During that first year after a family member has sustained a brain injury, it can be an extremely stressful and lonely time. But we are not alone; the incidence of brain injury is higher than one would expect.
After my partner’s serious motorcycle accident, I realized how difficult it was to get information on brain injuries or on how family members can help their brain-injured loved one. Following a brain injury it is necessary for those close to the injured person to know what to do when dealing with the monumental changes in both of their lives.
Often during the first few months when talking to medical staff, I felt it was difficult to get answers; partly because at the beginning very little was known about the severity of his injury or what the results of the injury would be. I also suspected that some of the information I was given may have been designed to not build up any hopes on my part. Further, I became aware that the more questions I asked, the more variety of answers I received with each person appearing to have a different opinion on both his injury as well as his prognosis. This may possibly have been because no two head injuries are the same.
The hospital library, I discovered, was a good place to start to initially look for information; the librarian I approached gave me some very good websites to check out. There are also many other sources available on internet. Brain Injury Associations are also excellent avenues for obtaining information, as well as brain injury support groups. And don’t forget the social worker at the hospital – she will have a lot of useful information for after the injured person returns home. But you must ask the questions because no one will come to you with answers to questions you have not voiced. It is absolutely necessary to be proactive in your loved one’s health care. This includes making sure that your injured family member will receive cognitive exercises as soon after their injury as possible even if it means doing them yourself.
At the beginning there may seem to be little progress; with a brain injury it is often two steps forward and one step back. The steps are small and sometimes may only be noticed after a big change has taken place. I was told that the majority of change takes place in the first year with possibly some improvement up to two years post-injury but in my partner’s case, there was some progress even after the two year time period.
During the first year the survivor will often experience confusion, short-term memory difficulties, anger, sometimes violence and possibly depression. I discovered that the extreme confusion lessened after about two months but after three years, my partner’s short-term memory problems have not improved. Often medication can assist with some of the other issues. There will sometimes be other deficits as well that will need to be dealt with such as lack of motivation problems, reasoning abilities, rigidity of thinking and anger.
It is very important also, when you are the caregiver, to remember that although what has happened is a tragedy for the injured person, it is a tragedy for his loved ones too. You must remember that you are important also and as such, you must set boundaries. Do not allow yourself to be verbally or physically abused. It is important that we take time for ourselves and not feel guilty about it.
Joining a brain injury support group, if there is not a strong network of supportive family and friends, will be helpful to the caregiver during the first year following their injured loved one’s accident. And remember, eventually that first difficult year will become history.
Tuesday, September 29, 2009
Sunday, August 30, 2009
Barriers to Returning to Work Following A Brain Injury
The severity of the injury – whether it is mild, moderate or severe - will have a large bearing on when and if someone is able to return to work following a traumatic brain injury. But that is only one of the many things that will determine a survivor’s ability to return to the work force. There will be many things also that will determine their ability to hold a job if they do manage to secure one.
Those with fewer memory problems or personality changes are better able to successfully obtain employment. The amount of cognitive deficits they are left with and whether they have adapted to them will play a large part in their re-entry into the job market.
Other things that will be a consideration are their attention skills; ability to respond to the needs of their work environment; ability to focus; memory; reasoning; problem-solving; anger management difficulties; inability to take initiative; problems in sustaining their behaviour, and poor inter-personal relationships.
Age also can be a barrier to successfully returning to work. Employers often prefer hiring a younger person rather than someone who is possibly considered past their ‘prime’ especially one who has a disability.
Also many times employers are nervous about hiring someone who has sustained a traumatic brain injury. Most people do not understand brain injuries and the worry is they don’t know what they’re getting and don’t wish to take a ‘chance’ on potential problems.
Some survivors don’t have the self-esteem, or they lack the initiative to apply for positions of employment. The fall-out for a young person especially of not working further harms their feelings of self-esteem. This is particularly true if they have few leisure time interests, lack outside social contacts or are completely dependent on their family, spouse or caregiver.
Studies show that those who have a higher education or an advanced level of training, are more successful in their ability to find work – and to be able to keep it. This also includes those who have had access to rehabilitation and especially if it was available as soon after the injury as possible.
Unfortunately many brain injury survivors are unable to return to work for various reasons and are left floundering – jobless and with few financial, emotional and physical resources.
Those with fewer memory problems or personality changes are better able to successfully obtain employment. The amount of cognitive deficits they are left with and whether they have adapted to them will play a large part in their re-entry into the job market.
Other things that will be a consideration are their attention skills; ability to respond to the needs of their work environment; ability to focus; memory; reasoning; problem-solving; anger management difficulties; inability to take initiative; problems in sustaining their behaviour, and poor inter-personal relationships.
Age also can be a barrier to successfully returning to work. Employers often prefer hiring a younger person rather than someone who is possibly considered past their ‘prime’ especially one who has a disability.
Also many times employers are nervous about hiring someone who has sustained a traumatic brain injury. Most people do not understand brain injuries and the worry is they don’t know what they’re getting and don’t wish to take a ‘chance’ on potential problems.
Some survivors don’t have the self-esteem, or they lack the initiative to apply for positions of employment. The fall-out for a young person especially of not working further harms their feelings of self-esteem. This is particularly true if they have few leisure time interests, lack outside social contacts or are completely dependent on their family, spouse or caregiver.
Studies show that those who have a higher education or an advanced level of training, are more successful in their ability to find work – and to be able to keep it. This also includes those who have had access to rehabilitation and especially if it was available as soon after the injury as possible.
Unfortunately many brain injury survivors are unable to return to work for various reasons and are left floundering – jobless and with few financial, emotional and physical resources.
Friday, August 21, 2009
Brain Injuries and Apathy
Apathy is very common following a traumatic brain injury and may often occur in conjunction with depression, but not always. It may become apparent shortly after a brain injury or may not be evident until a few years later.
There are many indications of this deficit – a decrease in goal-oriented activities and no interest in making goals of any kind; no interest in working towards rehabilitation; no effort towards becoming independent; no effort made towards any work-related activities; no interest in achievements of any kind; an emotional indifference; little effort at communication; little concern for their own health; loss of interest in daily activities; reduced interaction in personal relationships; few emotional reactions to situations and circumstances; unable to initiate, take action or make any plans; no interest in the future; little appreciation or notice of recovery made to date, and withdrawal creating social isolation. Their feelings of self-worth may plummet and they could possibly experience a sense of hopelessness. When survivors of brain injury are living with this deficit, they are often considered to be ‘lazy’ or possibly ‘couch potatoes’.
Following a brain injury, 61.4% of adults will exhibit signs of apathy. They will feel they have lost their role in life. For most of us, our role is defined by relationships we have established with others. But often after an injury friends don’t come by as often and eventually may stop coming altogether and sometime family relationships will become strained as well. Survivors often no longer seem to be the same person they once were.
Although apathy can be associated with depression, the latter is more common – found in 83% of traumatic brain injury survivors. There can however, be other factors associated with apathy. i.e.: health issues such as hypothyroidism or other illnesses; personality changes; difficult factors existing in their life; poverty or even the beginnings of dementia. Apathy is associated with a faster cognitive decline. There are, however, medications available for the treatment of this deficit.
From a recent study it has been suggested that there is a correlation with coping strategies and adapting – an active way of adapting to problems and managing stress versus a passive (avoidance) method which results in doing nothing and which often leads to substance abuse.
If someone is currently taking an anti-depression medication and still appears to be suffering from ‘depression-like’ symptoms, they may instead be suffering from the deficit of apathy; particularly if they continue to show a general lack of interest in most things in their life. If this is the case, it is important for them to see a medical practitioner.
There are many indications of this deficit – a decrease in goal-oriented activities and no interest in making goals of any kind; no interest in working towards rehabilitation; no effort towards becoming independent; no effort made towards any work-related activities; no interest in achievements of any kind; an emotional indifference; little effort at communication; little concern for their own health; loss of interest in daily activities; reduced interaction in personal relationships; few emotional reactions to situations and circumstances; unable to initiate, take action or make any plans; no interest in the future; little appreciation or notice of recovery made to date, and withdrawal creating social isolation. Their feelings of self-worth may plummet and they could possibly experience a sense of hopelessness. When survivors of brain injury are living with this deficit, they are often considered to be ‘lazy’ or possibly ‘couch potatoes’.
Following a brain injury, 61.4% of adults will exhibit signs of apathy. They will feel they have lost their role in life. For most of us, our role is defined by relationships we have established with others. But often after an injury friends don’t come by as often and eventually may stop coming altogether and sometime family relationships will become strained as well. Survivors often no longer seem to be the same person they once were.
Although apathy can be associated with depression, the latter is more common – found in 83% of traumatic brain injury survivors. There can however, be other factors associated with apathy. i.e.: health issues such as hypothyroidism or other illnesses; personality changes; difficult factors existing in their life; poverty or even the beginnings of dementia. Apathy is associated with a faster cognitive decline. There are, however, medications available for the treatment of this deficit.
From a recent study it has been suggested that there is a correlation with coping strategies and adapting – an active way of adapting to problems and managing stress versus a passive (avoidance) method which results in doing nothing and which often leads to substance abuse.
If someone is currently taking an anti-depression medication and still appears to be suffering from ‘depression-like’ symptoms, they may instead be suffering from the deficit of apathy; particularly if they continue to show a general lack of interest in most things in their life. If this is the case, it is important for them to see a medical practitioner.
Friday, August 14, 2009
Brain Injuries and Dependencies
Following a traumatic brain injury, the survivor may be left with various dependencies. They may be emotional in nature or based on a substance abuse. Whatever dependency is involved, it can lead to difficulties in recovering from the injury.
Some of the emotional problems that can lead to dependency are a result of lack of initiative; lack of motivation; planning and problem solving difficulties and lack of self-esteem. All of these things can lead to feelings of powerlessness. And for this reason they will often become emotionally dependent upon someone close to them. There is another type of dependency called learned helplessness or learned dependency which will sometimes come about when someone helps beyond the point where help is actually needed.
With frontal lobe injuries there may also be a difference in emotional intelligence post-injury versus pre-injury. This is quite different from intellectual intelligence. Emotional intelligence relates to emotional self-awareness, the ability to recognize others’ emotions, taking responsibility for their own feelings, empathy, self-confidence, self-control, feelings of independence, and getting along with others. Difficulty in these areas can lead to dependency on others, particularly a caregiver.
Another dependency may be that of substance abuse. Sixty-seven percent of those with brain injuries have a history of substance abuse pre-injury and fifty percent of those will return to using alcohol following their injury. However, substance abuse can often be a result of boredom and loneliness also. With the use of alcohol and drugs after a brain injury, there is an increased risk of seizures as well as the risk of sustaining further brain injuries.
But there are many others who will fight for their independence. i.e.: they will drive before they have been given the ‘go ahead’ to drive; will refuse to go to therapy appointments; will feel increased anger if they are personally, socially or financially limited, as well as if they are deprived of privacy. Also those who need help physically may resent the help they receive if they think they should be able to do it themselves.
Regardless of whether they have become dependent or are fighting for their independence, it is important to remember that there are no two brain injuries that are the same and each person will react differently to their circumstances.
Some of the emotional problems that can lead to dependency are a result of lack of initiative; lack of motivation; planning and problem solving difficulties and lack of self-esteem. All of these things can lead to feelings of powerlessness. And for this reason they will often become emotionally dependent upon someone close to them. There is another type of dependency called learned helplessness or learned dependency which will sometimes come about when someone helps beyond the point where help is actually needed.
With frontal lobe injuries there may also be a difference in emotional intelligence post-injury versus pre-injury. This is quite different from intellectual intelligence. Emotional intelligence relates to emotional self-awareness, the ability to recognize others’ emotions, taking responsibility for their own feelings, empathy, self-confidence, self-control, feelings of independence, and getting along with others. Difficulty in these areas can lead to dependency on others, particularly a caregiver.
Another dependency may be that of substance abuse. Sixty-seven percent of those with brain injuries have a history of substance abuse pre-injury and fifty percent of those will return to using alcohol following their injury. However, substance abuse can often be a result of boredom and loneliness also. With the use of alcohol and drugs after a brain injury, there is an increased risk of seizures as well as the risk of sustaining further brain injuries.
But there are many others who will fight for their independence. i.e.: they will drive before they have been given the ‘go ahead’ to drive; will refuse to go to therapy appointments; will feel increased anger if they are personally, socially or financially limited, as well as if they are deprived of privacy. Also those who need help physically may resent the help they receive if they think they should be able to do it themselves.
Regardless of whether they have become dependent or are fighting for their independence, it is important to remember that there are no two brain injuries that are the same and each person will react differently to their circumstances.
Friday, August 7, 2009
Brain Injuries and Attitude
For most of us, attitude is one hundred percent within our control. It is our choice whether or not to be in a good or a bad mood. But for those who are survivors of a brain injury, the choice has become much more difficult.
The majority of people prefer to be with someone who has a good attitude rather than with someone who grumbles constantly about little things; who looks for problems instead of accepting the challenges; who becomes depressed easily, or who rarely smiles. Those with poor attitudes usually go through life reacting to situations and problems instead of taking control of their lives.
Unfortunately, for those with brain injuries, the effort required to have a good attitude is particularly challenging. Because they are often left with the deficit of lack of motivation and lack of initiative, mustering up the energy required to work at it may prove to be more difficult for them than for others.
For those wishing to have a better attitude in order to assist themselves with the difficulties of recovering from a brain injury, it will be necessary for them to remember that it is important to look for the good in every situation instead of only the negative; to be willing to face any challenge; to believe that with persistence and perseverance most problems can be overcome; to have an optimistic outlook; and to see humour in most situations. While striving towards having an optimistic outlook, and therefore a good attitude, they will be working towards making themselves happier and as a result will become more contented and positive.
Happiness and good attitude will not only be important for themselves but will be valued by those who surround them. With the time and effort of working towards having a good attitude, it will eventually become a choice to live happily and to enjoy the important things in life such as family, friends and health.
For brain injury survivors, those who are positive and optimistic are better able to motivate themselves to accept the challenges facing them. And those with good attitudes are generally positive people who make things happen instead of blaming others because nothing has happened. As with most things in life, nothing happens unless we make it happen.
The majority of people prefer to be with someone who has a good attitude rather than with someone who grumbles constantly about little things; who looks for problems instead of accepting the challenges; who becomes depressed easily, or who rarely smiles. Those with poor attitudes usually go through life reacting to situations and problems instead of taking control of their lives.
Unfortunately, for those with brain injuries, the effort required to have a good attitude is particularly challenging. Because they are often left with the deficit of lack of motivation and lack of initiative, mustering up the energy required to work at it may prove to be more difficult for them than for others.
For those wishing to have a better attitude in order to assist themselves with the difficulties of recovering from a brain injury, it will be necessary for them to remember that it is important to look for the good in every situation instead of only the negative; to be willing to face any challenge; to believe that with persistence and perseverance most problems can be overcome; to have an optimistic outlook; and to see humour in most situations. While striving towards having an optimistic outlook, and therefore a good attitude, they will be working towards making themselves happier and as a result will become more contented and positive.
Happiness and good attitude will not only be important for themselves but will be valued by those who surround them. With the time and effort of working towards having a good attitude, it will eventually become a choice to live happily and to enjoy the important things in life such as family, friends and health.
For brain injury survivors, those who are positive and optimistic are better able to motivate themselves to accept the challenges facing them. And those with good attitudes are generally positive people who make things happen instead of blaming others because nothing has happened. As with most things in life, nothing happens unless we make it happen.
Wednesday, August 5, 2009
Brain Injuries and Poor Judgment
Poor judgment is one of the results of inadequate cognitive functioning following an injury to the frontal lobe. This deficit can involve many aspects of a person's life, including the situations mentioned below:
- When handling a motor vehicle of any kind, someone exhibiting poor judgment may place themselves, and others, in a dangerous situation because of their cognitive deficits. Those with frontal lobe injuries may not drive defensively or anticipate the actions of other drivers. They may tailgate, and possibly not realize the importance of signaling in an appropriate time to be able to safely make turns, particularly when turning left. Other potential problems could be not coming to a complete stop at stop signs, weaving in and out of traffic or going faster than the posted speed limits. Some may drive aggressively and as a result become rude as well as a dangerous driver. They may also decide that it is not necessary to wear appropriate seat belts or helmets thereby placing themselves at risk.
- Poor judgment may also involve excessive use of alcohol or non-prescription drugs. While using these substances they may become impulsive, place themselves and others at risk, act before thinking, perceive and interpret their surroundings in a different way than reality indicates, and not understand the possible consequences of their actions.
