Brain Injury Blog by Marilyn Lash

February 3, 2012

Driving poses new danger for veterans with PTSD/TBI

Something is happening on our roadways as many service members and veterans are returning from combat. We know that traumatic brain injury and post-traumatic stress disorder (commonly called PTSD) are the “signature wounds” of the conflicts in Iraq and Afghanistan. The New York Times just published a terrific article about the effects of PTSD  on many returning veterans’ driving. The routine sounds on the highway, a crowded parking lot, or an unmarked vehicle – these can all trigger flashbacks or reminders of roadside bombs, snipers, or ambushes for veterans of Iraq or Afghanistan. Speeding and road rage are common behaviors of veterans with PTSD who are thrill seeking to counteract the emotional numbness and social withdrawal so often seen with PTSD. Erratic driving among returning service members may be far more widespread than we realize. I recall one wife’s comment after her husband returned from service that her knuckles turned white every time she got in the got with him behind the wheel. 

Driving is risky business for everyone – with and without a brain injury

“Can I drive?” is one of the first questions asked by survivors after a brain injury. It’s the ticket to independence and autonomy that no adult wants to give up. Driving is something that most of us take for granted once we get our license. It’s a passage to adulthood and independence for most teenagers and young adults. We also know that it comes with risks for injuries or death from motor vehicle crashes which are a major cause of traumatic brain injuries. Driving requires skills and judgment that are developed with experience over time. We are all too familiar with the news stories of car crashes involving new drivers who are too often still in high school. When you combine speeding, alcohol, and recreational drugs with immaturity and inexperience, the results can be deadly. Many of us also know someone who is worried about an elderly parent’s driving and dread the discussion of when it is no longer safe for a parent to drive. 

A brain injury can affect the survivor’s ability to drive safely. This applies to young people as well as those of us considered to be “middle age” or even elderly. Not only are there physical skills required to drive, but it also requires visual, perceptual, and auditory skills for safely negotiating the roadway. More difficult to assess are the effects of brain trauma on the driver’s judgment, behavior, emotions, and impulses and distractions.

If you are in a situation where you are concerned about the driving of a family member, do something! Not taking action can be deadly. Many brain injury rehabilitation outpatient programs have therapists trained to assess driving safety. This can literally save a life.

Brain Injury Blog by Roger Daniel Rizzo

February 1, 2012

Overcoming All Challenges

My name is Roger Rizzo. I have three college degrees and traveled around the world twice. I was a civil trial attorney for 13 years and successfully tried some of the largest cases in the United States.

On June 30, 2011, I was involved in a horrendous motorcycle accident in Tiburon, overlooking the San Francisco Bay. I was the passenger on the motorcycle and not wearing a helmet.

The driver of the motorcycle veered off the road for no apparent reason. My body was catapulted off the vehicle and struck posts and boulders, and then was knocked back into the street. I slid face down for many yards.

I sustained severe, traumatic brain injury, broken bones, damage to several internal organs, and a myriad of other injuries. I was in a coma for six weeks and a human vegetable for five and one-half months.

Nevertheless, I survived and almost completely recovered. I recovered as a result of seemingly endless efforts and determination.

As a result of my almost fatal accident, I have authored a book entitled Overcoming All Challenges. My motivation in writing the book was to inspire others to overcome the serious challenges which they encounter, especially brain injury victims.

My book is available in two different versions. The first is the E-book version which costs only $1.95. The second is the soft cover book version which costs only $9.95. Overcoming All Challenges costs so little to make it available to as many people as possible.

Prospective purchasers of the book can click here to obtain directions on how to order either version of the book.

Brain Injury Blog by Marie G. Cooney

February 1, 2012

Work Comp Sucks

Work Comp Sucks! It sucks you dry. Work Comp sucks your energy, your finances, your physical and emotional wellbeing, your social life, your family life, and your friends. Work Comp depletes you of everything you knew or had before your injury. Work Comp sucks every ounce and every breath you think you have to fight a system that is suppose to help an injured worker, not suck you dry!

