Posts Tagged Traumatic Brain Injury

[Abstract] The Impact of Traumatic Brain Injury on Later Life: Effects on Normal Aging and Neurodegenerative Diseases

ABSTRACT

The acute and chronic effects of traumatic brain injury (TBI) have been widely described; however, there is limited knowledge on how a TBI sustained during early adulthood or mid-adulthood will influence aging. Epidemiological studies have explored whether TBI poses a risk for dementia and other neurodegenerative diseases associated with aging. We will discuss the influence of TBI and resulting medical comorbidities such as endocrine, sleep, and inflammatory disturbances on age-related gray and white matter changes and cognitive decline. Post mortem studies examining amyloid, tau, and other proteins will be discussed within the context of neurodegenerative diseases and chronic traumatic encephalopathy. The data support the suggestion that pathological changes triggered by an earlier TBI will have an influence on normal aging processes and will interact with neurodegenerative disease processes rather than the development of a specific disease, such as Alzheimer’s or Parkinson’s. Chronic neurophysiologic change after TBI may have detrimental effects on neurodegenerative disease.

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A Systematic Review of Psychological Interventions for Sleep and Fatigue after Mild Traumatic Brain Injury

Karen A. SullivanHannah BlaineSherrie-Anne KayeAlice TheadomCatherine HadenSimon S. Smith

Journal of Neurotrauma. November 2017, ahead of print.

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Prefrontal Cortical Thickening after Mild Traumatic Brain Injury: A One-Year Magnetic Resonance Imaging Study

Patrizia Dall’AcquaSönke JohannesLadislav MicaHans-Peter SimmenRichard GlaabJavier FandinoMarkus SchwendingerChristoph MeierErika Jasmin UlbrichAndreas MüllerLutz JänckeJürgen Hänggi

Journal of Neurotrauma. Dec 2017: 3270-3279.

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Risk Factors for Mild Traumatic Brain Injury and Subsequent Post-Traumatic Stress Disorder and Mental Health Disorders among United States Army Soldiers

Dennis E. ScofieldSusan P. ProctorJoseph R. KardouniOwen T. HillCraig J. McKinnon

Journal of Neurotrauma. Dec 2017: 3249-3255.

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Age at First Exposure to Repetitive Head Impacts Is Associated with Smaller Thalamic Volumes in Former Professional American Football Players

Vivian SchultzRobert A. SternYorghos TripodisJulie StammPawel WrobelChristian LepageIsabelle WeirJeffrey P. GuenetteAlicia ChuaMichael L. AloscoChristine M. BaughNathan G. FrittsBrett M. MartinChristine E. ChaissonMichael J. ColemanAlexander P. LinOfer PasternakMartha E. ShentonInga K. Koerte

Journal of Neurotrauma. November 2017, ahead of print.

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The Default Mode Network as a Biomarker of Persistent Complaints after Mild Traumatic Brain Injury: A Longitudinal Functional Magnetic Resonance Imaging Study

Harm J. van der HornMyrthe E. ScheenenMyrthe E. de KoningEdith J. LiemburgJacoba M. SpikmanJoukje van der Naalt

Journal of Neurotrauma. Dec 2017: 3262-3269.

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The Invisibility of Mild Traumatic Brain Injury: Impaired Cognitive Performance as a Silent Symptom

Leore R. HeimMiaad BaderShahaf EdutLital RachmanyRenana Baratz-GoldsteinRan LinAviya ElpazDoaa QubtyLior BikovskiVardit RubovitchShaul SchreiberChaim G. Pick

Journal of Neurotrauma. Sep 2017: 2518-2528.

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via The Impact of Traumatic Brain Injury on Later Life: Effects on Normal Aging and Neurodegenerative Diseases | Abstract

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[Abstract] Treatment of Traumatic Brain Injury with Vepoloxamer (Purified Poloxamer 188)

ABSTRACT

Vepoloxamer is an amphipathic polymer that has shown potent hemorrheologic, cytoprotective, and anti-inflammatory effects in both pre-clinical and clinical studies. This study was designed to investigate the therapeutic effects of vepoloxamer on sensorimotor and cognitive functional recovery in rats after traumatic brain injury (TBI) induced by controlled cortical impact. Young adult male Wistar rats were randomly divided into the following groups: 1) sham; 2) saline; or 3) vepoloxamer. Vepoloxamer (300 mg/kg) or saline was administered over 60 min via intravenous infusion into tail veins starting at 2 h post-injury. Sensorimotor function and spatial learning were assessed using a modified neurological severity score and foot fault test, and Morris water maze test, respectively. The animals were sacrificed 35 days after injury and their brains were processed for measurement of lesion volume and neuroinflammation. Compared with the saline treatment, vepoloxamer initiated 2 h post-injury significantly improved sensorimotor functional recovery (Days 1–35; p < 0.0001) and spatial learning (Days 32–35; p < 0.0001), reduced cortical lesion volume by 20%, and reduced activation of microglia/macrophages and astrogliosis in many brain regions including injured cortex, corpus callosum, and hippocampus, as well as normalized the bleeding time and reduced brain hemorrhage and microthrombosis formation. In summary, vepoloxamer treatment initiated 2 h post-injury provides neuroprotection and anti-inflammation in rats after TBI and improves functional outcome, indicating that vepoloxamer treatment may have potential value for treatment of TBI. Further investigation of the optimal dose and therapeutic window of vepoloxamer treatment for TBI and the mechanisms underlying beneficial effects are warranted.

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Hyperthermia and Mild Traumatic Brain Injury: Effects on Inflammation and the Cerebral Vasculature

Jessie TruettnerHelen M. BramlettW. Dalton Dietrich

Journal of Neurotrauma. November 2017, just accepted.

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Hyperbaric Oxygen Therapy in the Treatment of Acute Severe Traumatic Brain Injury: a Systematic Review

Samuel DalyMaxwell ThorpeSarah B RockswoldMolly HubbardThomas A BergmanUzma SamadaniGaylan Rockswold

Journal of Neurotrauma. November 2017, just accepted.

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A time limit for starting anti-inflammatory treatment for better improvement of olfactory dysfunction after head injury

Masayoshi KobayashiKengo TamariMasako KitanoKazuhiko Takeuchi

Journal of Neurotrauma. November 2017, just accepted.

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Head impact locations in US high school boys’ and girls’ soccer concussions, 2012/13-2015/16

Zachary KerrKody R CampbellMelissa A FraserDustin W CurrieLauren A PierpointThomas KamimskiJason Mihalik

Journal of Neurotrauma. November 2017, just accepted.

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Intranasally Delivered Wnt3a Improves Functional Recovery after Traumatic Brain Injury by Modulating Autophagic, Apoptotic and Regenerative Pathways in the Mouse Brain

James Ya ZhangJinhwan LeeXiaohuan GuZheng WeiMallory Jessica HarrisShan Ping P YuLing Wei

Journal of Neurotrauma. November 2017, just accepted.

