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Slips and falls due to sliding on slippery sidewalks and other surfaces are a concern, whether an individual does or does not have a brain injury. However, the risks are often more frequent and more serious after an injury.

Many brain injury survivors are able to walk after their injury but find that their balance is not as good as it was prior to their injury. Since these survivors can lose their balance more easily, this puts them at a greater risk for a slip and fall on wet, slippery surfaces. Similarly, many survivors do not have the same quick reaction times as they did prior to their injuries, so they have more difficulty catching their balance if they have a slip. Additionally, many survivor have one side of their bodies that is weaker than the other. When they fall, they tend to fall to the weaker side so there is little opportunity to brace themselves for falls. This potentially makes falls far more serious than prior to their brain injuries.

Survivors in wheelchairs are also at risk for accidents due to slippery sidewalks and other surfaces. The wheels on wheelchairs easily slip on wet surfaces. Wheelchairs pick up speed very quickly on wet sidewalk ramps, leading to potential accidents and injuries, due to an inability of survivors to control their wheelchairs at these higher speeds. Wet leaves and other slippery items on wheelchair ramps often exacerbate difficulties for wheelchair users.

Keep the following tips in mind to reduce sidewalk slip and falls:

  1. Always check the weather before you head out to your daily activities.
  2. Make sure leaves are regularly swept up in locations where they tend to accumulate on sidewalks. Don’t be shy about mentioning to companies that this is an issue for you being able to access their businesses.
  3. Be extra careful when walking or traveling in a wheelchair both during and after a rainstorm.
  4. When possible, use sidewalk ramps that are covered by an overhang.

Learn about brain injury treatment services at the Transitional Learning Center! Visit us at: http://tlcrehab.org/

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On Game of Thrones, Emilia Clarke’s character Daenerys Targaryen is tough as nails and always up for a battle. But perhaps Clarke’s toughest personal battle was when she had brain aneurysms, which included multiple surgeries to save her life. Click the link below to read her personal account of her brain aneurysm experience, including surgery and aphasia:

https://www.newyorker.com/culture/personal-history/emilia-clarke-a-battle-for-my-life-brain-aneurysm-surgery-game-of-thrones

Learn about brain injury treatment services at the Transitional Learning Center! Visit us at: http://tlcrehab.org/

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One of the basic truths of successful rehabilitation is that it involves a partnership between the patient and therapists/doctors.  It is important to understand what this partnership entails, namely that without both parties investments in the process, the patient will only have limited improvements.  This also means that each side has a responsibility to the other side to ensure success.  The job of rehabilitation is a shared job between the patient and rehabilitation professionals.

There are a number of implications to the basic truth of the rehabilitation partnership.  A therapist/doctor cannot make a patient improve.  A therapist/doctor can only work with a patient to help the patient improve.  Keeping this in mind should dissuade rehabilitation professionals from imagining themselves to be like Superman, swooping in to save the patient from the patient’s brain injury.  Brain injury rehabilitation simply does not function like a comic book story.  It should also empower the patient with the knowledge that their thoughts, feedback and effort are a vital part of rehabilitation, without which success cannot be fully achieved. Professionals need the patient’s thoughts and feedback to best plan and implement therapy.  Every patient is different so a method that helps one patient may hurt another patient.  There is no way for a professional to know this without feedback.  This should also dissuade patients from being passive in the therapy process.  Rehabilitation professionals cannot help a patient improve if the patient will not try to help themselves.   They cannot do the work for the patient.

When this partnership comes together, between patient, therapists and doctors, it becomes a rehabilitation team.  However, it is important to remember who is the “team captain”.  The patient is the “team captain” in the sense that the process is ultimately focused on the patient.  The patient needs to let the team in on their goals, expectations and dreams.  When the entire team has this information (which has to be updated on a regular basis), the team can best understand the direction therapy will take.  For instance, if a patient was formerly a chef and dreams of returning to their former occupation, a great deal of therapy will be focused on activities in the kitchen.  If the patient never went in the kitchen outside of opening the refrigerator door, then therapy will be focused on other activities.