Work Comp sucks, but I will survive! I will survive the dumb hired-guns, so called Independent Medical Experts, who we all know are Adversarial Moronic Examiners. Hired hit-men were paid to see me, an injured person once, or twice, or maybe three times, over more years than one should ever have to waste, waiting for a fair and equitable hearing before a justice of the courts. The Work Comp mob tries to counter what my authentic, legitimate, medical providers know about me and about my injuries, after seeing me so many times over so many, many years.

I will survive video surveillances, which are nothing short of misguided attempts to disgrace me, degrade me, mislead others, and trespass against me, violate my rights to privacy, as well as the rights of those I love. I will not fall into misbegotten booby-traps set to blackmail and bankrupt me into pathetic settlements, out of financial desperation, before I can obtain a fair and lawful hearing.

After almost seven years post Traumatic Brain Injury, I will have my own day in court. I will not settle my case as one in a million cases, with any insurance company, out of convenience or desperation. I will survive all attempts to attack my personal dignity, my altered sense of self worth, and all that I am learning about who I am and who I am becoming.

The people employed by Work Comp insurance companies don’t really see an ounce of me, the person I was before my Traumatic Brain Injury, the parts of me that I struggle every day to reclaim, or the parts I grieve repeatedly, knowing I must let go of them, in order to become the person I am today. Unlike many within the Work Comp so called “insurance” industry, I welcome the unknown person I am becoming tomorrow, and the next day, and all days to follow. I really don’t have any assurance of their support of me, my hopes, and my dreams, or struggles with the life long affects of a permanent disability.

Work Comp Sucks! It sucks you dry! It is a cesspool, clogged by its own dung. Above Workers Comp, and beyond all who slug through its cesspool and try to drown me, I will rise!  For a Divine Sculptress has carved me out a beautiful mass of stone. Chip by chip, and piece by piece, and fallen stone after fallen stone, I have been scribed into someone new. I am among the risen ones. You may have stolen shards of my being. But for the sake of my own growth, other unfinished gems had to be released by me. The Divine has looked down upon me, and She smiles. For in the end, I have survived! I will not be defined nor defiled by your cesspool. Work Comp, you have no power over me. Not anymore! I see you. I raise you. I call your bluff! I warn you, “My Royal Flush beats your crap, any day.”

I am Confidence reclaimed.

Brain Injury Blog by Janelle Breese Biagioni

January 30, 2012

Keep the Peace

“First keep the peace within yourself, then you can also bring peace to others.”

~ Thomas Kempis, Catholic Monk (1380-1471)

We all understand what it means to keep the peace in our communities and in the world. It’s not only important, but it is also the law. However, keeping the peace within ourselves should be equally as important and be second nature to us.

I don’t know about you, but often the events in my life leave me feeling frantic and overwhelmed. Nonetheless, I am still able to kick into ‘high gear,’ pull it together and get things done.

People often ask me how I can stay so calm and push through things. My answer: “I’m a fake!” All kidding aside, like so many others, I have the ability to appear cool as a cucumber while my insides churn away. Although I get all I need done, I am left feeling exhausted, tense and agitated. On the other hand, when I take time for myself and stay mindful as I move through the task at hand, I feel calm and peaceful within… and everything still gets done. The difference is in how I feel after, which is amazing. I am relaxed, energized, and ready to take on the next event. 

There are a lot of options available to help us learn to be peaceful and to stay calm: meditation, exercise, mindfulness and/or spiritual practice and more. While these all work, each person must determine for his or herself which one works best for them. Moreover, one must be committed to implement strategies throughout the day as he or she goes  

Thank you for your input. I will think about it.

Can we chat for a while?

Are you asking for my opinion or thoughts on this?

