[WEB SITE] 7 signs of executive dysfunction after brain injury

7 signs of executive dysfunction after brain injury Main Image

 ‘Executive dysfunction‘ is not, perhaps, a particularly well known term, but the effects of brain injury that it covers are very common indeed. It is used to collectively describe impairment in the ‘executive functions’ – the key cognitiveemotional and behavioural skills that are used to navigate through life, especially when undertaking activities and interacting with others.

Although executive dysfunction is a common problem among many brain injury survivors, it is most commonly experienced following an injury to the frontal lobe.

The importance of executive functions is shown by the difficulties caused when they don’t work properly and someone has problems with executive dysfunction. Since the executive functions are involved in even the most routine activities, frontal injuries leading to executive dysfunction can lead to problems in many aspects of life.

Here we list the most common effects of executive dysfunction, with some examples of common issues that brain injury survivors can face:

Difficulties with motivation and organisation

  • Loss of ‘get up and go’, which can be mistaken for laziness
  • Problems with thinking ahead and carrying out the sequence of steps needed to complete a task

Rigid thinking

  • Difficulty in evaluating the result of actions and reduced ability to change behaviour or switch between tasks if needed

Poor problem solving

  • Finding it hard to anticipate consequences
  • Decreased ability to make accurate judgements or find solutions if things are going wrong

Impulsivity

  • Acting too quickly and impulsively without fully thinking through the consequences, for example, spending more money than can be afforded

Mood disturbances

  • Difficulty in controlling emotions which may lead to outbursts of emotion such as anger or crying
  • Rapid mood changes may occur, for example, switching from happiness to sadness for no apparent reason

Difficulties in social situations

  • Reduced ability to engage in social interactions
  • Finding it hard to initiate, participate in, or pay attention to conversations
  • Poor judgement in social situations, which may lead to saying or doing inappropriate things

Memory/attention problems

  • Finding it harder to concentrate
  • Difficulty with learning new information
  • Decreased memory for past or current events, which may lead to disorientation

Find out more

If you or someone you care for is affected by executive dysfunction, it is important to seek support. Speak to your doctor about your symptoms, and ask about referral to specialist services such as counselling, neuropsychology and rehabilitation.

You can find out more and get tips and strategies to help manage your condition on our executive dysfunction after brain injury page.

Headway groups and branches can offer support in your area, and you can contact our helpline if you would like to talk things through.

via 7 signs of executive dysfunction after brain injury | Headway

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[WEB SITE] FDA approves marijuana based medication for epilepsy treatment

 

An advisory panel from the United States Food and Drug Administration (FDA) has recommended the approval of a novel epilepsy drug that is made up of ingredients from marijuana. The agency normally follows the recommendations of the advisory panels regarding approvals and rejections of applications of new drugs. The recommendation statement came yesterday (19th April 2018).

If this drug gets a green light, it is expected to become the first cannabis-derived prescription medicine to be available in the US. The drug is named Epidiolex and is made by GW Pharmaceuticals from Britain. It contains cannabidiol or CBD that is derived from cannabis. However the drug is not seen to cause any intoxication among the users.

Marijuana plant flowering outdoors. Image Credit: Yarygin / Shutterstock

Marijuana plant flowering outdoors. Image Credit: Yarygin / Shutterstock

The use of only one of the components of cannabis also makes it different from medical marijuana that is approved for pain management and other conditions around the world and in the United States. Synthetic forms of chemicals in the cannabis plant are also used to treat nausea among cancer patients and in AIDS patients to prevent weight loss.

Dr. Igor Grant, director of the Center for Medicinal Cannabis Research at the University of California San Diego welcomed this new recommendation from the panel saying, “This is a very good development, and it basically underscores that there are medicinal properties to some of the cannabinoids… I think there could well be other cannabinoids that are of therapeutic use, but there is just not enough research on them to say.”

As of now the panel has recommended the use of this new drug for two types of epilepsy only – Lennox-Gastaut syndrome and Dravet syndrome. These are notoriously difficult to treat and most people continue to have seizures despite treatment. Multiple seizures may occur in a day and this makes the children with these conditions vulnerable for developmental and intellectual disabilities. Lennox-Gastaut syndrome can appear in toddlers at around ages 3 to 5 and Dravet syndrome is usually diagnosed earlier. Nearly 30,000 children and adults suffer from Lennox-Gastaut syndrome and similar numbers of people are diagnosed with Dravet syndrome. Due to the small population of diagnosed patients Epidiolex was filed and classified under orphan drug status.

An orphan drug is one that is developed for a relatively rare disease condition. The FDA provides special subsidies and support for development of orphan drugs and often speed tracks their approval process.

The recommendation from the advisory panel is based on the results of three randomized, double-blind, placebo-controlled trials that included patients of both these disease conditions. The agency statement says, “The statistically significant and clinically meaningful results from these three studies provide substantial evidence of the effectiveness of CBD for the treatment of seizures associated with LGS and DS.” They drug causes liver damage but the report says that this could be managed effectively.

