The Basics of Alzheimer's Disease

Alzheimer's Disease is the most common kind of dementia. Sadly, it worsens as it progresses and there is no known cure. It is estimated that 5.1 million Americans may currently be living with the disease.

The first symptoms often appear when the person is about sixty years old. The symptoms initially are: inability to remember recent events, confusion, irritability, aggression, mood swings and difficulties with their reasoning abilities. The first warning signs are cognitive loss, however, not everyone with memory problems, or any of the other symptoms, will necessarily have Alzheimer's Disease. Long-term memory loss will also be affected as well as difficulties with word finding, vision/spatial issues. These will indicate the early stages of the disease.

When Alzheimer's is in the moderate stage, memory loss and confusion will become worse and sufferers may even have difficulty recognizing their family and friends. They may have problems getting themselves dressed or have hallucinations and behave impulsively.

In the final stage, brain tissue will have shrunk considerably and eventually their bodily functions will be lost as well. Those with the disease will lose their ability to carry on a conversation or to be able to respond to their environment. They will be completely dependent upon others for their care, likely spending most of their time in bed and their body will eventually shut down.

Alzheimer's Disease can progress without being diagnosed for years. There are no known treatments that will stop or reverse the progression of this terrible disease. Alzheimer's is a degenerative disease and one of the most costly for society. It accounts for fifty to eighty percent of all dementia cases.

It is not considered to be a normal part of aging although the risk does increase with age. Although there is as yet no cure, research is ongoing. It is thought that the disease progresses over two to twenty-five years with most patients experiencing the eight to fifteen year range of the illness.

Most sufferers of Alzheimer's don't usually die from it but rather from their inability to be able to swallow or from pneumonia symptoms. Each sufferer's ability to cope with the disease will depend upon the severity of it and on their own personalities. Such symptoms as depression, paranoia or delusions, as well as some of the other symptoms, can be treated and alleviated in some way, at least until the final stage.

Alzheimer's Disease is dreaded by everyone. Some believe, but don't know for sure, that keeping your brain active, maintaining a physical lifestyle, eating a healthy diet and by keeping involved in activities, may ward off the onset of this disease. At any rate, it certainly can't hurt.

How Best to Avoid Having a Stroke

Eighty per cent of strokes can be prevented by being aware of controllable risks. A stroke occurs when blood circulation to the brain fails and cells die as a result of lack of oxygen. Controlling risks can help prevent this.

Strokes are caused by either a blockage of blood flow or by bleeding into the brain. The following are things that can be done to help prevent having a stroke:

- Keep high blood pressure under control as it can make you susceptible to developing blood clots. If high blood pressure is left untreated, it can be a precursor for a stroke. It should be checked regularly by your family doctor and if it is higher than it should be there are things that can be done to control it. You can change your diet by eating healthy foods and by exercising. Exercise will make the heart stronger thereby requiring less effort for it to pump blood through the body. It is also important to avoid excessive sodium as it can contribute to high blood pressure. In some cases this may not be enough and medication may be necessary to keep it under control.

- Atrial fibrillation can increase the risk of stroke by five hundred per cent. It is an abnormal heartbeat and can cause blood to pool in the heart. Atrial fibrillation can be very serious and should not be taken lightly. Most times, as in my mother's case, medication is required to control it and constant attention and awareness of it is often required.

- Smoking is something every person has control over and it is wise to avoid as it doubles the risk of stroke. Smoking clogs the arteries, raises the blood pressure, damages blood vessels while narrowing them and causes the heart to work harder. Nicotine and carbon monoxide damage the cardiovascular system which can increase the risk of stroke.

- Over consumption of alcohol has been linked to stroke risk. It has been recommended during various studies than no more than two drinks are advisable for males and one drink for females should be consumed and less is better.

- High cholesterol should be checked regularly also by your family doctor. It can clog the arteries and puts those with it at a higher risk for strokes. High cholesterol can be regulated by diet and exercise but when this doesn't work, medication may be required.

- Diabetes can create a risk for getting a stroke. Diabetes II can sometimes by controlled by diet and exercise but in any case, it is something that should be taken care of and monitored by a family physician.

- Obesity can create a risk of stroke also. However, it can be controlled with a proper diet of fruit and vegetables, grains, nuts and foods low in calories. Regular exercise is also important; at least five times a week is suggested. It doesn't have to be strenuous. Walking and swimming are an excellent way to stay in shape and help your heart to stay healthy.

- Circulation problems can also lead to blocked arteries and can cause a stroke. Medication may be required to control this problem. It will be necessary to follow the advice of your doctor.

- Transient Tschemic Attack (TIA's) should be treated. They are mini strokes lasting usually only a short period of time. It is important that they be treated as they can lead to more serious strokes. My suffered suffered from these and was prescribed medication by her family doctor. She had them for years but because she took medication for them, she fortunately never did have a more serious type of stroke.

Having a risk factor for stroke doesn't necessarily mean you'll have a stroke. My mother has been proof of this. But it does mean that a particular effort should be made to control the controllable risk factors.

Can Anyone Have a Stroke?