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Correlation of Concussion Symptom Profile with Head Impact Biomechanics: A Case for Individual-Specific Injury Tolerance

Steven RowsonStefan M. DumaBrian D StemperAlok S ShahJason MihalikJaroslaw HarezlakLarry D RiggenChristopher C. GizaJohn DiFioriAlison BrooksKevin K GuskiewiczDarren CampbellJerry McGintySteve SvobodaKen CameronSteven P BroglioThomas McAllisterMichael McCrea

Journal of Neurotrauma. November 2017, just accepted.

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via Treatment of Traumatic Brain Injury with Vepoloxamer (Purified Poloxamer 188) | Abstract

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[WEB SITE] Can Cannabis Prevent and Treat Traumatic Brain Injury?

Traumatic Brain Injury, or TBI, is a serious condition usually caused by an external blow to the head that can cause severe and often chronic symptoms. These symptoms can be cognitive, behavioral, movement related, speech and visual impairing, mood altering, involve painful headaches, and even cause gastrointestinal issues.

Each year in just the U.S., nearly 52,000 people die from TBI and 80,000 sustain severe disabilities. Compare that to car fatalities (32,675) and homicides (14,196), which combined claim fewer lives. Moreover, 5.3 million people in the U.S. live with TBI-related disabilities, a number comparable to those living with Alzheimer’s disease.

How Cannabis Can Slow Traumatic Brain Injury Damage

Medical marijuana

While effective therapies to treat ongoing TBI symptoms have been difficult to come by, thanks to researchers like Prof. Yosef Sarne of Tel Aviv University, we’ve discovered that cannabis may prevent long-term brain damage by administering THC before or shortly after the injury. In fact, Israel Defense Force (IDF) practitioners administer CBD or low-dose THC as a first-line treatment to IDF soldiers – and even enemy combatants – who suffer brain trauma.

Sarne and his team published their results in 2013, where they demonstrated that administering just a fraction of the amount of THC that would be found in a typical cannabis joint anywhere from one to seven days prior to, or one to three days after an injury, induces the biochemical processes necessary to protect critical brain cells while preserving long-term cognitive function.

Can Cannabis Help People Currently Suffering From TBI?

Brain scan

Given the success found in Israel utilizing cannabis to halt TBI in its tracks, it begs the question: can cannabis help persistent TBI symptoms?

Anecdotally, many patients and their families report success. The daughter of one patient wrote in a Reddit forum:

“My father suffered severe TBI for years. He used to sit around hating his life all day. Once he started using marijuana, he changed a lot. He was able to get off some of his meds, start eating more, go outside, enjoy music, laugh at a movie, sleep at night, less anxiety in the day, less body pain. The list goes on and on.”

We hear many success stories like this, but these are, of course, anecdotal. Thus far, there aren’t any notable clinical trials demonstrating the efficacy of cannabis to treat ongoing symptoms in TBI patients. Unfortunately, even outside of cannabis research, phase II/III clinical trials of potential treatments haven’t demonstrated any consistent improvements in outcomes.

How Does Cannabis Consumption Affect the Brain?

The lack of cannabinoid-focused trials is likely due in part to the federal government’s long-standing position that cannabis is a “substance [with] no currently accepted medical use” and “a high potential for abuse” – a position that has long frustrated scientists who are forced to navigate significant bureaucratic obstacles to conduct high-quality rigorous studies.

Nonetheless, despite the federal government’s position, there is some evidence that at least lends support to speculation that cannabis-derived treatments may be beneficial:

Cannabinoids 101: What Makes Cannabis Medicine?

“Effect of Marijuana Use on Outcomes in Traumatic Brain Injury” (UCLA Medical Center, 2014):

In a three-year retrospective review of 446 separate cases of similarly injured patients, researchers found traumatic brain injury (TBI) patients who had a history of cannabis consumption possessed increased survival rates compared to non-consumers (97.6 percent survived surgery, versus 88.5% of those who didn’t consume cannabis).

“[O]ur data suggest an important link between the presence of a positive THC screen and improved survival after TBI,” the researchers concluded. “With continued research, more information will be uncovered regarding the therapeutic potential of THC, and further therapeutic interventions may be established.”

CTE in Professional Football Players, and the Potential of CBD to Address the Crisis

“Endocannabinoids and Traumatic Brain Injury” (Mechoulam, 2007):

This Israeli study points to research that demonstrates:

“…the [endocannabinoid] system…has the ability to [positively] affect the functional outcome after TBI by a variety of mechanisms.”

How Does Your Endocannabinoid System Impact Your Brain’s Response to Social Interaction?

“The Therapeutic Potential of the Cannabinoids in Neuroprotection” (Grundy RI, 2002):

This review shows that in experimental models:

“…various cannabinoids rescue dying neurons in experimental forms of acute neuronal injury, such as cerebral ischaemia and traumatic brain injury.”

5 Promising Cannabis Studies That Explore How Cannabinoids Interact with the Human Body

Positive results in experimental models don’t always translate to human subjects, hence the desperate need for more research. But, as early research shows promise and we know cannabinoids demonstrate neuroprotective effects in a variety of neurological conditions, there’s no excuse not to prioritize further research.

Further, because TBI is a condition affecting a highly complex, intricate system like the brain, successful strategies will likely involve more than a single “magic bullet.”

CBD Can Be Remarkably Effective for TBI

Patient receiving an MRI

In the meantime, as we continue to learn more about THC and other cannabinoids to treat traumatic brain injury, many physicians believe CBD can be a safe and effective treatment. CBD, a largely non-psychoactive cannabinoid that possesses neuroprotective, anti-inflammatory, and anti-anxiety properties, could be as close to a “magic bullet” as we have right now. In fact, CBD may be more beneficial than THC. Japanese researchers found cannabidiol (CBD) exhibited stronger antioxidative power than THC without creating tolerance to its neuroprotective effect.

Dr. Allan Frankel, of GreenBridge Medical in Santa Monica, California, believes incorporating small amounts of CBD as a daily nutritional supplement is a safe and sensible adjunct to therapy. “I had a patient recently, a 45 year mother who was in a bad car accident. She experienced memory loss, and hadn’t been making any progress. I suggested CBD,” recounts Frankel. “Within four to six weeks, she made significant progress – her cognitive function improved and her memory returned to normal.” Frankel notes that this is just one of many patients he’s had who have experienced successful recoveries.

While clearly there’s lots of promise in the limited research to date and anecdotal reports, we need to continue developing our understanding of cannabinoid neurobiology in order to most effectively exploit the numerous therapeutic properties of cannabis. We can then, hopefully, unleash the full spectrum of potential benefits cannabis may be able to provide and discover innovative new treatments that could quite possibly help the millions of people who continue to suffer.

How Does Cannabis Consumption Affect Neurodegenerative Diseases?

via Can Cannabis Prevent and Treat Traumatic Brain Injury? | Leafly

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[ARTICLE] Patient Registry of Spasticity Care World: Data Analysis Based on Physician Experience – Full Text

Objective The aim of the study was to report physician experience–based “real-world” treatment patterns with botulinum toxin type A in patients with stroke and traumatic brain injury.

Design A prospective, multicenter, international observational registry design was used.