The FDA will conduct a final vote for approval of this drug in June. Oral solution of the drug for a small group of patients with these conditions would be allowed.

Reference: https://www.fda.gov/downloads/AdvisoryCommittees/CommitteesMeetingMaterials/Drugs/PeripheralandCentralNervousSystemDrugsAdvisoryCommittee/UCM604736.pdf

 

via FDA approves marijuana based medication for epilepsy treatment

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[BLOG POST] Crafting a New Life after Brain Injury

Crafting a New Life after Brain Injury

By Carole Starr

 

When your life has been shattered by brain injury and the door to your old life has not just closed, but slammed shut, how do you find a new door to happiness?  Where do you look?  How do you begin?  Below is a list of actions that gradually helped me in my journey from banging against the closed door of my old life to walking through the open door of my new life after brain injury.  I hope they can help you too.

  • Get to know your new self
  • Listen for the wisdom of the little voice inside
  • Take action
  • Start small, find success and build on it
  • Find ways to give to others
  • Take risks: Feel the fear and move forward anyway
  • Make something: Create meaning out of suffering

Get to Know Your New Self 

Before you can find your new door to happiness, you have to turn away from the old one.  The longer we look at the old door of our lives, the longer we stay stuck in denial, grief and loss.  A crucial step in turning away from that old door is getting to know your new self, the person you are right now.  The importance of self-knowledge has been recognized for millennia, as evidenced by this wisdom from the ancient Greek philosopher Socrates:  ‘Know thyself’.

How can you get to know your new self?

Listen for the Wisdom of the Little Voice Inside 

When you’re focused on knowing yourself in the present, the door to a new life has begun to crack open.  I believe all of us have a little voice, an inner wisdom that can offer guidance about how to further open that door.  It’s a quiet voice, one that can’t be heard when you’re living in the past and trying desperately to get back to the way life used to be.  The little voice inside is like a compass, pointing you in the direction of your new life.  When you can hear and act on its wise counsel, you are on your way.

 What does your little voice inside say?

Take Action

It isn’t enough just to observe the little voice inside.  You have to act on it.  Observation without action won’t get you anywhere.  Even the smallest of actions can open new doors. Actions build on one another.  It doesn’t matter where you start or what you start with, just that you do.  Once you take one action, more can follow as you gain momentum.

What’s one small action you can take?

Start Small, Find Success and Build on It in Your New Life  

Whatever action you choose, it’s important to start where you can succeed.  Finding that success often means you have to break down tasks into very small pieces. When you find something you can do successfully, no matter how small it is, that’s where you build from.

 What’s an activity you’re successful at right now?

Find Ways to Give to Others 

Finding ways to give to others can open the door to happiness.  Giving to others is a win-win activity, with both the receiver and the giver benefiting.  Brain injury can make finding ways to give to others challenging. Often we have to find new ways to give, since our old ways may not work anymore. There are many simple ways to give to others and show how much you care.

In what ways can you give to others?

Take Risks:  Feel the Fear and Move Forward Anyway 

Moving forward into a new life means taking some risks.  I don’t mean negative risks that are impulsive and can lead to dangerous situations.  Instead, I mean positive risks that are calculated and can lead to growth, increased confidence and new opportunities.  Taking calculated risks can push your boundaries in a positive direction.  When you begin to stretch yourself, life becomes richer.

What’s one small, calculated risk you can take?

Make Something: Create Meaning out of Suffering

So many choices are taken from us with brain injury.  However, one thing we can choose is to turn all that suffering into something meaningful.  It’s about whatever brings a sense of purpose into your life.  When you can make meaning out of all you’ve been through, the door to your new life is flung wide open.

What gives your life meaning now?

 Conclusion

Finding another door to happiness is key to the brain injury acceptance process.  Creating that new life is not something that happens overnight.  It’s a long process, one that often takes years.  Know that you will grow and change as you progress through this journey.  You will be in a different place one year, two years and five years from now.

Never give up on having a fulfilling life.  Yes, brain injury means that dreams may have to change.  But by getting to know your new self, listening for your inner wisdom, taking action, building on success, giving to others, taking risks and creating meaning, you can craft your new life after brain injury.

Note: You can find Carole Starr’s book “To Root and To Rise: Accepting Brain Injury” at this link!

You can find Carole’s website at:  www.starspeakerauthor.com

via Crafting a New Life after Brain Injury – Brain Injury Blog With Free TBI Information

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[Abstract] Additional physical therapy services reduce length of stay and improve health outcomes in people with acute and sub-acute conditions: an updated systematic review and meta-analysis

Abstract

Objective

To update a previous review on whether additional physical therapy services reduce length of stay, improve health outcomes, are safe and cost effective for patients with acute or sub-acute conditions.

Data sources

Electronic database (AMED, CINAHL, EMBASE, MEDLINE, PEDro, PubMed) searches were updated from 2010 through June 2017.

