Posts Tagged brain injury

[BLOG POST] Survivors Speak About Recovery and Acceptance

By Marilyn Lash, MSW

You don’t get over a brain injury like you do the flu or even minor surgery. What can survivors and families expect for recovery? Why do so many struggle with acceptance of the changes and losses in their lives.

No one knows these issues more than the individuals who are survivors of brain injury. This issue of Brain Injury Bulletin features their voices about the meaning of recovery and acceptance.

Myth of Recovery

Learning to Live with Yourself after Brain Injury,is not an easy or quick process. Aptly the title of his book, Jeff Sebell says, “There are some hard realities we must face. First and foremost, there is no such thing as recovery. No one recovers from brain injury the way someone recovers from an illness. You don’t get released from the hospital, hug your family, and return to work vowing to put your brain injury in the rear view mirror. You don’t pick up where you left off in your life as though nothing happened.

You just don’t…. Life will not be the same as it was before…nor should it be. Being able to adapt to, and accept, drastic changes in life is an important skill. It means rather than looking at the time post-brain injury as recovery, or an attempt to return to a former life and pick up your routine where you left off, it’s all about discovery. It’s about learning what and who you have become and fitting into the world now.”

Hilary Zayed also avoids using the word recovery. Instead she talks about recalculating her life after her brain injury. Rather than a straight uphill climb of progress, she describes her recovery process as “…a spiral of getting better and getting worse. After the trauma of recovery, there is an expectation that you are fixed; and can move on. You are expected to believe the universe lies before your unfamiliar new feet. With strategies in hand, a game plan in mind, and friends and family for support, you set off into the unknown. However, you soon learn you need to recalculate.” This means finding new paths and new directions.

Trying a different way when old strategies no longer work. “Repurposing a life and finding a new direction can throw you in and out of a spiral of depression, anxiety, and needing help again…. This time of readjustment and recalculating brings up questions like, ‘Can I do this alone?’” She has learned to say to herself, “Stay strong and move forward.” Recalculating led her to a new journey of reinventing her self, perhaps her most important discovery.

Rising Again
Carole Starr explores the concept of acceptance  further in her book, To Root and To Rise – Accepting Brain Injury.  You’ve probably heard these questions or asked them yourself: What does accepting my brain injury really mean? What does acceptance look like? And most importantly, How do you know when you’ve accepted your injury?

She explains that, “Acceptance is acknowledging the reality of a situation. It’s about recognizing the difference between what can be changed and what can’t. It’s being able to say – without any internal resistance –  ‘It is what it is’.

Starr learned that acceptance isn’t a one-time event. Rather, it happens in small pieces over time. It doesn’t mean liking what has happened to you, nor does it mean you are giving up hope of making progress. Rather than trying to get back to the person you were – the “old me” – it’s about becoming the new me. Acceptance is not the end stage but the beginning of your journey into transitioning into living with a brain injury. Acceptance is about transitioning from mournfully looking back at what was to embracing what is.

Families Join Survivors
Brain injury is a family event; it affects everyone in the family. Relationships change along with altered hopes and dreams. From her experience as a caregiving spouse and her studies on grief and loss, Janelle Breese Biagioni views adjustment and acceptance, not as a destination, but as a process for survivors and families with three stages.

Say Hello…
This means reflect on the life you had before the injury, whether you are a survivor or family member. What was important to you in that life? What did you value? What brought meaning to your life? As you think back, reflect on your relationships, your interests, your work, your friendships, your hobbies….the list goes on.

Say Goodbye…
This is the hard part. It means letting go of parts of your previous life that no longer exist. You may be leaving behind concrete things like a job, college or travel. It may be relationships that have changed. It may be activities and interests that you let go.

Say hello…
Only once you say hello and goodbye to your past can you now say hello to the person you’ve become. This is the beginning of who you are now and how your life now is.

Your Journey
As you travel your journey toward acceptance, remember you are not alone. Others have shared your journey and still more will join you. 
Call us: 919-556-0300
Fax: 919-556-0900

via December 2017 Brain Injury Bulletin from Lash & Associates

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[Abstract] Transcranial Direct Current Stimulation Enhances Motor Skill Learning but Not Generalization in Chronic Stroke

Background. Motor training alone or combined with transcranial direct current stimulation (tDCS) positioned over the motor cortex (M1) improves motor function in chronic stroke. Currently, understanding of how tDCS influences the process of motor skill learning after stroke is lacking.

Objective. To assess the effects of tDCS on the stages of motor skill learning and on generalization to untrained motor function.

Methods. In this randomized, sham-controlled, blinded study of 56 mildly impaired chronic stroke patients, tDCS (anode over the ipsilesional M1 and cathode on the contralesional forehead) was applied during 5 days of training on an unfamiliar, challenging fine motor skill task (sequential visual isometric pinch force task). We assessed online and offline learning during the training period and retention over the following 4 months. We additionally assessed the generalization to untrained tasks.

Results. With training alone (sham tDCS group), patients acquired a novel motor skill. This skill improved online, remained stable during the offline periods and was largely retained at follow-up. When tDCS was added to training (real tDCS group), motor skill significantly increased relative to sham, mostly in the online stage. Long-term retention was not affected by tDCS. Training effects generalized to untrained tasks, but those performance gains were not enhanced further by tDCS.

Conclusions. Training of an unfamiliar skill task represents a strategy to improve fine motor function in chronic stroke. tDCS augments motor skill learning, but its additive effect is restricted to the trained skill.


via Transcranial Direct Current Stimulation Enhances Motor Skill Learning but Not Generalization in Chronic Stroke – Manuela Hamoudi, Heidi M. Schambra, Brita Fritsch, Annika Schoechlin-Marx, Cornelius Weiller, Leonardo G. Cohen, Janine Reis, 2018

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[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


  • 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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[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?


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:

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

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[BLOG POST] “I’m So Tired My Brain Hurts” Cognitive Fatigue

Sleeping boy

 Fatigue. And the good news is there are strategies to help minimize it.

Before I get to the strategies, here are a couple of real life descriptions to help explain what it is like:

In an article in The Guardian newspaper Tim Lusher  described his experiences following an abscess on the cerebellum, (the part of the brain that controls movement, balance and coordination).He vividly describes cognitive fatigue:

Ah, the tiredness. That’s another thing everyone talks about. It’s not a tough-week-at-the-office tiredness that you can rally through with a couple of drinks and the prospect of a weekend lie-in. It’s a leaden blanket of exhaustion that sweeps over you – utterly undeniable, non-negotiable and unshakeable.

And this description in an article entitled “Learning to Pace Yourself” from Synapse

Those who haven’t had their brain banged around won’t understand the feeling – they’ll picture how they feel after a bad night’s sleep or a big work day. But this mental exhaustion is much more than that. It feels as though even the simple act of pushing a few sluggish thoughts through this damaged brain takes far too much energy, let alone attempting things requiring physical exertion. To make things worse, when I got tired my emotions were worse than ever – my family was already struggling with my temper, depression and poor social skills. What little control I had in these areas just flew out the window once fatigue set in.

Cognitive fatigue is common after a brain injury, whether mild, moderate or severe.

The brain is working harder to keep up all its functions, even ones that were once second nature. Eventually it is like an overload button, the brain needs a rest. Without rest it can lead to headaches, or becoming irritable, confused and sometimes increasing problems with behaviour.