A successful partnership will generally allow the patient and rehabilitation professionals to have a mutual understanding and appreciation of one another.  It will also foster openness, honesty and trust between the patient and the rehabilitation professionals.

Remember, teamwork makes the dream work!

Learn about brain injury treatment services at the Transitional Learning Center! Visit us at: http://tlcrehab.org/

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Bret “The Hitman” Hart is a wrestling legend.  For years, he traveled around the world, one of the greatest stars in the wrestling world.  But even a tremendous athlete like Hart can have a stroke.  Hart had a stroke in 2001.  He spent three months in a wheelchair and countless hours in rehabilitation.  His hard work paid off in an excellent recovery.  Today, he represents the March of Dimes Canada’s Stroke Recovery Program, inspiring other stroke survivors!  Click on the link below to watch a video of Bret Hart talking about his stroke experience:

Canadian icon Bret Hart on his inspiring stroke recovery - YouTube

Learn about brain injury treatment services at the Transitional Learning Center! Visit us at: http://tlcrehab.org/

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One of the most common mistakes that brain injury survivors’ loved ones make after an injury is not giving the survivors enough time to respond or take an action.  For instance, a survivor and his family may be at a restaurant for dinner.  When the survivor is struggling to place his order, a family member may jump in to place the order for him.  If given enough time, the survivor may have been perfectly able to place the order but the family member did not give him enough time to respond.

There are a few reasons why survivors’ loved ones tend to not give enough time to the survivor to respond or take an action.   One reason is that silence is uncomfortable.  For instance, if a survivor is needing extra time to respond, the silence may be so uncomfortable that the loved one will jump in and speak “for” the survivor.  A second reason is that is uncomfortable to watch someone struggle.  As an example, a survivor may be slowly, and with great effort, reach toward an item on a table.  The loved one may be so uncomfortable watching the survivor’s struggle that they reach over to get the item for the survivor.  A third reason is the feeling that the survivor and loved ones are in a rush or feel like they are causing someone else to slow down.  For instance, a survivor in a wheelchair may be pedaling down a hospital hallway but family members, concerned that the wheelchair is blocking the nurses, decide to push the survivor’s wheelchair to more quickly reach their destination.

However, it is important to give the survivor more time.  First, and most importantly, if the survivor is able to make a response or take an appropriate action when given extra time, they should be allowed the independence and respect to do so.  By unnecessarily jumping in, loved ones are taking away the power and the dignity of the survivor to take care of their own needs.  Second, although a survivor may need extra time and effort to complete a task, they are more likely to get faster and more efficient over time with practice.  By doing the task for them, the loved one is taking away vital practice from the survivor who is trying to master a task.  Third, the survivor may need extra time to safely complete an activity.  After an injury, certain tasks may have concrete steps which take time or require more processing time to successfully finish without risk.  For example, most uninjured individuals simply stand up when they are ready to leave a room.  A survivor may have to go through multiple steps to safely transfer from sitting to standing.  These steps require extra time so the survivor can safely transfer.

When wondering about the survivor’s need for extra time and if they should jump in, loved ones should ask themselves the following questions:

  1.  Is the task truly out of the survivor’s skill range or do I just need to be more patient to allow them to complete the task?
  2. Are we actually in a rush or is a little extra time a reasonable request?  For example, if a survivor needs an extra ten seconds to place an order at a restaurant, keep in mind that the waitstaff is getting paid to serve you.  Ten extra seconds is not an unreasonable request.
  3. What message am I giving to the survivor if I do not allow them to do for themselves when they are able to so?
  4. Is the issue really about the survivor needing extra time or my personal discomfort in this situation?
  5. By going faster, have I compromised my or the survivor’s safety?

In most cases, a little extra time will help a brain injury survivor be more successful and allow everyone to have a better experience!