Anyone can have a stroke. About one quarter of all strokes happen to younger people and children. Babies have even had strokes. But almost eighty percent of all strokes can be prevented.

There are many risk factors. Men are at higher risk for stroke than women but women are one and a half times more likely to die than a man will. However, middle aged women are more at risk than middle aged men. People of South Asian, African-American or Hispanic have an increased risk than those of European origin and usually they have strokes at a younger age.

Controllable risk factors are: high blood pressure, high cholesterol, diabetes, poor circulation, smoking, alcohol, obesity, poor diet and inactivity. Uncontrollable risk factors are: age, gender, race, family history, being aged 55 or older or being male. Also those suffering from atrial fibrilation or TIA's (transient ischemic attack which are mini strokes) are more likely to experience a stroke.

Other uncontrollable risk factors are a genetic predisposition/genetic disorder which may be a gene mutation leading to damage of blood vessel walls in the brain, blocking the blood flow. Each child of a parent with a family history of this disorder has a fifty percent chance of inheriting the disease.

Your stroke risk is also higher if a parent, grandparent, sister or brother have already had a stroke. Also, those who have previously had strokes, TIA's or heart attacks are at a far greater risk of suffering from a stroke than those who have not.

Strokes are considered to be more common in the southeastern part of the United States than in other areas. There is also evidence that strokes are more common among low-income people than those who are more affluent. Alcohol and drug abuse are also considered to be high risk factors.

One in six people will have a stroke some time in their lifetime. Based on this information and the fact that there are so many risk factors involved pertaining to what is controllable and what isn't, we now know, as many people have long held to be true, that the risk is not only in being over sixty-five years of age.

And because thee are so many risk factors, and because younger as well as older people can have strokes, it is important to remember the following warning signs: F.A.S.T.: F. - Face drooping; A. - Arm weakness; S. - Speech difficulty; T. - Time to call 9-1-1.

So can anyone have a stroke? Technically almost anyone can but it's important to remember that there is much we can do to prevent a stroke from happening. But it is also important to remember that much of what happens concerning our health can be controlled by how we treat our bodies.

Strokes and Emotions Following a Stroke

Emotions and behaviour can change following a stroke. Approximately one third of all stroke survivors experience some emotional problems.

Emotional problems can result in depression, anger, frustration, feelings of loss and denial. There may be communication disorders which will include aphasia - to do with verbal abilities and auditory comprehension where they are unable to speak or read, write or comprehend numbers. Or there may be motor speech disorders with slurred or garbled speech. All of these difficulties will affect the emotions creating sadness and possibly depression.

Extreme emotions will interfere with the rehabilitation process. Emotions are hard to control, partly because of chemical changes within the brain caused by the stroke. It is also a reaction to the challenges of dealing with the effects of a stroke. There can be rapid mood changes also causing crying or laughing that may not be appropriate, feelings of hopelessness, changes in eating and sleeping, anger, anxiety and apathy.

Anxiety causes sleep disturbances and can cause difficulty with concentration. The stroke sufferer may avoid going out in public or even seeing friends. Irritability, another problem, can also cause problems with concentration and the sufferer may tire more quickly.

Apathy is a dangerous emotion for a stroke survivor. Its symptoms can be lack of enthusiasm, motivation, listlessness and they may exhibit no interest in anything. For the stroke sufferer, if they have apathy they will likely not wish to work diligently at their rehabilitation. This is detrimental to their long-term health and their chances of having fewer disabilities.

It is important for a stroke-impaired person to find ways to relax, i.e.: soak in a warm bath, listen to calm music, meditate or go for a walk. Writing down worries or talking to a friend or family member may also help. However, if it continues for quite a while and all else has failed, it may be necessary for them to see their family doctor. Medications may also be necessary.

Stroke recovery groups are also good for the stroke survivor because often talking about the effects of their stroke with others who are going through the same thing can help. Acknowledging their feelings will likely help them deal with their emotions also. It is also important for a stroke sufferer to be informed. The more they know, the more able they can help themselves.

Emotions following a stroke are often closer to the surface and may possibly intensify reactions to situations that may not have bothered them prior to their stroke. As upsetting as it is for the stroke survivor when their emotions are chaotic, it is good to know that in almost all cases, these intense feelings will go and eventually they will feel more like themselves.

Problems with emotions following a stroke can result in personality changes. But as the stroke-impaired person begins to feel more like themselves, these changes often will cease to exist.

Learning to Adjust to Life Following a Stroke

Statistics indicate that strokes are often life-altering. Sadly, fifteen percent will die, twenty-five percent will recover with only minor impairment and ten percent will almost completely recover. But the rest, fifty percent, will require some type of care.

There are huge challenges in adjusting to the effects of a stroke. There will likely be fear, apprehension, uncertainty and usually life changes. It will be important for the stroke sufferer to gain some control over his/her life and to work towards independence. They will need to work diligently to improve their emotional and physical well-being by thinking positively. It will be important for them to remain positive as expectations, by necessity, will be altered.

Adaptations will have to be made to overcome limitations. Practicing daily will be necessary as continual effort will have a cumulative effect on their abilities. It will be important to set goals, to do things they enjoy, to be social and to try new things. It will be important also to accept the many changes in their life and to adjust to how their stroke affects other people. It will be natural to initially fear the future because strokes affect the body, mind and emotions.

