Join Brainline.org | 9 Things NOT to Say to Someone with a Brain Injury

Written by Marie Rowland, PhD, EmpowermentAlly
www.brainhealthconsulting.com

Click here: Download Dr. Marie Rowland's article:

Brain injury is confusing to people who don’t have one. It’s natural to want to say something, to voice an opinion or offer advice, even when we don’t understand.

And when you care for a loved one with a brain injury, it’s easy to get burnt out and say things out of frustration.

Here are a few things you might find yourself saying that are probably not helpful:

1. You seem fine to me.

The invisible signs of a brain injury — memory and concentration problems, fatigue, insomnia, chronic pain, depression, or anxiety — these are sometimes more difficult to live with than visible disabilities. Research shows that having just a scar on the head can help a person with a brain injury feel validated and better understood. Your loved one may look normal, but shrugging off the invisible signs of brain injury is belittling. Consider this: a memory problem can be much more disabling than a limp.

2. Maybe you’re just not trying hard enough (you’re lazy).

Lazy is not the same as apathy (lack of interest, motivation, or emotion). Apathy is a disorder and common after a brain injury. Apathy can often get in the way of rehabilitation and recovery, so it’s important to recognize and treat it. Certain prescription drugs have been shown to reduce apathy. Setting very specific goals might also help.

Do beware of problems that mimic apathy. Depression, fatigue, and chronic pain are common after a brain injury, and can look like (or be combined with) apathy. Side effects of some prescription drugs can also look like apathy. Try to discover the root of the problem, so that you can help advocate for proper treatment.

3. You’re such a grump!

Irritability is one of the most common signs of a brain injury. Irritability could be the direct result of the brain injury, or a side effect of depression, anxiety, chronic pain, sleep disorders, or fatigue. Think of it as a biological grumpiness — it’s not as if your loved one can get some air and come back in a better mood. It can come and go without reason.

It’s hard to live with someone who is grumpy, moody, or angry all the time. Certain prescription drugs, supplements, changes in diet, or therapy that focuses on adjustment and coping skills can all help to reduce irritability.

4. How many times do I have to tell you?

It’s frustrating to repeat yourself over and over, but almost everyone who has a brain injury will experience some memory problems. Instead of pointing out a deficit, try finding a solution. Make the task easier. Create a routine. Install a memo board in the kitchen. Also, remember that language isn’t always verbal. “I’ve already told you this” comes through loud and clear just by facial expression.

5. Do you have any idea how much I do for you?

Your loved one probably knows how much you do, and feels incredibly guilty about it. It’s also possible that your loved one has no clue, and may never understand. This can be due to problems with awareness, memory, or apathy — all of which can be a direct result of a brain injury. You do need to unload your burden on someone, just let that someone be a good friend or a counselor.

6. Your problem is all the medications you take.

Prescription drugs can cause all kinds of side effects such as sluggishness, insomnia, memory problems, mania, sexual dysfunction, or weight gain — just to name a few. Someone with a brain injury is especially sensitive to these effects. But, if you blame everything on the effects of drugs, two things could happen. One, you might be encouraging your loved one to stop taking an important drug prematurely. Two, you might be overlooking a genuine sign of brain injury.

It’s a good idea to regularly review prescription drugs with a doctor. Don’t be afraid to ask about alternatives that might reduce side effects. At some point in recovery, it might very well be the right time to taper off a drug. But, you won’t know this without regular follow-up.

7. Let me do that for you.

Independence and control are two of the most important things lost after a brain injury. Yes, it may be easier to do things for your loved one. Yes, it may be less frustrating. But, encouraging your loved one to do things on their own will help promote self-esteem, confidence, and quality of living. It can also help the brain recover faster.

Do make sure that the task isn’t one that might put your loved one at genuine risk — such as driving too soon or managing medication when there are significant memory problems.

8. Try to think positively.

That’s easier said than done for many people, and even harder for someone with a brain injury. Repetitive negative thinking is called rumination, and it can be common after a brain injury. Rumination is usually related to depression or anxiety, and so treating those problems may help break the negative thinking cycle.

Furthermore, if you tell someone to stop thinking about a certain negative thought, that thought will just be pushed further towards the front of the mind (literally, to the prefrontal cortex). Instead, find a task that is especially enjoyable for your loved one. It will help to distract from negative thinking, and release chemicals that promote more positive thoughts.