Study selection

Randomized controlled trials evaluating additional physical therapy services on patient health outcomes, length of stay or cost effectiveness were eligible. Searching identified 1524 potentially relevant articles, of which 11 new articles from 8 new randomized controlled trials with 1563 participants were selected. In total, 24 randomized controlled trials with 3262 participants are included in this review.

Data extraction

Data were extracted using the form used in the original systematic review. Methodological quality was assessed using the PEDro scale and The Grading of Recommendation Assessment, Development and Evaluation (GRADE) approach was applied to each meta-analysis.

Data synthesis

Post intervention data were pooled with an inverse variance, random effects model to calculate standardized mean differences (SMDs) and 95% confidence intervals (CIs). There is moderate quality evidence that additional physical therapy services reduced length of stay by 3 days in sub-acute settings (MD-2.8, 95%CI -4.6 to -0.9, I20%) and low quality evidence that it reduced length of stay by 0.6 days in acute settings (MD -0.6, 95%CI -1.1 to 0.0, I2 65%). Additional physical therapy led to small improvements in self-care (SMD 0.11, 95%CI 0.03 to 0.19, I2 0%), activities of daily living (SMD 0.13, 95%CI 0.02 to 0.25, I2 15%) and health-related quality of life (SMD 0.12, 95%CI 0.03 to 0.21, I2 0%), with no increases in adverse events. There was no significant change in walking ability. One trial reported that additional physical therapy was likely to be cost-effective in sub-acute rehabilitation.

Conclusions

Additional physical therapy services improve patient activity and participation outcomes, while reducing hospital length of stay for adults. These benefits are likely safe and there is preliminary evidence to suggest they may be cost effective.

via Additional physical therapy services reduce length of stay and improve health outcomes in people with acute and sub-acute conditions: an updated systematic review and meta-analysis – Archives of Physical Medicine and Rehabilitation

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[Study] Transcranial Electrical Stimulation for mTBI (TES for mTBI)

Recruitment Status  : Recruiting

Study Description

Brief Summary:

Mild traumatic brain injury (mTBI) is a leading cause of sustained physical, cognitive, emotional, and behavioral deficits in OEF/OIF/OND Veterans and the general public. However, the underlying pathophysiology is not completely understood, and there are few effective treatments for post-concussive symptoms (PCS). In addition, there are substantial overlaps between PCS and post-traumatic stress disorder (PTSD) symptoms in mTBI. IASIS is among a class of passive neurofeedback treatments that combine low-intensity pulses for transcranial electrical stimulation (LIP-tES) with electroencephalography (EEG) monitoring. LIP-tES techniques have shown promising results in alleviating PCS individuals with TBI. However, the neural mechanisms underlying the effects of LIP-tES treatment in TBI are unknown, owing to the dearth of neuroimaging investigations of this therapeutic intervention. Conventional neuroimaging techniques such as MRI and CT have limited sensitivity in detecting physiological abnormalities caused by mTBI, or in assessing the efficacy of mTBI treatments. In acute and chronic phases, CT and MRI are typically negative even in mTBI patients with persistent PCS. In contrast, evidence is mounting in support of resting-state magnetoencephalography (rs-MEG) slow-wave source imaging (delta-band, 1-4 Hz) as a marker for neuronal abnormalities in mTBI. The primary goal of the present application is to use rs-MEG to identify the neural underpinnings of behavioral changes associated with IASIS treatment in Veterans with mTBI. Using a double-blind placebo controlled design, the investigators will study changes in abnormal MEG slow-waves before and after IASIS treatment (relative to a ‘sham’ treatment group) in Veterans with mTBI. In addition, the investigators will examine treatment-related changes in PCS, PTSD symptoms, neuropsychological test performances, and their association with changes in MEG slow-waves. The investigators for the first time will address a fundamental question about the mechanism of slow-waves in brain injury, namely whether slow-wave generation in wakefulness is merely a negative consequence of neuronal injury or if it is a signature of ongoing neuronal rearrangement and healing that occurs at the site of the injury. Specific Aim 1 will detect the loci of injury in Veterans with mTBI and assess the mechanisms underlying functional neuroimaging changes related to IASIS treatment using rs-MEG slow-wave source imaging. The investigators hypothesize that MEG slow-wave source imaging will show significantly higher sensitivity than conventional MRI in identifying the loci of injury on a single-subject basis. The investigators also hypothesize that in wakefulness, slow-wave generation is a signature of ongoing neural rearrangement / healing, rather than a negative consequence of neuronal injury. Furthermore, the investigators hypothesize IASIS will ultimately reduce abnormal MEG slow-wave generation in mTBI by the end of the treatment course, owing to the accomplishment of neural rearrangement / healing. Specific Aim 2 will examine treatment-related changes in PCS and PTSD symptoms in Veterans with mTBI. The investigators hypothesize that compared with the sham group, mTBI Veterans in the IASIS treatment group will show significantly greater decreases in PCS and PTSD symptoms between baseline and post-treatment assessments. Specific Aim 3 will study the relationship among IASIS treatment-related changes in rs-MEG slow-wave imaging, PCS, and neuropsychological measures in Veterans with mTBI. The investigators hypothesize that Reduced MEG slow-wave generation will correlate with reduced total PCS score, individual PCS scores (e.g., sleep disturbance, post-traumatic headache, photophobia, and memory problem symptoms), and improved neuropsychological exam scores between post-IASIS and baseline exams. The success of the proposed research will for the first time confirm that facilitation of slow-wave generation in wakefulness leads to significant therapeutic benefits in mTBI, including an ultimate reduction of abnormal slow-waves accompanied by an improvement in PCS and cognitive functioning.