What can you do about it? Well even understanding what it is, gives you clues about how you could assist a person manage it. Here are some ideas to get you started.

What Can You Do for Cognitive Fatigue?

Below is a list of strategies you might find useful to work with. Decide what might work with the person you are supporting and their network. Just choose the key strategies that might suit. Keep the change manageable for everyone involved.

  • Balance the daily routine with quiet times, rests, or restful activity; building in whatever rest time the person needs whether a short nap or a longer sleep time.
  • Help family and friends to understand cognitive fatigue and know that it is as a result of the brain damage, it’s not laziness or deliberate.
  • Plan ahead to allow opportunity for sleep and rest, program this into the daily plan before fatigue occurs.
  • Work out what time of day is best for activity. We often talk about whether we are a morning, afternoon or evening person, this is important in planning to minimize fatigue.
  • Allow extra time to complete work that requires extra concentration and effort.
  • Plan ahead for demanding activities, or when going to special events. Allow for extra rest time and / or quieter routines before and after.
  • Use aids, equipment, and technology to reduce effort wherever possible. For instance if the person has mobility aids encourage their use to minimize fatigue.
  • If helpful see about shorter days for school or work; and with frequent breaks according to need.
  • Encourage saying no to activities or demands that are not important, or that would overly fatigue them.
  • If there are a number of activities or things to do on a day, work out priorities and tackle the important, or interesting tasks first.
  • As much as possible have familiar routines and surroundings, which reduces to effort and need to concentrate.
  • Take notice of what factors contribute to fatigue and work out how to manage these as much as possible. This might include the effect of medication, weather, or illness, people, places.
  • Be aware that sensory overload can impact on fatigue; situations such as a busy shopping centre with lights and noise. Limit or avoid these situations.
  • Maintain optimal health and fitness. Take care with exercise that it is does not itself cause fatigue.
  • Develop ways to manage fatigue if and when it occurs. Think about at home and when out.
  • You as a supporter can minimize fatigue by assisting where necessary, and where appropriate. Carrying out tasks, understanding what needs to be done, assisting to maintain agreed rest routines.

When looking at ways to manage fatigue remember it is better for a person to try and manage cognitive fatigue before rather than after it happens. Plan to prevent rather than manage after fatigue occurs.

Finally remember to always work with the person and their support team when developing any strategies. Each person will have different needs and different responses. This may change over time. Consistency is a key.

Please share any successful (or unsuccessful ways) you might have seen cognitive fatigue managed.

via “I’m So Tired My Brain Hurts” Cognitive Fatigue – Changed Lives New Journeys

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[WEB SITE] Glossary of Brain Injury Terms

Browse our extensive glossary of brain injury terms, or search for a specific term.


ADL: Activities of daily living. Routine activities carried out for personal hygiene and health (including bathing, dressing, feeding) and for operating a household.

Acute Care: The phase of managing health problems which is conducted in a hospital on patients needing medical attention.

Acute Rehabilitation Program: Primary emphasis is on the early phase of rehabilitation which usually begins as soon as the patient is medically stable. The program is designed to be comprehensive and based in a medical facility with a typical length of stay of 1‑3 months. Treatment is provided by an identifiable team in a designated unit. See Program/Service Types.

Adaptive/Assistive Equipment: A special device which assists in the performance of self‑care, work or play/leisure activities, or physical exercise. See also adaptive equipment catalog.

Affect: The observable emotional condition of an individual at any given time. See also frontal lobe.

Agitation: Excessive restlessness, including increased physical activity which is usually non-purposeful and repetitious.

Agnosia: Failure to recognize familiar objects although the sensory mechanism is intact. May occur for any sensory modality.

Agrammatism: An inability to produce words in correct sequence.

Agraphia: Inability to express thoughts in writing. See also parietal lobe.

Alexia: Inability to read. See also parietal lobe.

Ambulate: To walk.

Amnesia: Lack of memory about events occurring during a particular period of time. See also: anterograde amnesia, retrograde amnesia, post‑traumatic amnesia.

Aneurysm: A balloon‑like deformity in the wall of a blood vessel. The wall weakens as the balloon grows larger, and may eventually burst, causing a hemorrhage.

AFO: Ankle-foot Orthosis. A below the knee brace that keeps the foot in a neutral position.

Anomia: Inability to recall names of objects. Persons with this problem often can speak fluently but have to use other words to describe familiar objects. See also parietal lobe.

Anosmia: Loss of the sense of smell.

Anoxia: A lack of oxygen. Cells of the brain need oxygen to stay alive. When blood flow to the brain is reduced or when oxygen in the blood is too low, brain cells are damaged.

Anterograde Amnesia: Inability to consolidate information about ongoing events. Difficulty with new learning.

Anticonvulsant: Medication used to decrease the possibility of a seizure (e.g., Dilantin, Phenobarbital, Mysoline, Tegretol). See also pharmacology guide.

Antidepressants: Medication used to treat depression. See also pharmacology guide.

Apathy: Absence of feelings or emotions. Person is indifferent.

Aphasia: Loss of the ability to express oneself and/or to understand language. There are many different kinds of aphasia. Receptive aphasia refers to the inability to understand what someone else is saying. This is often associated with damage in the temporal area of the brain. Expressive aphasia refers to an inability to express oneself. Some patients may know what they want to say, but many of the words they say may not “make sense”. Expressive aphasia is often associated with the left frontal area of the brain.

Apraxia: Inability to perform purposeful movements when paralysis is not present. Particularly refers to inability to use objects. For example, a patient may be unable to put together the proper movements to sit cross-legged on the floor or may not know what to do when handed a broom.

Aprosodia: A condition in which there is a loss of production or comprehension of the meaning of different tones of voice.

Arousal: Being awake. Primitive state of alertness managed by the reticular activating system (extending from medulla to the thalamus in the core of the brain stem) activating the cortex. Cognition is not possible without some degree of arousal. See also brain stem.

Articulation: Movement of the lips, tongue, teeth and palate into specific patterns for purposes of speech. Also, a movable joint.

Aspiration: When fluid or food enters the lungs through the wind pipe. Can cause a lung infection or pneumonia.

Astereognosia: Inability to recognize things by touch. See also parietal lobe.

Ataxia: Inability to coordinate muscle movements or having irregular muscle movements. This can interfere with the person’s ability to walk, talk, eat, perform self-care tasks, and work.

Attendant Care: Provision of assistance in activities of daily living for a person with disability. Daily number of hours of required assistance, either physical or supervisory.

Atrophy: A wasting away or decrease in size of a cell, tissue, organ, or part of the body caused by lack of nourishment, inactivity or loss of nerve supply.

Attention/Concentration: The ability to focus on a given task or set of stimuli for an appropriate period of time. The ability to remain alert, focused and to maintain attention to the environment. Includes ability to selectively attend to appropriate things and screen out unimportant information, shift attention from one activity to another and attend to several things at one time.

Audiologist: One who evaluates hearing defects and who aids in the rehabilitation of those who have such defects.

Auditory Comprehension: The ability to understand what is said.

Augmentative and Alternative Communication: Use of forms of communication other than speaking, such as: sign language, “yes, no” signals, gestures, picture board, and computerized speech systems to compensate (either temporarily or permanently) for severe expressive communication disorders.

Automatic Speech: Preservation of overly learned speech such as counting, alphabet, days of the week or songs.


