Posts Tagged brain injury

[WEB SITE] 10 things not to say to someone with a brain injury

10 things not to say to someone with a brain injury

 But you don’t look disabled!

Living with a brain injury presents a wide range of challenges, but one of the most difficult things for many survivors is the lack of understanding from the people around them.

Because of this, people with a brain injury often face comments from well-meaning family members, friends and strangers that only add to the frustration of living with a complex and often invisible condition.

To help address the problem, we asked our members to share their experiences of this and, judging by the responses we received, it’s clear this is an issue many people face! Here’s the top ten list of things not to say to someone living with a brain injury…

I know what you mean…I’ve got a terrible memory too!

For people who don’t have a brain injury, it can be difficult to imagine the reality of living with a memory problem. After all, we all forget things, but an injury to the brain can stop memories being stored and/or retrieved, meaning people genuinely can’t remember. Being forgetful and having memory problems as a result of brain injury are worlds apart!

Despite the best intentions, saying things like ‘I have a terrible memory too’ risks showing a lack of understanding and can come across as patronising and offensive.

But you don’t look disabled…

Brain injury is often referred to as ‘the hidden disability’ because the cognitive, emotional and behavioural effects can still be present long after any physical injuries have healed.

Don’t assume that just because someone looks fine on the outside, they’re not experiencing long-term effects. Comments such as: ‘It doesn’t look like there’s anything wrong with you’ and ‘But you’re better now, aren’t you?’ are unlikely to help!

Move on and stop dwelling on what happened.

One to avoid at all costs! The effects of a brain injury can last for weeks, months, years, or even a lifetime. Improvements may happen through the natural healing process, rehabilitation, hard work or a combination of these, but a person can’t simply decide to ‘get better’ and move on.

Encouragement and support are the best ways you can help people maximise their recovery after brain injury.

You should be back to normal by now.

Two big problems with this one!

Assessing the effects and likely outcomes of a brain injury challenges even the most experienced doctors, so receiving this advice is likely to result in an angry response. Yes, the injury may have occurred ‘a while ago’, but the recovery process is different for everyone and for some people the effects of a brain injury may last a lifetime.

At the same time, the word ‘normal’ can inadvertently cause offence. What is normal? Suggesting a person is not ‘normal’ again could lead to feelings that they are somehow inferior.

For someone living with a long-term condition, that’s not nice to hear!

You’re tired? At your age?!

A surprising number of people experience comments along these lines. Fatigue is a very real and very debilitating effect of a brain injury, but because it’s often almost completely invisible, it’s perhaps understandable that people don’t immediately pick up on the difficulties it can cause.

Living with fatigue is very different to the normal feeling of tiredness we all experience at the end of a busy day. It requires careful management and the support and understanding of friends, family and colleagues.

It’s all in your mind!

A brain injury does affect the mind, but unfortunately not in a way that means a person can just decide to get better. Damage to the brain cannot be repaired, and any recovery is a result of the brain adapting to change and finding new ways to work.

This isn’t something that can be controlled by simple conscious thought so there’s little more frustrating for a person with a brain injury than being told to ‘snap out of it’!

Chin up – there’s always someone worse off.

This common line is certainly well-meaning, with a clear intention to make the person with a brain injury feel better about their situation and encourage positive thinking.

But when dealing with everyday fatigue, memory problems, difficulty concentrating or anything else from the long list of brain injury symptoms, it doesn’t always help to know that some people are dealing with worse.

Instead of saying ‘It could’ve been worse’, a better approach might be simply to acknowledge their difficulties, offering help if it’s needed.

Are you sure you should be doing that?

An essential part of the rehabilitation process is relearning lost skills by pushing yourself to do challenging tasks. It’s often better to give things a go than simply accept defeat, so having your ability judged by someone else can be extremely frustrating. It’s great to offer help and support in case the person with a brain injury can’t manage a task, but tread carefully when judging ability.

One of the key aims of Headway is to help people regain as much independence as possible. Brain injury survivors don’t want people to do everything for them – they want help to be able to do things themselves.

I know someone who had a brain injury and they’re fine now.

This comes down to something many people don’t understand – no two brain injuries are the same! Even two people with very similar injuries may experience totally different effects, and while it can be a motivation to hear of other people making good progress, it certainly isn’t helpful to be judged for not recovering as quickly as them.

But you were able to do that yesterday…

People who say this don’t realise the fluctuating nature of a brain injury, which is often down to fatigue. In some cases it can be because they did a task yesterday that they can’t today.

Pushing too hard after a brain injury can cause difficulties for hours or even days afterwards, and this is a time when support and understanding is needed more than ever.

