Archive for category TBI

[Abstract] Rhythmic Auditory Stimulation and Gait Training in Traumatic Brain Injury: A Pilot Study

Abstract

Rhythmic auditory stimulation (RAS) has been well researched with stroke survivors and individuals who have Parkinson’s disease, but little research exists on RAS with people who have experienced traumatic brain injury (TBI). This pilot study aimed to (1) assess the feasibility of the study design and (2) explore potential benefits. This single-arm clinical trial included 10 participants who had a 2-week control period between baseline and pretreatment. Participants had RAS daily for a 2-week treatment period and immediately completed post-treatment assessments. Participants then had a 1-week control period and completed follow-up assessment. The starting cadence was evaluated each day of the intervention period due to the variation in daily functioning in this population. All 10 participants were 1-20 years post-TBI with notable deviations in spatial-temporal aspects of gait including decreased velocity, step symmetry, and cadence. All participants had a high risk of falling as defined by achieving less than 22 on the Functional Gait Assessment (FGA). The outcome measures included the 10-m walk test, spatial and temporal gait parameters, FGA, and Physical Activity Enjoyment Scale. There were no adverse events during the study and gait parameters improved. After the intervention, half of the participants achieved a score of more than 22 on the FGA, indicating that they were no longer at high risk of experiencing falls

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[ARTICLE] Action observation training for rehabilitation in brain injuries: a systematic review and meta-analysis – Full Text

Abstract

Background

To systematically review and analyse the effects of Action Observation Training on adults and children with brain damage.

Methods

Seven electronic databases (Cochrane, EBSCO, Embase, Eric, PubMed, Scopus and Web of Science) were searched up to 16 September 2018 to select Randomized Controlled Trials focused on adults and children with brain damage that included AOT training on upper and/or lower limb carried out for at least 1 week. Identification of studies and data extraction was conducted with two reviewers working independently. Oxford Centre for Evidence-based Medicine (March2009) – Levels of Evidence and Physiotherapy Evidence Database scale were used to grade studies. The data collected from the articles were analysed using software R, version 3.4.3. Hedge’s g values were calculated and effect size estimates were pooled across studies. Separate meta-analyses were carried out for each ICF domain (i.e. body function and activity) for upper and lower limb.

Results

Out of the 210 records identified after removing duplicates, 22 were selected for systematic review and 19 were included in the meta-analysis. Thirteen studies included in the meta-analysis focused on upper limb rehabilitation (4 in children and 9 in adults) and 6 on lower limb rehabilitation (only studies in adults). A total of 626 patients were included in the meta-analysis. An overall statistically significant effect size was found for upper limb body function (0.44, 95% CI: [0.24, 0.64], p < 0.001) and upper limb activity domain (0.47, 95% CI: [0.30, 0.64], p < 0.001). For lower limb, only the activity domain was analysed, revealing a statistically significant overall effect size (0.56, 95% CI: [0.28, 0.84], p < 0.001).

Conclusions

Action Observation Training (AOT) is an innovative rehabilitation tool for individuals with brain damage, which shows promising results in improving the activity domain for upper and lower limbs, and also the body function domain for the upper limb. However, the examined studies lack uniformity and further well-designed, larger controlled trials are necessary to determine the most suitable type of AOT particularly in children.

Introduction

Action observation therapy (AOT) is a novel rehabilitation strategy for both adults and children. It involves observation of meaningful actions with the intention to imitate and then performing those actions. AOT is based on neurophysiological knowledge that observation of a goal-directed action [12] activates the same neural substrate, called the Mirror Neuron System, as does the physical execution of the observed action.