Balance: The ability to use appropriate righting and equilibrium reactions to maintain an upright position. It is usually tested in sitting and standing positions.

Behavior: The total collection of actions and reactions exhibited by a person. See also Working with Behavior Disorders.

Bilateral: Pertaining to both right and left sides.

Brain Injury, Acquired: The implication of this term is that the individual experienced normal growth and development from conception through birth, until sustaining an insult to the brain at some later time which resulted in impairment of brain function.

Brain Injury, Closed (CHI): Occurs when the head accelerates and then rapidly decelerates or collides with another object (for example the windshield of a car) and brain tissue is damaged, not by the presence of a foreign object within the brain, but by violent smashing, stretching, and twisting, of brain tissue. Closed brain injuries typically cause diffuse tissue damage that result in disabilities which are generalized and highly variable.

Brain Injury, Mild: A patient with a mild traumatic brain injury is a person who has had a traumatically‑induced physiological disruption of brain function, as manifested by at least one of the following: 1) any period of loss of consciousness, 2) any loss of memory for events immediately before or after the accident, 3) any alteration in mental state at the time of the accident (e.g., feeling dazed, disoriented, or confused), 4) focal neurological deficit(s) which may or may not be transient; but where the severity of the injury does not exceed the following: a) loss of consciousness of approximately 30 minutes or less; b) after 30 minutes, an initial Glasgow Coma Scale score of 13‑15; c) Post Traumatic Amnesia not greater than 24 hours.

Brain Injury, Traumatic (TBI): Damage to living brain tissue caused by an external, mechanical force. It is usually characterized by a period of altered consciousness (amnesia or coma) that can be very brief (minutes) or very long (months/indefinitely). The specific disabling condition(s) may be orthopedic, visual, aural, neurologic, perceptive/cognitive, or mental/emotional in nature. The term does not include brain injuries that are caused by insufficient blood supply, toxic substances, malignancy, disease‑producing organisms, congential disorders, birth trauma or degenerative processes.

Brain Plasticity: The ability of intact brain cells to take over functions of damaged cells; plasticity diminishes with maturation.

Brain Scan: An imaging technique in which a radioactive dye (radionucleide) is injected into the blood stream and then pictures of the brain are taken to detect tumors, hemorrhages, blood clots, abscesses or abnormal anatomy.

Brain Stem: The lower extension of the brain where it connects to the spinal cord. Neurological functions located in the brain stem include those necessary for survival (breathing, heart rate) and for arousal (being awake and alert). It also houses the reticular formation which controls consciousness, drowsiness, and attention.


Cerebellum: The portion of the brain which is located below the cortex. The cerebellum is concerned with coordinating movements.

Case Management: Facilitating the access of a patient to appropriate medical, rehabilitation and support programs, and coordination of the delivery of services. This role may involve liaison with various professionals and agencies, advocacy on behalf of the patient, and arranging for purchase of services where no appropriate programs are available.

Catheter: A flexible tube for withdrawing fluids from, or introducing fluids into, a cavity of the body. Frequently used to drain the urinary bladder (Foley catheter).

Cerebellum: The portion of the brain (located at the back) which helps coordinate movement. Damage may result in ataxia.

Cerebral‑Spinal Fluid (CSF): Liquid which fills the ventricles of the brain and surrounds the brain and spinal cord.

Chronic: Marked by long duration or frequent recurrence.

Circumlocution: Use of other words to describe a specific word or idea which cannot be remembered.

Client: A person under the protection of another; one who engages the professional advice or services of another. See Consumer and Patient.

Clonus: A sustained series of rhythmic jerks following quick stretch of a muscle.

Cognition: Knowing, awareness, perceiving objects, thinking, remembering ideas. The learned set of rules on which all thinking is based.

Cognitive Rehabilitation: Therapy programs which aid persons in the management of specific problems in perception, memory, thinking and problem solving. Skills are practiced and strategies are taught to help improve function and/or compensate for remaining deficits. The interventions are based on an assessment and understanding of the person’s brain‑behavior deficits and services are provided by qualified practitioners.

Coma: A state of unconsciousness from which the patient cannot be awakened or aroused, even by powerful stimulation; lack of any response to one’s environment. Defined clinically as an inability to follow a one‑step command consistently; Glasgow Coma Scale score of 8 or less.

Communicative Disorder: An impairment in the ability to 1) receive and/or process a symbol system, 2) represent concepts or symbol systems, and/or 3) transmit and use symbol systems. The impairment may be observed in disorders of hearing, language, and/or speech processes.

Community Skills: Those abilities needed to function independently in the community. They may include: telephone skills, money management, pedestrian skills, use of public transportation, meal planning and cooking.

Comprehension: Understanding of spoken, written, or gestural communication.

Concentration: Maintaining attention on a task over a period of time; remaining attentive and not easily diverted.

Concrete Thinking: A style of thinking in which the individual sees each situation as unique and is unable to generalize from the similarities between situations. Language and perceptions are interpreted literally so that a proverb such as “a stitch in time saves nine” cannot be readily grasped.

Concussion: The common result of a blow to the head or sudden deceleration usually causing an altered mental state, either temporary or prolonged. Physiologic and/or anatomic disruption of connections between some nerve cells in the brain may occur. Often used by the public to refer to a brief loss of consciousness.

Confabulation: Verbalizations about people, places, and events with no basis in reality. May be a detailed account delivered. Patient appears to make up stories about events that occurred. Patient actually believes what he or she is saying and is not trying to lie or deceive. Stories are used to fill in for information gaps or memory loss.

Confusion: A state in which a person is bewildered, perplexed, or unable to self‑orient.

Conjugate Movement: Both eyes move simultaneously in the same direction. Convergence of the eyes toward the midline (crossed eyes) is a disconjugate movement.

Continent: Voluntary control over bowel and bladder function.

Contracture: Loss of range of motion in a joint due to abnormal shortening of soft tissues.

Contra-coup: When the brain is hit with sufficient force, causing it to “bounce” against the opposite side of the skull, thereby causing injury to both the site of the impact and the part of the brain opposite the impact. (For example, if the impact is to the left frontal area, contra-cup damage may occur to the right occipital area.)

Convergence: Movement of two eyeballs inward to focus on an object moved closer. The nearer the object, the greater is the degree of convergence necessary to maintain single vision. See also vision after head injury.

Coordination: Harmonious working together of muscles or muscle groups to perform complicated movements.

Cortical Blindness: Loss of vision resulting from a lesion of the primary visual areas of the occipital lobe. Light reflex is preserved.

CT Scan/Computerized Axial Tomography: A series of X‑rays taken at different levels of the brain that allows the direct visualization of the skull and intracranial structures. A scan is often taken soon after the injury to help decide if surgery is needed. The scan may be repeated later to see how the brain is recovering.


Decerebrate Posture (Decerebrate Rigidity): Exaggerated posture of extension as a result of a lesion to the prepontine area of the brain stem, and is rarely seen fully developed in humans. In reporting, it is preferable to describe the posture seen.

Decorticate Posture (Decorticate Rigidity): Exaggerated posture of upper extremity flexion and lower extremity extension as a result of a lesion to the mesencephalon or above. In reporting, it is preferable to describe the posture seen.

Decubitus: Pressure area, bed sore, skin opening, skin breakdown. A discolored or open area of skin damage caused by pressure. Common areas most prone to breakdown are buttocks or backside, hips, shoulder blades, heels, ankles and elbows.

