During that first year after a family member has sustained a brain injury, it can be an extremely stressful and lonely time. But we are not alone; the incidence of brain injury is higher than one would expect.
After my partner’s serious motorcycle accident, I realized how difficult it was to get information on brain injuries or on how family members can help their brain-injured loved one. Following a brain injury it is necessary for those close to the injured person to know what to do when dealing with the monumental changes in both of their lives.
Often during the first few months when talking to medical staff, I felt it was difficult to get answers; partly because at the beginning very little was known about the severity of his injury or what the results of the injury would be. I also suspected that some of the information I was given may have been designed to not build up any hopes on my part. Further, I became aware that the more questions I asked, the more variety of answers I received with each person appearing to have a different opinion on both his injury as well as his prognosis. This may possibly have been because no two head injuries are the same.
The hospital library, I discovered, was a good place to start to initially look for information; the librarian I approached gave me some very good websites to check out. There are also many other sources available on internet. Brain Injury Associations are also excellent avenues for obtaining information, as well as brain injury support groups. And don’t forget the social worker at the hospital – she will have a lot of useful information for after the injured person returns home. But you must ask the questions because no one will come to you with answers to questions you have not voiced. It is absolutely necessary to be proactive in your loved one’s health care. This includes making sure that your injured family member will receive cognitive exercises as soon after their injury as possible even if it means doing them yourself.
At the beginning there may seem to be little progress; with a brain injury it is often two steps forward and one step back. The steps are small and sometimes may only be noticed after a big change has taken place. I was told that the majority of change takes place in the first year with possibly some improvement up to two years post-injury but in my partner’s case, there was some progress even after the two year time period.
During the first year the survivor will often experience confusion, short-term memory difficulties, anger, sometimes violence and possibly depression. I discovered that the extreme confusion lessened after about two months but after three years, my partner’s short-term memory problems have not improved. Often medication can assist with some of the other issues. There will sometimes be other deficits as well that will need to be dealt with such as lack of motivation problems, reasoning abilities, rigidity of thinking and anger.
It is very important also, when you are the caregiver, to remember that although what has happened is a tragedy for the injured person, it is a tragedy for his loved ones too. You must remember that you are important also and as such, you must set boundaries. Do not allow yourself to be verbally or physically abused. It is important that we take time for ourselves and not feel guilty about it.
Joining a brain injury support group, if there is not a strong network of supportive family and friends, will be helpful to the caregiver during the first year following their injured loved one’s accident. And remember, eventually that first difficult year will become history.
Tuesday, September 29, 2009
Sunday, August 30, 2009
Barriers to Returning to Work Following A Brain Injury
The severity of the injury – whether it is mild, moderate or severe - will have a large bearing on when and if someone is able to return to work following a traumatic brain injury. But that is only one of the many things that will determine a survivor’s ability to return to the work force. There will be many things also that will determine their ability to hold a job if they do manage to secure one.
Those with fewer memory problems or personality changes are better able to successfully obtain employment. The amount of cognitive deficits they are left with and whether they have adapted to them will play a large part in their re-entry into the job market.
Other things that will be a consideration are their attention skills; ability to respond to the needs of their work environment; ability to focus; memory; reasoning; problem-solving; anger management difficulties; inability to take initiative; problems in sustaining their behaviour, and poor inter-personal relationships.
Age also can be a barrier to successfully returning to work. Employers often prefer hiring a younger person rather than someone who is possibly considered past their ‘prime’ especially one who has a disability.
Also many times employers are nervous about hiring someone who has sustained a traumatic brain injury. Most people do not understand brain injuries and the worry is they don’t know what they’re getting and don’t wish to take a ‘chance’ on potential problems.
Some survivors don’t have the self-esteem, or they lack the initiative to apply for positions of employment. The fall-out for a young person especially of not working further harms their feelings of self-esteem. This is particularly true if they have few leisure time interests, lack outside social contacts or are completely dependent on their family, spouse or caregiver.
