind closed doors. For each of us, a decision such as this can only be made by those individuals involved.

"Roller Coaster Ride With Brain Injury (For Loved Ones)"

2009-06-23T21:05:00.000-07:00

In the last part of this book, at twelve months post injury, I did a question-and-answer section to see where Larry was at this stage and for comparison for the future. During this period there was much he did not remember. One thing he mentioned that I found rather interesting was that because he had been out of the loop for so long, he felt a little uncomfortable - more like a guest in someone else's home rather than that he was home. Part of this may have had to do with the fact that we had only moved to the house two months before his accident.

........

"Larry initially had no inclination to read my story but later he listened while I read it to him. I told him I was going to tell it like it was and wasn't pulling any punches. He had no problem with that he said, if it helped someone else."

I also included a series of exercises that I did with Larry shortly after his accident. These included orientation aid exercises, memory, therapy and cognitive exercises. I believe very strongly in the value of doing exercises as soon as possible after a brain injury.

Excerpt from "Roller Coaster Ride With Brain Injury (For Loved Ones)"

2009-06-22T20:07:00.000-07:00

Epilogue

"Larry still becomes affected by 'bumps in the road' so we are still in the process of steps forward and backward. He may always be affected by 'bumps'. But all in all, I believe he has done well considering his injuries. I also believe that having him do cognitive exercises at an early stage after his injury increased his recovery at a quicker rate than may have happened had he received no cognitive therapy until a later date."

......

"I'm sure there will be many things we will have to learn to deal with; his inability to cope when things don't go well, resulting in his frustration, anger and irritability; his tendency to be self-centered; rigidity in his thinking; being unmotivated and his memory difficulties."

.......

"Although he may never be the person he was before his accident, who he has become is better than the alternative might have been. There may still be times when I will have to remember not to take things personally when he is going through a frustrated period; and there may also be times ahead where it will be two steps forward and one step back. Hopefully over time he will learn to cope with the many 'bumps' there are in every road."

Brain Injuries and Denial

2009-06-20T19:30:00.000-07:00

Denial is often a survival technique used when the reality of their situation cannot be accepted; they have not come to terms with what has been lost, and they have not acknowledged their grief. Anna Freud has called this type of denial a defense mechanism.

Another form is when a person can see the limitations but doesn’t understand the impact of it on their daily life – they just don’t get it. This has been referred to as the ‘Anton Syndrome’.

Denial can sabotage any progress towards recovery. In order to work at getting better, it is necessary to make realistic adjustments to their disabilities. When a brain injured survivor is faced with the realization of problems relating to his/her capabilities and deficits, there will more than likely be increased anxiety. This creates a problem and many will deny, like the proverbial ostrich with his head buried in the sand – if you ignore it and pretend it doesn’t exist, perhaps it will go away. By being in denial, attention is drawn away from the problem; there is no need to work towards recovery, and there is no necessity to be accountable.

Their focus then may be placed on the fact that they’re tired, that they have aches and pains or they may blame other people rather than admit that there may be a problem with their brain’s cognitive functioning. Quite often it is the person closest to them where the finger of blame is most often pointed.

My partner is a survivor who is in denial. He is not convinced of his brain injury although he does admit to memory and motivation problems. However, his main focus has become centered on his legs and the pain he feels in his knee.

It is difficult for someone who has suffered a brain injury to be cognitively aware and to learn compensatory strategies. It is easier for them to deny rather than to work towards achieving a new normal; many survivors of brain injuries will remain in denial their entire lives.

“The greatest barrier to someone achieving their potential is their denial of it.” By Simon Travaglia

Excerpt from "Roller Coaster Ride With Brain Injury (For Loved Ones)"

2009-06-16T21:05:00.000-07:00

Adaptations And Adjustments

"Because Larry's file had been closed, I did research on Internet to discover ways to help him adapt to his deficits. One study said, "Those with brain injuries must find different ways to deal with their new limitations. With help and patience, as well as using strategies and tools to compensate, they can overcome their deficits. After reading this excerpt to Larry, I asked him if he was interested in trying, with my help, to adapt to his deficits. He said, "probably not."

His decision, I realized, left me with the challenge of learning to adapt and adjust to his brain injury myself, without his help. I decided, after thinking about the challenge, that adapting and adjusting was more a matter of coping and accepting.

According to McCubbin and McCubbin, 1991, the necessary requirements involve several important issues. First, there must be resiliency for there to be the ability to adapt and adjust to living with a family member with brain injury. Other important requirements included the following:

Personal Resources:......

Family Resources:.......

Social Support:.........

Coping patterns:........"

Excerpt from "Roller Coaster Ride With Brain Injury (For Loved Ones)"

2009-06-14T21:19:00.000-07:00

Bumps In The Road

"Larry was back to being argumentative, disagreeable, cantankerous, belligerent, self-centered and downright unpleasant. If I didn't agree with him about something, he became very angry. He wouldn't discuss anything. He was very upset that he hadn't heard anything about the date for his Driving Assessment - that is what had set him off. It was another 'bump'. I e-mailed the ICBC therapist to let her know that he'd become very anxious about not hearing of a date for when he would be having the Assessment. She responded that she had heard nothing either.

Larry finally decided that he was going to get the insurance on his own car because he was determined that he was going to drive. I told him if he was going to drive when he didn't have his driver's license that I wan't going to take him to get the insurance. He said he'd walk there - a distance of about ten blocks each way. Although he complains about the pain in his legs, he made no comment when he got back about his legs hurting, in spite of the long walk.

Larry had angrily called the ICBC coordinator and told her he was going to drive his motorhome whether he had his license back or not. The ICBC therapist explained to him, when she came to visit, that things take time and he wasn't the only one waiting. I suggested to Larry that perhaps the ICBC coordinator wasn't the one to be having a temper tantrum with because they were the ones who hold the power and will determine when things are going to happen. He only became angrier with me."

Excerpt from "Roller Coaster Ride With Brain Injury (For Loved Ones)"

2009-06-13T21:27:00.000-07:00

Two Steps Forward and One Step Back

The ICBC therapist called to see how things were going with Larry. "He's doing quite well," I told her, "and the party went very well. He didn't drink anything and he seemed to be okay with it. Uh, I know its two steps forward and one step back but do you think there will be any more steps back?"

Laughing she said, "I wish I had a crystal ball but I don't. Things will probably go along well for a while and then he'll probably get bored with the exercises or something. Or his lack of independence may hit him again. It's difficult to know what bump will set him off but there are very likely going to be more bumps along the way."

That wasn't what I wanted to hear. "He will probably also go through a grieving process about not being able to do what he once was able to do," she continued.

Life Goes On

"Larry began his physiotherapy program. He would be going three hours a day, five days a week. He was not very happy when he came home after the first session. It was harder than he imagined it was going to be and his body was sore. He got electrical therapy on his knee; he used the bicycle and treadmill machine and other weight machines as well as doing exercises on his own. I hoped it was not going to be another 'bump' in the road."

.......

"Larry was still smoking in the bedroom/ensuite. I hesitated for some time mentioning it to him again in case it would affect his mood. I didn't want another unpleasant episode. Finally, I decided to take the risk and brought the subject up, reminding him of how I felt about smoking. I also asked him if he remembered he had been told smoking wasn't good for the healing process of his brain.

Looking me straight in the face, he again denied that he had been smoking."

Brain Injuries - Understanding Metacognition

2009-06-12T22:42:00.000-07:00

Metacognition, as defined by Wikipedia, is ‘cognition about cognition’ or ‘knowing about knowing’. i.e.: it is knowledge concerning one’s own cognitive processes – awareness and self-awareness.

A survivor I spoke with said that it is an awareness of thoughts as well as behaviour. She said that you can’t alter behaviour and attitude until you know you are doing something. She said metacognition is the beginning of real rehabilitation and that cognitive therapy will help with the process.

John Flavell has written much on this subject. (1979, 1987). He divides the process into the categories of: person variables, task variables and strategy variables. He feels it has to do with how each person learns (the learning process and the planning process for each particular task).

Metacognition is the knowledge of self and the realization that it must be combined with commitment, focus and attitude. It involves an awareness of control over the process of thinking.

Commitment, attitude and focus are extremely important when working towards success. In order for someone to succeed, they must be entirely committed to the task at hand and must be persistent in their efforts.

A good attitude is about being positive and accountable. Your attitude on what you want to achieve will determine the result of what you get. Having a negative outlook will only bring more negativity.

To be focused is to have a definite and doable goal. Being focused helps to be successful in the performance of specific tasks. This thought is reinforced when they realize that their success is based upon their own efforts. Once they realize that they know how things work, they can plan, evaluate and then problem-solve each task.

“A human being can alter his life by altering his attitudes.” By William James

"Our thoughts create our reality - where we put our focus is the direction we tend to go." By Peter McWilliams

"Success doesn't come to you - you go to it." By Marva Collins

Excerpt From 'Roller Coaster Ride With Brain Injury (For Loved Ones)'

2009-06-11T22:32:00.001-07:00

Not Taking It Personally

.....