Diffuse Axonal Injury (DAI): A shearing injury of large nerve fibers (axons covered with myelin) in many areas of the brain. It appears to be one of the two primary lesions of brain injury, the other being stretching or shearing of blood vessels from the same forces, producing hemorrhage.

Diffuse Brain Injury: Brain damage which covers many areas of the brain rather than one specific location. Diffuse damage is common in closed-head injuries due to the brain moving about and tissue being torn, stretched and bruised.

Diplopia: Seeing two images of a single object; double vision. See also vision after head injury.

Discipline: When referring to health care or education it means a particular field of study, such as medicine, occupational therapy, nursing, recreation therapy or others.

Disinhibition: The inability to control or inhibit impulses and emotions.

Disorientation: Not knowing where you are, who you are, or the time. Often, professions use the term “oriented in all three spheres” or “oriented times three” which refers to person, place, and time.

Diplopia: Seeing two images of a single object – “double vision”

Dysarthria: Difficulty forming or articulating words. This may be caused by damage to the motor areas of the cortex or damage to the brain stem. Dysarthria may include speech that is slurred, talking extremely fast or slow, or improper pitch.

Dysphagia: A swallowing disorder characterized by difficulty in oral preparation for the swallow, or in moving material from the mouth to the stomach. This also includes problems in positioning food in the mouth.

Dyslexia: Difficulty with reading ability.

Dysphagia: Swallowing difficulties.


Edema: Collection of fluid in the brain tissue causing swelling.

Electroencephalogram (EEG): A procedure that uses electrodes on the scalp to record electrical activity of the brain. Used for detection of epilepsy, coma, and brain death.

Electromyography (EMG): An insertion of needle electrodes into muscles to study the electrical activity of muscle and nerve fibers. It may be somewhat painful to the patient. Helps diagnose damage to nerves or muscles.

Emotional Lability: Exhibiting rapid and drastic changes in emotional state (laughing, crying, anger) inappropriately without apparent reason.

Endotracheal Tube: A tube that serves as an artificial airway and is inserted through the patient’s mouth or nose. It passes through the throat and into the air passages to help breathing. To do this it must also pass through the patient’s vocal cords. The patient will be unable to speak as long as the endotracheal tube is in place. It is this tube that connects the respirator to the patient.

Evoked Potential: Registration of the electrical responses of active brain cells as detected by electrodes placed on the surface of the head at various places. The evoked potential, unlike the waves on an EEG, is elicited by a specific stimulus applied to the visual, auditory or other sensory receptors of the body. Evoked potentials are used to diagnose a wide variety of central nervous system disorders.

Executive functions: Skills that are necessary to be competent on a job such as initiation, self control, self evaluation, self correction, goal setting, prioritizing, flexibility, time management and leadership skills.

Expressive Language: Ability to communicate using spoken or printed words.

Extended Care Facility‑Basic: Residential facility which supplies 24‑hour nursing care and supervision and assistance with activities of daily life. See Program/Service Types.

Extended Care Facility‑Skilled: A residential facility for the patient who requires 24‑hour nursing care (IV, intramuscular injections, special feeding tubes, skin care, oxygen) and rehabilitative therapy, such as physical therapy, occupational therapy, or speech therapy on a less intensive basis than as an inpatient in a comprehensive rehabilitation center. An extended care facility can be a short‑term alternative (a few months) prior to placement at home (with outpatient therapy) or in a nursing home. See Program/Service Types.

Extremity: Arm or leg.


Fading: A teaching device in which a prompt is gradually removed.

Figure‑Ground: The differentiation between the foreground and the background of a scene; this refers to all sensory systems, including vision, hearing, touch.

Flaccid: Lacking normal muscle tone; limp.

Flexion: Bending a joint.

Foley Catheter: This is a tube inserted into the urinary bladder for drainage of urine. The urine drains through the tube and collects into a plastic bag.

Frontal Lobe: The areas of the brain located at the front on both the left and right sides. This area plays a role in controlling emotions, motivation, social skills, expressive language (in an area on the left side referred to as Broca’s area), and inhibition of impulses. The motor strip, controlling movement and motor integration, runs along the posterior (back) of the frontal lobe.

Frustration Tolerance: The ability to persist in completing a task despite apparent difficulty. Individuals with a poor frustration tolerance will often refuse to complete tasks which are the least bit difficult. Angry behavior, such as yelling or throwing things while attempting a task is also indicative of poor frustration tolerance.


Gainful Occupation: Includes employment in the competitive labor market, practice of a profession, farm or family work (including work for which payment is “in kind” rather than in cash), sheltered employment, work activity (to the extent that there is net pay), and home industries or other home‑bound work.

Gait Training: Instruction in walking, with or without equipment; also called “ambulation training.”

GI Tube (G-Tube): A tube inserted through a surgical opening into the stomach. It is used to introduce liquids, food, or medication into the stomach when the patient is unable to take these substances by mouth.

Generalization: The tendency, after learning a response to one stimulus, to make that response also to other similar stimuli.

Glasgow Coma Scale: A standardized system used to assess the degree of brain impairment and to identify the seriousness of injury in relation to outcome. The system involves three determinants: eye opening, verbal responses and motor response all of which are evaluated independently according to a numerical value that indicates the level of consciousness and degree of dysfunction. Scores run from a high of 15 to a low of 3. Persons are considered to have experienced a `mild’ brain injury when their score is 13 to 15. A score of 9 to 12 is considered to reflect a `moderate’ brain injury and a score of 8 or less reflects a ‘severe’ brain injury.


Head Injury: Refers to an injury of the head and/or brain, including lacerations and contusions of the head, scalp and/or forehead. See also Brain Injury.

Hematoma: The collection of blood in tissues or a space following rupture of a blood vessel. Regarding Brain:

Epidural‑‑Outside the brain and its fibrous covering, the dura, but under the skull.

Subdural‑‑Between the brain and its fibrous covering (dura).

Intracerebral‑‑In the brain tissue.

Subarachnoid‑‑Around the surfaces of the brain, between the dura and arachnoid membranes.

Hemianopsia Hemianopia: Visual field cut. Blindness for one half of the field of vision. This is not the right or left eye, but the right or left half of vision in each eye. See also vision after head injury.

Hemiparesis: Weakness of one side of the body (or part of it) due to injury to the motor areas of the brain.

Hydrocephalus: Enlargement of fluid‑filled cavities in the brain, not due to brain atrophy.

Hyperplegia: Paralysis on one side of the body.

Hyperphasia: Voracious food seeking or overeating.

Hypertonic: Abnormal increase in muscle tone. Extremely tense or unrelaxed.

Hypoxia: Insufficient oxygen reaching the tissues of the body.


Impulse Control: Refers to the individual’s ability to withhold inappropriate verbal or motor responses while completing a task. Persons who act or speak without first considering the consequences are viewed as having poor impulse control.

Incontinent: Inability to control bowel and bladder functions. Many people who are incontinent can become continent with training. See also Bowel and Bladder Training manual.

Inflexibility: The inability to adjust to everyday changes in routines, usually related to injury to the frontal lobes. Some head-injured persons may have little difficulty following a structured routine but may exhibit sudden frustration and confusion when their routine is changed.

Initiative: Refers to the individual’s ability to begin a series of behaviors directed toward a goal.