Studies show that those who have a higher education or an advanced level of training, are more successful in their ability to find work – and to be able to keep it. This also includes those who have had access to rehabilitation and especially if it was available as soon after the injury as possible.
Unfortunately many brain injury survivors are unable to return to work for various reasons and are left floundering – jobless and with few financial, emotional and physical resources.
Those with fewer memory problems or personality changes are better able to successfully obtain employment. The amount of cognitive deficits they are left with and whether they have adapted to them will play a large part in their re-entry into the job market.
Other things that will be a consideration are their attention skills; ability to respond to the needs of their work environment; ability to focus; memory; reasoning; problem-solving; anger management difficulties; inability to take initiative; problems in sustaining their behaviour, and poor inter-personal relationships.
Age also can be a barrier to successfully returning to work. Employers often prefer hiring a younger person rather than someone who is possibly considered past their ‘prime’ especially one who has a disability.
Also many times employers are nervous about hiring someone who has sustained a traumatic brain injury. Most people do not understand brain injuries and the worry is they don’t know what they’re getting and don’t wish to take a ‘chance’ on potential problems.
Some survivors don’t have the self-esteem, or they lack the initiative to apply for positions of employment. The fall-out for a young person especially of not working further harms their feelings of self-esteem. This is particularly true if they have few leisure time interests, lack outside social contacts or are completely dependent on their family, spouse or caregiver.
Studies show that those who have a higher education or an advanced level of training, are more successful in their ability to find work – and to be able to keep it. This also includes those who have had access to rehabilitation and especially if it was available as soon after the injury as possible.
Unfortunately many brain injury survivors are unable to return to work for various reasons and are left floundering – jobless and with few financial, emotional and physical resources.
Friday, August 21, 2009
Brain Injuries and Apathy
Apathy is very common following a traumatic brain injury and may often occur in conjunction with depression, but not always. It may become apparent shortly after a brain injury or may not be evident until a few years later.
There are many indications of this deficit – a decrease in goal-oriented activities and no interest in making goals of any kind; no interest in working towards rehabilitation; no effort towards becoming independent; no effort made towards any work-related activities; no interest in achievements of any kind; an emotional indifference; little effort at communication; little concern for their own health; loss of interest in daily activities; reduced interaction in personal relationships; few emotional reactions to situations and circumstances; unable to initiate, take action or make any plans; no interest in the future; little appreciation or notice of recovery made to date, and withdrawal creating social isolation. Their feelings of self-worth may plummet and they could possibly experience a sense of hopelessness. When survivors of brain injury are living with this deficit, they are often considered to be ‘lazy’ or possibly ‘couch potatoes’.
Following a brain injury, 61.4% of adults will exhibit signs of apathy. They will feel they have lost their role in life. For most of us, our role is defined by relationships we have established with others. But often after an injury friends don’t come by as often and eventually may stop coming altogether and sometime family relationships will become strained as well. Survivors often no longer seem to be the same person they once were.
Although apathy can be associated with depression, the latter is more common – found in 83% of traumatic brain injury survivors. There can however, be other factors associated with apathy. i.e.: health issues such as hypothyroidism or other illnesses; personality changes; difficult factors existing in their life; poverty or even the beginnings of dementia. Apathy is associated with a faster cognitive decline. There are, however, medications available for the treatment of this deficit.
From a recent study it has been suggested that there is a correlation with coping strategies and adapting – an active way of adapting to problems and managing stress versus a passive (avoidance) method which results in doing nothing and which often leads to substance abuse.
If someone is currently taking an anti-depression medication and still appears to be suffering from ‘depression-like’ symptoms, they may instead be suffering from the deficit of apathy; particularly if they continue to show a general lack of interest in most things in their life. If this is the case, it is important for them to see a medical practitioner.