- Other examples of this deficit may be indicated by improper behaviour which may include inappropriate touching or sexual innuendoes. Some survivors may have difficulty understanding cause and effect and may have problems with their reasoning abilities. And many will have problems learning from their past mistakes.
- Social situations may also be difficult for some brain injury survivors. Some may possibly behave in an inappropriate manner by being rude, disrespectful of another's personal space, make inappropriate comments, or dominate a conversation. They may also have poor social skills and problems with communication.
There are other ways where poor judgment may become a problem following a brain injury but the ones listed above are quite often the main concerns.
- When handling a motor vehicle of any kind, someone exhibiting poor judgment may place themselves, and others, in a dangerous situation because of their cognitive deficits. Those with frontal lobe injuries may not drive defensively or anticipate the actions of other drivers. They may tailgate, and possibly not realize the importance of signaling in an appropriate time to be able to safely make turns, particularly when turning left. Other potential problems could be not coming to a complete stop at stop signs, weaving in and out of traffic or going faster than the posted speed limits. Some may drive aggressively and as a result become rude as well as a dangerous driver. They may also decide that it is not necessary to wear appropriate seat belts or helmets thereby placing themselves at risk.
- Poor judgment may also involve excessive use of alcohol or non-prescription drugs. While using these substances they may become impulsive, place themselves and others at risk, act before thinking, perceive and interpret their surroundings in a different way than reality indicates, and not understand the possible consequences of their actions.
- Other examples of this deficit may be indicated by improper behaviour which may include inappropriate touching or sexual innuendoes. Some survivors may have difficulty understanding cause and effect and may have problems with their reasoning abilities. And many will have problems learning from their past mistakes.
- Social situations may also be difficult for some brain injury survivors. Some may possibly behave in an inappropriate manner by being rude, disrespectful of another's personal space, make inappropriate comments, or dominate a conversation. They may also have poor social skills and problems with communication.
There are other ways where poor judgment may become a problem following a brain injury but the ones listed above are quite often the main concerns.
Saturday, June 27, 2009
Caregiving Your Spouse Following A Brain Injury
It is a challenging and difficult task to be a caregiver for a spouse. The caregiver will often have to be in the role of being parent to their spouse. This is not a comfortable situation for either the brain injured survivor or for the ‘healthy’ partner but may very often be necessary – particularly if there is no one else to act in the ‘caregiver’ capacity.
With a brain injury and possibly physical injuries, the injured person may be a shell of who he/she once was. Because of this, caregivers often become ‘married widows’ because of the loss of the relationship they had prior to the injury. They may no longer have an equal partner. With the many changes in their spouse, social occasions with friends and family may also gradually become fewer and fewer. This places the ‘healthy’ partner in a ‘social limbo’ situation.
Caregivers very often receive little sympathy or support from family and friends because the injured person will often be on their best behaviour when they occasionally do see those outside of immediate family members. Survivors usually save their worst behaviour for their spouses.
And for this reason, occasionally parents or grown children, (particularly if they are not the caregiver’s children), of an adult survivor may attempt to intervene to the detriment of the attempts of the spousal caregiver to give support and stability. The intervention sometimes may not be in the form of help but rather of criticism or attempts to dissuade the brain-injured survivor to cooperate. i.e.: not attending support groups or therapy sessions, etc. if he/she doesn’t want to or the parents or children don’t think there is a need for them to go. This makes the role of a spousal caregiver even more difficult.
For the non-injured person, although the spouse they once knew may no longer exist, he/she is still alive. How do they mourn the loss of what is gone but is actually there? For many there will be a process of mourning for the relationship that once existed but few friends and family members will understand or have sympathy for those feelings of grief that will likely be experienced by the non-injured spouse.
It is important for caregivers to look after themselves so that they remain healthy and are able to make better decisions. It is also important that they stay connected with others – their friends and family, as well as possibly joining a support group. It will be equally important for them to occasionally get respite and take time for themselves, and if necessary, they must ask for help. No one knows if help is needed unless it is asked for.
Because of the difficulties of being a caregiver, many relationships dissolve following the injury. Those who make the decision to leave the relationship usually do so with feelings of guilt and certainly with feelings of failure. Friends and family will sometimes not understand this choice and may fault the caregiver for ‘giving up’ especially if it appears to others that things are going well.
For those who would criticize, it is best to remember that none of us know what goes on behind closed doors. For each of us, a decision such as this can only be made by those individuals involved.
With a brain injury and possibly physical injuries, the injured person may be a shell of who he/she once was. Because of this, caregivers often become ‘married widows’ because of the loss of the relationship they had prior to the injury. They may no longer have an equal partner. With the many changes in their spouse, social occasions with friends and family may also gradually become fewer and fewer. This places the ‘healthy’ partner in a ‘social limbo’ situation.
Caregivers very often receive little sympathy or support from family and friends because the injured person will often be on their best behaviour when they occasionally do see those outside of immediate family members. Survivors usually save their worst behaviour for their spouses.
And for this reason, occasionally parents or grown children, (particularly if they are not the caregiver’s children), of an adult survivor may attempt to intervene to the detriment of the attempts of the spousal caregiver to give support and stability. The intervention sometimes may not be in the form of help but rather of criticism or attempts to dissuade the brain-injured survivor to cooperate. i.e.: not attending support groups or therapy sessions, etc. if he/she doesn’t want to or the parents or children don’t think there is a need for them to go. This makes the role of a spousal caregiver even more difficult.
For the non-injured person, although the spouse they once knew may no longer exist, he/she is still alive. How do they mourn the loss of what is gone but is actually there? For many there will be a process of mourning for the relationship that once existed but few friends and family members will understand or have sympathy for those feelings of grief that will likely be experienced by the non-injured spouse.
It is important for caregivers to look after themselves so that they remain healthy and are able to make better decisions. It is also important that they stay connected with others – their friends and family, as well as possibly joining a support group. It will be equally important for them to occasionally get respite and take time for themselves, and if necessary, they must ask for help. No one knows if help is needed unless it is asked for.
Because of the difficulties of being a caregiver, many relationships dissolve following the injury. Those who make the decision to leave the relationship usually do so with feelings of guilt and certainly with feelings of failure. Friends and family will sometimes not understand this choice and may fault the caregiver for ‘giving up’ especially if it appears to others that things are going well.
For those who would criticize, it is best to remember that none of us know what goes on behind closed doors. For each of us, a decision such as this can only be made by those individuals involved.
Tuesday, June 23, 2009
"Roller Coaster Ride With Brain Injury (For Loved Ones)"
In the last part of this book, at twelve months post injury, I did a question-and-answer section to see where Larry was at this stage and for comparison for the future. During this period there was much he did not remember. One thing he mentioned that I found rather interesting was that because he had been out of the loop for so long, he felt a little uncomfortable - more like a guest in someone else's home rather than that he was home. Part of this may have had to do with the fact that we had only moved to the house two months before his accident.
........
"Larry initially had no inclination to read my story but later he listened while I read it to him. I told him I was going to tell it like it was and wasn't pulling any punches. He had no problem with that he said, if it helped someone else."
I also included a series of exercises that I did with Larry shortly after his accident. These included orientation aid exercises, memory, therapy and cognitive exercises. I believe very strongly in the value of doing exercises as soon as possible after a brain injury.
........
"Larry initially had no inclination to read my story but later he listened while I read it to him. I told him I was going to tell it like it was and wasn't pulling any punches. He had no problem with that he said, if it helped someone else."
I also included a series of exercises that I did with Larry shortly after his accident. These included orientation aid exercises, memory, therapy and cognitive exercises. I believe very strongly in the value of doing exercises as soon as possible after a brain injury.
Monday, June 22, 2009
Excerpt from "Roller Coaster Ride With Brain Injury (For Loved Ones)"
Epilogue
"Larry still becomes affected by 'bumps in the road' so we are still in the process of steps forward and backward. He may always be affected by 'bumps'. But all in all, I believe he has done well considering his injuries. I also believe that having him do cognitive exercises at an early stage after his injury increased his recovery at a quicker rate than may have happened had he received no cognitive therapy until a later date."
......
"I'm sure there will be many things we will have to learn to deal with; his inability to cope when things don't go well, resulting in his frustration, anger and irritability; his tendency to be self-centered; rigidity in his thinking; being unmotivated and his memory difficulties."
.......
"Although he may never be the person he was before his accident, who he has become is better than the alternative might have been. There may still be times when I will have to remember not to take things personally when he is going through a frustrated period; and there may also be times ahead where it will be two steps forward and one step back. Hopefully over time he will learn to cope with the many 'bumps' there are in every road."
"Larry still becomes affected by 'bumps in the road' so we are still in the process of steps forward and backward. He may always be affected by 'bumps'. But all in all, I believe he has done well considering his injuries. I also believe that having him do cognitive exercises at an early stage after his injury increased his recovery at a quicker rate than may have happened had he received no cognitive therapy until a later date."
......
"I'm sure there will be many things we will have to learn to deal with; his inability to cope when things don't go well, resulting in his frustration, anger and irritability; his tendency to be self-centered; rigidity in his thinking; being unmotivated and his memory difficulties."
.......
"Although he may never be the person he was before his accident, who he has become is better than the alternative might have been. There may still be times when I will have to remember not to take things personally when he is going through a frustrated period; and there may also be times ahead where it will be two steps forward and one step back. Hopefully over time he will learn to cope with the many 'bumps' there are in every road."
Saturday, June 20, 2009
Brain Injuries and Denial
Denial is often a survival technique used when the reality of their situation cannot be accepted; they have not come to terms with what has been lost, and they have not acknowledged their grief. Anna Freud has called this type of denial a defense mechanism.
Another form is when a person can see the limitations but doesn’t understand the impact of it on their daily life – they just don’t get it. This has been referred to as the ‘Anton Syndrome’.
Denial can sabotage any progress towards recovery. In order to work at getting better, it is necessary to make realistic adjustments to their disabilities. When a brain injured survivor is faced with the realization of problems relating to his/her capabilities and deficits, there will more than likely be increased anxiety. This creates a problem and many will deny, like the proverbial ostrich with his head buried in the sand – if you ignore it and pretend it doesn’t exist, perhaps it will go away. By being in denial, attention is drawn away from the problem; there is no need to work towards recovery, and there is no necessity to be accountable.
Their focus then may be placed on the fact that they’re tired, that they have aches and pains or they may blame other people rather than admit that there may be a problem with their brain’s cognitive functioning. Quite often it is the person closest to them where the finger of blame is most often pointed.
My partner is a survivor who is in denial. He is not convinced of his brain injury although he does admit to memory and motivation problems. However, his main focus has become centered on his legs and the pain he feels in his knee.
It is difficult for someone who has suffered a brain injury to be cognitively aware and to learn compensatory strategies. It is easier for them to deny rather than to work towards achieving a new normal; many survivors of brain injuries will remain in denial their entire lives.
“The greatest barrier to someone achieving their potential is their denial of it.” By Simon Travaglia
Another form is when a person can see the limitations but doesn’t understand the impact of it on their daily life – they just don’t get it. This has been referred to as the ‘Anton Syndrome’.
Denial can sabotage any progress towards recovery. In order to work at getting better, it is necessary to make realistic adjustments to their disabilities. When a brain injured survivor is faced with the realization of problems relating to his/her capabilities and deficits, there will more than likely be increased anxiety. This creates a problem and many will deny, like the proverbial ostrich with his head buried in the sand – if you ignore it and pretend it doesn’t exist, perhaps it will go away. By being in denial, attention is drawn away from the problem; there is no need to work towards recovery, and there is no necessity to be accountable.
Their focus then may be placed on the fact that they’re tired, that they have aches and pains or they may blame other people rather than admit that there may be a problem with their brain’s cognitive functioning. Quite often it is the person closest to them where the finger of blame is most often pointed.
My partner is a survivor who is in denial. He is not convinced of his brain injury although he does admit to memory and motivation problems. However, his main focus has become centered on his legs and the pain he feels in his knee.
It is difficult for someone who has suffered a brain injury to be cognitively aware and to learn compensatory strategies. It is easier for them to deny rather than to work towards achieving a new normal; many survivors of brain injuries will remain in denial their entire lives.
“The greatest barrier to someone achieving their potential is their denial of it.” By Simon Travaglia
Tuesday, June 16, 2009
Excerpt from "Roller Coaster Ride With Brain Injury (For Loved Ones)"
Adaptations And Adjustments
"Because Larry's file had been closed, I did research on Internet to discover ways to help him adapt to his deficits. One study said, "Those with brain injuries must find different ways to deal with their new limitations. With help and patience, as well as using strategies and tools to compensate, they can overcome their deficits. After reading this excerpt to Larry, I asked him if he was interested in trying, with my help, to adapt to his deficits. He said, "probably not."
His decision, I realized, left me with the challenge of learning to adapt and adjust to his brain injury myself, without his help. I decided, after thinking about the challenge, that adapting and adjusting was more a matter of coping and accepting.
According to McCubbin and McCubbin, 1991, the necessary requirements involve several important issues. First, there must be resiliency for there to be the ability to adapt and adjust to living with a family member with brain injury. Other important requirements included the following:
Personal Resources:......
Family Resources:.......
Social Support:.........
Coping patterns:........"
"Because Larry's file had been closed, I did research on Internet to discover ways to help him adapt to his deficits. One study said, "Those with brain injuries must find different ways to deal with their new limitations. With help and patience, as well as using strategies and tools to compensate, they can overcome their deficits. After reading this excerpt to Larry, I asked him if he was interested in trying, with my help, to adapt to his deficits. He said, "probably not."
His decision, I realized, left me with the challenge of learning to adapt and adjust to his brain injury myself, without his help. I decided, after thinking about the challenge, that adapting and adjusting was more a matter of coping and accepting.
According to McCubbin and McCubbin, 1991, the necessary requirements involve several important issues. First, there must be resiliency for there to be the ability to adapt and adjust to living with a family member with brain injury. Other important requirements included the following:
Personal Resources:......
Family Resources:.......
Social Support:.........
Coping patterns:........"
Sunday, June 14, 2009
Excerpt from "Roller Coaster Ride With Brain Injury (For Loved Ones)"
Bumps In The Road
"Larry was back to being argumentative, disagreeable, cantankerous, belligerent, self-centered and downright unpleasant. If I didn't agree with him about something, he became very angry. He wouldn't discuss anything. He was very upset that he hadn't heard anything about the date for his Driving Assessment - that is what had set him off. It was another 'bump'. I e-mailed the ICBC therapist to let her know that he'd become very anxious about not hearing of a date for when he would be having the Assessment. She responded that she had heard nothing either.
Larry finally decided that he was going to get the insurance on his own car because he was determined that he was going to drive. I told him if he was going to drive when he didn't have his driver's license that I wan't going to take him to get the insurance. He said he'd walk there - a distance of about ten blocks each way. Although he complains about the pain in his legs, he made no comment when he got back about his legs hurting, in spite of the long walk.
Larry had angrily called the ICBC coordinator and told her he was going to drive his motorhome whether he had his license back or not. The ICBC therapist explained to him, when she came to visit, that things take time and he wasn't the only one waiting. I suggested to Larry that perhaps the ICBC coordinator wasn't the one to be having a temper tantrum with because they were the ones who hold the power and will determine when things are going to happen. He only became angrier with me."
"Larry was back to being argumentative, disagreeable, cantankerous, belligerent, self-centered and downright unpleasant. If I didn't agree with him about something, he became very angry. He wouldn't discuss anything. He was very upset that he hadn't heard anything about the date for his Driving Assessment - that is what had set him off. It was another 'bump'. I e-mailed the ICBC therapist to let her know that he'd become very anxious about not hearing of a date for when he would be having the Assessment. She responded that she had heard nothing either.
Larry finally decided that he was going to get the insurance on his own car because he was determined that he was going to drive. I told him if he was going to drive when he didn't have his driver's license that I wan't going to take him to get the insurance. He said he'd walk there - a distance of about ten blocks each way. Although he complains about the pain in his legs, he made no comment when he got back about his legs hurting, in spite of the long walk.
Larry had angrily called the ICBC coordinator and told her he was going to drive his motorhome whether he had his license back or not. The ICBC therapist explained to him, when she came to visit, that things take time and he wasn't the only one waiting. I suggested to Larry that perhaps the ICBC coordinator wasn't the one to be having a temper tantrum with because they were the ones who hold the power and will determine when things are going to happen. He only became angrier with me."
Saturday, June 13, 2009
Excerpt from "Roller Coaster Ride With Brain Injury (For Loved Ones)"
Two Steps Forward and One Step Back
The ICBC therapist called to see how things were going with Larry. "He's doing quite well," I told her, "and the party went very well. He didn't drink anything and he seemed to be okay with it. Uh, I know its two steps forward and one step back but do you think there will be any more steps back?"