MORE —>  Transcranial Electrical Stimulation for mTBI – No Study Results Posted – ClinicalTrials.gov

 

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[ARTICLE] Moderate Traumatic Brain Injury: Clinical Characteristics and a Prognostic Model of 12 Month Outcome – Full Text

Abstract

Background

Patients with moderate traumatic brain injury (TBI) are often studied together with patients with severe TBI, even though expected outcome is better. Therefore, we aimed to describe patient characteristics and 12-month outcome, and to develop a prognostic model based on admission data, specifically for patients with moderate TBI.

Methods

Patients with Glasgow Coma Scale score of 9-13 and age ≥16 years were prospectively enrolled in two level I trauma centers in Europe. Glasgow Outcome Scale Extended (GOSE) score was assessed at 12 months. A prognostic model predicting moderate disability or worse (GOSE score ≤6) as opposed to a good recovery, was fitted by penalized regression. Model performance was evaluated by area under the curve (AUC) of the receiver operating characteristics curves.

Results

Of the 395 enrolled patients 81% had intracranial lesions on head CT and 71% were admitted to an intensive care unit. At 12 months, 44% were moderately disabled or worse (GOSE score ≤6), while 8% were severely disabled and 6% died (GOSE score ≤4). Higher age, lower GCS score, no day-of-injury alcohol intoxication, presence of a subdural hematoma, occurrence of hypoxia and/or hypotension and pre-injury disability were significant predictors of GOSE score ≤6 (AUC = 0.80).

Conclusions

Patients with moderate TBI exhibit characteristics of significant brain injury. Although few patients died or experienced severe disability, 44% did not experience good recovery, indicating that follow-up is needed. The model is a first step in development of prognostic models for moderate TBI that are valid across centers.

 

Download full text in PDF

via Moderate Traumatic Brain Injury: Clinical Characteristics and a Prognostic Model of 12 Month Outcome – ScienceDirect

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[WEB SITE] Human brains make new nerve cells — and lots of them — well into old age.

Previous studies have suggested neurogenesis tapers off or stops altogether

BY
LAUREL HAMERS, APRIL 5, 2018
nerve cells in hippocampi

NEURON NURSERY  Roughly the same number of new nerve cells (dots) exist in the hippocampus of people in their 20s (three hippocampi shown, top row) as in people in their 70s (bottom). Blue marks the dentate gyrus, where new nerve cells are born.
M. BOLDRINI/COLUMBIA UNIV.

Your brain might make new nerve cells well into old age.

Healthy people in their 70s have just as many young nerve cells, or neurons, in a memory-related part of the brain as do teenagers and young adults, researchers report in the April 5 Cell Stem Cell. The discovery suggests that the hippocampus keeps generating new neurons throughout a person’s life.

The finding contradicts a study published in March, which suggested that neurogenesis in the hippocampus stops in childhood (SN Online: 3/8/18). But the new research fits with a larger pile of evidence showing that adult human brains can, to some extent, make new neurons. While those studies indicate that the process tapers off over time, the new study proposes almost no decline at all.

Understanding how healthy brains change over time is important for researchers untangling the ways that conditions like depression, stress and memory loss affect older brains.

When it comes to studying neurogenesis in humans, “the devil is in the details,” says Jonas Frisén, a neuroscientist at the Karolinska Institute in Stockholm who was not involved in the new research. Small differences in methodology — such as the way brains are preserved or how neurons are counted — can have a big impact on the results, which could explain the conflicting findings. The new paper “is the most rigorous study yet,” he says.

Researchers studied hippocampi from the autopsied brains of 17 men and 11 women ranging in age from 14 to 79. In contrast to past studies that have often relied on donations from patients without a detailed medical history, the researchers knew that none of the donors had a history of psychiatric illness or chronic illness. And none of the brains tested positive for drugs or alcohol, says Maura Boldrini, a psychiatrist at Columbia University. Boldrini and her colleagues also had access to whole hippocampi, rather than just a few slices, allowing the team to make more accurate estimates of the number of neurons, she says.

To look for signs of neurogenesis, the researchers hunted for specific proteins produced by neurons at particular stages of development. Proteins such as GFAP and SOX2, for example, are made in abundance by stem cells that eventually turn into neurons, while newborn neurons make more of proteins such as Ki-67. In all of the brains, the researchers found evidence of newborn neurons in the dentate gyrus, the part of the hippocampus where neurons are born.