AOT has been investigated for its potential benefits for children with cerebral palsy (CP) [3,4,5], adult stroke patients [67], individuals suffering from Parkinson’s [8] and Alzheimer’s disease [9]. The use of AOT in rehabilitation programs may have top-down effects involving higher-level networks that impact peripheral circuits, e.g. central movement planning areas, motor areas and peripheral structures [10]. To our knowledge, only few systematic reviews have explored AOT effectiveness on upper and lower limb rehabilitation. One was carried out in both neurological and orthopedic diseases [11]. Another was carried out on patients with stroke and explored AOT enhancement in motor function and upper limb motor performance [12]. Others have only explored the effectiveness of AOT on limb pain [13] and in Parkinson disease [8].

However, in previous reviews, no meta-analysis including studies on children and on lower limb was carried out. Moreover, the data were not analyzed taking account of the International Classification of Functional Disability and Health (ICF) framework. The ICF, with its multidimensional nature, provides an international framework for measuring and documenting health outcomes at the body function and structure level as well as for activities and participation.

This review addresses clinical research questions related to: i) how many studies focused on the rehabilitation of the upper or lower limb, ii) how many studies were conducted on adults and on children, iii) what type of training was conducted, where did it take place, how long did it last and did it influence the outcome, iv) what are the effects of AOT on upper and lower limb measures according to ICF domains, in adults and children with brain damage.[…]

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[BLOG POST] Traumatic Brain Injury and Hyperbaric Oxygen Treatment

In 2015, the Will Smith film Concussion, which depicts Dr. Bennet Omalu’s struggle to uncover the truth about brain damage to football players, brought international attention to Traumatic Brain Injury (TBI) and its long-term complications.

According to the Center for Disease Control (CDC), there were 2.87 million TBI-related emergency room visits in 2014 — and an estimated 817,000 children were treated for TBI-related head injuries.

While the brain sits inside the hard, bony case of the skull, it is soft, almost like a banana. This makes it vulnerable to rapid acceleration and deceleration injuries known as concussions, which occurs when the brain impacts the skull with sufficient force that it causes bruising. At each point of injury, local swelling, bleeding, and even neuronal death can occur.

Over the following hours and days, inflammation develops around the bruised area, just like injuries do elsewhere in the body. Since the skull is inflexible, the swelling pushes inward on the brain, reducing blood flow and extending the damage further across the brain adjacent to the injury and causing impairments over a much larger area; moreover, neurons in this expanded area may be damaged and unable to carry out their function. They may not die, but they will persist in an inactive or stunned state, basically not functioning for an indefinite period of time.

The immediate injury may cause loss of consciousness, or people may just feel stunned and lose track of what is happening around them. They also may have an initial headache and some confusion, which typically improves over the next several hours.

Long-term Consequences of TBI

Let’s now look at how TBI symptoms often develop after a concussion. As inflammation develops, more serious symptoms can increase, peaking over the next one to two weeks. These include headache; a confusion often described as “brain fog”; nausea; irritability, emotional lability; being overwhelmed easily; sensitivity to light and sound; impaired concentration, memory, and problems solving; difficulty multitasking; struggle with visual stimulation, such as processing information from computer or TV screens; and severe fatigue. These symptoms typically plateau and slowly improve over several months.

When brain scans reveal no gross destruction of brain matter, this type of injury is typically referred to as “mild” TBI. However, functional scans (PET, SPECT) will demonstrate impairment in blood flow and metabolism in the affected areas. These impairments in blood flow and neuronal activity may persist for years, resulting in chronic impairments of brain function with the associated symptoms described above.

These persistent symptoms can lead to further life problems, such as loss of job, relationship problems, loss of self-esteem or confidence, financial problems, mood dysregulation, and other mental health problems.

Common causes of TBI include anything that causes concussions, such as: falls — 48% of all head injuries are due to falls; being struck by or against an object — 17%, the second-most common cause; followed by motor-vehicle accidents. Other causes include bike accidents, sports injuries, and combat injuries, such being near concussive bomb blasts.

