Memory Loss - Some Important Things to Know

When determining that someone is suffering from memory loss, it is necessary to know what the symptoms are and to discover the cause. The next important thing to know is how to prevent memory loss and to decide on the best avenue to take to slow down the symptoms.

Some of the symptoms of memory loss are:

- an inability to recall events over a short period of time;
- forgetting names, dates and appointments;
- getting lost even in a familiar neighbourhood;
- having difficulty comprehending and completing tasks previously familiar with;
- there may be some confusion relating to memory;
- will worsen as a person becomes tired.

Some of the possible causes of memory loss are:

- the aging process (in the normal aging process, a person will still continue to function normally);
- traumatic brain injuries or brain damage caused from strokes;
- Parkinson's or Huntington's disease, Lyme disease and HIV/AIDS;
- early dimentia or Alzheimers;
- some drugs such as statins, chemotherapy, or vitamin deficiencies;
- certain types of seizures;
- depression;
- alcohol abuse.

How someone suffering from memory loss can help themselves:

- it is important to spend time with people to help keep mind active;
- read the newspaper and keep up with current events;
- try to learn a new skill;
- it is necessary to get lots of rest;
- it is important to have a nutritional diet;
- focus on things that are important to remember;
- avoid drinking alcohol;
- make use of calendars, notes and to-do lists for appointments, etc.

Some of the ways to help those who are suffering from memory loss are:

- take sufferer for a complete physical examination to determine the reason for the memory loss so that proper treatment can be given depending on the cause;
- follow-up on what they are doing to ensure that they are helping themselves in the best way possible;
- give reminders regarding such things as diet, when necessary;
- make sure that the family member is not isolated, help them to stay involved;
be there to offer encouragement and support;
- take for regular medical check-ups.
Because memory loss is serious for both the person who is experiencing it and for family members, encourage everyone close to the family member who is having difficulty, to lend their assistance when they think help may be needed.

personality Changes - Lack of Motivation Following a Brain Injury

Lack of motivation is a direct result of injury to the frontal lobe and can create a change in a person's personality. This deficit can lead to social isolation for the brain injured survivor as they are usually not interested in recreational activities.

It is often the case that the injured person is not even interested in activities that had been enjoyed previously. They may have no interest in events and complain that there is nothing to do. It is more that there is nothing they are interested in doing or have the energy to pursue because fatigue is also part of the personality changes. As a result they may prefer to sit on the couch all day.

Motivation requires persistence and determination in order to be able to follow through on something. It requires self-confidence and a degree of self-esteem to realize their potential for accomplishment. And it requires effort, even if something is started, to be able to sustain the activity through to completion.

The following are ways to assist someone who lacks motivation:

- make a list of activities they may be interested in doing;
- help them initiate an activity;
- encourage their continued effort;
- assist them, if necessary;
- check off the activity when it has been completed to support their feeling of accomplishment.

Sometimes if something can be found that really interests them, it will help towards motivation. Perhaps suggest a potentially interesting activity that may appeal to them; borrow a book on various hobbies from the library or have someone talk to them that has a particularly creative hobby which may be of some interest for them. Cognitive therapy can also help but it is difficult to get and is rarely covered under medical plans.

Lack of motivation or interest can also be a result of depression which is common following a brain injury. This in turn leads to feeling tired all of the time; a general feeling of fatigue, no energy and a complete unwillingness to do anything.

If depression is suspected, encourage a visit to the doctor to be properly assessed. There are medications which can help. Depression can be very serious if not properly treated. If lack of motivation is a result of depression, once the depression is treated then motivation could cease to be a problem.

Personality changes with lack of motivation being the root can cause problems in relationships and families. For those who are assisting anyone with this problem, continue to encourage and support as best as possible.

Personality Changes - Communication Difficulties Following a Brain Injury

There are many deficits following a brain injury that can cause personality changes. One of these problematic changes is in how a person communicates with others. Communication, for many reasons, often becomes difficult particularly in group conversations.

Pragmatic communication impairment causes problems in relationship as well as in work environments. Because of this, if severe, it will determine their success in employment situations and possibly within their social networks. With lack of communication skills often these social networks will gradually fade into the background.

A high percentage of those with brain injuries have communication difficulties. They very often have problems initiating conversation or in continuing with one. They will disassociate and be unable to interact with others either verbally or non-verbally, even if they know the people well. These difficulties seem to be enhanced when in large groups.
Over time their communication skills can either increase or decrease depending on the positive or negative results they get from their efforts.

When in conversation with others, it is common that they will rarely ask questions. The reason for this may be that in many cases, those who have suffered from a brain injury will tend to be self-centered and as a result, they have little interest in what someone else is saying. Another reason is they often have memory problems so may hesitate to ask because they don't remember if they've already been told before.