"The following morning I came downstairs about fifteen minutes after him. He was sitting at the dining room table playing solitaire. I made him a breakfast of scrambled eggs and toast and placed it on the table in front of him.

"I've already eaten."

Looking around I saw nothing to indicate that he had eaten. "You have to eat Larry. You didn't have dinner last night."

Baring his teeth and glaring at me he said, "If I want to eat, I'll eat. If I don't want to eat, I won't." Gathering up his bills, he growled, "You can drop me off at the bank."

Looking at the snow and the ice on the sidewalks and he with his crutches, I said, "I'll wait for you. It's dangerous to walk in this stuff with your crutches."

"I'm not coming back and you can wait until you're blue in the face. I'm going someplace else."

He got out of the car and without much alternative, I came home. I then called the ICBC therapist.

.......

After speaking with him, his therapist said that his biggest thing was that all of his independence had been taken away from him and I'm one of the ones who had taken it away and who was telling him what to do. He was also angry by the fact that his license had been removed. She told him she would organize a taxi account for him so he could go to the clinic and to his doctor appointments on his own so he would feel more independent. He said he didn't want me helping him with things - he wanted me to 'butt out'. She said if he refused to take his medication that they would send someone to give it to him so I wouldn't have to get into an altercation with him. As a final comment she said, "Don't take it personally."

Although that is what everyone says, it is difficult not to take it personally when a person is looking directly at you with anger and hatred on his face. I do believe, if only at that moment, there is a personal nature to it.

Role Changes Following A Brain Injury

2009-06-10T21:27:00.000-07:00

After a traumatic brain injury, it is very common for roles to change. Often the survivor is not able to do what he/she once did. i.e.: they cannot return to the job they once had; they may not be able to help in ways they once did within the home; their role as a parent may have changed, as well as that of a spouse.

Where there has been a serious injury and one partner is unabe to return to work, the financial situation in the household most likely will change. A stay-at-home mom may have to shoulder the responsibilities of working, often at a low-paying job. That person may possibly have the additional responsibility of looking after a family if there are children still living at home, as well as looking after the injured survivor. When the main wage earner is no longer able to work, there is often a financial hardship placed on the family.

All of the household responsibilities may now have to be assumed by the 'healthy' partner and all decisions may also have to be made solely by that person. It may no longer be a joint effort or an equal partnership. 'What do you think' questions may no longer be able to be asked - or answered. The strength and the coping abilities of the 'healthy' spouse will be important during this difficult period.

The injured survivor may no longer be able to parent as he/she once did. Anger, irritability and frustration may be the dominant issue and may cause problems where young children are concerned. This puts an additional burden of responsibility on the non-injured partner and can create a domino effect within the family structure as more and more stress is placed upon the 'healthy' partner. For the non-injured spouse, it may appear as if there is now an additional child to care for. This is especially true if there is not a large family support system or if no insurance is available for medical, therapeutic and other assistance.

Their relationship as a couple may also have changed. The survivor very often will lack empathy and may have become self-centered. He/she may, as a result, live in a 'me' world with little concern for his/her partner's problems. The brain-injured person may have difficulties showing affection. These issues will almost certainly have a detrimental effect upon their relationship. But at the very least, the onus is placed almost entirely on the shoulders of the non-injured partner regarding the health of their relationship.

The above instances are mainly where roles may change - possibly only for a short time or it may be forever.

Excerpt from 'Roller Coaster Ride With Brain Injury (For Loved Ones)'

2009-06-09T21:43:00.001-07:00

Chapter Ten

The End of the First Phase

"Larry was leaving the hospital! He was happy to be going home and I was fearful of what I might be facing.

Before we left I talked to the social worker. She gave me information on the Acquired Brain Injury Program which Larry had been referred to. The doctor wanted to talk to me before he discharged Larry to get my assurance that I felt I would be able to handle him. I wasn't sure but felt if he continued with his medications that hopefully it would be alright.

His pleasant mood continued to reign. The following morning I said, "I know you're putting weight on your leg but I'm not going to nag you about it. You know what the consequences are and you are the one who will have to live with them. But I AM going to insist that you take your medication because if you don't, I will be the one who has to bear the consequences of that. And I don't intend to." He took his pill.

..........

Then things began to change drastically."

Excerpt from 'Roller Coaster Ride With Brain Injury (For Loved Ones)'

2009-06-08T21:26:00.001-07:00

Anger and Frustration

"Day sixty-one was the beginning of some more new changes. Around this time Larry's frustration and anger were becoming very specifically directed at me. On this particular day when I got to the hospital he was cranky and complained about the therapist not knowing what she was doing; about them doing nothing for him; how he had to sit and twiddle his thumbs all day watching the sun come up and the sun go down; that he hadn't gone for a walk; and that now they were putting cream on his feet and legs for no reason.

"We're doing it because you have a fungus," one nurse told him patiently as she liberally spread the cream onto his legs and feet.

Shrugging, he said, "Well, knock your socks off then."

......... "That same week Larry went for x-rays. "Good news," he greeted me when I arrived at the hospital. "I can't weight bear for four more weeks but the doctor said I can probably go home next week."

My heart almost stopped beating at the prospect of bringing him home. I wasn't ready for him to come home while he was in his present state of mind. I didn't know if I could hold up to twenty-four hours of nasty treatment and being talked to like I was nothing more than a rat in his garbage.

"But I can't watch you twenty-four hours a day to make sure you don't injure your leg. You can't be trusted not to put your weight on it. If you could guarantee me that you would do as you are supposed to do and wouldn't be nasty to me, it would be a different story." (The comment about going home was made by the orthopedic surgeon who had no idea what his behavior had been like; he had been speaking from a surgical point of view).

"I can't guarantee you that," he told me. "I am not going to stay in the hospital for another four weeks. Everyone around here seems to be more concerned about you than they are about me." He continued to be argumentative, unreasonable, sulky, self-centered and complaining.

His nasty treatment of me was becoming increasingly difficult to handle and I spent most of each day either in tears or near to tears."

Excerpt from 'Roller Coaster Ride With Brain Injury (For Loved Ones)'

2009-06-08T21:09:00.000-07:00

Changes On His Road To Rehabilitation

"At the Care Centre, Larry seemed to become even more frustrated and angry. He became a very difficult patient and began 'lumping' me in with those he considered were the 'bad guys' (the hospital staff). Trying to get him to do any exercises to help with his memory and other issues with his brain injury was like butting my head against the wall. During this period of time, he thought the staff should be doing things for him and he shouldn't have to do anything for himself even when he was able to.

I reminded him of the ball I had brought in previously so he could squeeze it to help build up the strength in his hands and upper body - he wouldn't do it. I again suggested that he be proactive - that it was his body and he should have the most interest in making it well. He insisted that it wasn't up to him. He insisted they should be taking him to the exercise pool but they couldn't because he couldn't weight bear and he wouldn't listen to instructions and/or couldn't remember them.

During this period Larry often asked me to leave. Some days he was so difficult that I dreaded the thought of returning the following day. One day I was so frustrated with his behavior that I left. But most days I stayed for about six or seven hours. His biggest area of difficulty during this time seemed to be his short-term memory. He couldn't remember his recent 'yesterdays'. There were exercises which I tried to convince him were extremely important to do but most often he argued."

Excerpt from 'Roller Coaster Ride With Brain Injury (For Loved Ones)

2009-06-06T20:40:00.001-07:00

Doing Things His Way

"Larry is convinced that he can walk (in spite of his two broken legs) and insists he can go to the bathroom on his own. He won't listen to the nurses, the doctor or me. "We'll just negotiate the time I have to stay off my leg," he told me.

"Larry," I said with more than a little exasperation, "some things can be negotiated but the healing of bones can't be; it is one of those things that you just have to accept. The healing process can't be hurried but it can be hindered and it definitely can't be negotiated."

"Everything can be negotiated," he answered angrily.

They sent him for x-rays and decided that as yet he hadn't done any extensive damage. After this last escapade they put a monitor on his bed so that if he tried for another adventure, it would alert them. He was extremely angry about the monitor.

"I wasn't walking in the hall," he told me belligerently. "I was up on the roof and no one said anything about that. I spent the night up there and then they left me sitting in a wheelchair all morning. I met Todd at the railway station too and no one worried about that either."

He was becoming an increasingly difficult patient. One of the nurses told me it was for this reason that he wouldn't be going home because of how difficult he would be for me to handle."

Excerpt from 'Roller Coaster Ride With Brain Injury (For Loved Ones)'

2009-06-05T20:48:00.000-07:00

Panic Sets In

"One day I was later than usual getting into the hospital. He seemed to be quite annoyed with me and barely acknowledged my presence. Then later when I wouldn't undo his restraints, he said, "Why don't you get the f..... out of here." Although I didn't realize it at that moment, it was the beginning of his quite lengthy period of nastiness.