Learn about brain injury treatment services at the Transitional Learning Center! Visit us at: http://tlcrehab.org/

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Survivors with brain injuries push themselves to get better.  The staff at TLC see this every day.  Survivors push themselves to walk better.  They push themselves to speak better.  They push themselves to improve their memory.  They push themselves in every aspect of the rehabilitation experience.  But recovery from a serious brain injury can be quite slow.  It is almost always slower than the survivor would like it to be.  Unfortunately, this leads some survivors to talk badly about themselves.  They say things such as “I am a failure because I am not 100% improved” or “I should be much better than I am now.  I am doing poorly in therapy”.  This negative self-talk often leads emotional difficulties such as stress, low mood and sometimes even to depression.

If looked at objectively, this negative self-talk is often due to unrealistic expectations that the survivors have regarding their recoveries.  The survivors may believe that the amount of time necessary to recover is in excess of what they expected, even when the medical research shows that they are progressing at a normal rate.  By expecting faster or better results than is humanly possible, survivors can cause themselves unnecessary frustration.

Interestingly, these same survivors who hold unrealistic expectations of themselves generally do not hold these same expectations of others.  They are often more logical and understanding of other survivors than themselves.  It is common at TLC for the same patients who have unrealistic personal expectations to support realistic expectations in other patients.  They will make supportive statements to other patients such as “Don’t worry and take it slow.  You will get better over time.  You are running a marathon not a sprint.”  When the patients with unrealistic expectations are asked if they believe the advice they are giving to others, they always answer in the affirmative.  They understand that the brain injury recovery process is a slow process which requires lots of work.  They understand it is a long-term process.  But they tell themselves that their personal recovery should be quicker than everyone else, holding themselves up to unfair, often impossible, standards.

One way to manage this negative self-talk is by using the “open chair” technique.  How this technique works is that patients are asked to imagine they are sitting next themselves and the person in their seat is someone else with the exact same issues and deficits that they have.  The patients are then asked to give this “other person” honest feedback about how the “other person” is doing.  Often, patients find that this leads them to soften their tone and make more supportive statements.  Similar to when they are actually talking to other patients, when they address themselves as the “other person”, patients demonstrate more realistic expectations and are less likely to attack themselves.  The “open chair” technique often helps patients treat themselves not only better, but also more fairly and honestly.  By being more fair and honest to themselves, survivors tend to have an improved mood.  And the better the mood that survivors have, the easier it is to go through the rehabilitation process.

Learn about brain injury treatment services at the Transitional Learning Center!  Visit us at: tlcrehab.org

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Olympic gold medal sprinter Michael Johnson has always kept himself in great shape, even after retiring from professional racing.  However,  it is possible for even a healthy individual to have a stroke.  Michael Johnson had a transient ischemic attack (TIA), also known as a “mini stroke”.  Though he has recovered well from the TIA, the experience taught him a lesson about vulnerability and motivated him to educate others about the risks for stroke.  Click the link below to read more about Michael Johnson’s stroke experience:

https://www.bbc.com/sport/athletics/46798931

Learn about brain injury treatment services at the Transitional Learning Center!  Visit us at: tlcrehab.org

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This post, as many of the posts on this blog, are motivated by everyday experiences I have at work or in my personal life.  This particular post was influenced by a conversation I had on Facebook.  Recently, a friend of mine posted a picture from 20 years ago.  The picture was taken after he had a serious bicycle accident.  He mentioned breaking several bones and having a concussion.  He said that the accident was proof that bicycle helmets work and that he needs to wear one all of the time.  I mentioned that I have seen several patients with severe brain injuries due to bicycle accidents and agreed that he needs to wear a helmet whenever bicycling.  He responded by telling me that the accident was so serious that it affected his memory.  He woke in the emergency room with a note taped to his chest, telling him what happened, as he had no idea how he ended up in the emergency room.

This brings us to a worrisome trend I have noticed.  While many more children are wearing bicycle helmets while out riding than in the past, many adults are not.  This is especially concerning when looking at accident data from the National Highway Traffic Safety Administration (NHTSA).  According to the NHTSA, the average age of bicycle accident fatalities as of 2016 (most recent data available) is 46.  Moreover, for children under the age of 14, there are on average approximately 1 death per million resident population while for adults between the ages of 50-65, the average is over 4.6 per million.  These findings should raise concern in all adult bicycle riders.