Hyperbaric Oxygen Treatment

Recently, hyperbaric oxygen treatment (HBOT) has been demonstrated to provide marked improvement in people suffering with TBI, even years after their injuries occurred. HBOT is the use of oxygen at higher-than-atmospheric concentrations and pressures for the treatment of disease. HBOT was first used in the 1930s to treat decompression sickness in divers (commonly known as “the bends”) and currently has 13 FDA-approved uses, including: gas gangrene, air embolism, osteomyelitis, radiation necrosis, diabetic ulcers, and the aforementioned decompression sickness.

Current scientific evidence suggests that HBOT can permanently and dramatically improve symptoms of chronic TBI years after the initial head injury. Understanding the physiologic effects of HBOT gives insight as to its therapeutic benefits.

Breathing room air (21% oxygen or O2) at atmospheric pressure at sea level (1 atmosphere or 1ATM), about 97 percent of the total oxygen in the blood is bound to hemoglobin and 3 percent dissolved into the blood serum. By the time the oxygen diffuses through the tissues, into the cells, and reaches the mitochondria (energy producing organelles inside the cells), only trace amounts are available. HBOT’s main function is to temporarily super-saturate body tissues with oxygen. HBOT delivering 100-percent oxygen at 1.3 ATM increases dissolved oxygen in the serum by seven-fold. HBOT delivering 100-percent oxygen at 3.00 ATM increases dissolved oxygen in the serum by more than a factor of 15. Body tissues outside the circulation will thereby experience a commensurate increase in oxygen concentration.

A warning: If a hyper-oxygenated state is maintained for long periods, it will cause significant oxidative damage to the body tissues, undermining any health benefits. Long periods of HBOT are harmful. But short, 1-hour pulses of HBOT triggers a variety of healing processes without overwhelming the body’s antioxidant systems. Current known health-inducing responses from HBOT include stimulating powerful anti-inflammatory effect, reduction of edema, increased blood perfusion, new blood vessel growth, improved immune response, enhancement of the body’s antioxidant system, improved stem-cell activity from bone marrow, improved growth of neuronal axons, and modulation of thousands of genes involved in bodily healing.

Just as with any medicinal dosing, while the right dose can heal, too much medicine can harm. With TBI, too big a dose of HBOT will worsen the condition. Dose is determined by the pressure in the chamber and the time spent in the chamber. The higher-pressure treatment of 2.0 ATM is best for infections but will worsen TBI. After several decades of research, it has been determined that TBI is best treated with lower pressures and session time limits.

The recommended HBOT protocol for TBI is currently one or more blocks of 40, 1-hour sessions delivered at 1.3 or 1.5 ATM. Case reports of individuals who have suffered with post-TBI symptoms for decades, and who prior to treatment had SPECT scans showing decreased perfusion in multiple brain regions, found not only marked improvement in function, but SPECT scans after HBOT were normal.

After treatment, patients report improvement in concentration, emotional stability, ability to multitask, and memory.

HBOT is not FDA-approved for TBI treatment. This is due to the fact that it is not possible to develop a sham treatment for it and, thus, no placebo-controlled trials have been done to demonstrate its effectiveness over a placebo. Because HBOT is not FDA approved, insurance companies will typically not pay for it.

However, if you or someone you love has suffered with TBI and struggled with functional impairments, I recommend you speak with your healthcare provider about a trial of HBOT.

References

  1. Goderez, B., Treatment of Traumatic Brain Injury with Hyperbaric Oxygen Therapy, Psychiatric Times, Vol. 36, Iss. 5, May, 28, 2019. https://www.psychiatrictimes.com/tbi/treatment-traumatic-brain-injury-hyperbaric-oxygen-therapy
  2. Harch PG, Andrews SR, Fogarty EF, et.al. A phase I study of low-pressure hyperbaric oxygen therapy for blast-induced post-concussion syndrome and post-traumatic stress disorder. J Neurotrauma. 2012;29:168-185.
  3. Efrati S, Ben-Jacob E. How and why hyperbaric oxygen therapy can bring new hope for children suffering from cerebral palsy: an editorial perspective. Undersea Hyperbaric Med. 2014;41:71-74.
  4. Harch, P. Hyperbaric oxygen in chronic traumatic brain injury: oxygen, pressure, and gene therapy. Med Gas Res. 2015;5:9.
  5. Harch P, Mccullough V. The Oxygen Revolution. Hobart, NY: Hatherleigh Press; 2010.
  6. Mukherjee A, Raison M, Sahni T, et.al. Intensive rehabilitation combined with HBO2 therapy in children with cerebral palsy: a controlled longitudinal study. Undersea Hyperbaric Med. 2014;41:77-85.
  7. Harch PG, Fogarty EF. Hyperbaric oxygen therapy for Alzheimer’s dementia with positron emission tomography imaging: a case report. Med Gas Res. 2018:8:181-184.
  8. Jain KK. Textbook of Hyperbaric Medicine. New York, NY: Springer International Publishing AG; 2017: 345-348.