There are many indications of this deficit – a decrease in goal-oriented activities and no interest in making goals of any kind; no interest in working towards rehabilitation; no effort towards becoming independent; no effort made towards any work-related activities; no interest in achievements of any kind; an emotional indifference; little effort at communication; little concern for their own health; loss of interest in daily activities; reduced interaction in personal relationships; few emotional reactions to situations and circumstances; unable to initiate, take action or make any plans; no interest in the future; little appreciation or notice of recovery made to date, and withdrawal creating social isolation. Their feelings of self-worth may plummet and they could possibly experience a sense of hopelessness. When survivors of brain injury are living with this deficit, they are often considered to be ‘lazy’ or possibly ‘couch potatoes’.
Following a brain injury, 61.4% of adults will exhibit signs of apathy. They will feel they have lost their role in life. For most of us, our role is defined by relationships we have established with others. But often after an injury friends don’t come by as often and eventually may stop coming altogether and sometime family relationships will become strained as well. Survivors often no longer seem to be the same person they once were.
Although apathy can be associated with depression, the latter is more common – found in 83% of traumatic brain injury survivors. There can however, be other factors associated with apathy. i.e.: health issues such as hypothyroidism or other illnesses; personality changes; difficult factors existing in their life; poverty or even the beginnings of dementia. Apathy is associated with a faster cognitive decline. There are, however, medications available for the treatment of this deficit.
From a recent study it has been suggested that there is a correlation with coping strategies and adapting – an active way of adapting to problems and managing stress versus a passive (avoidance) method which results in doing nothing and which often leads to substance abuse.
If someone is currently taking an anti-depression medication and still appears to be suffering from ‘depression-like’ symptoms, they may instead be suffering from the deficit of apathy; particularly if they continue to show a general lack of interest in most things in their life. If this is the case, it is important for them to see a medical practitioner.
Friday, August 14, 2009
Brain Injuries and Dependencies
Following a traumatic brain injury, the survivor may be left with various dependencies. They may be emotional in nature or based on a substance abuse. Whatever dependency is involved, it can lead to difficulties in recovering from the injury.
Some of the emotional problems that can lead to dependency are a result of lack of initiative; lack of motivation; planning and problem solving difficulties and lack of self-esteem. All of these things can lead to feelings of powerlessness. And for this reason they will often become emotionally dependent upon someone close to them. There is another type of dependency called learned helplessness or learned dependency which will sometimes come about when someone helps beyond the point where help is actually needed.
With frontal lobe injuries there may also be a difference in emotional intelligence post-injury versus pre-injury. This is quite different from intellectual intelligence. Emotional intelligence relates to emotional self-awareness, the ability to recognize others’ emotions, taking responsibility for their own feelings, empathy, self-confidence, self-control, feelings of independence, and getting along with others. Difficulty in these areas can lead to dependency on others, particularly a caregiver.
Another dependency may be that of substance abuse. Sixty-seven percent of those with brain injuries have a history of substance abuse pre-injury and fifty percent of those will return to using alcohol following their injury. However, substance abuse can often be a result of boredom and loneliness also. With the use of alcohol and drugs after a brain injury, there is an increased risk of seizures as well as the risk of sustaining further brain injuries.
But there are many others who will fight for their independence. i.e.: they will drive before they have been given the ‘go ahead’ to drive; will refuse to go to therapy appointments; will feel increased anger if they are personally, socially or financially limited, as well as if they are deprived of privacy. Also those who need help physically may resent the help they receive if they think they should be able to do it themselves.
Regardless of whether they have become dependent or are fighting for their independence, it is important to remember that there are no two brain injuries that are the same and each person will react differently to their circumstances.
Some of the emotional problems that can lead to dependency are a result of lack of initiative; lack of motivation; planning and problem solving difficulties and lack of self-esteem. All of these things can lead to feelings of powerlessness. And for this reason they will often become emotionally dependent upon someone close to them. There is another type of dependency called learned helplessness or learned dependency which will sometimes come about when someone helps beyond the point where help is actually needed.