Results Six hundred twenty-seven participants with stroke and 132 participants with traumatic brain injury were assessed and treated by 17 more experienced physicians and 12 less experienced physicians. Due to the limited usage of abobotulinumtoxinA Dysport and incobotulinumtoxinA Xeomin, data were reported on onabotulinumtoxinA BOTOX only. Based on physician experience, onabotulinumtoxinA doses were statistically different with larger mean doses injected by more experienced physicians in the upper limb (59.9 [39.0], P = 0.001) and in the lower limb (101.8 [69.2], P < 0.001). Treated deformities significantly differed for both upper limb and lower limb (P < 0.001). More experienced physicians showed a larger mean change in Ashworth Scale scores from baseline for the equinovarus/equinus foot and stiff knee (P = 0.001 and 0.03). Less experienced physicians showed a larger mean change in Ashworth Scale scores from baseline for the adducted thigh (P = 0.05). Less experienced physicians had statistically significant larger change in hand pain scores for clenched fist deformity treatment at follow-up compared with more experienced physicians (P = 0.01). Physician experience demonstrated a significant difference on patients reported satisfaction toward their secondary goal with higher scores for more experienced physician (P = 0.04).

Conclusions This international registry provides clinical nuances of treatment based on physician clinical experience in a robust sample size.

 

Every year, 15 million people worldwide are adversely affected by a stroke, and according to the World Health Organization, traumatic brain injury (TBI) will surpass by 2020 many other diseases as the major cause of death and disability.1 Functional problems caused by stroke or a TBI may include paralysis, cognitive and speech changes, and impaired motor control and dexterity as well as abnormal muscle activity that include spasticity, clonus, dystonia, co-contraction, associated reactions, and flexor and extensor spasms as seen in the upper motor neuron syndrome.2Spasticity as a motor behavior is a specific physiologic sign that has classically been described by Lance et al.3 as one component of the upper motor neuron syndrome, distinguishable from other positive features of muscle overactivity (e.g., dystonia, co-contraction). For simplification, all of these abnormal muscle activation patterns are frequently referred to as “spasticity.”4 We have elected the term spastic muscle overactivity as a more encompassing and better suited term.5–7Muscle overactivity can result in multiple patterns of clinical motor dysfunction affecting the lower (e.g., equinovarus, stiff knee, striatal toe, adducted thighs, flexed hip) and/or upper limbs (flexed elbow, internally rotated shoulder, flexed wrist, clenched fist, thumb-in-palm, intrinsics).4

Botulinum toxin has become a widely used biological toxin for a growing number of clinical applications. Clinical trials provide evidence that botulinum toxin can improve symptoms of muscle overactivity when appropriate muscles, doses, and the number of injection sites are selected.4,7 The proper use of these treatments in a “real-world” setting is not restricted to a regimented dosing structure provided by a clinical trial requires appropriate training and education. As in other areas of medicine, physician experience may play a role in care delivery. Physician level of experience may serve as a surrogate in understanding physician practice patterns variation that can inform healthcare services use8 and reduce physician care variations.9 Given these information void, we proposed and conducted a global, multicenter, observational study of participants treated with botulinum toxins in patients with stroke- or TBI-related spastic muscle overactivity to generate real-world data. The use of botulinum toxin A varies internationally; onabotulinumtoxinA (onaBoNTA) BOTOX has been approved for use in the United States for many years, whereas abobotulinumtoxinA (aboBoNTA) Dysport and incobotulinumtoxinA (incoBoNTA) Xeomin were only recently approved (2016). The onaBoNTA and aboBoNTA have been in use in Europe for more than 20 yrs, and incoBoNTA was approved only 10 yrs ago. Published registries have presented real-life data on the treatment of spasticity with onaBonTA10–12; however, to our knowledge, this is the first international registry that includes real-world longitudinal data that include baseline, injection, and outcomes when using the various botulinum toxins available while considering physician experience for its stratification and analysis. Despite the available evidence of botulinum toxin use, it is unclear whether physician level of experience may play a role in the appropriate delivery of toxin-related care. We hypothesized that the physician experience level may impart differences in care patterns in the use of botulinum toxin for spasticity management. Specifically, we focus on analyses based on the physician experience related to the identification of the problem presentation, muscle selection for treatment, formulation selected, dosing, injection technique, dilution, and number of injection sites. We also recorded the primary and secondary goals for treatment as selected by the patient and agreed upon by the treating physician. The primary purpose for this registry was to describe treatment patterns and clinical presentation used in these populations from a global perspective on the basis of clinical experience. Ashworth Scale (AS), presence of pain, and patient-reported satisfaction after treatment were stratified on the basis of reported physicians’ clinical experiences to determine treatment effect.[…]

Continue —> Patient Registry of Spasticity Care World: Data Analysis Bas… : American Journal of Physical Medicine & Rehabilitation

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[Study] A New Online Program May Help People with TBI Build Emotion Regulation Skills – NARIC

A traumatic brain injury (TBI) is lasting brain damage from an external force, such as a fall or a car accident. People with TBI may have challenges with emotion regulation (ER), the process of recognizing and controlling their feelings or their reactions to feelings. Previous research has shown that a structured group therapy program can help people with TBI develop and practice ER skills in real-life situations. However, some people with TBI may not be able to get to a clinic to receive group therapy, or they may not be able to afford it. Internet-based therapy programs may offer a convenient alternative for these individuals to receive the therapy they need. In a recent NIDILRR-funded study, researchers tested an Internet-based program to teach ER skills to people with TBI through group videoconferencing. The researchers wanted to find out whether people who participated in the program experienced less difficulties with ER after the program than before, and whether they experienced improvements in mood or quality of life. They also wanted to find out what the participants thought of the online program format.

Researchers at the New York Traumatic Brain Injury Model System Center enrolled 91 adults with TBI in a study. The participants came from 33 U.S. states and 5 countries. They had experienced their TBI at least six months prior to starting the program, with a group average of five years of living with TBI. All of the participants reported multiple challenges with ER.

All of the participants were enrolled in the experimental program, called Online EmReg, which was adapted from a face-to-face group therapy program. Online EmReg consists of 24 one-hour videoconference sessions, held twice a week for 12 weeks. A small group of 4-5 participants attend each session, which is led by a trained facilitator. The participants and facilitator use the GotoMeeting platform to communicate and share information. During the first 8 sessions, the participants learn about the basics of ER, how ER can be impacted by TBI, and some specific strategies or tools for managing their emotions. The participants also set specific goals for improvements during the program, such as learning to feel calmer under pressure or being more patient with themselves and others. During the final 16 program sessions, the participants practice their skills in individual and group exercises.

To find out how the program impacted ER, the researchers gave online questionnaires to the participants 4 weeks before the program started, immediately after the program ended, and again 12 weeks after the program ended. Each questionnaire included a 36-question scale called the Difficulties with Emotion Regulation Scale (DERS), where the participants reported how often they encounter various challenges with ER, such as losing control of impulses or having trouble identifying their feelings, on a scale from 1 (almost never) to 5 (almost always). The participants also completed additional scales rating their current positive and negative emotions, overall satisfaction with their lives, and the extent to which they experienced challenges with other mental activities such as problem-solving, planning, and decision-making. To find out what the participants thought of the program, the participants answered questions regarding their satisfaction with the program and the extent to which they felt they achieved their goals for the program. Each participant was also interviewed by phone after the program ended to obtain more detailed feedback.