Although the number of neural stem cells was a bit lower in people in their 70s compared with people in their 20s, the older brains still had thousands of these cells. The number of young neurons in intermediate to advanced stages of development was the same across people of all ages.

Still, the healthy older brains did show some signs of decline. Researchers found less evidence for the formation of new blood vessels and fewer protein markers that signal neuroplasticity, or the brain’s ability to make new connections between neurons. But it’s too soon to say what these findings mean for brain function, Boldrini says. Studies on autopsied brains can look at structure but not activity.

Not all neuroscientists are convinced by the findings. “We don’t think that what they are identifying as young neurons actually are,” says Arturo Alvarez-Buylla of the University of California, San Francisco, who coauthored the recent paper that found no signs of neurogenesis in adult brains. In his study, some of the cells his team initially flagged as young neurons turned out to be mature cells upon further investigation.

But others say the new findings are sound. “They use very sophisticated methodology,” Frisén says, and control for factors that Alvarez-Buylla’s study didn’t, such as the type of preservative used on the brains.

via Human brains make new nerve cells — and lots of them — well into old age | Science News

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[WEB SITE] How to Put a Stop to Catastrophic Thinking

Learn to skillfully respond to the cognitive distortion of catastrophizing.

Cognitive distortions are errors in thinking. The phrase refers to our irrational and exaggerated thoughts: thoughts that have no basis in fact, but which we believe anyway. These distorted thoughts then become the breeding ground for stressful emotions. The result is anxiety and the undermining of our ability to feel good about life or ourselves. In September 2014, I wrote an post entitled “How Distorted Thinking Increases Stress and Anxiety.” You might want to have a look at it. One of those distortions is called catastrophizing and it is the subject of this post.

Catastrophizing is also called magnifying. This is a good way to think of it, because it emphasizes how we often magnify things way out of proportion, dreaming up nightmare scenarios that we believe without question.

The first and second arrows

Catastrophizing is an example of thoughts (and the emotions they give rise to) that the Buddha called the “second arrow.” The first arrow refers to those familiar, unpleasant experiences that are an inevitable part of everyday life, from the mundane (a light bulb that burns out when we flip on the switch) to more profound unpleasant experiences (waking up with a flare in a chronic pain condition). We could each make a list of our own “first arrow” experiences. Some days we’re bombarded with them, again from the relatively minor (a computer crash) to the major (the loss of a job… or a friend). Life is hard enough just coping with the first arrow, that’s for sure.

The second arrow is an unnecessary one. Here’s how it happens. We experience the unpleasantness of the first arrow, but instead of simply acknowledging its presence and, if possible, trying to make things better (e.g., change the light bulb, take a warm shower to try and ease our physical pain), we engage in a stream of stressful thoughts and emotions about that unpleasant “first arrow” experience. Although the Buddha didn’t use the word catastrophize, it’s an example of how we shoot ourselves with a second arrow by mocking up worst-case scenarios instead of just taking care of the business at hand. In other words, we make things worse for ourselves.

It’s as if we’re looking at an unpleasant experience through binoculars, and so it appears way out of proportion to us. I used a light bulb burning out as an example, because it’s a trivial experience. And yet, when it’s happened to you, how often do you say without irritation: “Oh, well, the light bulb burned out; no big deal, I’ll just change it”?

If you’re like me, when you encounter an unpleasant experience, you tend to add a negative reaction, which may not always rise to the level of catastrophizing, but can if it takes on this type of form: “Why do light bulbs always burn out on me? The new one will probably burn out in a few days — on me again.” It’s this second arrow, magnifying an unpleasant experience and making it into a catastrophe, that keeps us from feeling at peace with our lives. After all, if we changed the light bulb mindfully — paying careful attention as we get a new bulb, unscrew the old bulb, screw in the new one, and perhaps even take a moment to reflect on the wonders of electricity — we might even enjoy the experience.

And what about that “first arrow” unpleasant experience of waking up with a flare in our chronic pain levels? Instead of keeping calm and waiting to see if the pain subsides as the morning wears on, there’s a tendency to catastrophize by convincing ourselves that this is our new normal. We say to ourselves: “This pain will never go away; I’ll be miserable the rest of my life.” That’s the experience of the second arrow and, not surprisingly, it tends to be a source of stress and anxiety.

Through habits we’ve developed over our lifetimes, we seem to be quite adept at making ourselves miserable by magnifying our disappointments and frustrations until they seem like catastrophes. Another simple example. I’ve been teaching myself some new embroidery stitches. A few months ago, I was embroidering an underwater scene and wanted to use a “cretan stitch” to make a fish. But I couldn’t do it. Every fish I tried looked awful. Instead of feeling compassion for how hard this was proving to be, I started spinning irrational stories about my attempts: “I’ll never figure out this stitch. I might as well throw the whole piece away.” Catastrophizing.