Laughing she said, "I wish I had a crystal ball but I don't. Things will probably go along well for a while and then he'll probably get bored with the exercises or something. Or his lack of independence may hit him again. It's difficult to know what bump will set him off but there are very likely going to be more bumps along the way."
That wasn't what I wanted to hear. "He will probably also go through a grieving process about not being able to do what he once was able to do," she continued.
Life Goes On
"Larry began his physiotherapy program. He would be going three hours a day, five days a week. He was not very happy when he came home after the first session. It was harder than he imagined it was going to be and his body was sore. He got electrical therapy on his knee; he used the bicycle and treadmill machine and other weight machines as well as doing exercises on his own. I hoped it was not going to be another 'bump' in the road."
.......
"Larry was still smoking in the bedroom/ensuite. I hesitated for some time mentioning it to him again in case it would affect his mood. I didn't want another unpleasant episode. Finally, I decided to take the risk and brought the subject up, reminding him of how I felt about smoking. I also asked him if he remembered he had been told smoking wasn't good for the healing process of his brain.
Looking me straight in the face, he again denied that he had been smoking."
The ICBC therapist called to see how things were going with Larry. "He's doing quite well," I told her, "and the party went very well. He didn't drink anything and he seemed to be okay with it. Uh, I know its two steps forward and one step back but do you think there will be any more steps back?"
Laughing she said, "I wish I had a crystal ball but I don't. Things will probably go along well for a while and then he'll probably get bored with the exercises or something. Or his lack of independence may hit him again. It's difficult to know what bump will set him off but there are very likely going to be more bumps along the way."
That wasn't what I wanted to hear. "He will probably also go through a grieving process about not being able to do what he once was able to do," she continued.
Life Goes On
"Larry began his physiotherapy program. He would be going three hours a day, five days a week. He was not very happy when he came home after the first session. It was harder than he imagined it was going to be and his body was sore. He got electrical therapy on his knee; he used the bicycle and treadmill machine and other weight machines as well as doing exercises on his own. I hoped it was not going to be another 'bump' in the road."
.......
"Larry was still smoking in the bedroom/ensuite. I hesitated for some time mentioning it to him again in case it would affect his mood. I didn't want another unpleasant episode. Finally, I decided to take the risk and brought the subject up, reminding him of how I felt about smoking. I also asked him if he remembered he had been told smoking wasn't good for the healing process of his brain.
Looking me straight in the face, he again denied that he had been smoking."
Friday, June 12, 2009
Brain Injuries - Understanding Metacognition
Metacognition, as defined by Wikipedia, is ‘cognition about cognition’ or ‘knowing about knowing’. i.e.: it is knowledge concerning one’s own cognitive processes – awareness and self-awareness.
A survivor I spoke with said that it is an awareness of thoughts as well as behaviour. She said that you can’t alter behaviour and attitude until you know you are doing something. She said metacognition is the beginning of real rehabilitation and that cognitive therapy will help with the process.
John Flavell has written much on this subject. (1979, 1987). He divides the process into the categories of: person variables, task variables and strategy variables. He feels it has to do with how each person learns (the learning process and the planning process for each particular task).
Metacognition is the knowledge of self and the realization that it must be combined with commitment, focus and attitude. It involves an awareness of control over the process of thinking.
Commitment, attitude and focus are extremely important when working towards success. In order for someone to succeed, they must be entirely committed to the task at hand and must be persistent in their efforts.
A good attitude is about being positive and accountable. Your attitude on what you want to achieve will determine the result of what you get. Having a negative outlook will only bring more negativity.
To be focused is to have a definite and doable goal. Being focused helps to be successful in the performance of specific tasks. This thought is reinforced when they realize that their success is based upon their own efforts. Once they realize that they know how things work, they can plan, evaluate and then problem-solve each task.
“A human being can alter his life by altering his attitudes.” By William James
"Our thoughts create our reality - where we put our focus is the direction we tend to go." By Peter McWilliams
"Success doesn't come to you - you go to it." By Marva Collins
A survivor I spoke with said that it is an awareness of thoughts as well as behaviour. She said that you can’t alter behaviour and attitude until you know you are doing something. She said metacognition is the beginning of real rehabilitation and that cognitive therapy will help with the process.
John Flavell has written much on this subject. (1979, 1987). He divides the process into the categories of: person variables, task variables and strategy variables. He feels it has to do with how each person learns (the learning process and the planning process for each particular task).
Metacognition is the knowledge of self and the realization that it must be combined with commitment, focus and attitude. It involves an awareness of control over the process of thinking.
Commitment, attitude and focus are extremely important when working towards success. In order for someone to succeed, they must be entirely committed to the task at hand and must be persistent in their efforts.
A good attitude is about being positive and accountable. Your attitude on what you want to achieve will determine the result of what you get. Having a negative outlook will only bring more negativity.
To be focused is to have a definite and doable goal. Being focused helps to be successful in the performance of specific tasks. This thought is reinforced when they realize that their success is based upon their own efforts. Once they realize that they know how things work, they can plan, evaluate and then problem-solve each task.
“A human being can alter his life by altering his attitudes.” By William James
"Our thoughts create our reality - where we put our focus is the direction we tend to go." By Peter McWilliams
"Success doesn't come to you - you go to it." By Marva Collins
Thursday, June 11, 2009
Excerpt From 'Roller Coaster Ride With Brain Injury (For Loved Ones)'
Not Taking It Personally
.....
"The following morning I came downstairs about fifteen minutes after him. He was sitting at the dining room table playing solitaire. I made him a breakfast of scrambled eggs and toast and placed it on the table in front of him.
"I've already eaten."
Looking around I saw nothing to indicate that he had eaten. "You have to eat Larry. You didn't have dinner last night."
Baring his teeth and glaring at me he said, "If I want to eat, I'll eat. If I don't want to eat, I won't." Gathering up his bills, he growled, "You can drop me off at the bank."
Looking at the snow and the ice on the sidewalks and he with his crutches, I said, "I'll wait for you. It's dangerous to walk in this stuff with your crutches."
"I'm not coming back and you can wait until you're blue in the face. I'm going someplace else."
He got out of the car and without much alternative, I came home. I then called the ICBC therapist.
.......
After speaking with him, his therapist said that his biggest thing was that all of his independence had been taken away from him and I'm one of the ones who had taken it away and who was telling him what to do. He was also angry by the fact that his license had been removed. She told him she would organize a taxi account for him so he could go to the clinic and to his doctor appointments on his own so he would feel more independent. He said he didn't want me helping him with things - he wanted me to 'butt out'. She said if he refused to take his medication that they would send someone to give it to him so I wouldn't have to get into an altercation with him. As a final comment she said, "Don't take it personally."
Although that is what everyone says, it is difficult not to take it personally when a person is looking directly at you with anger and hatred on his face. I do believe, if only at that moment, there is a personal nature to it.
.....
"The following morning I came downstairs about fifteen minutes after him. He was sitting at the dining room table playing solitaire. I made him a breakfast of scrambled eggs and toast and placed it on the table in front of him.
"I've already eaten."
Looking around I saw nothing to indicate that he had eaten. "You have to eat Larry. You didn't have dinner last night."
Baring his teeth and glaring at me he said, "If I want to eat, I'll eat. If I don't want to eat, I won't." Gathering up his bills, he growled, "You can drop me off at the bank."
Looking at the snow and the ice on the sidewalks and he with his crutches, I said, "I'll wait for you. It's dangerous to walk in this stuff with your crutches."
"I'm not coming back and you can wait until you're blue in the face. I'm going someplace else."
He got out of the car and without much alternative, I came home. I then called the ICBC therapist.
.......
After speaking with him, his therapist said that his biggest thing was that all of his independence had been taken away from him and I'm one of the ones who had taken it away and who was telling him what to do. He was also angry by the fact that his license had been removed. She told him she would organize a taxi account for him so he could go to the clinic and to his doctor appointments on his own so he would feel more independent. He said he didn't want me helping him with things - he wanted me to 'butt out'. She said if he refused to take his medication that they would send someone to give it to him so I wouldn't have to get into an altercation with him. As a final comment she said, "Don't take it personally."
Although that is what everyone says, it is difficult not to take it personally when a person is looking directly at you with anger and hatred on his face. I do believe, if only at that moment, there is a personal nature to it.
Wednesday, June 10, 2009
Role Changes Following A Brain Injury
After a traumatic brain injury, it is very common for roles to change. Often the survivor is not able to do what he/she once did. i.e.: they cannot return to the job they once had; they may not be able to help in ways they once did within the home; their role as a parent may have changed, as well as that of a spouse.
Where there has been a serious injury and one partner is unabe to return to work, the financial situation in the household most likely will change. A stay-at-home mom may have to shoulder the responsibilities of working, often at a low-paying job. That person may possibly have the additional responsibility of looking after a family if there are children still living at home, as well as looking after the injured survivor. When the main wage earner is no longer able to work, there is often a financial hardship placed on the family.
All of the household responsibilities may now have to be assumed by the 'healthy' partner and all decisions may also have to be made solely by that person. It may no longer be a joint effort or an equal partnership. 'What do you think' questions may no longer be able to be asked - or answered. The strength and the coping abilities of the 'healthy' spouse will be important during this difficult period.
The injured survivor may no longer be able to parent as he/she once did. Anger, irritability and frustration may be the dominant issue and may cause problems where young children are concerned. This puts an additional burden of responsibility on the non-injured partner and can create a domino effect within the family structure as more and more stress is placed upon the 'healthy' partner. For the non-injured spouse, it may appear as if there is now an additional child to care for. This is especially true if there is not a large family support system or if no insurance is available for medical, therapeutic and other assistance.
Their relationship as a couple may also have changed. The survivor very often will lack empathy and may have become self-centered. He/she may, as a result, live in a 'me' world with little concern for his/her partner's problems. The brain-injured person may have difficulties showing affection. These issues will almost certainly have a detrimental effect upon their relationship. But at the very least, the onus is placed almost entirely on the shoulders of the non-injured partner regarding the health of their relationship.
The above instances are mainly where roles may change - possibly only for a short time or it may be forever.
Where there has been a serious injury and one partner is unabe to return to work, the financial situation in the household most likely will change. A stay-at-home mom may have to shoulder the responsibilities of working, often at a low-paying job. That person may possibly have the additional responsibility of looking after a family if there are children still living at home, as well as looking after the injured survivor. When the main wage earner is no longer able to work, there is often a financial hardship placed on the family.
All of the household responsibilities may now have to be assumed by the 'healthy' partner and all decisions may also have to be made solely by that person. It may no longer be a joint effort or an equal partnership. 'What do you think' questions may no longer be able to be asked - or answered. The strength and the coping abilities of the 'healthy' spouse will be important during this difficult period.
The injured survivor may no longer be able to parent as he/she once did. Anger, irritability and frustration may be the dominant issue and may cause problems where young children are concerned. This puts an additional burden of responsibility on the non-injured partner and can create a domino effect within the family structure as more and more stress is placed upon the 'healthy' partner. For the non-injured spouse, it may appear as if there is now an additional child to care for. This is especially true if there is not a large family support system or if no insurance is available for medical, therapeutic and other assistance.
Their relationship as a couple may also have changed. The survivor very often will lack empathy and may have become self-centered. He/she may, as a result, live in a 'me' world with little concern for his/her partner's problems. The brain-injured person may have difficulties showing affection. These issues will almost certainly have a detrimental effect upon their relationship. But at the very least, the onus is placed almost entirely on the shoulders of the non-injured partner regarding the health of their relationship.
The above instances are mainly where roles may change - possibly only for a short time or it may be forever.
Tuesday, June 9, 2009
Excerpt from 'Roller Coaster Ride With Brain Injury (For Loved Ones)'
Chapter Ten
The End of the First Phase
"Larry was leaving the hospital! He was happy to be going home and I was fearful of what I might be facing.
Before we left I talked to the social worker. She gave me information on the Acquired Brain Injury Program which Larry had been referred to. The doctor wanted to talk to me before he discharged Larry to get my assurance that I felt I would be able to handle him. I wasn't sure but felt if he continued with his medications that hopefully it would be alright.
His pleasant mood continued to reign. The following morning I said, "I know you're putting weight on your leg but I'm not going to nag you about it. You know what the consequences are and you are the one who will have to live with them. But I AM going to insist that you take your medication because if you don't, I will be the one who has to bear the consequences of that. And I don't intend to." He took his pill.
..........
Then things began to change drastically."
The End of the First Phase
"Larry was leaving the hospital! He was happy to be going home and I was fearful of what I might be facing.
Before we left I talked to the social worker. She gave me information on the Acquired Brain Injury Program which Larry had been referred to. The doctor wanted to talk to me before he discharged Larry to get my assurance that I felt I would be able to handle him. I wasn't sure but felt if he continued with his medications that hopefully it would be alright.
His pleasant mood continued to reign. The following morning I said, "I know you're putting weight on your leg but I'm not going to nag you about it. You know what the consequences are and you are the one who will have to live with them. But I AM going to insist that you take your medication because if you don't, I will be the one who has to bear the consequences of that. And I don't intend to." He took his pill.
..........
Then things began to change drastically."
Monday, June 8, 2009
Excerpt from 'Roller Coaster Ride With Brain Injury (For Loved Ones)'
Anger and Frustration
"Day sixty-one was the beginning of some more new changes. Around this time Larry's frustration and anger were becoming very specifically directed at me. On this particular day when I got to the hospital he was cranky and complained about the therapist not knowing what she was doing; about them doing nothing for him; how he had to sit and twiddle his thumbs all day watching the sun come up and the sun go down; that he hadn't gone for a walk; and that now they were putting cream on his feet and legs for no reason.
"We're doing it because you have a fungus," one nurse told him patiently as she liberally spread the cream onto his legs and feet.
Shrugging, he said, "Well, knock your socks off then."
......... "That same week Larry went for x-rays. "Good news," he greeted me when I arrived at the hospital. "I can't weight bear for four more weeks but the doctor said I can probably go home next week."
My heart almost stopped beating at the prospect of bringing him home. I wasn't ready for him to come home while he was in his present state of mind. I didn't know if I could hold up to twenty-four hours of nasty treatment and being talked to like I was nothing more than a rat in his garbage.
"But I can't watch you twenty-four hours a day to make sure you don't injure your leg. You can't be trusted not to put your weight on it. If you could guarantee me that you would do as you are supposed to do and wouldn't be nasty to me, it would be a different story." (The comment about going home was made by the orthopedic surgeon who had no idea what his behavior had been like; he had been speaking from a surgical point of view).
"I can't guarantee you that," he told me. "I am not going to stay in the hospital for another four weeks. Everyone around here seems to be more concerned about you than they are about me." He continued to be argumentative, unreasonable, sulky, self-centered and complaining.
His nasty treatment of me was becoming increasingly difficult to handle and I spent most of each day either in tears or near to tears."
"Day sixty-one was the beginning of some more new changes. Around this time Larry's frustration and anger were becoming very specifically directed at me. On this particular day when I got to the hospital he was cranky and complained about the therapist not knowing what she was doing; about them doing nothing for him; how he had to sit and twiddle his thumbs all day watching the sun come up and the sun go down; that he hadn't gone for a walk; and that now they were putting cream on his feet and legs for no reason.
"We're doing it because you have a fungus," one nurse told him patiently as she liberally spread the cream onto his legs and feet.
Shrugging, he said, "Well, knock your socks off then."
......... "That same week Larry went for x-rays. "Good news," he greeted me when I arrived at the hospital. "I can't weight bear for four more weeks but the doctor said I can probably go home next week."
My heart almost stopped beating at the prospect of bringing him home. I wasn't ready for him to come home while he was in his present state of mind. I didn't know if I could hold up to twenty-four hours of nasty treatment and being talked to like I was nothing more than a rat in his garbage.
"But I can't watch you twenty-four hours a day to make sure you don't injure your leg. You can't be trusted not to put your weight on it. If you could guarantee me that you would do as you are supposed to do and wouldn't be nasty to me, it would be a different story." (The comment about going home was made by the orthopedic surgeon who had no idea what his behavior had been like; he had been speaking from a surgical point of view).
"I can't guarantee you that," he told me. "I am not going to stay in the hospital for another four weeks. Everyone around here seems to be more concerned about you than they are about me." He continued to be argumentative, unreasonable, sulky, self-centered and complaining.
His nasty treatment of me was becoming increasingly difficult to handle and I spent most of each day either in tears or near to tears."