Because he couldn't remember much of his past, I tried doing memory exercises with him. Often he would stare at me and stubbornly resist doing them or else he would shrug and say nothing, completely ignoring my efforts at trying to help him.

In the Land of the Confused

"On the ward, Larry was assigned a sitter so one of his hands could be unrestrained but he became so violent with her that they were forced to totally restrain him again. While trying to get out of bed, he glared and bared his teeth at her and said, "I have to frigging get out of here." There were times when he directed the same type of anger towards me as well.

He often went off on tangents. At one time he thought one of his friends had something to do with raising me. When one of the nurses asked him questions relating to his health, he told her he had quit smoking three years ago but later was looking all over for cigarettes. Another time he looked at me with shock and asked, "Where are they?"

"Where are what?"

"Our drinks. I just poured them."

One day when my brother came to visit, Larry said, "I drink about six cups of coffee a day and then I go for the hard stuff."

"What's the 'hard stuff', my brother asked?

"That's when I have it with cream and sugar."

Excerpt from 'Roller Coaster Ride With Brain Injury (For Loved Ones)'

2009-06-05T20:34:00.000-07:00

Chapter III

"Look who's here. Do you know who this is, Larry?"

Looking at me he answered, "Steve."

"He's just joking," I laughed. I soon realized, however, that none of his answers were making any sense. It wasn't long before I became aware, with a sick feeling of dread in the pit of my stomach, that he hadn't been joking and didn't seem to know who I was.

Later in the visit he began to look at me very strangely.

"Do you know what my name is?" I asked him.

With a puzzled look on his face he said, "It isn't what you want it to be."

"What do you think I want it to be?"

"Coffee and toast," he answered."

Later - "Quickly finding a nurse I tearfully said, "He doesn't seem to remember anything from before his accident. Is he going to get his memory back?"

"We have been asking him dates and he has no idea what month it is or even what year. He thinks it's 1996."

"How would he know me? I thought. "We didn't know each other in 1996."

Excerpt from 'Roller Coaster Ride With Brain Injury (For Loved Ones)'

2009-06-04T22:13:00.000-07:00

Introduction

"'Roller Coaster Ride With Brain Injury (For Loved Ones)' has been written as a result of my partner's serious motorcycle accident. When I realized how difficult it was to get information on brain injuries or on how family members can help their brain-injured loved ones, I knew there was a need for something to be written. There seemed to be very little that was readily available for those close to the injured person in learning how to deal with the monumental changes in both the injured person's life and those of his family and friends."

"I found it was also sometimes difficult to get any extensive information from the doctors or nurses. This was partly because at the beginning very little seemed to be known about the severity of his injury or what the result of his injury would be. Further, I became aware that the more questions I asked, the more variety of answers I received. Each person I talked to seemed to have a different opinion on both his injury as well as his recovery prognosis.

By writing this book about our situation, I hope to help others in a similar situation realize they are not alone. There will be progress and although it appears to be slow - brain injury progress is often two steps forward and one step back - it will happen."

Our First Day In Hell

"Unable to stop the floodgate of tears, I cried the whole way to the hospital, praying that Larry would be alive. Karen, the Social Worker, met me in the Emergency and led me to a Family Room. "They are stabilizing him and then he'll be going for a CT scan. I'll let you know when you can see him."

With no one to talk to, my only company was the terrifying images that plagued my thoughts. I could not control my flood of tears and no matter how many times I brushed them aside, they continued to fall. It was like trying to contain water in a bag made of cloth. The half hour or so I sat alone in the room with my brain alternating between mush and the horrible imagines that cascaded through my head, my usually calm nature did not hold up very well."

Ways To Improve Short-Term Memory Following a Brain Injury

2009-06-04T21:54:00.000-07:00

Short-term memory loss is one of the most common deficits following a brain injury and one that the survivor is usually most aware of. With a concerted effort, this loss can be improved upon. The following are ways to improve memory problems:

- Make a list of what can be remembered from the previous day. i.e.: what was eaten for breakfast, lunch and dinner; what was done in the morning, afternoon and evening; who was spoken to, and what the conversations were about.
- Have the injured person read the newspaper and then later in the day, or the next day query him/her on what the article or articles were about.
- Similarly, ask him/her what they remember of something they were told one, two or three days previously.
- After going for a drive or an outing, two or three days later ask him/her what they remember of the event. i.e.: was the server a male or a female; what had they ordered to eat; what had the weather been like, or anything specific about what had been seen, heard or done.
- Be purposefully aware in any new situation in order to be able to remember events and anything specific. For example: forgetting where you parked your car at the mall may not be solely a matter of forgetting as it is of not taking special note when you left your car of where you did park it - it may be more of an issue of awareness.
- Listen carefully. Often the fact of just having listened will be of help when trying to remember people and conversations. This is particularly true with being introduced to new people.
- Internally repeat new things, like the name of a person when being introduced. Anything that is repeated has a better chance of being remembered.
- This also includes anything that is written down. Writing something down places the incident more firmly into the memory bank. Keeping a daily diary or journal will help because the process of writing in it will help the memory plus there is a record to refer to for assistance in remembering.
- Carry a notebook to record such things as new people's names, appointments, to-do lists and any other pertinent information to assist with memory.
- Another idea is: if there were bread, milk, eggs, potatoes and cereal to pick up at the store, it helps to remember what the items are if the number of items is remembered.

Practicing the above exercises will help with memory difficulties. Many of the exercises for short-term memory loss can help any of us but particularly those who have sustained a brain injury.

Additionally, there are other problems that will interfere with memory. Fatigue - when someone is tired, it is difficult to be 'on top of things' and to be able to remember. Anxiety will also interfere with memory. i.e.: if you are nervous when you are meeting someone new, it may make it more difficult to remember their name.

The effort to improve short-term memory is like everything else. It will take effort and perseverance. Nothing comes easily so the desire to improve one's memory has to be important to that person.

A Brain Injury Can Happen To Anyone

2009-05-27T20:24:00.000-07:00

According to the Brain Injury Association of America, brain injuries occur more often than breast cancer, multiple sclerosis, spinal cord injury and AIDS, combined. And in spite of the fact that more than 2% of the U.S. population live with a disability as a result of a traumatic brain injury, public awareness of the devastating impact of brain injuries is extremely low. Brain injuries are the leading cause of death and disability world-wide. Despite these statistics, and the high percentage of brain injuries in comparison to other life-threatening illnesses, there is less funding provided. There are also fewer services available for survivors of brain injuries.

Very few people understand the problems associated with brain injuries. The majority know nothing about brain injuries until it happens to them or their loved one. When my partner sustained a traumatic brain injury, I was one of those people. At this time many brain injury survivors will feel the numerous losses associated with brain injury - many will experience the loss of some family members and often their friends. They will continue their journey through life with injuries that are invisible to a public that has little understanding or awareness of what it means to have a brain injury. It is a long, lonely walk for those people living with the effects of brain injuries.

The good news is that most traumatic brain injuries can be prevented. Educating young people on how to prevent brain injuries should be as important as teaching children the rudiments of math and English. Education should emphasize safety and how to reduce risk factors. Most traumatic brain injuries are caused by motor vehicle accidents, falls, sports injuries or violence and often by carelessness.

By adhering to the following rules, most of us could prevent brain injuries: a) don't drink and drive; b) wear seat belts; c) wear approved safety helmets when biking, snowboarding, motorcycling, etc.; d) use proper equipment when playing sports; e) make common sense choices and decisions; f) use caution.

The effects of brain injury are as follows: cognitive, physical and psychological difficulties, short-term memory loss, lack of information processing skills, poor concentration and chronic fatigue, difficulty in completing tasks, depression, mood swings, anger and irritability. The impact of these injuries is not only felt by the brain injured survivor but by his family, the health care system and the community.

Because of the lack of public awareness concerning the number of brain injuries that occur each year, little is done for the survivors. Support services are wherever the family can find them but most fall through the cracks. Because of the lack of services and awareness, a large portion of those in the prison system have been discovered to have previously incurred brain injuries. It is important that the public be made aware of the causes, impact and prevention of traumatic brain injuries.

In the United States, March is Brain Injury Awareness Month. In Canada, it is June. It is important for each of us to remember that brain injuries can happen to all of us.

The Importance of Support Groups for Survivors of Traumatic Brain Injury

2009-05-26T21:12:00.000-07:00

For those who have survived a traumatic brain injury, there is often little treatment available after an injury and almost no counseling. For this reason the advantages of joining a support group are beneficial in many ways. And for those who are adamant that they do not want to join a group, there are internet brain injury support groups for those who are computer literate. The following is a list of the benefits of joining such an organization.

