May 16, 2012

Youngsville, NC: Lash and Associates Publishing/Training addresses the impact of a parent’s wartime injury upon children in the family with Shannon Maxwell’s book Our Daddy is Invincible.   With so many service members and veterans returning from Iraq and Afghanistan with traumatic brain injuries and other wounds, this book is greatly needed and very timely. Any life threatening injury to a parent is emotionally traumatic for a family, but for the sons and daughters with a mother or father deployed to a war zone there are special fears. The news that mom or dad has had a traumatic brain injury, spinal cord injury, amputations, or burns can lead to long absences from home for medical care and rehabilitation. When the parent does come home, children often don’t know what to expect and are unprepared for the physical, cognitive, emotional, and behavioral changes they see. 

Shannon Maxwell and illustrator Liza Biggers address children’s fears and worries in this beautifully illustrated book suitable for children in preschool and elementary school. Even older children in middle school will find the section with personal vignettes of personal stories helpful. This book is an important tool to help parents talk with their children about the effect of a parent’s injuries and wounds on their lives and relationships. It helps children understand their emotions, confusion and reactions but most of all, it gives them hope as they learn to live with a parent who is a wounded warrior but who has survived and come home.

For more information, contact Lash and Associates at 919-556-0300 or visit www.lapublishing.com

By Marilyn Lash, M.S.W.

PTSD and TBI wounds wives

“We were high school sweethearts and engaged. When he found out he was going to be deployed, we had a courthouse wedding. Two days later he left for 15 months in Iraq.”

“Every time he came back from a deployment, a piece of him was missing. He’s just not the same person now.”

“My children don’t understand why he yells at them. They think he doesn’t love them anymore.”

“He never hit me before he was injured. But now there are times when I do not feel safe in our home.”

“He still sleeps with a gun in our bed.”

“He never touches me anymore. The loss of intimacy makes me feel rejected and unloved.”

These are the voices of the wives of wounded warriors. After managing the household and family during long and often multiple deployments, they are now caregivers for husbands who are living with traumatic brain injuries and post-traumatic stress disorders. Many of them are young – just in their 20s – and newly married. Many are mothers with young children; others wonder if they will ever have children now. Some hold full time jobs and find some sense of normalcy and escape in the workplace. Others are full-time caregivers for their husbands 24/7 and rarely leave home.

Military and civilians worlds – distinct but coexisting

The military culture and life is different than that of civilians. The women with husbands in the service as a career have moved many times from base to base. Their children have changed schools over and over. They have packed up, left friends, moved across country or overseas, changed jobs, and rebuilt their lives more times than many of us can imagine. This resilience is now being tested even more as their husbands return home with disabling injuries. Even now the transition from the military community to the civilian world is a lengthy and confusing process. Many of their husbands are being treated in warrior transition units and still in the lengthy process of disability determination and review by medical boards. This can take years. Meanwhile, their lives are on hold.

For others whose husbands are in the National Guard or Reserves, they bridge both military and civilian worlds and don’t quite fit into either. Many lost their jobs when they were deployed and now face uncertain futures as they try to pay the mortgage or rent. They travel back and forth for medical treatment and rehabilitation while they try to put their lives and families back together.

The emotional trauma of caregiving

Each day the wives of wounded warriors try to understand what has happened to their husbands and to their marriage and to their family. As caregivers, they are under enormous physical, emotional and financial stress. Many are experiencing compassion fatigue which is also called secondary traumatic stress. Depression, emotional swings, anxiety, sleep disorders – many wives are having these symptoms as the cumulative stress of caregiving builds over time.

Traumatic brain injury and post-traumatic stress disorder or PTSD as it’s commonly called can take a heavy toll on the individual and on relationships. Each disorder is complex but when both conditions coexist, the effects compound each other. The changes in behaviors, emotions, and cognition can be frustrating, challenging, frightening and overwhelming for spouses. Simply put, it is not only the warrior who has been injured. The home is also wounded.

Recommended Reading

Healing Together

By Suzanne Phillips, Psy.D and Dianne Kane, D.S.W.

May 7, 2012

Youngsville, NC: Lash & Associates Publishing/Training Inc. introduces a new tip card on concussion: Concussion Education in the Student-Athlete’s Neighborhood.  This tip card helps:

• physicians examine and treat athletes
• parents understand changes at home
• friends be aware of concussion symptoms
• educators make classroom adjustments
• school nurses oversee school programs
• coaches recognize and refer, and
• athletic trainers assess and monitor the student-athlete. 

