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.
Tuesday, April 28, 2009
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.
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