Following a stroke there may be paralysis, weakness in the limbs, difficulties with balance or language, pain or vague sensations of feelings in their body, cognitive and memory problems, feelings of frustration, feeling a sense of loss, difficulties with bowel or bladder control, fatigue, trouble swallowing or difficulty maintaining their hygiene. There may also be depression. It will be important to seek help if depression is suspected.

In some cases, brain cells may be only temporarily damaged. In other cases, different areas of the brain will take over from the damaged areas. Rehabilitation will play a large part in helping the brain sufferer. Goal setting will also be important. And as with everything, a proper diet is necessary.

It will be important for either the stroke-impaired person or his/her caregiver to ask questions regarding their care, to allow him/her to express their wishes and opinions and to be made a partner in their own health care. It will be important to keep them informed and to encourage them to join a stroke support group.

Special equipment may also be required following a stroke, i.e.: a cane, walker, wheelchair, orthotic devices or communication aids. There are also services available such as meals on wheels and transportation services.

Adjusting to the effects of a stroke will be different for each stroke survivor because, like every brain injury, each stroke is different also. A lot will depend on the attitude of the survivor and how hard he/she is willing to work at rehabilitation. It will also depend on the severity of the stroke and where it was. Whether there is a family member and/or caregiver available to assist with follow-up care and rehabilitation will make a difference too in both physical recovery and in a positive attitude.

Helping Victims of Strokes

More than 700,000 people suffer from a stroke each year in the United States. Strokes are the fourth leading cause of death in the United States and the most common cause of long-term disability. One American dies of a stroke every four minutes.

It is thought that sensory stimulation, i.e.: gentle touching of the face and hands, etc. or talking in a soft voice to the person who is suspected of having a stroke may reroute the brain's blood supply while waiting for an ambulance to arrive. By doing this, it is hoped that the stimulation may assist in keeping cells from dying while a person is experiencing a stroke.

There is also a drug available that breaks up blood clots if it is administered within three hours following a stroke. However, it doesn't work for everyone and of course, getting help quickly is of paramount importance.

But what is required after someone has had a stroke? A person who has suffered from a stroke should begin rehabilitation no longer than 24 to 48 hours following their stroke because most will require at least some rehabilitation in order to become as independent as possible in the future.

It may be necessary to relearn some skills that may have been lost, i.e.: walking or talking. They may have to learn new ways of doing things, i.e.: how to bath, dress themselves or to eat. They may only be able to use one hand. If that is the case, they will have to practice repetitive exercises to strengthen the stroke-impaired limbs. If there is some weakness or paralysis on one side of their body, they should use those limbs to do basic activities for their daily living. Once begun, it may be an ongoing process to maintain and refine these skills.

Strokes can affect both speaking or understanding; motor control, i.e.: their face, arm or leg usually on one side of their body; sensory disturbance problems; memory and cognitive problems; emotional disturbances, i.e.: psychological trauma as a result of the stroke, and depression. As in other brain injuries, stroke victims will not usually experience all of these problems and the fortunate ones will have only mild limitations that may require little rehabilitation.

Many people are involved in stroke rehabilitation: the patient, family member, caregivers, doctors, rehabilitation nurses, physical therapists, occupational and recreational therapists, speech therapists, and vocational therapists.

As a family member, if you have been there when the stroke happened, your most important task is to get your loved one to the hospital as quickly as possible because early intervention will mean there will be a more positive outcome.

It is important if a family member has had a stroke that he/she and/or his family members/caregivers do all they can to work towards rehabilitation so they are not one of the more negatively impacted.

Assessment Tools for Concussions

As there is more awareness of the dangers of concussions, particularly when playing sports, most now realize that concussions have to be assessed early and that proper follow-up care is necessary. As a result, there are now several assessment tools now available for the amateur, scholastic and professional level of athletes.|

The following are some of the diagnostic and assessment tools now being used:

- The C3 Logix system is an assessment tool that was initially used for research into Parkinson's disease but is now being used to assess those with concussions. It determines rate of dizziness, balance and visual disturbances. The data is stored in the system, eliminating the guesswork and makes managing brain injuries, and particularly concussions, easier. Tpad2's are currently being used along with the C3 system as the assessment tool. A baseline assessment is done on players pre-season so that if there should be a suspected concussion then another follow-up assessment will be done to compare the two assessments in order to determine the degree of the injury. Another assessment may be done during the recovery period to determine rate of injury improvement and another before the player is allowed to return to the game. By doing these types of assessments, it ensures that no player will be allowed to play with any symptoms that have not been resolved. This data collection system assesses the neurocognitive symptoms, balance, reaction times, memory and motor function to determine brain health so that concussions can be better managed. It is portable and accurate and is able to focus on moving objects. It can test athletes at all levels.

- SCAT2 is another diagnostic assessment tool for determining concussions. It is a standardized method of evaluating athletes for concussions from as young as ten years and older. The SCAT2 also does pre-season baseline testing of athletes.