The researchers found that the participants reported less frequent challenges with ER after the program started than before. Their total scores on the DERS decreased by an average of 10% between the beginning and end of the program, and these scores decreased by another 4% during the 12 weeks after the program ended, for a total decrease of 14% by the end of the follow-up period. The participants also reported an 18%  decrease in negative emotions, a 17% improvement in overall satisfaction with their lives, and a 65% improvement in planning and decision-making scores, and an 11% improvement in problem-solving scores between the beginning and end of the program. The participants’ overall satisfaction with their lives increased by another 14% during the 12 weeks after the end of the program, for a total increase of 31%.

The researchers also found that most of the participants were satisfied with the program and found it helpful. When asked to rate their improvement in ER skills during the program, 49% of the participants reported a large improvement, another 41% reported a moderate improvement, and only 10% reported little or no improvement. During the interviews after the program had ended, nearly all of the participants said that they felt the program was relevant to their goals. The participants said that the program was a good learning experience, that they enjoyed the connections with others, and that it was convenient to participate from their homes.

The authors noted that, because there was no comparison group for this study, it is unclear whether or not the improvements were a direct result of the program or if the participants’ skills simply improved over time. In the future, randomized experiments may be useful in establishing the impact of the Online EmReg program compared with usual care for people with TBI. They also noted that the participants in this study had access to the high-speed Internet and equipment necessary to use videoconferencing, which may not be available to people with lower incomes or those who live in rural areas. These individuals might face more challenges to participating in this type of program.

The authors noted that Internet-based programs such as Online EmReg may benefit diverse groups of people with TBI, particularly those who live far away from a medical center or who may not be able to travel for regular appointments. The program can also be implemented at low cost since videoconferencing platforms such as GoToMeeting may be free for participants to use. In this study, the participants were very satisfied with the Online EmReg program, and reported improvements in ER as well as more general life satisfaction and well-being. These improvements were maintained over time after the program was over, suggesting that the participants may have continued to practice and apply their newfound skills in their everyday lives. These findings may show a promise for researchers and rehabilitation professionals to consider developing similar programs for people with TBI to practice coping skills and exchange support with one another.

To Learn More

The authors continue to study the impact of Online EmReg with a new NIDILRR-funded randomized controlled trial as part of the 2017-2022 New York TBI Model System Center. To learn more about the current study and how to participate, contact the Brain Injury Research Center at birc@mountsinai.org

The Model Systems Knowledge Translation Center (MKSTC) has many information resources for people living with TBI, including:

Tessa Hart, PhD, director of the NIDILRR-funded Moss TBI Model System Center, discussed recent research in ER and TBI in a blog post at Moss Rehabilitation Hospital http://mrri.org/regulating-emotion-after-traumatic-brain-injury/

People living with TBI and their families can find a wealth of information and support resources, including local groups and organizations, from the Brain Injury Association of America http://www.biausa.org and from Brainline.org http://www.brainline.org

To Learn More About this Study

Tsaousides, T., Spielman, L., Kajankova, M., Guetta, G., Gordon, W., and Dams-O’Connor, K. (2017) Improving emotional regulation following Web-based group intervention for individuals with traumatic brain injury. Journal of Head Trauma Rehabilitation, 32(5) 354-365. This article is available from the NARIC collection under accession number J77071.

Date published:

2017-12-06

via National Rehabilitation Information Center | Information for Independence

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[WEB SITE] 31 Strategies for Living with Traumatic Brain Injury – BrainLine

by Melissa Johnson, Bringing the Battle Home
31 Strategies for Living with Traumatic Brain Injury
Caregiver blogger, Melissa Johnson, shares 31 tips and strategies she uses to help her husband cope with his TBI in a more effective manner.

1. Use a Mobile Calendar App

I created a calendar for Sean in my iPhone and shared it with him (see brief instructions below or click here). Now I can add his appointments, meetings, and trips on my phone and he is able to access them through the app on his iPhone and iPad. In addition to time and date, I can add the location or notes for the event. The app allows me set alerts which come across both our mobile devices as notifications. I normally set alerts a day in advance and an hour in advance to allow  me time to remind him and avoid last-minute surprise. Using the calendar also helps me track his events that aren’t on my personal schedule (such as VFW meetings). I check the calendar each night and remind Sean of the next day’s schedule. It’s handy because i can manage it for him, see any items he adds himself, and view my own calendar at the same time.

Open the iPhone’s calendar app and click on “Calendars”:

Open the iPhone's calendar app and click on Calendars

Select “Edit” under iCloud Calendars:

Select Edit under iCloud Calendars

Select “Add Calendar” and follow instructions for naming calendar:

Select Add Calendar and follow instructions for naming calendar

Select “Add Person” to share the calendar:

Select Add Person to share the calendar

2. Sign up for Cozi

Visit cozi.com and sign up for their shared online calendar (I use the free version). Cozi offers shared calendars and lists that can be accessed by any family members with login information on their computers or mobile devices. You can opt to text individual mobile devices with appointments and notes automatically. I use Cozi to send Sean text messages each day reminding him to take medications and when to eat meals. I have the texts sent to my phone as well so I can verbally remind him (in case I lose track of time). There is room to add notes to each event, so messages sent can be as detailed as needed.

3. Develop a White Board Schedule

We started with a very detailed daily schedule to help Sean remember the progression of each day’s tasks. It worked well for a time, then reached a point where it overwhelmed him visually and cognitively. We now use a simpler version and combine it with text reminders for medications, meals etc. and verbal reminders.

Develop a White Board Schedule

Develop a White Board Schedule

4. Hold Daily Meetings

Choose a time of day that is structured (not over dinner, while doing homework with the kids, or while distracted with other activities) and is a typically a good time of day for focus. Sean and I chose to have our meetings each morning. This time was set aside to review the day’s activities, discuss needs, and address any military or VA issues or answer questions he had (to avoid fixating on these issues all day long—which had become a huge problem). We recorded a few notes in a notebook so he could look back at the discussion if he had questions later in the day, or needed a reminder of what we decided. Gradually, we have moved away from structured meetings since we don’t deal with the same volume of VA and military issues at the moment, and instead do a brief check in each morning to cover his schedule. I also check the calendar on Sunday night and alert him to upcoming activities and appointments for the week ahead.

5. Use a Timer

Time can be difficult to track for a person with a TBI. Setting a timer can help add structure to the day, aid in staying on task, and improve efficiency and independence. Try setting a timer to:

  • Break tasks into smaller steps
  • Allow for scheduled breaks
  • Set start or end times for activities
  • Allow transition time

6. Use Labels

TBI can make it difficult to remember where items are stored, and looking through multiple cupboards and drawers can add frustration. We use a system of labels around the house to locate key items.  After our home remodel a couple years ago, Sean found the increased number of light switches especially confusing, so I labeled those as well. You may want to label drawers, cupboard doors, bathroom cabinets, nightstand drawers, storage in the garage, etc. to fit the needs in your home.

Use Labels

It can also be confusing, and even frightening, to operate appliances or equipment. Sean struggled for months to operate the new microwave since the buttons were different. Our new flat-top stove was a particular concern as the burners have options for different sized pans, and the surface stays hot long after the burner is turned off. I printed brief instructions for each appliance, mounted on a magnetic sheet, and covered with laminating film so they can be wiped clean, if needed. We also used orange bump dots to mark the buttons he may  need to use most to make them more visible.