A concussion is a head injury, although the more accurate description is a brain injury, since the brain has been traumatized. A sports concussion certainly falls into this category. The most common signs and symptoms of a concussion include:

• persistent headache
• dizziness
• nausea
• vomiting
• confusion
• fatigue
• irritability
• depression 

Even though the athlete may look fine, one cannot assume that he is okay. Athletic trainer and author Phil Hossler says, “There is no such thing as a ‘minor’ concussion. Sometimes there is a brief loss of consciousness for seconds or minutes. However, there is no loss of consciousness in 90% of concussions. Younger people have more immature, still developing brains and therefore may have more serious and longer lasting concussions than adults.”

After a student-athlete has received a head injury or a blow to the body, no physical or emotional changes should be taken lightly. “When can I play again?” is the biggest question from the student-athlete’s point of view. This tip card gives safety guidelines for parents, coaches and trainers. The majority of state laws require a physician’s approval before any student-athlete returns to play following a concussion.

It is important that everyone in the student-athlete’s neighborhood – parents, physicians, educators, athletic trainers, coaches, school nurses and friends – all keep a watchful eye on the injured athlete. Each and every one plays an integral part in recognizing the student-athlete’s injury and helping in the recovery. The more that’s known about a concussion, the safer the athlete.

About the author

Phil Hossler, MS, ATC is the certified athletic trainer at East Brunswick High School in East Brunswick, New Jersey and has authored 3 texts for high school athletic trainers, parents and athletes. His most recent publications on concussion and school sports are Getting A-Head of Concussion: Educating the student athlete’s neighborhood  and Concussion Policy: A construction guide for schools.  He has also developed a Player’s Contract with the Team Poster to encourage student athletes to promptly report concussion symptoms. Mr. Hossler has had 30 articles published in various professional, coaching and teaching magazines. He has written for, been featured in or been interviewed for over 85 magazine, newspaper, radio and television outlets on topics related to high school athletic health.

Phil Hossler is a member of four halls of fame, including the New Jersey Athletic Trainers’ Society, New Jersey Interscholastic Coaches Association, New Jersey State Interscholastic Athletic Association and the National Athletic Trainers’ Association.

Recommended Reading

School Sports Concussions in Children and Teens

By Phil Hossler, A.T.C., Jeanne Dise-Lewis, Ph.D., Marilyn Lash, M.S.W., Roberta DePompei, Ph.D., Ron Savage, Ed.D.

Marilyn Lash, M.S.W.

 A Brain Injury Can Change How You Think

Many survivors have changes in cognition after a traumatic brain injury. These cognitive changes often mean that thinking is simply harder and takes longer. These are the changes that so often greatly concern survivors and families. They can affect everything from making a shopping list to returning to work. Some cognitive changes are so minor or subtle that only the survivor or close family members are aware of them. Other changes are obvious and significantly affect the survivor’s daily life, relationships, ability to work or go to school. Cognitive challenges are a major factor in determining whether a survivor can live independently, must rely on family for support, or needs a residential program for assistance and supervision. 

Memory

Physical healing is much more predictable – and faster – than cognitive recovery. Memory is an area that is often affected by a traumatic brain injury. The ability to remember can affect just about every aspect of a person’s life. Challenges with memory can be frustrating and confusing, not only for the person with the brain injury but for family members and caregivers as well. Difficulty recalling information, events, people, and details is more than just missing appointments or forgetting names. It can jeopardize a person’s safety and affect both personal and professional relationships. 

These are some common difficulties with memory after a brain injury:

• Difficulty remembering people, conversations, places, events, instructions, appointments, telephone numbers, and dates
• Inability to recall tasks from day to day
• Gaps in memory gaps for events and conversations
• Hard time remembering new information
• Tendency to lose or misplace personal items
• Trouble remembering when to take medications

Survivors, caregivers and family members have found that compensatory strategies can be especially helpful if they are used regularly. It also helps if everyone working with the survivor uses and reinforces the same compensatory strategies to avoid further confusion and conflicting instructions or cues. Here are some compensatory strategies that are useful when a person has difficulty with memory. 

Tips on compensatory strategies…

• Record names of visitors or callers in a journal.
• Use memory aids such as calendars, daily planners, and checklists.
• Write down information and make lists.
• Post visual reminders in key places such as mirrors, doorways, and entry or exit areas.
• Repeat new information.
• Have cues to help with memory recall.
• Structure a routine for daily, weekly, and monthly tasks and events.
• Use alarms on watches or timers to cue when to do a task.
• Use tape recorders.
• Keep personal and household items in the same place.
• Use medication organizers.

