Archive for category TBI

[BLOG POST] TBI AND ALCOHOL?

Canva - Assorted Wine Bottles.jpgAccording to MSKTC, “Drinking increases your chances of getting injured again, makes cognitive (thinking) problems worse, and increases your chances of having emotional problems such as depression. In addition, drinking can reduce brain injury recovery.”  Traumatic brain injury (TBI) has many side-effects including cognitive problems, depression, difficulty with balance and alcohol only intensifies these challenges. Alcohol can cause dizziness, staggering and falling, and this is not good for anybody.  In fact, many TBI injuries are alcohol related. Maria Magana recants how she got her TBI by saying, Sadly my TBI was from an alcohol/benzo issue. Yeah I was dumb as hell, but I learned through the hardest way. So I really hate talking to other TBI people about it.”  Alcohol related TBI injuries could be more common than you think. Additionally, accidental alcohol related deaths are not unheard of. Wendy Harris said, “ My uncle was a TBI survivor and he recently passed away bt drinking, falling, ang hitting his head.”  Both the coordination issues that comes with alcohol and the balance issues with TBI, together, can cause a deadly combination.  Furthermore, MSKTC continued by saying, “ says, “Traumatic brain injury puts survivors at risk for developing seizures (epilepsy). Alcohol lowers the seizure threshold and may trigger seizures.”  All of these complications are unnecessary troubles for a TBI survivor to have and we forgot to mention that the majority of TBI survivors are on medications such as muscle relaxers, blood thinners, and seizure medications that more than often counteract with alcohol.  With that said, let’s throw the anti alcohol disclaimer out the window and explore the pros and cons of alcohol consumption post TBI.

“POSITIVE” SIDE EFFECTS OF ALCOHOL

Canva - Clear Drinking Glass With Beer.jpgFor most, an alcoholic drink or two is a nice way to celebrate an occasion or to go with a nice meal. Some actually despise all alcohol – the taste, feeling, and smell.

But those who love alcohol love the sensation of being tipsy, wild, and feeling out of control. The unusual feeling is also encouraged by peers through a form of peer pressure and FOMO (fear of missing out). You’re at a party, and friends are drinking all around you, so why wouldn’t you, too? Roger Osburn, a fellow TBI survivor answred this question by saying, “Alcohol exacerbates my TBI related challenges. I do not drink anymore but sometimes will have a glass of wine, always remembering later why I don’t. It can be challenging socially.”

Canva - Shallow Focus Photography of Clear Cocktail Glass (1).jpgFor people with alcohol addictions, it’s a way to feel “numb,” separate themselves from reality, and to cope with various mental illnesses.  The problem is, individuals with TBI have higher rates of alcohol abuse than their peers, according to NCBI.  Additionally, according to MSKTC, “Up to two-thirds of people with TBI have a history of alcohol abuse or risky drinking.”  Alcohol consumption and TBI are closely related as is TBI and alcoholism.  While recreational alcohol is tolerable for the average person, for a TBI survivor, such behavior is ill-advised.  Below is a testimony given by a TBI survivor who requested to stay anonymous.  With that said, This is only anecdotal experience, and  cannot speak for everybody, and if you would like to share your experience with TBI and alcohol please do so in the comments below.

“Do you want a glass of wine?”  A friend I met in the hospital, Ben, came to visit me at my house with a bottle of wine.  Ben attempted to make a generous greeting by brandishing a bottle of wine however, I was skeptical in taking part of his offering as I am recovering from a traumatic brain injury.  I did not know how alcohol would affect my brain recovery, how alcohol would interfere with my medication, or how alcohol would make me feel. Additionally, I have to get my blood checked regularly, because I am on blood thinners, and I did not know how thin my blood would get by consuming wine. Despite my reluctance, I threw my caution to the wind and I told myself, “I was shot in the head, a glass of wine will not hurt.”  I began sipping the wine and next thing I knew it was time to take my muscle relaxers, this was not good. I took my medication and over the course of the night I took three more doses of TBI related medications which was dangerous, stupid, and made me very sick. For the next week my stomach was torn up, I was exhausted, and both my body and mind felt like it was hit by a dozen semi trucks and I still had therapy eight hours a day, everyday for the next week.  Luckily I am confined to a wheelchair because had I been walking around drunk or buzzed I would be putting myself at risk for a second brain injury.My experience with the wine I drank was so bad that I cut Ben off and told him we could not hang out again.”