Laminate labels so they can be wiped clean.

Laminte labels so they can be wiped clean.

It’s easy to forget the items you need when you leave the house. I hang notes on doors (try colored Post It notes), and set necessary items on a chair next to the back door where they will be visible on the way out. I also made magnetic notes for items Sean needs each time he leaves the house.

Magnetic notes for items Sean needs each time he leaves the house.

7. Keep Things in the Same Location

When our daughter was home last summer she helped put groceries away and moved the yogurt to the opposite side of the refrigerator shelf. Sean thought we were out of yogurt for days when in fact we had plenty–just in the wrong spot. The same happens if I wash a bag of carrots and put them in a Tupperware bowl to preserve freshness. I now label that container so he knows what’s inside (the same for fresh cut fruit or vegetables) with reusable wipe-off labels.

Staying organized is a matter of establishing a habit for most of us. Many times I can’t find my wallet, keys, or phone if I put them in new locations. We have a shelf by the door for Sean’s keys and wallet. His medications for the day go on the same counter each morning. His chargers stay plugged in next to his nightstand. His hearing aids stay on top of the dresser. He has a small set of stacking drawers on his dresser for extra keys, cords, and eyeglasses. This routine aids with memory when he can’t locate an item.

8. Simplify Household Chores

Keep chores simple. We have learned that multi-step instructions or long lists of tasks overwhelm Sean’s brain and result in nothing being accomplished. To enable him to be helpful and avoid nagging we’ve come up with our own system.

Sean has a few tasks that he is in charge of completing. I can remind him with a note on the counter, but then allow plenty of time for him to complete the job independently. He is in charge of taking out the trash, feeding the dogs in the afternoon, keeping his area in the basement clean and organized, and putting away leftovers after each meal. In order to ensure he is completing chores independently, I do not step in to take over or redo what he has done. This means the trash might sit in the porch for a couple days until he remembers to pick it up and take it outside (though I remind him more frequently if it has food waste or it’s hot outside).

Sean still enjoys maintaining our home and yard, although he’s not able to do many tasks independently. He is no longer able to safely mow the lawn or shovel the snow. Since I have no desire to do either, our solution was to locate dependable people who offer those services and make it Sean’s job to call them when needed. At times it takes a day or two for him to remember to make the call, but the responsibility for doing so is solely his. He also calls to schedule car maintenance or home repair and I help him identify the person to call when necessary.

It’s important to note that changes in our routine (illness, pain, travel, company) will disrupt his routine and we will need to start over getting him back on track.

9. Create a Safe Space

Sensory overload and stress can lead to fatigue, anxiety, and anger. Having a safe space to retreat and decompress is an easy way to take time away and calm down or rest. Choose a quiet place that can be dedicated to relaxing activities. Equip this space with whatever you find comforting: TV, headphones, computer, comfortable chair, puzzles, books, etc. It is helpful to have items dedicated only to this space, with spares for other areas of the house, so this area is always prepared and ready.

When spending time at the home of relatives or friends, try to identify a safe space ahead of time. Talk to the host about the purpose of this space and ask them to help you select a location. Bring portable headphones, laptop, iPad, books, etc. in a back pack as a “mobile safe space.” Prepare ahead of time by discussing the plan and visit the safe area when you arrive.

Be aware of clues. For example, if Sean disappears with no notice I know he is taking down time and doesn’t need my support, but if he is seeking my attention, he needs me to direct him to the safe area and help him get settled in. He may need pain meds or extra support.

It may also be helpful to choose a safe word or code word that can be used during times of distress.

10. Using Tools to Aid Memory

Highlighters and Post-It notes or sticky tabs are great for marking important information in books, binders, and manuals. They are also handy if you print emails, memos, or meeting notes.

Digital recorders can be used to record meetings or classes, but can also be used to keep audio notes or reminders throughout the day. Most smart devices have digital recorders built in, so there is no need to purchase a separate device.

Lists can serve a variety of purposes. Sean is currently using a small whiteboard to track his to-do items for bike camp along with his weekly schedule. He keeps a Post-It note on the counter where he can jot down things he needs me to know (which can range from grocery items to appointments or tasks) and I can add to the calendar or to my own list. We also keep a list of his goals on the bulletin board along with a list of upcoming travel dates. The key is keeping all these lists in one location so he knows where to find them.

11. Track Health and Activity

It is important to document health changes and symptoms to identify patterns and track changes over time. Many times when doctors ask Sean how has been feeling, his answer is based on how he is feeling at the moment because he can’t recall how his mood or pain has been over the past few weeks or months since he last saw the doctor.

I make brief notes each day on Sean’s level and type of pain, if he uses additional medications, his sleep quality, nightmares, periods of confusion, etc. along with his activity levels such as riding his bike, walking his dog, or attending events and meetings. This enables us to give his providers the most accurate picture of his overall health and activity.

12. Manage Medications

Medication errors can be harmful or even fatal. Be sure to keep all medications in a safe place (we use a small safe) out of reach of children. Store medications in their original containers with pharmacy labels intact. Double check dates on labels for expiration and refill information.

Since Sean takes many daily pills, we use a pill sorter designed to hold a week’s worth of medication and divided into slots for AM, noon, and PM medications (the Velcro at the top of each box is to help him identify the AM container due to diminished vision). Occasionally, Sean gets confused and takes pills from the wrong slot at the wrong time of day, so we use a small jar with a lid to avoid confusion.

We keep an up-to-date printed list of medications in the safe, my purse, Sean’s wallet, and with emergency information.

If you receive prescriptions from the VA, you can use My HealtheVet to manage prescriptions and refills.

For more information, read this article about VA prescriptions from Family Of a Vet.

13. Find a Hobby

Keeping the mind and body active is an effective tool against depression, anxiety, and even pain. After an injury, it can be difficult to stay active and enjoy the same activities as before. Finding a hobby is one way to stay connected with others and constructively deal with stress and tension.

Exploring different hobbies can open your mind to new and creative endeavors. Engage local friends and family members to increase your amount of social interaction. Check your local area for hobby groups that have clubs or meetings. Take a class to learn something new.

Take time to explore alternatives and get connected with groups that offer adaptive sporting programs like Challenge Aspen Military OpportunitiesLakeshore Foundation’s Lima Foxtrot programUSABA, and Higher Ground (a few of many available to veterans). Building new skills is an excellent strategy for coping with changes in your life.

Volunteer activities can also offer a fantastic outlet and can become a hobby of sorts, too. The focus is on finding new activities to keep you active and healthy.

14. Allow More Time to Complete Activities

Cognitive deficits due to TBI can cause a variety of processing and attention difficulties. The following are key areas that can impact success when completing tasks and activities:

  • Difficulty sustaining concentration for a period of time
  • Inability to filter or combine information
  • Losing track of time
  • Fixating on one aspect of the task, unable to move forward
  • Inability to make decisions, or making quick decisions which are not thought out
  • Memory and confusion issues
  • Slower processing time

It is important to allow time to think and respond, and provide prompting as necessary. Good ways to assist include:

  • Be generous with wait time.
  • Limit the number of steps.
  • Use note cards or prompts.
  • Remember building toward independence is a process.