Some of the reasons for communication difficulties are:

- too much background noise can be confusing;
- it can be difficult to concentrate if the person is tired or anxious;
- they may have difficulty explaining their thoughts;
- pain can make communication more difficult because it may limit concentration;
- moods and fatigue can affect communication;
- long sentences can sound confusing as can complex conversations;
- alcohol can increase communication problems;
- over-stimulation;
- large groups;
- inability to take cues from others when in conversations;
- inattentiveness to conversation and/or lack of interest.

Ways of helping someone who is having difficulty with communication:

- keep sentences short;
- do not interrupt;
- be positive;
- have person avoid, when possible, large groups;
- when in groups encourage topics that the brain injured person may feel comfortable discussing;
- discourage, if possible, the use of alcohol;
- give emotional support.

Because of communication difficulties, especially in groups, many of those who have suffered from a brain injury tend to feel lonely. Over time it may be one of the most difficult deficits they will have to deal with.

Is Alcohol Bad for the Brain?

I believe that excessive alcohol can contribute to dire consequences for the brain. Because of alcohol's effects on the brain, studies have shown that other areas can also be affected such as the central nervous system and the blood supply.

Alcohol will cause speech to be slurred, vision to be blurred, reaction times to be slower and memory to be impaired. Depending on whether a person is drinking on an empty stomach and how quickly they consume the alcohol, these affects can sometimes be apparent after only one or two drinks.

How often a person drinks, when they first began drinking, their gender and size and whether there is a family history of alcohol all will determine what the effects will be. Heavy drinking is one of the causes of acquired brain injury (Alcohol Related Brain Injury - ARBI). Alcohol can cause short-term memory loss, dehydration and can lead to falls and accidents. Alcohol can also increase the risk of seizures following brain injury.

Alcohol abuse can also lead to traumatic brain injuries because someone who is drinking may still drive without making reasonable judgments and may take more risks than a sober person would. Their chance of falling is increased as is the potential of getting into verbal altercations or fisticuffs. Alcoholics tend to have more head injuries; there is a high rate of alcohol abuse before TBI.

Those who continue to use alcohol after a traumatic brain injury have more difficulty with thinking abilities, cognitive function and memory problems. Cells are lost after a brain injury and other cells will have to work that much harder. If those cells are affected by alcohol, it makes it more difficult for them to work. Alcohol worsens problems already brought about by the brain injury.

People who use alcohol after a brain injury don't recover as quickly or as completely and in fact, can lose much of the progress they have made. They will lose what skills they had previous to the brain injury that they could possibly have regained.

For people who have alcohol related brain injury or have suffered a traumatic brain injury, because of their impaired insight they do not realize that their substance abuse is a problem. The problem is exacerbated for counselors working with survivors of brain injury and those with ARBI because when those with brain injuries report on their use of alcohol the figures are usually inaccurate because of their memory deficits.

For those who have brain injuries, the affects of alcohol will be more quickly apparent. After only two beers, my partner will have problems with speech and attitude and after only one glass of rye, (particularly the way he likes to pour them), he is slurring his words and having difficulty walking. Before his brain injury, although he drank several glasses every day, I saw no outward signs of inebriation.

These signs become readily apparent because of alcohol's effect on the brain. The only conclusion possible, therefore, is that alcohol is bad for the brain.

The Impact of Frontal Lobe Injuries

Our frontal lobe is the emotional control center of our brain and is the director of our personalities. For this reason, when we receive brain trauma to the frontal lobe, many areas of our life will be affected.

Because of the size and location of the frontal lobe, this is the most common area to be injured. A traumatic injury to this part of our brain can affect problem solving, short term memory loss, motivation, judgment, impulsivity, behavior, perception, attention span difficulties, rationality, apathy, inhibition (possibly social or sexually inappropriate behavior), strategizing problems, and decision making.

A very common deficit of frontal lobe injury is perseveration which is non-compliance with rules. There may also be difficulty in interpreting cues to guide behavior. This can have a serious affect on interpersonal relationships; especially if perseveration is not acknowledged by the survivor.

A brain injured survivor is considered to be in denial when deficits are unacknowledged. Denial hinders rehabilitation and recovery. It also has a detrimental affect on relationships.

Personality changes can generally be significant with this type of injury. The changes will be dependent upon the survivor's deficits and upon his/her acceptance of the injury and willingness to work towards a new life through adaptations and adjustments.

Studies have found that some survivors with frontal lobe injuries have difficulty understanding some types of humor; many prefer the slapstick variety. In some cases however, the personality may become flat with no sense of humor and little facial expression.

Abstract thinking can also sometimes be affected. The ability to understand others allows us to feel empathy, sympathy, and to realize when others are being sarcastic or deceptive. Other areas of the brain can sometimes adapt to be able to take over the functions of the damaged area; this is more likely if the injured person is young. Additionally some sufferers of a frontal lobe injury may have problems consistently performing a task which may make job performance difficult.

