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~ THERAPY BLOG ~

  • What Brain Injury Survivors Want You to Know

    From brainline.org

    A brain injury affects not only the person injured, but also those around them, and it can be confusing for everyone. Here is what someone with a brain injury might want their friends, family and others to know.

    Lost & Found: What Brain Injury Survivors Want You to Know
    Barbara J. Webster, Lash & Associates

    I need a lot more rest than I used to. I’m not being lazy. I get physical fatigue as well as a “brain fatigue.” It is very difficult and tiring for my brain to think, process, and organize. Fatigue makes it even harder to think.
    My stamina fluctuates, even though I may look good or “all better” on the outside. Cognition is a fragile function for a brain injury survivor. Some days are better than others. Pushing too hard usually leads to setbacks, sometimes to illness.

    Brain injury rehabilitation takes a very long time; it is usually measured in years. It continues long after formal rehabilitation has ended. Please resist expecting me to be who I was, even though I look better.
    I am not being difficult if I resist social situations. Crowds, confusion, and loud sounds quickly overload my brain, it doesn’t filter sounds as well as it used to. Limiting my exposure is a coping strategy, not a behavioral problem.

    If there is more than one person talking, I may seem uninterested in the conversation. That is because I have trouble following all the different “lines” of discussion. It is exhausting to keep trying to piece it all together. I’m not dumb or rude; my brain is getting overloaded!

    If we are talking and I tell you that I need to stop, I need to stop NOW! And it is not because I’m avoiding the subject, it’s just that I need time to process our discussion and “take a break” from all the thinking. Later I will be able to rejoin the conversation and really be present for the subject and for you.

    Try to notice the circumstances if a behavior problem arises. “Behavior problems” are often an indication of my inability to cope with a specific situation and not a mental health issue. I may be frustrated, in pain, overtired or there may be too much confusion or noise for my brain to filter.

    Patience is the best gift you can give me. It allows me to work deliberately and at my own pace, allowing me to rebuild pathways in my brain. Rushing and multi-tasking inhibit cognition.

    Please listen to me with patience. Try not to interrupt. Allow me to find my words and follow my thoughts. It will help me rebuild my language skills.

    Please have patience with my memory. Know that not remembering does not mean that I don’t care.

    Please don’t be condescending or talk to me like I am a child. I’m not stupid, my brain is injured and it doesn’t work as well as it used to. Try to think of me as if my brain were in a cast.

    If I seem “rigid,” needing to do tasks the same way all the time; it is because I am retraining my brain. It’s like learning main roads before you can learn the shortcuts. Repeating tasks in the same sequence is a rehabilitation strategy.

    If I seem “stuck,” my brain may be stuck in the processing of information. Coaching me, suggesting other options or asking what you can do to help may help me figure it out. Taking over and doing it for me will not be constructive and it will make me feel inadequate. (It may also be an indication that I need to take a break.)

    You may not be able to help me do something if helping requires me to frequently interrupt what I am doing to give you directives. I work best on my own, one step at a time and at my own pace.

    If I repeat actions, like checking to see if the doors are locked or the stove is turned off, it may seem like I have OCD — obsessive-compulsive disorder — but I may not. It may be that I am having trouble registering what I am doing in my brain. Repetitions enhance memory. (It can also be a cue that I need to stop and rest.)

    If I seem sensitive, it could be emotional liability as a result of the injury or it may be a reflection of the extraordinary effort it takes to do things now. Tasks that used to feel “automatic” and take minimal effort, now take much longer, require the implementation of numerous strategies and are huge accomplishments for me.

    We need cheerleaders now, as we start over, just like children do when they are growing up. Please help me and encourage all efforts. Please don’t be negative or critical. I am doing the best I can.

    Don’t confuse Hope for Denial. We are learning more and more about the amazing brain and there are remarkable stories about healing in the news every day. No one can know for certain what our potential is. We need Hope to be able to employ the many, many coping mechanisms, accommodations and strategies needed to navigate our new lives. Everything single thing in our lives is extraordinarily difficult for us now. It would be easy to give up without Hope.

     

  • Learning how to learn in college, especially after a brain injury (click title to watch)

    In the September Issue of Brain Line, the above video was posted. 

    "If you look at what successful students do, they're very engaged with their material. They attend study groups. They go to the professor when they don't do well on a quiz. … A lot of kids have to learn how to learn in college," says researcher and speech pathologist Juliet Haarbauer-Krupa, Ph.D. She talks about how the most successful students with TBI in college are those who know themselves and who are willing to access the support services they need.

  • Basic information about neuroplasticity

    Neuroplasticity is explained in simple terms by Lumosity 

    Neuroplasticity: the incredible, flexible brain Your brain has the innate ability to physically change itself when faced with new, challenging experiences. This ability is called neuroplasticity.

    Your brain's billions of neurons —its cellular building blocks—interact with each other in complex ways. Signals travel from one neuron to another down intricate neural pathways whose structures determine your thoughts, impulses, emotions, insights, and more.

    As our brains age through childhood, these neural pathways change: less-used pathways are pruned away
    while pathways that you use regularly grow stronger. Each task relies on a different neural pathway.