Excerpt from 'Roller Coaster Ride With Brain Injury (For Loved Ones)'
Changes On His Road To Rehabilitation
"At the Care Centre, Larry seemed to become even more frustrated and angry. He became a very difficult patient and began 'lumping' me in with those he considered were the 'bad guys' (the hospital staff). Trying to get him to do any exercises to help with his memory and other issues with his brain injury was like butting my head against the wall. During this period of time, he thought the staff should be doing things for him and he shouldn't have to do anything for himself even when he was able to.
I reminded him of the ball I had brought in previously so he could squeeze it to help build up the strength in his hands and upper body - he wouldn't do it. I again suggested that he be proactive - that it was his body and he should have the most interest in making it well. He insisted that it wasn't up to him. He insisted they should be taking him to the exercise pool but they couldn't because he couldn't weight bear and he wouldn't listen to instructions and/or couldn't remember them.
During this period Larry often asked me to leave. Some days he was so difficult that I dreaded the thought of returning the following day. One day I was so frustrated with his behavior that I left. But most days I stayed for about six or seven hours. His biggest area of difficulty during this time seemed to be his short-term memory. He couldn't remember his recent 'yesterdays'. There were exercises which I tried to convince him were extremely important to do but most often he argued."
"At the Care Centre, Larry seemed to become even more frustrated and angry. He became a very difficult patient and began 'lumping' me in with those he considered were the 'bad guys' (the hospital staff). Trying to get him to do any exercises to help with his memory and other issues with his brain injury was like butting my head against the wall. During this period of time, he thought the staff should be doing things for him and he shouldn't have to do anything for himself even when he was able to.
I reminded him of the ball I had brought in previously so he could squeeze it to help build up the strength in his hands and upper body - he wouldn't do it. I again suggested that he be proactive - that it was his body and he should have the most interest in making it well. He insisted that it wasn't up to him. He insisted they should be taking him to the exercise pool but they couldn't because he couldn't weight bear and he wouldn't listen to instructions and/or couldn't remember them.
During this period Larry often asked me to leave. Some days he was so difficult that I dreaded the thought of returning the following day. One day I was so frustrated with his behavior that I left. But most days I stayed for about six or seven hours. His biggest area of difficulty during this time seemed to be his short-term memory. He couldn't remember his recent 'yesterdays'. There were exercises which I tried to convince him were extremely important to do but most often he argued."
Saturday, June 6, 2009
Excerpt from 'Roller Coaster Ride With Brain Injury (For Loved Ones)
Doing Things His Way
"Larry is convinced that he can walk (in spite of his two broken legs) and insists he can go to the bathroom on his own. He won't listen to the nurses, the doctor or me. "We'll just negotiate the time I have to stay off my leg," he told me.
"Larry," I said with more than a little exasperation, "some things can be negotiated but the healing of bones can't be; it is one of those things that you just have to accept. The healing process can't be hurried but it can be hindered and it definitely can't be negotiated."
"Everything can be negotiated," he answered angrily.
They sent him for x-rays and decided that as yet he hadn't done any extensive damage. After this last escapade they put a monitor on his bed so that if he tried for another adventure, it would alert them. He was extremely angry about the monitor.
"I wasn't walking in the hall," he told me belligerently. "I was up on the roof and no one said anything about that. I spent the night up there and then they left me sitting in a wheelchair all morning. I met Todd at the railway station too and no one worried about that either."
He was becoming an increasingly difficult patient. One of the nurses told me it was for this reason that he wouldn't be going home because of how difficult he would be for me to handle."
"Larry is convinced that he can walk (in spite of his two broken legs) and insists he can go to the bathroom on his own. He won't listen to the nurses, the doctor or me. "We'll just negotiate the time I have to stay off my leg," he told me.
"Larry," I said with more than a little exasperation, "some things can be negotiated but the healing of bones can't be; it is one of those things that you just have to accept. The healing process can't be hurried but it can be hindered and it definitely can't be negotiated."
"Everything can be negotiated," he answered angrily.
They sent him for x-rays and decided that as yet he hadn't done any extensive damage. After this last escapade they put a monitor on his bed so that if he tried for another adventure, it would alert them. He was extremely angry about the monitor.
"I wasn't walking in the hall," he told me belligerently. "I was up on the roof and no one said anything about that. I spent the night up there and then they left me sitting in a wheelchair all morning. I met Todd at the railway station too and no one worried about that either."
He was becoming an increasingly difficult patient. One of the nurses told me it was for this reason that he wouldn't be going home because of how difficult he would be for me to handle."
Friday, June 5, 2009
Excerpt from 'Roller Coaster Ride With Brain Injury (For Loved Ones)'
Panic Sets In
"One day I was later than usual getting into the hospital. He seemed to be quite annoyed with me and barely acknowledged my presence. Then later when I wouldn't undo his restraints, he said, "Why don't you get the f..... out of here." Although I didn't realize it at that moment, it was the beginning of his quite lengthy period of nastiness.
Because he couldn't remember much of his past, I tried doing memory exercises with him. Often he would stare at me and stubbornly resist doing them or else he would shrug and say nothing, completely ignoring my efforts at trying to help him.
In the Land of the Confused
"On the ward, Larry was assigned a sitter so one of his hands could be unrestrained but he became so violent with her that they were forced to totally restrain him again. While trying to get out of bed, he glared and bared his teeth at her and said, "I have to frigging get out of here." There were times when he directed the same type of anger towards me as well.
He often went off on tangents. At one time he thought one of his friends had something to do with raising me. When one of the nurses asked him questions relating to his health, he told her he had quit smoking three years ago but later was looking all over for cigarettes. Another time he looked at me with shock and asked, "Where are they?"
"Where are what?"
"Our drinks. I just poured them."
One day when my brother came to visit, Larry said, "I drink about six cups of coffee a day and then I go for the hard stuff."
"What's the 'hard stuff', my brother asked?
"That's when I have it with cream and sugar."
"One day I was later than usual getting into the hospital. He seemed to be quite annoyed with me and barely acknowledged my presence. Then later when I wouldn't undo his restraints, he said, "Why don't you get the f..... out of here." Although I didn't realize it at that moment, it was the beginning of his quite lengthy period of nastiness.
Because he couldn't remember much of his past, I tried doing memory exercises with him. Often he would stare at me and stubbornly resist doing them or else he would shrug and say nothing, completely ignoring my efforts at trying to help him.
In the Land of the Confused
"On the ward, Larry was assigned a sitter so one of his hands could be unrestrained but he became so violent with her that they were forced to totally restrain him again. While trying to get out of bed, he glared and bared his teeth at her and said, "I have to frigging get out of here." There were times when he directed the same type of anger towards me as well.
He often went off on tangents. At one time he thought one of his friends had something to do with raising me. When one of the nurses asked him questions relating to his health, he told her he had quit smoking three years ago but later was looking all over for cigarettes. Another time he looked at me with shock and asked, "Where are they?"
"Where are what?"
"Our drinks. I just poured them."
One day when my brother came to visit, Larry said, "I drink about six cups of coffee a day and then I go for the hard stuff."
"What's the 'hard stuff', my brother asked?
"That's when I have it with cream and sugar."
Excerpt from 'Roller Coaster Ride With Brain Injury (For Loved Ones)'
Chapter III
"Look who's here. Do you know who this is, Larry?"
Looking at me he answered, "Steve."
"He's just joking," I laughed. I soon realized, however, that none of his answers were making any sense. It wasn't long before I became aware, with a sick feeling of dread in the pit of my stomach, that he hadn't been joking and didn't seem to know who I was.
Later in the visit he began to look at me very strangely.
"Do you know what my name is?" I asked him.
With a puzzled look on his face he said, "It isn't what you want it to be."
"What do you think I want it to be?"
"Coffee and toast," he answered."
Later - "Quickly finding a nurse I tearfully said, "He doesn't seem to remember anything from before his accident. Is he going to get his memory back?"
"We have been asking him dates and he has no idea what month it is or even what year. He thinks it's 1996."
"How would he know me? I thought. "We didn't know each other in 1996."
"Look who's here. Do you know who this is, Larry?"
Looking at me he answered, "Steve."
"He's just joking," I laughed. I soon realized, however, that none of his answers were making any sense. It wasn't long before I became aware, with a sick feeling of dread in the pit of my stomach, that he hadn't been joking and didn't seem to know who I was.
Later in the visit he began to look at me very strangely.
"Do you know what my name is?" I asked him.
With a puzzled look on his face he said, "It isn't what you want it to be."
"What do you think I want it to be?"
"Coffee and toast," he answered."
Later - "Quickly finding a nurse I tearfully said, "He doesn't seem to remember anything from before his accident. Is he going to get his memory back?"
"We have been asking him dates and he has no idea what month it is or even what year. He thinks it's 1996."
"How would he know me? I thought. "We didn't know each other in 1996."
Thursday, June 4, 2009
Excerpt from 'Roller Coaster Ride With Brain Injury (For Loved Ones)'
Introduction
"'Roller Coaster Ride With Brain Injury (For Loved Ones)' has been written as a result of my partner's serious motorcycle accident. When I realized how difficult it was to get information on brain injuries or on how family members can help their brain-injured loved ones, I knew there was a need for something to be written. There seemed to be very little that was readily available for those close to the injured person in learning how to deal with the monumental changes in both the injured person's life and those of his family and friends."
"I found it was also sometimes difficult to get any extensive information from the doctors or nurses. This was partly because at the beginning very little seemed to be known about the severity of his injury or what the result of his injury would be. Further, I became aware that the more questions I asked, the more variety of answers I received. Each person I talked to seemed to have a different opinion on both his injury as well as his recovery prognosis.
By writing this book about our situation, I hope to help others in a similar situation realize they are not alone. There will be progress and although it appears to be slow - brain injury progress is often two steps forward and one step back - it will happen."
Our First Day In Hell
"Unable to stop the floodgate of tears, I cried the whole way to the hospital, praying that Larry would be alive. Karen, the Social Worker, met me in the Emergency and led me to a Family Room. "They are stabilizing him and then he'll be going for a CT scan. I'll let you know when you can see him."
With no one to talk to, my only company was the terrifying images that plagued my thoughts. I could not control my flood of tears and no matter how many times I brushed them aside, they continued to fall. It was like trying to contain water in a bag made of cloth. The half hour or so I sat alone in the room with my brain alternating between mush and the horrible imagines that cascaded through my head, my usually calm nature did not hold up very well."
"'Roller Coaster Ride With Brain Injury (For Loved Ones)' has been written as a result of my partner's serious motorcycle accident. When I realized how difficult it was to get information on brain injuries or on how family members can help their brain-injured loved ones, I knew there was a need for something to be written. There seemed to be very little that was readily available for those close to the injured person in learning how to deal with the monumental changes in both the injured person's life and those of his family and friends."
"I found it was also sometimes difficult to get any extensive information from the doctors or nurses. This was partly because at the beginning very little seemed to be known about the severity of his injury or what the result of his injury would be. Further, I became aware that the more questions I asked, the more variety of answers I received. Each person I talked to seemed to have a different opinion on both his injury as well as his recovery prognosis.
By writing this book about our situation, I hope to help others in a similar situation realize they are not alone. There will be progress and although it appears to be slow - brain injury progress is often two steps forward and one step back - it will happen."
Our First Day In Hell
"Unable to stop the floodgate of tears, I cried the whole way to the hospital, praying that Larry would be alive. Karen, the Social Worker, met me in the Emergency and led me to a Family Room. "They are stabilizing him and then he'll be going for a CT scan. I'll let you know when you can see him."
With no one to talk to, my only company was the terrifying images that plagued my thoughts. I could not control my flood of tears and no matter how many times I brushed them aside, they continued to fall. It was like trying to contain water in a bag made of cloth. The half hour or so I sat alone in the room with my brain alternating between mush and the horrible imagines that cascaded through my head, my usually calm nature did not hold up very well."
Ways To Improve Short-Term Memory Following a Brain Injury
Short-term memory loss is one of the most common deficits following a brain injury and one that the survivor is usually most aware of. With a concerted effort, this loss can be improved upon. The following are ways to improve memory problems:
- Make a list of what can be remembered from the previous day. i.e.: what was eaten for breakfast, lunch and dinner; what was done in the morning, afternoon and evening; who was spoken to, and what the conversations were about.
- Have the injured person read the newspaper and then later in the day, or the next day query him/her on what the article or articles were about.
- Similarly, ask him/her what they remember of something they were told one, two or three days previously.
- After going for a drive or an outing, two or three days later ask him/her what they remember of the event. i.e.: was the server a male or a female; what had they ordered to eat; what had the weather been like, or anything specific about what had been seen, heard or done.
- Be purposefully aware in any new situation in order to be able to remember events and anything specific. For example: forgetting where you parked your car at the mall may not be solely a matter of forgetting as it is of not taking special note when you left your car of where you did park it - it may be more of an issue of awareness.
- Listen carefully. Often the fact of just having listened will be of help when trying to remember people and conversations. This is particularly true with being introduced to new people.
- Internally repeat new things, like the name of a person when being introduced. Anything that is repeated has a better chance of being remembered.
- This also includes anything that is written down. Writing something down places the incident more firmly into the memory bank. Keeping a daily diary or journal will help because the process of writing in it will help the memory plus there is a record to refer to for assistance in remembering.
- Carry a notebook to record such things as new people's names, appointments, to-do lists and any other pertinent information to assist with memory.
- Another idea is: if there were bread, milk, eggs, potatoes and cereal to pick up at the store, it helps to remember what the items are if the number of items is remembered.
Practicing the above exercises will help with memory difficulties. Many of the exercises for short-term memory loss can help any of us but particularly those who have sustained a brain injury.
Additionally, there are other problems that will interfere with memory. Fatigue - when someone is tired, it is difficult to be 'on top of things' and to be able to remember. Anxiety will also interfere with memory. i.e.: if you are nervous when you are meeting someone new, it may make it more difficult to remember their name.
The effort to improve short-term memory is like everything else. It will take effort and perseverance. Nothing comes easily so the desire to improve one's memory has to be important to that person.
- Make a list of what can be remembered from the previous day. i.e.: what was eaten for breakfast, lunch and dinner; what was done in the morning, afternoon and evening; who was spoken to, and what the conversations were about.
- Have the injured person read the newspaper and then later in the day, or the next day query him/her on what the article or articles were about.
- Similarly, ask him/her what they remember of something they were told one, two or three days previously.
- After going for a drive or an outing, two or three days later ask him/her what they remember of the event. i.e.: was the server a male or a female; what had they ordered to eat; what had the weather been like, or anything specific about what had been seen, heard or done.
- Be purposefully aware in any new situation in order to be able to remember events and anything specific. For example: forgetting where you parked your car at the mall may not be solely a matter of forgetting as it is of not taking special note when you left your car of where you did park it - it may be more of an issue of awareness.
- Listen carefully. Often the fact of just having listened will be of help when trying to remember people and conversations. This is particularly true with being introduced to new people.
- Internally repeat new things, like the name of a person when being introduced. Anything that is repeated has a better chance of being remembered.
- This also includes anything that is written down. Writing something down places the incident more firmly into the memory bank. Keeping a daily diary or journal will help because the process of writing in it will help the memory plus there is a record to refer to for assistance in remembering.
- Carry a notebook to record such things as new people's names, appointments, to-do lists and any other pertinent information to assist with memory.
- Another idea is: if there were bread, milk, eggs, potatoes and cereal to pick up at the store, it helps to remember what the items are if the number of items is remembered.
Practicing the above exercises will help with memory difficulties. Many of the exercises for short-term memory loss can help any of us but particularly those who have sustained a brain injury.
Additionally, there are other problems that will interfere with memory. Fatigue - when someone is tired, it is difficult to be 'on top of things' and to be able to remember. Anxiety will also interfere with memory. i.e.: if you are nervous when you are meeting someone new, it may make it more difficult to remember their name.
The effort to improve short-term memory is like everything else. It will take effort and perseverance. Nothing comes easily so the desire to improve one's memory has to be important to that person.
Wednesday, May 27, 2009
A Brain Injury Can Happen To Anyone
According to the Brain Injury Association of America, brain injuries occur more often than breast cancer, multiple sclerosis, spinal cord injury and AIDS, combined. And in spite of the fact that more than 2% of the U.S. population live with a disability as a result of a traumatic brain injury, public awareness of the devastating impact of brain injuries is extremely low. Brain injuries are the leading cause of death and disability world-wide. Despite these statistics, and the high percentage of brain injuries in comparison to other life-threatening illnesses, there is less funding provided. There are also fewer services available for survivors of brain injuries.