Intensive therapy following this type of injury, according to some studies, is important towards achieving successful rehabilitation. Sadly, in many communities there are few resources available for brain injured survivors. And in some cases unfortunately, the injured person is reluctant to participate in programs that would assist him/her in recovery.

Frontal lobe injuries change the brain injured survivor's life; in most cases forever. This will be more evident in some people than in others because no two brain injuries are the same.

Brain Injury Awareness

It is important to those who have sustained brain injuries that the public be made aware of the difficulties and challenges they encounter following such an injury. Few people are aware of the consequences of a brain injury until it happens to them or to a family member. In the United States, March is Brain Injury Awareness Month; in Canada it is June.

There has been much mentioned lately about the dangers of concussions and the risks involved when young people play sports. Concussions are now considered to be a mild brain injury and while initially may not appear to be serious, can result in later consequences if not looked after at the time of the injury. It is important therefore that coaches, teachers and parents who are involved in youth sports be made aware of concussion prevention, recognition and response.

Brain injury awareness campaigns attempt to educate the public in the prevention of traumatic brain injuries. In spite of the fact that many of these injuries can be prevented, the lack of awareness of the consequences of this type of injury means that prevention mesures are often not taken. Prevention can be accomplished in many ways, i.e.: by living a healthy lifestyle, and by wearing helmets when riding a motorcycle, biking, skiing, snowboarding, horseback riding, skating and skateboarding. Also, seatbelts should be worn at all times when in a motor vehicle; driving should be done defensively; and alcohol and illegal drugs should be avoided while in control of a motor vehicle.

Other reminders to help people become aware of, and prevent needless brain injuries are: to keep guns in locked cabinets; keep guns unloaded, and to store ammunition separately from guns.

Those most vulnerable for sustaining brain injuries are children under five, seniors seventy or over and those between fifteen and forty. Men are twice as likely as women to sustain traumatic brain injuries. The most likely causes of brain injury are vehicular accidents, falls and accidents. However, others at risk are those who are in contact or extreme sports, construction workers and, in more recent years, those who have served in the military.

Brain injury awareness information also attempts to reinforce the importance of support programs to assist survivors in working towards successful rehabilitation. And for this reason, a rehabilitation team is necessary for best results. This includes physiotherapists, occupational therapists and support groups.

Because social, physical and economic challenges are created as a result of brain damage and resulting cognitive problems, caregiver support is also necessary. Relationships are difficult to maintain when there are behavior and cognitive difficulties. This is especially true when friends no longer visit the survivor thereby relieving the caregiver.

Despite the staggering statistics of brain injuries suffered each year in both Canada and the United States, there is very little public awareness of the problem. Let 2010 be your year to learn more about this often preventable and devastating tragedy.

Relationship Break-downs Following a Brain Injury - The Reasons for Them

In most relationships, it takes two people working together to make it a success. In the case where one has suffered a traumatic brain injury, this likely won't be the case because of cognitive impairments and deficits. When a relationship is unequal, it places an extra burden on the healthy partner.

Some of the problems that will have a bearing on the success or failure of the relationship will depend on the following:

- The length of the relationship at the time of the injury. Long-term relationships where a strong bond has already been firmly established, and one especially where they've raised children together, will have a better chance of survival.
- Whether it is a first or a second marriage. If it is a second marriage there may be other issues such as step-children and problems that have been brought into the relationship that could cause additional difficulties.
- The role of any step-children can make a very big difference. This is especially true if there has not been enough time to establish a good relationship between them and the caregiver or if they didn't have a good relationship with the parent.
- Whether or not there is friend and family support. If there is not, there is an additional burden on the caregiver which adds extra stress to the relationship. Often friends will not keep in contact after the initial injury.
- Is there community support? This is important to both the survivor and the caregiver. Brain injury survivors very often fall through the cracks in obtaining required support. Also in many communities, very little is offered for the survivors of brain injury.
- If outside social support is not available and leisure activities have become fewer, the family becomes isolated. This is hard on a relationship especially if the couple had originally been socially active. This may be even more difficult for the healthy partner than for the survivor.
- Role changes will be difficult for both partners but probably more difficult for the caregiver. In all liklihood the caregiver will carry most of the work load and responsibility that had previously been shared.
- If the relationship becomes a dependency/co-dependency one, it will make neither partner happy and eventually there will be resentment on both sides.
- Substance abuse can create severe problems in a relationship. It will be important to try to get help by possibly joining an Alcoholics Anonymous group and/or Al-Anon.
- Stress, as a result of changes in both the survivor and the caregiver's life, can cause many problems. As well, there may be stress as a result of depression.

If counseling is available in the area and both are agreeable to attending sessions, a counselor could help the brain injured survivor with cognitive impairments that may be impacting the relationship. Some of these might be denial issues; help with problems of self-awareness; lack of empathy; the inability to assess the difference between right and wrong, and to give encouragement to the injured person to work on his own behalf towards recovery.