    Neuroplasticity is your brain's ability to create neural pathways and reshape existing ones—even as an adult. Your brain makes these small changes naturally throughout your lifetime. But when neuroplasticity's potential is thoughtfully and methodically explored, this physical reorganization can make your brain faster and more efficient at performing all manner of tasks—no matter how large or small they may be.

    Novelty forces your brain to change Novel challenges present unexpected obstacles, forcing your brain to work in new ways. When your brain encounters these new challenges, it must remodel its existing circuitry and find new pathways for information processing.

    That's because the brain assigns special neural pathways for each type of task. Just as you use different muscle
    groups for running and swimming, so you use different neural circuitry for reading and watching a movie. Familiar tasks simply reactivate existing circuitry—which can keep your brain active, but won't change or improve it in fundamental ways.

    Adaptivity keeps your brain challenged You have a unique set of cognitive strengths and weaknesses. A task that's easy for someone else may be a challenge to you, and vice versa.

    In order to improve, you need tasks appropriate for your brain's ever-changing ability levels. As your brain becomes stronger, it's able to handle tougher challenges. This response to challenges is a key part of neural growth, and you need challenges that adapt quickly enough to push you.
    That's where online cognitive training is truly breaking ground. Cutting-edge technology makes it possible for online games to adapt to your brain on a moment-by-moment basis.

    Keep things new and challenging to build new pathways at any age with any history or diagnosis!

  • Blood Test for Concussions

    Blood Test for Concussion?

    S100B is a serum protein that is thought to aid in the functioning of neurons early in life, and it is present only in the brain. In studies over the past several years, the S100B protein has been found to be transiently increased in the bloodstream after mild TBI (Dash et al, 2010), suggesting that the blood brain barrier can be compromised in traumatic brain injury, including concussion.  It has been evaluated in six clinical trials with over 2000 participants and demonstrated 98% sensitivity in diagnosis of mild TBI. 

    The blood–brain barrier (BBB) is a separation of circulating blood from cerebral spinal fluid in the central nervous system (CNS).  It is semi-permeable, allowing some materials to cross, but preventing others from crossing.  The blood–brain barrier protects the brain from many common bacterial infections, antibodies, poisons and certain drugs.

    When the S100B protein becomes present in the bloodstream, the body may react to it as a foreign invader and release auto-antibodies to attack it. The antibodies can then leak into the brain through the weakened blood-brain barrier where they are thought to attack brain tissue. In one recent study, four out of 27 football players who had pre- and in-season blood tests showed signs of an autoimmune response to elevated S100B levels.

    In the future, testing for the presence of the S100B protein following suspected concussion may be one way to rapidly confirm injury. In 2010, the U.S. Army announced that 34 patients had been accurately diagnosed with traumatic brain injury via a blood test for other proteins (SBDP145 and SBDP120) that seep through the blood-brain barrier after damage. The Army data focused on mild to severe injury, so ongoing S100B studies might help create blood testing technology to detect mild brain trauma quickly and perhaps for as little as $40. S100B blood tests are already used outside of sports, and as a standard procedure in a few emergency rooms in Germany for diagnosing brain trauma.

  • New Concussion Guidelines

    New Concussion Guidelines Released
    The American Academy of Neurology released a report on Monday, March 19, 2013 stating that it had revised its guidelines for handling concussions to emphasize treating athletes case by case rather than according to a predetermined scale.
    “We’ve moved away from the concussion grading systems we first established in 1997 and are now recommending that concussion and return to play be assessed in each athlete individually,” said Christopher C. Giza, a doctor at the David Geffen School of Medicine and Mattel Children’s Hospital at U.C.L.A. and one of the lead authors of the new guidelines. “There is no set timeline for safe return to play.”
    Concussions, Giza and other authors of the report said, are clinical diagnoses. “Symptom checklists, the Standardized Assessment of Concussion (SAC), neuropsychological testing (paper-and-pencil and computerized) and the Balance Error Scoring System may be helpful tools in diagnosing and managing concussions but should not be used alone for making a diagnosis.”
    They also reported that there are more than a million sports-related concussions annually in the US, and that the risk of concussion was greatest in football and rugby, followed by hockey and soccer. For young women and girls, the risk was greatest in soccer and basketball.
    Signs and symptoms of a concussion are complex and variable, and any athlete suspected of having a concussion should be thoroughly evaluated by a qualified medical professional. The AAN guidelines recommend that athletes suspected of having a concussion should be immediately removed from play.
    “If in doubt, sit it out,” said Dr. Jeffrey S. Kutcher, a physician at the University of Michigan Medical School in Ann Arbor and a member of the academy. “You only get one brain; treat it well.”

  • Video illustrating and explaining physiology of Mild Traumatic Brain Injuries

    Brainline.org is was a fantastic website with information for people with TBI, family members and professionals. In the 14 min. video sited below, the physiology and anatomy of what happens to the brain during a mild traumatic brain injury is beautifully illustrated and explained.

    Video Illustration of Physiology of MTBI
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