Posts Tagged brain injury
Following encephalitis and acquired brain injury, driving has been a very tricky thing to reintroduce into the mix. In the early days of recovery, my vision problems played a big role in my decision to simply not attempt to get behind the wheel. My vision could be blurry, full of black spots, at times I would lose my peripheral vision, I’d struggle to refocus and I’d often had what I call delayed vision. Vision obviously plays a big role with driving, but I also discovered that other factors were to be considered. My reaction time was greatly reduced so I was mindful that all my reflexes were far from being optimized. Driving is also one of the most cognitively demanding exercise. It requires a huge amount of concentration, attention, and multi-tasking. In normal circumstances, much of the multi-tasking used to happened instinctively for me, but following brain injury, I discovered that it was no longer the case.
Whilst taking into account all these reasons, my partner and I made the decision for me not to drive in the early stage of recovery. I’d walk or bike places, I’d be driven places or simply stay home. Having a young family, driving meant that I’d typically carry a very special cargo with me and we established that it simply wasn’t worth the risk. Risking getting myself injured was one thing, but risking others being injured wasn’t something that bode well with me. With me not driving came a HUGE loss of independence and it made the family daily routine quite tricky. The weeks had to be planned down to a tee to figure out who/how we’d get the kids to their after school activities, who/how I’d get myself to appointments, do the groceries and so on. It was all very limiting and highly frustrating.
As months went by, I was slowly starting to regain some brain capacity and some of the residual effects were lessened or not “showing up” as frequently so we started to introduce short distance drives within a 5km radius, then 10km radius and so on.
Even then though, I’d base my decision to drive on the amount of brain energy available at that particular point in time. I soon discovered that I could get to a specific place ok, but that completing an additional task (e.g. grocery shopping) meant that I was using up a lot of my brain energy. Therefore, I didn’t always have the brain capacity to drive back safely. That lead to several hard to managed scenarios. How do I then get back? If I get picked up, how do we bring the car back and so on. So after a few trials, we put driving places that included additional cognitively demanding tasks on ice for a while longer. To manage this limitation, I’d grab rides into town with friends & I started doing pretty much all of my shopping online (so lucky to have that option nowadays). I almost always found a way to get out and about, but that loss of independence was another loss I had to learn to accept and manage on top of everything else. It had a negative impact on my sense of self-worth, my feeling of accomplishment and so much more! I knew I was making the right decision, but it also triggered lots of mixed feelings.
Years have now passed since the original brain insult, but driving remains an activity that isn’t considered lightly. Sometimes, I’ll find myself napping in the car before coming back home, some days I’ll postpone a trip into town for another time, I’m still planning my weeks around when/where I may have to drive, driving distances are still managed very carefully and I’ll still grab rides when possible. Every now and again, I still need to be rescued and I’m still avoiding driving at night as if my life depends on it…because it probably does.
It’s really hard to explain to others what this delayed vision feels like. But I hope the following photos give you a bit on an insight as to how the world truly appears to me when the brain slows down and stops processing things normally. It is always pretty scary when it happens and I think you’ll agree with me saying that driving therefore not always an option.
The Brain Injury Dictionary
Common and uncommon terms and acronyms to help navigate the complex world of brain injury.
Rhythmic auditory stimulation (RAS) has been well researched with stroke survivors and individuals who have Parkinson’s disease, but little research exists on RAS with people who have experienced traumatic brain injury (TBI). This pilot study aimed to (1) assess the feasibility of the study design and (2) explore potential benefits. This single-arm clinical trial included 10 participants who had a 2-week control period between baseline and pretreatment. Participants had RAS daily for a 2-week treatment period and immediately completed post-treatment assessments. Participants then had a 1-week control period and completed follow-up assessment. The starting cadence was evaluated each day of the intervention period due to the variation in daily functioning in this population. All 10 participants were 1-20 years post-TBI with notable deviations in spatial-temporal aspects of gait including decreased velocity, step symmetry, and cadence. All participants had a high risk of falling as defined by achieving less than 22 on the Functional Gait Assessment (FGA). The outcome measures included the 10-m walk test, spatial and temporal gait parameters, FGA, and Physical Activity Enjoyment Scale. There were no adverse events during the study and gait parameters improved. After the intervention, half of the participants achieved a score of more than 22 on the FGA, indicating that they were no longer at high risk of experiencing falls.