It is likely that a big reason that children are wearing helmets while adults are not is that many states and cities have laws mandating that children wear helmets while there are no similar laws for adults.  For instance, it is illegal in the city of Houston, TX for anyone under the age of 18 to ride a bicycle without a helmet but there is no equivalent law for adults.  These laws ignore a basic medical reality.  An adult can just as easily get a brain injury as a child and, based on NHTSA data, are dying from bicycle accidents at a higher rate than children.  Just as children need to protect their brains from injury, so do adults.  Reaching the age of 18 does not magically make a bicycle rider immune to serious accidents.  Everyone, including adults, should always wear a helmet when riding a bicycle!

Learn about brain injury treatment services at the Transitional Learning Center!  Visit us at: tlcrehab.org

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Neurorehabilitation from a brain injury involves learning and re-learning a long list of activities.  Patients work on skills such as naming items, transferring from a wheelchair and using adaptive equipment.  Therapy sessions often consist of countless repetitions of the same action, drilling skills over and over.  Further, therapists will usually send patients home with discharge plans to continue practicing these same skills at home.  Sometimes, patients will wonder why they have to practice activities.  After all, if they demonstrated the skill once, doesn’t that mean they possess the skill?  Why is this repeated practice necessary?

In reality, to truly become proficient at any skill, lots of practice is necessary.  Just because a patient has succeeded at a skill on one occasion does not mean that he or she will succeed in the future.  This is true for any activity or field.  For instance, imagine hearing the following overhead announcement prior to a flight taking off the runway: “Ladies and gentleman, welcome aboard our plane.  My name is Captain Mike and I will be your pilot today.  I have successfully flown a plane once.  I anticipate we will have a smooth flight.”  After hearing this announcement, most passengers would probably run toward the exit door as quickly as possible.  Who would trust a pilot to fly a plane with a history of only one successful attempt.  We inherently recognize that lots of practice is necessary to trust that a person can reliably complete a task.  This holds true for therapy as much as for flying a plane.  Repeated practice, both in therapy and at home, is necessary for a patient to gain the skills and competence to succeed in rehabilitation goals.  It is only through practice that patients can become proficient.

Learn about brain injury treatment services at the Transitional Learning Center!  Visit us at: tlcrehab.org

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Recently, I was talking with an acquaintance about our jobs.  He is a young, bright family physician.  The young physician explained to me how the patients he treats with brain injuries all have suffered mild brain injuries.  He then proceeded to give a list of some of the more common symptoms that his patients experience.  His description of the symptoms of mild brain injuries were well-informed and accurate.  I mentioned how I treat patients with moderate to severe brain injuries.  The young physician stated that there is not much you can do with patients that have such serious brain injuries.  On this point, he was sadly misinformed.  I explained to him that the terms “mild”, “moderate” and “severe” simply refer to the initial start point of an injury and not the end result.  I told him about several TLC patients who were quite successful following rehabilitation, such as patients who have graduated from college following treatment at TLC.  He clearly took in the information and hopefully, has learned from our brief interaction.

This interaction led me to have other thoughts.  Here is an well-educated, excellent doctor who lacked a full understanding of brain injury.  How more so is there a lack of brain injury education in the general public.  How many people in the general public have false ideas about brain injuries?  The desire to educate the public on brain injury is one of the principal reasons this blog was created.  Moreover, every article, news story and conversation about brain injury that we share with others helps educate individuals outside of the brain injury treatment world about brain injury.  We need to let the general public know that a brain injury is not the end of someone’s life but rather a new pathway in life.  We need to let the general public know that and individual with a brain injury may have significant difficulties but also can have a successful life.  We need the general public to learn to see beyond the injury and to see the person.

Learn about brain injury treatment services at the Transitional Learning Center! Visit us at: http://tlcrehab.org/

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