 

via 10 things not to say to someone with a brain injury | Headway

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[WEB SITE] New APTA-Supported CPG Looks at Best Ways to Improve Walking Speed, Distance for Individuals After Stroke, Brain Injury, and Incomplete SCI

(Journal of Neurologic Physical Therapy, January, 2020)

The message
A new clinical practice guideline (CPG) supported by APTA and developed by the APTA Academy of Neurologic Physical Therapy concludes that when it comes to working with individuals who experienced an acute-onset central nervous system (CNS) injury 6 months ago or more, aerobic walking training and virtual reality (VR) treadmill training are the interventions most strongly tied to improvements in walking distance and speed. Other interventions such as strength training, circuit training, and cycling training also may be considered, authors write, but providers should avoid robotic-assisted walking training, body-weight supported treadmill training, and sitting/standing balance that doesn’t employ augmented visual inputs.

The study
The final recommendations in the CPG are the result of an extensive process that began with a scan of nearly 4,000 research abstracts and subsequent full-text review of 234 articles, further narrowed to 111 randomized controlled trials (RCTs), all focused on interventions related to CNS injuries, with outcome data that included measures of walking distance and speed. CPG panelists evaluated the data and developed recommendations, which were informed by data on patient preferences and submitted for expert and stakeholder review.

Development of the CPG was supported through an APTA-sponsored program that assists APTA sections — in the case, the Academy of Neurologic Physical Therapy — in the development stages such as drafting, appraisal, planning, and external review (for more detail on the program, visit APTA’s CPG Development webpage).

Findings

  • Moderate- to high-intensity (60%-80% of heart rate reserve or up to 85% of heart rate maximum) walking training was associated with the strongest evidence for improvements in walking speed and distance.
  • Walking training using VR also fared well, due in part to the ability of a VR treadmill system to allow “safe practice of challenging walking activities,” something that’s hard to do in a more traditional hospital or clinic setting.
  • Strength training, while not included among the interventions that should be performed, was designated as an intervention that may be considered. Authors cite inconsistent evidence on the connection between strength training and improved walking speed and distance, but they acknowledge potential benefits.
  • Also among the list of interventions that “may be considered”: circuit training, as well as cycling training. In both cases, authors cite a paucity of evidence related to how the interventions affect walking speed and distance. They note that these interventions may be revisited during a future reevaluation of the CPG.
  • Body-weight supported treadmill training was labeled as an intervention that should not be performed in order to increase walking speed and distance, with authors finding little evidence supporting the approach, which is often associated with a greater cost. However, they write, the individuals included in the studies reviewed for the CPT were able to ambulate over ground without the use of a body-weight support device, and “different results may occur in those who are nonambulatory or unable to ambulate without the use of [body-weight support].”
  • Both static and dynamic (nonwalking) balance training and robotic-assisted walking training were also characterized as interventions that should not be performed. Authors acknowledge the ways that postural stability and balance are associated with fall risk and reduced participation, but they were unable to find sufficient evidence to support these particular interventions as effective in increasing walking speed and distance (although static and dynamic balance training with VR fared a bit better). As for robotic-assisted walking training, CPG authors note that while ineffective for individuals with CNS who were already ambulatory, “this recommendation … may not apply to nonambulatory individuals or those who require robotic assistance to ambulate.”

Why it matters
Authors note that “the implementation of evidence-based interventions in the field of rehabilitation has been a challenge,” and they believe that the new CPG offers a real opportunity for clinicians to “integrate available research into their practice patterns.” Further, they believe that the CPG has arrived at an important moment in the evolution of health care, with its greater emphasis on evidence for the cost-effectiveness and outcomes of various interventions.

More from the study
The CPG also offers tips for clinicians to implement its recommendations, including acquiring equipment to help providers monitor vital signs, implementing “automatic prompts in electronic medical records that will facilitate obtaining orders to attempt higher-intensity training strategies,” providing training sessions for clinicians, establishing organizational policies to promote use and documentation of the recommended interventions, and simply keeping a few copies of the study on hand for easy reference.

