[WEB SITE] Communication problems after brain injury

Communication problems after brain injury are very common. Although most of us take it for granted, the ability to communicate requires extremely complex skills and many different parts of the brain are involved.

There are four main categories of the effects of brain injury. Any of these can cause communication problems:

• Physical – affecting how the body works
• Cognitive – affecting how the person thinks, learns and remembers
• Emotional – affecting how the person feels
• Behavioural – affecting how a person acts

Many people will experience more than one form of communication problem after brain injury, depending on the areas of the brain affected and the severity of the injury. It is also important to recognise that such problems may occur alongside other changes in physical, cognitive, emotional and behavioural functions.

The diagram below shows the cerebral cortex. The cortex is the outer part of the brain, which is responsible for our more sophisticated thinking skills. Many of the functions listed are important for communication and injury to any of these areas can impair communication skills.

This section explains some of the ways brain injury can affect communication.

• Language impairment – aphasia (often called dysphasia)
  Covers problems with understanding language and expressing thoughts through language. Also covers problems with reading and writing.
• Speech difficulties
  Discusses disorders of speech that can occur after brain injury.
• Cognitive communication difficulties
  Covers some of the problems with communication caused by cognitive difficulties, such as memory impairment, attention difficulties, poor social skills and fatigue.

Our booklet Coping with communication problems after brain injury provides more in-depth information about the issues covered here, and you can contact the Headway helpline if you have any further questions.

via Communication problems | Headway

[Factsheet] Understanding TBI: Part 2 – Brain injury impact on individuals functioning – Model Systems Knowledge Translation Center (MSKTC)

Written by Thomas Novack, PhD and Tamara Bushnik, PhD in collaboration with the MSKTC

 

A traumatic brain injury interferes with the way the brain normally works. When nerve cells in the brain are damaged, they can no longer send information to each other in the normal way. This causes changes in the person’s behavior and abilities. The injury may cause different problems, depending upon which parts of the brain were damaged most.

There are three general types of problems that can happen after TBI: physical, cognitive and emotional/ behavioral problems. It is impossible to tell early on which specific problems a person will have after a TBI. Problems typically improve as the person recovers, but this may take weeks or months. With some severe injuries changes can take many years.

Structure and function of the brain

The brain is the control center for all human activity, including vital processes (breathing and moving) as well as thinking, judgment, and emotional reactions. Understanding how different parts of the brain work helps us understand how injury affects a person’s abilities and behaviors.

Left vs. Right Brain

• The brain is divided into two halves (hemispheres). The left half controls movement and sensation in the right side of the body, and the right half controls movement and sensation in the left side. Thus, damage to the right side of the brain may cause movement problems or weakness on the body’s left side.
• For most people, the left half of the brain is responsible for verbal and logical functions including language (listening, reading, speaking, and writing), thought and memory involving words.
• The right half is responsible for nonverbal and intuitive functions such as putting bits of information together to make up an entire picture, recognizing oral and visual patterns and designs (music and art), and expressing and understanding emotions.

Brain Areas & Associated Functions

The brain is made up of six parts that can be injured in a head injury. The effect of a brain injury is partially determined by the location of the injury. Sometimes only a single area is affected, but in most cases of TBI multiple areas have been injured. When all areas of the brain are affected, the injury can be very severe.

Six parts	Functions
Brain Stem	Breathing Heart Rate Swallowing Reflexes for seeing and hearing Controls sweating, blood pressure, digestion, temperature Affects level of alertness Ability to sleep Sense of balance
Cerebellum	Coordination of voluntary movement Balance and equilibrium Some memory for reflex motor acts
Frontal Lobe	How we know what we are doing within our environment How we initiate activity in response to our environment Judgments we make about what occurs in our daily activities Controls our emotional response Controls our expressive language Assigns meaning to the words we choose Involves word associations Memory for habits and motor activities Flexibility of thought, planning and organizing Understanding abstract concepts Reasoning and problem solving
Parietal Lobe	Visual attention Touch perception Goal directed voluntary movements Manipulation of objects Integration of different senses
Occipital Lobes	Vision
Temporal Lobes	Hearing ability Memory aquisition Some visual perceptions such as face recognition and object identification Categorization of objects Understanding or processing verbal information Emotion

Physical Problems

Most people with TBI are able to walk and use their hands within 6-12 months after injury. In most cases, the physical difficulties do not prevent a return to independent living, including work and driving.

In the long term the TBI may reduce coordination or produce weakness and problems with balance. For example, a person with TBI may have difficulty playing sports as well as they did before the injury. They also may not be able to maintain activity for very long due to fatigue.