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[Abstract] Recovering social participation – experience with a relational group intervention for traumatic brain injury patients

Abstract

BACKGROUND:Traumatic brain injuries often result in impaired social functioning that may cause uncertainty, isolation, and precipitation of significant stress in social situations. Involvement in directed group treatment helps participants to develop new capabilities for feeling relationally connected, improving verbal and nonverbal communication skills, as well as building the capacity for empathic intersubjectivity. We suggest that group intervention to improve communication and social skills may provide an efficient and effective way for a patient to return to successful social participation.

OBJECTIVE:The purpose of this paper is to describe and discuss the principles of a clinical group intervention for increasing the social participation of persons with traumatic brain injury.

METHODS:Since 2000, several intervention periods, each with 10–20 group meetings, including some individual sessions for guidance, have been carried out under our direction in Finland. The intervention periods include education, reflection, and practical experiential exercises and can be multidisciplinary with both speech-language pathologists and neuropsychologists providing oversight and direction. The main goal of the described group interventions is to support community participation and social reintegration. In this article, we describe guiding principles and provide examples of the clinical group interventions drawn from our experience.

CONCLUSION:As determined by clinical observations and patient reports, the group intervention for social participation has proven to be beneficial. The participants report gaining more understanding of and insight into social situations, nonverbal and verbal communication, as well as affective interactive experience. Practicing social skills in a group situation is inherently self-motivating and encourages a constructive, positive impetus toward greater social participation. Based on our experience with this approach, it appears that this experiential form of group intervention is an effective bridge between structured cognitive-communication rehabilitation and successful real-life social participation.

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[BLOG POST] Responding to ‘Quit Using Your Brain Injury as an Excuse’

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When a Friend Said ‘Quit Using Your Brain Injury as an Excuse’

by Amy Zellmer  


“Quit using your brain injury as an excuse!”

I was caught completely off guard by this statement a few weeks ago, said by someone I have known many years. She had followed my TBI story, and I thought she had an understanding of what I was going through. Apparently I was wrong.

We had been talking, and I had to ask her to repeat what she said a bit earlier. When I did, she looked at me and said, “You know, Amy. You really need to stop using your brain injury as an excuse. You’re starting to use it as a crutch.”

Wait, what?

I wanted to scream, “Are you kidding? This is a joke, right?”

But I didn’t. I kept my composure and explained to her how it’s not an excuse or a crutch — it’s my “new normal” and she doesn’t understand the pain it causes me to know that this is how it is, now. I further explained that the damaged part of my brain now causes me to have difficulty remembering things in the short-term, and I often confuse words and forget meanings.

Why on earth would I ask her to repeat something if I didn’t really need her to? She explained that she thought I wasn’t focused enough — and I should “try harder” to remember things.

I about fell off my chair.

I actually have to try twice as hard to follow a conversation as I did before my brain injury. One of my biggest struggles two-and-a-half years after my TBI is my short-term memory. I have to pay extra attention, and sometimes get confused by words I “should” know the meaning of but have forgotten, which is part of the aphasia.