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via TBI AND ALCOHOL? – treatment

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[QUOTATION] Surviving Head Trauma

Η εικόνα ίσως περιέχει: κείμενο

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[VIDEO] Woman with Traumatic Brain Injury (TBI) Improves with Neurofeedback — Even Over 9 Years Later – YouTube

http://www.CenterforBrain.com

April has suffered debilitating symptoms for over nine years since an illness left her with a severe traumatic brain injury (TBI). After just six weeks of neurofeedback, she has experienced significant improvement. This interview with April, her daughter, and Mike Cohen of the Center for Brain Training explores the power neurofeedback can have in people’s lives, even many years after a brain injury occurs.

Neurofeedback, or brain training, can help people suffering repercussions of traumatic brain injury, post-concussive syndrome, and stroke.

A transcript of the video is available below:

A: She is a walking miracle for sure.

Ap: Yes.

A: I mean, even now if you look at her actual MRI or anything, there is so much damage that people thought that she should be a vegetable or something like that by now. So after she got out of the hospital she couldn’t read, she couldn’t write, she had no depth perception. She was very out of it. She didn’t remember our names or anything like that.

M: What are you both seeing change since you’ve been training your brain with the neurofeedback?

Ap: My communication is lot better. My finding direction is a lot better.

A: I think she’s becoming more of herself again. She’s getting some of her personality back. She has always been pretty feisty. She keeps going no matter what happens. She seems to be getting a lot better. She can tell her right from left, which is a big deal. She is becoming a lot more sharp, I guess, mentally. She definitely has a ways to go, but this is improving her for sure. I think that a lot of things are possible with her because, before she got sick, she had so much drive and she was very inventive and creative and never let anything in life stop her. She’s still like that now, but she is really having a hard time putting her thoughts together and being organized, and the sharper her brain gets, I think that she could take that a long way.

M: When I met you, one of the things I noticed, April, was that you were almost like in a fog.

Ap: Yes. I’m much more alert.

M: So you are better able to communicate with other people now?

Ap: Yes, much better. Sometimes I have to hear what they said, and I can hear what they said but I couldn’t process it all. This is very encouraging. It’s amazing how I am seeing the brain come back around.

M: Did any of your doctors ever mention anything like this?

Ap: No.

A: No.

M: Did any of the other therapies ever help your brain like this?

Ap: No.

M: I am just excited for you that your brain seems to be waking up.

Ap: Yes.

M: Is that what it seems like?

Ap: Yes, in so many ways. I mean, I had other things; it’s very interesting, like the taste and the smell. You know, that didn’t really work.

A: Yes she had no taste, no smell for the most part. Even her vision changes all the time. Like when she goes to the doctor, everything is different all the time, so they can never give her glasses or contacts that actually work the whole time, which is really interesting, but it seems like since she has been doing the brain therapy, some of that has been coming back.

M: And you are interested in medical and going to a med school, is that right?

A: Yes, definitely. So the brain is definitely something that I am really interested in now, especially after seeing this, because doctors don’t seem to use this, like you had said, so I would definitely be interested in learning more and seeing how far you can go with it.

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[VIDEO] Stages of Brain Injury – YouTube

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[BLOG POST] TBI Grief Is A Thief…and Post-TBI Grief Is Rarely Brief

Having something personal stolen from you isn’t just upsetting…it’s offensive, and well…it’s just not fair. That’s how TBI feels to many. Leaving a TBI survivor to start over, the thief (TBI) often leaves no trace. Still, other times there is more than enough evidence.

Talking about grief, versus experiencing grief…or living with grief daily are totally different things. Grief can be an overwhelming sense of loss, a heavy mental weight pressing down on your very soul. After a traumatic brain injury, grief is an understatement. But it’s a place to start a discussion of what grief is, and how it’s different to people that may have been through similar situations.