Keep in mind …
Authors acknowledged that the CPG has a few limitations. While the review of RCTs only is a strength, they write, some of those studies involved small sample sizes, and many lacked details on intervention dosage. Additionally, the CPG does not fully address the potential costs associated with its recommendations — specifically VR — which could impact a clinic’s ability to implement a particular intervention. Authors also acknowledge that walking speed and distance are not the only important outcomes related to mobility among individuals with CNS injury, and that other factors such as dynamic stability while walking, peak walking capacity, and community mobility may be incorporated in an assessment of walking function.

via New APTA-Supported CPG Looks at Best Ways to Improve Walking Speed, Distance for Individuals After Stroke, Brain Injury, and Incomplete SCI

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[WEB SITE] Neurobehavioral Challenges After Brain Injury

The effects of neurological damage from events like trauma and stroke can be devastating to the individual and those close to them. Brain injury can result in lifelong physical, cognitive, and behavioral changes. The impact of behavior changes can profoundly alter how the injured person functions day to day, even impeding rehabilitative goals and impacting the ability to live independently. Changes in personality and behavior following traumatic brain injury (TBI) often represent the most significant barrier to a successful outcome including reintegration into the community whether for basic daily tasks, work or recreational/social activities.

Common behavior issues following brain injury include behavioral excesses (occurring too much) such as irritability (e.g., poor tolerance, short temper) and aggression (e.g., hitting, grabbing, kicking), property destruction (e.g., striking furniture, throwing items) and inappropriate vocalizations (e.g., cursing, yelling, threats). Also presenting a concern are behavior deficits (do not occur enough) such as compliance with tasks (e.g., cooperation with requests), social skills (e.g., overfamiliar discussions, uncharacteristically rude remarks), initiation (e.g., knowing when to begin tasks) and the academic and return to work skills (e.g., being on time, following directions) to be successful. Some of the most difficult behaviors can be dangerous to the patient and others around them. Treating these dangerous and challenging behaviors, which may include physical aggression toward others, self-injurious behavior, sexual disinhibition, and escape or elopement, requires a treatment commitment across the continuum of care.

In the early, acute stages of recovery from brain injury, many of the behavioral complications demonstrated are considered to be a normal phase of recovery. When these behaviors continue beyond those early phases, however, and form on-going negative patterns of interaction with others, very specialized treatment is required.  These behaviors can be disturbing to families and staff, disruptive to therapy, and jeopardize patient safety. The future quality of life for the patient and their family depends on effective interventions, provided with a great deal of consistency and structure. Behavior analysts (professionals in Applied Behavior Analysis) add value to interdisciplinary rehabilitation teams by helping to develop both skill acquisition and behavior reduction programs throughout the patient’s recovery (i.e., acute, post-acute, long term care). Behavior analysts spend a great deal of time directly observing interactions, determining what may be motivating the difficult behaviors, and what responses may need to be strengthened and reinforced. The behavior analyst must then provide training to all those who may interact with the patient, including most importantly, the family. This skilled, specialized intervention establishes more effective and acceptable response patterns that allow the patient to have their needs met and be better understood without displaying problem behavior. The structured behavior plan can also help the patient develop positive, prosocial responses, and more efficient functional skills.

The effects of brain injury are highly individual, which then challenges the behavior analysts, family and others on the treatment team to continually evaluate the responses, goals, and outcomes throughout recovery (e.g., monitoring response to new medications).

Considering the risk to patients and families, the rising healthcare cost and the possibility of reduced services being available, a focus on efficient and effective interventions such as behavior analysis seems essential to a well-integrated, interdisciplinary rehabilitation treatment team. The quality of life for those affected by brain injury depends on having the opportunity to receive not just the standard rehabilitation one might get following knee surgery but rather specialized, experienced and effective treatment specifically designed to address the unique difficulties they face including difficult behavior.

via Neurobehavioral Challenges After Brain Injury | CNS Traumatic Brain Injury Rehabilitation

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[VIDEO] Managing Fatigue After A Brain Injury – YouTube

via Managing Fatigue After A Brain Injury – YouTube

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[ARTICLE] Clinical Practice Guideline to Improve Locomotor Function Following Chronic Stroke, Incomplete Spinal Cord Injury, and Brain Injury

Abstract

Background:

Individuals with acute-onset central nervous system (CNS) injury, including stroke, motor incomplete spinal cord injury, or traumatic brain injury, often experience lasting locomotor deficits, as quantified by decreases in gait speed and distance walked over a specific duration (timed distance). The goal of the present clinical practice guideline was to delineate the relative efficacy of various interventions to improve walking speed and timed distance in ambulatory individuals greater than 6 months following these specific diagnoses.

Methods:

A systematic review of the literature published between 1995 and 2016 was performed in 4 databases for randomized controlled clinical trials focused on these specific patient populations, at least 6 months postinjury and with specific outcomes of walking speed and timed distance. For all studies, specific parameters of training interventions including frequency, intensity, time, and type were detailed as possible. Recommendations were determined on the basis of the strength of the evidence and the potential harm, risks, or costs of providing a specific training paradigm, particularly when another intervention may be available and can provide greater benefit.