- ImPact Sports Concussion Assessment and Cognitive testing is also utilized. It tracks the injury from the time of concussion and throughout the recovery process.

- The C3 Application is often used with the ImPact Sports Assessment. It is an iPad based application to assess concussions. All information is put into the medical record system so that follow-ups can be made. As part of this assessment, there will likely be a physical assessment done as well, i.e.: a drop test and a balance test.

There are approximately 500,000 sports related concussions in the United States each year. MRI's and CT scans do not detect concussions. Because concussion symptoms can be very difficult to correctly determine the degree of injury, these diagnostic assessment tools are a huge advantage to medical professionals as well as athletes to ensure that proper care is received and that hopefully long-term problems can be avoided in the future.

These diagnostic assessment tools are being used more and more frequently within schools and universities in the United States. Hopefully the advantages of their use will begin to be realized.

Brain Injuries and Behavioural Problems

Behavioural problems quite often are a result of brain injuries. There can be many problems or few depending upon the severity of the injury and in what part of the brain the injury is located. Some of the potential problems are as follows:

Mood swings, depression, hyperactivity, aggression, sexual inappropriateness and/or promiscuity, lack of initiative or motivation, changes in emotional control, lack of impulse control, poor concentration, lack of empathy, fatigue, thoughtless or hurtful remarks, difficulty in relating to others, excessive demands, personality changes, a tendency towards being frustrated, irritated or angering easily. Unawareness of others' feelings is other another deficit and may be something that has to be relearned. Another serious and very common problem is short-term memory difficulties, as is a lack of awareness of their deficits.

If a brain injury survivor is affected with any of these behavioual problems, it is very stressful for family members and caregivers. It may be important to have cognitive and behavioural rehabilitation and possibly the help of a neuropsychologist. It will also be important to have an assessment done which will help both the survivor and the family member. And because behavioural problems not only affect relationships but performance in school and work, it will be necessary to attempt to alleviate the problems or at the least, to help cope with their impact. The following are some of the things that can be done in order to help minimize problems associated with behavioural changes following a brain injury:

- to be calm and speak in a soothing manner when the brain injured survivor is angry or frustrated;

- help them attempt to problem-solve their difficulties;

- use anger management strategies and remain low-key;

- avoid confrontation if they are angry;

- attempt to distract;

- attempt to identify any triggers so as to avoid future difficult situations;

- encourage the survivor to join a support group;

- be non-judgmental;

- help a sufferer of a brain injury to have positive experiences by offering encouragement and support;

- avoid arguments and criticism;

- help them to have a schedule and structure in their lives;

- don't give too much information at one time;

- establish consistency and always remain calm;

- and, if depression is suspected, have survivor see the doctor and if necessary, ensure that he/she gets treatment.

A total reversal of behavioural problems following a brain injury may not be possible. Modifying behaviour may be a more realistic goal while working towards improved quality of life and successful community integration.

Developing adaptive behaviour requires recognizing triggers and anticipating factors preceding the behaviour. These may be internal such as fatigue or hunger. External factors may be a frustrating task or increased levels of stimulation. Prior signs to difficult behaviour may be pacing, becoming fidgety, their face may become flushed, or they may begin muttering to themselves. Early intervention when a problem arises may assist them, over time, in changing their behaviours.

Brain Injuries and Sensory Deficits

Sensory deficits following a brain injury are usually the result of damage to either the right side of the brain or the parietal and occipital lobe region. Sensory deficits are those to do with hearing, smell, taste, touch and body language such as emotional and non-verbal signals. These deficits can lead to lack of communication, confusion and frustration. Some may even develop tinnitus, a ringing in the ears.

Other problems may be auditory perception having to do with sounds and visual perception relating to colour confusions, shapes, size, depth and distance. Those who suffer from the sensory deficit of vision loss, problems with hand-eye coordination or having blind spots or double vision may, as a result, be somewhat clumsy.

Another sensory deficit is textile perception relating to pain, pressure and temperature. The skin may also tingle or itch excessively. Olfactory perceptions relates to smells where everything has an unpleasant odor, and gustatory perceptions relate to taste where everything tastes bitter are some of the other deficits.

Those suffering from sensory deficits may also have problems copying or recognizing objects, being able to tell their left from right, doing mathematics, or analyzing and remembering visual information. They may also have a problem with awareness of their body such as when climbing stairs, following directions or constructing even simple objects.

One well-known syndrome involves ignoring something from, typically the left side, i.e.: food on the left side of their plate. They may also have an inability to recognize faces, even those very familiar to them, such as their own spouse, and are often unable to determine emotional cues of any kind. In some cases, they will not even be able to recognize a picture of themselves.

Identifying any object requires most of the senses: sight, (What does it look like?); touch, (What does it feel like?); sound, (What does it sound like if chewed? Does it even have a sound?); smell, (Does it have a smell?), and by taste, (What does it taste like?). If one or some of these senses don't work, the person will have to rely on their other senses.

Other solutions may be retraining which would include repetitive and intensive exercises of the necessary skills. This can be effective with specific skills, i.e.: recognizing faces of their closest family members. Compensatory strategies may be another solution. Modifying their environment may also be necessary using safety devices such as hand rails, ramps or by moving furniture, etc. to make movement within their home environment easier.