Finding your way through the grieving process is like navigating without a map (or a GPS) – because there’s no set arrival time, and no itinerary – you just go along at your own pace, feel what you feel, and hope for the best. Nobody wants to hear that! With that being said, here’s an excerpt from a “tip card” by Lash & Associates Publishing titled “Loss, Grief, and Mourning.”

Tips for persons with brain injury to grieve and mourn…

✓ Be gentle with yourself – grieving can be physically, spiritually, and emotionally draining.

✓ Do not diminish how you feel about what has happened and don’t allow others to underrate your loss either. Your loss is real.

✓ Take time to work through your feelings about what has happened and how it affects you.

✓ Recognize that you may have secondary losses (e.g., loss of income, loss of friends, and loss of lifestyle).

 

✓ Recognize that your family is also experiencing grief. They need time to work through their emotions and may do it differently than you do.

✓ Find appropriate and safe ways to express your grief. It is essential to your well-being.

✓ Take time to reflect on who you were before your injury, who you are now, and who you want to be in the future.

✓ Ask for help – you do not need to do this alone.

✓ Keep life in perspective so that grieving and mourning do not totally overwhelm you.

Bereavement, Grieving, and Mourning

They are not the same. These words are used inter­changeably; however, they have different meanings. Dr. Alan Wolfelt, of the Center for Loss and Life Transition in Fort Collins, CO, defines bereavement, grieving, and mourning as follows.

Bereavement is the “call”.

It is the event that causes a loss (death, injury, ending of a relationship, etc.).

Grieving is the “internal response” to loss.

It is how one feels on the inside (sad, angry, confused, afraid, alone, etc.).

Mourning is the “external response” to the loss.

It is how one expresses feelings about the loss (funerals, ceremonies, rituals, talking, writing, etc.).

Primary and secondary losses are also a part of the process, in a “domino effect” of sorts. The initial injury of the TBI survivor is considered the primary loss…the other losses that follow affect the survivor, their family, friends, co-workers, and more. Everyone’s lives are changed.

Also, a whole range of emotions come with these losses, and mourning due to the situation can range from complicated, to extraordinary.

The journey of grief is complex, and acceptance is a big part of getting to the point with your life that you can go forward and find some happiness and reward. Embracing the new isn’t replacing the old…it’s acknowledging the old but moving ahead without it! It would be too easy to say “don’t let it get you down” …and survivors hear that more than they’d like. Although it’s meant as encouragement, many folks just don’t know how to put it into words in a more empathetic way. The point is that they didn’t experience what the TBI survivor did, but they deal with a lot of the aftermath on a daily basis – and they are just trying to build up and encourage the survivor.

In closing, grief is different in every single instance because every injury is different, every survivor is different…and every family is different. The difference is inevitable, but embracing each other’s differences after TBI is the best way to help each other feel included, and a part of the survivor community. Work to accept your differences as well, and you’ll be better prepared to have empathy for what other survivors have overcome too.

If you’d like to purchase the Lash tip card “Loss, Grief and Mourning After Brain Injury, by Janelle Breese Biagioni, you can click this link (price is $1.00 each, and is great to share with others).  https://www.lapublishing.com/loss-grief-mourning-tbi/

 

via TBI Grief Is A Thief…and Post-TBI Grief Is Rarely Brief

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[ARTICLE] Follow-up after 5.5 years of treatment with methylphenidate for mental fatigue and cognitive function after a mild traumatic brain injury – Full Text

Objective: Prolonged mental fatigue and cognitive impairments are common after a mild traumatic brain injury (TBI). This sets limits for rehabilitation and for regaining the capacity for work and participation in social life.

Method: This follow-up study, over a period of approximately 5.5 years was designed to evaluate the effect and safety of methylphenidate treatment for mental fatigue after a mild TBI. A comparison was made between those who had continued, and those who had discontinued the treatment. The effect was also evaluated after a four-week treatment break.