Look for the humour in things

Life is fluid and nothing stays the same

Know your limits and honour them

Delegate and/or ask for help

Follow your instinct, listen to your heart and act out of kindness and love

What others say about you is none of your business

Retreat

Don’t read too much into things

By Bridgid M. Ruden, ARNP

My memory and speech changed after my brain injury

In May of 2008, I suffered traumatic brain injury following a bicycle accident. I needed four brain surgeries, three of which were life saving entities. The fourth brain surgery replaced my previously infected skull bone with a titanium plate. My brain has responded to this trauma by forcing epilepsy into my system. Such trauma has shocked my mind and body especially since this has changed me. Frequent denial of this experience is my way of coping. Denial clouds aspects of my acquired memory loss and therefore distorts my reality. 

Some of the most challenging aspects I continue to struggle with are aphasia and memory loss. Aphasia is the partial or total loss of the ability to communicate verbally or use written words. I required two years of speech therapy which has improved my aphasia greatly. I continue to experience aphasia in the following ways: 

• Difficulty speaking effectively and recognizing the name of basic objects, streets, animals, food, etc.
• Reading two pages slowly and losing my memory of what I just read.
• Writing accurate sentences, spelling correctly and appropriately and effectively using a computer.
• Noise greatly impacts my ability to focus, concentrate and remember the things I am attempting to complete.

In addition to aphasia, I maintain significant memory loss, which truly impacts my life experiences. Memory loss is a frequent lifelong result for traumatic brain injury survivors. Therefore, I do not feel insane for the occurrence of my situation. I am challenged to understand and remember what people say to me. The slower a person speaks to me significantly enhances my ability to understand. 

I usually forget the names of people and how I met them. In order for me to remember their name, I need to practice saying their name numerous times before it is obtained. In addition, I also have to see a person several times to understand where I met them or what they do. Sometimes I recognize the sound of their voice, potentially linking me to where I met them.  

Searching for all those lost things  

I frequently lose and forget where objects, such as a cell phone, were placed. Therefore, people have a challenging time reaching me. I have lost so many items and recently learned that I find them in the garbage can!  We have had to purchase so many cat litter scoopers! Can you guess where I found the last one? It was in the garbage! Therefore, I continue to check in the garbage for any lost items when it is not too disgusting! 

One of my most embarrassing moments occurred when I was doing laundry. I went to pull out the clothing from the washer and at the top of the clean laundry was a Playtex container that was scattered! All the tampons were still covered with plastic so naturally I tried to save them! When I got to the bottom of the clothes I found a full bag of brownie mix! At this point, I felt as if I had lost my mind, as I had no idea how or why this occurred!  

I have a tendency to forget to put the washed clothes into the dryer and place things in the dryer that I have been asked not to mechanically dry! I frequently forget to take my seizure medicine which is prescribed for the morning and evening. I do not realize that I have not taken it until later in the afternoon or early evening. A properly labeled daily medication container is used but I often forget what day it is to make sure that I took the medication! 

My memory affects my children too.  

Utter sadness is instilled at the loss of my ability to assist with homework, play certain games with my children and cook effectively. Homework was challenging even when they were in elementary school! This was embarrassing and demeaning since prior to this brain injury, I used to be a good speller and could effectively use a computer. When I play simple games with my children, I am slower than previously, forget how to play the games and usually do not win or excel in my understanding or knowledge of the game. In addition, I cannot remember what is supposed to happen tomorrow even when I heard about it the night before. I also have a tendency to burn myself when cooking and forget a recipe I knew before. I need to read a recipe several times, slowly, to comprehend it.  

Steps, seizures and driving bring more challenges

My memory loss and balance issues present themselves when I do not notice or recall uneven ground or steps. I have injured myself when I hiked on a wooded trail, walked on a sidewalk that was altered for the handicapped and when I departed from a podium. It is difficult for me to walk up and down stadium bleachers.  Once I was on a podium platform sharing my story and as I left, I thought that in front of the area was a typical step. But this area was a huge single step downward like the front area of a stage! I am frequently asked, “How did you get your bruises?” Bleeding and bruising can result from secondary side effects of my seizure medicine.

I am finally able to drive again as my seizures have not re-occurred for six months! Being able to drive gives me such joy, especially since I have three children. I often forget where I parked the car or placed the keys. To help me remember where I park when I go shopping, I tell myself over and over again where I parked and which car I drove. The electronic key that activates the horn has been very helpful to me in locating the car. My worse episode occurred as I drove the car into the garage, parked, shut the garage door and headed into the house. There was a strange noise and I didn’t know where it came from. I stepped into the garage and I gasped as the car was still running! 