Some sensory deficits may initially go unnoticed by others such as the sense of smell or taste but can be unpleasant for the sufferer. Whereas others can cause severe problems such as vision or communication deficits. Helping to find a solution to these deficits will be important for your loved one.

Long-term Effects of Concussions in Children

In some cases, the effects of concussions can last for decades following an injury. Many of these long-term effects can have serious repercussions.

There can be abnormal brain wave activity for years following a concussion leading to attention problems. Those who return to active sports, school or play too quickly following an injury are more likely to sustain a second concussion. And repeated concussions will increase the risk for later developing dementia, Parkinsons and/or depression, headaches, a feeling of being in a fog, behaviourial changes and slowed reaction times.

Some studies indicate that even one concussion can result in long-term structural damage or brain atrophy. Children, particularly those between ten and seventeen years of age, who have sustained concussions may be more susceptible to long-term effects. An already vulnerable brain can be further injured if there is not rest both physically and mentally following a concussion. A child's brain continues to develop until they are twenty-five years old.

When I was sixteen years old, I sustained a concussion and a broken nose, while in an automobile accident. I was unconscious for a few minutes. I did not suffer any memory problems or any of the other symptoms except for a very bad headache and the feeling of being somewhat foggy for a short period of time. The headache, however, lasted for several years. I did not rest either mentally or physically following the concussion and my doctor's idea of treating my headaches was to attempt to hypnotize me.

About twenty years later, I began having mild seizures which, periodically over the years, became more frequent. I was eventually put on medication which cured my seizures and my headaches. Because of my experience, I can certainly attest to the importance of having proper care following a concussion.

At that time neither my parents or my doctor placed much importance on a 'bang on the head'. I think my parents felt a broken nose and a knock on the head were relatively minor; at least I was still alive. Over the years I have spent a lot of time working on keeping my brain sharp and my memory in good condition and in fact, I have an excellent memory. But there are many who, like me, did not receive the necessary follow-up treatment after a mild head injury and are not aware of the necessity of keeping their brains sharp as they age. Are they doomed to suffer from dementia?

It is for this reason that we need to protect our children, as much as possible, from receiving concussions and if they do, to ensure that they rest both physically and mentally until it is deemed that they are well enough to return to school and sports. If this is not done, the long-term consequences of concussions can affect their whole lives particularly as they age.

How the Brain Can Change Itself

It is believed that the brain can change itself, with determination, perseverance and hard work, during both healthy development as well as following a brain injury. The reason for this is because of its plasticity.

Even as we age, our brains can change. The old saying, 'you can't teach an old dog new tricks' simply isn't true. As people age they can still learn something as difficult as a new language or learn to play an instrument. This has to do with neuroplasticity. It's true that we don't learn as quickly when we are older and we have to work harder at it but with determination and hard work, it definitely can be done. This is because the brain is making new connections between brain cells similar to that of a pathway. And like a pathway that is often used, the way is clear and easy to follow. But a pathway that is rarely used will become overgrown and difficult to find. The expression, 'use it or lose it', is not just a cute cliche.

Neuroplasticity plays an important role not only in healthy development but also when recovering from a brain injury or the results of a stroke. Simply put, other areas that are close to the damaged area of the brain, will take over. Following brain injuries or strokes, it has been proven that our brains will adapt and compensate by creating new connections.,p> Genetic factors, our environment and how we think and behave all have a bearing on neuroplasticity as well. Things like using your opposite hand to do everyday functions such as peeling vegetables, using your mouse and brushing your teeth will eventually create new connections between brain cells, if done often enough. Also, keeping your eyes closed when you do such things as getting up in the middle of the night to use the washroom, (if you are in a familiar area), choosing clothes from your closet based on the feel and texture of the fabric or setting the table.

The power of positive thinking uses the ability of the brain to be plastic. We are what we think just as much as we are what we eat. If we think we are inferior to others, our brain will tell us we are but if we think we are worthwhile, we will behave as if we are. By continually thinking we are worthwhile, we will be remapping our brains and creating new neural connections. It is the power of visualization. Athletes often use this technique to help them prepare for various sports events even when they are not actually physically able to practice.

Also, according to Norman Doidge, Psychiatrist and Psychoanalyst and a specialist in neuroplasticity, it is believed that intelligence is not fixed; it can be changed. For each new thing we learn, our ability to learn more increases.

Therefore, Dr. Doidge and many others like him, believe our brains can find new connections following head injuries and strokes. He also believes that we have the ability to increase our mental capabilities throughout our whole life and even well into our advanced years.

Concussions and Children - Important Things to Remember

It is important to protect our children against concussions and the effects of these injuries. In order to do this, we must know as much as possible.

The following are important things to remember:

- A sudden acceleration or deceleration of the brain within the skull can cause a concussion or brain injury.

- A person does not have to lose consciousness to have sustained a concussion.

- Being unable to recall recent events prior to or following a concussion is one of the symptoms of an injury.

- A child cannot return to playing the game after a concussion with only the approval of their parents. He or she should be immediately removed from the game, be evaluated by a physician and not be allowed to return until after he/she has received medical clearance to do so.