Results: Significant improvement in mental fatigue, depression, and anxiety for the group treated with methylphenidate (p < .001) was found, while no significant change was found for the group without methylphenidate. The methylphenidate treatment group also improved their processing speed (p = .008). Withdrawal produced a pronounced and significant deterioration in mental fatigue, depression, and anxiety and a slower processing speed. This indicates that the methylphenidate effect is reversible if discontinued and that continued methylphenidate treatment can be a prerequisite for long-term improvement. The effect was found to be stable and safe over the years.

Conclusion: We suggest methylphenidate to be a possible treatment option for patients with post-TBI symptoms including mental fatigue and cognitive symptoms.

Introduction

Long-term mental fatigue and cognitive impairment are common after a mild, moderate or severe traumatic brain injury (TBI) and these can have a significant impact on work, well-being and quality of life (1). Fatigue and concentration deficits are acknowledged as being one of the most distressing and long-lasting symptoms following mild TBI (1). There is currently no approved treatment (2), although the most widely used research drug for cognitive impairments after TBI is methylphenidate (3). A few studies have used methylphenidate for mental fatigue after TBI with promising results including our own (4,5). Other clinical trials of drugs have reported improvements in mental fatigue ((−)-osu6162 (6)) or none ((−)-osu616, modafinil (79)).

In our feasibility study of methylphenidate (not placebo controlled) we reported decreased mental fatigue, improved processing speed and enhanced well-being with a “normal” dose of methylphenidate compared to no methylphenidate for people suffering from post-traumatic brain injury symptoms (4). We tested methylphenidate in two different dosages and found that the higher dose (20 mg three times/day) had the better effect compared to the lower dose. We also found methylphenidate to be well tolerated by 80% of the participants. Adverse events were reported as mild and the most commonly reported side-effects included restlessness, anxiety, headache, and increased heart rate; no dependence or misuse were detected (10). However, a careful monitoring for adverse effects is needed, as many patients with TBI are sensitive to psychotropic medications (11).

Participants who experienced a positive effect with methylphenidate were allowed to continue the treatment. We have reported the long-term positive effects on mental fatigue and processing speed after 6 months (12) and 2 years (13). No serious adverse events were reported (13)(Figure 1). In a 30-week double-blind-randomized placebo-controlled trial, Zhang et al. reported that methylphenidate decreased mental fatigue and improved cognitive function in the participants who had suffered a TBI. Moreover, social and rehabilitation capacity and well-being were improved (5). Other studies evaluating methylphenidate treatment after TBI have focused only on cognitive function reporting improved cognitive function with faster information processing speed and enhanced working memory and attention span (1421). A single dose of methylphenidate improved cognitive function and brain functionality compared to placebo in participants suffering from post-TBI symptoms (22,23). Most of these have been short-term studies covering a period between 1 day and 6 weeks and included participants suffering from mild or more severe brain injuries.

This clinical follow-up study was designed to evaluate the long-term effect and safety of methylphenidate treatment. We also evaluated the effect after a four-week treatment break and compared the subjective and objective effects with and without methylphenidate. Patients who had discontinued methylphenidate during this long-term study were also included in this follow-up, as it was our intention to compare the long-term effects on mental fatigue in patients with and without methylphenidate treatment.

[…]

 

Continue —->  Follow-up after 5.5 years of treatment with methylphenidate for mental fatigue and cognitive function after a mild traumatic brain injury: Brain Injury: Vol 0, No 0

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[WEB PAGE] Types and Levels of Brain Injury

Types of Brain Injury

All brain injuries are unique.  The brain can receive several different types of injuries depending on the type of force and amount of force that impacts the head. The type of injury the brain receives may affect just one functional area of the brain, various areas, or all areas of the brain.

Traumatic Brain Injury  •  Acquired Brain Injury • Levels of Brain Injury

 


Traumatic Brain Injury

Concussion

Even a concussion can cause substantial difficulties or impairments that can last a lifetime. Whiplash can result in the same difficulties as head injury. Such impairments can be helped by rehabilitation, however many individuals are released from treatment without referrals to brain injury rehabilitation, or guidance of any sort.