With frontal lobe injuries there may also be a difference in emotional intelligence post-injury versus pre-injury. This is quite different from intellectual intelligence. Emotional intelligence relates to emotional self-awareness, the ability to recognize others’ emotions, taking responsibility for their own feelings, empathy, self-confidence, self-control, feelings of independence, and getting along with others. Difficulty in these areas can lead to dependency on others, particularly a caregiver.
Another dependency may be that of substance abuse. Sixty-seven percent of those with brain injuries have a history of substance abuse pre-injury and fifty percent of those will return to using alcohol following their injury. However, substance abuse can often be a result of boredom and loneliness also. With the use of alcohol and drugs after a brain injury, there is an increased risk of seizures as well as the risk of sustaining further brain injuries.
But there are many others who will fight for their independence. i.e.: they will drive before they have been given the ‘go ahead’ to drive; will refuse to go to therapy appointments; will feel increased anger if they are personally, socially or financially limited, as well as if they are deprived of privacy. Also those who need help physically may resent the help they receive if they think they should be able to do it themselves.
Regardless of whether they have become dependent or are fighting for their independence, it is important to remember that there are no two brain injuries that are the same and each person will react differently to their circumstances.
Friday, August 7, 2009
Brain Injuries and Attitude
For most of us, attitude is one hundred percent within our control. It is our choice whether or not to be in a good or a bad mood. But for those who are survivors of a brain injury, the choice has become much more difficult.
The majority of people prefer to be with someone who has a good attitude rather than with someone who grumbles constantly about little things; who looks for problems instead of accepting the challenges; who becomes depressed easily, or who rarely smiles. Those with poor attitudes usually go through life reacting to situations and problems instead of taking control of their lives.
Unfortunately, for those with brain injuries, the effort required to have a good attitude is particularly challenging. Because they are often left with the deficit of lack of motivation and lack of initiative, mustering up the energy required to work at it may prove to be more difficult for them than for others.
For those wishing to have a better attitude in order to assist themselves with the difficulties of recovering from a brain injury, it will be necessary for them to remember that it is important to look for the good in every situation instead of only the negative; to be willing to face any challenge; to believe that with persistence and perseverance most problems can be overcome; to have an optimistic outlook; and to see humour in most situations. While striving towards having an optimistic outlook, and therefore a good attitude, they will be working towards making themselves happier and as a result will become more contented and positive.
Happiness and good attitude will not only be important for themselves but will be valued by those who surround them. With the time and effort of working towards having a good attitude, it will eventually become a choice to live happily and to enjoy the important things in life such as family, friends and health.
For brain injury survivors, those who are positive and optimistic are better able to motivate themselves to accept the challenges facing them. And those with good attitudes are generally positive people who make things happen instead of blaming others because nothing has happened. As with most things in life, nothing happens unless we make it happen.
The majority of people prefer to be with someone who has a good attitude rather than with someone who grumbles constantly about little things; who looks for problems instead of accepting the challenges; who becomes depressed easily, or who rarely smiles. Those with poor attitudes usually go through life reacting to situations and problems instead of taking control of their lives.
Unfortunately, for those with brain injuries, the effort required to have a good attitude is particularly challenging. Because they are often left with the deficit of lack of motivation and lack of initiative, mustering up the energy required to work at it may prove to be more difficult for them than for others.
For those wishing to have a better attitude in order to assist themselves with the difficulties of recovering from a brain injury, it will be necessary for them to remember that it is important to look for the good in every situation instead of only the negative; to be willing to face any challenge; to believe that with persistence and perseverance most problems can be overcome; to have an optimistic outlook; and to see humour in most situations. While striving towards having an optimistic outlook, and therefore a good attitude, they will be working towards making themselves happier and as a result will become more contented and positive.
Happiness and good attitude will not only be important for themselves but will be valued by those who surround them. With the time and effort of working towards having a good attitude, it will eventually become a choice to live happily and to enjoy the important things in life such as family, friends and health.