Interdisciplinary Approach: A method of diagnosis, evaluation, and individual program planning in which two or more specialists, such as medical doctors, psychologists, recreational therapists, social workers, etc., participate as a team, contributing their skills, competencies, insights, and perspectives to focus on identifying the developmental needs of the person with a disability and on devising ways to meet those needs.

Intracranial Pressure (ICP): Cerebrospinal fluid (CSF) pressure measured from a needle or bolt introduced into the CSF space surrounding the brain. It reflects the pressure inside of the skull.


Jargon: Spoken language that has a normal rate and rhythm but is full of nonsense words.

Job Analysis: Involves the systematic study of an occupation in terms of what the worker does in relation to data, people, and things; the methods and techniques employed, the machines, tools, equipment, and work aids used; the materials, products, subject matter or services which result, and the traits required of the worker.

Judgment: The process of forming an opinion, based on an evaluation of the situation at hand. “Good” judgment refers to choosing the most optimal course available. Judgment involves cognitive skills, personal values and preferences, and insight into what our abilities and disabilities are. For example, a client with judgment deficits may be able to make decisions, but the decisions may be unsafe or unsuccessful.


Kinesthesia: The sensory awareness of body parts as they move (see Position Sense and Proprioception).


Lability: State of having notable shifts in emotional state (e.g., uncontrolled laughing or crying).

Leg Bag: A small, thick plastic bag that can be tied to the leg and collects urine. It is connected by tubing to a catheter inserted into the urinary bladder. See also Bowel and Bladder Training manual.

Locked‑in Syndrome: A condition resulting from interruption of motor pathways in the ventral pons, usually by infarction. This disconnection of the motor cells in the lower brain stem and spinal cord from controlling signals issued by the brain leaves the patient completely paralyzed and mute, but able to receive and understand sensory stimuli; communication may be possible by code using blinking, or movements of the jaw or eyes, which can be spared.

Lower Extremity: The lower limbs including the hip, thigh, calf, ankle and foot.


Magnetic Resonance Imaging (MRI): A type of diagnostic radiography using electromagnetic energy to create an image of soft tissue, central nervous system and musculoskeletal systems.

Malingering: To pretend inability so as to avoid duty or work.

Memory: The process of perceiving information, organizing and storing it, and retrieving it at a later time as needed. Memory is a complex function that involves many parts of the brain working together. There are different types of memory, including immediate (repeating a phone number just related), recent (recalling what occurred the previous day), and remote (recalling the name of a childhood friend).

Memory, Episodic: Memory for ongoing events in a person’s life. More easily impaired than semantic memory, perhaps because rehearsal or repetition tends to be minimal.

Memory, Immediate: The ability to recall numbers, pictures, or words immediately following presentation. Patients with immediate memory problems have difficulty learning new tasks because they cannot remember instructions. Relies upon concentration and attention.

Memory, Long Term: In neuropsychological testing, this refers to recall thirty minutes or longer after presentation. Requires storage and retrieval of information which exceeds the limit of short term memory.

Memory, Short Term: Primary or ‘working’ memory; its contents are in conscious awareness. A limited capacity system that holds up to seven chunks of information over periods of 30 seconds to several minutes, depending upon the person’s attention to the task.

Modeling: Exhibiting a behavior which is intended to teach someone else through the observer’s imitation of the desired behavior.

Money Management: Ability to distinguish the different denominations of money, count money, make change, budget.

Motor Control: Regulation of the timing and amount of contraction of muscles of the body to produce smooth and coordinated movement. The regulation is carried out by operation of the nervous system.

Motor Planning: Action formulated in the mind before attempting to perform.

Muscle Tone: Used in clinical practice to describe the resistance of a muscle to being stretched. When the peripheral nerve to a muscle is severed, the muscle becomes flaccid (limp). When nerve fibers in the brain or spinal cord are damaged, the balance between facilitation and inhibition of muscle tone is disturbed. The tone of some muscles may become increased and they resist being stretched – a condition called hypertonicity or spasticity.


Nasogastric Tube (NG Tube): A tube that passes through the patient’s nose and throat and ends in the patient’s stomach. This tube allows for direct “tube feeding” to maintain the nutritional status of the patient or removal of stomach acids.

Neglect: Paying little or no attention to a part of the body.

Neologis: Nonsense or made‑up word used when speaking. The person often does not realize that the word makes no sense.

Neurologist: A physician who specializes in the nervous system and its disorders.

Neuropsychologist: A psychologist who specializes in evaluating (by tests) brain/behavior relationships, planning training programs to help the survivor of brain injury return to normal functioning and recommending alternative cognitive and behavioral strategies to minimize the effects of brain injury. Often works closely with schools and employers as well as with family members of the injured person.

Non‑ambulatory: Not able to walk.

Nystagmus: Involuntary horizontal, vertical, or rotary movement of the eyeballs. See also vision after head injury.


Occipital Lobe: Region in the back of the brain which processes visual information. Damage to this lobe can cause visual deficits.

Occupational Therapy: Occupational Therapy is the therapeutic use of self‑care, work and play activities to increase independent function, enhance development and prevent disability; may include the adaptation of a task or the environment to achieve maximum independence and to enhance the quality of life. The term occupation, as used in occupational therapy, refers to any activity engaged in for evaluating, specifying and treating problems interfering with functional performance.

Oral/Motor Function: Movement of the tongue, lips, jaw and palate.

Orientation: Awareness of one’s environment and/or situation, along with the ability to use this information appropriately in a functional setting. Awareness of who and where one is, who others are, time and events, etc.

Orthopedics: The branch of medicine devoted to the study and treatment of the skeletal system, its joints, muscles and associated structures.

Orthosis: Splint or brace designed to improve function or provide stability.

Outpatient: The patient residing outside the hospital but returning on a regular basis for one or more therapeutic services.

Overlearning: Continuing to work and memorizing material beyond the point which it is adequately mastered.


Paraphasia: A speech problem where there is a substitution or transposition of one sound, syllable or word for another.

Paraplegia: Paralysis of the legs (from the waist down).

Parietal lobe: The upper middle lobe of each side of the brain, involved in receiving and understanding sensations, and closely linked to speech fluency and writing.

Perception: The ability to make sense of what one sees, hears, feels, tastes or smells. Perceptual losses are often very subtle, and the patient and/or family may be unaware of them.

Perseveration: Becoming “stuck” on one work or task and not being able to switch back and forth or go on to the next word/task. (For example, a patient may be asked to draw a circle on a piece of paper. He may then be asked to draw a square, but continues drawing circles.)

Persistent Vegetative State (PVS): A long‑standing condition in which the patient utters no words and does not follow commands or make any response that is meaningful.

Phonation: The production of sound by means of vocal cord vibration.

Physiatrist: Pronounced Fizz ee at’ rist. A physician who specializes in physical medicine and rehabilitation. Some physiatrists are experts in neurologic rehabilitation, trained to diagnose and treat disabling conditions. The physiatrist examines the patient to assure that medical issues are addressed; provides appropriate medical information to the patient, family members and members of the treatment team. The physiatrist follows the patient closely throughout treatment and oversees the patient’s rehabilitation program.

Physical Therapist: The physical therapist evaluates components of movement, including: muscle strength, muscle tone, posture, coordination, endurance, and general mobility. The physical therapist also evaluates the potential for functional movement, such as ability to move in the bed, transfers and walking and then proceeds to establish an individualized treatment program to help the patient achieve functional independence.