  • A concussion can be caused by direct blows to the head, gunshot wounds, violent shaking of the head, or force from a whiplash type injury.
  • Both closed and open head injuries can produce a concussion. A concussion is the most common type of traumatic brain injury.
  • A concussion is caused when the brain receives trauma from an impact or a sudden momentum or movement change. The blood vessels in the brain may stretch and cranial nerves may be damaged.
  • A person may or may not experience a brief loss of consciousness.
  • A person may remain conscious, but feel dazed.
  • A concussion may or may not show up on a diagnostic imaging test, such as a CAT Scan.
  • Skull fracture, brain bleeding, or swelling may or may not be present. Therefore, concussion is sometimes defined by exclusion and is considered a complex neurobehavioral syndrome.
  • A concussion can cause diffuse axonal type injury resulting in temporary or permanent damage.
  • A blood clot in the brain can occur occasionally and be fatal.
  • It may take a few months to a few years for a concussion to heal.

Contusion

  • A contusion can be the result of a direct impact to the head.
  • A contusion is a bruise (bleeding) on the brain.
  • Large contusions may need to be surgically removed.

Coup-Contrecoup

  • Coup-Contrecoup Injury describes contusions that are both at the site of the impact and on the complete opposite side of the brain.
  • This occurs when the force impacting the head is not only great enough to cause a contusion at the site of impact, but also is able to move the brain and cause it to slam into the opposite side of the skull, which causes the additional contusion.

Diffuse Axonal

  • A Diffuse Axonal Injury can be caused by shaking or strong rotation of the head, as with Shaken Baby Syndrome, or by rotational forces, such as with a car accident.
  • Injury occurs because the unmoving brain lags behind the movement of the skull, causing brain structures to tear.
  • There is extensive tearing of nerve tissue throughout the brain. This can cause brain chemicals to be released, causing additional injury.
  • The tearing of the nerve tissue disrupts the brain’s regular communication and chemical processes.
  • This disturbance in the brain can produce temporary or permanent widespread brain damage, coma, or death.
  • A person with a diffuse axonal injury could present a variety of functional impairments depending on where the shearing (tears) occurred in the brain.

Penetration

Penetrating injury to the brain occurs from the impact of a bullet, knife or other sharp object that forces hair, skin, bones and fragments from the object into the brain.

  • Objects traveling at a low rate of speed through the skull and brain can ricochet within the skull, which widens the area of damage.
  • A “through-and-through” injury occurs if an object enters the skull, goes through the brain, and exits the skull. Through-and-through traumatic brain injuries include the effects of penetration injuries, plus additional shearing, stretching and rupture of brain tissue. (Brumback R. (1996). Oklahoma Notes: Neurology and Clinical Neuroscience. (2nd Ed.). New York: Springer.)
  • The devastating traumatic brain injuries caused by bullet wounds result in a 91% firearm-related death rate overall. (Center for Disease Control. [Online August 22, 2002: http://www.cdc.gov/ncipc/didop/tbi.htm#rate,]).
  • Firearms are the single largest cause of death from traumatic brain injury.
  • (Center for Disease Control. [Online August 22, 2002: http://www.cdc.gov/ncipc/didop/tbi.htm#rate,]).

Acquired Brain Injury

Acquired Brain Injury, (ABI), results from damage to the brain caused by strokes, tumors, anoxia, hypoxia, toxins, degenerative diseases, near drowning and/or other conditions not necessarily caused by an external force.

Anoxia

Anoxic Brain Injury occurs when the brain does not receive any oxygen. Cells in the brain need oxygen to survive and function.

Types of Anoxic Brain Injury

  • Anoxic Anoxia- Brain injury from no oxygen supplied to the brain
  • Anemic Anoxia- Brain injury from blood that does not carry enough oxygen
  • Toxic Anoxia- Brain injury from toxins or metabolites that block oxygen in the blood from being used Zasler, N. Brain Injury Source, Volume 3, Issue 3, Ask the Doctor

Hypoxic

A Hypoxic Brain Injury results when the brain receives some, but not enough oxygen.

Types of Hypoxic Brain Injury

  • Hypoxic Ischemic Brain Injury, also called Stagnant Hypoxia or Ischemic Insult- Brain injury occurs because of a lack of blood flow to the brain because of a critical reduction in blood flow or blood pressure.