I realize that before my injury I was a focused, independent, strong-willed woman. I was full of confidence, and my peers looked to me for advice. I understand that it’s hard for those peers to understand exactly what I am going through — but to tell me I’m using my brain injury as an excuse, and that I “just” need to try harder and focus more — well, that is just plain ignorance.

It is frustrating to vividly remember the woman I once was, the woman who could remember a 30-item shopping list and multi-task with ease. Those days are long gone, for now. I am hopeful that my memory will continue to improve, and that my cognitive function comes back to full capacity. But for now, I am who I am.

Terry Berg from Edmonton, Alberta, Canada wrote,

“When someone implies that I am faking, I feel alone, wrongly accused, and frustrated with that person’s lack of knowledge and understanding. I am on a mission to help educate those who are not familiar with the long-term affects of brain injury.”

We hear celebrities like comedian Tracy Morgan express that he is 100 percent back to normal just one year after a horrific car accident, when in reality, these types of recoveries are extremely rare. Most recoveries take years and are almost never complete. Perhaps he is putting on a positive front, but I wonder whether Morgan has actually completely recovered. Those closest to him are likely to notice he still has speech and memory issues, in addition to neuro-fatigue.

Lauren Giambri from Pennsylvania puts it so eloquently, “I have to embrace my ‘new normal’ to the best of my ability or else I will be lying to myself and get nowhere. With the support of the people in my life, mindfulness, spiritual awareness and a never-give-up attitude, I am able to enlighten others with awareness of the huge shift in what is now my life. I would be lying to say it’s as easy as black and white, because it is not. I must remember to ground myself and to prove only to myself that I am going to be OK.”

I have (almost) completely accepted this “new me” who has memory and word issues, and cognitive impairments. I understand that I am in this for the long haul. I just wish those around me would show more compassion and make an attempt at understanding. I regularly hear from other survivors about how they feel so isolated and alone because their friends and family don’t understand what they’re going through.

Having to stuff our anger inside when someone says something like “Quit using your brain injury as an excuse,” is frustrating. Yet I also know lashing out at them with anger doesn’t solve anything. So the next time someone says something like this to me, I am going to simply respond with: “I am so sorry you feel that way.”

To those who do not completely understand and think we’re making excuses, please know that recovery can take years — and may never be full and complete. Next time you’re tempted to imply we’re making excuses, understand that most survivors will be left with a combination of these symptoms:

– Short-term memory loss
– Trouble focusing our attention
– Neuro-fatigue (running out of energy)
– Dizziness and balance issues
– Cognitive deficits (processing things slower than before)
– Aphasia (trouble recalling or understanding words)
– Not being able to handle overstimulation (lots of people and noise)
– Anxiety about the simplest things
– Depression
– Chronic pain

In short, we are not making excuses, we are simply doing the best we can with what we have been given. We want to get back to work, back to a meaningful life, back to the way we were before our injury. It’s a long, lonely road which is not made easier by other people’s ignorance. Remember, compassion makes the world go around.

I have a brain injury; what’s your excuse?

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Thinkstock photo by Zdravinjo.

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[ARTICLE] Differences between Men and Women in Treatment and Outcome after Traumatic Brain Injury – Full Text