- The child should be monitored for at least two hours following a suspected concussion.

- A child should be kept awake for about two hours following a concussion; not the twenty-four hours that was originally considered to be necessary.

- Anyone suffering from a concussion should not read, text, play video games or go on the computer.

- They should wear sunglasses when outside in the bright light and if nouise is a problem, should wear earplugs.

- If they are a teenager or young adult, they should not drive following a concussion and should try to avoid all stimulation.

- Let a physician know if the child is more emotional than normal or if there is a sudden sleep problem. It is important to monitor all symptoms.

- Multiple concussions can increase the time it takes for someone to recover and can in all likelihood create long-term problems.

- Symptoms can appear immediately or not until a few hours or even days following the event.

- It will be important to avoid physically and mentally demanding activities following a concussion.

- If a teenager or young adult, he/she should avoid alcohol or drug use.

- All activities should be returned to gradually.

- It will be important to get plenty of sleep.

- Almost half of all concussions are not recognized or diagnosed by coaches or even physicians. Following a suspected concusion, there should be neurocognitive testing done to determine the extent of the injury and as a guide for follow-up monitoring.

- Each player suspected of sustaining a concussion must be diagnosed individually by a properly trained health care professional.

- All parents, coaches and officials should be familiar with concussion protocols.

The reason it is so important for a young child or teenager to rest both physically and mentally following a concussion is the brain's vulnerability to even minor jolts. For children who don't rest, the possibility of 'second impact syndrome' increases. This can possibly cause the brain to swell which may severely disable a child.

The more we understand concussions, the better able we are to protect our children against life-long problems as a result of them.

Brain Injuries and Their Treatment for Young Children

Brain injuries can be concussions, skull fractures or serious traumatic brain injuries. Those most at risk are the very young, because of tumbles and falls; and teens, often because of sports injuries or of thinking themselves to be invincible. Children's brains are very vulnerable.

If a young child has a suspected serious bump on the head and is dizzy or confused, has difficulty seeing, it will be important to consult your doctor. If the child appears unaffected, it will still be important to keep them awake for an hour or two before sleeping. Then check the child's skin colour and breathing pattern every couple of hours. If these are normal, allow them to continue sleeping. If either seems abnormal, gently rouse the child from sleep. If he fusses and wants to go back to sleep, he's fine but if he cannot be roused, or it is difficult to do so, it is important to call the doctor and probably place a 911 call.

Even when all seems normal, watch the child closely for the next twenty-four hours. If he/she vomits repeatedly, becomes confused, is listless or extremely irritable, complains of a headache, has slurred speech, neck pain, seizures, poor coordination, displays aggressive behaviour, has any discolouration or bruising around the eyes, blood or other discharge from the nose, enlarged pupils or loses consciousness, call your doctor or emergency services immediately. It is important to trust your instincts at this time.

Following any type of head injury, a child should be monitored. They should not return to playing sports or activities of any kind. Rest is important until the doctor advises that activities can be resumed again. It is a good idea for a child with a head injury to be examined by a doctor and if thought advisable that a CT scan be done.

Risks for future injuries should be minimized for sports related trauma as well as in other areas where children play and are active. Secondary injuries to the head can result in more longer lasting problems, i.e.: with neurocognitive problems, behaviours, learning skills, memory issues and depression.

Ways to minimize further injuries are:

- Banning body checking in the younger age groups.

- Reducing violence and defining acceptable behaviour.

- Changing the rules to protect children from getting concussions or more serious head injuries.

- Teaching correct tackling, contact procedures and collision techniques. Better training is important. Often it is parents who are doing the training and coaching and they may not have the necessary knowledge.

- Immediately replace damaged equipment. It is also important to remember that helmets, even when properly fitted and worn correctly, only protect against skull fractures. They do not protect against concussion because a bump on the head will still cause the brain to move around inside the skull.

- For children who are skateboarding, running or playing, it is important to do so in well-lit areas that are free of obstacles and holes or uneven ground.

- Follow the rules of the game and all other safety rules.

Now is the time to protect our children. Not when it is too late. If only, should have, and I wish I had, do not correct damage that has already been done.

Sports Related Childhood Brain Injuries

Through hockey, football and soccer, we are possibly placing our children in harm's way. There is the potential for brain injuries in all of these sports. But the dangers can be avoided if common sense is used and proper safety measures are considered.

More than half of the sports-related brain injuries that children suffer is while playing ice hockey, generally as a result of player contact, getting hit from behind or being hit into the boards. In football it is usually as a result of tackling and in soccer, it will result from head-to-head contact, collisions, high kicks or from hitting goal posts. Baseball injuries are usually the result of ball, bat or another player contact. This occurs more often in younger players, usually under ten, who stand too close to the swing of a bat or don't wear proper head gear when on the field. Other sports teams, where people can suffer head injuries, are lacrosse and basketball. Injuries in basketball have increased significantly in the past ten years from elbowing or by hitting a fixed structure.

Soccer and hockey are the most common sports played by children's leagues particularly for those in the five to fourteen age range. But other sports outside of leagues where there can be the potential for brain injuries are for skiers, snowboarders, cyclists, skateboarders, water skiers and for those who horseback ride.

