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Q. Why do outcomes vary so greatly among survivors?

A. We each have genetic differences neurologically to begin with. Some people
have neuro pathways that are more or less developed than other
people-depending on environmental and familial factors. So individual
differences exist even before injury. Then too, brain injuries themselves are
never identical. Issues like fatigue, concentration and attention complicate
capacity. For example, even at different times of day, people may be able to
perform better for you if they are well rested. Certainly, we in this neuro
psychology field, are changing our thinking in the last decade about brain tissue
that we once believed could not regenerate itself. We now realize that post
injury neuron sprouting may indeed take place! There are ways to engage new
pathways, while also teaching survivors compensating strategies. We can work
together to handle glitches and emotional issues which may come up.

Q. Can you get specific on what you mean by glitches?

A. Short term memory problems are frequent. The memory system is so
complex! There are many components in memory functioning. There are so many
parts of our brain that we think contribute to encoding (getting the information
into our minds). So it is very easy for memory to be affected when any part of
the brain is damaged. Memory (as well as other cognitive processing) involves
attention, concentration, processing, organizing the data and storing it for
retrieval. Sensory overload is another common problem for survivors. One of
the first things to go after a tbi, even a mild one, is the ability to manage multiple
simultaneous stimuli. Incoming sensory stimulation can bombard you with
sights, sounds, smells, lighting, etc. The brain tries to process all this through a
sorting and filtering process that has been disrupted by the tbi. Inability to attend
or focus can diminish an already sluggish capacity for thinking. So this can feel
like "stirring mud" to be working on a particular thing-very fatiguing! Then if
you add another stimuli on top of that, sensory overload occurs. For those of us
without brain injuries, we are able to filter out the distractions and concentrate
on the one thing we are focussing on. People with brain injuries may not be able
to filter out the stimuli.

Q. You said Post Injury Neuron Sprouting may take Place. What does that
Mean?

A. In brain injury, some of the neurons are bruised or broken. Some are
damaged, others are dead. To some degree, we now believe that some of the
bruised ones can restore and repair themselves. When neurons have died, we
may be able to retrain others to take their place.
then to use the strategies daily. I also encourage my clients to
use a DayTimer/planner to help with organizing their time, appointments and
pacing their daily lives.

Q. What if We don’t have a Neuro-Rehab Specialist?

A. Refer to a speech pathologist or brain injury program for cognitive
re-training help. There are also things that can be done at home to strengthen
survivor’s skills. I may recommend computer programs or games. Or playing
Scategories or Scrabble with a friend or family member can help. Remember,
all brain injuries are different and capacities are too! I try to set realistic goals
with my clients and their families.

Q. How do cognitive glitches affect a survivor’s emotions?

A. Often there’s a huge emotional component to brain injury recovery.
Emotional adjustment to the “new self” may be one of the last pieces of the
recovery process to fall into place. An example of this could be if someone is
non-functional at home, because of memory impairment. They can’t remember to
go to the grocery store (or even to eat sometimes), and this interrupts family life.
We work together, in therapy to figure out some cognitive strategy for memory.
We simultaneously address their feelings of “less than” or other emotions that
brings — to feel non- functional in their family.

Q.What about emotional adjustment . Why is this process so intense?

A. People do not just step out of a vacuum the day before their brain injury.
They come to it with real life stories! The fact that they’re depressed might not
only be an effect of the TBI. You need to look at their baseline functioning (how
the person performed) before their injury. Information from educational records,
family members, and self reports from the survivor can help us differentiate
how many depression-related issues were pre-existing problems versus results
of the brain injury. From the clinical perspective. This is what they are like now and these are remedies we need to apply to help them deal with their glitches and depression.

Q. What about suicidal depression?

A. I recommend both individual and group supportive psychotherapy where
redefinition of self and redefinition of purpose are the focus. “What remains of
me??” and “What remains for me?” are the questions survivors must face.
Adjusting to a new set of strengths and weaknesses and a new self-definition
sends survivors scrambling for a solid sense of identity (self). Once that hurdle
is crossed, we explore the possibilities for developing a goal-directed purpose
in life. This focus may be quite different from their pre-injury goals. With a
re-adjusted sense of self and clearer “reasons to be”, most suicidal depressions
can be worked through. This process, of course, has to be accompanied by
balanced life-styles of good nutrition, sleeping habits, exercise routines I advise
staying away from drugs and alcohol which accentuate depression. Many
survivors benefit from antidepressant medications which allow them to do the
therapeutic work described above.

Q. Guiding patients toward healing?

A. An ancient saying states “give a man a fish and you feed him for a day. Teach
him how to fish & you feed him for a lifetime!” Ideally, a therapist will teach
healthy adaptive coping skills to promote continuing growth. This will lead to
enhanced personal satisfaction in work, love and play.

Q.Is a stroke a mental illness?

A. Stroke is not a mental illness. However the resulting behavioral, emotional and
cognitive problems may resemble those of psychiatric disorders. Often there’s a
false assumption that patients can simply exert more effort to overcome their
problems This is often not the case, since many of the problems are outside of
their control. Sigmund Freud likened some of these problems that patients suffer
to a “wild horse the rider cannot control.”

Q.How do you help a stroke survivor as a family member?

A. Teach them adaptive coping skills that they can use to enhance their self
esteem and improve relationships with others. After loss, a spectrum of
emotions usually occur. Denial of feelings and anger may be part of their
grieving process. The important issue is how to cope with and express those
feelings. It’s important to explore any resistance that patients may have to
participating in any form of therapy.

First I’d discuss what concerns they might have about any particular therapy or
support group. Frequently concerns may center around shame or guilt about
needing help. If this is the case, one could point out that patients are not being
asked to be a passive participant in therapy. We are asking them to avail
themselves of the information, strategies, and skills they will need to actively
use in their own recovery.

I’d also remind patients and families of the importance of being advocates for
themselves by persisting in getting their needs adequately met. Remember no
one health care provider has time or skills to address all the problems resulting
from a sroke.

To Society: Remember, a person is so fragile after a trauma. In other countries,
there’s a warmth and sense of community, acceptance and respect.

Q. Advice?

A. For Family: Be prepared for the worst and hope for the best. Set aside any
pre-injury differences and be prepared to be a friend no matter what.

For Professionals: Survivors and family have an especially difficult disability
to deal with because no one can “see” it, especially in mild TBI.

Your genuine concern is better than any pill.

To Survivors: Many of us care deeply about you. We honor and respect you

--Resources:

1. Catalogue for Functional Living Solutions.............................(800) 235-7054

2. Sears Home Health Supplies...............................................(800) 326-1750

Selected information from 14 pages of resources contained in Volume 1 and
2

"Hotline" numbers

Family Help Line 800-444-6443
Stroke Connection 800-553-6321
American Pain Society 847-375-4715
Parents Active for Vision Education 800-728-3988
International Brain Injury Association 202-296-6443

Newsletters

Brain Injury Connection Quarterly Newsletter
PO Box 2452 Alameda, CA 94501

Through the Looking Glass Newsletter
For parents with disabilities 800-644-2666

Emerging Horizons-Travelers Connection
PO Box 278 Ripon, Ca 95366

Adaptive a

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Page Updated Sun Mar 9, 2003 11:34am EST