Counseling can also help the caregiver understand the difficulties the survivor is experiencing and to learn strategies to help him/her with his rehabilitation. A good counselor can also help if there have been sexual problems since the injury.

However, even with knowledge, awareness and effort, relationship break-downs following a brain injury do happen.

Brain Injury Survivors - Learning to be in Control of their Own Lives

For brain injury survivors to gain control over their own lives following a traumatic brain injury, they must learn ways of working towards becoming the person they want to be. If they want to realize their dreams, it will mean never giving up their fight to be that person.

In order to do this, they will have to learn specific tools and strategies to make their life more enjoyable and productive. One way to do this is to keep their brain active and involved. An active brain will grow and develop while a brain that is not used will lie dormant. It will be important for them to challenge their brain. One of the strategies is the use of lists to help them organize their life; and with organization comes planning. By becoming organized both mentally and physically it will help both their mental and physical wellbeing. Some of the ways to do this are to write down on a list exactly what they are going to do each day. By planning ahead in this way, if the unexpected happens, it can be handled more effectively because they can just go on to the next thing on the list. Having a secondary back-up plan in place will also help them to be in better control of their life.

Other areas where it will be important to practice learning to become their own masters are to work towards being calm and in developing a good attitude. Being positive is very important because it seems that things usually go wrong for the person who is consistently negative. Also, it will be necessary for them to stay focused and to be consistently determined to be the person they want to be. The big thing is to never give up.

When doing a large task, a good strategy is to break it into smaller components so that it is easier to focus and concentrate on one small part of the task in order to avoid the feeling of being overwhelmed.

Learn to communicate with others. If help is required, it is better to ask for help and admit that help may be reqired than to continue to a point where a situation may be made worse because help wasn't asked for.

It is also necessary for survivors to be able to shoulder the responsibility of their mistakes and admit to those mistakes without looking to blame others for them. Only in this way can they take control of their lives because then they can correct those mistakes and learn from them.

Joining a brain injury support group will help the brain injured survivor to become more independent because of the help he/she will receive from others who have had similar experiences. They will learn how to adapt and adjust to them while using specific tools and strategies. It will be a continuation of their rehabilitation. This is necessary for recovery because brain injuries do not go away. It will help them also to recognize and accept their limitations so that denial does not become their mantra.

The main thing for those with brain injuries wanting the abilities to be in control of their own lives to remember is to stay focused, always be determined and to never give up. If they do this, they will in all likelihood be successful.

Beware of Concussions - They Are Brain Injuries

Concussions are mild head injuries and are the most common of traumatic brain injuries. Most people do not think of concussions as being serious but there is the possibility that later life symptoms can occur because of scar tissue build-up.

Concussions can cause physical, cognitive and emotional symptoms. These symptoms will usually disappear in about three weeks when there has been sufficient rest following the injury. With this type of injury there can be loss of consciousness of minutes or more and possibly post-amnesia which could last twenty-four hours or less. Loss of consciousness indicates a more severe blow to the head than if there was none. Concussions are usually caused from falls, sports injuries or car accidents.

Headaches are one of the most common symptoms. Other symptoms can include dizziness, nausea, difficulty with balancing, light sensitivity, blurred vision, confusion, focusing difficulties, disorientation, reasoning problems, concentration, crankiness, tearfulness, inappropriate emotional displays and possibly, but not likely, convulsions.

It is advised that following an injury such as this that individuals get a lot of sleep at night with rest during the day before gradually returning to normal activities. It is also advised that sufferers don't drink alcohol or take drugs that have not been authorized by their doctors.

It is rare that resultant problems from concussions will be permanent but for those over fifty-five years old, it may take longer to heal or they may have more persistent problems. Occasionally those with concussions may suffer from post-concussion syndromes for weeks or possibly even years after. These symptoms may include headaches, dizziness, attention, memory or sleep problems as well as irritability. Symptoms may be more severe with subsequent concussions.

When doing research, I heard that one concussion sufferer experienced headaches for many years following her injury. There had been no follow-up after her injury even though she had lost consciousness. At the time of her injury, little was known about concussions and very little attention paid to them. People are now becoming more aware of the seriousness of these injuries and most now realize that they are a mild head injury.

In the case of students playing high school sports, concussions are very common. Very often after only a brief period of sitting out, most will return to finish the game. It is serious when they do this as follow-up care is important after this type of injury.

It is important that these injuries be taken seriously not only for today but for future health and wellbeing also.

What Are the Possibilities of Developing a Seizure Disorder Following a Brain Injury?

Seizures may occur immediately after an injury or they may not show up until months or years later. Eighty percent of seizures occur within the twenty-four month period after an injury. In general, the greater the injury, the higher the risk of developing seizures will be. In some cases brain injury survivors may develop epilepsy.