How to stop the tendency to catastrophize

To reverse the tendency to catastrophize, put your experience into perspective. Start by reminding yourself that unpleasant experiences — not having things go as you want — are an inevitable part of life. Then reframe your thoughts regarding whatever unpleasant experience is threatening to set off that second arrow. Sticking with my examples, remind yourself that everyone has to change light bulbs sometimes; it’s no big deal. Remind yourself that just because you’re in pain this morning doesn’t mean you’ll be in pain every morning. Everything changes, including pain levels. Remind yourself that some embroidery stitches are hard to learn, and besides, an underwater scene doesn’t have to have a fish in it anyway — put in a crab.

In other words, put a stop to this type of distorted thinking by first becoming aware that you’re engaged in it, and then countering that thinking by adopting a reasonable perspective on what’s going on. Sometimes I even say to myself: “Stop! You’re going down that catastrophizing road again, and it’s only going to make an unpleasant situation worse.” Gently saying, “Stop!” like this can interrupt your tendency to start spinning those “second arrow” worst-case scenarios.

I’m not saying this will always be easy. You may have a lifelong habit of blowing things out of proportion and assuming the worst, often about yourself. The good news is that habits can change, and the first step is to become aware of how you’re making life more difficult for yourself by magnifying unpleasant experiences and blowing them out of proportion.

I recommend that you start small — maybe with that light bulb or something you’ve spilled. The better you get at keeping calm and not going straight to exaggerating and catastrophizing over minor unpleasant experiences (“I’m always spilling things and always will”), the easier it will be to maintain your peace of mind when you’re struck by harsher first arrows.

via How to Put a Stop to Catastrophic Thinking | Psychology Today

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[Abstract] The feasibility, acceptability and preliminary efficacy of a low-cost, virtual-reality based, upper-limb stroke rehabilitation device: a mixed methods study.

Abstract

PURPOSE:

To establish feasibility, acceptability, and preliminary efficacy of an adapted version of a commercially available, virtual-reality gaming system (the Personalised Stroke Therapy system) for upper-limb rehabilitation with community dwelling stroke-survivors.

METHOD:

Twelve stroke-survivors (nine females, mean age 58 years, [standard deviation 7.1], median stroke chronicity 42 months [interquartile range 34.7], Motricity index 14-25 for shoulder and elbow) were asked to complete nine, 40-min intervention sessions using two activities on the system over 3 weeks. Feasibility and acceptability were assessed through a semi-structured interview, recording of adverse effects, adherence, enjoyment (using an 11-point Likert scale), and perceived exertion (using the BORG scale). Assessments of impairment (Fugl-Meyer Assessment Upper extremity), activity (ABILHAND, Action Research Arm Test, Motor Activity Log-28), and participation (Subjective Index of Physical and Social Outcome) were completed at baseline, following intervention, and at 4-week follow-up. Data were analysed using Thematic Analysis of interview and intervention field-notes and Wilcoxon Signed Ranks. Side-by-side displays were used to integrate findings.

RESULTS:

Participants received between 175 and 336 min of intervention. Thirteen non-serious adverse effects were reported by five participants. Participants reported a high level of enjoyment (8.1 and 6.8 out of 10) and rated exertion between 11.6 and 12.9 out of 20. Themes of improvements in impairments and increased spontaneous use in functional activities were identified and supported by improvements in all outcome measures between baseline and post-intervention (p < 0.05 for all measures).

CONCLUSIONS:

Integrated findings suggested that the system is feasible and acceptable for use with a group of community-dwelling stroke-survivors including those with moderately-severe disability. Implications for rehabilitation To ensure feasibility of use and maintenance of an appropriate level of challenge, gaming technologies for use in upper-limb stroke rehabilitation should be personalised, dependent on individual need. Through the use of hands-free systems and personalisation, stroke survivors with moderate and moderately-severe levels of upper-limb impairment following stroke are able to use gaming technologies as a means of delivering upper-limb rehabilitation. Future studies should address issues of acceptability, feasibility, and efficacy of personalised gaming technologies for delivery of upper-limb stroke rehabilitation in the home environment. Findings from this study can be used to develop future games and activities suitable for use in stroke rehabilitation.

 

via The feasibility, acceptability and preliminary efficacy of a low-cost, virtual-reality based, upper-limb stroke rehabilitation device: a mixed meth… – PubMed – NCBI

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[WEB SITE] 17 Apps That Can Make Life Easier With Brain Fog and Chronic Illness

If you struggle with brain fog due to chronic illness or medication, it can be difficult to keep track of all your doctor appointments, medications and symptoms – not to mention all your other responsibilities, such as work, chores or taking care of your family. Staying organized and remembering everything you put on your mental to-do list can be a challenge for anyone, but with brain fog and a chronic illness thrown into the mix, it becomes especially important to find the methods that most help you stay on top of things.

For many with chronic illness, smartphones can be a lifesaver. Many of us carry our phones everywhere we go anyway, so utilizing them as a tool to keep track of our lives and our illnesses can be extremely helpful. Most smartphones nowadays come with apps already programmed in, such as a notepad, a calendar or a voice memo recorder, which are simple, easy to use and great for jotting down important notes or dates.