Pica: Ingestion of nonfood substances.

Plasticity: The ability of cellular or tissue structures and their resultant function to be influenced by an ongoing activity.

Plateau: A temporary or permanent leveling off in the recovery process.

Polypharmacy: Indiscriminant, symptomatic prescribing of medications by one, and sometimes multiple physicians with little or no consideration given to the etiology of the symptom(s). This is very common in the treatment of remote TBI, where the brain injury may not be mentioned in current medical records, having been replaced by psychiatric diagnoses.

Post Traumatic Amnesia (PTA): A period of hours, weeks, days or months after the injury when the patient exhibits a loss of day‑to‑day memory. The patient is unable to store new information and therefore has a decreased ability to learn. Memory of the PTA period is never stored; therefore things that happened during that period cannot be recalled. May also be called Anterograde Amnesia.

Posture: The attitude of the body. Posture is maintained by low‑grade, continuous contraction of muscles which counteract the pull of gravity on body parts. Injury to the nervous system can impair the ability to maintain normal posture, for example holding up the head.

Pre‑Morbid Condition: Characteristics of an individual present before the disease or injury occurred.

Presupposition: Ability to identify a problem, consider relevant information, explore possible solutions, and select the best solution for a given situation.

Problem‑Solving Skill: Ability to consider the probable factors that can influence the outcome of each of various solutions to a problem, and to select the most advantageous solution. Individuals with deficits in this skill may become “immobilized” when faced with a problem. By being unable to think of possible solutions, they may respond by doing nothing.

Prognosis: The prospect as to recovery from a disease or injury as indicated by the nature and symptoms of the case.

Program/Service Types: The following program/service categories describe the array of organized services (not mutually exclusive) and not an exhaustive list available for the rehabilitation of persons with brain injury:

Acute Rehabilitation: Based in a medical facility; accepts patient as soon as medically stable; focuses on intensive physical and cognitive restorative services in early months after injury; typical length of stay one week to several months (short term); identifiable team and program with specialized unit.

Behavior Disorders: For the patient exhibiting patterns of behavior preventing participation in active rehabilitation, including destructive patient behavior to self and others; continuum of controlled settings.

Community Integration Program: Provides services designed to accomplish functional outcomes focused on home and community integration, including productive activity. Services may be provided in residential facilities, day treatment programs, and the consumer’s home. They may be of short‑term (several weeks) or long‑term duration (several months).

Independent Living: Community‑based to maximize a person’s ability to be empowered and self‑directed; allows an individual to live in one’s own home with maximum personal control over how services are delivered, combined with the opportunity to work as appropriate.

Lifelong Living: For persons discharged from rehabilitation who need ongoing lifetime supports; located in residential or skilled nursing environment; structured activities available on individual and group basis.

Residential Services: Assumes a 24‑hour residential environment outside the home and includes 24‑hour provision of or access to support personnel capable of meeting the client’s needs. (Adopted by the PostAcute Committee of ISIG on Head Injury October 28, 1991.)

Subacute: May follow a period of acute rehabilitation; not necessarily hospital based; typical length of rehabilitation stay 6‑24 months (short to intermediate term); stay based on demonstrated improvement; identifiable team and program with specialized unit.

Supervised Living: Setting is a home which is like other homes in the neighborhood in terms of size and number of residents. Consumers are provided individualized care, supervision, support and training services to maximize and/or maintain function and self‑direction. Staff is present at night and other times when the consumer is present.

Supported Independent Living: Setting is a home chosen by the consumer who is primarily independent. Program offers support to assist the resident in maximizing and/or maintaining independence and self‑direction. Staff is available as needed and at planned intervals to offer assistance and support but not to provide supervision.

Transitional Living: Non‑medical residential program providing training for living in a setting of greater independence. The primary focus is on teaching functional skills and compensating for abilities that cannot be restored.

Vocational Evaluation: An organized and comprehensive service staffed by specialists who systematically and comprehensively utilize work activities (real or simulated) and/or educational services as the focal point for educational and vocational assessment and exploration. In addition, psychological testing, counseling, social summaries, occupational information, etc., are other evaluation tools that are used. It incorporates the medical, psychological, social, vocational, educational, cultural, and economic data for establishment and attainment of individual goals.

Prone: Lying on one’s stomach.

Proprioception: The sensory awareness of the position of body parts with or without movement. Combination of kinesthesia and position sense.

Proximal Instability: Impaired strength or muscle tone of the trunk, shoulder girdle, or hip girdle. This can cause poor posture, abnormal movement of the limbs, inability to sit up and inability to hold one’s head up, caused by damage to the motor strip of the brain.

Problem Solving: The ability to evaluate all of the factors involved when faced with a problem, and to generate and evaluate possible solutions. Clients with deficits in this area may “freeze” when faced with a problem; i.e. they may not be able to think of possible solutions and instead will respond by doing nothing.

Post-Traumatic Amnesia (PTA): A loss of memory that occurs immediately after injury, and which may continue for weeks or months. During this time, many clients are unable to organize or retrieve information. The length of PTA is regarded as an indicator of eventual recovery.

Psychologist: A professional specializing in counseling, including adjustment to disability. Psychologists use tests to identify personality and cognitive functioning. This information is shared with team members to assure consistency in approaches. The psychologist may provide individual or group psychotherapy for the purpose of cognitive retraining, management of behavior and the development of coping skills by the patient/client and members of the family.


Quadriparesis: A weakness which involves all four limbs.


Range of Motion (ROM): Refers to movement of a joint (important to prevent contractures).

AROM — The amount of motion at a joint when the person uses his/her muscle strength to move it.

PROM — The amount of motion at a joint when someone else passively moves it.

Reasoning, Abstract: Mode of thinking in which the individual recognizes a phrase that has multiple meanings and selects the meaning most appropriate to a given situation. The term “abstract” typically refers to concepts not readily apparent from the physical attributes of an object or situation.

Reasoning, Concrete: The ability to understand the literal meaning of a phrase.

Reasoning, Problem‑Solving: The ability to analyze information related to a given situation and generate appropriate response options. Problem‑solving is a sequential process that typically proceeds as follows: identification of problem; generation of response options; evaluation of response option appropriateness; selection and testing of first option; analysis as to whether solution has been reached. A patient/client may discontinue making a cup of coffee because the sugar bowl is empty, even though sugar is readily available in a nearby cabinet. A patient/client may easily navigate his way into a room crowded with furniture, but request staff assistance to navigate his way out.

Reasoning, Sequencing: The ability to organize information or objects according to specified rules, or the ability to arrange information or objects in a logical, progressive manner. Nearly every activity, including work and leisure tasks, requires sequencing. For example, in cooking certain foods it is important that ingredients be added and mixed in a specified order; in dressing, undergarments must be put on prior to outer garments.

Recreation Therapist: Individual within the facility responsible for developing a program to assist persons with disabilities plan and manage their leisure activities; may also schedule specific activities and coordinate the program with existing community resources.

Rehabilitation: Comprehensive program to reduce/overcome deficits following injury or illness, and to assist the individual to attain the optimal level of mental and physical ability.

Rehabilitation Counselor: Also called Vocational Counselor. A specialist in social and vocational issues who helps the patient develop the skills and aptitudes necessary for return to productive activity and the community.