Many problems can result with seizures such as injuries caused when falling, a risk of choking or injuries sustained if an individual suffers a seizure while driving a motor vehicle and has an accident. In some cases individuals experience warning signs prior to a seizure such as a tingling sensation, a change in lights or an odor. However, in many cases there are no warning signals. Following a seizure there is usually a feeling of extreme fatigue.

In one situation that I know of the survivor didn't have any evidence of seizures until about fifteen years post-injury. His injuries at the time were quite severe. Initially the seizures were mild and were not diagnosed immediately. They gradually became Tonic-Clonic seizures and now more than ten years after the onset he is unable to drive as medication has not yet stabilized their impact.

In another situation, the individual suffered a concussion when she was sixteen years old. It wasn't until she was thirty-five years old before she experienced her first complex partial seizure. She didn't have another one for several years and only periodically after that. It wasn't until she was in her late fifties that the episodes became consistent and often and she was eventually diagnosed as having seizures. In this case, the seizures are completely controlled with medication. My partner at three and a half years post-injury has had no indication of being likely to experience a seizure disorder. This is fortunate because his injury was serious and he's also in the higher-risk group because he is a drinker.

There are many different kinds of seizures. The Partial Seizure disorder is subtle causing perception changes, visual abnormalities, hearing distortions and unusual sensations. Alteration of memory or consciousness is not associated with this type of seizure.

The Complex Partial Seizure is preceded by an aura. The individual may appear to be dazed or confused and then it passes. This is the most common type of seizure.

Generalized Seizures usually involve a loss of consciousness but may not be convulsive. The Generalized Absence Seizure will usually accompany a complete loss of awareness where the individual may stare into space and appear to be dazed. It will not be preceded by a warning and may go unnoticed by others because it is usully followed by normal activity. It is similar to the Complex Partial Seizure but quicker in duration. It is more common in children.

The Tonic-Clonic Seizure has a convulsion phase with muscle stiffening; the person may lose consciousness and the body will become rigid possibly jerking and twitching in the second phase. After consciousness returns the person will be confused and disoriented. It is not one of the most common types of seizures although it is the type that one thinks of when thinking of seizures.

Status Epilepticus is the most serious of the various kinds of seizures. It is potentially life-threatening and can lead to brain damage. This type of seizure can last longer than thirty minutes or will be a recurrent seizure without regaining consciousness. An ambulance should be called for seizures that last longer than five minutes. Treatment must be initiated quickly. This is the least common of all the various types of seizures.

The good news is that although some survivors of a brain injury will possibly get seizures, the majority will not develop this disorder. However, if they do, most can be easily controlled with medication.

How to Deal With Learned Dependencies and Co-Dependency Following a Brain Injury

Learned dependency and co-dependency will often go hand-in-hand when a loved one has sustained a traumatic brain injury. It usually begins innocently enough but will end up being healthy for neither the brain injured survivor or the caregiver.

Brain injury survivors can, over time become dependent on their caregiver so that even when they are able to do things for themselves, they won't. As a result they will continue to become more and more reliant on their caregiver instead of calling on their own resources. It will affect their emotional and physical wellbeing which will then affect their recovery process. A survivor of traumatic brain injury will learn to become dependent as a result of receiving help when it wasn't required.

A co-dependent becomes overly involved in the patient's care. When this happens they don't allow the patient to be responsible for doing things even if they are capable of doing them. Caregivers initially become co-dependents because of love; they are trying to do the right thing by helping their loved one. With co-dependency and patient dependency, each person is robbed of their own identity. Co-dependency can create too much control over the patient leading to disempowerment. This can hinder the brain injured person's ability to take control of their own lives. Unfortunately, over time many who have learned dependency will be resistant to unlearning it and will not wish to do things for themselves.

Independence should be encouraged even if it means stepping away and leaving the situation. It may be a case of having to exercise tough love in order to force the patient to do things for himself/herself. This will be difficult to do for many reasons. It will be hard for the caregiver because they may feel that by not doing things for the patient, they are not doing what they should be doing. The brain injured survivor may also attempt to emotionally manipulate the caregiver to feel guilt for not continuing to do what they've been doing.

Other people may also negatively judge a caregiver who does not behave co-dependently when someone appears to need the help. But because others do not walk in the shoes of the caregiver they are unable to see that often the patient is more capable than he may appear to be to outsiders.

Learned dependencies and co-dependency becomes a vicious circle. Once the cycle begins, it is difficult to get out of but it is as important for the brain injured survivor as it is for the caregiver to attempt to do so. Looking after someone who is emotionally dependent is very tiring; and feeling dependent on another thwarts any possible progress towards healthy living.

If the brain injured survivor is capable, encouraging independence and backing off is the most positive thing that can be done to assist your loved one in getting better.