Abstract

Traumatic brain injury (TBI) is a significant cause of disability, but little is known about sex and gender differences after TBI. We aimed to analyze the association between sex/gender, and the broad range of care pathways, treatment characteristics, and outcomes following mild and moderate/severe TBI. We performed mixed-effects regression analyses in the prospective multi-center Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study, stratified for injury severity and age, and adjusted for baseline characteristics. Outcomes were various care pathway and treatment variables, and 6-month measures of functional outcome, health-related quality of life (HRQoL), post-concussion symptoms (PCS), and mental health symptoms. The study included 2862 adults (36% women) with mild (mTBI; Glasgow Coma Scale [GCS] score 13–15), and 1333 adults (26% women) with moderate/severe TBI (GCS score 3–12). Women were less likely to be admitted to the intensive care unit (ICU; odds ratios [OR] 0.6, 95% confidence interval [CI]: 0.4-0.8) following mTBI. Following moderate/severe TBI, women had a shorter median hospital stay (OR 0.7, 95% CI: 0.5-1.0). Following mTBI, women had poorer outcomes; lower Glasgow Outcome Scale Extended (GOSE; OR 1.4, 95% CI: 1.2-1.6), lower generic and disease-specific HRQoL, and more severe PCS, depression, and anxiety. Among them, women under age 45 and above age 65 years showed worse 6-month outcomes compared with men of the same age. Following moderate/severe TBI, there was no difference in GOSE (OR 0.9, 95% CI: 0.7-1.2), but women reported more severe PCS (OR 1.7, 95% CI: 1.1-2.6). Men and women differ in care pathways and outcomes following TBI. Women generally report worse 6-month outcomes, but the size of differences depend on TBI severity and age. Future studies should examine factors that explain these differences.

Introduction

Traumatic brain injury (TBI) is a major public health concern and a leading cause of mortality and disability.1 Many persons who have experienced a TBI show long-term disturbances in physical, cognitive, emotional, and overall functioning.1–5 Nevertheless, sex and gender differences in health care and outcomes after TBI are still insufficiently investigated.

Sex refers to biological characteristics and it can be defined according to genetics, and morphology, whereas gender refers to sociocultural behaviors and attitudes. Although the terms are distinct, “sex” and “gender” are usually used interchangeably in the field of neurotrauma.6–8 Nevertheless, they highly interact in humans, and differences in the context of health outcomes in humans are rarely the product of exclusively sex or gender.9,10 To emphasize that it is difficult to disentangle biological and sociocultural components in TBI, and that sex and gender probably have a combined impact, we will use the term “sex/gender” to refer to differences between men and women.

TBI was traditionally considered a “male problem” and associated with risk-taking behaviors and male-dominated professions.7,11 Generally, men have more than a two-fold risk for sustaining a TBI and tend to acquire TBIs at a younger age.12 Women, however, catch up in older age with a high proportion of fall-related TBIs.13,14 In addition, increased participation of women in the military and contact sports has led to higher TBI rates among women.1,13,15,16 Moreover, a substantial percentage of women experience repetitive TBIs as a result of intimate partner violence.17–20

Current scientific guidelines strongly advise considering sex and gender in analyzing and reporting outcomes and treatment effects.21–23 Some studies have shown that women have less access and lower rates of direct transfers to trauma centers6,24 and fewer admissions to intensive care25 after traumatic injuries. Following TBI, adherence to guidelines for performing computed tomography (CT) seem to be lower for women.26,27 Further, there is evidence from other medical fields that can potentially be translated to the field of neurotrauma, such as men being provided with more aggressive treatments in cardiovascular medicine.28 However, studies on differences in care specifically for patients with TBI remain limited, and TBI researchers are encouraged to investigate sex/gender difference in admission and referral from the emergency room (ER), and in outcome measures.29

Sex/gender differences in outcomes following TBI have been investigated more frequently, but often with inconsistent results,29 even for important outcomes such as mortality.6,7,30 Generally, systematic reviews and syntheses of studies found worse outcomes in women,8,30,31 particularly following mild TBI (mTBI) and when cognitive and psychological symptoms after several months were analyzed as outcomes.8 In the moderate to severe spectrum of TBI, in which functional outcome and mortality were mostly analyzed as outcomes, a larger proportion of studies showed similar32,33 outcomes in men and women, or better outcomes8 in women.