15. Use Photo Albums to Aid in Memory

Several years ago Sean and my dad went on a fly fishing trip to Sun Valley Idaho. A few weeks later a friend asked Sean about the trip. Sean gave a blank stare and said he hadn’t been on a fishing trip. Several other times Sean has had difficulty remembering the events of trips, and the people he has met. I have put together small albums from each trip to help Sean recall these events. I have used labels to help him identify people. We look at the photos together and talk about what he did that he enjoyed. Slowly, people he has met multiple times have stuck in his memory. It’s handy when he asks questions about a trip, or about someone he’s met, to have the photos close at hand.

16. Use a Script

That might sound funny at first, but it’s incredibly helpful. I have found over the years that having scripts for the children when they are assisting Sean can make for a much smoother visit. I have included a few examples. Be sure to make note of what works in your individual situation.

Our daughter was staying with Sean and he was requesting to eat out every night. She had purchased groceries and was getting frustrated with his wanting to change her plans every night. I explained that he was probably getting hungry and making suggestions simply as a way to solve his hunger problem. I told her that as it neared dinner time she should tell him, “I’m making ____ for dinner tonight. It will be ready around 6:00.” The simple act of making him aware of what was coming next was enough to put him at ease.

When he gets anxious in public we practice using calming words such as, “We will be finished shortly.” “I understand your frustration, let’s finish up and get out of here.” “If you need to leave, just let me know.” Hearing the phrases he is used to helps him remain calm, and helps whoever is assisting him know what to do in tense situations.

When Sean is having a migraine the pain is normally compounded by confusion. He repeatedly gets out of bed, or asks what he should be doing. It is helpful to say, “You need to lay down (take a pill, use an ice pack, stay still) until you are feeling better. That’s your only job right now.” I may need to repeat it a few times, but it works much more effectively than trying to answer each question or concern he raises.

17. Manage Stress

Stress is a normal physical response to events that make you feel threatened or upset your balance in some way.  Stress can also impair cognition, processing, and memory, and prolonged stress can wreak havoc on the entire body.  It’s important to take time to restore the balance in your body and brain on a regular basis. Here are a few ways you can recover from and reduce the stress in your life.

  • Get regular exercise.
  • Eat a healthy diet.
  • Practice good sleep habits.
  • Reduce caffeine and sugar intake.
  • Avoid alcohol, cigarettes, and other drugs.
  • Take regular breaks.
  • Learn to say no.
  • Take time to connect with others.
  • Find activities that replenish your soul.

18. Stick to a Routine

Individuals with brain injury may have difficulty planning and organizing their daily tasks. It is helpful to plan out a consistent routine at home that is predictable. Get up at the same time each day. Perform hygiene tasks in the same order. Eat scheduled meals. Use checklists where necessary to help stay on track. Predictability can reduce anxiety about the unknown and consistency will increase the level of independence in the home.

19. Travel Wisely

Travel can be stressful even under the best of circumstances. Being prepared can ensure your travel plans go as smoothly as possible.

Use a specific packing list. Sean often means to pack an item, or thinks he has it when he doesn’t. Having a list to check off allows him to pack independently and be confident he has all he needs.

Bring enough medications (prescription and over-the-counter as needed). Include an extra day or two to allow a buffer should travel plans change. Be sure to include extra pain medications. Always keep medications and any critical care items in your carry-on baggage should flights be canceled or delayed

Pack a variety of comfort items and activities such as a travel pillow and blanket, books or audio books, portable electronic device loaded with music or games, headphones, and snacks. Sean packs the items he needs in his backpack whether we are flying or driving so he has them close at hand.

If you have a service dog, be sure to include treats and comfort items along with necessary care tools and plenty of food. Keep the dog’s critical items in your carry-on baggage. It’s helpful to have ADA guidelines available along with service animal guidelines from the Air Carrier Access Act (see Seat Assignments page 6) should you encounter any questions or concerns about your service animal.

If driving, be prepared to make stops along the way and allow break time.

When flying, allow enough time to comfortably get through security and to gates on time. TSA offers a service for disabled veterans that will provide assistance at the airport. Contact the TSA Cares Helpline for more information.

When you arrive at your destination, allow time to settle in before starting activities.

If you are staying in a hotel, locate nearby restaurants or choose a hotel with a restaurant onsite. Dine at off-peak hours to avoid crowds.

If using public transportation, study the routes and fares ahead of time. Have taxi fare and reliable cab company numbers on hand. If driving, know the best routes around town and the locations of your destinations.

Have a clear (but flexible) itinerary with planned breaks and meal times.

Remember that when you return home extra recovery time will be needed before starting your normal routine.

20. Prepare Simple Meals

One of Sean’s goals is to help plan and prepare meals a couple times a week. Sean received training in safe cooking techniques during his blind rehab programs and is interested in becoming more independent in the kitchen.

  • Plan the menu and shopping list. Choose meals with fewer steps to follow.
  • Store all items in one spot with a label in the cupboard and/or refrigerator.
  • Use a tray to gather ingredients at preparation time. Gather needed cooking utensils in the same fashion. Have a timer available.
  • Use recipe cards with clear steps. Follow all steps in order and use the timer to signal when it’s time for the next step.
  • Practice kitchen safety.
  • Include clean up as part of meal prep.

Store all items in one spot with a label in the cupboard and/or refrigerator.Store all items in one spot with a label in the cupboard and/or refrigerator.

You might also try make-ahead freezer meals that can be reheated by following instructions taped to the container. Convenience meals such as microwave meals, frozen dinners, or sandwiches are another easy way to share in the cooking responsibilities.

21. Prepare for Absence or Illness

Preparing to be away from home (or, gasp! sick) can be incredibly stressful. By planning ahead of time (when possible) you can make your absence easier for all parties. Pre-planning is especially valuable when absences come as a surprise.

Identify how the care recipient will:

  • get to and from appointments, meetings, and outings
  • get meals or groceries (and/or remember to prepare and eat meals)
    • stock up on microwaveable meals, canned goods, frozen foods, juices
  • remember to take medications
  • care for pets
  • stay on a sleep schedule
  • clean up

Identify people who can assist with daily tasks, or who can stop by during the day to check in.

Have a list of emergency number on hand.

Have copies of medication lists, doctors, insurance information in a central location.

Help your loved one identify what he/she can do to help you. Being helpful and providing care for you is an easy way to put anxieties to rest.

22. Emergency Information

Always carry emergency information in your wallet or purse. This information should include medical conditions, doctors’ information, current medications, and insurance information along with any emergency contact numbers.

As an added measure, you might consider a free AVBI Medical Alert Tag and ID Cardthrough American Veterans with Brain Injuries.

A new option available for purchase is My ID band which allows medical professionals to electronically access your emergency information.

Smart phone users can download an app such as ICE (In Case of Emergency) which displays emergency information on the lock screen in case you are in an accident.

23. Create an Emergency Binder

I know what to do in an emergency involving Sean. I carry his critical medical information and know his history. But what if an accident occurred and I was not the person on the scene? What if something happened to me, would he know what to do? Creating an Emergency Binder could literally save a life.