There are, however, safeguards that can be adhered to in an attempt to protect our children against brain injuries while playing sports. They are:

- All children should wear protective gear, which includes properly fitted helmets that are worn correctly. And proper equipment should be used at all times - both in games and at practices.

- All rules and regulations for each sport should be strictly adhered to, i.e.: by following game regulations and making sure that all rules are enforced. (One rule that is not strictly enforced is hitting from behind in hockey which continues to happen in spite of the rule against it).

- All government officials, sports organizations, sports sponsors, schools, coaches, parents and players need to be aware of the dangers, and to change their behaviours and attitudes.

- Adult supervision should be mandatory in all children's sports.

- There should be programs available to educate the public on the dangers of children in sports and subsequent head injuries.

- There should be rules and incentives in place to encourage safety in sports.

- In soccer and football, padded goal posts should be on every field as both of these sports are highly physical games and children are at risk of injuries.

Although I no longer have young children playing sports, I do have grandchildren who play baseball and soccer. I see my seven year old grandson heading the ball, which is encouraged in soccer even with the very young, and wonder what that is doing to his brain. My son feels that the ball is not being kicked with any great force at that age so it's unlikely to do any damage.

I believe very strongly that attitudes have to change and people have to be educated. We have to protect our young people. They have no one else to do it for them but us.

The Good, Better, Best of Brain Health

Brain health is very important as a safeguard against dementia and Alzheimer's; as protection against memory loss and, as help against aging of the brain. There are many things we can do to help ourselves. The following are some of them.

Eating the colours of the rainbow gives our diets a boost, i.e.: choosing colourful fruits and vegetables such as carrots, yams, beets, tomatoes, blueberries, blackberries, mangos, papaya, purple grapes, corn, dried cranberries, oranges, melon, peaches, black beans, red onions and the red, orange and yellow peppers and, green vegetables such as broccoli, peas, spinach, kale, green peppers and lettuce. It is thought by some that having sufficient of the B vitamins in our system will also help ward off Parkinson's disease. These are all good for the brain.

Avoiding excessive use of alcohol, cigarettes, caffeine and refined white sugar is even better when added with eating colourful fruits and vegetables. Add to that by cutting down on meat consumption and eating more wild fish. It is also important to ensure that there is sufficient fiber in our diets and enough protein. Also avoid processed foods and increase your intake of omega 3 fatty acids in your diet by including olive oil, nuts, flax and other seeds. It is also important to drink a lot of water. And when adding these things to the rainbow of fruits and vegetables, your brain will be even better.

And best of all, besides doing the above, is to reduce stress. It is also important to sleep between seven and eight hours each night, sweat to rid your body of toxins and get a lot of exercise. Also engage in intellectual pursuits by doing daily brain games to keep your brain active.

Doing brain games will help with your memory, mind flexibility, problem solving, speed of thinking, visual recall (faces and names), spatial reasoning, problem solving, information processing, verbal fluency, concentration and being able to stay focused. To do this, there are math games, puzzle games and word and memory games. Besides doing them, it is important to increase the speed at which you do them.

Because physical exercise is a crucial factor in the good, better and best of brain health, it is important to remember that it is not for losing weight or to compete as an athlete does but to maintain a healthy brain. It is thought that even one half hour a day will help not only your brain but also with detoxification, skeletal mobility and muscle tone. The purpose of exercise is to encourage brain health and to feel revitalized and energized by doing it.

Also, excessive stress has been discovered to cause shrinkage to some areas of the brain which could have an affect on specific areas of our lives. One of these is our ability to cope over time. Stress can, however be relieved through exercise and meditation.

Sleep deprivation can have an effect on the brain also causing some parts to slow or shut down completely. And in some cases, the person may even appear to be drunk. Often those lacking sleep will have more difficulty with their memory.

There is not one thing that is more important than the other, but in combination it will help your brain to be the best it can be.

Lives Altered as a Result of Short Term Memory Loss

Our memories affect everything in our lives. If we have short term memory loss, we can't remember what has been said to us each day or what we have done on any given day.

It means we may not be able to remember a special conversation with a loved one, the special things that our children or grandchildren have done, or a romantic dinner. There will be no continuity in our lives if we can't remember from one day to the next.

Short term memory loss is often the result of either a traumatic brain injury or an acquired one. There are things that can assist with memory loss, i.e.: having a calendar to keep track of dental and doctor appointments and any other place it is necessary to be. We can keep 'to do' lists, grocery lists, lists of names and phone numbers and lists of birthdays.

But what can be done to help us remember those special moments that slip away all too quickly? One idea might be a daily diary or journal. This can be referred to periodically so as to be able to enjoy those special moments again and also to help jog the memory into remembering them.

We can also avoid the use of alcohol and drugs which are likely to further debilitate the memory. If someone is in an alcoholic or drug induced fog, it will make remembering even that much more difficult.