9. You’re lucky to be alive.

This sounds like positive thinking, looking on the bright side of things. But be careful. A person with a brain injury is six times more likely to have suicidal thoughts than someone without a brain injury. Some may not feel very lucky to be alive. Instead of calling it “luck,” talk about how strong, persistent, or heroic the person is for getting through their ordeal. Tell them that they’re awesome.

A Proposal | Four Measures to Deal with the NFL's Concussion Problem

TBI ADVOCATE'S NOTE:  This past March 2015, Jason Lacanfora of CBS Sports NFL Insider bravely challenged the NFL Competition Commitee to consider 4 more potential changes to the Florida game — all of which, he writes are lingering loopholes in the system-in-place to detect and determine head and neck injuries.

It was a strong proposal.  It was spurred by the unfortunate event:  Patriots wide receiver Julian Edelman was told to remain in a Super Bowl game even after he took a nasty hit in the fourth quarter.

What follows is a severely redacted excerpt of Lacanfora's article, entitled "Here are four things the NFL needs to do to fix its concussion problem."  Visit the complete article by clicking here to read beyond what's shared here.

Before joining CBS Sports, Jason La Canfora was the Washington Redskins beat writer for The Washington Post for six years and served as NFL Network's insider. The Baltimore native can be seen every Sunday during the season onThe NFL Today.

Follow Jason on Twitter.

Julian Edelman staggers to his feet after a vicious hit by Kam Chancellor. (USATSI)

Here Are Four Things the NFL Needs to Do to Fix Its Concussion Problem

By Jason Lacanfora

CBS Sports NFL Insider:  The NFL Competition Committee has a bevy of potential changes to the game to consider this week as it continues to meet in Naples, Florida, before ultimately making suggestions for owners to vote on later this month.

I can only hope that when these measures go before ownership at the spring meeting there is a concerted effort made to close lingering loopholes in the system in place to detect and determine head and neck injuries.

If the Super Bowl, and the sight of a staggering and apparently dazed Julian Edelman staying in the game, taught us anything, it's that even with the world's eyes on the game there are still instances where players are not potentially being saved from themselves. Edelman took a nasty hit from Kam Chancellor in the fourth quarter that left him dazed but he never left the field. He went on to catch three more balls for 33 yards, including a game-tying touchdown.


There remains significant work to be done at the highest levels of the NFL to ensure safer conditions; Troy Vincent, the league's VP of football operations, has written and talked about the import of such initiatives and now is the time to put them into practice.

Vincent, in providing a preview on the Competition Committee meetings on the NFL's Football Operations website over the weekend, outlined the various proposals being discussed. They include tweaking the extra point, modifying what is reviewable on instant replay and possibly eliminating the chop block.

1) Medical timeouts
To me, the most significant of them all was the potential introduction of a medical timeout where an independent third party would be empowered to stop the game and require a player to undergo a concussion test.

2) Better spotters, better communication
I don't think it would take all that elaborate of a plan to make this work. Give the spotters a device that signals the head official to immediately stop the game….

New England Patriots' Julian Edelman. (USATSI)

The [injured] player is ushered off the field in a careful and timely manner and then play resumes while the concussion test is administered.

3) Expanding game-day rosters
Vincent states the league is considering expanding the game-day roster for Thursday night games. I still can't understand why such a novel concept isn't already in place.

Forget game-day inactives and make all 53 players active for every game. Eliminate the roster pinch and the concern in the back of any coach's mind about not having enough players to fill in while someone is being evaluated on the sidelines.

4) Establishing an IR (or Designated to Return) like baseball
And, while we're at it, let's add a new injury designation to provide more flexibility for concussed players. Establishing an IR — Designated To Return — was a nice step to provide a cushion for teams to use a player later without losing him for the season (why only one designation per year, though?), but like baseball the NFL should add a concussion-specific designation that allows a player to not count against the active roster for any amount of time – one week, two weeks, a month, whatever – while he remains in the concussion protocol.

Read the entire 4-point proposal by clicking here.

Let's Be Social | Google+ Post You May Like From #TBIAffectedMe

GOOGLE+   In the interest of bringing greater awareness to Traumatic Brain Injury (also known as intracranial injury), an image post by a G+ site called "TBI Support for Family and Caregivers" caught our eye.  Scroll down and check out the informative post.