Resources:

Brain Injury Association of America, Causes of Brain Injury. www.biausa.org

Zasler, N. Brain Injury Source, Volume 3, Issue 3, Ask the Doctor

 


Levels of Brain Injury Brain Injury

Mild Traumatic Brain Injury (Glasgow Coma Scale score 13-15)

Mild traumatic brain injury occurs when:

  • Loss of consciousness is very brief, usually a few seconds or minutes
  • Loss of consciousness does not have to occur—the person may be dazed or confused
  • Testing or scans of the brain may appear normal
  • A mild traumatic brain injury is diagnosed only when there is a change in the mental status at the time of injury—the person is dazed, confused, or loses consciousness. The change in mental status indicates that the person’s brain functioning has been altered, this is called a concussion

Moderate Traumatic Brain Injury (Glasgow Coma Scale core 9-12)

Most brain injuries result from moderate and minor head injuries. Such injuries usually result from a non-penetrating blow to the head, and/or a violent shaking of the head. As luck would have it many individuals sustain such head injuries without any apparent consequences. However, for many others, such injuries result in lifelong disabling impairments.

A moderate traumatic brain injury occurs when:

  • A loss of consciousness lasts from a few minutes to a few hours
  • Confusion lasts from days to weeks
  • Physical, cognitive, and/or behavioral impairments last for months or are permanent.

Persons with moderate traumatic brain injury generally can make a good recovery with treatment or successfully learn to compensate for their deficits.

Severe Brain Injury

Severe head injuries usually result from crushing blows or penetrating wounds to the head. Such injuries crush, rip and shear delicate brain tissue. This is the most life threatening, and the most intractable type of brain injury.

Typically, heroic measures are required in treatment of such injuries. Frequently, severe head trauma results in an open head injury, one in which the skull has been crushed or seriously fractured. Treatment of open head injuries usually requires prolonged hospitalization and extensive rehabilitation. Typically, rehabilitation is incomplete and for most part there is no return to pre-injury status. Closed head injuries can also result in severe brain injury.

TBI can cause a wide range of functional short- or long-term changes affecting thinking, sensation, language, or emotions.

TBI can also cause epilepsy and increase the risk for conditions such as Alzheimer’s disease, Parkinson’s disease, and other brain disorders that become more prevalent with age.1

Repeated mild TBIs occurring over an extended period of time (i.e., months, years) can result in cumulative neurological and cognitive deficits. Repeated mild TBIs occurring within a short period of time (i.e., hours, days, or weeks) can be catastrophic or fatal.

Resources:

National Institute of Neurological Disorders and Stroke. Traumatic brain injury: hope through research. Bethesda (MD): National Institutes of Health; 2002 Feb. NIH Publication No.: 02-158.

Centers for Disease Control and Prevention (CDC), National Center for Injury Prevention and Control. Report to Congress on mild traumatic brain injury in the United States: steps to prevent a serious public health problem. Atlanta (GA): Centers for Disease Control and Prevention; 2003.

Brain Injury Association of America, Causes of Brain Injury. www.biausa.org

via Types and Levels of Brain Injury – Brain Injury Alliance of Utah

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[Infographic] Traumatic Brain Injury

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[VIDEO] Recovery from Brain Injury Occurs for the Rest of a Person’s Life – YouTube

The human brain is a wonderful organ with amazing flexibility. Learn more about recovery.

 

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[BLOG POST] Shuffled Neurons, and Other Speed Bumps in The Search for Self-Awareness

By Bill Herrin

Self-awareness after a brain injury

Experiences in life make us who we are – they can intrinsically change who we are for better or worse, sometimes in a temporary way, and sometimes for the rest of our lives. There are things that happen that we’ll cherish, things we look back on and laugh about, things that we’d rather not think about…and then there are things that we won’t even recall. TBI can be like a thief in the night…slipping away with treasured memories and leaving us with little to work with. But take heart, because as the old saying “time heals all wounds” actually rings true, especially in the realm of brain injury. When a brain is injured, the severity really depends on where the injury occurred, the level of the impact, and to some degree – whether the trauma was over the line of being able to overcome or not…not to mention that every person’s brain is as different as their TBI.