How To Achieve a More Successful Recovery Following a Brain Injury

The degree of success with the progress of recovery will be dependent upon many things. It is rare, however, that there is ever complete recovery from brain injury because the brain injured survivor is usually left with some deficits. These deficits generally are permanent and cannot be overcome like one would with a case of the flu. However the deficits can be adapted to and adjustments can be made for them.

The most important element of recovery is that expectations must change so that limitations can be accepted. Learning to cope and accept will be vital in the challenge to improve progress. If this is not done, disappointment and frustration with abilities that aren't the same as those pre-injury will definitely hold back the process.

Additionally, it is important that expectations be realistic. The severity and the location of the injury, what the pre-injury characteristics and personality were, and awareness and acceptance of limitations will all have a bearing on this progress. What is most associated with a more successful recovery is pre-injury intelligence, cognitive abilities and willingness to establish new life goals and a new life with different abilities.

Both overly optimistic attitudes as well as pessimistic expectations are harmful. Recovery may be slow but can continue sometimes for years, with changes possibly being in stops and starts. At times, after a lull with what seems like little progress there can suddenly be a spurt of improvement which could possibly be caused by a change in circumstances in the life of the survivor.

The fact remains is that the more time that has passed since the injury, the less likelihood there will be of many further changes. However, each individual is different but in most cases there is usually more recovery made in the earlier years following an injury than later.

As people age, some recovery may be reversed because of cognitive decline due to the lack of exercise or mental stimulation. Exercise stimulates the brain so it is very important for those who have sustained a brain injury to remain physically active. Reading, doing crossword puzzles and Suduko can help to keep the brain stimulated.

Quality and enjoyment of life as well as the opportunity for the best recovery possible for the brain injured survivor will also depend upon his/her effort to be involved with others, to eat a nutritional diet, to avoid alcohol or illegal drugs and to continually strive for improvement in all aspects of his/her life.

Although family and community can assist the brain injured survivor towards recovery, the majority of the effort towards this goal will need to be made by the patient through his attitude and his effort to work towards progress.

How Brain Injuries Affect Personalities

Brain injuries affect our personalities in many ways but severity of injury and pre-injury personality will have a bearing on the changes. Because our brains control who we are, when our brains are affected, so shall our personalities be. Because no two brain injuries are the same and no two people are the same, no one will experience the same personality changes. However, most brain injury survivors, and certainly those who are closest to them, will acknowledge that there most often are some changes.

Changes will be based on the deficits that a survivor is left with; some people will be left with many deficits while someone else may be left with only a few. These deficits will contribute to various behaviors which will change a person. Some of these deficits may be involving memory, concentration, anger problems, frustration, lack of motivation, feelings of detachment and anxiety.

Brain injuries can cause impairments to how we think and act which will cause changes in personality. Our brain is what gives us our reasoning abilities, helps us to interact socially and tells us how to live morally; it makes us who we are.

Personality changes can happen one, five or even fifteen years after the injury. Some personality disorders can be managed by the avoidance of caffeine and alcohol or by avoiding becoming overtired. Maintaining a regular exercise program could also help lessen the degree of change there may be.

Many of the changes that brain injured patients have experienced cannot be attributed directly to deficits. While doing research, I discovered that many brain injury survivors mention changes to their sense of humor, i.e.: they may no longer have one; or where they were once creative, they may no longer be; their interests may have changed or they don't have any, and many say they feel dull.

A bigger change, and one that is more likely to affect relationships, is that they may no longer have the same likes and desires; their feelings may have changed. It is possible that they no longer have the same interests they shared with their partner or enjoy doing the things they once did together. They may no longer make any effort to be affectionate but instead may be more focused on themselves.

The sexual part of their relationship may also have changed. Often there is less interest in sex after a brain injury. This change may become a problem in the relationship.

Personality changes such as these are difficult for family members but are not easy for the brain injured survivor as well. Survivors know they have changed; they know they no longer feel the same way and most often they don't know what to do about it.

Chronic Pain and Brain Injuries

Brain injuries, according to some studies, appear to have a correlation to chronic pain. In most cases it is related to headaches but it can also be related to other injured areas as well. Most physicians agree that chronic and acute pain is a further complication of traumatic brain injuries and is difficult to deal with.

According to the Mayo Clinic, your brain sends messages that influence your perception of pain. It's believed that how our pain is tolerated depends upon our emotional and psychological states, what our past pain experiences have been, what our childhood pain memories and experiences were, and our expectations of the pain we will have. Also, quite simply some people experience pain to a greater degree than others do.

According to research, there may be some influence in how we tolerate pain if we were raised to be brave when confronted with pain or other difficulties versus if we were catered to for the slightest discomfort. Fear and anxiety can also increase the intensity of the pain we feel.

