The Impact of Frontal Lobe Injuries

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

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

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

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

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

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

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

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

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

Brain Injury Awareness

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Beware of Concussions - They Are Brain Injuries

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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