Besides outcome measures and TBI severity, there are other personal and clinical factors that could impact the results of sex/gender-based analyses such as extracranial injuries or medical history, but these are often not included.8,31 For instance, stratified analyses on both age and sex have shown that certain subgroups are at higher risk for developing poor outcomes following TBI, such as young women for post-traumatic stress disorder (PTSD),34 women in “child-bearing years” for post-concussion symptoms (PCS),35 and older women for mortality after isolated TBI.36

Nevertheless, sex/gender differences in treatment and outcomes after TBI remain inconclusive. Therefore, the aim of this study was to determine the association between sex/gender and a broad range of care pathway and treatment characteristics, and outcomes following mTBI and moderate/severe TBI.[…]

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[BLOG POST] Living With Brain Injury: Ten Things

Living With Brain Injury: Ten Things

Here’s a list of just ten of the many things I’ve found to be helpful as I’ve tried to navigate living with brain injury – I believe these can help those of you who don’t have one as well.

1. Keep a daily schedule and write down reminders

Because of my short term memory problems, I always worry that I’m going to forget things. But when I keep a schedule or use a list of reminders to help me in my daily life, it reduces the stress of trying to remember all I have going on and allows me to function at a much higher level. I actually think being less stressed helps my natural memory work better as well.

2. Say “no” when necessary

I was always the type of person who wanted to say “yes” to everything but I am learning the importance of saying “no.” I’ve heard before that, “Sometimes you have to say “no” to good things so you can say “yes” to the better.” I guess that was probably always true for me, but after my brain injury, I just find it’s even more so the case.

3. Take breaks regularly and learn to pace yourself

I have learned it’s necessary for me to take frequent breaks throughout the day. Sometimes this might mean stepping away from a task for a minute. Other times it could be walking away from people or from conversations so I can “rest” my brain. They call this coping strategy “pacing” and it was something my occupational therapist (OT) taught me alot about when I was working with her. Pacing has proven to be an important thing for me to practice as it allows me to maintain my focus and energy for much longer periods of time.

4. Be open and honest with others

I think I grew up trying to hide my weaknesses from others but I’ve learned this was a very unhealthy way to live. I’ve now figured out how when I’m open and honest about my struggles, I can function much better. For example, because of my brain injury, words don’t always come out the way I intended. Sometimes I can’t think of the right word or I say the wrong one. Other times the person I’m talking with will use a word that I don’t know or understand. However, when I explain this to someone before having a conversation with them, I’ve found it takes the pressure off of me and this allows my speech, word finding, and comprehension to actually improve. I’ve also found other people to be very receptive and accepting of this, as well as my many other struggles, when I disclose them upfront.

5. Ignore those who doubt you

Brain injury is often times referred to as an “invisible injury.” Most people with one won’t look any different than they did before. They will just look like anyone else. That’s why there will likely be some people who think you are simply using your brain injury as an excuse, that you’re just being lazy, or that you’re trying to get some sort of secondary gain from it. But you have to learn to ignore these people! Pay more attention to and focus on those who have your back, who trust what you’re saying, and who are there to help and support you.

6. Accept help from others

After a brain injury, there will be many things you can’t do nearly as well as you used to, even some you can’t do at all anymore. You will probably start needing help with many things you could once easily do by yourself. This can be a very humbling thing to experience. But because it will most likely happen if you have a brain injury, it’s very important to let go of your pride and be willing to accept help from others when they offer it. It also means being willing to be proactive and not being ashamed to ask for help when you need it.

7. Get plenty of rest and sleep

Getting an adequate amount of rest and sleep is important for anyone. But I think this is especially true for people with a brain injury. It took me a long time to admit it but I’ve become okay with needing more rest than I used to. I’ve even had to become okay with having to take a nap almost every afternoon. This has allowed me to be much more functional and coherent when my kids come home after school and with any activities we might have going on later that night.

8. Don’t use your brain injury as an excuse to be a jerk

I am tempted at times to talk without thinking things through, and if I hurt someone’s feelings, I know that I can always use my brain injury as an excuse. But I know that I need to be responsible and take ownership of my actions and words. I know that brain injury makes this extremely difficult for some people but that’s just not my case. Although my “filter” doesn’t work as well as it did before my brain injury, I still have control over my words and actions – I need to be responsible and exercise that control.

