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.
Thursday, January 28, 2010
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.
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.
Wednesday, January 27, 2010
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.
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.
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.
Monday, January 11, 2010
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,.
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,.
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