In acknowledgment of Brain Injury Awareness Month this March, we shed light on how brain injury occurs, bodily systems it can affect, and factors that influence recovery.
17 MAR 2021
Although many recognize the term “brain injury”, its varied causes and effects are less understood. In acknowledgment of Brain Injury Awareness Month this March, this article will shed light on the many ways a brain injury can occur, bodily functions that can be impacted by brain injury, as well as factors that influence brain injury recovery.
- What are the different types of brain injury?
- What are the effects of a brain injury?
- What are the long-term outcomes of a brain injury?
What are the different types of brain injury?
Brain injury can be classified according to when and how the injury occurred.
Congenital: A brain injury that is present from birth. Types of congenital brain injuries include Chiari malformation, encephaloceles, and anencephaly. Cerebral palsy is most often a congenital brain injury as well.
Acquired: A brain injury that occurs after the time of birth.
Traumatic: A brain injury that occurs due to an external force acting upon the brain. This can result from causes including a fall, a blow to the head, whiplash, or a penetrating force like a bullet or knife.
Non-traumatic: A brain injury that occurs due to an internal force or event. This can result from causes including a stroke, a brain tumor, an infection, or oxygen deprivation.
Additional Classifications of Brain Injury
In addition to the categories above, brain injuries can be further distinguished by their impact (mild, moderate, or severe), whether the skull is intact or broken at the time of injury, and whether the injury occurs in a localized or widespread area.
It is not necessary for survivors to understand the nature of their injury in this much detail. However, what is most important for anyone to note is that due to the variability surrounding brain injury, survivors can not be stereotyped. No two brain injuries are alike, and not all survivors are affected the same way by their injury.
What are the effects of a brain injury?
A brain injury can have very different effects based on where it occurred in the brain. Here are some bodily functions that can be affected by brain injury:
Movement: An injury to one side of the brain can affect movement on the opposite side of the body. Some brain injury survivors experience hemiplegia, or one-sided weakness that interferes with their ability to use their arms and legs.
Other movement-related effects of a brain injury include ataxia or incoordination, apraxia or problems with planning movement, and loss of the sense of balance.
Speech: Brain injury can cause difficulties in both producing and understanding speech. If the brain injury caused facial muscle weakness, an individual may have difficulty making the correct lip movements to form words clearly.
Brain injuries affecting specific speech centers can result in aphasia, or an inability to form or interpret language that is not due to muscle weakness.
Thinking: The brain regulates cognitive processes that control behavior, also known as executive functions. Dependent on the area that was damaged, a brain injury survivor may have difficulty with skills including attention, memory, problem-solving, and self-control.
Brain injuries can also affect a person’s insight, impacting a survivor’s awareness of their own condition or happenings in the world around them.
Vision: Brain injuries affecting vision centers can affect the ability to see. Some can cause visual neglect, where visual structures are intact but the brain is no longer able to attend to one half of the visual field. Other brain injuries can cause temporary or permanent vision loss in part or all of the visual field.
Brain Injury: An Invisible Disability
Brain injuries are sometimes referred to as invisible disabilities because their effects are not always readily apparent. Although it is often easy to spot a broken bone due to a cast or crutches, a brain injury survivor’s limitations might not be noticeable at first glance.
It is important to be aware that brain injuries can cause obvious or subtle performance deficits; however, do not assume that a brain injury survivor needs help unless they have specifically asked for assistance. Know that many survivors do not have limitations in daily functioning. Others use adaptive strategies or solutions that allow them to be independent through a different route.
What are the long-term outcomes of a brain injury?
It is not possible to perfectly predict long-term physical or cognitive outcomes of a brain injury. Factors including older age at the time of injury and greater severity and extent of damage are associated with reduced independence. However, there are many variables that a brain injury survivor can control to positively influence their recovery potential.