Things to include:

  • Personal Information (for each family member): name, SSN, DOB, height, weight
  • Copies of insurance cards, VA ID card, military ID
  • Allergy information
  • Names of doctors with specialties and contact information
  • Brief medical history, including any mental health conditions
  • Current medications and dosages with prescriber and pharmacy information
  • Emergency contact numbers for family members
  • Copies of legal documents such as a Durable Power of Attorney for Health Care, Living Will, and Advance Directives

If you are interested in a free, ready-made packet you can print and fill in, email me at melissa@familyofavet.com and I will send to you.

Also, be sure to post emergency numbers in a visible location and include suicide hotline numbers.

24. Use Apps

Check out these Life-Changing Mobile Apps for People with Brain Injury.

From this list Sean uses Audible, Cozi, ICE, Lumosity, PTSD Coach, Dragon Dictation, Breathe2Relax, and T2 Mood Tracker. Check them out and see what might work for your situation.

Sean also uses Brain Fit and Brain Trainer apps occasionally. He has the MyLocation app which allows a user to find their location and share with others. Sean’s is set up to send me his location if he is confused or lost.

25. Educate Family and Friends

It can be incredibly difficult for family members and friends to understand the changes that happen after injury. This is especially true when dealing with an invisible injury like TBI. It’s important to have a support system that includes loved ones, which means you may need to take an active role as educator to help them understand how the injury has impacted the immediate family, as well as the care recipient, and how they can best be of assistance.

Be prepared to have difficult conversations. Whether discussing care concerns or expressing a need for space and privacy, conversations with family members can be touchy post injury.

Have realistic expectations. Every member of the team has different abilities, skills, comfort levels, and limitations.

Be clear about who is in charge of making care decisions, and what medical information will be shared.

Share strategies that work. Encourage others to get involved in positive ways by following the model that works for you.

Make necessary adaptations for holidays and events. Discuss strategies for success in advance.

Most importantly, be sure all members are educated about the nature of the disability and expected outcomes. Share information on TBI that you find helpful. You can find tons of helpful articles and videos at BrainlineBrainline Military, and Family Of a Vet. Also check out Brain Injury Association of America and American Veterans with Brain Injuries. Visit your local county extension office, or do a quick google search, for local brain injury agencies or support groups.

26. Keep a Journal

Journaling has been shown to help reduce symptoms of anxiety and depression and improve overall feelings of self-worth. Taking time each day to jot down notes about the events of the day and how you felt throughout the day is an excellent tool to help get in touch with emotions and process feelings. By reading through previous journal entries you can identify common stressors or triggers and develop a plan for positive coping strategies when those triggers arise. Depending on your preference, a personal journal can be shared with doctors or counselors for more insight.

For those with TBI, a journal can also serve as a reference book to record events and memories. It’s easy to look back and see when something happened, or browse through entries to refresh your memory.

If paper and pencil isn’t your thing, or you’re on the go, try using a digital voice recorder to dictate your journal entries

27. Keep it Simple

Eliminate what you can. Think you can’t? Start by reviewing activities for each family member. Evaluate your choices. Why are you involved with each activity? Is this activity meaningful and necessary? Does this activity enrich our lives in long-term ways? If not, consider eliminating it. Keep in mind that the goal is to streamline your home life and relieve stress and tension from your family.

Consider your options. You won’t be the world’s worst parent if you don’t attend every single game. Talk to other parents about carpooling to activities. There are usually other parents who would be relieved by a rotating schedule. If a season-long program doesn’t fit into your schedule, check into local day camps or classes your child could attend. Choose activities where your child is adequately supervised and time is structured to gain time for yourself. Use this time to run errands, or, bring a good book and enjoy a little down time.

Don’t do things simply because you’re feeling pressured. While it may be easier to say “yes” in the moment, think about how you will feel once you are obligated. If it’s not the right choice for you say “no” and stick to it.

What can you outsource? Do you have a neighbor who can share carpooling duties to and from school? Is there a friend or family member who can take the kids off-site for playdates? Can you afford to have someone come in to clean or have groceries delivered? Check with your local VA facilities, veterans’ organizations, or churches for additional resources and services.

Be honest about your needs and limitations. Many times people want to help but don’t know how.

Utilize available services such as Occupational Therapy, Speech Therapy, Physical Therapy, or Recreation Therapy along with services through any available caregiver programs. These trained professionals have a wealth of information and resources.

Forgive yourself. No one is prepared for major life changes. It’s ok to not have all the answers or to not have your sh*t together all the time. We all struggle to get through the day at times and find it takes much longer to recover after setbacks or when new issues arise.

28. Get Plenty of Sleep

Sleep is essential to good physical and mental health. When you don’t get enough sleep memory, concentration, coordination, and mood are negatively impacted. Lack of sleep over a period of time causes your physical health to decline and can lead to increased depression and anxiety. Sean’s nightmares, night sweats, insomnia, fatigue, restless leg syndrome, sleep apnea, and chronic pain all have a negative impact on his quality and quantity of sleep (and mine!). Sleep medications help with some of the symptoms, but don’t solve the problem.

To combat sleep deprivation and allow your body as much rest as possible, establish a sleep schedule by going to be and waking at set times each day.  Take naps, if needed, early in the day. Avoid if napping disrupts nighttime sleep.

Turn off electronics. Keep the room dark and cool. Make the bedroom a quiet space, or use a white noise machine to create an audibly peaceful environment. Invest in a comfortable mattress, pillows, and bedding.

Avoid caffeine and sugar after dinner, and don’t eat large meals late in the day. Alcohol and nicotine can also be factors in quality of sleep.

Take time to unwind before bedtime. Read, meditate, or practice deep breathing exercises. Take a warm bath. Listen to soothing music. Dim the lights. This can help your body and brain get into sleep mode.

29. Encourage Independence

Independence is a critical component of recovery after TBI. While your loved one may not be able to do all their former activities to the same extent as before the injury, implementing support and modifications can maximize independence.

  • Set realistic goals and start small.
  • Create an environment for success. Have needed materials on hand in areas where they are easy to access.
  • Use checklists or verbal prompts where possible.
  • Practice safety and good judgement.
  • Give immediate, constructive feedback. Use praise and encouragement.
  • Accept that mistakes will happen and make modifications when necessary.
  • Connect with others who will encourage independence in or out of the home.

30. Use Praise and Positive Affirmations

A little praise can go a long way toward boosting a person’s mood and creating a positive pattern of behavior and interaction.

  • Remember to say, “Thank you.” Even for the small things like taking out the trash (even if it takes several days to get it done) or wiping off the table.
  • Leave little notes of appreciation around the house.
  • Share your pride in their accomplishments.
  • Keep a gratitude journal.

31. Resources

Looking for additional information on traumatic brain injury? Check out these websites:

Additional resources and reading material available on tabs at the top of this page.