For brain injury survivors, those who are positive and optimistic are better able to motivate themselves to accept the challenges facing them. And those with good attitudes are generally positive people who make things happen instead of blaming others because nothing has happened. As with most things in life, nothing happens unless we make it happen.
Wednesday, August 5, 2009
Brain Injuries and Poor Judgment
Poor judgment is one of the results of inadequate cognitive functioning following an injury to the frontal lobe. This deficit can involve many aspects of a person's life, including the situations mentioned below:
- When handling a motor vehicle of any kind, someone exhibiting poor judgment may place themselves, and others, in a dangerous situation because of their cognitive deficits. Those with frontal lobe injuries may not drive defensively or anticipate the actions of other drivers. They may tailgate, and possibly not realize the importance of signaling in an appropriate time to be able to safely make turns, particularly when turning left. Other potential problems could be not coming to a complete stop at stop signs, weaving in and out of traffic or going faster than the posted speed limits. Some may drive aggressively and as a result become rude as well as a dangerous driver. They may also decide that it is not necessary to wear appropriate seat belts or helmets thereby placing themselves at risk.
- Poor judgment may also involve excessive use of alcohol or non-prescription drugs. While using these substances they may become impulsive, place themselves and others at risk, act before thinking, perceive and interpret their surroundings in a different way than reality indicates, and not understand the possible consequences of their actions.
- Other examples of this deficit may be indicated by improper behaviour which may include inappropriate touching or sexual innuendoes. Some survivors may have difficulty understanding cause and effect and may have problems with their reasoning abilities. And many will have problems learning from their past mistakes.
- Social situations may also be difficult for some brain injury survivors. Some may possibly behave in an inappropriate manner by being rude, disrespectful of another's personal space, make inappropriate comments, or dominate a conversation. They may also have poor social skills and problems with communication.
There are other ways where poor judgment may become a problem following a brain injury but the ones listed above are quite often the main concerns.
- When handling a motor vehicle of any kind, someone exhibiting poor judgment may place themselves, and others, in a dangerous situation because of their cognitive deficits. Those with frontal lobe injuries may not drive defensively or anticipate the actions of other drivers. They may tailgate, and possibly not realize the importance of signaling in an appropriate time to be able to safely make turns, particularly when turning left. Other potential problems could be not coming to a complete stop at stop signs, weaving in and out of traffic or going faster than the posted speed limits. Some may drive aggressively and as a result become rude as well as a dangerous driver. They may also decide that it is not necessary to wear appropriate seat belts or helmets thereby placing themselves at risk.
- Poor judgment may also involve excessive use of alcohol or non-prescription drugs. While using these substances they may become impulsive, place themselves and others at risk, act before thinking, perceive and interpret their surroundings in a different way than reality indicates, and not understand the possible consequences of their actions.
- Other examples of this deficit may be indicated by improper behaviour which may include inappropriate touching or sexual innuendoes. Some survivors may have difficulty understanding cause and effect and may have problems with their reasoning abilities. And many will have problems learning from their past mistakes.
- Social situations may also be difficult for some brain injury survivors. Some may possibly behave in an inappropriate manner by being rude, disrespectful of another's personal space, make inappropriate comments, or dominate a conversation. They may also have poor social skills and problems with communication.
There are other ways where poor judgment may become a problem following a brain injury but the ones listed above are quite often the main concerns.
Saturday, June 27, 2009
Caregiving Your Spouse Following A Brain Injury
It is a challenging and difficult task to be a caregiver for a spouse. The caregiver will often have to be in the role of being parent to their spouse. This is not a comfortable situation for either the brain injured survivor or for the ‘healthy’ partner but may very often be necessary – particularly if there is no one else to act in the ‘caregiver’ capacity.
With a brain injury and possibly physical injuries, the injured person may be a shell of who he/she once was. Because of this, caregivers often become ‘married widows’ because of the loss of the relationship they had prior to the injury. They may no longer have an equal partner. With the many changes in their spouse, social occasions with friends and family may also gradually become fewer and fewer. This places the ‘healthy’ partner in a ‘social limbo’ situation.