Very few people understand the problems associated with brain injuries. The majority know nothing about brain injuries until it happens to them or their loved one. When my partner sustained a traumatic brain injury, I was one of those people. At this time many brain injury survivors will feel the numerous losses associated with brain injury - many will experience the loss of some family members and often their friends. They will continue their journey through life with injuries that are invisible to a public that has little understanding or awareness of what it means to have a brain injury. It is a long, lonely walk for those people living with the effects of brain injuries.
The good news is that most traumatic brain injuries can be prevented. Educating young people on how to prevent brain injuries should be as important as teaching children the rudiments of math and English. Education should emphasize safety and how to reduce risk factors. Most traumatic brain injuries are caused by motor vehicle accidents, falls, sports injuries or violence and often by carelessness.
By adhering to the following rules, most of us could prevent brain injuries: a) don't drink and drive; b) wear seat belts; c) wear approved safety helmets when biking, snowboarding, motorcycling, etc.; d) use proper equipment when playing sports; e) make common sense choices and decisions; f) use caution.
The effects of brain injury are as follows: cognitive, physical and psychological difficulties, short-term memory loss, lack of information processing skills, poor concentration and chronic fatigue, difficulty in completing tasks, depression, mood swings, anger and irritability. The impact of these injuries is not only felt by the brain injured survivor but by his family, the health care system and the community.
Because of the lack of public awareness concerning the number of brain injuries that occur each year, little is done for the survivors. Support services are wherever the family can find them but most fall through the cracks. Because of the lack of services and awareness, a large portion of those in the prison system have been discovered to have previously incurred brain injuries. It is important that the public be made aware of the causes, impact and prevention of traumatic brain injuries.
In the United States, March is Brain Injury Awareness Month. In Canada, it is June. It is important for each of us to remember that brain injuries can happen to all of us.
Very few people understand the problems associated with brain injuries. The majority know nothing about brain injuries until it happens to them or their loved one. When my partner sustained a traumatic brain injury, I was one of those people. At this time many brain injury survivors will feel the numerous losses associated with brain injury - many will experience the loss of some family members and often their friends. They will continue their journey through life with injuries that are invisible to a public that has little understanding or awareness of what it means to have a brain injury. It is a long, lonely walk for those people living with the effects of brain injuries.
The good news is that most traumatic brain injuries can be prevented. Educating young people on how to prevent brain injuries should be as important as teaching children the rudiments of math and English. Education should emphasize safety and how to reduce risk factors. Most traumatic brain injuries are caused by motor vehicle accidents, falls, sports injuries or violence and often by carelessness.
By adhering to the following rules, most of us could prevent brain injuries: a) don't drink and drive; b) wear seat belts; c) wear approved safety helmets when biking, snowboarding, motorcycling, etc.; d) use proper equipment when playing sports; e) make common sense choices and decisions; f) use caution.
The effects of brain injury are as follows: cognitive, physical and psychological difficulties, short-term memory loss, lack of information processing skills, poor concentration and chronic fatigue, difficulty in completing tasks, depression, mood swings, anger and irritability. The impact of these injuries is not only felt by the brain injured survivor but by his family, the health care system and the community.
Because of the lack of public awareness concerning the number of brain injuries that occur each year, little is done for the survivors. Support services are wherever the family can find them but most fall through the cracks. Because of the lack of services and awareness, a large portion of those in the prison system have been discovered to have previously incurred brain injuries. It is important that the public be made aware of the causes, impact and prevention of traumatic brain injuries.
In the United States, March is Brain Injury Awareness Month. In Canada, it is June. It is important for each of us to remember that brain injuries can happen to all of us.
Tuesday, May 26, 2009
The Importance of Support Groups for Survivors of Traumatic Brain Injury
For those who have survived a traumatic brain injury, there is often little treatment available after an injury and almost no counseling. For this reason the advantages of joining a support group are beneficial in many ways. And for those who are adamant that they do not want to join a group, there are internet brain injury support groups for those who are computer literate. The following is a list of the benefits of joining such an organization.
- Encouragement is given to assist members in achieving their rehabilitation goals.
- Members are encouraged not to give up when the going is tough and when things do not come easily.
- There will be assistance in helping a brain injured person acknowledge their losses and to move on with their new life.
- Members share their personal experiences which often helps others with their own problems.
- Being a member of a support group helps those with head injuries retain a continuing safety net. Many survivors have lost their homes, their jobs and their families. They do not have a healthy network of family and friends who are involved with their rehabilitation. Many are unable to return to the jobs they had pre-injury. They have nowhere to turn and often no motivation to look for help. Support groups can help them through these difficult times. Brain injuries are a lifelong disability and as such will require lifelong assistance. Support groups can fill this need.
- Members of support groups will hear stories of others' challenges and successes which may help them with motivation.
- Support groups can give assistance in helping to get resources, information, education and help.
- Attendance in a group will almost certainly ensure inclusion in social activites, offer the opportunity to become aware of recreation programs and available community services.
- Sharing experiences can bolster self-awareness and self-esteem.
- Many groups have access to a resource library.
- Help is offered in coping with difficulties associated with brain injuries and also with anger management problems.
- Most groups will have speakers in to discuss relevant problems, to give information on brain injuries and its effects as well as give assurances that they are not alone.
- Many groups offer life skills classes and help with adjusting to deficits.
- A few will offer counseling or make recommendations of where to go for counseling.
- Because all members have experienced similar difficulties, they support each other, listen, and understand the problems each person is faced with.
- Some groups meet on a drop-in basis while others meet on regular days at specified times with people who attend each meeting faithfully.
Those who have taken that step to joining a support group have also taken one of their first steps towards accepting their new life and moving forward.
- Encouragement is given to assist members in achieving their rehabilitation goals.
- Members are encouraged not to give up when the going is tough and when things do not come easily.
- There will be assistance in helping a brain injured person acknowledge their losses and to move on with their new life.
- Members share their personal experiences which often helps others with their own problems.
- Being a member of a support group helps those with head injuries retain a continuing safety net. Many survivors have lost their homes, their jobs and their families. They do not have a healthy network of family and friends who are involved with their rehabilitation. Many are unable to return to the jobs they had pre-injury. They have nowhere to turn and often no motivation to look for help. Support groups can help them through these difficult times. Brain injuries are a lifelong disability and as such will require lifelong assistance. Support groups can fill this need.
- Members of support groups will hear stories of others' challenges and successes which may help them with motivation.
- Support groups can give assistance in helping to get resources, information, education and help.
- Attendance in a group will almost certainly ensure inclusion in social activites, offer the opportunity to become aware of recreation programs and available community services.
- Sharing experiences can bolster self-awareness and self-esteem.
- Many groups have access to a resource library.
- Help is offered in coping with difficulties associated with brain injuries and also with anger management problems.
- Most groups will have speakers in to discuss relevant problems, to give information on brain injuries and its effects as well as give assurances that they are not alone.
- Many groups offer life skills classes and help with adjusting to deficits.
- A few will offer counseling or make recommendations of where to go for counseling.
- Because all members have experienced similar difficulties, they support each other, listen, and understand the problems each person is faced with.
- Some groups meet on a drop-in basis while others meet on regular days at specified times with people who attend each meeting faithfully.
Those who have taken that step to joining a support group have also taken one of their first steps towards accepting their new life and moving forward.
Thursday, May 21, 2009
Ten Steps To Helping Your Brain Injured Family Member
The role of a caregiver to someone who has suffered a traumatic brain injury is an important one. And as such, there are many ways they can give assistance. The following are some of the ways:
1. They can give assistance by helping to further the health of the brain injured survivor. This can be done in several ways.
- By beginning cognitive and memory exercises as soon after the injury as possible. This will help to increase the chances of a successful recovery.
- Reminders for taking medications;
- Ensuring that they have a healthy diet;
- Assisting them in getting to medical appointments as they are required;
- Encouraging them towards healthy choices in their lifestyle. i.e.: not smoking, drinking or using drugs. You may not be successful because you can only lead the horse to water but it is important to continue to remind them of the harm they are doing to themselves when they make unhealthy choices.
2. Help to identify any potential problems and make an effort to avoid them.
- Avoid the company of those who encourage drinking or the use of drugs.
3. Assistance in avoiding situations that can contribute to anger and frustration.
- Determine what issues trigger anger and frustration - long line-ups?
- Having to wait for an anticipated outing or event?
- The noise of young children?
- Being uncomfortable - too hot or in pain, etc.?
- Being required to do something they don't want to do?
Some things, of course, are unavoidable.
4. Assistance in helping with adjusting and adapting to deficits.
- This will be difficult if they are in denial and do not admit to having deficits.
- Help with issues relating to loss of short-term memory;
- Help with issues relating to motivation.
These issues seem to be more readily admitted.
5. Assistance with things they have difficulty doing or are unable to do.
6. Offer encouragement, support and acceptance.
7. Have a sense of humor.
8. Try to remain calm and optimistic.
9. Encourage them to try new challenges.
10. Repeat regularly any reminders as one would have to do with a child.
- This seems to be working with my partner regarding his insistence in smoking in the bedroom/ensuite - he now rarely does this having finally decided to smoke instead in his workshop most of the time. This has not been easy. I have had to say it many, many times over the past two and a half years before he finally seemed to 'get it'.
- And with regards to my partner's drinking, although I'm not sure if he does still occasionally drink when I'm not home, I haven't heard him slurring his words recently. He also has repeated words to others that I have said to him referring to his drinking. i.e.: that he can't drink like he used to be able to because he isn't able to handle it. (He still doesn't say it's because of his brain injury, only that he is unable to any longer).
Any caregiver will agree that the list does not stop there but it is a good beginning.
1. They can give assistance by helping to further the health of the brain injured survivor. This can be done in several ways.
- By beginning cognitive and memory exercises as soon after the injury as possible. This will help to increase the chances of a successful recovery.
- Reminders for taking medications;
- Ensuring that they have a healthy diet;
- Assisting them in getting to medical appointments as they are required;
- Encouraging them towards healthy choices in their lifestyle. i.e.: not smoking, drinking or using drugs. You may not be successful because you can only lead the horse to water but it is important to continue to remind them of the harm they are doing to themselves when they make unhealthy choices.
2. Help to identify any potential problems and make an effort to avoid them.
- Avoid the company of those who encourage drinking or the use of drugs.
3. Assistance in avoiding situations that can contribute to anger and frustration.
- Determine what issues trigger anger and frustration - long line-ups?
- Having to wait for an anticipated outing or event?
- The noise of young children?
- Being uncomfortable - too hot or in pain, etc.?
- Being required to do something they don't want to do?
Some things, of course, are unavoidable.
4. Assistance in helping with adjusting and adapting to deficits.
- This will be difficult if they are in denial and do not admit to having deficits.
- Help with issues relating to loss of short-term memory;
- Help with issues relating to motivation.
These issues seem to be more readily admitted.
5. Assistance with things they have difficulty doing or are unable to do.
6. Offer encouragement, support and acceptance.
7. Have a sense of humor.
8. Try to remain calm and optimistic.
9. Encourage them to try new challenges.
10. Repeat regularly any reminders as one would have to do with a child.
- This seems to be working with my partner regarding his insistence in smoking in the bedroom/ensuite - he now rarely does this having finally decided to smoke instead in his workshop most of the time. This has not been easy. I have had to say it many, many times over the past two and a half years before he finally seemed to 'get it'.
- And with regards to my partner's drinking, although I'm not sure if he does still occasionally drink when I'm not home, I haven't heard him slurring his words recently. He also has repeated words to others that I have said to him referring to his drinking. i.e.: that he can't drink like he used to be able to because he isn't able to handle it. (He still doesn't say it's because of his brain injury, only that he is unable to any longer).
Any caregiver will agree that the list does not stop there but it is a good beginning.
Sunday, May 17, 2009
Brain Injuries: The Importance of Friend and Family Involvement
It is a long and lonely road for both the brain injured survivor and the caregiver without the support and involvement of family and friends. Often when those who had previously been close to the injured person think the 'worst' is over, their support ends. But as every caregiver knows, brain injuries really are forever.
If friends no longer call when their injured friend is unable to converse as they once did, go golfing, play racketball, tennis or whatever sport they did together, there is a feeling of abandonment on the part of the brain injured survivor. Those with brain injuries know things are different but they are not sure what it is. All they know is that their friends no longer call and they are alone and lonely. They have a lot of time and nothing to fill their time with. Often they will turn to substance abuse. This places a huge burden and responsibility on the caregiver. The caregiver then feels required to give 100% of their time and effort to the injured family member. This is often a difficult expectation when there are likely other members of the family that require attention also. The result of a situation such as this is that the injured family member, in the eyes of the rest of the family, is the only one that is important.
For those friends who think there is nothing they can do - they are very wrong. If their friend is no longer able to go golfing or play racketball, he/she would almost certainly enjoy being invited out to lunch, for a drive or a walk. They would then feel valued; not abandoned.
When those with injuries are no longer able to do what they once did - whether it be a job or in a social situation, they are set adrift. They are left with very little. Where do they turn? To their caregiver? The majority of people have very little knowledge of brain injuries so are unable to understand the burden the caregiver has without the support of those friends the injured person once thought he had. Most caregivers have sadly discovered that few people want to be involved.
Will the injured person turn to alcohol or drugs? Through boredom and lack of self-esteem, many of those with brain injuries will. Why not, they wonder? Their friends have abandoned them. My partner was called an 'embecile' by one of his 'friends' because he did not do a job well. This type of thing makes the role of the caregiver even more difficult while trying to bolster an already shaky self-esteem problem.
Are friends only friends when things are going well? In many cases, it would seem so.
As a caregiver, I have appreciated those who have shown understanding and compassion and have offered whatever assistance they can give. Outside of my own immediate family, (which I'm extremely fortunate to have), those people have been few. As an example, although my partner has had an alcohol abuse issue, one of his friends told me they could not tell him he couldn't drink while he was in their home. The opposite of that was while visiting my brother and sister-in-law for one week in their home, they kept the alcohol out of sight and offered him other refreshments. Their attitude, in comparison, was supportive and their understanding appreciated. My own feelings of frustration were validated. It is all any caregiver would ask for.
If friends no longer call when their injured friend is unable to converse as they once did, go golfing, play racketball, tennis or whatever sport they did together, there is a feeling of abandonment on the part of the brain injured survivor. Those with brain injuries know things are different but they are not sure what it is. All they know is that their friends no longer call and they are alone and lonely. They have a lot of time and nothing to fill their time with. Often they will turn to substance abuse. This places a huge burden and responsibility on the caregiver. The caregiver then feels required to give 100% of their time and effort to the injured family member. This is often a difficult expectation when there are likely other members of the family that require attention also. The result of a situation such as this is that the injured family member, in the eyes of the rest of the family, is the only one that is important.
For those friends who think there is nothing they can do - they are very wrong. If their friend is no longer able to go golfing or play racketball, he/she would almost certainly enjoy being invited out to lunch, for a drive or a walk. They would then feel valued; not abandoned.
When those with injuries are no longer able to do what they once did - whether it be a job or in a social situation, they are set adrift. They are left with very little. Where do they turn? To their caregiver? The majority of people have very little knowledge of brain injuries so are unable to understand the burden the caregiver has without the support of those friends the injured person once thought he had. Most caregivers have sadly discovered that few people want to be involved.
Will the injured person turn to alcohol or drugs? Through boredom and lack of self-esteem, many of those with brain injuries will. Why not, they wonder? Their friends have abandoned them. My partner was called an 'embecile' by one of his 'friends' because he did not do a job well. This type of thing makes the role of the caregiver even more difficult while trying to bolster an already shaky self-esteem problem.
Are friends only friends when things are going well? In many cases, it would seem so.
As a caregiver, I have appreciated those who have shown understanding and compassion and have offered whatever assistance they can give. Outside of my own immediate family, (which I'm extremely fortunate to have), those people have been few. As an example, although my partner has had an alcohol abuse issue, one of his friends told me they could not tell him he couldn't drink while he was in their home. The opposite of that was while visiting my brother and sister-in-law for one week in their home, they kept the alcohol out of sight and offered him other refreshments. Their attitude, in comparison, was supportive and their understanding appreciated. My own feelings of frustration were validated. It is all any caregiver would ask for.
Wednesday, May 13, 2009
Brain Injuries - Anger, Frustration and Bumps In The Road
When living with someone who has sustained a traumatic brain injury, there will no doubt always be some anger, frustration, irritability and bumps in the road when things don't go as expected, as wanted or take longer than anticipated. Things happen to all of us and when they do we learn, as we mature, to accept those situations that are often beyond our control. However, when someone has experienced a brain injury, there is a self-centered way of looking at a situation. Because those who have had brain injuries are often like young children again, it is hard for them to accept the fact that things don't always happen when they want them to.