- Encouragement is given to assist members in achieving their rehabilitation goals.
- Members are encouraged not to give up when the going is tough and when things do not come easily.
- There will be assistance in helping a brain injured person acknowledge their losses and to move on with their new life.
- Members share their personal experiences which often helps others with their own problems.
- Being a member of a support group helps those with head injuries retain a continuing safety net. Many survivors have lost their homes, their jobs and their families. They do not have a healthy network of family and friends who are involved with their rehabilitation. Many are unable to return to the jobs they had pre-injury. They have nowhere to turn and often no motivation to look for help. Support groups can help them through these difficult times. Brain injuries are a lifelong disability and as such will require lifelong assistance. Support groups can fill this need.
- Members of support groups will hear stories of others' challenges and successes which may help them with motivation.
- Support groups can give assistance in helping to get resources, information, education and help.
- Attendance in a group will almost certainly ensure inclusion in social activites, offer the opportunity to become aware of recreation programs and available community services.
- Sharing experiences can bolster self-awareness and self-esteem.
- Many groups have access to a resource library.
- Help is offered in coping with difficulties associated with brain injuries and also with anger management problems.
- Most groups will have speakers in to discuss relevant problems, to give information on brain injuries and its effects as well as give assurances that they are not alone.
- Many groups offer life skills classes and help with adjusting to deficits.
- A few will offer counseling or make recommendations of where to go for counseling.
- Because all members have experienced similar difficulties, they support each other, listen, and understand the problems each person is faced with.
- Some groups meet on a drop-in basis while others meet on regular days at specified times with people who attend each meeting faithfully.

Those who have taken that step to joining a support group have also taken one of their first steps towards accepting their new life and moving forward.

Ten Steps To Helping Your Brain Injured Family Member

2009-05-21T20:57:00.000-07:00

The role of a caregiver to someone who has suffered a traumatic brain injury is an important one. And as such, there are many ways they can give assistance. The following are some of the ways:

1. They can give assistance by helping to further the health of the brain injured survivor. This can be done in several ways.
- By beginning cognitive and memory exercises as soon after the injury as possible. This will help to increase the chances of a successful recovery.
- Reminders for taking medications;
- Ensuring that they have a healthy diet;
- Assisting them in getting to medical appointments as they are required;
- Encouraging them towards healthy choices in their lifestyle. i.e.: not smoking, drinking or using drugs. You may not be successful because you can only lead the horse to water but it is important to continue to remind them of the harm they are doing to themselves when they make unhealthy choices.

2. Help to identify any potential problems and make an effort to avoid them.
- Avoid the company of those who encourage drinking or the use of drugs.

3. Assistance in avoiding situations that can contribute to anger and frustration.
- Determine what issues trigger anger and frustration - long line-ups?
- Having to wait for an anticipated outing or event?
- The noise of young children?
- Being uncomfortable - too hot or in pain, etc.?
- Being required to do something they don't want to do?
Some things, of course, are unavoidable.

4. Assistance in helping with adjusting and adapting to deficits.
- This will be difficult if they are in denial and do not admit to having deficits.
- Help with issues relating to loss of short-term memory;
- Help with issues relating to motivation.
These issues seem to be more readily admitted.

5. Assistance with things they have difficulty doing or are unable to do.

6. Offer encouragement, support and acceptance.

7. Have a sense of humor.

8. Try to remain calm and optimistic.

9. Encourage them to try new challenges.

10. Repeat regularly any reminders as one would have to do with a child.
- This seems to be working with my partner regarding his insistence in smoking in the bedroom/ensuite - he now rarely does this having finally decided to smoke instead in his workshop most of the time. This has not been easy. I have had to say it many, many times over the past two and a half years before he finally seemed to 'get it'.
- And with regards to my partner's drinking, although I'm not sure if he does still occasionally drink when I'm not home, I haven't heard him slurring his words recently. He also has repeated words to others that I have said to him referring to his drinking. i.e.: that he can't drink like he used to be able to because he isn't able to handle it. (He still doesn't say it's because of his brain injury, only that he is unable to any longer).

Any caregiver will agree that the list does not stop there but it is a good beginning.

Brain Injuries: The Importance of Friend and Family Involvement

2009-05-17T21:49:00.000-07:00

It is a long and lonely road for both the brain injured survivor and the caregiver without the support and involvement of family and friends. Often when those who had previously been close to the injured person think the 'worst' is over, their support ends. But as every caregiver knows, brain injuries really are forever.

If friends no longer call when their injured friend is unable to converse as they once did, go golfing, play racketball, tennis or whatever sport they did together, there is a feeling of abandonment on the part of the brain injured survivor. Those with brain injuries know things are different but they are not sure what it is. All they know is that their friends no longer call and they are alone and lonely. They have a lot of time and nothing to fill their time with. Often they will turn to substance abuse. This places a huge burden and responsibility on the caregiver. The caregiver then feels required to give 100% of their time and effort to the injured family member. This is often a difficult expectation when there are likely other members of the family that require attention also. The result of a situation such as this is that the injured family member, in the eyes of the rest of the family, is the only one that is important.

For those friends who think there is nothing they can do - they are very wrong. If their friend is no longer able to go golfing or play racketball, he/she would almost certainly enjoy being invited out to lunch, for a drive or a walk. They would then feel valued; not abandoned.

When those with injuries are no longer able to do what they once did - whether it be a job or in a social situation, they are set adrift. They are left with very little. Where do they turn? To their caregiver? The majority of people have very little knowledge of brain injuries so are unable to understand the burden the caregiver has without the support of those friends the injured person once thought he had. Most caregivers have sadly discovered that few people want to be involved.

Will the injured person turn to alcohol or drugs? Through boredom and lack of self-esteem, many of those with brain injuries will. Why not, they wonder? Their friends have abandoned them. My partner was called an 'embecile' by one of his 'friends' because he did not do a job well. This type of thing makes the role of the caregiver even more difficult while trying to bolster an already shaky self-esteem problem.

Are friends only friends when things are going well? In many cases, it would seem so.

As a caregiver, I have appreciated those who have shown understanding and compassion and have offered whatever assistance they can give. Outside of my own immediate family, (which I'm extremely fortunate to have), those people have been few. As an example, although my partner has had an alcohol abuse issue, one of his friends told me they could not tell him he couldn't drink while he was in their home. The opposite of that was while visiting my brother and sister-in-law for one week in their home, they kept the alcohol out of sight and offered him other refreshments. Their attitude, in comparison, was supportive and their understanding appreciated. My own feelings of frustration were validated. It is all any caregiver would ask for.

Brain Injuries - Anger, Frustration and Bumps In The Road

2009-05-13T21:45:00.000-07:00

When living with someone who has sustained a traumatic brain injury, there will no doubt always be some anger, frustration, irritability and bumps in the road when things don't go as expected, as wanted or take longer than anticipated. Things happen to all of us and when they do we learn, as we mature, to accept those situations that are often beyond our control. However, when someone has experienced a brain injury, there is a self-centered way of looking at a situation. Because those who have had brain injuries are often like young children again, it is hard for them to accept the fact that things don't always happen when they want them to.

This has been the case since my partner had his motorcycle accident. He became very frustrated and irritable when it took longer than he expected to get an Assessment regarding being able to drive again; while he waited for his subsequent driver's license and, when on our first family vacation after his accident - (probably as a result of being out of his comfort zone). The most recent time was when we didn't get away in our motorhome when it was hoped we would be able to leave. He eventually in frustration, set off on his own. When someone has a brain injury, anger and frustration will often lurk just below the surface when things don't go smoothly.

I have noticed with my partner that his anger is usually fueled by frustration. It can also be the result of a loss of emotional control or any perceived lack of control. For many people there is a trigger to anger and frustration. It can be a high level of noise, long line-ups, being asked to do something they are no longer capable of doing, fatigue or anything that makes them uncomfortable.

As caregivers it is up to us to try to keep things running as smoothly as possible but because we are human, this doesn't always happen. We can assist our family member by trying to encourage them to increase their self-awareness by determining the causes of their anger; have them attempt to calm down when they feel themselves becoming frustrated; practice thinking before reacting in anger and, avoid a situation that can create frustrations.

As Mark Victor Hansen said, "Things will never be perfect. There are always challenges, obstacles and less than perfect conditions."

And a quote by Bob Greene: "Setbacks are bumps in the road; they are not the end of the road."

Brain Injuries and Lack of Empathy

2009-05-02T20:24:00.000-07:00

The dictionary lists empathy as being able to identify with and understand another person's situation, feelings and motive. The state of being selfish, self-absorbed and self-centered indicates concern only with oneself. Lack of empathy and self enteredness are often deficits of brain injury. These deficits can cause difficulties within the family structure as well as getting along with friends.

Damage to the frontal lobe can affect feelings of not only empathy but also of lack of compassion. And in most cases there are few feelings of guilt as a result of their behavior. This deficit can alter decisions that most likely would have been handled very differently pre-injury.

My partner has shown this deficit many times - when he has been unable to comprehend my feelings of not wishing him to smoke in the bedroom/ensuite; his inability to see the hurt on the faces of small grandchildren when he has been playing with them and then suddenly becomes angry; and when I asked him if he realized that I had been upset about something he had been planning to do and he answered that he had realized it. 'And you did it anyway?' I asked. He answered that he had because he wanted to. These are only a few of the ways that lack of empathy can be shown but there are many. This lack of feeling and caring on behalf of those with brain injuries hurt family members whether it is their spouse, children or grandchildren.

