Posts Tagged change

[BLOG POST] A Brain Injury Life – formerly TBI to LIFE

Perception of Self after Brain Injury

Lately I’ve been wondering whether brain injury really changed the person I am or if it just added a new layer to my old self.  It may be impossible to articulate and probably unanswerable. Obviously, an injury physically changes how the brain works and directly causes a host of problems—physical pain, cognitive deficits, and the loss of identity (e.g. the tendency to ask existential questions like this). But cause and effect are not always clear. There are many problems that could be organic or could just as well be new incarnations of innate character traits.

I’ve gotten used to the idea that everything different in my life since my TBI has either been caused by the brain injury or what I learned in my neuropsychological rehabilitation. But what if there are fewer changes than I imagined? Am I still who I was but with some parts missing? That would explain the feeling of being lost in a foreign land.

For example, I used to think I was always right. But if brain injury has altered me functionally (it has, now I am often wrong), while leaving my sense of self intact (i.e. I still see myself as in the right), my perception would contradict reality. Since I’m nothing if not logical, one or the other would have to give. The belief of always being right could, unconsciously, be directed somewhere else. So instead of being convinced that my answers were better, I’d think I was wiser because I’d learned the best strategies, and was convinced that I could recognize a brain injury—or deficit—intuitively and in the moment. Which I am.

Does that make any sense? One more try:

If brain injury changed the life I lived—the structure, productivity, and satisfaction—but not who I think I am in life, it would explain why I feel rudderless. I keep trying to find my place in the world, a goal I can realistically accomplish and the initiation to follow through. Instead, I feel like I have no purpose. I come up with labels to define myself like an advocate (really?), a leader in the community (since when—6 years ago?), or educating people about brain injury (who am I teaching?). So what’s up with that?

All I can say with certainty is that the feeling of being unmoored seems to grow deeper as time passes.

via A Brain Injury Life – formerly TBI to LIFE

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[Abstract] Interventions to improve real-world walking after stroke: A systematic review and meta-analysis

Abstract

Objective: This study aimed to determine the effectiveness of current interventions to improve real-world walking for people with stroke and specifically whether benefits are sustained.

Data sources: EBSCO Megafile, AMED, Cochrane, Scopus, PEDRO, OTSeeker and Psychbite databases were searched to identify relevant studies.

Review methods: Proximity searching with keywords such as ambulat*, walk*, gait, mobility*, activit* was used. Randomized controlled trials that used measures of real-world walking were included. Two reviewers independently assessed methodological quality using the Cochrane Risk of Bias Tool and extracted the data.

Results: Nine studies fitting the inclusion criteria were identified, most of high quality. A positive effect overall was found indicating a small effect of interventions on real-world walking (SMD 0.29 (0.17, 0.41)). Five studies provided follow-up data at >3–6 months, which demonstrated sustained benefits (SMD 0.32 (0.16, 0.48)). Subgroup analysis revealed studies using exercise alone were not effective (SMD 0.19 (–0.11, 0.49)), but those incorporating behavioural change techniques (SMD 0.27 (0.12, 0.41)) were.

Conclusions: A small but significant effect was found for current interventions and benefits can be sustained. Interventions that include behaviour change techniques appear more effective at improving real-world walking habits than exercise alone.

 

Source: Interventions to improve real-world walking after stroke: A systematic review and meta-analysis

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