This has been the case since my partner had his motorcycle accident. He became very frustrated and irritable when it took longer than he expected to get an Assessment regarding being able to drive again; while he waited for his subsequent driver's license and, when on our first family vacation after his accident - (probably as a result of being out of his comfort zone). The most recent time was when we didn't get away in our motorhome when it was hoped we would be able to leave. He eventually in frustration, set off on his own. When someone has a brain injury, anger and frustration will often lurk just below the surface when things don't go smoothly.
I have noticed with my partner that his anger is usually fueled by frustration. It can also be the result of a loss of emotional control or any perceived lack of control. For many people there is a trigger to anger and frustration. It can be a high level of noise, long line-ups, being asked to do something they are no longer capable of doing, fatigue or anything that makes them uncomfortable.
As caregivers it is up to us to try to keep things running as smoothly as possible but because we are human, this doesn't always happen. We can assist our family member by trying to encourage them to increase their self-awareness by determining the causes of their anger; have them attempt to calm down when they feel themselves becoming frustrated; practice thinking before reacting in anger and, avoid a situation that can create frustrations.
As Mark Victor Hansen said, "Things will never be perfect. There are always challenges, obstacles and less than perfect conditions."
And a quote by Bob Greene: "Setbacks are bumps in the road; they are not the end of the road."
This has been the case since my partner had his motorcycle accident. He became very frustrated and irritable when it took longer than he expected to get an Assessment regarding being able to drive again; while he waited for his subsequent driver's license and, when on our first family vacation after his accident - (probably as a result of being out of his comfort zone). The most recent time was when we didn't get away in our motorhome when it was hoped we would be able to leave. He eventually in frustration, set off on his own. When someone has a brain injury, anger and frustration will often lurk just below the surface when things don't go smoothly.
I have noticed with my partner that his anger is usually fueled by frustration. It can also be the result of a loss of emotional control or any perceived lack of control. For many people there is a trigger to anger and frustration. It can be a high level of noise, long line-ups, being asked to do something they are no longer capable of doing, fatigue or anything that makes them uncomfortable.
As caregivers it is up to us to try to keep things running as smoothly as possible but because we are human, this doesn't always happen. We can assist our family member by trying to encourage them to increase their self-awareness by determining the causes of their anger; have them attempt to calm down when they feel themselves becoming frustrated; practice thinking before reacting in anger and, avoid a situation that can create frustrations.
As Mark Victor Hansen said, "Things will never be perfect. There are always challenges, obstacles and less than perfect conditions."
And a quote by Bob Greene: "Setbacks are bumps in the road; they are not the end of the road."
Saturday, May 2, 2009
Brain Injuries and Lack of Empathy
The dictionary lists empathy as being able to identify with and understand another person's situation, feelings and motive. The state of being selfish, self-absorbed and self-centered indicates concern only with oneself. Lack of empathy and self enteredness are often deficits of brain injury. These deficits can cause difficulties within the family structure as well as getting along with friends.
Damage to the frontal lobe can affect feelings of not only empathy but also of lack of compassion. And in most cases there are few feelings of guilt as a result of their behavior. This deficit can alter decisions that most likely would have been handled very differently pre-injury.
My partner has shown this deficit many times - when he has been unable to comprehend my feelings of not wishing him to smoke in the bedroom/ensuite; his inability to see the hurt on the faces of small grandchildren when he has been playing with them and then suddenly becomes angry; and when I asked him if he realized that I had been upset about something he had been planning to do and he answered that he had realized it. 'And you did it anyway?' I asked. He answered that he had because he wanted to. These are only a few of the ways that lack of empathy can be shown but there are many. This lack of feeling and caring on behalf of those with brain injuries hurt family members whether it is their spouse, children or grandchildren.
Because empathy depends on seeing yourself as being similar to another person, having a brain injury precludes this ability. They are no longer the same as someone else, even someone with a brain injury since no two brain injuries are alike. Empathy also is the ability to understand another's perspective and to be able to see and appreciate that the other person's values and feelings will be different. Having empathy for others includes being interested in them but many brain injury survivors also have the deficit of being self-centered and self-absorbed so interest in others is difficult. When someone has empathy for another, it shows that they care about the other person's needs also. This is not the case when someone has the deficit of lack of empathy.
According to my research, it is felt that people can learn to have empathy if they want to make the effort. They can attempt to distinguish their feelings from someone else's; they can try to see the other person's perspective about a situation, and they can listen to what someone else is really saying. Although it can be done with effort, for those who have sustained a brain injury, it will be a much more difficult task.
Damage to the frontal lobe can affect feelings of not only empathy but also of lack of compassion. And in most cases there are few feelings of guilt as a result of their behavior. This deficit can alter decisions that most likely would have been handled very differently pre-injury.
My partner has shown this deficit many times - when he has been unable to comprehend my feelings of not wishing him to smoke in the bedroom/ensuite; his inability to see the hurt on the faces of small grandchildren when he has been playing with them and then suddenly becomes angry; and when I asked him if he realized that I had been upset about something he had been planning to do and he answered that he had realized it. 'And you did it anyway?' I asked. He answered that he had because he wanted to. These are only a few of the ways that lack of empathy can be shown but there are many. This lack of feeling and caring on behalf of those with brain injuries hurt family members whether it is their spouse, children or grandchildren.
Because empathy depends on seeing yourself as being similar to another person, having a brain injury precludes this ability. They are no longer the same as someone else, even someone with a brain injury since no two brain injuries are alike. Empathy also is the ability to understand another's perspective and to be able to see and appreciate that the other person's values and feelings will be different. Having empathy for others includes being interested in them but many brain injury survivors also have the deficit of being self-centered and self-absorbed so interest in others is difficult. When someone has empathy for another, it shows that they care about the other person's needs also. This is not the case when someone has the deficit of lack of empathy.
According to my research, it is felt that people can learn to have empathy if they want to make the effort. They can attempt to distinguish their feelings from someone else's; they can try to see the other person's perspective about a situation, and they can listen to what someone else is really saying. Although it can be done with effort, for those who have sustained a brain injury, it will be a much more difficult task.
Friday, May 1, 2009
Brain Injuries Are Forever - Adaptations and Adjustments
Initially I believed that as a person with brain injury improved, they would begin to learn skills to be able to adapt to and deal with any deficits they were left with. I have since discovered this is not necessarily the case. Often brain injury survivors are unable to admit to having any deficits. They are in denial. Some will remain in denial their whole lives. This makes it difficult for them to receive help of any kind. It is almost impossible to help someone when they don't think they have a problem.
My partner is in denial although he did admit that things weren't the same in his head. (He would not admit this to his therapist). Most often, however, he focused on his legs which had been broken in his accident. For those who have sustained brain injuries, it will be important to find different ways to deal with their new limitations. After reading that with patience and help, as well as using strategies and tools to compensate, most brain injury survivors can often overcome their deficits I asked my partner if he was interested in trying, with my help, to adapt. He said, 'Probably not.' His decision left me with the challenge of learning to adapt and adjust to his brain injury without his help. After thinking about his answer, I decided that adapting and adjusting was more a matter of me learning to cope and accept.
From what I have read, it is stressed that the family member living with brain injury must be resilient in order for there to be the ability to adapt and adjust to the brain injury. Other important requirements include:
- Personal Resources: a sense of humor; physical and emotional health, and a belief that one has some control over the circumstances of one's life.
- Family Resources: capabilities of the family to meet obstacles; create family continuity and stability; be organized, and have active involvement of family and friends through the rehabilitation process.
- Social Support: Support of friends and family. This is very important to both the survivor of brain injury and for the caregiver.
- Coping Patters include: take action to reduce the demands created by the brain injury; manage emotional and financial difficulties and cope to make the head injury manageable and acceptable within the family structure.
Some of the challenges associated with adapting to the brain injury are increased emotional and marital stresses and the suppression of anger on the part of the family member living with the injured person. Caregiving a patient with brain injury can present challenges relating to role changes, loss of sexual intimacy, and loss of empathy. Therefore, it is extremely important to establish coping patterns rather than just adjusting or adapting to this difficult situation.
Brain injuries are a hidden disability. In most cases, the deficits and differences in the individual are noticeable only to those who live with the affected individual. In many cases other family members and friends do not offer support because to them the brain injured survivor seems fine. This very likely is not the case and unfortunately lack of support places an additional burden on the caregiver. Those who live every day with a brain injured survivor know that brain injuries are forever.
My partner is in denial although he did admit that things weren't the same in his head. (He would not admit this to his therapist). Most often, however, he focused on his legs which had been broken in his accident. For those who have sustained brain injuries, it will be important to find different ways to deal with their new limitations. After reading that with patience and help, as well as using strategies and tools to compensate, most brain injury survivors can often overcome their deficits I asked my partner if he was interested in trying, with my help, to adapt. He said, 'Probably not.' His decision left me with the challenge of learning to adapt and adjust to his brain injury without his help. After thinking about his answer, I decided that adapting and adjusting was more a matter of me learning to cope and accept.
From what I have read, it is stressed that the family member living with brain injury must be resilient in order for there to be the ability to adapt and adjust to the brain injury. Other important requirements include:
- Personal Resources: a sense of humor; physical and emotional health, and a belief that one has some control over the circumstances of one's life.
- Family Resources: capabilities of the family to meet obstacles; create family continuity and stability; be organized, and have active involvement of family and friends through the rehabilitation process.
- Social Support: Support of friends and family. This is very important to both the survivor of brain injury and for the caregiver.
- Coping Patters include: take action to reduce the demands created by the brain injury; manage emotional and financial difficulties and cope to make the head injury manageable and acceptable within the family structure.
Some of the challenges associated with adapting to the brain injury are increased emotional and marital stresses and the suppression of anger on the part of the family member living with the injured person. Caregiving a patient with brain injury can present challenges relating to role changes, loss of sexual intimacy, and loss of empathy. Therefore, it is extremely important to establish coping patterns rather than just adjusting or adapting to this difficult situation.
Brain injuries are a hidden disability. In most cases, the deficits and differences in the individual are noticeable only to those who live with the affected individual. In many cases other family members and friends do not offer support because to them the brain injured survivor seems fine. This very likely is not the case and unfortunately lack of support places an additional burden on the caregiver. Those who live every day with a brain injured survivor know that brain injuries are forever.
Tuesday, April 28, 2009
Brain Injuries and Substance Abuse
As a family member who is living with someone who has suffered a traumatic brain injury and dealing with their subsequent deficits, I initially could not say which deficit was the most difficult to live with. That is until my partner began to drink. Presumably he began drinking as a result of having extra time on his hands which resulted in extreme boredom.
Because I was dealing with my mother's health issues and her eventual move into an assisted living home, I have been spending many hours and weeks downsizing her from two bedrooms and a den to a studio apartment. Unfortunately, that has often left my partner alone with nothing he had any interest in doing.
I first became aware that he was drinking when, on several occasions, I came home and realized he was slurring his words. He initially denied that he had been drinking. In spite of reminding him of the harmful effects drinking can have after a brain injury, his behavior continued to escalate. As a result, his poor judgment has increased (poor reasoning and judgment are already part of his deficits). One day I received a phone call from friends while I was taking my mother to the doctor, to tell me that my partner had arrived at their home exceedingly inebriated. He then drove home, in spite of their efforts to detain him, and was still drunk when he arrived.
Alcohol and drugs have a more intense affect after a brain injury. According to my research, alcohol, even in small amounts, further decreases cognitive and physical functioning. Because of the already existing memory problems, they may incorrectly underestimate the amount they have consumed. Alcohol and drugs will also further impair an already faulty memory. According to the Brain Injury Association of America there is no safe amount to drink after a brain injury. Those who use alcohol or other drugs after a brain injury do not recover as well and can in fact lose much of the progress they have gained.
It is recommended that in order to maximize the quality of their life they be encouraged to join support groups, recreational groups and other activities so they will have fewer times to be alone and therefore avoid becoming bored. This will only work of course if the injured person is agreeable to becoming involved in activities. It is also suggested that liquor not be kept in the home. However, if the injured person is able to drive, this will not be a solution.
Another important consideration is that alcohol and other drugs can interfere with prescribed medications. There is also the increased risk and potential for seizures when substance abuse is an issue. And those who use alcohol, etc. after a brain injury have a greater chance of having another brain injury because of their lack of reasoning skills and poor judgment creating the potential for future accidents.
Since my partner has begun drinking again following his accident, he has regressed. In the Fall I was pleased to see that there had been a spurt of improvement - a huge step forward. But since he began to drink, he is now at his last year springtime development level - two big steps backwards. His motivation level has also deteriorated and his short-term memory is worse than it has been for some time. His lack of self-awareness and insight mean he can not see the relationship between his behavior and the resulting consequences.
The difficulty is in convincing someone who has a substance abuse issue that a problem does indeed exist. If they don't understand there is a problem, they will make no attempt to change their behavior. Once they admit there is a problem, they can commit to making changes. At that time they will have to establish a goal, make changes in their behavior and possibly change their environment and way of doing things.
The family member can help by controlling their own frustration with the situation because becoming frustrated can only make an already difficult situation worse; by realizing you are not responsible for someone else's drinking problem; by not enabling them; by not feeling guilty and by remembering that you are not a victim.
Because I was dealing with my mother's health issues and her eventual move into an assisted living home, I have been spending many hours and weeks downsizing her from two bedrooms and a den to a studio apartment. Unfortunately, that has often left my partner alone with nothing he had any interest in doing.
I first became aware that he was drinking when, on several occasions, I came home and realized he was slurring his words. He initially denied that he had been drinking. In spite of reminding him of the harmful effects drinking can have after a brain injury, his behavior continued to escalate. As a result, his poor judgment has increased (poor reasoning and judgment are already part of his deficits). One day I received a phone call from friends while I was taking my mother to the doctor, to tell me that my partner had arrived at their home exceedingly inebriated. He then drove home, in spite of their efforts to detain him, and was still drunk when he arrived.
Alcohol and drugs have a more intense affect after a brain injury. According to my research, alcohol, even in small amounts, further decreases cognitive and physical functioning. Because of the already existing memory problems, they may incorrectly underestimate the amount they have consumed. Alcohol and drugs will also further impair an already faulty memory. According to the Brain Injury Association of America there is no safe amount to drink after a brain injury. Those who use alcohol or other drugs after a brain injury do not recover as well and can in fact lose much of the progress they have gained.
It is recommended that in order to maximize the quality of their life they be encouraged to join support groups, recreational groups and other activities so they will have fewer times to be alone and therefore avoid becoming bored. This will only work of course if the injured person is agreeable to becoming involved in activities. It is also suggested that liquor not be kept in the home. However, if the injured person is able to drive, this will not be a solution.
Another important consideration is that alcohol and other drugs can interfere with prescribed medications. There is also the increased risk and potential for seizures when substance abuse is an issue. And those who use alcohol, etc. after a brain injury have a greater chance of having another brain injury because of their lack of reasoning skills and poor judgment creating the potential for future accidents.
Since my partner has begun drinking again following his accident, he has regressed. In the Fall I was pleased to see that there had been a spurt of improvement - a huge step forward. But since he began to drink, he is now at his last year springtime development level - two big steps backwards. His motivation level has also deteriorated and his short-term memory is worse than it has been for some time. His lack of self-awareness and insight mean he can not see the relationship between his behavior and the resulting consequences.
The difficulty is in convincing someone who has a substance abuse issue that a problem does indeed exist. If they don't understand there is a problem, they will make no attempt to change their behavior. Once they admit there is a problem, they can commit to making changes. At that time they will have to establish a goal, make changes in their behavior and possibly change their environment and way of doing things.
The family member can help by controlling their own frustration with the situation because becoming frustrated can only make an already difficult situation worse; by realizing you are not responsible for someone else's drinking problem; by not enabling them; by not feeling guilty and by remembering that you are not a victim.
Wednesday, April 15, 2009
Brain Injuries and Depression
Depression is a scary thing when it happens - for both the person suffering from it and also for his/her family members. The dictionary states that depression is the condition of being gloomy or sad. In my experience, my partner's depression went far beyond this explanation.
The symptoms of depression were extreme anger, frustration, irritability, hostility, and being critical and uncommunicative. He had no interest either in any of his former activities. He also made a decision during the time when he was angry that he was going to sell the house and go to Mexico.