9. Don’t isolate yourself

“Alone” time is extremely important for someone with a brain injury and it’s something I strongly encourage. I think people with a brain injury need more time alone that most to “recharge” themselves. However, you must try and be aware of when you start isolating yourself from the outside world. You also need to give a friend or loved one permission to call you out when you’re heading in the direction of isolation. It’s so vital for you to remain socially engaged. Even though the types of people and settings you engage in can look very different than they did before your brain injury, you need to be intentional about being around and interacting with others.

10. Find your new purpose

It’s been said many times before that “If you’re not dead, you’re not done!” Basically, that means if you are still here on this Earth, you are here for a reason. I know that because of all the changes you undergo with a brain injury, you may feel like a brand new and completely different person and this can be a very tough thing to accept. But it’s so important to find a healthy perspective about your “new” life. Find your new passions. Discover your new strengths. And then try to learn how the two of these can best work together. I think if you can do this, you just might find your new purpose!

JHsig-new.jpg

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[BLOG POST] How my self-esteem plummeted after a brain injury.

Before my brain injury, and being a realist about my strengths and weaknesses, I was comfortable with them. I was in my early 30’s, and had just got to that point when you really know yourself. Being honest with myself meant I achieved things by playing to my strong points, and asking for support on the things I wasn’t confident in. (Sounds obvious but previously I had been too scared to admit when I was finding something hard.) Life was good, and my self-esteem was in the best place it has ever been.

Enter stage left: Brain injury shakes everything up.

By now you will have heard me talk about how my career ended following my accident. And you might have read how looking for a new job didn’t pan out well for me in Unexpected interviewing disaster for TBI survivor. All of which is bad news for anyone’s self-esteem. But maybe that’s just ego, and I’m over that (sort of).

I have a problem with ME. My consciousness, spirit, soul…. whatever you want to call it. Weirdly, I’m not even sure that I’d noticed. That is until my partner, James, said to me “What’s with all the negative self talk?” This was after days of me listing my perceived faults at any given opportunity. I left like I was just being realistic and acknowledging the facts. But actually this is a change in my “self-concept.”

What is self-concept?

This is the feeling that you’re not the person you were, cognitively or physically, wrapped up in your level of self-esteem. But I’d been through to darkest phase of wondering what was the point of surviving my accident to be left with this inferior version of me. As I knew what that felt like, and how all-consuming it is to question your own existence, I had been brushing under the carpet what I was now feeling.

It appears to me that this can keep coming in waves or cycles. First when you return home and start to see how you can’t go back to life as it was is the first one. But then you adjust and on some level accept what you can achieve. However  I allowed myself to be lulled into a false sense of security. Yes I’ve come a long way, and I do have a place in this world. But as my priorities had changed I’d let go of my vanity. I’d become fat and ugly. (Please don’t feel the need to write in telling me what a ‘beautiful’ woman I am. I realise that this is my inner voice being unreasonably hard on me, and I’m not attention seeking or craving compliments.) I think as my life moves forward my attention and priorities move. Thus I have become more interested again in my appearance and how the world sees me. Basically I am regretting letting myself go.

self-esteem issues following brain injury

The importance of self-care.

I thought to worry about my appearance was self-centered. When you have been faced with your own mortality and continuing health issues it seemed trivial. But that’s really not the case. I know pride is one of the seven deadly sins and as I’m an atheist you might think I’m falling into its trap. But you have to look after yourself in order to have the strength to give to others. I know I said this before in Confess to pressure: being a voice of brain injury, so I’m not going to bang that drum again. Just know that it’s something that you have to keep coming back to and maintain it.

I know that as a natural part of aging everyone has to face changes in their life. Be it our role in society or how our bodies change, no one is immune. Of course each stage means we have to adjust, and sometimes it’ll be harder than others. You don’t need to feel like you’re failing just because it’s hard. After all, it’s the biggest challenges that teach us the most.

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Do you struggle with your self-esteem following a brain injury? Have you got an advice you want to give to others?

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[Infographic] Behavioral Broblems of TBI

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