Rehabilitation Facility: Agency of multiple, coordinated services designed to minimize for the individual the disabling effects of one’s physical, mental, social, and/or vocational difficulties and to help realize individual potential.

Rehabilitation Nurse: A nurse specializing in rehabilitation techniques as well as basic nursing care. Nurses assist the patient and family in acquiring new information, developing skills, achieving competence and exhibiting behaviors that contribute to the attainment of a healthy state.

Reinforcement: A consequence of a response that increases the probability of that response occurring again.

Retrograde Amnesia: Inability to recall events that occurred prior to the accident; may be a specific span of time or type of information.


Seizure: An uncontrolled discharge of nerve cells which may spread to other cells nearby or throughout the entire brain. It usually lasts only a few minutes. It may be associated with loss of consciousness, loss of bowel and bladder control and tremors. May also cause aggression or other behavioral change.

Sensation: Feeling stimuli which activate sensory organs of the body, such as touch, temperature, pressure and pain. Also seeing, hearing, smelling and tasting.

Sensorimotor: Refers to all aspects of movement and sensation and the interaction of the two.

Sensory Integration: Interaction of two or more sensory processes in a manner that enhances the adaptiveness of the brain.

Sequencing: Reading, listening, expressing thoughts, describing events or contracting muscles in an orderly and meaningful manner.

Shaping: Inducing an individual to make a completely new response by reinforcing gradually closer and closer approximations to it.

Sheltered Workshop: A work setting certified as such by the Wage & Hour Division. It provides transitional and/or long‑term employment in a controlled and protected working environment for those who are unable either to compete or to function in the open job market due to their disabilities. May provide vocational evaluation and work adjustment services.

Shunt: A procedure to draw off excessive fluid in the brain. A surgically‑placed tube running from the ventricles which deposits fluid into either the abdominal cavity, heart or large veins of the neck.

Somatosensory: Sensory activity having its origin elsewhere than in the special sense organs (such as eyes and ears) and conveying information to the brain about the state of the body proper and its immediate environment.

Spasticity: An involuntary increase in muscle tone (tension) that occurs following injury to the brain or spinal cord, causing the muscles to resist being moved. Characteristics may include increase in deep tendon reflexes, resistance to passive stretch, clasp knife phenomenon, and clonus. An abnormal increase in muscle tone, causing the muscles to resist being stretched. A client with spasticity may look “curled up,” with arms held close to his chest, or may appear very stiff.

Spatial Ability: Ability to perceive the construction of an object in both two and three dimensions. Spatial ability has four components: the ability to perceive a static figure in different positions, the ability to interpret and duplicate the movements between various parts of a figure, the ability to perceive the relationship between an object and a person’s own body sphere, and the ability to interpret the person’s body as an object in space.

Speech‑language Pathology Services: A continuum of services including prevention, identification, diagnosis, consultation, and treatment of patients regarding speech, language, oral and pharyngeal sensorimotor function.

Spontaneous Recovery: The recovery which occurs as damage to body tissues heals. This type of recovery occurs with or without rehabilitation and it is very difficult to know how much improvement is spontaneous and how much is due to rehabilitative interventions. However, when the recovery is guided by an experienced rehabilitation team, complications can be anticipated and minimized; the return of function can be channeled in useful directions and in progressive steps so that the eventual outcome is the best that is possible.

Subdural: Beneath the dura (tough membrane) covering the brain and spinal cord.

Supine: Lying on one’s back.

Suppository: Medicine contained in a capsule which is inserted into the rectum so that the medicine can be absorbed into the blood stream.


Tactile Defensiveness: Being overly sensitive to touch; withdrawing, crying, yelling or striking when one is touched.

Tangential Response: A correct response is elicited from the person and it is followed by excessive extraneous information which is not related to the response or stimulus.

Task Analysis: Breakdown of a particular job into its component parts; information gained from task analysis can be utilized to develop training curricula or to price a product or service.

Temporal Lobes: There are two temporal lobes, one on each side of the brain located at about the level of the ears. These lobes allow a person to tell one smell from another and one sound from another. They also help in sorting new information and are believed to be responsible for short‑term memory.

Right Lobe‑‑Mainly involved in visual memory (i.e., memory for pictures and faces).

Left Lobe‑‑Mainly involved in verbal memory (i.e., memory for words and names).

Token Economy: An arrangement for behavior modification in which appropriate behavior is reinforced with tokens that can later be exchanged for desired activities, objects, or treats (reinforcers).

Tracheostomy: A temporary surgical opening at the front of the throat providing access to the trachea or windpipe to assist in breathing.

Tracking, Visual: Visually following an object as it moves through space. See also vision after head injury.

Tremor, Intention: Course, rhythmical movements of a body part that become intensified the harder one tries to control them.

Tremor, Resting: Rhythmical movements present at rest and may be diminished during voluntary movement.


Unilateral Neglect: Paying little or no attention to things on one side of the body. This usually occurs on the side opposite from the location of the injury to the brain because nerve fibers from the brain typically cross before innervating body structures. In extreme cases, the patient may not bathe, dress or acknowledge one side of the body.

Urinary Tract Infection: When bacteria have reproduced to a large number in the bladder. This can cause fever, chills, burning on urination, urgency, frequency, incontinence or foul smelling urine.


Verbal Apraxia: Impaired control of proper sequencing of muscles used in speech (tongue, lips, jaw muscles, vocal cords). These muscles are not weak but their control is defective. Speech is labored and characterized by sound reversals, additions and word approximations.

Vestibular: Pertaining to the vestibular system in the middle ear and the brain which senses movements of the head. Disorders of the vestibular system can lead to dizziness, poor regulation of postural muscle tone and inability to detect quick movements of the head.

Visual Field Deficit: Not visually perceiving information in a specific area of the visual field. Often this involves either the left or right half of the field of vision, but may involve a quarter of the visual field, etc.


via Glossary of Brain Injury Terms | FINR

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[WEB SITE] Local rehabilitation center uses virtual reality to help patients

SPOKANE, Wash. — Virtual reality technology makes it possible to visit a new world, or test drive a new ride from the comfort of your home. But it offers more than just a good time.

Saint Luke’s Rehabilitation Institute is using our region’s first ever virtual reality driving simulator to provide patients with rehab exercises.

“There’s a lot of anxiety of even though they’ve been told by a therapist that they can drive, or that they might be ok to drive, they still have that question of ‘am I ready’ or ‘is this safe?'” St. Luke’s Occupational Therapist Devin Hatch said. “This allows them to get more comfortable.”

Hatch said their virtual reality simulator helps patients who have suffered a stroke, spinal cord or brain injury re-learn safe driving skills before trying it out in reality.

“There was no real good bridge between actual driving and in-clinic stuff,” Hatch said. “So this has given us the bridge to cover the gap of what we do in the clinic and actual on the road driving.”

The VR driving simulator allows Hatch to assess his patient’s brain injury with steering and braking, and how they manage typical distractions they would experience on the road. Scenarios range from city driving to country roads.

“It’s nice to see what people are coming up with and how we can apply that to a health care setting to let people practice things without putting anyone at danger,” Hatch said.