Losing my sense of self worth and finding a new purpose in life

Sadness, despair and hardship surround my sense of self worth from the dynamics of my memory loss. I also lack the ability to assist with our financial issues which I easily understood previously. I no longer understand when payments are due, what we pay for and have trouble with adding and subtracting! One of the most debilitating consequences of my disabilities is that I no longer have the health care knowledge that I had previously as a Pediatric Nurse Practitioner. My health care knowledge has been significantly diminished! 

Despite the aspects of my disabilities, I have learned and achieved an experience that has returned JOY to my soul! I speak publicly to health care professionals, legislators, survivors and their advocates to share what I have experienced in the process of exploring, managing and recovering from traumatic brain injury. I have achieved validation that my struggles are typical for other survivors. I am amazed and honored that those participants who have heard my story described it as inspirational, a powerful story, personally moving, amazing testimony and beneficial and necessary for health care professionals. Over time, I have slowly and gently learned and gratefully accepted that I still have a purpose in this lifetime!

www.bridgidruden.com

http://bridgidruden.wordpress.com/

Recommended Reading 

Lost and Found  

Barbara Webster

Living Life Fully after Brain Injury: A workbook for survivors, families and caregivers 

January 27, 2012

New Beginnings 

It’s still January, still the beginning of a new year. The time of year we all get a do-over. People make promises to start over: lose weight, exercise more, get that promotion, or spend more time with family. They make these promises because they choose to. They make them because they want to. 

In 2002, after Hugh was struck by a car and suffered a severe traumatic brain injury, our family was forced to start over because of an accident. 

Hugh lost the very aspects of himself that defined him: his ability to participate in sports, his ability to do his job, his role as financial provider for his family, and the confidence that he was a strong and capable man worthy of a family’s love. As his caregiver, I reminded him constantly that he was loved more than ever, that he was not only a business executive and an athlete; he was a loving husband, father, son, and friend.  After facing that he could no longer perform the executive job he had spent his entire life working to achieve, he was severely shaken. I sat with him as a neuropsychologist advised us to “take some time at home to grieve for our old life and start a new one.”

Hard news.

Starting over—not because we wanted to, but we had to, in order to move forward. 

Sometimes the hardest news is what’s needed the most. We had to let go. We had to stop feeling stuck in bitterness and anger over the accident. We had to stop “missing” our old life so we could get down to business and start a new life.

In a way, we were newlyweds again, on a strict budget, and getting to know each other in our new circumstances. 

I returned to school and shared fresh knowledge with Hugh who lapped it up. Hugh returned to the gym and worked out to gain strength. We encouraged each other. We accepted help from our family and friends. Hugh began to notice aspects of our family life he had never witnessed because he was in the office: his daughters arriving home from school in the afternoon, the rhythm of a domestic day at home, the simple joys of living. Our spirits lifted as he made slow progress and we celebrated our cherished friendships and connection to others more than ever before. 

Just shy of two years after his brain injury, Hugh returned to work full-time, an almost unheard of feat for someone with his severity of brain injury. Part of his success is due to his ability to say, “The past is past, what happened, happened. I will deal with my new reality one day at a time to the best of my ability and I will enjoy the present moment.” 

Starting over can seem impossible—but it is possible, and it may even prove enjoyable. So, here’s to new beginnings, and knowing they can occur any time of year if we open our hearts and minds to the possibilities before us.

Rosemary has written a book, Learning by Accident, chronicling her family’s experiences after her husband suffered a TBI; to find out more about it, click here.

Rosemary Rawlins

Rare Compositions, LLC

Marilyn Lash, M.S.W.