Results:

Strong evidence indicates that clinicians should offer walking training at moderate to high intensities or virtual reality–based training to ambulatory individuals greater than 6 months following acute-onset CNS injury to improve walking speed or distance. In contrast, weak evidence suggests that strength training, circuit (ie, combined) training or cycling training at moderate to high intensities, and virtual reality–based balance training may improve walking speed and distance in these patient groups. Finally, strong evidence suggests that body weight–supported treadmill training, robotic-assisted training, or sitting/standing balance training without virtual reality should not be performed to improve walking speed or distance in ambulatory individuals greater than 6 months following acute-onset CNS injury to improve walking speed or distance.

Discussion:

The collective findings suggest that large amounts of task-specific (ie, locomotor) practice may be critical for improvements in walking function, although only at higher cardiovascular intensities or with augmented feedback to increase patient’s engagement. Lower-intensity walking interventions or impairment-based training strategies demonstrated equivocal or limited efficacy.

Limitations:

As walking speed and distance were primary outcomes, the research participants included in the studies walked without substantial physical assistance. This guideline may not apply to patients with limited ambulatory function, where provision of walking training may require substantial physical assistance.

Summary:

The guideline suggests that task-specific walking training should be performed to improve walking speed and distance in those with acute-onset CNS injury although only at higher intensities or with augmented feedback. Future studies should clarify the potential utility of specific training parameters that lead to improved walking speed and distance in these populations in both chronic and subacute stages following injury.

Disclaimer:

These recommendations are intended as a guide for clinicians to optimize rehabilitation outcomes for persons with chronic stroke, incomplete spinal cord injury, and traumatic brain injury to improve walking speed and distance.

TABLE OF CONTENTS

INTRODUCTION AND METHODS

Summary of Action Statements………………………………………………..53

Levels of Evidence and Grade of Recommendations…………………54

Methods………………………………………………………………………………….57

ACTION STATEMENTS AND RESEARCH RECOMMENDATIONS

Action Statements…………………………………………………………………..63

Discussion…………………………………………………………………………….79

Conclusions…………………………………………………………………………..82

Summary of Research Recommendations……………………………….83

ACKNOWLEDGMENTS AND REFERENCES

Acknowledgments…………………………………………………………………84

References……………………………………………………………………………84

TABLES AND FIGURE

Table 1: Levels of Evidence for Studies……………………………………54

Table 2: Standard and Revised Definitions for Recommendations………………..54

Table 3: Example of PICO Search Terms for Strength Training………………….58

Table 4: Survey Results………………………………………………….59

Figure 1: Flow chart for article searches and appraisals…………………….60

Table 5: Final Recommendations for Clinical Practice Guideline on Locomotor Function…..79

APPENDIX: EVIDENCE TABLES

Appendix Table 1: Walking Training at Moderate to High Aerobic Intensities…….91

Appendix Table 2: Walking Training With Augmented Feedback/Virtual Reality…….92

Appendix Table 3: Strength Training……………………………………….93

Appendix Table 4: Cycling and Recumbent Stepping Training……………………94

Appendix Table 5: Circuit and Combined Exercise Training…………………….95

Appendix Table 6A: Balance Training: Sitting/Standing With Altered Feedback/Weight Shift……..96

Appendix Table 6B: Balance Training: Augmented Feedback With Vibration………..97

Appendix Table 6C: Balance Training: Augmented Visual Feedback……………….98

Appendix Table 7: Body Weight–Supported Treadmill Walking………………99

Appendix Table 8: Robotic-Assisted Walking Training………………………..100

[…]

 

Continue —-> Clinical Practice Guideline to Improve Locomotor Function Fo… : Journal of Neurologic Physical Therapy

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[BLOG POST] Exercise can help your brain injury, not just your muscles – #jumbledbrain

Having suffered a car accident, I had some serious injuries. These included my spine, nerves and my brain. I had foot drop, where when you raise your leg, you can not raise your foot from your ankle, leaving it to hang limply. That means you cannot put any weight on it and it will not offer any support or flexibility. On top of this, due tExerciseo a damaged nerve in my neck, and had weakness down my left side. However after 10 days, the hospital team got me walking with crutches, and sent me home.

I knew that I needed to do some exercise to help rebuild some of my strength. But what I didn’t know was how good exercise is for your brain as well.

