My Child had a Brain Injury

My Son’s Recovery after TBI Started with Tic Tac Toe

By Lainie Cohen

A car crash left my son with a traumatic brain injury

When my seventeen-year-old son, Daniel, sustained a severe brain injury in a car crash, we didn’t know that Tic Tac Toe would be an important element to his recovery.

After Daniel emerged from his five week coma, his recovery was slow paced. The physicians weren’t optimistic about his prognosis. They told us that in addition to his right-sided hemiparesis (weakness on the right side of his body), they were concerned about his language skills. They predicted significant impairment in Daniel’s receptive language skills (his ability to understand what was said to him) and his expressive language skills (his ability to express himself either verbally or in writing).

Friends visit and play games after his coma to help his recovery

 At the time, Daniel’s friends were regular visitors. They brought in music tapes, hung posters to decorate his hospital room, and told him stories of events from school, hockey and summer camp. And they started playing games with him. The first was Tic Tac Toe. Using a white board that can be written on with markers and wiped clean, they drew a grid and filled in the first X. Then they handed Daniel the marker. He drew a wobbly O in a square beside the X. That game was the first of many.

We’d discuss the placement of each symbol, although we weren’t sure if Daniel could understand. “The X is in the middle. You drew the O in the bottom left corner. Now here’s another X. Uh, oh! Better watch out,” we’d cue him. The first time he deliberately blocked two Xs was very exciting. Soon, Daniel insisted on going first, and then he started winning.

Games and activities are cognitive rehabilitation

Game playing places demands on cognitive, physical and sensory skills. Deficits from an acquired brain injury can limit success. However, games can serve as a wonderful medium for rehabilitation because the “fun factor” promotes repetition. Consider the basic skill sets needed for games: attention and concentration, turn taking and following rules. Even simple card games like War or board games like Snakes and Ladders tap into multiple skills: color differentiation, number recognition, identifying higher and lower numerals, and associating the spatial arrangement of dots on dice with a numeral.

The recreational therapist in the rehabilitation center showed us that teenagers could still have fun after brain injury. Daniel participated with others in cooperative activities like cooking, baking, artwork and music. We couldn’t believe our ears when we first heard him play a harmonica, long before he had the breath control to speak. Daniel was encouraged to try new activities, and as he improved, we watched him engage in wheelchair sports: basketball, hockey and balloon badminton. Not only was he increasing his skills, but also more importantly, he was socializing with his peers.

Make changes that are needed to accommodate a brain injury

Observing Daniel in this environment made us acutely aware how important it is to monitor for low frustration tolerance and fatigue, issues that can be challenging following a brain injury. Modifications were often needed to ensure his safety and enjoyment. When Daniel returned to high school, his Special Education teacher helped him organize a weekly Euchre club at lunchtime. Daniel started carrying around a deck of cards. Years later, on a flight home from a family ski holiday, I watched Daniel use his cards as an icebreaker as he invited his seatmate to join in a game.

Our society emphasizes competition. After a brain injury, it’s important to change the emphasis from winning to participating. Just play the game and have some fun. You’ll be surprised at the results.

Helpful hints for families and friends when visiting after brain injury

• Keep it short and sweet. Focus on having fun. Don’t worry about finishing the game.
• At first, play a familiar game. (You’re tapping into procedural memory.)
• Simplify the rules if needed to increase success. (e.g. for the card game Fish, make sets of two matching numbers instead of four; for board games use one die instead of two dice.)
• Use aids to modify demands, e.g. a plastic cardholder to display the hand of cards, cards with large print numerals.
• Avoid verbal challenges with games featuring a visual-spatial component: Checkers, Connect Four, Chess, and card games (War, Fish, Crazy Eights, Gin, Euchre).
• Choose activities that can be done cooperatively, such as puzzles.
• Some games can be played individually: Solitaire, Rush Hour and many computer and video games.
• Lainie Cohen speaks at ABI conferences and conducts workshops on family-centered care for rehab students and professionals. Visit her website: www.crookedsmile.org if you are interested in learning more.