Caregivers very often receive little sympathy or support from family and friends because the injured person will often be on their best behaviour when they occasionally do see those outside of immediate family members. Survivors usually save their worst behaviour for their spouses.
And for this reason, occasionally parents or grown children, (particularly if they are not the caregiver’s children), of an adult survivor may attempt to intervene to the detriment of the attempts of the spousal caregiver to give support and stability. The intervention sometimes may not be in the form of help but rather of criticism or attempts to dissuade the brain-injured survivor to cooperate. i.e.: not attending support groups or therapy sessions, etc. if he/she doesn’t want to or the parents or children don’t think there is a need for them to go. This makes the role of a spousal caregiver even more difficult.
For the non-injured person, although the spouse they once knew may no longer exist, he/she is still alive. How do they mourn the loss of what is gone but is actually there? For many there will be a process of mourning for the relationship that once existed but few friends and family members will understand or have sympathy for those feelings of grief that will likely be experienced by the non-injured spouse.
It is important for caregivers to look after themselves so that they remain healthy and are able to make better decisions. It is also important that they stay connected with others – their friends and family, as well as possibly joining a support group. It will be equally important for them to occasionally get respite and take time for themselves, and if necessary, they must ask for help. No one knows if help is needed unless it is asked for.
Because of the difficulties of being a caregiver, many relationships dissolve following the injury. Those who make the decision to leave the relationship usually do so with feelings of guilt and certainly with feelings of failure. Friends and family will sometimes not understand this choice and may fault the caregiver for ‘giving up’ especially if it appears to others that things are going well.
For those who would criticize, it is best to remember that none of us know what goes on behind closed doors. For each of us, a decision such as this can only be made by those individuals involved.
With a brain injury and possibly physical injuries, the injured person may be a shell of who he/she once was. Because of this, caregivers often become ‘married widows’ because of the loss of the relationship they had prior to the injury. They may no longer have an equal partner. With the many changes in their spouse, social occasions with friends and family may also gradually become fewer and fewer. This places the ‘healthy’ partner in a ‘social limbo’ situation.
Caregivers very often receive little sympathy or support from family and friends because the injured person will often be on their best behaviour when they occasionally do see those outside of immediate family members. Survivors usually save their worst behaviour for their spouses.
And for this reason, occasionally parents or grown children, (particularly if they are not the caregiver’s children), of an adult survivor may attempt to intervene to the detriment of the attempts of the spousal caregiver to give support and stability. The intervention sometimes may not be in the form of help but rather of criticism or attempts to dissuade the brain-injured survivor to cooperate. i.e.: not attending support groups or therapy sessions, etc. if he/she doesn’t want to or the parents or children don’t think there is a need for them to go. This makes the role of a spousal caregiver even more difficult.
For the non-injured person, although the spouse they once knew may no longer exist, he/she is still alive. How do they mourn the loss of what is gone but is actually there? For many there will be a process of mourning for the relationship that once existed but few friends and family members will understand or have sympathy for those feelings of grief that will likely be experienced by the non-injured spouse.
It is important for caregivers to look after themselves so that they remain healthy and are able to make better decisions. It is also important that they stay connected with others – their friends and family, as well as possibly joining a support group. It will be equally important for them to occasionally get respite and take time for themselves, and if necessary, they must ask for help. No one knows if help is needed unless it is asked for.
Because of the difficulties of being a caregiver, many relationships dissolve following the injury. Those who make the decision to leave the relationship usually do so with feelings of guilt and certainly with feelings of failure. Friends and family will sometimes not understand this choice and may fault the caregiver for ‘giving up’ especially if it appears to others that things are going well.
For those who would criticize, it is best to remember that none of us know what goes on behind closed doors. For each of us, a decision such as this can only be made by those individuals involved.
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