We all know that the more you practise at something, the better you will get at it. Well, the brain is just the same. Every time you perform an action, you are creating the building blocks for a new pathway in your brain. Let me give you an example. I used to love painting and drawing. But following my  brain injury, I could barely write legibly. For me this was depressing, as my art was a part of who I was. My partner James, kept badgering me to keep trying although I felt he just didn’t understand. I couldn’t make my hand follow the instructions I gave it properly, leaving me frustrated.

Exercise doesn’t mean you have to hit the gym. Just practise a physical activity.

So many sheets of paper ended up in the bin. (I would like to apologise to the trees who were sacrificed  for my cause.) But in time my writing improved, and I found my artistic flair returning to me. Just by reminding the muscles in my hand and arm how to behave, I had begun to regain my skill. But it wasn’t because the muscles needed to be rebuilt, it was because my brain needed to create new pathways to replace those that were damaged. This is the same process as when you learn a skill for the first time, and why your mother always said “practise makes perfect.” The more we do an action, the more the brain prioritises building pathways which make a shortcut to that action.

Now I know you are saying “but Michelle drawing and writing isn’t exercise.” And yes you are right, but I wanted to share this example with you to help you see that although there is the physical muscles movements, there is much more that needs to happen and I think we can all agree agree creativity is something very much in your brain.

Think about how in sports there is a tactical element, spacial awareness, problem solving… the list goes on.

Think of your favourite teams and how some are better at the element of surprise than others. This is the players having to read the current situation and apply the tactics that they have been practising all whilst dealing with how their opponents are trying to stop them. Yes it helps to be the fastest and strongest person on the pitch, but if you can’t get your timing, accuracy and game plan right, you’re going to still struggle. And whilst you might take the feedback from your coach with, you can only get better at these things by going out there and trying again. Ths that’s why exercise can help your brain injury recovery for other parts of the brain too.

I’m now 5 years on from my accident, and most people wouldn’t notice my slight limp. For someone who struggled to walk for so long, that’s not bad. I still have nerve damage, and I may do for the rest of my life, but I can deal with it. I’d be frightened to go skiing again, but it doesn’t affect my everyday life much at all. Yes I get pain and tire much easier, but I can cope with that.

My brain is still trying to repair my cognitive skills. Bearing in mind I couldn’t read or write to start with, I think it’s fair to say it’s doing a pretty good job. I even set up this website all by myself even though I had no experience of doing this sort of thing before. (If you are thinking of starting a blog but aren’t sure where to start head over to Starting a blog following a brain injury is difficult, but it is achievable to get some ideas on how to get going.)

No matter what your fitness level, or sporting ability never underestimate the importance of exercise.

You don’t need to run like you’re Mo Farah, just find something you enjoy which you can fit into your busy schedule. Dance, yoga and swimming are all great options. As evidence is growing to show regular exercise can stave off dementia, your brain will thank you for it. We all have days when just getting out of bed is an achievement, so don’t feel any shame in taking it easy. But just remember your efforts will encourage enhancements in much more than just becoming physically stronger. Your mental health and general well being will benefit too. Exercise can help your brain injury recovery process and you might even discover a talent for something new that you never knew you had.

Other articles you may like:

What exercises have you found most beneficial following your brain injury?

via Exercise can help your brain injury, not just your muscles #jumbledbrain

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[WEB PAGE] I’m clawing my way back from a brain injury, so please be patient

ILLUSTRATION BY ASHLEY WONG

First Person is a daily personal piece submitted by readers. Have a story to tell? See our guidelines at tgam.ca/essayguide.

I was 35 years old when the inoperable arteriovenous malformation (AVM) in my brain was first diagnosed.

After years of headaches and cervical pain (which I later found out were small cerebral hemorrhages), and after years of being told by doctors that I suffered from stress headaches, migraines and poor coping skills, the undiagnosed vascular grenade in my head finally blew.

I lost the feeling and movement on the left side of my body, and the vision in my left eye doubled – I saw two of everything. I lost my balance and my co-ordination. It was a hard thing for a previously healthy young woman – a mother, nurse, wife and go-getter – to deal with.

Time, rehabilitation, physiotherapy, a lot of sweat and tears … those losses all came back – maybe not as good as they had once been, but they came back.

That was 18 years ago. A lot has happened since then.

I hear voices, but I am learning to ignore them

Running nearly killed me, but it also saved my life

Over the years, as I experienced repeat bleeding, endured radiation and battled brain swelling, I lost and rebuilt many many things.

I lost my career (I was a military nursing officer), my husband to divorce, my confidence – and more than just a little bit of who I was.

Brain injury is a thief. A silent and invisible thief.

When the brain is first injured, little thought is given, in those first crisis stages, to feelings. There is just no time to worry about the emotional when the fight is on to save brain function.