Other symptoms can include less energy, a feeling of being slowed down, restlessness, low self-esteem, anxiety, difficulty concentrating, increased weight or loss of weight, increased appetite or loss of appetite, sleeping too much or other sleep problems. However, fatigue is a common symptom of brain injury, not only when associated with depression. There can also be thoughts of suicide in severe cases of depression.
Depression can be brought about by a biochemical imbalance of serotonin, dopamine or norepinephrine; a distressing life event; trauma or genetics. People who have low-self-esteem, negative outlooks, physical or health conditions or other psychological disorders are also at risk.
This condition can easily be treated by medication and/or psychological counseling and support from friends, family and self-help groups. Changes won't happen overnight although my partner did claim to feel better more quickly than I expected. In most cases medication can take a few weeks to begin working. In the case of clinical depression, it will likely need to be managed over a person's lifetime.
Depression will affect not only the sufferer but his family as well and can put huge stress on the partner. It is important that family members be patient and non-judgmental and that they listen and offer their support.
My partner was diagnosed with depression several months following his serious motorcycle accident. Besides his brain injury, he suffered other injuries which included broken shoulders, a broken collar bone, his left hand and two badly broken legs. All of the ribs on his left side were also broken, puncturing his lung in the process.
We were told that it was very common for someone to have depression brought about because of a chemical imbalance following so many physical injuries combined with the traumatic brain injury. They expected that he would be on the medication for approximately six months and then it would be gradually reduced and eventually would be tapered off until he no longer needed it. However, when it was initially reduced, there was an almost immediate reversal back to his behavior and mood difficulties, pre-medication. And at over two years since beginning the medication, it is still necessary to continue with it.
The symptoms of depression were extreme anger, frustration, irritability, hostility, and being critical and uncommunicative. He had no interest either in any of his former activities. He also made a decision during the time when he was angry that he was going to sell the house and go to Mexico.
Other symptoms can include less energy, a feeling of being slowed down, restlessness, low self-esteem, anxiety, difficulty concentrating, increased weight or loss of weight, increased appetite or loss of appetite, sleeping too much or other sleep problems. However, fatigue is a common symptom of brain injury, not only when associated with depression. There can also be thoughts of suicide in severe cases of depression.
Depression can be brought about by a biochemical imbalance of serotonin, dopamine or norepinephrine; a distressing life event; trauma or genetics. People who have low-self-esteem, negative outlooks, physical or health conditions or other psychological disorders are also at risk.
This condition can easily be treated by medication and/or psychological counseling and support from friends, family and self-help groups. Changes won't happen overnight although my partner did claim to feel better more quickly than I expected. In most cases medication can take a few weeks to begin working. In the case of clinical depression, it will likely need to be managed over a person's lifetime.
Depression will affect not only the sufferer but his family as well and can put huge stress on the partner. It is important that family members be patient and non-judgmental and that they listen and offer their support.
My partner was diagnosed with depression several months following his serious motorcycle accident. Besides his brain injury, he suffered other injuries which included broken shoulders, a broken collar bone, his left hand and two badly broken legs. All of the ribs on his left side were also broken, puncturing his lung in the process.
We were told that it was very common for someone to have depression brought about because of a chemical imbalance following so many physical injuries combined with the traumatic brain injury. They expected that he would be on the medication for approximately six months and then it would be gradually reduced and eventually would be tapered off until he no longer needed it. However, when it was initially reduced, there was an almost immediate reversal back to his behavior and mood difficulties, pre-medication. And at over two years since beginning the medication, it is still necessary to continue with it.
Tuesday, April 7, 2009
Brain Injuries and the Importance of Cognitive Exercises
While trying to determine how was the best way to help my partner after his motorcycle accident and subsequent brain injury, I was told that the earlier a person could begin doing cognitive exercises after their injury, the better their chances of recovery would be. This, however, is easier said than done because in the early stage of their injury they are often confused and angry and not in the slightest inclined towards doing exercises.
Some of the cognitive symptoms include impairments regarding perception, communication, reasoning, problem solving, planning, sequencing, lack of motivation, memory problems, inability to initiate activities and often poor judgment.
My partner displayed most of these symptoms and even at two and a half years post injury, he still has difficulties with some of them although to a lesser degree than he originally had. I believe strongly that my persistence in having him do the various cognitive exercises helped him reach the stage where he now can enjoy life to a greater degree than he might otherwise have.
I am listing below some of the cognitive exercises that we did. I included many more in my recently published book entitled 'Roller Coaster Ride With Brain Injury (For Loved Ones)' . This book can be purchased online at: www.trafford.com/08-0107 or orders@trafford.com or by telephoning: 1-888-232-4444.
The exercises:
- Draw lines at different angles and have injured person copy the angles of the lines drawn;
- Do lines like a backwards 'Z', and 'M' on its side facing left or right and other similar lines then have them draw the same outlines themselves;
- Do various other shapes - curved lines and patterns that are irregular, etc. and have him/her copy and draw these outlines;
- Do a partial pattern of a circle, oval, triangle, etc. and let him/her complete the patterns;
- Do circles, triangles, squares, rectangles, etc. and have him/her duplicate these shapes;
- Do a series of shapes that are all the same except for one, then have him/her circle the shape that is different;
- Do sequences of various shapes and have him/her continue making his/her own outlines of the sequences in proper order;
- Draw a maze and have him/her find his way out of the maze;
- Do word searches;
- Show a street map and have him/her find various streets on the map;
- Read him/her a very short story and then ask questions relating to the story. The same can be done with an item in the newspaper.
- Crossword puzzles and Suduko.
Some of the cognitive symptoms include impairments regarding perception, communication, reasoning, problem solving, planning, sequencing, lack of motivation, memory problems, inability to initiate activities and often poor judgment.
My partner displayed most of these symptoms and even at two and a half years post injury, he still has difficulties with some of them although to a lesser degree than he originally had. I believe strongly that my persistence in having him do the various cognitive exercises helped him reach the stage where he now can enjoy life to a greater degree than he might otherwise have.
I am listing below some of the cognitive exercises that we did. I included many more in my recently published book entitled 'Roller Coaster Ride With Brain Injury (For Loved Ones)' . This book can be purchased online at: www.trafford.com/08-0107 or orders@trafford.com or by telephoning: 1-888-232-4444.
The exercises:
- Draw lines at different angles and have injured person copy the angles of the lines drawn;
- Do lines like a backwards 'Z', and 'M' on its side facing left or right and other similar lines then have them draw the same outlines themselves;
- Do various other shapes - curved lines and patterns that are irregular, etc. and have him/her copy and draw these outlines;
- Do a partial pattern of a circle, oval, triangle, etc. and let him/her complete the patterns;
- Do circles, triangles, squares, rectangles, etc. and have him/her duplicate these shapes;
- Do a series of shapes that are all the same except for one, then have him/her circle the shape that is different;
- Do sequences of various shapes and have him/her continue making his/her own outlines of the sequences in proper order;
- Draw a maze and have him/her find his way out of the maze;
- Do word searches;
- Show a street map and have him/her find various streets on the map;
- Read him/her a very short story and then ask questions relating to the story. The same can be done with an item in the newspaper.
- Crossword puzzles and Suduko.
Monday, April 6, 2009
Deficits Following A Brain Injury
Most of those who have sustained a brain injury will almost certainly be left with some deficits. Depending upon where the brain injury was, its severity, the person's personality as well as other circumstances, the deficits will vary. Some of the most common are: lack of motivation, short-term memory loss, personality changes, perseveration and rigidity of thinking, inability to remain focused, impatience, inability to follow written instructions, self-centeredness, lack of empathy, frustration, anger, poor judgment, social withdrawal, inability to learn new facts, depression, task performance difficulties and lack of enthusiasm for anything. My partner, although having many of the above deficits, admits to only his short-term memory loss and his lack of motivation. He is completely unaware that his deficits affect his functioning or how they affect our relationship.
Denial, according to my research, is an adaptive strategy to protect themselves from the reality of their situation. But, in many cases, the failure to recognize deficits leads to a high risk of conflict with family members because they are unable to understand that a function is impaired; they don't recognize the problem when it occurs and they are unable to anticipate that a problem will occur because of their deficits. When brain injury survivors become aware of deficits, it allows them to adapt to the physical, mental and emotional losses they have incurred. Hard work does not completely eliminate deficits. Deficits, for the most part, will have to be adapted to.
In the words of a brain injury survivor, those who have had a brain injury have suffered a terrible insult to the insight portion of their brain and in many cases they simply just don't 'get it'. I had noticed this with my partner also.
She also said that denial is not stubbornness as it appears to be - it's brain injury - and it leaves one without the ability to see oneself as one really is. Knowing what one is doing and saying, and to be aware of one's thoughts and behavior is a deliberate action. She said you can't alter behavior and attitudes until you know that you are doing something. This behavior follows a thought so if the behavior is unacceptable, you have to recognize the thought that generated the behavior. The process is called metacognition. She further commented that self-evaluation is the beginning of metacognition which is the beginning of real rehabilitation. She recommended checking out: http://www.mybrainconnections.org
Cognitive therapy is training in the use of compensatory strategies for cognitive deficits. It utilizes the patient's strengths and because no two injuries are the same, treatment plans and goals are designed specifically for each person.
Suggested strategies to help with adapting to deficits are: a positive attitude, to keep trying things that are challenging, writing something down because it is more likely to get into the memory bank and to join brain injury support groups to learn what strategies others have developed.
After reading personal stories of other brain injury survivors, I asked my partner, at 26 months post injury, if he would like to write his own story. He said he wouldn't know what to write.
"You could say how your accident happened, what you remember of your hospital stay and how you feel about what has happened to you," I suggested.
"I don't think it's my head. I think it's my legs, so I could only write about my legs," he answered.
"You don't think you have a head injury?" I asked him.
"I don't know. I know my memory isn't very good but I think the reason I haven't been motivated is because of my legs."
I decided at this point he is still not ready to discuss the issue of his deficits.
The following is a list of useful resources:
Brain Injury Association of Canada http://www.biac-aclc.ca
British Columbia Brain Injury Association http://www.bcbraininjuryassociation.com
Brain Injury Association of America http://www.biausa.org
Denial, according to my research, is an adaptive strategy to protect themselves from the reality of their situation. But, in many cases, the failure to recognize deficits leads to a high risk of conflict with family members because they are unable to understand that a function is impaired; they don't recognize the problem when it occurs and they are unable to anticipate that a problem will occur because of their deficits. When brain injury survivors become aware of deficits, it allows them to adapt to the physical, mental and emotional losses they have incurred. Hard work does not completely eliminate deficits. Deficits, for the most part, will have to be adapted to.
In the words of a brain injury survivor, those who have had a brain injury have suffered a terrible insult to the insight portion of their brain and in many cases they simply just don't 'get it'. I had noticed this with my partner also.
She also said that denial is not stubbornness as it appears to be - it's brain injury - and it leaves one without the ability to see oneself as one really is. Knowing what one is doing and saying, and to be aware of one's thoughts and behavior is a deliberate action. She said you can't alter behavior and attitudes until you know that you are doing something. This behavior follows a thought so if the behavior is unacceptable, you have to recognize the thought that generated the behavior. The process is called metacognition. She further commented that self-evaluation is the beginning of metacognition which is the beginning of real rehabilitation. She recommended checking out: http://www.mybrainconnections.org
Cognitive therapy is training in the use of compensatory strategies for cognitive deficits. It utilizes the patient's strengths and because no two injuries are the same, treatment plans and goals are designed specifically for each person.
Suggested strategies to help with adapting to deficits are: a positive attitude, to keep trying things that are challenging, writing something down because it is more likely to get into the memory bank and to join brain injury support groups to learn what strategies others have developed.
After reading personal stories of other brain injury survivors, I asked my partner, at 26 months post injury, if he would like to write his own story. He said he wouldn't know what to write.
"You could say how your accident happened, what you remember of your hospital stay and how you feel about what has happened to you," I suggested.
"I don't think it's my head. I think it's my legs, so I could only write about my legs," he answered.
"You don't think you have a head injury?" I asked him.
"I don't know. I know my memory isn't very good but I think the reason I haven't been motivated is because of my legs."
I decided at this point he is still not ready to discuss the issue of his deficits.
The following is a list of useful resources:
Brain Injury Association of Canada http://www.biac-aclc.ca
British Columbia Brain Injury Association http://www.bcbraininjuryassociation.com
Brain Injury Association of America http://www.biausa.org
Sunday, April 5, 2009
Brain Injuries: Perseveration and Rigidity of Thinking
Perseveration and rigidity of thinking are two of the deficits of frontal lobe injury. The frontal lobe is the largest part of the brain and is, therefore, most often the area of injury. As with most deficits, it will be important to find solutions that will work and to make adjustments in both your life and your injured family member's life. But, it will probably be necessary for the majority of adjustments to be made by the 'healthy' partner.
Perseveration is a repetitive and continuous behavior where a person is locked into a specific activity; persisting or persevering with repeated behavior; being narrowly focused or having tunnel vision; or having an inappropriate cognitive-behavioral response in spite of a changing task requirement. The brain injured person is unable to change his process of thinking because of difficulties in abstract reasoning.
Dealing with perseveration is like watching a dog with his bone. He only has one thought in his mind and very little will remove his focus from that bone. And if you try to remove that bone from the dog, you had better be prepared to accept the consequences of such an action.
In my injured partner's case, his 'dog with a bone' behavior showed up especially in his determination to smoke in the ensuite when smoking had never previously been done in the house before. At the same time, he first denied vehemently that he was smoking at all and secondly that he was smoking in the ensuite. In spite of the year of discussions we had over this issue, his perseveration continued. I've since decided that in order to avoid further stressing myself, I will give up mentioning the smoking issue to him. Some things are just not worth the hassle. ** (See note below)
A possible solution for perseveration is cognitive-behavioral training. However, this option is not always available.
Mental rigidity is another deficit of frontal lobe injuries. It can show itself with difficulties in experiencing emotions or the ability to move from one emotion to another at appropriate times; difficulty in accepting changes and difficulties when they are out of their regular routine. My partner, although now in his third year post injury, still has difficulties when he is out of his regular routine. By 'regular routine', in our case I mean the difference between whether or not I'm here. One example is if I am not at home, he usually does not remember to take his medications.
Some possible solutions for this deficit are that family members can help the injured person by discussing upcoming changes and assure them that not all routines will be changed. The injured member of the family can also do their part as well by learning to be accepting of changes since not all changes can be prevented; and by doing self-talk strategies. i.e.: 'I don't like changes but this will be okay.'
The most important thing you can do for your loved one who has had a brain injury is to be supportive and encouraging.
When dealing with brain injuries, the following quote is a thought to remember for those who have considered giving up or for those who have thought there was no problem to consider:
'No head injury is too severe to despair of, nor too trivial to ignore.' - Hippocrates
** Note: Smoking severely inhibits the healing process of a brain injury. It restricts the vessels and the blood flow to the brain and thereby slows the healing.
Perseveration is a repetitive and continuous behavior where a person is locked into a specific activity; persisting or persevering with repeated behavior; being narrowly focused or having tunnel vision; or having an inappropriate cognitive-behavioral response in spite of a changing task requirement. The brain injured person is unable to change his process of thinking because of difficulties in abstract reasoning.
Dealing with perseveration is like watching a dog with his bone. He only has one thought in his mind and very little will remove his focus from that bone. And if you try to remove that bone from the dog, you had better be prepared to accept the consequences of such an action.
In my injured partner's case, his 'dog with a bone' behavior showed up especially in his determination to smoke in the ensuite when smoking had never previously been done in the house before. At the same time, he first denied vehemently that he was smoking at all and secondly that he was smoking in the ensuite. In spite of the year of discussions we had over this issue, his perseveration continued. I've since decided that in order to avoid further stressing myself, I will give up mentioning the smoking issue to him. Some things are just not worth the hassle. ** (See note below)
A possible solution for perseveration is cognitive-behavioral training. However, this option is not always available.
Mental rigidity is another deficit of frontal lobe injuries. It can show itself with difficulties in experiencing emotions or the ability to move from one emotion to another at appropriate times; difficulty in accepting changes and difficulties when they are out of their regular routine. My partner, although now in his third year post injury, still has difficulties when he is out of his regular routine. By 'regular routine', in our case I mean the difference between whether or not I'm here. One example is if I am not at home, he usually does not remember to take his medications.
Some possible solutions for this deficit are that family members can help the injured person by discussing upcoming changes and assure them that not all routines will be changed. The injured member of the family can also do their part as well by learning to be accepting of changes since not all changes can be prevented; and by doing self-talk strategies. i.e.: 'I don't like changes but this will be okay.'
The most important thing you can do for your loved one who has had a brain injury is to be supportive and encouraging.