Because empathy depends on seeing yourself as being similar to another person, having a brain injury precludes this ability. They are no longer the same as someone else, even someone with a brain injury since no two brain injuries are alike. Empathy also is the ability to understand another's perspective and to be able to see and appreciate that the other person's values and feelings will be different. Having empathy for others includes being interested in them but many brain injury survivors also have the deficit of being self-centered and self-absorbed so interest in others is difficult. When someone has empathy for another, it shows that they care about the other person's needs also. This is not the case when someone has the deficit of lack of empathy.

According to my research, it is felt that people can learn to have empathy if they want to make the effort. They can attempt to distinguish their feelings from someone else's; they can try to see the other person's perspective about a situation, and they can listen to what someone else is really saying. Although it can be done with effort, for those who have sustained a brain injury, it will be a much more difficult task.

Brain Injuries Are Forever - Adaptations and Adjustments

2009-05-01T22:23:00.000-07:00

Initially I believed that as a person with brain injury improved, they would begin to learn skills to be able to adapt to and deal with any deficits they were left with. I have since discovered this is not necessarily the case. Often brain injury survivors are unable to admit to having any deficits. They are in denial. Some will remain in denial their whole lives. This makes it difficult for them to receive help of any kind. It is almost impossible to help someone when they don't think they have a problem.

My partner is in denial although he did admit that things weren't the same in his head. (He would not admit this to his therapist). Most often, however, he focused on his legs which had been broken in his accident. For those who have sustained brain injuries, it will be important to find different ways to deal with their new limitations. After reading that with patience and help, as well as using strategies and tools to compensate, most brain injury survivors can often overcome their deficits I asked my partner if he was interested in trying, with my help, to adapt. He said, 'Probably not.' His decision left me with the challenge of learning to adapt and adjust to his brain injury without his help. After thinking about his answer, I decided that adapting and adjusting was more a matter of me learning to cope and accept.

From what I have read, it is stressed that the family member living with brain injury must be resilient in order for there to be the ability to adapt and adjust to the brain injury. Other important requirements include:

- Personal Resources: a sense of humor; physical and emotional health, and a belief that one has some control over the circumstances of one's life.
- Family Resources: capabilities of the family to meet obstacles; create family continuity and stability; be organized, and have active involvement of family and friends through the rehabilitation process.
- Social Support: Support of friends and family. This is very important to both the survivor of brain injury and for the caregiver.
- Coping Patters include: take action to reduce the demands created by the brain injury; manage emotional and financial difficulties and cope to make the head injury manageable and acceptable within the family structure.

Some of the challenges associated with adapting to the brain injury are increased emotional and marital stresses and the suppression of anger on the part of the family member living with the injured person. Caregiving a patient with brain injury can present challenges relating to role changes, loss of sexual intimacy, and loss of empathy. Therefore, it is extremely important to establish coping patterns rather than just adjusting or adapting to this difficult situation.

Brain injuries are a hidden disability. In most cases, the deficits and differences in the individual are noticeable only to those who live with the affected individual. In many cases other family members and friends do not offer support because to them the brain injured survivor seems fine. This very likely is not the case and unfortunately lack of support places an additional burden on the caregiver. Those who live every day with a brain injured survivor know that brain injuries are forever.

Brain Injuries and Substance Abuse

2009-04-28T22:34:00.000-07:00

As a family member who is living with someone who has suffered a traumatic brain injury and dealing with their subsequent deficits, I initially could not say which deficit was the most difficult to live with. That is until my partner began to drink. Presumably he began drinking as a result of having extra time on his hands which resulted in extreme boredom.

Because I was dealing with my mother's health issues and her eventual move into an assisted living home, I have been spending many hours and weeks downsizing her from two bedrooms and a den to a studio apartment. Unfortunately, that has often left my partner alone with nothing he had any interest in doing.

I first became aware that he was drinking when, on several occasions, I came home and realized he was slurring his words. He initially denied that he had been drinking. In spite of reminding him of the harmful effects drinking can have after a brain injury, his behavior continued to escalate. As a result, his poor judgment has increased (poor reasoning and judgment are already part of his deficits). One day I received a phone call from friends while I was taking my mother to the doctor, to tell me that my partner had arrived at their home exceedingly inebriated. He then drove home, in spite of their efforts to detain him, and was still drunk when he arrived.

Alcohol and drugs have a more intense affect after a brain injury. According to my research, alcohol, even in small amounts, further decreases cognitive and physical functioning. Because of the already existing memory problems, they may incorrectly underestimate the amount they have consumed. Alcohol and drugs will also further impair an already faulty memory. According to the Brain Injury Association of America there is no safe amount to drink after a brain injury. Those who use alcohol or other drugs after a brain injury do not recover as well and can in fact lose much of the progress they have gained.

It is recommended that in order to maximize the quality of their life they be encouraged to join support groups, recreational groups and other activities so they will have fewer times to be alone and therefore avoid becoming bored. This will only work of course if the injured person is agreeable to becoming involved in activities. It is also suggested that liquor not be kept in the home. However, if the injured person is able to drive, this will not be a solution.

Another important consideration is that alcohol and other drugs can interfere with prescribed medications. There is also the increased risk and potential for seizures when substance abuse is an issue. And those who use alcohol, etc. after a brain injury have a greater chance of having another brain injury because of their lack of reasoning skills and poor judgment creating the potential for future accidents.

Since my partner has begun drinking again following his accident, he has regressed. In the Fall I was pleased to see that there had been a spurt of improvement - a huge step forward. But since he began to drink, he is now at his last year springtime development level - two big steps backwards. His motivation level has also deteriorated and his short-term memory is worse than it has been for some time. His lack of self-awareness and insight mean he can not see the relationship between his behavior and the resulting consequences.

The difficulty is in convincing someone who has a substance abuse issue that a problem does indeed exist. If they don't understand there is a problem, they will make no attempt to change their behavior. Once they admit there is a problem, they can commit to making changes. At that time they will have to establish a goal, make changes in their behavior and possibly change their environment and way of doing things.

The family member can help by controlling their own frustration with the situation because becoming frustrated can only make an already difficult situation worse; by realizing you are not responsible for someone else's drinking problem; by not enabling them; by not feeling guilty and by remembering that you are not a victim.

Brain Injuries and Depression

2009-04-15T21:43:00.000-07:00

Depression is a scary thing when it happens - for both the person suffering from it and also for his/her family members. The dictionary states that depression is the condition of being gloomy or sad. In my experience, my partner's depression went far beyond this explanation.

The symptoms of depression were extreme anger, frustration, irritability, hostility, and being critical and uncommunicative. He had no interest either in any of his former activities. He also made a decision during the time when he was angry that he was going to sell the house and go to Mexico.

Other symptoms can include less energy, a feeling of being slowed down, restlessness, low self-esteem, anxiety, difficulty concentrating, increased weight or loss of weight, increased appetite or loss of appetite, sleeping too much or other sleep problems. However, fatigue is a common symptom of brain injury, not only when associated with depression. There can also be thoughts of suicide in severe cases of depression.

Depression can be brought about by a biochemical imbalance of serotonin, dopamine or norepinephrine; a distressing life event; trauma or genetics. People who have low-self-esteem, negative outlooks, physical or health conditions or other psychological disorders are also at risk.

This condition can easily be treated by medication and/or psychological counseling and support from friends, family and self-help groups. Changes won't happen overnight although my partner did claim to feel better more quickly than I expected. In most cases medication can take a few weeks to begin working. In the case of clinical depression, it will likely need to be managed over a person's lifetime.

Depression will affect not only the sufferer but his family as well and can put huge stress on the partner. It is important that family members be patient and non-judgmental and that they listen and offer their support.

My partner was diagnosed with depression several months following his serious motorcycle accident. Besides his brain injury, he suffered other injuries which included broken shoulders, a broken collar bone, his left hand and two badly broken legs. All of the ribs on his left side were also broken, puncturing his lung in the process.

We were told that it was very common for someone to have depression brought about because of a chemical imbalance following so many physical injuries combined with the traumatic brain injury. They expected that he would be on the medication for approximately six months and then it would be gradually reduced and eventually would be tapered off until he no longer needed it. However, when it was initially reduced, there was an almost immediate reversal back to his behavior and mood difficulties, pre-medication. And at over two years since beginning the medication, it is still necessary to continue with it.

Brain Injuries and the Importance of Cognitive Exercises

2009-04-07T21:15:00.000-07:00

While trying to determine how was the best way to help my partner after his motorcycle accident and subsequent brain injury, I was told that the earlier a person could begin doing cognitive exercises after their injury, the better their chances of recovery would be. This, however, is easier said than done because in the early stage of their injury they are often confused and angry and not in the slightest inclined towards doing exercises.