Cognitive (Thinking) Problems

• Individuals with a moderate-to-severe brain injury often have problems in basic cognitive (thinking) skills such as paying attention, concentrating, and remembering new information and events.
• They may think slowly, speak slowly and solve problems slowly.
• They may become confused easily when normal routines are changed or when things become too noisy or hectic around them.
• They may stick to a task too long, being unable to switch to different task when having difficulties.
• On the other hand, they may jump at the first solution they see without thinking it through.
• They may have speech and language problems, such as trouble finding the right word or understanding others.
• After brain injury, a person may have trouble with all the complex cognitive activities necessary to be independent and competent in our complex world. The brain processes large amounts of complex information all the time that allows us to function independently in our daily lives. This activity is called executive function because it means being the executive or being in charge of one’s own life.

Emotional/Behavioral Problems

Behavioral and emotional difficulties are common and can be the result of several causes:

• First, the changes can come directly from damage to brain tissue. This is especially true for injuries to the frontal lobe, which controls emotion and behavior.
• Second, cognitive problems may lead to emotional changes or make them worse. For example, a person who cannot pay attention well enough to follow a conversation may become very frustrated and upset in those situations.
• Third, it is understandable for people with TBI to have strong emotional reactions to the major life changes that are caused by the injury. For example, loss of job and income, changes in family roles, and needing supervision for the first time in one’s adult life can cause frustration and depression.

Brain injury can bring on disturbing new behaviors or change a person’s personality. This is very distressing to both the person with the TBI and the family. These behaviors may include:

• Restlessness
• Acting more dependent on others
• Emotional or mood swings
• Lack of motivation
• Irritability
• Aggression
• Lethargy
• Acting inappropriately in different situations
• Lack of self-awareness. Injured individuals may be unaware that they have changed or have problems. This can be due to the brain damage itself or to a denial of what’s really going on in order to avoid fully facing the seriousness of their condition.

Fortunately, with rehabilitation training, therapy and other supports, the person can learn to manage these emotional and behavioral problems.

Disclaimer

This information is not meant to replace the advice from a medical professional. You should consult your health care provider regarding specific medical concerns or treatment.

Source

Our health information content is based on research evidence whenever available and represents the consensus of expert opinion of the TBI Model Systems directors.

Our health information content is based on research evidence and/or professional consensus and has been reviewed and approved by an editorial team of experts from the TBI Model Systems.

Authorship

Understanding TBI was developed by Thomas Novack, PhD and Tamara Bushnik, PhD in collaboration with the Model System Knowledge Translation Center. Portions of this document were adapted from materials developed by the University of Alabama TBIMS, Baylor Institute for Rehabilitation, New York TBIMS, Mayo Clinic TBIMS, Moss TBIMS, and from Picking up the pieces after TBI: A guide for Family Members, by Angelle M. Sander, PhD, Baylor College of Medicine (2002).

via Understanding TBI: Part 2 – Brain injury impact on individuals functioning | Model Systems Knowledge Translation Center (MSKTC)

[ARTICLE] Course of Social Participation in the First 2 Years After Stroke and Its Associations With Demographic and Stroke-Related Factors – Full text

Abstract

Background. Many persons with stroke experience physical, cognitive, and emotional problems that contribute to restrictions in social participation. There is, however, a lack of knowledge on the long-term course of participation over time post-stroke.

Objective. To describe the time course of participation up to 2 years post-stroke and to identify which demographic and stroke-related factors are associated with this time course.

Methods. This was a multicenter, prospective cohort study following 390 persons with stroke from hospital admission up to 2 years (at 2, 6, 12, and 24 months). Multilevel modeling with linear and quadratic time effects was used to examine the course of the frequency of vocational and social/leisure activities, experienced restrictions, and satisfaction with participation.

Results. The frequency of vocational activities increased up to 1 year post-stroke and leveled off thereafter. Older and lower-educated persons showed less favorable courses of participation than younger and higher-educated persons, respectively. The frequency of social/leisure activities decreased post-stroke. Participation restrictions declined up to 1 year post-stroke and leveled off thereafter. Persons dependent in activities of daily living (ADL) kept experiencing more restrictions throughout time than independent persons. Satisfaction with participation increased slightly over time.

Conclusions. Changes in participation occurred mostly in the first year post-stroke. Particularly older and lower-educated persons, and those dependent in ADL showed less favorable courses of participation up to 2 years post-stroke. Clinicians can apply these findings in identifying persons most at risk of long-term unfavorable participation outcome and, thus, target rehabilitation programs accordingly.