Although headaches are quite often the main cause of chronic pain in cases where there has been a traumatic brain injury, but there are often other severe injuries as well that can cause prolonged and severe pain.

Chronic pain can be a result of nerve damage resulting from an accident but in some cases there may be no evidence of anything that doctors can link pain to and the pain will still be felt long after the injury has healed.

Malingering may also be considered as a possibility in instances where there is the incentive of financial remuneration where there is a lawsuit pending. Most doctors, however, believe that when a patient says they are in pain, they must be feeling pain and are not exaggerating the degree of pain they feel.

There is also a theory that chronic pain could be a symptom of a neurotic personality type who hopes to acquire nurturing through chronic pain complaints so as to receive more attention and sympathy from family and friends. Those with neurotic tendencies tend to be dissatisfied with their lives in general and will often complain to others. People who are survivors of a traumatic brain injury quite often are not happy with their lives, the changes in themselves or with their limitations. This may possibly cause them to focus more on their pain level than otherwise may be the case if they were leading a more active and contented lifestyle.

Unfortunately, there is very little understanding of chronic pain and there are a variety of theories as to its causes. As a result, little seems to be able to be done about it.

Rehabilitation and Brain Injuries

There is no limit to the degree that a survivor of a traumatic brain injury can be rehabilitated. However, the secret of this success will depend upon the determination and perseverance of the survivor and his family because rehabilitation is hard work.

Following a brain injury, cognitive impairment can leave brain injury survivors with concentration, focus and confusion difficulties. Memory issues also are a problem. There may also be difficulties with problem solving abilities, making decisions, reading and writing, the ability to logically solve puzzles, fatigue, denial, mathematical skills and they may suffer from lack of motivation. Basic abilities such as perceptual skills and those dealing with attention will need to be strengthened before more advanced skills can be added to what they can already do. In some cases other areas of the brain will take over the function of the damaged area. This is particularly true in the case of children and young people.

Initially assessments will be done regarding speech, cognitive and behavioral difficulties and the ability to perform daily living chores. Many cognitive and communication problems will be treated while the patient is still in the hospital but may continue for some time after. Longer term therapy may be performed either on an individual basis or in groups, often at a rehabilitation facility. Other rehabilitation may be done at home by a visiting therapist or as an outpatient. It is usually considered best to be done in a setting that is familiar to the patient.

Rehabilitation is designed to assist brain injured patients in relearning lost skills or in learning different ways to do things. When possible, it is important if family members can be involved in the process. In some cases, this includes the availability of caregiver support services.

As part of the process, patients may receive physical therapy, occupational therapy, speech and language therapy and task-specific training of cognitive deficits depending on the requirements of each individual.

Structure is a very important element in the life of a brain injured survivor; with structure their capabilities can be increased. It is important also, where bad behavior is a problem, that the patient be corrected. If poor behavior is allowed, it doesn't help the brain injured survivor and the end result could be that it may drive people away who might otherwise be able to help.

I believe that what gives the most liklihood of a more successful recovery is the survivor's ability to persevere and work hard.

Brain Injuries and Total Denial

Denial is common with brain injury survivors. They want to maintain a positive image of themselves and therefore will often deny that they have even had a brain injury. They may instead insist that any problems they have will go away. Denial is the enemy of all survivors and to their relationships.

When survivors are threatened with exposure such as when smoking in an unauthorized area, i.e.: the washroom at a restaurant, or becoming so drunk that they fall down, they may deny that this had happened even when confronted with the truth. These two situations have happened with my partner. It appears to be lying but in actual fact is denial not only to themselves but to others. There can be no progress as long as denial exists.

Often, rather than admit that they have suffered a brain injury, they will focus on other things such as pain from arthritis in their legs or they will blame other people or things for their problems. It is a self-defense mechanism. But it is one that will get them nowhere. It will in fact, sabotage any future progress they may have.

For those who have not accepted their limitations, they feel that denial of them will draw attention away from their problems. Their hope is that others won't suspect there are things they are unable to do. If they refuse to believe that they have a problem, it gives them the excuse of not having to be accountable for their actions.

In order to combat the problems that being in denial cause them, it will be necessary for the survivor to understand and realize what the effects of their injury have on their life. If they can admit that they can and do make mistakes, they will be able to learn from those mistakes and they will not repeat the same ones again.

In order to be able to accept that their abilities are not the same as they once were and that they are not the same person, it will be necessary for them to face their fears. When one is consumed with fear, it increases feelings of loss of power. When this is the case, it is almost impossible for someone to be able to succeed at anything they try to do or to make any progress towards living a satisfying and fulfilled life.

By accepting their limitations, they can acknowledge that they cannot, for example, do the same job they once did. But perhaps there is another way of doing it or there is another job they can do while still working with the same company or a similar one. Or they can acknowledge other talents they have and pursue those. It will just be a different way of living.