Recommended Reading

Cognition after Brain Injury in Adults and Veterans: Tips and information on thinking and learning

By Tami Guerrier, B.S., Flora Hammond, M.D., Marilyn Lash, M.S.W., McKay Moore Sohlberg, Ph.D., Barbara J. Webster  

Cognition: Compensatory Strategies after Brain Injury

By Flora Hammond, M.D., Tami Guerrier, B.S., Marilyn Lash, M.S.W.

Marilyn Lash, M.S.W. and Taryn Stejskal, Ph.D.

When someone in your family has a traumatic brain injury, feelings of stress and anxiety can be overwhelming at times. Initial worries usually focus on whether the person will survive the injury. Once the person’s medical condition has stabilized, the family’s concern then shifts to what kind of recovery can be expected. The uncertainty about the future can be very stressful for everyone. The brain is such a complex organ that recovery is hard to predict after it has been injured. This uncertainty is the basis for many fears, worries, and questions.

Know Your Signs of Stress and Anxiety

Stress feels like an overwhelming pressure that a person just doesn’t feel capable of facing or handling. Anxiety is a more severe form of stress that causes apprehension, avoidance, and fear.

Everyone experiences some stress and anxiety in their life at some time. But it is very common among families when a person has had a brain injury as this can be a life changing event for everyone.

So what can you do?

It helps to know the common signs and symptoms of stress and anxiety.  They are:

• Hard time making decisions, even small ones
• Short temper or fuse
• Less energy and motivation
• Difficulty relaxing
• Changes in appetite
• Racing thoughts
• Difficulty sleeping
• Higher body temperature or increased heart rate
• Physical complaints such as indigestion, shakiness, jaw and shoulder tension, headaches, fatigue, etc.
• Impatience and irritability
• Feeling of being alone, hopeless, and unproductive

Once you recognize the signs of stress, it’s important to manage it to prevent its negative impact on your life and health. Learning how to cope and manage stress and anxiety is a step in rebuilding your life after brain injury. Here are 6 techniques that can help.

1. Think positive about your physical health and try to do fun and stress reducing activities that you did before the brain injury occurred.
2. Deep breathing can help calm you when you begin to feel stressed or anxious.
3. Meditation helps you calm your mind and focus on productive thoughts.
4. Visualization helps you picture what you would like to happen.
5. Thought stopping helps you control your thought patterns.
6. Ending negative self talk helps you think more positively. 

There will be many challenges in your life, whether you are a survivor of a brain injury, a caregiver, or a spouse, parent, child, or sibling. Learning how to decrease, manage and control your stress and anxiety is an important step in regaining and rebuilding your lives and your future.

Recommended Reading

Stress and Anxiety after Brain Injury

By Taryn Stejskal, Ph.D.

Brain Injury Blog by Marilyn Lash

May 1, 2012

TBI and PTSD – Is there a difference?

We hear so often that, “TBI and PTSD are the signature wounds of the wars in Iraq and Afghanistan.” It’s on the news, in the papers, and featured in stories all over the media. We hear it so often, yet I still believe that the general public does not really know what it means. The wounded warriors and their families who are living with this dual diagnosis know all too well that simply getting through each day can be a constant struggle. The combination of traumatic brain injury and post-traumatic stress disorder results in a cascade of symptoms that affect not only the wounded warrior but everyone in the family as well. 

What’s TBI and what’s PTSD?

“How do you tell the difference?” That’s the question most often asked by the wives of wounded warriors whom I have met at retreats over the past 6 months. I wish there were a simple answer. Even the most skilled clinicians find it hard to answer this question. 

PTSD has some distinguishing symptoms – the flashbacks, nightmares, hypervigilance, and increased startled response are classic. What most service members, veterans, families and caregivers find most confusing and frustrating is the overlapping symptoms of PTSD and TBI. Take a look at the following list of shared symptoms: cognitive changes, depression, anxiety, insomnia, and fatigue. Cognitive changes can include a wide array ranging from difficulty with memory to slower processing, and lower attention.   

Dangers on the Road – and the Roadside

One scenario that the wives have shared repeatedly is riding in the car with their husband driving when he “lost it” or “had a meltdown” and they literally feared for their lives. Erratic driving has been increasingly reported among returning service members and veterans. Let’s take a look at how the combined effects of PTSD and TBI can lead to real dangers in the car. The wounded warrior may already be in a state of high alertness when driving as the roads in the war zones held constant dangers for roadside bombs and IEDs. Even when back home and driving in a familiar neighborhood, the sight of a blowing trash bag at the curb may heighten the warrior’s anxiety and even trigger flashbacks. If the warrior has not slept well the night before – common with both both TBI and PTSD – then he may already be on edge. Leaving the isolation and safety of the house may further increase the anxiety and sense of vulnerability for the wounded warrior. 