Timely therapy treatment improves outcomes: Multiple studies have found that earlier and more rehab results in better outcomes for acute brain injury. As a brain injury can affect multiple body systems, it is important to get evaluated by physical, occupational, and speech therapists right away as their treatments can lay the groundwork for a successful recovery.
Individuals who are further out from an initial brain injury can still benefit from rehabilitation. Multiple studies show that those with chronic brain injury can still make significant changes in areas including motor function following intensive training programs.
Exercise improves outcomes: Survivors do not need to be in a therapy program to engage in exercise that is helpful to their recovery. Many exercises promoting neuroplasticity, or the brain’s ability to reorganize itself to regain lost functions, can be performed at home with everyday objects.
In addition to strengthening muscles and keeping weight under control, exercise is shown to boost mood and perceived quality of life after brain injury, two factors that positively influence recovery.
Social support improves outcomes: Social support is one of the most important elements that can influence brain injury recovery. Research reveals that stronger social networks after brain injury can reduce depression and increase activity participation.
Social support can take many forms, whether it is immediate family, friends in the community, or a virtual peer network. Although it can seem difficult or daunting, evidence points to the payoff in building solid relationships for better quality of life.
Looking for a fun and effective brain injury rehabilitation solutions? Check out the Neofect Smart Pegboard, a dexterity training tool incorporating varied shapes, lights, and sounds for functional fine motor training.
Seeking a system targeting thinking skills? Neofect Cognition contains 45 games spanning multiple domains of executive function, with an adaptive level control ensuring that training is just the right challenge for each user.
Call us at (888) 623-8984 or email us at email@example.com to learn more!
Posted by Debbie Overman
Treating patients with an injection of bone marrow cells may lead to a reduction in brain injury after a stroke, according to results from a clinical trial published in STEM CELLS Translational Medicine.
“Nearly 90 percent of patients who suffer an ischemic stroke – the most common type of stroke – exhibit weakness or paralysis to one side of the body. Injuries to the corticospinal tract (CST), which is the main white matter connection in the brain responsible for carrying movement-related information to the spinal cord, is the primary cause of this motor function impairment. In stroke animal models, we’ve seen how bone marrow mononuclear cells (BM-MNC) attenuate secondary degeneration and enhance recovery, including white matter tract remodeling. That led us to our current study.”
— Muhammad E. Haque, PhD
Hague, along with Sean I. Savitz, MD, and colleagues from the Institute for Stroke and Cerebrovascular Disease at The University of Texas Health Science Center in Houston, conducted the study.
Previously, the team led by Dr. Savitz had conducted a phase I clinical trial on the safety and feasibility of intravenous administration of autologous (a patient’s own) bone marrow-derived mononuclear cells (BM-MNCs) in patients with ischemic stroke. In that study, they reported preliminary CST recovery in the part of the brain stem called the rostral pons.
In their current work, they delved deeper into this intriguing finding by using 3D anatomical and DTI images obtained from MRI scans to compare extensive longitudinal microstructural changes in the white matter of BM-MNC-treated stroke patients to a group who did not receive the cells. (DTI – or diffusion tensor imaging – is an MRI technique that is most commonly used to examine the brain and estimate its white matter organization.)
CST Improvement from Injections
The 37 patients in the study ranged in age from 18 to 80. While all received the standard stroke treatment and rehabilitation follow-up, 17 patients whose strokes were the most severe received the additional BM-MNC injections. Three months later, MRI scans of each patient showed, as the researchers expected, a decrease in the integrity of their CST. However, scans taken 12 months after the stroke occurred showed an improvement in the CST of the 17 patients who received injections. Conversely, the CST of the non-injected group exhibited ongoing and continuing microstructural injury and axonal degeneration.
“These results suggest the possibility of microstructural stabilization in the cell-injected group as compared with the non-treated patients. We envision that future clinical trials might be directed toward identifying white matter protection or repair as an important mechanistic target of efficacy studies and potency assays for bone marrow cell therapies.”