© 2018 KREM-TV

via Local rehabilitation center uses virtual reality to help patients |

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[BLOG POST] Alcohol, Seizures and Brain Injury

A drunk driving accident.  A fight at a bar after a night of drinking.  A serious tumble at home after a few too many.  Many brain injury survivors received their brain injuries while under the influence of alcohol.  In fact, studies have shown that between 35% and 81% of traumatic brain injuries occur in individuals who had been drinking at the time of their injuries.  Doctors and therapists routinely recommend that survivors abstain from alcohol after a brain injury but some survivors choose to ignore this advice. Drinking after a brain injury though carries with it fresh and frighteningly dangerous risk.  Namely, such unwise behavior invites the post-injury seizure.

In general, brain injury survivors are more prone to developing a seizure disorder than are people without brain injuries.  Depending on the severity and location of a traumatic brain injury, research shows post-traumatic brain injury seizure rates to sit somewhere between 2% and 50%.  Similarly, post-stroke seizure rates range between 5% and 20%.  Both of these are significantly higher than the seizure rate found in the general populace.

Unfortunately, alcohol can increase the likelihood and frequency of post-injury seizures.  Clinical research has consistently shown alcohol to lower the threshold above which a seizure will occur.  Alcohol also interferes with the performance of anti-seizure medication, which of course increases the risk of seizure in those who depend on its assistance.  As a seizure is at base a potentially life-threatening medical issue, anything that might raise the likelihood of seizures should be avoided.

Overall, it is smart for many reasons to avoid consuming alcohol after an injury.  The enhanced risk of seizure stands alone among these reasons though in both gravity and consequence, and as such should be granted special consideration.

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


via Alcohol, Seizures and Brain Injury | The Transitional Learning Center’s Blog

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[BLOG POST] Flying with a brain injury: my first long flight – Finding a new normal

Flying is my least favourite mode of transportation. Unfortunately it’s also the most convenient way to travel outside of Europe.

After my brain injury I was very curious about whether or not I’d still be able to fly (by myself). This called for an experiment.

Trying out flying

My first flight was a year and a half after my brain injury. At that time I could handle far less compared to the situation now. I had far less energy and got overstimulated very easily. Or maybe I had yet to discover how I should handle the ‘new me’.

So I avoided places with a lot of people. As fifteen minutes in a busy place would deteriorate my speech, thinking and balance quickly. Flying thus was written of in advance.

Luckily someone told me about the special assistence you can request when you plan to fly. This service makes it easier for people with any kind of disability to travel by plane. Once requested in advance, someone will escort you all the way into the plane. Which means that you get a lot faster through the airport and can save some precious energy. This service made flying suddenly a possibility.

And as a result I had two succesful flights within Europe. Which meant that it was time for the next step. To take a long flight and to try it without any kind of assistance.

A ten hour flight

That long flight was my flight to Sri Lanka last week. This time, not the airport but the flight itself was the most challenging. In the airport I had my earplugs, noise cancelling headphones and sunglasses and could hide out in a quiet corner. I even made a reservation for an airport lounge to rest in, which almost made me forget I was at an airport.

In the plane however, you can’t leave. Blocking out the world is a whole lot harder if there’s nowhere for you to go. This made the flight challenging, thought the last three hours of turbulance might also be to blame. Still I learned some lessons for my next flight in five weeks.

Know your triggers

I always find travel days extremely stressful. Nine out of ten times this culminates in a panic attack. This time was no different. Thankfully I recognised I was having a panic attack early on, so I could do something about it.

Follow your gut

If you notice that you stress yourself out over something, try and do something about it. I kept chaecking my watch every other minute, because I was afraid to be late. After an hour of annoying myself I finally decided to just go to the airport way too early. Looking back I should have done that earlier.

Plan your route

Nowadays, I think you can find the map of almost all airports online. This means that you can plan where to go in advance. Knowing where the lounges, quiet areas or prayer rooms are located beforehand can give you some piece of mind. Once you’ve passed security at the airport you already know the shortest way to where you plan to rest.

Keep a choice of distractions ready

Once you’re seated in the plane, it’s a matter of sitting it through. Of waiting until the plane has landed and you can get off. I discovered that I can’t read or watch tv on a plane. My mp3 player is therefore filled with different kinds of music. Music to sleep, to distract or to cancel out other noises. Make sure you have the option of distractions for the duration of the flight.

Keep yourself hydrated

Any time you get offered a drink on the plane, take it. Not only will it help you to stay hydrated (so don’t pick an alcoholic drink) it’ll force you to go to the toilet. In other words to stand up and walk around.

After care

The second or third day after the flight, I’ll feel the consequences. So listen to your body. If you need to sleep for 12 hours, do that. If you crave sugary or salty snacks, have those. Flying is hard and challenging, so take some recovery days into account and allow yourself some rest.

– I can only speak from my own exprience, so do check with your doctor if you have specific requirements to take into account when flying –

What do you do when you fly? Do you have or need something special that really helps you?

via Flying with a brain injury: my first long flight – Finding a new normal

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[BLOG POST] Parenting After Brain Injury – Neuro Landscape


While there are no prerequisites for the job, parenthood is a lifelong responsibility. It is also one of the most fulfilling and important roles a person can have in life. Brain injury, unfortunately, impacts individuals without regard to their roles and responsibilities.

Persons with brain injury are challenged in their ability to care for themselves, much less others, making parenting more difficult. Yet, in order to achieve long-term success post-injury, family reintegration, including parenting, is imperative. And the best way to achieve this is through skill redevelopment during postacute rehabilitation.

The Basics Still Apply, Before and After Brain Injury

Parenting requires the ability to not only care for oneself, but to do so often in deference to caring for children. Parents are frequently required to subjugate their needs and wishes to the importance of providing for the well-being, nurturing, education, safety, development, and future of their children.

This requires a mindful approach, planning with a spouse or partner, or managing alone with family and friends to provide for housing, food, clothing, and education all the while seeking to instill family and societal values. Most parents want their children to be safe and to have a future that is the same as or better than their own.

Raising children presents a range of personal challenges to most parents. It may require developing a willingness for selflessness while acquiring skills as a teacher, mentor, role model, and disciplinarian, at least. Many couples acknowledge that arriving at a parenting style can be arduous and the source of conflict in their relationship as they negotiate stylistic differences and determine and articulate behavioral, educational, value, and moral expectations for their children.

Relearning Parenting Skills is Vital to Family Integration

After brain injury, however, individuals tend to become more focused on themselves, and fail to provide the same kind of parenting approach/skills as they exerted prior to injury. They are likely to be much less involved in child rearing, in general, failing to participate in determining, communicating, and facilitating goals for their children. These responsibilities either are not met well, or fall entirely to a non-injured spouse, partner, or family member.

Active discussions must be undertaken with an individual and/or couple to raise awareness of the importance of assessment and intervention for parenting skills, and to actively intervene to redevelop such skills and focus within the family. Family members must be relied upon to build an understanding of parenting skills and styles prior to injury as well as parenting-related family dynamics so as to serve as goals for treatment.

These efforts must focus not only on reacquisition of parenting styles and skills, but also on parental engagement with children in accordance with the manner in which they engaged prior to injury. Finally, teaching must include knowledge of common reactions children may have to the temporary or permanent loss of a parent to injury. Counseling can be extremely effective in raising awareness of these issues and changing behaviors within a family system. Counseling can incorporate other family members such as spouses/partners, children themselves, or key extended family members with meaningful insights such as close aunts/uncles or grandparents. Re-engagement within a family system to the various roles one played prior to injury is critical to the long-term success of family reintegration.


via Parenting After Brain Injury – Neuro Landscape

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