Some of the cognitive symptoms include impairments regarding perception, communication, reasoning, problem solving, planning, sequencing, lack of motivation, memory problems, inability to initiate activities and often poor judgment.

My partner displayed most of these symptoms and even at two and a half years post injury, he still has difficulties with some of them although to a lesser degree than he originally had. I believe strongly that my persistence in having him do the various cognitive exercises helped him reach the stage where he now can enjoy life to a greater degree than he might otherwise have.

I am listing below some of the cognitive exercises that we did. I included many more in my recently published book entitled 'Roller Coaster Ride With Brain Injury (For Loved Ones)' . This book can be purchased online at: www.trafford.com/08-0107 or orders@trafford.com or by telephoning: 1-888-232-4444.

The exercises:
- Draw lines at different angles and have injured person copy the angles of the lines drawn;
- Do lines like a backwards 'Z', and 'M' on its side facing left or right and other similar lines then have them draw the same outlines themselves;
- Do various other shapes - curved lines and patterns that are irregular, etc. and have him/her copy and draw these outlines;
- Do a partial pattern of a circle, oval, triangle, etc. and let him/her complete the patterns;
- Do circles, triangles, squares, rectangles, etc. and have him/her duplicate these shapes;
- Do a series of shapes that are all the same except for one, then have him/her circle the shape that is different;
- Do sequences of various shapes and have him/her continue making his/her own outlines of the sequences in proper order;
- Draw a maze and have him/her find his way out of the maze;
- Do word searches;
- Show a street map and have him/her find various streets on the map;
- Read him/her a very short story and then ask questions relating to the story. The same can be done with an item in the newspaper.
- Crossword puzzles and Suduko.

Deficits Following A Brain Injury

2009-04-06T19:54:00.000-07:00

Most of those who have sustained a brain injury will almost certainly be left with some deficits. Depending upon where the brain injury was, its severity, the person's personality as well as other circumstances, the deficits will vary. Some of the most common are: lack of motivation, short-term memory loss, personality changes, perseveration and rigidity of thinking, inability to remain focused, impatience, inability to follow written instructions, self-centeredness, lack of empathy, frustration, anger, poor judgment, social withdrawal, inability to learn new facts, depression, task performance difficulties and lack of enthusiasm for anything. My partner, although having many of the above deficits, admits to only his short-term memory loss and his lack of motivation. He is completely unaware that his deficits affect his functioning or how they affect our relationship.

Denial, according to my research, is an adaptive strategy to protect themselves from the reality of their situation. But, in many cases, the failure to recognize deficits leads to a high risk of conflict with family members because they are unable to understand that a function is impaired; they don't recognize the problem when it occurs and they are unable to anticipate that a problem will occur because of their deficits. When brain injury survivors become aware of deficits, it allows them to adapt to the physical, mental and emotional losses they have incurred. Hard work does not completely eliminate deficits. Deficits, for the most part, will have to be adapted to.

In the words of a brain injury survivor, those who have had a brain injury have suffered a terrible insult to the insight portion of their brain and in many cases they simply just don't 'get it'. I had noticed this with my partner also.

She also said that denial is not stubbornness as it appears to be - it's brain injury - and it leaves one without the ability to see oneself as one really is. Knowing what one is doing and saying, and to be aware of one's thoughts and behavior is a deliberate action. She said you can't alter behavior and attitudes until you know that you are doing something. This behavior follows a thought so if the behavior is unacceptable, you have to recognize the thought that generated the behavior. The process is called metacognition. She further commented that self-evaluation is the beginning of metacognition which is the beginning of real rehabilitation. She recommended checking out: http://www.mybrainconnections.org

Cognitive therapy is training in the use of compensatory strategies for cognitive deficits. It utilizes the patient's strengths and because no two injuries are the same, treatment plans and goals are designed specifically for each person.

Suggested strategies to help with adapting to deficits are: a positive attitude, to keep trying things that are challenging, writing something down because it is more likely to get into the memory bank and to join brain injury support groups to learn what strategies others have developed.

After reading personal stories of other brain injury survivors, I asked my partner, at 26 months post injury, if he would like to write his own story. He said he wouldn't know what to write.

"You could say how your accident happened, what you remember of your hospital stay and how you feel about what has happened to you," I suggested.

"I don't think it's my head. I think it's my legs, so I could only write about my legs," he answered.

"You don't think you have a head injury?" I asked him.

"I don't know. I know my memory isn't very good but I think the reason I haven't been motivated is because of my legs."

I decided at this point he is still not ready to discuss the issue of his deficits.

The following is a list of useful resources:

Brain Injury Association of Canada http://www.biac-aclc.ca
British Columbia Brain Injury Association http://www.bcbraininjuryassociation.com
Brain Injury Association of America http://www.biausa.org

Brain Injuries: Perseveration and Rigidity of Thinking

2009-04-05T17:35:00.000-07:00

Perseveration and rigidity of thinking are two of the deficits of frontal lobe injury. The frontal lobe is the largest part of the brain and is, therefore, most often the area of injury. As with most deficits, it will be important to find solutions that will work and to make adjustments in both your life and your injured family member's life. But, it will probably be necessary for the majority of adjustments to be made by the 'healthy' partner.

Perseveration is a repetitive and continuous behavior where a person is locked into a specific activity; persisting or persevering with repeated behavior; being narrowly focused or having tunnel vision; or having an inappropriate cognitive-behavioral response in spite of a changing task requirement. The brain injured person is unable to change his process of thinking because of difficulties in abstract reasoning.

Dealing with perseveration is like watching a dog with his bone. He only has one thought in his mind and very little will remove his focus from that bone. And if you try to remove that bone from the dog, you had better be prepared to accept the consequences of such an action.

In my injured partner's case, his 'dog with a bone' behavior showed up especially in his determination to smoke in the ensuite when smoking had never previously been done in the house before. At the same time, he first denied vehemently that he was smoking at all and secondly that he was smoking in the ensuite. In spite of the year of discussions we had over this issue, his perseveration continued. I've since decided that in order to avoid further stressing myself, I will give up mentioning the smoking issue to him. Some things are just not worth the hassle. ** (See note below)

A possible solution for perseveration is cognitive-behavioral training. However, this option is not always available.

Mental rigidity is another deficit of frontal lobe injuries. It can show itself with difficulties in experiencing emotions or the ability to move from one emotion to another at appropriate times; difficulty in accepting changes and difficulties when they are out of their regular routine. My partner, although now in his third year post injury, still has difficulties when he is out of his regular routine. By 'regular routine', in our case I mean the difference between whether or not I'm here. One example is if I am not at home, he usually does not remember to take his medications.

Some possible solutions for this deficit are that family members can help the injured person by discussing upcoming changes and assure them that not all routines will be changed. The injured member of the family can also do their part as well by learning to be accepting of changes since not all changes can be prevented; and by doing self-talk strategies. i.e.: 'I don't like changes but this will be okay.'

The most important thing you can do for your loved one who has had a brain injury is to be supportive and encouraging.

When dealing with brain injuries, the following quote is a thought to remember for those who have considered giving up or for those who have thought there was no problem to consider:

'No head injury is too severe to despair of, nor too trivial to ignore.' - Hippocrates

** Note: Smoking severely inhibits the healing process of a brain injury. It restricts the vessels and the blood flow to the brain and thereby slows the healing.

Personality Changes Following A Brain Injury

2009-04-04T12:56:00.000-07:00

Personality changes can include many things. Most of these changes will be based on deficits resulting from brain injuries. They will contribute to associated behaviors and these behaviors will contribute to the changes in a personality.

Becoming 'stuck' on a notion such as the 'dog with a bone' attitude is one such change; mood changes are another. A change that I found rather disconcerting was my partner's tendency, after his injury, to make up stories. This, I believe is the result of his short-term memory difficulties - if he can't remember the whole story, he makes up what he can't remember. In spite of the fact that he doesn't appear to remember the original story, he does remember his 'made-up' version and will argue it vehemently.

While doing research, I have read that personality changes will sometimes be an exaggeration of the person's pre-injury personality (an amplification of their negative traits increased by frustration and a sense of loss); or at other times the personality change can be a complete reversal of the pre-injury personality. i.e.: Where once the person may have been easy-going and thoughtful, they may now be easily angered and self-absorbed.

Also, according to my research, some changes may be due to the brain injured person's coping style and responses to stressful situations pre-injury, i.e.: their adaptability to change, or their tendencies towards minimizing or magnifying their emotional situation.

In frontal lobe injuries, the changes are mostly in the emotional and behavioral area with some relating to cognitive impairments. In my partner's case, a couple of the behavioral deficits he has been left with are his difficulty to tolerate frustrations and his decreased social skills. One of the results of this is he does not participate in conversations as he once did.