However, in my all-too-informed opinion, the emotional fallout of brain injury can be just as important as the physical in the long run.

I don’t presume to speak for everyone. More than any other organ, the brain remains a mystery; it’s unique to each person. Some brain-injury survivors suffer no deficits at all, others simply never come back. And some, like me, get stuck somewhere between who we once were and who we are eventually going to be.

The first thing I want people to know is that I am still here. No, I am not the same. I have lost pieces of myself. I may never again be exactly who I was and who you knew, but I am still here.

I am still me.

I am, I have to admit, a little slower than I was. My processing speed is seriously messed up. I will no longer be the nurse who can juggle multiple patients or the mother who can hike and bike and keep up with her two busy sons. But I will always have that deep need to help others that all nurses have, and I will always love my sons and family as I always have.

Those parts of me remain.

So, have patience with the slower me. And have patience with the tired me.

Of all of the things that have proven unbeatable and intractable on this long journey is the fatigue. It is pathological and relentless and well … embarrassing. If you catch me napping in the afternoon (and I now must do so almost every afternoon), please do not go out of your way to make me feel lazy or indulgent. My brain – energy suck that it is – is simply working overtime, rewiring and rerouting signals; doing whatever a brain must do when its normal pathways have been obliterated.

I also ask that you forgive the new unpredictable me.

I will have good days and I will have bad days. There are days when I won’t answer the phone and days that an unexpected headache will send me into hiding. I will inevitably cancel plans. I will skip an appointment or bail on lunch or refuse an invitation.

Please, don’t take it personally.

I now have a hair-trigger head. Sometimes, it seems that any little thing can set it off. The weather can be my enemy, a certain type of food, too much activity.

With all that my poor brain went through, I now have to deal with this thing called “flooding” – which I’ve since learned is a common brain injury outcome for those like me. My normal brain filters are all but fried and can no longer muffle or regulate incoming (or outgoing, unfortunately) information as it once did. Too much noise, too many lights, too many people, too much anything is all amplified in my head. Too much unregulated input can all too quickly turn into a roar, a buzz that will shut me down, make me stutter and become so overwhelming that I can’t find words, I mess up and I lose things.

So please, don’t rush me.

Sit down and join me in my quiet, now slower world. I am good in the quiet – deserted beaches are my happy place – and still quite social when there are only one or a few people to interact with.

I may not always be able to join you in your world, but I do hope that you will choose to join me in mine every once in a while. For, while it may not be as exciting or as busy as yours, this is where you will find me – a little broken, perhaps, and with a few pieces missing – but you will find me.

I’m still here.

Brenda Lloyd lives in Frankford, Ont.

via I’m clawing my way back from a brain injury, so please be patient – The Globe and Mail

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[WEB SITE] Understanding & Communicating Your Emotions After Brain Injury – BrainLine

Part I

After injury, survivors and their family members often experience a variety of strong emotions. Many people describe feeling frustrated, angry, or sad about changes following the injury. Others talk about feeling worried or scared about what will happen in the future. Some people notice that their emotions change quickly, “like a roller coaster.” Feeling misunderstood is also common. Strong emotions can weaken your ability to solve problems, handle challenges effectively, and get along with others. Recognizing, understanding, and controlling your feelings can be very difficult.

This is part of a series of articles focusing on intense feelings and how to manage them effectively. In this article, we’ll present Parts I and II. Part I covers understanding and identifying your emotions. Part II covers barriers to communicating about your feelings.  Part III, a separate article, will focus on ways to manage intense emotions effectively.

The first step in controlling your emotions is recognizing how you feel and noticing when your emotions get in the way. If you can figure out how you’re feeling early on, you can get your feelings under control faster and more easily. Then you’ll be able to feel better and reach your goals more efficiently.

Take a moment to think about how you feel. Below, check off the sentences that describe you:

  • I often feel frustrated.
  • I get angry easily.
  • I can’t do much to make things better.
  • I don’t like much about myself.
  • I worry a lot.
  • I have made many mistakes.
  • I worry about the future.
  • I’m lonely.
  • I believe I am at fault for many of my family’s problems.
  • I feel sad.
  • I cry over the least little thing.
  • People don’t understand me.
  • I feel overwhelmed.
  • My feelings change from minute to minute.
  • I get upset easily.
  • Very few people care about me.
  • I have many fears.
  • I feel like I should be doing more.
  • I’m disappointed in myself.
  • I wish my life could be the way it was before.
  • I am often grouchy.
  • Sometimes I feel I’m on top of the world.