— Muhammad E. Haque, PhD
[Source(s): Alphamed Press, EurekAlert]
Injury disclosure is a very personal decision, and I often review this with my clients prior to commencing the job-search process. First of all, the job goal you are aiming for needs to be suitable to maximise your chances of success. Does the job goal utilise some of your strengths? Are you able to complete the inherent requirements of the role? Inherent requirements are the essential requirements of the job. For example, if you are applying for a job as a truck driver, but you do not have a truck licence, the employer is under no obligation to hire you, whether you have a disability or not. You must be qualified for the job you are applying for. If you are qualified for the job, but your disability means that you may struggle with some aspects of it, the employer is required to make ‘reasonable accommodations’ to enable you to do the work. For countries who have anti-discrimination laws, the employer could be found to be discriminating if they do not hire you (or if they fire you) because of disability-related issues if it is found that job modifications, equipment, etc., could have been provided to enable you to do the work, and you can fulfil the inherent requirements of the work. In Australia and America, anti-discrimination laws do not require an employer to make adjustments or accommodations if the cost of doing so would be unreasonable. For example, if installing an elevator would be the only way to enable an employee with a disability to access areas of a worksite that were essential to the job, but the cost of providing the elevator was excessively high, it could be considered unreasonable to expect the employer to do this. Anti-discrimination laws may differ in each country, so it is important to know your rights.
It is also important to have medical approval from your specialist to confirm that you are medically fit to work. If the job you wish to undertake is safe, suitable, and sustainable, you will need to consider whether you want to disclose your injury or disability to the employer. Some people may choose to disclose during the application process. Some may choose to disclose during the interview process or after they get the job. Some may choose not to disclose at all.
Employers receive many applications for one vacant position, and I personally believe that the decision to interview someone following receipt of their application should be based on skills. If, however, you will need some significant (yet reasonable) work adjustments, they may take some time to implement, so advising the employer early on can build trust and facilitate a plan for your commencement. Approaching the discussion with a solution-focused framework will help your negotiations.
If the workplace modifications you require are less costly, such as an ergonomic chair, or are practical accommodations, such as adjusting work hours to cope with fatigue, it may be better to have those conversations at the interview, rather than in your application for the job.
If you have developed effective memory management strategies and other strategies to manage your injury limitations and have trialled your ability to cope with the work, you may not need to disclose your injury. This is a personal decision. If your injury is related to work insurance, however, you should talk to a lawyer regarding what you may be required by law to disclose on a job application form that seeks information about work-related injuries. This will differ between countries.
By Nicole Yeates, Best-selling author of Holding on to Hope, Finding the ‘New You’ after a Traumatic Brain Injury
Let’s talk about sex…
“Sex after a stroke is tricky, but you don’t have to just do the missionary position.”
Let’s talk about sex…
It’s one of the most natural things in the world, yet intimacy and sex are still seen as taboo subjects that many of us don’t feel comfortable talking about.
Throw disability into the mix and there seems to be a stony silence pervading the scene. There also appears to be an implicit reluctance, including among the professional world, to acknowledge and address the fact that having a disability does not stop feelings of wanting romance, intimacy and sex.
Brain injury, as we well know, affects people both physically and in ‘hidden’ ways such as cognitively, psychologically, emotionally and behaviourally. All of these effects can have an impact on the brain injury survivor and their sexual partner’s feelings towards sex.
Here, we discuss the challenges that having a brain injury can pose when it comes to having a healthy sex life, as well as how to address the issues head-on and work towards ending the myths around brain injury and sex.
Okay, so we all know that sex is the rumpy-pumpy hanky-panky business that typically takes place between the bed sheets. But sex isn’t just about the physical act.
Sex has different elements that make it a much more intimate and psychologically fulfilling process, while also having a basic reproductive purpose that comes down to pure biology. So all in all, what is sex?
Sex is sometimes divided into two aspects of sexual functioning: the physical aspect of sex (such as sexual arousal, intercourse and orgasm…the ‘rumpy-pumpy’ stuff, if you will), and sexual well-being, which relates to the emotional and psychological aspect of sex such as sexual satisfaction. It also includes acts of intimacy such as touching and kissing.