But some consequences of brain injury can also affect driving safety. The wounded warrior may have some changes in vision that affect the ability to see clearly, particularly areas that fall within peripheral (side view) vision. Or it may be that a hearing loss from a blast injury means that the wounded warrior driver does not hear an approaching car until it is right next to his vehicle. The persistent headaches, so common with mild brain injuries, can affect the driver’s concentration and alertness. Sensitivity to noise after a brain injury can make it hard for the driver to deal with honking horns or radios. The noise of children arguing or playing in the back seat may increase irritability and lead to distractions. The traffic helicopter overhead may be a trigger of combat memories or even flashbacks. Sensitivity to light may make it hard to adjust to sunlight or shadows on the road. The quick temper that often accompanies a brain injury may shorten the warrior’s fuse and contribute to road rage. The increased distractibility from a brain injury can lower alertness for other vehicles. It is no wonder that so many women report they were trapped in their car with their wounded warrior driving and literally feared for their lives. 

Living with both

This example illustrates that it’s not always a clear “either or” situation. Both PTSD and TBI are complex diagnoses with many overlapping effects. Being aware of their combined effects can help everyone living with the wounded warrior be alert to possible interactions. It’s not as simple as, “he’s a jerk” or “doesn’t care” or “won’t listen.” Discussing these combined effects with treating clinicians or counselors can help shed light on this. 

Recommended Reading 

Tool Kit for Veterans and Service Members on Blast Injury, Traumatic Brain Injury and PTSD

April 30, 2012

Youngsville, NC  - Lash and Associates Publishing/Training Inc., leading publisher on brain injury, has published a new tip card titled, Cognition – Compensatory Strategies after Brain Injury.  It is loaded with valuable information for survivors, veterans, families and caregivers. Changes in thinking and learning, often called cognition, are often a determining factor in whether a survivor of a brain injury can live independently, must rely on family for support, or needs a residential program.    

Many survivors have cognitive difficulties after a brain injury. Thinking takes longer and is much harder. Physical healing is more predictable than cognitive recovery and is usually quicker. Each person is different and each brain injury is different. However, many common changes in thinking after a brain injury include: 

• memory deficits
• difficulty concentrating and paying attention
• mental fatigue, and
• impaired judgment  

This new tip card addresses these challenges. It poses questions and then offers strategies to help survivors, physicians, therapists and caregivers work through these obstacles. All of this helpful information is in an easy-to-read, user-friendly format.   

 The process of cognitive recovery is very difficult to predict and depends on where the brain has been injured and the severity of the injury. Cognitive changes are frustrating, frightening, confusing and challenging to not only the survivors of a brain injury, but also to their families and caregivers. Support groups, neuropsychologists and physicians with experience in brain injury are all valuable resources for the survivors and their families.  

This tip card summarizes the difficulties of cognitive recovery. Everyone who lives with or cares for a survivor of a brain injury is an important observer in the recovery process with the experience to identify more strategies, make necessary changes and find out what works best for the survivor. This tip card helps caregivers, families and survivors understand the importance and uses of compensatory strategies.

Recommended Reading

Cognition Functional Rehabilitation Activity Manual

By Marilyn Lash, M.S.W. and Taryn Stejskal, Ph.D.

It’s a common belief that most marriages end in separation or divorce after a spouse has a traumatic brain injury. Certainly the physical, cognitive, social, behavioral and communicative changes caused by brain trauma can affect a couple’s relationship. These changes are just the primary losses. Additional changes, known as secondary losses, can range from loss of income, to loss of friends, jobs or careers. As roles and responsibilities formerly shared by a couple are reexamined and redistributed after a spouse is injured, the relationship between a husband and wife changes in many ways. 

There is very little scientific research on marital relationships so much is still unknown about the impact of a spouse’s brain injury on the marriage. Reasons for a marriage dissolving are always complex, but this may be even more so when one partner has a disability or impairment due to a brain injury.  So it is important to look at the findings from 3 research studies on this topic. 

• One study conducted by Thomsen in 1984 found a very high rate of 78% for marital breakdown. But it is important to note that this was a very select group of individuals who were studied. It examined only 9 couples who were 10-15 years post-injury. In addition, many of them had severe brain injuries and most were living in a residential assisted living program. So one must question how applicable these findings are today.
• The second study led by J.C. Arango-Lasprilla was more recent in 2008. It also was much larger, including 927 individuals who were injured. In contrast to the earlier study, the marital breakdown rate was only 15% within the first 2 years post-injury. This study offers much more hope for relationships to survive the stresses and challenges of daily living after a partner has been hurt. 
• The third study led by J. Kreutzer in 2007 not only found that 25% of relationships broke down but that this occurred an average of 4.1 years after a spouse’s injury. 