Posted on BrainLine October 25, 2016

About the Author

Melissa and Sean JohnsonMelissa Johnson and her husband, Sean, were married in 1995 and raised their three children in Aberdeen, SD. Melissa taught for 15 years in Special Education and First Grade. Sean served in the US Army and was deployed three times in his 24-year career in the military. Sean was injured by a mortar blast on March 25, 2006, in Balad, Iraq. The blast resulted in a traumatic brain injury. Sean is also legally blind and struggles with post-traumatic stress disorder.

When Sean returned home in 2007, the family struggled to adjust to this “new” man in their house. Melissa eventually left her teaching job to become a full-time caregiver to her husband. She is now a certified caregiver through the VA’s Caregiver Program.

Both Melissa and Sean have been active with the Blinded Veterans Association since 2009. Sean serves as Commander of his local VFW chapter and is also the Junior Vice of the local Disabled American Veterans chapter. Melissa currently works with the Military and Veteran Caregiver Network as the Education and Training Coordinator. She serves with the Elizabeth Dole Foundation as a Caregiver Fellow. She is honored to work alongside other caregivers from across the nation to raise awareness of the issues facing our nation’s caregivers and families.

Read more from Melissa on her blog: Bringing the Battle Home

via 31 Strategies for Living with Traumatic Brain Injury | BrainLine

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[Abstract+References] A pilot randomized controlled trial of on-line interventions to improve sleep quality in adults after mild or moderate traumatic brain injury.

To explore feasibility and potential efficacy of on-line interventions for sleep quality following a traumatic brain injury (TBI).

A two parallel-group, randomized controlled pilot study.

Community-based.

In all, 24 participants (mean age: 35.9 ± 11.8 years) who reported experiencing sleep difficulties between 3 and 36 months after a mild or moderate TBI.

Participants were randomized to receive either a cognitive behaviour therapy or an education intervention on-line. Both interventions were self-completed for 20–30 minutes per week over a six-week period.

The Pittsburgh Sleep Quality Index assessed self-reported sleep quality with actigraphy used as an objective measure of sleep quality. The CNS Vital Signs on-line neuropsychological test assessed cognitive functioning and the Rivermead Post-concussion Symptoms and Quality of Life after Brain Injury questionnaires were completed pre and post intervention.

Both programmes demonstrated feasibility for use post TBI, with 83.3% of participants completing the interventions. The cognitive behaviour therapy group experienced significant reductions (F = 5.47, p = 0.04) in sleep disturbance (mean individual change = −4.00) in comparison to controls post intervention (mean individual change = −1.50) with a moderate effect size of 1.17. There were no significant group differences on objective sleep quality, cognitive functioning, post-concussion symptoms or quality of life.

On-line programmes designed to improve sleep are feasible for use for adults following mild-to-moderate TBI. Based on the effect size identified in this pilot study, 128 people (64 per group) would be needed to determine clinical effectiveness.

 

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via A pilot randomized controlled trial of on-line interventions to improve sleep quality in adults after mild or moderate traumatic brain injuryClinical Rehabilitation – Alice Theadom, Suzanne Barker-Collo, Kelly Jones, Margaret Dudley, Norah Vincent, Valery Feigin, 2017

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[REVIEW] Photobiomodulation for Traumatic Brain Injury and Stroke – Abstract

Abstract

There is a notable lack of therapeutic alternatives for what is fast becoming a global epidemic of traumatic brain injury (TBI). Photobiomodulation (PBM) employs red or near-infrared (NIR) light (600–1100nm) to stimulate healing, protect tissue from dying, increase mitochondrial function, improve blood flow, and tissue oxygenation. PBM can also act to reduce swelling, increase antioxidants, decrease inflammation, protect against apoptosis, and modulate microglial activation state. All these mechanisms of action strongly suggest that PBM delivered to the head should be beneficial in cases of both acute and chronic TBI. Most reports have used NIR light either from lasers or from light-emitting diodes (LEDs). Many studies in small animal models of acute TBI have found positive effects on neurological function, learning and memory, and reduced inflammation and cell death in the brain. There is evidence that PBM can help the brain repair itself by stimulating neurogenesis, upregulating BDNF synthesis, and encouraging synaptogenesis. In healthy human volunteers (including students and healthy elderly women), PBM has been shown to increase regional cerebral blood flow, tissue oxygenation, and improve memory, mood, and cognitive function. Clinical studies have been conducted in patients suffering from the chronic effects of TBI. There have been reports showing improvement in executive function, working memory, and sleep. Functional magnetic resonance imaging has shown modulation of activation in intrinsic brain networks likely to be damaged in TBI (default mode network and salience network).

via Photobiomodulation for Traumatic Brain Injury and Stroke – Hamblin – 2017 – Journal of Neuroscience Research – Wiley Online Library

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[Poster] Sleep Experiences Following Traumatic Brain Injury: A Qualitative Descriptive Study

First page of article

To describe the sleep experiences of adults living with moderate or severe traumatic brain injury (TBI).

via Sleep Experiences Following Traumatic Brain Injury: A Qualitative Descriptive Study – Archives of Physical Medicine and Rehabilitation

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[WEB SITE] Hot Topic Module: Changes in Memory After Traumatic Brain Injury

This Hot Topic Module consists of a suite of resources to help individuals with traumatic brain injury understand changes in memory after TBI and offers strategies that can help people who experience this function more effectively.

Resources

TBI and Memory Resources

VIDEOS: Changes in Memory After Traumatic Brain Injury
Our featured video and brief video clips explain changes in memory after traumatic brain injury (TBI). Jason Cowper and Tonya Howell share their stories of coming to terms with changes in their memory, and strategies they use to compensate for these changes. The video also includes the perspectives of TBI experts at the Texas TBI Model System of TIRR Memorial Hermann, who provide clinical insight on the changes in memory that some people experience after sustaining a TBI. View the featured video here. View additional video clips here.

FACTSHEET: Memory and Moderate to Severe Traumatic Brain Injury
This fact sheet explains memory problems that may affect people with moderate to severe traumatic brain injury (TBI). By understanding the new limits on their memory and ways to help overcome those limits, people with TBI can still get things done every day. View the factsheet here.

SLIDESHOW: Memory and Moderate to Severe Traumatic Brain Injury
Memory problems are very common in people with moderate to severe TBI. The information in this slideshow explains memory problems that may affect people with moderate to severe TBI. By understanding the new limits on their memory and ways to help overcome those limits, people with TBI can still get things done every day. View the slideshow here.

Related Reso

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FACTSHEET: Depression After Traumatic Brain Injury
Fatigue is one of the most common problems people have after a traumatic brain injury (TBI). If you are experiencing fatigue, there are things you can do to decrease feelings of exhaustion, tiredness, weariness or lack of energy. The information in this factsheet describes causes of fatigue after TBI and ways to help alleviate these problems. View the factsheet here.

FACTSHEET: Emotional Problems After Traumatic Brain Injury
A brain injury can change the way people feel or express emotions. An individual with TBI can have several types of emotional problems. This factsheet discusses possible emotional problems and what can be done about depression. View the factsheet here.

SLIDESHOW: Emotional Problems After Traumatic Brain Injury
Emotional problems occur in people after a traumatic brain injury (TBI). A brain injury can change the way people feel or express emotions. An individual with TBI can have several types of emotional problems. The information in this slideshow describes the causes of emotional problems after a TBI. View the slideshow here.

via Memory

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