Review the items you’ve checked and the ones you haven’t to better understand your feelings. The more items you’ve checked, the more likely it is that you are experiencing many different and strong emotions. Is there a pattern to the items you’ve checked? Show your checklist to someone you know and trust. Do you agree on the items that should be checked?

Once you recognize how you feel, you can take steps to help yourself cope with the emotions effectively. Talking about your feelings is an important first step to feeling better. But, many people have trouble talking about their feelings.

In Part II (below), we’ll talk about common barriers that keep people from talking with others about their feelings.

Part II

Talking about your feelings may be difficult. People often say they worry about what others will think of them. Others say they don’t know who to turn to or who they can trust. Think about what gets in the way of talking to others about your feelings. The following questionnaire will help you figure out the answer. Circle T (True) or F (False) to figure out the challenges you face in talking about your emotions.

T  F        1. My feelings change from day to day.

T  F        2. Nobody understands what I am going through.

T  F        3. I feel uncomfortable around other people.

T  F        4. I’m worried about what others think of me.

T  F        5. Nobody cares about me.

T  F        6. I have a hard time describing my feelings.

T  F        7. I don’t want to burden people with my feelings.

T  F        8. I feel uncomfortable talking about my feelings.

T  F        9. I don’t know where to turn for help.

T  F        10. I can’t hide my feelings like I used to.

T  F        11. I’m afraid to show my true feelings.

T  F        12. I don’t want to upset people by talking about my feelings.

T  F        13. I’m afraid to let my guard down.

T  F        14. I keep my feelings bottled up.

T  F        15. I don’t know how I’m feeling.

T  F        16. I don’t feel anything anymore.

Look over your answers with family, friends, or trusted professionals. Think about the main issues that are getting in the way of talking about your feelings.

  • Is it that you feel like other people don’t understand you or don’t care?
  • Do you feel uncomfortable around other people or uncomfortable talking about feelings?
  • Do you have trouble recognizing how you feel or describing your feelings to other people?
  • Do you worry about being able to trust others with personal information?

Each of these issues may get in the way of you talking to others about your feelings. Remember that talking to others about your feelings is a big step toward feeling better. Often, you need support from others to be able to deal with difficult emotions, so you can handle your responsibilities effectively.

Asking for help lets people know that you value their support and involvement and offers chances to build relationships. Talk to trusted family, friends, and professionals about your feelings and about ways to cope with strong emotions. They may be able to give you some good ideas about ways to cope with your feelings.

We’ve talked to lots of survivors and their families to find out ways they cope with strong feelings. Here are a few strategies that have worked for other people. Look over this list and pick out which ones you think will work for you and your family:

  • Remember that ups and downs are normal parts of life. Realize that your feelings are a common, normal response to your experience. Try to look forward to the ups!
  • Stop the cycle before your emotions get too intense. Watch out for early warning signs of intense emotions. It’s harder to calm down once they get out of control.
  • Intense emotions often come in response to stress. Monitor your stress level and take steps to control your stress. Some stress management strategies actually work well for dealing with intense emotions too.
  • Be hopeful and positive. Say positive things to yourself and others (e.g., “I will make it through this,” “I’m trying my hardest,” “I’m a good person”). Try to keep a good sense of humor.
  • Recognize the difficulties and challenges you face, and how hard you are working to make things better. Give yourself credit when you control your emotions and express your feelings in positive ways.

Emotional Adjustment Project

Virginia Commonwealth University’s TBI Model System includes a research project to better understand how to look at emotional adjustment after brain injury. Participants for this study need to have had a traumatic brain injury and be at least 18 years old. If you have questions about the project or would like to be involved, please call Jenny Marwitz at: (804) 828-3704 or toll free (866) 296-6904, or email her at jhmarwit@vcu.edu.

Part III

Managing Intense Feelings

After injury, survivors and their family members often experience a variety of strong emotions. Many people describe feeling frustrated, angry, or sad about changes following the injury. Others talk about feeling worried or scared about what will happen in the future. Some people notice that their emotions change quickly, “like a roller coaster.” Feeling misunderstood is also common. Strong emotions can weaken your ability to solve problems, handle challenges effectively, and get along with others.

Recognizing, understanding, and controlling your feelings can be very difficult. The first step in controlling your emotions is recognizing how you feel and noticing when your emotions get in the way. If you can figure out how you’re feeling early on, you can get your feelings under control faster and more easily. Then you’ll be able to feel better and reach your goals more efficiently.