Every TBI is Personal

The different levels of self-awareness that arise from having a TBI can spark debate because everyone’s TBI is personal to them, but their self-awareness will never be exactly like someone else’s…although there will be common similarities. That’s where we should focus – on the broad similarities that we can all relate to, and support each other in. For survivors and their friends, families and beyond, there can be friction – often caused by the survivor saying “I don’t need help, I’ll be fine” to someone telling a survivor “you don’t look injured, you’ll be fine.” That’s a hard pill to swallow, especially when the survivor has isolated themselves or if their family has withdrawn from trying to encourage or help them because of previous resistance.

Self-Awareness Doesn’t Come Easy

Awareness of how you’ve changed after a TBI may be harder to do than many realize. I’ll be referencing some points regarding self-awareness from a Lash & Associates “tip card” (an 8-page brochure that they sell) that is packed with great advice for survivors, therapists, clinicians, families, and caregivers. These excerpts will be highlighted in italics.

Why is Self Awareness Important?

Self-awareness is the ability to view ourselves somewhat objectively. It is also the ability to see ourselves from the perspective of other people. It allows us to use feedback from others as we develop our personal identity. We rely on self-awareness when we…

  • interact socially with others
  • decide what situations or information to share
  • make judgments about ourselves, and
  • act in ways that ensure our personal safety.

Brain injury can impair the critical capacity for self-awareness.”

The previous sentence says so much because impairments in self-awareness come from different causes, and can show up at any time – and every person with a TBI will have different impairments or limitations of varying degrees. Hence, their own ability to assess their self-awareness is negligible in many cases. Damage in different parts of the brain can impair self-awareness in ways other than judgment – such as awareness of paralysis of certain parts of the body, awareness of loss of memory, problem-solving skills, reasoning, or being unable to anticipate consequences of decisions (based, in part, by lack of recall of it happening at a prior point in time, etc.)

“What Helps Unawareness?

Working on awareness can help people make better decisions. Efforts to increase a person’s understanding of abilities/disabilities must be done in a manner that preserves self-esteem. A healthy sense of self is critical for recovery. The two primary methods to address impaired self-awareness are education and structured feedback.

Both require an interpersonal bond between the person delivering information or feedback and the individual with impaired self-awareness. It is also important to have an environment that helps the person learn about strengths and weaknesses while still maintaining hope.”

The deficits of self-awareness can be obvious to family, friends, caregivers, and clinicians, and many times be quite frustrating. Helping a survivor to have a clear vision of their actual cognitive and physical abilities should be addressed with patience, positivity, and prudence.

“The goal of feedback is to orient individuals to the aspects of their performance that they do not accurately perceive. It is very important to balance feedback for problem areas with feedback for strengths.

Regardless of the approach used to help someone increase self-awareness, the person in the role of therapist, coach or caregiver needs to have a positive bond or connection with the individual. In order for a person to accept feedback, the person needs to feel that there is a partnership. The clinical term for this partnership is therapeutic alliance.”

In closing, it’s important to realize that everyone has the potential for unrealistic self-awareness – it’s what the long-running TV show “American Idol” was built upon…people whose self-awareness about their vocal abilities may have been bolstered by false praise, or just delusions of grandeur…many times, the people that go on the show with a humble approach are the ones that blow the judges away!!

Help your friend, colleague, partner, family member achieve a realistic understanding of where they are, but help foster a vision for them that will lead them to further improvements through encouragement, suggestions, positivity, strong communication, realistic goals, and love. Dealing with a huge change in self-awareness is complex and there is no “set route” to get to the next level. Understanding this helps both the caregiver and the survivor to make progress on the best terms possible.

The tip card “Changes in Self Awareness” is written by written by McKay Moore Sohlberg, Ph.D. and is available for just $1.00 at www.lapublishing.com/brain-injury-self-awareness-survivor/  – it’s a great resource for families or clinicians.

via Shuffled Neurons, and Other Speed Bumps in The Search for Self-Awareness

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