Research has found that several factors make a difference in whether couples stay together or separate after one of the partners has a brain injury. The highest rates of marital breakdown are found among younger couples and in shorter or more recent marriages. Another risk factor is domestic violence. Couples with a more severely injured member were also found to be at greater risk for separation or divorce. 

Much more research is needed to understand why some couples manage to stay together and others separate. But one thing is clear – research does not support the common belief that there is a much higher incidence of marital separation and divorce when one partner or spouse has a brain injury. 

Recommended Reading

Couples: Hope and Intimacy after Brain Injury

 By Taryn Stejskal, Ph.D.

Brain Injury Blog by Barbara Stahura

April 25, 2012

Journaling Is Like a Hot Bath (Excerpt)

“You can change the world with a hot bath, if you sink into it from a place of knowing that you are worth profound care, even when you’re dirty and rattled.”    ~ Anne Lamott

Isn’t this a beautiful quote? It warms my heart every time I read it. The phrase “profound care” invites me to sink into it, like that hot bath, and let the waters of deep, intense care embrace me. This sentiment applies to anyone, of course, but, to my mind, it applies especially to family caregivers. These heroic people certainly are “worth profound care,” even though they don’t often allow themselves to believe it—or experience it. And journaling is one way for caregivers to offer themselves this kind of profound care that can relieve stress, lower blood pressure, strengthen immune function, boost mood, lift spirits, improve sleep, offer comfort, build resilience, and so much more.

To read the rest of Barbara’s blog click here!

YOUR STORY MATTERS
Barbara Stahura, CJF 
• Certified Journal Facilitator

• http://www.barbarastahura.com

• Blog: Journal After Brain Injury • Co-author with Susan B. Schuster, M.A., CCC-SLP, of “After Brain Injury: Telling Your Story,” the first journaling workbook for people with brain injury.

http://www.lapublishing.com/tbi-survivor-journal

• Author of “What I Thought I Knew,” a memoir about how changing my mind changed my life.

By Barbara Webster

Memory is one of the biggest challenges facing many survivors after a traumatic brain injury. Memory impairments can be unsettling, frustrating and stressful. Trying to recall and perform routine functions can become formidable tasks. Changes in memory can affect everything from remembering to turn off the stove to paying your bills to keeping appointments. These challenges can be the difference in being able to live independently, succeed in school or do your job. 

By using compensatory strategies, the survivor, family and caregivers can address these challenges and be more productive. The following tips and strategies can be useful. 

Use checklists

By posting written checklists in key locations, such as by the door or phone, at your desk, and on the bathroom mirror or refrigerator, you will have visual reminders to jog your memory. You can also record verbal checklists to listen to on a tape recorder, on your computer or your smart phone so you can replay them whenever you need a reminder.

Checklists with personal care reminders for grooming and dressing can be really helpful for getting ready in the morning and getting out the door on time. These can be customized by how much detail you need. Examples are:

• Putting toiletries in plain sight
• Laying out clothing the night before

Daily life can be complicated for anyone, but it can be even more complex and stressful if you have a memory impairment after a brain injury. Some basic strategies for organizing your life are:

• Do your laundry the same day each week.
• Make a master list of monthly bills.
• Ask for and save appointment cards.
• Use different colored inks to note different types of appointments on your calendar.
• Consult a map or program your GPS before you get in the car and leave home.
• Get reverse directions as well.
• Park in the same area every time.
• Place all ingredients on the counter before you start cooking and put them away as you use them.
• Carry a timer when you have something in the oven. 

There are many aids and tool available to help individuals who have difficulty with memory. These include planners and organizers, calendars, computer programs, special applications and smart phones. Your preference may be influenced by what you feel comfortable using now and what type of reminders helped you before your injury. The key is to develop a system that works for you and your lifestyle.  

It is also important that the people who are close to you are familiar with the memory strategies and reminders that you use. This includes your family members, caregivers, close friends and any others who interact with you regularly. Consistency is important so you want to be sure that everyone uses the same strategies. 

Conclusion

Your memory may improve as your brain heals and your recovery progresses. However, many persons with moderate and severe brain injuries continue to have some challenges with memory over many years and even over their lifetime. Some final suggestions are:

• develop routines
• make lists and check them daily
• work deliberately, one step at a time
• don’t try to do everything at once
• be patient with yourself.

Recommended Reading

Memory Strategies Brain Injury

By Barbara Webster