Coping styles vary within families after brain injury

Every family has an emotional reaction when a spouse, sibling, child, or other relative has a traumatic brain injury. Each family has learned ways of coping from previous experiences with stresses, losses and changes in their lives. Some methods of coping have been productive for families in the past and helped ease not only their levels of stress and anxiety, but helped them problem solve and prepare for the future. Other ways of coping may not have been as productive for families. Some may have learned from this and changed how they cope with stress or change, while others may be stuck repeating negative patterns.

Emotional trauma of brain injury

We all know that nothing prepares families for the emotional trauma of brain injury. But we do know most people, including families, often react and cope in ways that are familiar when facing a crisis. If a strategy has helped in the past, the hope is that it will help in this new crisis. If it has not worked in the past, hopefully a different strategy will be considered. This sounds simplistic but it makes sense and it is based on patterns of human behavior. 

So if you are a family member of someone with a brain injury, you might consider thinking about how you have coped with the many changes and losses in your life. Surveys of families with a member who had a traumatic brain injury grouped their responses into five categories of cognitive, psychological, spiritual, support systems, and physical coping (DePompei, 2011).

Cognitive coping

This person looks for and uses information. Searching the internet is a common example. There are lots of ways that “cognitive copers” gather information including reading books and articles, talking with other families, attending conferences and workshops and contacting experts.

Psychological coping  

This person’s coping style uses internal positive thoughts. Examples are individuals who count their blessings, take it one day at a time, and focus on improvements and hope. Some take up a cause for prevention or public awareness or finding a cure – it may be brain injury in this case. For others, it may be breast cancer, diabetes, or some other illness.

Spiritual coping

Belief in a higher power brings great comfort to many. Those who use spiritual coping strategies may talk with clergy, read religious books, inspirational stories, or meditate. 

Support systems for coping

These people cope by reaching out to others. It may be as simple and informal as talking with friends to joining formal support groups on brain injury to participating in community groups or activities. 

Physical coping

Many people find that exercise reduces their stress and tension – it may be walking, jogging or aerobics. Others clean house, eat, cook or listen to music. 

Find what works for you

Everyone is different so it’s important to know what works for you. Most of us use several coping styles depending on the circumstances and the types of stress we are facing. By better understanding how you cope, you can take the steps to a more positive future. 

References

DePompei, R (2011). Coping Styles of Individuals and Families after Traumatic Brain Injury. Brain Injury/Professional,  8(4), 26-27. 

Recommended Reading 

Brain Injury It is a Journey

Flora Hammond, M.D. and Tami Guerrier, B.S., Editors 

Life Changes: When a spouse or partner has a brain injury

Brain Injury Blog by William C. Jarvis, Ed.D.

January 24, 2012

Psychological Dimension TBI Improvement – Part 4

The psychological aspect of improvement is probably the greatest influence upon the other three areas.  It is assumed there is also a culminating effect of applying cognitive strategies for improvement in other dimensions as well.  It is a person’s ability to psychologically know he is improving when progress is so slow that makes the difference.

A person should use common sense to visualize possible things, but not easily giving up on various treatments.  Not giving up is a strong key to improvement.  The last key is probably the most powerful, that is to “believe” there is a possibility that improvement is possible. 

A TBI survivor saw a Spanish child after he awoke from his coma that said, “(Name), don’t worry, everything is going to be okay!”  This was enough for this person to truly believe things would be okay.  Although the person never knew where the boy came from, it was enough to cause great belief that it maximized healing.  It has been affirmed by Dr. Benson in Timeless Healing that “belief” can have a powerful impact on healing. 

Psychological aspects effect social, cognitive, and physical improvement.  It is ironic that the very thing injured in a TBI, i.e., thinking can have that much influence in healing a person.  Therefore, believe that healing is possible, even though it sometimes seems improbable and a person will get as far as practicable or further.

In the book Seven Habits of Highly Effective People by Dr. Stephen Covey, in a chapter in this book is called:  “Begin with the End in Mind.”  Dr. Covey explains that a person must begin an idea with the final outcome in mind to be effective.  Likewise, a person must always visualize where he wants to go in his improvement.  This will greatly affect his attitude toward improving.  It is a through an optimistic outlook that a person maximizes his ability to get through adversity.  I would always see myself as walking, no matter how difficult it was for me.  This helped make it happen.  Visualizing does not insure complete healing, but increases the probability of maximum healing within the framework of a person’s injury.