However, if you struggle with brain fog and are looking for a different way to organize your notes, lists, calendar and medical information, then there are a number of other apps you may find to be extremely useful.

To help you manage your personal life, professional life, and physical and mental health, we asked our Mighty community to share which apps help them navigate their day-to-day lives despite the effects of brain fog. Here are their recommendations.

Just so you know, we’ve selected these links to make shopping easier for you. We do not receive any funds from purchases or downloads you make.

1. Habitica

habitica screenshot

Habitica is a video game that allows you to “gamify” your life by turning your daily activities and to-do lists into monsters to conquer. It can help motivate you to change your habits by giving you in-game incentives every time you complete a task. You can play on your computer or download the app for either iOS and Android.

Jess Van Meter told The Mighty, “It’s amazing. It helps me pretend my life is a video game and doing self-care, building habits and performing daily tasks actually does help me ‘level up.’ It has a built in community and reward system too.”

Sara Wilson added, “I can put as many tasks on it as I want, little or large, and it’s also a game, so I get coins whenever I complete a task! I can set up IRL [in real life] rewards for myself for earning so many coins and that helps keep me motivated. I check it several times a day and one last time before bed. I put everything on there from medications to everyday tasks to important, one-time events.”

Download Habitica for free from Apple or Google Play.

2. Medisafe

medisafe

Medisafe helps you keep track of which medications you need to take and when. Each day is divided into four quadrants – morning, afternoon, evening, night – with visual representations of which pills you should be taking at which time. The app will send you reminders when it’s time to take your pills, and it also provides you with information about each medication. Physicians and pharmacists are also able to connect with patients and communicate through Medisafe.

“It has the details of all my meds and alerts me to what I need to take and when. I always forget to take anything without the app reminders! Now I only have to worry about brain fog making me forget if I actually did take the meds it told me to before I pressed the ‘take all’ button,” Amie Addison wrote.

“It reminds me to take my meds and business calendar reminds me of all my day to day stuff,” Marnie Dueck told us.

Download Medisafe for free from Apple or Google Play.

3. Daylio

daylio screenshots

Daylio is a mobile diary that lets you easily track how you’re feeling and what you’re doing. Over time, the app can help you discover patterns in your moods, behavior and activities so you can make changes to your daily routine that will help you to feel your best.

Liberty White wrote, “Great for symptom tracking and customizing. It beeps at the end of the day and I tell it how my day went. It tracks trends in my activities (or lack of activities) and helps me keep track of when I’m having a bad time.”

Download Daylio for free from Apple or Google Play.

4. Flaredown

flaredown app

Flaredown was made just for people with chronic illness as a way to track symptoms, record treatments and reactions, track triggers and connect with others who have similar conditions. There are also places where you can easily note other important parts of your day, such as what you ate, what the weather was like, and any activities or events that took place.

“By far my favorite app to track my various symptoms!” Bay Howe said. “Makes it much easier to discuss symptoms and illnesses when you can remember what they are and when they happen.”

Download Flaredown for free from Apple or Google Play.

5. Evernote

evernote app

Evernote is a note-taking app that helps you stay organized in your personal and/or professional life. You can add notes in a variety of forms, including text, sketches, photos, audio, video, PDF and web clippings, and have everything saved in one place.

Morgan Storm Ray said, “I use Evernote. I also have memory loss so it helps with that too. It is a simple note-taking app. But it has a bunch of different ways to take notes. By voice, picture, text, etc.”

Jess N. Law added, “Evernote – for notes on anything and everything I can’t remember. I also use it to record meetings because multitasking has gotten too difficult.”

Download Evernote Basic for free from Apple or Google Play.

6. CareZone

carezone app

CareZone offers patients a simple way to keep track of all their medical information. Several of its features include a journal for documenting symptoms, to-do lists, contacts (doctors, pharmacies, insurance providers, etc.), medication information (names, dosages, reminders for when it’s time to refill, etc.) and a calendar for keeping track of appointments and other important dates. Any information you input remains private and secure.

Nancy Lea Martine Koontz told us, “I use CareZone which includes all kinds of daily trackers and makes sharing information with doctors quite easy.“

Download CareZone for free from Apple or Google Play.

7. Asana

asana

For those who work with a company or business, Asana is an app that can help you and your team stay organized, manage projects and track your progress. This app allows you to create project task lists and personal to-do lists, track when work is due with a calendar and converse with coworkers about various tasks or projects.

“[I use] Asana – a project management app. I can list phone calls, emails, work, everything I need to do today or in the future. It’s free and has saved my business,” Jess N. Law wrote.

Download Asana for free from Apple or Google Play.

8. myHomework

myhomework app

The myHomework app is a virtual planner for students. You can track when assignments, essays or projects are due, track your class schedule and receive due date or test reminders.

“I’m a full-time student,” said Eri Rhodes. “The myHomework app is critical to me not forgetting due dates.”