Introduction

Stroke can lead to long-lasting physical problems such as mobility limitations,¹cognitive problems such as attention or memory deficits,² and emotional problems such as anxiety,^3,4 depressive symptoms,^3–5 and fatigue.^4,6 The population of persons surviving a stroke^7,8 increases, consistent with major improvements in acute stroke care (eg, stroke units, thrombolysis, and thrombectomy^9,10), but this also means that more people have to deal with the long-lasting consequences of stroke.^11,12 These consequences contribute to the deterioration of social participation post-stroke.^13–17 Importantly, persons with stroke view social participation (participation hereafter) as a central aspect of their recovery.^18,19

Participation can be defined as involvement in a life situation such as paid work, family, or community life,¹⁷ which consists of actual performed activities,²⁰ such as the frequency of observable actions and behaviors,^21–23 and the subjective experience of persons,²⁰ such as experienced restrictions and satisfaction.^21–23

In previous studies, it was observed that the frequency of activities decreases in persons with stroke, relative to their premorbid levels.^16,24–28 This particularly applies to vocational activities (work, unpaid work, and household activities), but social activities decrease after stroke, too.²⁸ Four months after discharge from outpatient rehabilitation, 50% of persons with stroke still experienced participation problems.²⁹Social activity levels have been reported to be lower in persons with stroke at 1 year post-stroke than in healthy controls,³⁰ a level that remained stable up to 3 years.³¹Past studies showed that only 39% of persons with stroke were satisfied with their lives as a whole after 1 year,¹⁶ which might be even lower up to 3 years post-stroke,³² especially in socially inactive persons.³³

Although studies have shed some light on the course of participation over time post-stroke, it is difficult to get a good understanding of how levels of participation develop and change over time. This is a result of the use of cross-sectional designs,^{16,24,26,27,33} longitudinal designs limited to either only the first 6 months^13,25,28,29 or only the long-term levels of participation after stroke,^31,32,34studies only incorporating 2 time points,³⁵ and many different participation measures, some measuring the frequency of activities and others the subjective experience of participation.³⁶

Research into factors associated with participation post-stroke could lead to identifying possible risk factors of an unfavorable outcome. Earlier studies showed that demographic factors such as older age at stroke onset,^14,37 lower levels of education,^29,38 and female sex³⁷ were related to a less favorable outcome in terms of participation, along with stroke-related factors such as dependence in activities of daily living (ADL),^39,40 more severe stroke,³⁷ and lower levels of cognitive functioning.^26,29 However, these factors are yet to be examined in relation to the course of participation over time and as such to be identified as possible risk factors.

To get a more detailed and comprehensive understanding of participation over time, it is necessary to include repeated measurements of objective (ie, frequency of activities) as well as subjective (ie, experienced restrictions and satisfaction) aspects of participation. Furthermore, it is important to identify persons in the early stage after stroke, who are at risk of an unfavorable outcome in the long term. At this point in time, potential risk factors can be easily determined through available information, including demographics and stroke-related information, and rehabilitation care can be provided. Consequently, we studied participation over a 2-year follow-up in a clinical cohort of persons with stroke in order to answer the following research questions: how does participation develop over the first 2 years after stroke in terms of frequency, restrictions, and satisfaction? Moreover, which demographic and stroke-related factors are associated with this time course?[…]

 

Continue —> Course of Social Participation in the First 2 Years After Stroke and Its Associations With Demographic and Stroke-Related Factors – Daan P. J. Verberne, Marcel W. M. Post, Sebastian Köhler, Leeanne M. Carey, Johanna M. A. Visser-Meily, Caroline M. van Heugten, 2018

[Abstract] Electromyography Based Orthotic Arm and Finger Rehabilitation System

Abstract

Electromyography (EMG), a technique used to analyze and record electric current produced by skeletal muscles, has been used to control replacement limbs, and diagnose muscle irregularities. In this work, an EMG based system comprising of an orthotic arm and finger device to aid in muscle rehabilitation, is presented. As the user attempts to contract their bicep or forearm muscles, the system senses the change in the EMG signals and in turn triggers the motors to assist with flexion and extension of the arm and fingers. As brain is a major factor for muscle growth, mental training using motor imagery was incorporated into the system. Subjects underwent mental training to show the capability of muscle growth. The measured data reveals that the subjects were able to compensate for the loss of muscle growth, due to shorter physical training sessions, with mental training. Subjects were then tested using the orthotic arm and finger rehabilitation device with motor imagery. The findings also showed a positive increase in muscle growth using the rehabilitation system. Based on the experimental results, the EMG rehabilitation system presented in this paper has the potential to increase muscle strength and improve the recovery rate for muscle injuries, partial paralysis, or muscle irregularities.

via Electromyography Based Orthotic Arm and Finger Rehabilitation System – IEEE Conference Publication

[WEB SITE] Transcranial electrical stimulation shows promise for treating mild traumatic brain injury

 

Credit: copyright American Heart Association

Using a form of low-impulse electrical stimulation to the brain, documented by neuroimaging, researchers at the University of California San Diego School of Medicine, Veterans Affairs San Diego Healthcare System (VASDHS) and collaborators elsewhere, report significantly improved neural function in participants with mild traumatic brain injury (TBI).