In the words of a brain injury survivor - 'each person has personality traits, habits, strengths and weaknesses before they sustain a traumatic brain injury. If a person was disorganized before their injury, they'll look like a train wreck after; if they were cranky before, they'll be ruthless after; if they were low maintenance before, they'll completely disengage after; if they were extremely bright before, they'll have some 'cognitive reserves' to help make up for their deficits; if they were of low or average intelligence, they're going to struggle to keep up; if they had interpersonal problems before, they'll have chaotic relationships after.' She said each of us is flawed in some way and a brain injury makes those flaws worse.

Extreme fatigue is another change. When my partner required what seemed to be an excessive amount of sleep, I assumed that his body was still healing from his many other injuries. But through my research, I have discovered that fatigue is a very common symptom of brain injury. Because the brain isn't working in the same way, the survivor has to work much harder to be able to accomplish less than what he once did. Also the extra effort that is required to compensate for short-term memory loss has an enormous fatiguing effect. Added to this is the effort of trying to keep up with a conversation; the difficulty of paying attention or analyzing what is being said, thinking of a response and trying to look interested all at the same time.

And then there is the change that is difficult to describe. There is a song by Johnny Reid about an angel who has fallen from heaven. Before my partner's accident, he used to say I was his angel. But something has been lost since his brain injury. Although I believe the caring is still there, the ability to show it, and definitely the ability to articulate it, is gone. It is another change in his personality.

Relationships After Brain Injury

2009-04-03T21:39:00.000-07:00

Following a brain injury, dynamics change. The relationship is no longer equal - you are no longer partners in the same sense you were before the injury. Initially it becomes almost like a parent-child relationship where the survivor becomes dependent upon their healthy partner. A new balance must be achieved and the new status must be dealt with if it is to work. Many brain injury survivors cannot accept what they are left with and find it difficult to move on with living. In many cases, they have lost the life they once led and the person they once were. Even if they can't verbalize this realization, they are aware that something is very different.

According to research, often as long as ten years post injury, relationships may still be undergoing problems. An international brain injury support organization states that relationship breakdowns run as high as 78%. They are often a result of the survivor's lack of empathy which can place a significant strain on relationships. Also damage can be done over time to the relationship by the survivor's inability to adapt to the brain injury and their resultant deficits. It has been said that the impact of brain injury on partners and families is similar to throwing a pebble into a pond; the ripples created have an effect on the entire pond.

It is through our brains that we experience ourselves and our environments. It is what makes us who we are. Brain injuries cause diminished self-awareness which results in an inability to recognize personal changes. Although brain injury strikes an individual, the entire family lives with the impact of the injury.

In order to attempt to alleviate potential problems, it may be necessary to avoid exchanges that may lead to misunderstandings - even a suggestion of doing something other than their way can cause a swift change in mood.

As with children, reminders are often necessary. Have you taken your pills is a common one. Resentment becomes a companion to their anger and frustration when they are seemingly treated like a child. But when memory is an issue, these reminders become a necessary part of living.

Many survivors are self-centered and consumed with their own loss. In their concern for what they have lost, they are unable to realize that the loss is not one-sided. For their partners, even with the knowledge that the behavior is unintential, the hurt still exists. Although we, as the healthy partner, have been told not to take it personally, it is difficult to remain immune to the hurt.

Are there answers? In general the relationship will depend mostly upon the healthy partner. It is recomended that the healthy partner not disagree with the brain injured person; not challenge or confront him; remain calm; be willing to ignore bad behavior; show support and affection; offer positive reinforcement and to be patient.

But the relationship is unlikely to be what it was before the brain injury happened. Dreams have changed; new dreams and new strengths must be developed, if possible. The ability of the non-injured partner to cope is of prime importance. Some caregivers find that sharing their feelings with others can help them through difficult times. Others use humor to focus on solutions instead of problems. But most importantly, remaining positive will be the best coping strategy of all.

I used to say that it takes two people to work at a relationship; one can't do it alone. This line of thinking cannot exist in uch a situation. In most cases, there will only be one person working at it. The success will depend largely upon that partner's willingness to continue to work alone.

Brain Injuries: The Two Steps Forward and One Step Back Dance

2009-03-30T20:46:00.000-07:00

There are many instances where it will be 'two steps forward and one step back'. This will be especially evident in the first year following an injury. However, it is probably something that will continue throughout the entire journey of life with a brain injury.

Recently the incidents with my partner of 'two steps forward and one step back' have been fewer but nonetheless have made a difference in his progress towards recovery. About one and a half years post-injury, I felt we had a handle on the 'lack of motivation' issue and he did seem to be doing quite well.

During the Spring time and into Summer, the weather was nice; he had several interesting projects to work on; a friendly neighbor to converse with and his mood began to improve. But as the seasons changed from Fall to Winter and the weather became cold and nasty, the neighbor was no longer outside and my partner's motivation level began to take a drastic turn backwards. He went back to doing what he had been doing previously - dozing on the couch, playing solitaire and occasionally doing crossword puzzles.

Now, two and a half years post injury, he is looking forward to when I have time to go away - so he can relax - which is what he has been doing all Fall and Winter. Perhaps when Spring finally arrives, he will return to his past Spring time level of motivation.

Another area where he had been making progress and where he now seems to have gone backwards is indicated in the work he does. He had done small projects within the home which he had taken care with but recently he painted the powder room in a way that looked as if it had been done by someone with little or no painting experience. Also, over the last year and a half, he has occasionally gotten small jobs to do, but recently he has had to go back and redo things that haven't been done properly. As a result of this no doubt, the jobs are becoming fewer. This may only be a momentary 'one step backwards' and hopefully he will eventually move forward again.

Around his two year post-injury period, there seemed to be a general spurt of improvement. He seemed to be more comfortable when in company; he seemed more interested in things that were happening and he became more interactive as far as communication. Now six months later, there has been a backwards slide in this area as well.

It seems that with brain injuries, there continues to be the 'two steps forward, one step backwards' dance with plateaus and sudden spurts of improvement. I anticipate that where he has taken backward steps, there will also be a few steps forward in the future as he makes another burst of improvement.

Don't Take It Personally

2009-03-29T21:57:00.000-07:00

Not taking it personally, together with setting boundaries, is extremely important for those living with a family member who has suffered a brain injury. Coping with the changes in your loved one is difficult enough without taking to heart verbal abuse that you know they would never have said before their accident. They mean it no more than you want to hear it. But since you do hear it, the best thing to do is relegate it to that portion of your memory bank where things that aren't worth remembering go.

Those who have experienced brain injuries are no longer the same person they were before their injury. We had many incidents in the early stages, brought about by frustration and anger, and although they do not happen as often, there is still the occasional time that it does. At those times, I must remember to remain calm; to consider that his bad behavior is a result of his brain injury and that he has been left with deficits that he is unaware of or at the very least, has not as yet acknowledged, not even to himself.

It can also come about when there are difficulties with the thought processes. Written instructions of any kind were often a prelude to bad behavior and anger where at times in exasperation, he would throw the offending instructions at me. Sometimes he'd bare his teeth and glare at me when he was angry or, refuse to eat meals put in front of him or, become angry at not being included in something that he was physically or otherwise unable to do. I am thankful that angry, hate-filled looks don't kill.

He had also on occasion chosen to sit in another area of the doctor's office from me because he was angry at my insistence that he needed to go; and he has refused to talk to me, sometimes for a whole trip, because he was angry or frustrated.

Depression plays a large part in behaviors such as these. It is a very common problem with brain injury. If problems such as these persist, it would be advisable to have the injured family member assessed.

Brain Injuries and Motivation

2009-03-28T22:14:00.000-07:00

Lack of motivation is quite often one of the deficits of frontal lobe brain injury. It is a monumental task to try to get someone motivated to do something if there's nothing they really want to do. It is particularly challenging when they don't want to be motivated in the first place. It's like trying to beat a dead horse. No matter how hard you beat that dead horse, he's not going to get up.

During the first year after my partner sustained his brain injury, life was a roller coaster ride. By the end of that first year though, his confused periods became fewer and his moods improved little by little but as time progressed, I gradually became more aware of his deficits.

A brain injury is a hidden disability affecting a person in a way that will sometimes make them appear, to others, to be lazy. This apparent laziness is the result of lack of motivation. Those with frontal lobe damage very often experience this deficit along with the accompanying inability to plan ahead. They sometimes also exhibit poor judgment. For this reason, lack of motivation can be a major concern for family members.

My partner, following his brain injury, had no interest in doing anything. For most of his days he sat on the couch and dozed off and on, occasionally playing a game of solitaire. He wa bored. When I made suggestions of what he could do, he had no desire to try them.

I recalled when one of my children was ten months old, he had no desire to learn to crawl. Being easy-going and placid by nature, he was content to sit and watch the world from his blanket on the floor. But he was attracted to the budgies in their cage. One day I placed the birds in their cage on the floor, set him in 'crawl mode' and he was off. I considered how I could translate this knowledge into something that would work with my partner. Desire, I realized, had to be the motivating factor.

Being a strong believer in 'lists', I made up a list of things he had previously enjoyed doing. By having several tasks written down, he now had choices. It was a checklist with a beginning and an end when he was able to cross off the completed task. The result was a feeling of accomplishment (if not for him, then for me). The list idea did help somewhat with his lack of motivation.