A therapist was working with a person’s right arm and would stretch the shoulder muscles.   One of the exercises he did with the patient was making large circles with the out stretched arm straight up in the air.  It was very difficult to control the circular movement of his arm. 

The therapist said, “Control builds strength!” 

This comment was very profound.  The same is true with the ability to see improvement in adversity.  That is, when a person has control of his adversity, he has inner strength.  A person gains control by implementing strategies and a plan for meeting the challenges he encounters.  A person should be proactive in his approach to dealing with his adversity.  This will result in control over the situation.  A person will build strength of character and motivation.  Seeing and knowing personal improvement is very encouraging.  Even though the improvement is very small, a person must consciously look for it systematically.  Know it is there; find it!

Luke Skywalk in “Star Wars” wanted to be a Jedi Knight.  He was told to find Yoda in a swamp area in order to be instructed how to be Jet Eye Knight.  Luke found Yoda and began training.  After a while Yoda told Luke to use the Powers of the Force and raise his Space ship out of the swamp.  Luke tried several times and could not do it.  Luke sat off to the side extremely discouraged.  Yoda stepped to the edge of the swamp area pointed a finger and the ship slowly rose out of the swamp. 

Luke in awe said, “I don’t believe it!”

Yoda responded, “That is why you fail!”

There are two aspects to “believing.”  The first is to have a sincere faith that God will help to heal a person.   The second is to believe in your own ability to follow through with a rehabilitation plan.  The strategy of “visualizing” is really in a sense having faith in getting better.  This does not mean unrealistic expectations for the future, but not knowing what the future will bring, have faith that it will be as good as possible.  There is always some degree of healing until we die.  Having “Faith” and “Believing” promotes wellness psychologically.  This psychological advantage has a positive effect on physical healing.  Although complete restoration is not assured, there have been many examples of healing that are unexplained by science.

Brain Injury Blog by Janelle Breese Biagioni

Januray 23, 2012

Restoring Confidence after Brain Injury

The other day I was writing about confidence after we suffer a loss. It sparked me to look at all the ways in which one’s confidence can be shattered. Events such as the death of a loved one, infidelity, divorce, relationship changes, a job loss, financial disaster and compromised health all came to mind. I was also reminded of the many individuals where a lack of confidence became a problem after they suffered a brain injury.

Having confidence enables us to do so many things in life. It is something we develop for ourselves and something that we can glean through the encouragement of others. And it absolutely is put to the test or can leave a person feeling abandoned following a brain injury.

Both my husband, Gerry and my friend, Ruth, struggled with a lack of confidence when they came home from hospital. Things that they likely could have done blindfolded before their injuries were extremely problematic for them to carry out after. Both shared experiences of starting out with confidence to do a task only to have that belief shattered when they missed a step or two or were not able to complete what they were doing. It was very hard for them to see that what they could not do today may be something they could do tomorrow or the next month or the next year. From the outside looking in, I tried to be supportive and understanding, but I doubt that any of us can appreciate the full magnitude of what they felt unless we personally have experienced a similar situation.

How can one rebuild their confidence? It isn’t any one thing. It’s many. Rebuilding confidence comes through reflection, healing, support from others, baby steps, solitude, prayer, and remembering to breathe. There is one thing that is imperative to NOT do and that is to languish in negative self-talk. The moment you hear yourself say, “I can’t do this” or “I am just a screw up” or “My life is a waste” hit the ‘mental delete button’! That’s right… the delete button. Visualize a large computer button that says delete and hit it. The more you do this, the easier it will be to stop those statements. It’s important you do because those words will hold you back indefinitely. Continue to surround yourself with those who believe in you and love you unconditionally. Your confidence may not be restored overnight, but I promise, it is something that we can regain… it just takes time.

Brain Injury Blog by Barbara Stahura

Build Resiliency with Positive Emotions after Brain Injury