Also focusing on what is being said by really listening, repeating what has been said and, in the case of those special times as well as the children or grandchildren's special funny ways, these can be gone over in your mind after the fact. Also, things can be remembered more easily if they are attached to something known that is in the long term memory, i.e.: a memorable association with something that happened before the injury. Writing things down or repetition always makes them easier to remember. Find applicable words to trigger memories. Reading or saying aloud things that you wish to remember helps also. Increased exercise improves the blood circulation which assists memory too. And avoid districtions.

There are also exercises that can be done to strengthen the memory in order to improve the problem of short term memory loss. Some of these are:

- Read a grocery list (or any list) and then try to remember what was on the list. Repeat the exercise until you can remember everything on the list. Then practice with a new list.

- Look at a picture in a book or a magazine for a few minutes then put it aside. Write down as many things about the picture as can be remembered. Repeat with another picture until your memory improves. Also decrease the amount of time you give yourself to retrieve the information from your memory.

Remembering special times, and day-to-day events, is worth the effort it takes to exercise our memories.

Brain Injuries and Cognitive Disabilities in the Classroom

Cognitive disabilities can be the result of learning disabilities from birth or from a brain injury. Regardless of the reason for it, those children who have these disabilities can have difficulties in the classroom.

Disabilities can include sensory impairments such as visual or hearing; physical or motor difficulties or, cognitive disabilities with mental tasks and processing. This can include difficulty with reading or comprehension because of problem-solving difficulties, and memory or attention/focusing. Problems such as these can be the result of a traumatic brain injury, autism, dyslexia, ADHD or a health or emotional problem.

For those children that have a brain injury or a learning disability, the classroom can be a scary place to be. Classrooms are often overcrowded and may appear chaotic to a child with a disability.

The prevalent philosophy is for all children to be treated equally so they feel that they fit in. But this is obviously not working. Many of these children need to be treated differently in order to learn because many of them have different learning requirements than those in the general education classroom. These problems often require an appropriate learning format for their type of disability.

Some children have difficulty with time constraints and work more efficiently at their own speed. This is very difficult in a general classroom situation where everyone is supposed to be working together and keeping up. These children are likely to be left in the dust and the spotlight will be on them. This will make them feel even more different than if the teaching had been geared to their own learning requirements right from the beginning.

It is difficult for a student to receive this type of support for their cognitive disabilities within the school system because of the lack of funding. It is very difficult, if not nearly impossible, for one teacher to handle a mixed bag of disabilities with the necessary strategies required to suit each disability. In order for there to be success, it is necessary for there to be some assistance within the classroom but this is often not the case. Funding in many schools has been lost and there are few teachers aides available in many schools.

There have been some suggestions made such as the restructuring of how classrooms operate. Another idea has been differentiated instruction (tailoring instruction to meet individual needs) done with a flexible and individual approach; using peer tutoring and, grouping students who struggle.

There is no easy solution but it is clear that the present classroom situation does not work for all children. Although there are approaches that can help, it boils down to the need for further funding for schools, with more teachers aides, so that all children can receive the education they require.

Brain Injuries and Personality Changes

Personality changes often show as an extreme exaggeration of a brain injury survivor's pre-injury personality. Or it can result in them appearing to be totally opposite from the person they used to be. The reasons for this can be varied.

Memory impairment can have a large bearing on these changes. Short term memory is almost always affected but some long term memories can also be lost. Those with brain injuries may become angry or aggressive, possibly saying hurtful things that later they will have forgotten all about. As a result apologies may never happen. Conflict resolution will be difficult, if not impossible, when someone has short term memory losses and denies that they have been aggressive or said angry or mean things. Memory impairment is one of the big issues in personality changes because it affects almost everything we do and think.

Another change may be impaired impulse control, lack of judgment or an inability to self-monitor their behaviour. And from this may come denial that they have behaved inappropriately. Some may even deny that they have had a brain injury and instead will insist that the problem is the other person's, refusing to take any responsibility for their own actions.

Other changes in a brain injury survivor may be the inability to problem solve, withdrawal, lack of interest in anything they previously enjoyed, and lack of motivation. This will often result in feelings of isolation for them as fewer and fewer friends keep in touch.

Because of the changes that many suffering from a brain injury have, and ones they they don't understand because they still feel they are the same person, depression often follows. Depression exaggerates the feelings of isolation and can cause all the other changes to increase also, i.e.: anger and aggression may be more of an issue making conflict resolution even more difficult. It will be important for their caregiver to be aware of this and seek medical help for them.

Often those who have had brain injuries have substance abuse issues as well. Because they lack motivation, their interests may be few or non-existent and because their friends may have moved on, they possibly will begin to rely on alcohol or other forms of substance abuse to alleviate their boredom. They may try to hide this from their caregivers and may even lie about their use of it.

All of these changes will be difficult for their caregiver/family member. They are no longer the same person they once were. It will be important for their caregiver to encourage them to be more motivated, perhaps join a group, get new interests and get professional intervention when needed. However, in many cases those with the injury will resist any effort to change and will remain steadfast in their determination to do things their way, or do nothing at all. They will become entrenched in what they wish to do.

If a brain injury survivor remains stubborn and refuses to accept help from professionals or otherwise, the caregiver/family member may find it necessary, and important, to join a support group of their own in order to help themselves through this difficult situation.