Their findings are published online in the current issue of the journal Brain Injury.

TBI is a leading cause of sustained physical, cognitive, emotional and behavioral problems in both the civilian population (primarily due to motor vehicle accidents, sports, falls and assaults) and among military personnel (blast injuries). In the majority of cases, injury is deemed mild (75 percent of civilians, 89 percent of military), and typically resolves in days.

But in a significant percentage of cases, mild TBI and related post-concussive symptoms persist for months, even years, resulting in chronic, long-term cognitive and/or behavioral impairment.

Much about the pathology of mild TBI is not well understood, which the authors say has confounded efforts to develop optimal treatments. However, they note the use of passive neuro-feedback, which involves applying low-intensity pulses to the brain through transcranial electrical stimulation (LIP-tES), has shown promise.

In their pilot study, which involved six participants who had suffered mild TBI and experienced persistent post-concussion symptoms, the researchers used a version of LIP-tES called IASIS, combined with concurrent electroencephalography monitoring (EEG). The treatment effects of IASIS were assessed using magnetoencephalography (MEG) before and after treatment. MEG is a form of non-invasive functional imaging that directly measures brain neuronal electromagnetic activity, with high temporal resolution (1 ms) and high spatial accuracy (~3 mm at the cortex).

“Our previous publications have shown that MEG detection of abnormal brain slow-waves is one of the most sensitive biomarkers for mild traumatic brain injury (concussions), with about 85 percent sensitivity in detecting concussions and, essentially, no false-positives in normal patients,” said senior author Roland Lee, MD, professor of radiology and director of Neuroradiology, MRI and MEG at UC San Diego School of Medicine and VASDHS. “This makes it an ideal technique to monitor the effects of concussion treatments such as LIP-tES.”

The researchers found that the brains of all six participants displayed abnormal slow-waves in initial, baseline MEG scans. Following treatment using IASIS, MEG scans indicated measurably reduced abnormal slow-waves. The participants also reported a significant reduction in post-concussion scores.

“For the first time, we’ve been able to document with neuroimaging the effects of LIP-tES treatment on brain functioning in mild TBI,” said first author Ming-Xiong Huang, PhD, professor in the Department of Radiology at UC San Diego School of Medicine and a research scientist at VASDHS. “It’s a small study, which certainly must be expanded, but it suggests new potential for effectively speeding the healing process in mild traumatic braininjuries.”

Source: Transcranial electrical stimulation shows promise for treating mild traumatic brain injury

[WEB SITE] TherapWii – game suggestions

Why TherapWii

Gaming activates and is fun to do! In a playful and often unnoticed way skills are trained. Adolescents grow up in a digital world; they enjoy gaming and do it frequently. For adults and elderly gaming has been shown to be a useful type of therapy.

In a virtual environment moving, executing, learning and enjoying are appealing; if circumstances or limitations keep you from going to the bowling alley or playing an instrument, gaming can broaden your boundaries.

Gaming with the Wii can complement therapy, can make therapy more attractive, intenser and more provocative.

TherapWii has been developed to support therapists in an effective and specific way while using the Nintendo Wii and offer options to game in the home environment.

TherapWii is the product of an exploratory research project done by the Special Lectorship Rehabilitation at the Hague University. The results of this project can be found by clicking on the header ‘research’ at the end of the page.

How does TherapWii work?

Per therapy goal there are three colored tabs to help find the most suitable games. Each game lists specific information in text and symbols. There is also a level of difficulty; by moving the cursor over this button you see more information.

User information is saved in ‘explanation and tips’. To enhance this section you can email recommendations and suggestions to the email address listed below.

TherapWii has been developed, also for home use, so that experience lead to personal growth.

Advice for game adjustments

It is important that the therapist stays close to the patient’s goals and abilities and adjusts the game program appropriately. If you, as therapist, want to make the game easier, more difficult or more daring, you can change the instruction, implementation or setting.

A few examples:

Physical: strength (add weights to the arms or legs or change the starting position); balance/stability (play while standing on an instable foundation (ball, mat). Or play the games while sitting on a stationary bicycle!

Cognition: create double tasks (ask mathematics, questions or riddles); spatial orientation or visual adjustments (play with one eye covered or in front of a mirror).

Social-emotional: stimulate cooperation or competition (create bets or role-playing).

Let us know if you have other ideas to make the games more provoking.

How are the games rated?

The games were tested by several professionals (physical therapists, occupational therapists and sport therapists). Differences in opinion or scores were discussed and voted on.

Give us feedback, corrections and advice, we will adjust the TherapWii program monthly and will use your suggestions.

Which ability do you choose?

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