Acceptance of their brain injury and of their limitations will increase their enjoyment in living. Denial, avoidance and making excuses are hard work when instead that effort could go into making positive changes in their lives.

Brain Injuries and Amnesia

For someone who has sustained a traumatic brain injury, there is the risk of amnesia or loss of memory. Following my partner's motorcycle accident and subsequent injury, he lost all memory of the ten years preceding his accident.

This type of memory loss is called retrograde amnesia which eliminates any memory of events prior to the accident. It may only be for the preceding few minutes, hours or days rather than the more unusual extensive period that my partner experienced. When he became more aware, after ten days in a medically induced coma, he thought it was ten years in the past. He had no recollection at all of his accident and had lost ten years of his memory.

This was a traumatic experience for me, as I'm sure it was for him because during this ten year amnesia period, his wife had died and we met each other three years prior to his accident. When I visited him, there were times that he knew my name and other times when I asked him if he knew who I was that he avoided the question. But even when he seemed to know my name, I don't think he had any real understanding of what our relationship meant to him. Even after he had been out of the hospital for several months and appeared to have recovered most of his memory of that ten year period, he admitted that he had no accurate realization of what our relationship had been like prior to his accident. This was very disconcerting. We were virtually strangers.

This period was a learning experience for him. When I asked him how old he was, he gave me the age he would've been ten years previously. There were many friends who visited that he didn't recognize including some he had known for twenty plus years. He had no memory of the new home we had moved into, still thinking he lived where he had for many years. He also had no memory of the year or make of car that he drove instead telling me about one he had driven years before.

He talked about people in his past I had never heard of as if they were current friends. I began an experiement of asking him to help me make up a list of our 'welcome to our new home' party. All of his first suggestions were people who were mostly unknown to me. The second time we did the experiment a couple of weeks later, the list was comprised of some people that I knew and others that I didn't. On the third try, the list was pretty much who would normally have been on it.

During the six to eight week period before he gradually began to remember some of that lost period of time, I brought pictures into the hospital of family and friends, pictures of our new home, things from our home that I hoped might jog his memory and albums showing different trips we had taken together.

As he began remembering a few things, it seemed that he was making up stories. In actual fact, when someone has suffered retrograde amnesia, they will often fill in the blanks in stories when they can't quite remember the whole story.

It is difficult to say whether my partner does remember everything from that ten year period or not since I can't verify all of it. Even he is not sure whether he does or not. Some of his memory may, in fact, be made up to replace what he can't remember.

My partner also suffered from anterograde amnesia which is memory loss immediately following an injury. Even now after three and a half years post injury, he has no memory of his accident. He also has very little memory of any of his four month hospital stay. Survivors of brain injury will often have difficulty remembering anything new. In this case new events or learning new things will often not go into the long-term memory bank. For this reason they may become discouraged from doing anything that they aren't already familiar with.

For those people suffering from these types of memory losses, it must be like living in a fog - they know it's there but it's just beyond their grasp.

Adult Step-Children Relationships and Brain Injuries

It is difficult being in the position of caregiver to a spouse with a brain injury and also dealing with problematic grown step-children. This is particularly true if the situation had not been good to begin with. However, the degree of difficulty will depend upon a number of factors.

Some of the things that will have a bearing on the situation with grown step-children will depend on how long the couple has been together before the injury; what the relationship with the step-children was like before the injury and probably more important, what the relationship was like between the survivor and his/her children.

In our situation, we knew each other about three and a half years before my partner sustained his brain injury. At the time of his accident he wasn't speaking to his oldest son and still doesn't; there was little interaction between him and his second son, and he saw and talked to his daughter only occasionally. This had been the case both before his accident as well as being the situation before I met him.

After his accident, there had been no offers of help of any kind from any of his children and admittedly I was upset with the poor treatment of their father. But then when he was doing up his Will, they suddenly wanted to bond with him; they wanted to take him for dinner - a dinner I was excluded from. He has since done up his Will and has given his daughter his Power of Attorney. Needless to say, there has been no more effort at bonding since or anything more than the occasional phone call from his daughter.

There has never once been a "We appreciate all you've done for our father. Is there anything we can do to help?" But this is not a surprise. How could I expect that they would treat me any other way when they treat their father so badly?

In circumstances such as this, where does that leave the partner/caregiver? The answer is - in a very vulnerable position; particularly when the stepchild has the Power of Attorney but the spousal/caregiver is doing the caring for their brain injured partner. For anyone who finds themselves in this position, I would recommend talking to a lawyer in order to get advice on how best to protect themselves and their own families. Your partner very likely is not well enough to protect you if he/she has not already taken steps to do so before their injury.

This is not an uncommon scenario with grown step-children but is made especially more difficult when brain injury is involved. It is a time for the spousal/caregiver to be proactive in order to safeguard their home and their own children,.