When dealing with brain injuries, the following quote is a thought to remember for those who have considered giving up or for those who have thought there was no problem to consider:
'No head injury is too severe to despair of, nor too trivial to ignore.' - Hippocrates
** Note: Smoking severely inhibits the healing process of a brain injury. It restricts the vessels and the blood flow to the brain and thereby slows the healing.
Saturday, April 4, 2009
Personality Changes Following A Brain Injury
Personality changes can include many things. Most of these changes will be based on deficits resulting from brain injuries. They will contribute to associated behaviors and these behaviors will contribute to the changes in a personality.
Becoming 'stuck' on a notion such as the 'dog with a bone' attitude is one such change; mood changes are another. A change that I found rather disconcerting was my partner's tendency, after his injury, to make up stories. This, I believe is the result of his short-term memory difficulties - if he can't remember the whole story, he makes up what he can't remember. In spite of the fact that he doesn't appear to remember the original story, he does remember his 'made-up' version and will argue it vehemently.
While doing research, I have read that personality changes will sometimes be an exaggeration of the person's pre-injury personality (an amplification of their negative traits increased by frustration and a sense of loss); or at other times the personality change can be a complete reversal of the pre-injury personality. i.e.: Where once the person may have been easy-going and thoughtful, they may now be easily angered and self-absorbed.
Also, according to my research, some changes may be due to the brain injured person's coping style and responses to stressful situations pre-injury, i.e.: their adaptability to change, or their tendencies towards minimizing or magnifying their emotional situation.
In frontal lobe injuries, the changes are mostly in the emotional and behavioral area with some relating to cognitive impairments. In my partner's case, a couple of the behavioral deficits he has been left with are his difficulty to tolerate frustrations and his decreased social skills. One of the results of this is he does not participate in conversations as he once did.
In the words of a brain injury survivor - 'each person has personality traits, habits, strengths and weaknesses before they sustain a traumatic brain injury. If a person was disorganized before their injury, they'll look like a train wreck after; if they were cranky before, they'll be ruthless after; if they were low maintenance before, they'll completely disengage after; if they were extremely bright before, they'll have some 'cognitive reserves' to help make up for their deficits; if they were of low or average intelligence, they're going to struggle to keep up; if they had interpersonal problems before, they'll have chaotic relationships after.' She said each of us is flawed in some way and a brain injury makes those flaws worse.
Extreme fatigue is another change. When my partner required what seemed to be an excessive amount of sleep, I assumed that his body was still healing from his many other injuries. But through my research, I have discovered that fatigue is a very common symptom of brain injury. Because the brain isn't working in the same way, the survivor has to work much harder to be able to accomplish less than what he once did. Also the extra effort that is required to compensate for short-term memory loss has an enormous fatiguing effect. Added to this is the effort of trying to keep up with a conversation; the difficulty of paying attention or analyzing what is being said, thinking of a response and trying to look interested all at the same time.
And then there is the change that is difficult to describe. There is a song by Johnny Reid about an angel who has fallen from heaven. Before my partner's accident, he used to say I was his angel. But something has been lost since his brain injury. Although I believe the caring is still there, the ability to show it, and definitely the ability to articulate it, is gone. It is another change in his personality.
Becoming 'stuck' on a notion such as the 'dog with a bone' attitude is one such change; mood changes are another. A change that I found rather disconcerting was my partner's tendency, after his injury, to make up stories. This, I believe is the result of his short-term memory difficulties - if he can't remember the whole story, he makes up what he can't remember. In spite of the fact that he doesn't appear to remember the original story, he does remember his 'made-up' version and will argue it vehemently.
While doing research, I have read that personality changes will sometimes be an exaggeration of the person's pre-injury personality (an amplification of their negative traits increased by frustration and a sense of loss); or at other times the personality change can be a complete reversal of the pre-injury personality. i.e.: Where once the person may have been easy-going and thoughtful, they may now be easily angered and self-absorbed.
Also, according to my research, some changes may be due to the brain injured person's coping style and responses to stressful situations pre-injury, i.e.: their adaptability to change, or their tendencies towards minimizing or magnifying their emotional situation.
In frontal lobe injuries, the changes are mostly in the emotional and behavioral area with some relating to cognitive impairments. In my partner's case, a couple of the behavioral deficits he has been left with are his difficulty to tolerate frustrations and his decreased social skills. One of the results of this is he does not participate in conversations as he once did.
In the words of a brain injury survivor - 'each person has personality traits, habits, strengths and weaknesses before they sustain a traumatic brain injury. If a person was disorganized before their injury, they'll look like a train wreck after; if they were cranky before, they'll be ruthless after; if they were low maintenance before, they'll completely disengage after; if they were extremely bright before, they'll have some 'cognitive reserves' to help make up for their deficits; if they were of low or average intelligence, they're going to struggle to keep up; if they had interpersonal problems before, they'll have chaotic relationships after.' She said each of us is flawed in some way and a brain injury makes those flaws worse.
Extreme fatigue is another change. When my partner required what seemed to be an excessive amount of sleep, I assumed that his body was still healing from his many other injuries. But through my research, I have discovered that fatigue is a very common symptom of brain injury. Because the brain isn't working in the same way, the survivor has to work much harder to be able to accomplish less than what he once did. Also the extra effort that is required to compensate for short-term memory loss has an enormous fatiguing effect. Added to this is the effort of trying to keep up with a conversation; the difficulty of paying attention or analyzing what is being said, thinking of a response and trying to look interested all at the same time.
And then there is the change that is difficult to describe. There is a song by Johnny Reid about an angel who has fallen from heaven. Before my partner's accident, he used to say I was his angel. But something has been lost since his brain injury. Although I believe the caring is still there, the ability to show it, and definitely the ability to articulate it, is gone. It is another change in his personality.
Friday, April 3, 2009
Relationships After Brain Injury
Following a brain injury, dynamics change. The relationship is no longer equal - you are no longer partners in the same sense you were before the injury. Initially it becomes almost like a parent-child relationship where the survivor becomes dependent upon their healthy partner. A new balance must be achieved and the new status must be dealt with if it is to work. Many brain injury survivors cannot accept what they are left with and find it difficult to move on with living. In many cases, they have lost the life they once led and the person they once were. Even if they can't verbalize this realization, they are aware that something is very different.
According to research, often as long as ten years post injury, relationships may still be undergoing problems. An international brain injury support organization states that relationship breakdowns run as high as 78%. They are often a result of the survivor's lack of empathy which can place a significant strain on relationships. Also damage can be done over time to the relationship by the survivor's inability to adapt to the brain injury and their resultant deficits. It has been said that the impact of brain injury on partners and families is similar to throwing a pebble into a pond; the ripples created have an effect on the entire pond.
It is through our brains that we experience ourselves and our environments. It is what makes us who we are. Brain injuries cause diminished self-awareness which results in an inability to recognize personal changes. Although brain injury strikes an individual, the entire family lives with the impact of the injury.
In order to attempt to alleviate potential problems, it may be necessary to avoid exchanges that may lead to misunderstandings - even a suggestion of doing something other than their way can cause a swift change in mood.
As with children, reminders are often necessary. Have you taken your pills is a common one. Resentment becomes a companion to their anger and frustration when they are seemingly treated like a child. But when memory is an issue, these reminders become a necessary part of living.
Many survivors are self-centered and consumed with their own loss. In their concern for what they have lost, they are unable to realize that the loss is not one-sided. For their partners, even with the knowledge that the behavior is unintential, the hurt still exists. Although we, as the healthy partner, have been told not to take it personally, it is difficult to remain immune to the hurt.
Are there answers? In general the relationship will depend mostly upon the healthy partner. It is recomended that the healthy partner not disagree with the brain injured person; not challenge or confront him; remain calm; be willing to ignore bad behavior; show support and affection; offer positive reinforcement and to be patient.
But the relationship is unlikely to be what it was before the brain injury happened. Dreams have changed; new dreams and new strengths must be developed, if possible. The ability of the non-injured partner to cope is of prime importance. Some caregivers find that sharing their feelings with others can help them through difficult times. Others use humor to focus on solutions instead of problems. But most importantly, remaining positive will be the best coping strategy of all.
I used to say that it takes two people to work at a relationship; one can't do it alone. This line of thinking cannot exist in uch a situation. In most cases, there will only be one person working at it. The success will depend largely upon that partner's willingness to continue to work alone.
According to research, often as long as ten years post injury, relationships may still be undergoing problems. An international brain injury support organization states that relationship breakdowns run as high as 78%. They are often a result of the survivor's lack of empathy which can place a significant strain on relationships. Also damage can be done over time to the relationship by the survivor's inability to adapt to the brain injury and their resultant deficits. It has been said that the impact of brain injury on partners and families is similar to throwing a pebble into a pond; the ripples created have an effect on the entire pond.
It is through our brains that we experience ourselves and our environments. It is what makes us who we are. Brain injuries cause diminished self-awareness which results in an inability to recognize personal changes. Although brain injury strikes an individual, the entire family lives with the impact of the injury.
In order to attempt to alleviate potential problems, it may be necessary to avoid exchanges that may lead to misunderstandings - even a suggestion of doing something other than their way can cause a swift change in mood.
As with children, reminders are often necessary. Have you taken your pills is a common one. Resentment becomes a companion to their anger and frustration when they are seemingly treated like a child. But when memory is an issue, these reminders become a necessary part of living.
Many survivors are self-centered and consumed with their own loss. In their concern for what they have lost, they are unable to realize that the loss is not one-sided. For their partners, even with the knowledge that the behavior is unintential, the hurt still exists. Although we, as the healthy partner, have been told not to take it personally, it is difficult to remain immune to the hurt.
Are there answers? In general the relationship will depend mostly upon the healthy partner. It is recomended that the healthy partner not disagree with the brain injured person; not challenge or confront him; remain calm; be willing to ignore bad behavior; show support and affection; offer positive reinforcement and to be patient.
But the relationship is unlikely to be what it was before the brain injury happened. Dreams have changed; new dreams and new strengths must be developed, if possible. The ability of the non-injured partner to cope is of prime importance. Some caregivers find that sharing their feelings with others can help them through difficult times. Others use humor to focus on solutions instead of problems. But most importantly, remaining positive will be the best coping strategy of all.
I used to say that it takes two people to work at a relationship; one can't do it alone. This line of thinking cannot exist in uch a situation. In most cases, there will only be one person working at it. The success will depend largely upon that partner's willingness to continue to work alone.
Monday, March 30, 2009
Brain Injuries: The Two Steps Forward and One Step Back Dance
There are many instances where it will be 'two steps forward and one step back'. This will be especially evident in the first year following an injury. However, it is probably something that will continue throughout the entire journey of life with a brain injury.
Recently the incidents with my partner of 'two steps forward and one step back' have been fewer but nonetheless have made a difference in his progress towards recovery. About one and a half years post-injury, I felt we had a handle on the 'lack of motivation' issue and he did seem to be doing quite well.
During the Spring time and into Summer, the weather was nice; he had several interesting projects to work on; a friendly neighbor to converse with and his mood began to improve. But as the seasons changed from Fall to Winter and the weather became cold and nasty, the neighbor was no longer outside and my partner's motivation level began to take a drastic turn backwards. He went back to doing what he had been doing previously - dozing on the couch, playing solitaire and occasionally doing crossword puzzles.
Now, two and a half years post injury, he is looking forward to when I have time to go away - so he can relax - which is what he has been doing all Fall and Winter. Perhaps when Spring finally arrives, he will return to his past Spring time level of motivation.
Another area where he had been making progress and where he now seems to have gone backwards is indicated in the work he does. He had done small projects within the home which he had taken care with but recently he painted the powder room in a way that looked as if it had been done by someone with little or no painting experience. Also, over the last year and a half, he has occasionally gotten small jobs to do, but recently he has had to go back and redo things that haven't been done properly. As a result of this no doubt, the jobs are becoming fewer. This may only be a momentary 'one step backwards' and hopefully he will eventually move forward again.
Around his two year post-injury period, there seemed to be a general spurt of improvement. He seemed to be more comfortable when in company; he seemed more interested in things that were happening and he became more interactive as far as communication. Now six months later, there has been a backwards slide in this area as well.
It seems that with brain injuries, there continues to be the 'two steps forward, one step backwards' dance with plateaus and sudden spurts of improvement. I anticipate that where he has taken backward steps, there will also be a few steps forward in the future as he makes another burst of improvement.
Recently the incidents with my partner of 'two steps forward and one step back' have been fewer but nonetheless have made a difference in his progress towards recovery. About one and a half years post-injury, I felt we had a handle on the 'lack of motivation' issue and he did seem to be doing quite well.
During the Spring time and into Summer, the weather was nice; he had several interesting projects to work on; a friendly neighbor to converse with and his mood began to improve. But as the seasons changed from Fall to Winter and the weather became cold and nasty, the neighbor was no longer outside and my partner's motivation level began to take a drastic turn backwards. He went back to doing what he had been doing previously - dozing on the couch, playing solitaire and occasionally doing crossword puzzles.
Now, two and a half years post injury, he is looking forward to when I have time to go away - so he can relax - which is what he has been doing all Fall and Winter. Perhaps when Spring finally arrives, he will return to his past Spring time level of motivation.
Another area where he had been making progress and where he now seems to have gone backwards is indicated in the work he does. He had done small projects within the home which he had taken care with but recently he painted the powder room in a way that looked as if it had been done by someone with little or no painting experience. Also, over the last year and a half, he has occasionally gotten small jobs to do, but recently he has had to go back and redo things that haven't been done properly. As a result of this no doubt, the jobs are becoming fewer. This may only be a momentary 'one step backwards' and hopefully he will eventually move forward again.
Around his two year post-injury period, there seemed to be a general spurt of improvement. He seemed to be more comfortable when in company; he seemed more interested in things that were happening and he became more interactive as far as communication. Now six months later, there has been a backwards slide in this area as well.
It seems that with brain injuries, there continues to be the 'two steps forward, one step backwards' dance with plateaus and sudden spurts of improvement. I anticipate that where he has taken backward steps, there will also be a few steps forward in the future as he makes another burst of improvement.
Sunday, March 29, 2009
Don't Take It Personally
Not taking it personally, together with setting boundaries, is extremely important for those living with a family member who has suffered a brain injury. Coping with the changes in your loved one is difficult enough without taking to heart verbal abuse that you know they would never have said before their accident. They mean it no more than you want to hear it. But since you do hear it, the best thing to do is relegate it to that portion of your memory bank where things that aren't worth remembering go.
Those who have experienced brain injuries are no longer the same person they were before their injury. We had many incidents in the early stages, brought about by frustration and anger, and although they do not happen as often, there is still the occasional time that it does. At those times, I must remember to remain calm; to consider that his bad behavior is a result of his brain injury and that he has been left with deficits that he is unaware of or at the very least, has not as yet acknowledged, not even to himself.
It can also come about when there are difficulties with the thought processes. Written instructions of any kind were often a prelude to bad behavior and anger where at times in exasperation, he would throw the offending instructions at me. Sometimes he'd bare his teeth and glare at me when he was angry or, refuse to eat meals put in front of him or, become angry at not being included in something that he was physically or otherwise unable to do. I am thankful that angry, hate-filled looks don't kill.
He had also on occasion chosen to sit in another area of the doctor's office from me because he was angry at my insistence that he needed to go; and he has refused to talk to me, sometimes for a whole trip, because he was angry or frustrated.
Depression plays a large part in behaviors such as these. It is a very common problem with brain injury. If problems such as these persist, it would be advisable to have the injured family member assessed.
Those who have experienced brain injuries are no longer the same person they were before their injury. We had many incidents in the early stages, brought about by frustration and anger, and although they do not happen as often, there is still the occasional time that it does. At those times, I must remember to remain calm; to consider that his bad behavior is a result of his brain injury and that he has been left with deficits that he is unaware of or at the very least, has not as yet acknowledged, not even to himself.
It can also come about when there are difficulties with the thought processes. Written instructions of any kind were often a prelude to bad behavior and anger where at times in exasperation, he would throw the offending instructions at me. Sometimes he'd bare his teeth and glare at me when he was angry or, refuse to eat meals put in front of him or, become angry at not being included in something that he was physically or otherwise unable to do. I am thankful that angry, hate-filled looks don't kill.
He had also on occasion chosen to sit in another area of the doctor's office from me because he was angry at my insistence that he needed to go; and he has refused to talk to me, sometimes for a whole trip, because he was angry or frustrated.
Depression plays a large part in behaviors such as these. It is a very common problem with brain injury. If problems such as these persist, it would be advisable to have the injured family member assessed.
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