But sex refers to more than just physicality. Complex emotional, psychological and social customs, such as forming romantic relationships in the first instance, are often involved in both initiating and having sex. The act of sexual intercourse itself is both physical and emotional.
Finally, there is no single definition of the word sex – it can mean different things to different people, depending on personal experience, values, personality and preferences.
Sex and the brain
So what does the brain have to do with sex? Actually, a lot! The brain is responsible for processing the feelings and sensations that are a core part of a sexual experience.
Different parts of the brain are involved in things such as the behaviour and social skills we use to meet and interact with a sexual partner, and our personality and overall interest in sex. These aspects can all be affected by a brain injury.
Sexual relationships after brain injury
Couples who already shared a sex life before the occurrence of a brain injury commonly find that the injury affects one or both party’s interest or ability to have sex.
This in turn can cause difficulties in the relationship such as feelings of loss and a lack of fulfilment. But in some circumstances, can fear play a part?
Anna Smith-Higgs suffered a life changing stroke aged 24, just one month after her son was born. She was left partially paralysed down her right-hand side, has mobility issues and is partially sighted.
Anna, now 38, said following her stroke sex was the last thing on her mind.
“I couldn’t accept what I’d become,” said Anna. “I’d gone from being a fit 24 year old with everything to look forward to, to struggling to change my child’s nappy.
“Before my stroke I had a very active sex life, but afterwards I spent months in bed and was scared to move, terrified that I’d have another stroke. At that point I was battling depression and I didn’t want to know or partake in sex at all.”
‘Communication is the key’
Anna said sex after having a stroke can be extremely scary and fill you full of doubts.
“My stroke was due to hormones from child birth so I was scared of sex as getting pregnant again was my biggest fear.
“I would also worry in case an orgasm increased my blood pressure. I worried that with only half of my body working to its full capacity, the sex wouldn’t be the same as it was before. I doubted that I wouldn’t be able to perform the way I once did.
“These fears got so bad that my partner and I just didn’t do it. This left both of us frustrated. It just wasn’t a very nice way to live.
“But with time I realised that all these worries were not worth thinking about. I realised that no, my blood pressure won’t increase; no, I won’t be able to perform like I did before. But that doesn’t mean my sex life is over.”
Anna said communicating with her partner about how she was feeling was the key.
“You have to try and not feel self conscious, you need talk to your partner, no matter how uncomfortable you may be feeling,” said Anna.
“It not only helps bring you closer as a couple but you will probably find your partner is feeling the same. A strong relationship can survive anything. It turned out my partner was just as scared as me the first time we had sex after my stroke.”
Anna said sex after a brain injury can still be fulfilling.
“Sex after a stroke is tricky but you don’t have to just do the missionary position. Why would I just lay there and get no pleasure at all. You need to experiment and find positions that work for the both of you.”
Anna said taking up burlesque dancing was also a massive help to build up her confidence and feel sexy again.
She said: “I found my confidence through burlesque. I now perform as a disabled performer. I don’t care that I am disabled and overweight – I embrace it.
Anna said her biggest advice about sex after brain injury is not to be put off.
“Talk to your partner and try to keep things relaxed. Things are going to fail but that shouldn’t put you off, try again. Oh and most importantly, have fun.”
Top tips for managing sexual relationships after brain injury
- Try to identify if a particular effect of brain injury is causing the sexual issues, such as fatigue, pain or psychological effects. Read up on ways of coping with these effects and seeking professional support for them, for instance from Headway’s booklets and factsheets at www.headway.org.uk/information-library
- Both your body and your brain need time to prepare for sexual activity, so don’t rush into having sex. Instead, set time aside and make sure there are no distractions in the environment, and start off by engaging in activity such as touching and kissing to create a sense of intimacy.
- Seek support from professionals, such as your GP, a sex and relationship therapist, a neuropsychologist or the Headway helpline.
- Be adventurous! Having a disability, physical or otherwise, does not mean that you cannot try out new things and explore other ways of having sex.