Download myHomework Basic for free from AppleGoogle PlayMicrosoft or Amazon.

9. Microsoft OneNote

microsoft onenote

Microsoft OneNote is a place you can jot down any important notes, information or thoughts that cross your mind – in whichever way works best for you. You can type, write, draw, make to-do lists or clip things from the web, and OneNote keeps everything organized and easy to find.

“I have OneNote on my phone. It’s basically an electronic notebook and you can make as many [notes] as you want, but I find it helpful because if I want to remember something for later, I can just open it and type it out then go back to look at it later when I need the information. Also have it on my computer and tablet all connected so I always have access to it,” said Chelsea Smith.

Download Microsoft OneNote from MicrosoftApple or Google Play.

10. MyTherapy

mytherapy app

MyTherapy gives you reminders when it’s time to take your medication, take measurements or do exercises, and it also serves as a journal where you can track your symptoms and overall health.

Anna A. Legault told us, “MyTherapy helps me remember medications, measurements and log symptoms.”

Download MyTherapy for free from Apple or Google Play.

11. TaoMix 2

taomix 2 app

Living with chronic illness and brain fog can be stressful, and while it’s important to keep track of your physical health, caring for your mental health is necessary, too. TaoMix 2 provides you with soundscapes you can mix and match to help you relax or meditate. Whether you’re soothed by the sounds of waves crashing on the beach or the quiet chatter of people in a café, this app can help take your mind off the stresses of chronic illness.

All kinds of reminders and calendar apps are a must,” said Irma-Helen Lorentzon. “But something that really helps me is TaoMix – it has great nature sounds and I use it to help my brain focus and/or relax.”

Download TaoMix 2 for free from Apple or Google Play.

12. Google Calendar

google calendar app

Google Calendar can help you keep track of important dates or events. You can view the calendar by day, week or month, color code events and, if you use Gmail, import dates from there. You can also schedule reminders to give you a heads up about upcoming events.

Tiffany Anne told us, “I use Google Calendar to remind myself if I need to bring something somewhere, follow up on something or anything that requires reminders since I pay attention to those.”

Heather Jo Skidmore said, “Google Calendar. One for work, one for my MA program, one for my three kids’ activities. Color coded, and shared with my husband.”

Download Google Calendar app for free from Apple or Google Play.

13. ColorNote

colornote app

This Android app lets you make color-coded notes and checklists to help you stay organized. You can also set reminders for each note to make sure you get each task done on time.

Christine Cousins wrote, “I love ColorNote. I can make checklists for groceries or things I need to get done or write myself notes about things I need to discuss with my doctors so I’m prepared for my appointment. The app automatically backs everything up, so when my phone took a swim and I downloaded ColorNote on a new device, all of my stuff was there!”

Download ColorNote for free from Google Play or Amazon.

14. Stop, Breathe & Think

stop, breathe & think app

This meditation app encourages you to stop what you’re doing and check in with how you’re feeling, practice some mindful breathing and think deeply to broaden your perspectives and increase your level of relaxation.

“SBT is an amazing app that allows you to rate how you’re feeling physically and mentally and specify certain emotions. It then tabulates and suggests meditation/mindfulness exercises in order to attend to whatever issues you’re experiencing. Once finished with an exercise, you can again rate how you’re feeling. You can earn stickers as you accomplish certain exercises, and it keeps track of your emotional and physical check-ins. Pretty cool,” Meghan Leigh explained.

Download Stop, Breathe & Think for free from Apple or Google Play or use on your web browser.

15. ICE Contact

ice app

If you have a medical condition and ever find yourself in an emergency situation, an ICE (In Case of Emergency) app may be of use. You can store all your personal and medical information here for either yourself or others to access in an emergency. Having this information handy can also be useful if you struggle with brain fog.

Stephanie Bowman told us, “I use an ICE app. It stores a list of all my illnesses, medication, people to contact and my allergies. I’m never stuck when put on the spot to think of important information.”

Download ICE for free from Apple.

16. Cozi

cozi app

Cozi is an organization app specifically designed for families. You can keep all of your family’s activities and appointments in one place, and create checklists (grocery lists, chore lists, to-do lists, etc.) to share with other family members.

Crystal Dewey said, “It’s a calendar app on steroids! It connects with my family members, sends reminders, we can all add to-do and grocery lists… It’s my electronic brain!”

Download Cozi for free from AppleGoogle Play or Microsoft.

17. Waze

waze app

Waze is a navigation app that lets you know what traffic conditions are like in real time and which route you should take. Waze can also give you reminders when it’s time to leave based on both the time you need to arrive and current traffic. After you arrive at your destination, park your car and close Waze, it will automatically drop a pin to remind you later on exactly where you parked.

Jess N. Law recommends integrating Waze with Google Calendar. “Reminds me of everything I have planned and when to leave. Lifesaver some days.”

Download Waze for free from Apple or Google Play.

 

via 17 Apps That Can Make Life Easier With Brain Fog and Chronic Illness | The Mighty

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