This is a big step for those with a lack of motivation deficit. Their efforts should be supported and encouraged. And if things don't go well, stay calm, don't overreact and remember to take one day at a time. They are baby steps towards recovery.

Most people suffering from brain injuries are unaware, (at least in the initial stages), of their deficits. As one neurologist said, 'How do you get someone to work on a problem they don't believe they have nor care about?'

Frontal Lobe Brain Injuries and Short-Term Memory Loss

2009-03-25T22:42:00.000-07:00

Short-term memory loss is almost always a result of frontal lobe brain injuries. Shortly after the injury has happened, the short-term memory loss can be so severe that the memory of visitors will last only until shortly after the visitor has left, and memories of what has last been eaten will be irretrievable.

This type of memory loss affects areas you may not have thought of. In my partner's case, he no longer will watch television other than the news. Because of his short-term memory loss, he is unable to follow the necessary sequences of a program or movie to be able to understand what is happening. He also no longer plays games with the family as he used to do. He also, until very recently, avoided socializing because it was difficult to interact in conversations when thoughts from the beginning of a conversation were lost by the end of it. It made continuation and inclusion in a conversation very stressful. He has improved in this area when in the company of people he knows well.

The more usual short-term memory difficulties are remembering appointments. Using a daytimer, calendar or making a list are some of the ways this problem can be solved. The additional problem, however, is to remember to use it. Another example is when something has been mentioned the previous day and cannot be remembered the following day.

My partner plays the game of pretending to remember. He'll say, "Oh, right, I remember." He will continue to play the game even when I have told him something that I had not mentioned previously and he 'lets on' that I had already told him by preteding to 'remember'.

There are many exercises that can help the memory. One is to have him/her look at a picture for 60 seconds to begin with and then ask them to remember as many things as they can about the picture. As their memory improves, shorten the time. And when they have met that challenge, change the picture.

Another memory exercise is to write down a list of twelve items. Let him/her look at the list for three minutes and then ask them to write down as many of the items as they can remember. As they improve and are able to remember more items, have them do it in less time. Eventually change the list and do it again.

Short-term memory loss can be very upsetting but over time and with practising memory exercises, it can improve.

Roller Coaster Ride With Brain Injury

2009-03-24T22:03:00.000-07:00

In the beginning, coping with brain injury is a roller coaster ride. Although a tragedy for the injured person, it is an equal tragedy for the family.

Because of the lack of information available, the family member closest to the injured person will likely feel very much alone. When my partner had a very serious motorcycle accident, we were fortunate in that we were surrounded by a huge family support system. As one who has gone through this difficult experience, I would highly recommend enlisting the help of a support group (if there is no strong family support) for assistance with the monumental changes you will be facing in your life as well as in the life of your loved one.

There will be difficulties in adjusting to these changes as well as difficulties in getting the necessary answers to questions. As the 'healthy' person, there will be many crucial things that are necessary to do. You must 'ask the right questions', 'take control of the situation', 'be proactive', 'be your own advocate for your injured family member', and 'realize the necessity of having support'. These will be vital when battling cognitive and behavioral problems, frustration and anger management difficulties, confusion and short-term memory loss as well as other brain injury impairments.

It will often be two steps forward and one step back and although this is discouraging, that is initially what happens. It will be important not to take things personally when your brain injured loved one becomes angry or verbally abusive. It will also be necessary to set boundaries for yourself. It is equally important not to feel guilty if you wish time for yourself or if you occasionally feel frustrated; your life has changed too.

I was not aware that someone suffering from a brain injury could change so drastically; that he couldn't remember who had visited a few minutes after that person had left, and that I would be treated like someone he hated most in the world. I did not know this is all very typical behavior by those who are suffering from a brain injury.

There will be adaptations and adjustments that will be necessary to make and there will be many 'bumps in the road' but things do eventually get better.

When Tragedy Shakes Your World

2009-03-23T22:12:00.000-07:00

Immediately after your loved one has been involved in a serious accident, your brain doesn't want to think about what has happened. Then as you come to terms with it, you will have many questions. In the beginning, there are few answers because no one really knows. 'No two brain injuries are alike,' they tell you. Being told this doesn't help; you want answers. What do you do when life as you knew it changes? At this point you see no light at the end of the tunnel and you are not sure if there ever will be again.

I received our life-altering telephone call less than two hours after my partner had left our home on his motorcycle. It was a phone call no one ever wants to receive. Driving to the Emergency Ward, I cried copious amounts of tears and prayed as I tried to stem the flow. When I arrived, the Social Worker led me to an empty Family Room. I was told they were stabilizing him as he'd lost a lot of blood. She said he had many injuries as well as his brain injury and that a doctor would come and talk to me soon. Alone in the room, my only company were the terrifying images that plagued my thoughts until one by one my family began to arrive. During this terrible time, I realized how fortunate I was to have so many supporters.

When tragedy happens, and after you get over the initial shock, most people look for hope. They want confirmation that their loved one will get better; that things will go back to the way they were. Neither doctors nor nurses will guarantee how things will be in the future. In the beginning, with swelling in the brain and most often bleeding, it is difficult to judge the severity of a brain injury. There had been shearing of my partner's brain and I was told they would not know until he was walking and talking again.

During this period of time, I asked questions but realized that the more questions I asked, the more different opinions I received on both his injury as well as his recovery prognosis. Hope was not my constant companion during those early months.

After your loved one's injury, there will be many concerns. It will be necessary to express them so you can do the best you can in helping your family member become well again. I found most of the medical practitioners were approachable and willing to listen to my concerns and to help me find a solution. But I did have to ask the questions.

By two weeks after his accident, I knew our life had changed. He was now awake but with shock I realized he had lost ten years of his memory. The frightening thing was that we hadn't known each other ten years previously. But interestingly, because the brain is so amazing, most often he could tell me what my name was when asked.

With his increasingly longer periods of wakefulness came confusion and anger. Restraints were necessary. He went on tangents where what he said had no basis in reality. He had to have a sitter because he refused to do as he was told and continually attempted to pull out his tubes. There were many visitors he did not recognize; some had been friends for years. I brought pictures and items into the hospital that I thought might jog his memory. Some seemed to work, many didn't. About six weeks after his injury, he finally realized what year it was - mostly, I believe, from being told repeatedly. Thankfully he gradually improved and by the time he came home from the hospital, he was able to recall most things from that ten year memory loss.

There is no doubt that the first year is very difficult but bemoaning the tragedy will not make it go away. Trying to do the best you can for your loved one will help. One of the most important things I learned from my research during those early months was that the sooner after an injury a patient can do cognitive exercises, the better his prognosis for recovery will be. I tried daily to help him with these exercises; he was very often verbally abusive. I believe very strongly in the value of my insistence that he do those exercises and I give full credit to them as the reason my partner is doing as well as he is today. As a result, we discovered there was a light at the end of the tunnel.

What Is A Brain Injury?

2009-03-23T21:51:00.000-07:00

The statistics are heartbreaking. Every 23 seconds, one person in the United States sustains a traumatic brain injury; and 1.4 million Americans sustain a traumatic brain injury each year. The symptoms of brain injury are many but every brain injury is different.

Some of the symptoms are: short-term memory loss; fatigue; insomnia; apathy; social withdrawal; irritability; frustration and anger; slowed thinking; inability to carry out routine tasks; inability to learn new facts; disorganization; diminished attention span; poor concentration when there is two or more stimuli; impaired judgment; depression; anxiety; lack of motivation; perseveration; lack of empathy; rigidity of thinking; and headaches.

Every brain injury survivor has a story to tell and many have learned ways to adapt and adjust to their deficits. Some may never learn. Those who are attempting to deal with their problems discover how difficult it is to concentrate on the process of thinking. They have to learn to maintain attention and stay focused. They often have difficulty in comprehending information as it is presented and in integrating any related information. Many will also have difficulty in following the plot of a story.

Most brain injury survivors will have problems with extreme fatigue and will require what appears to be an excessive amount of sleep. This will be critical in order to have improved cognitive functioning. They often have difficulty in interacting emotionally with other people; they will also usually have difficulty putting names to faces. In general it is agreed that it is important to attempt to learn compensatory strategies. It is all about achieving a new normal as it is unlikely they will ever go back to who they once were.

With brain injury recovery, there are no miracles. It is step-by-step gradual improvements with some occasional blacksliding. A great deal will depend upon the attitude, courage, determination, patience, strength and the willingness of the survivor to accept new possibilities, potentials, goals and expectations. They must also be aware of their limitations. It will help if they have a strong desire to achieve a specific goal, i.e.: perhaps to play golf again. However, it is unlikely that any of this will be possible if the survivor has not as yet accepted what he has lost and come to terms with it.

Because brain injury is considered a 'hidden' disability, it is interesting that often only the person who is closest to the brain injury survivor will be aware of the full extent of the disability.