Take a moment to think about how you feel. On the list below, mark the sentences that describe you:

  •  I often feel frustrated.
  •  I get angry easily.
  •  I can’t do much to make things better.
  •  I don’t like much about myself.
  •  I worry a lot.
  •  I have made many mistakes.
  •  I worry about the future.
  •  I’m lonely.
  •  I believe I am at fault for many of our problems.
  •  I feel sad.
  •  People don’t understand me.
  •  I feel overwhelmed.
  •  My feelings change from minute to minute.
  •  I get upset easily.
  •  Very few people care about me.
  •  I have many fears.
  •  I feel like I should be doing more.
  •  I’m disappointed in myself.
  •  I wish my life could be the way it was before.
  •  I am often grouchy.

Review the items you’ve checked and the ones you haven’t to better understand your feelings. The more items you’ve checked, the more likely it is that you are experiencing many different and strong emotions. Is there a pattern to the items you’ve checked? Show your checklist to someone you know and trust. Do you agree on the items that should be checked?

Once you recognize how you feel, you can take steps to help yourself cope with the emotions effectively. We’ve talked to lots of survivors and their families to find out ways they cope with strong feelings. Here are a few strategies that have worked for other people. Look over this list with trusted family, friends, or professionals and pick out which ones you think will work for you and your family:

  •  Remember that ups and downs are normal parts of life. Realize that your feelings are a common, normal response to your experience. Try to look forward to the ups!
  •  Remember that you have the power to control your emotions. You can choose to change the way you feel and the way you react. Your ability to control strong emotions will get better with practice.
  •  Stop the cycle before your emotions get too intense. Watch out for early warning signs of intense emotions. It’s harder to calm down once they get out of control.
  •  Be hopeful and positive. Say positive things to yourself and others (e.g., “I will make it through this,” “I’m trying my hardest,” “I’m a good person”). Remember that persistence is the best way to solve your problems and avoid failure. Try to keep a good sense of humor.
  •  Count your blessings. Think about things you are thankful for. Recognize positive feelings, good things about yourself, and changes for the better.
  •  If you can’t do something to make the situation better, don’t make it worse. Sometimes you may feel like there’s nothing you can do to make the situation better. Try to avoid doing silly things that may make the situation worse. Doing nothing may be better.
  •  Intense emotions often come in response to stress. Monitor your stress level and take steps to control your stress. Some stress management strategies actually work well for dealing with intense emotions too.
  •  Avoid thinking too much about your feelings. Instead, focus on positive steps you can take to feel better.
  •  Put yourself in the other person’s shoes. Try to understand other people’s points of view. Think about how they will feel in response to your actions or words. Remember that hurting others won’t make your life better, make people like you, or help you get what you want.
  •  Don’t say or do the first thing that comes to mind. Take a deep breath. Count to ten. Get into the habit of thinking about what you want to say or do before you say or do it.
  •  Wait and deal with problems when you are calm. Strong emotions will keep you from thinking clearly. Calm yourself down first — count to 10, take a break, or do something relaxing and fun. Then, think about the consequences and possible ways to solve your problems.
  •  Remember that nobody can solve all their problems by themselves. Talk to trusted family, friends, and professionals about your feelings and about how they cope with strong emotions. Ask for help when you need it. Doing so will let people know you value their support and offers chances to build relationships.
  •  Recognize the difficulties and challenges you face, and how hard you are working to make things better. Give yourself credit when you control your emotions and express your feelings in positive ways.

Sometimes people have trouble helping themselves feel better. Often, you can benefit from support and guidance from others. Talk with trusted family, friends, or professionals about your feelings. Also, consider joining a support group, so you can learn from others about how they’ve dealt successfully with similar emotions.

This column was written by Laura Taylor and Jeff Kreutzer from the VCU TBI Model System Family Support Research Program. The program teaches families how to deal with stress and intense emotions. For more information about the program, please contact Laura at 804-828-3703, toll free at 866-286-6904, or by email at taylorla@vcu.edu.

via Understanding & Communicating Your Emotions After Brain Injury | BrainLine

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[VIDEO] Flooding – Becoming Overwhelmed After Brain Injury – YouTube

Welcome to the Northern Brain Injury Association’s webcast on ‘flooding’, created to help you assist survivors of brain injury who are experiencing flooding by teaching them to identify their triggers, control their exposure and manage their anxiety. For more webcasts on issues faced by survivors of brain injury, visit http://www.nbia.ca

 

 

 

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

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

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

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

Tips for persons with brain injury to grieve and mourn…

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

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

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

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

 

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

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

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

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

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

Bereavement, Grieving, and Mourning

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

Bereavement is the “call”.

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

Grieving is the “internal response” to loss.

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

Mourning is the “external response” to the loss.

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

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

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

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

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

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

 

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

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