It's a very personal G+ site maintained by Pamela Guerin who works at BayShore Agency and lives in New Gretna, New Jersey.  The site tracks her work with family and caregivers of persons struck by TBI.  It also informs.  For example, one post explains that 

TBI "occurs when an external force traumatically injures the brain. TBI can be classified based on severity, mechanism, or other features. Head injury usually refers to TBI, but is a broader category because it can involve damage to structures other than the brain, such as the scalp and skull (from en.wikipedia.org).

Without a doubt, "TBI Support for Family and Caregivers" cares very much.  

This past March 2015 — which was Brain Injury Awareness Month — the site offered this fine post:

To honor our friends, supporters, and all the remarkable survivors of brain injury, we are launching the #TBIaffectedme campaign!  Our goal is to encourage those affected by brain injury, whether directly or indirectly, to share their stories using #TBIaffectedme. 

By taking part in our campaign, you can unite with the thousands of New Jerseyans living with brain injury and their families who are taking action to ensure their voices are heard.  We would welcome your support! 

Do consider joining this #TBIaffectedme Twitter campaign, if you like. After all, this advocacy project began because TBI did affect us who are participants of Mount Sinai Hospital's Bridge and Phase 2 programs. —tbi advocate  

Emotional Regulation | Changing Emotions by Acting Opposite to the Current Emotion

TBI Advocate's Note:  What follows is an excerpt from a splendid website entitled "How Psychology Tests Brain Injury." 

Please visit this valuable site by click here.  Offer your support. 

Having studied psychology, the Dutch author Feri Kovács has specialized in neuropsychology and rehabilitation.  This field studies the relationship between brain and behavior — more specifically, brain injury and its consequences and how to cope with it.

By FERI KOVÁCS
Clinical neuropsychologist in Holland         

NETHERLANDS |  Emotions are not only essential in life, they give the flavor to your life as well. Without them, life would be dull but also your information processing would be making much more mistakes.

Feri Kovács

Feelings closely work together with your cognitive (information processing) system to handle yourself, your world and others. Brain injury can change all this.

The most common complaint of family members is that their partner is changed, in his or her emotional reactions.

Meaning: less emotionally stable.

If someone was quite in balance, after the brain injury there can be sudden outbursts of aggression or anxiety.


               

Brain injury affects your emotions and increases stress

Mood changes tend to come more frequently and much more intense than they used to be. Control over such outbursts seems to be reduced. It is as if someone has more stress than before and can not handle it effectively anymore.

Four basic emotions and control

Science dictates that there are six basic emotions:

1. anger, 
2. fear, 
3. sadness, 
4. joy, 
5. disgust and 
6. surprise. 

Actually, one scientist Ekman made this divisions after studying facial expressions all over the world. I and especially some philosophers disagree with this list and I believe that there are only 4 basic emotions.  The rest is just a derivative of these four.

The four fundamental basic ones are:

1. anger, 
2. fear, 
3. sadness and
4. last but not least joy. 

As you can see, nature has provided us and most higher animals with 75% negative feelings. Joy is clearly in the minority.  I always can speculate quite simply why this is so.  I always tell my patients how they can imagine that in the jungle a group of lions can survive if joy would be the most important emotion.

Ever seen only happy lions around? Just laughing? When seeing a deer or a gazelle, they would just laugh? Can you imagine how long such lions would survive out there?

Evolution is also the reason that fear is the most predominant emotion in most higher animals, and also in man.  Sadness is a special case and it only exists in higher animals, not in reptiles. Ever seen a crocodile grieving or sad (as far as we can tell)?

Although feelings are very useful and even necessary for survival, we as human beings have one fundamental task: to control them and not getting overwhelmed by them.

Read the rest of this essay.  Please click here.  Don't forget to check the rest of the site.

© Copyright  F. Kovács. All rights reserved. No reproduction of any kind without express permission.

On Self-Esteem | 10 Ways to Feel Better About Yourself

NEW YORK CITY:  In a March 31, 2011 article on Emotional Fitness, Psychology Today states, "Everyday, you have another chance to make things better. Some days are better than others. On those days that go less well, we usually end up being hard on ourselves."

Here are some tools to avoid doing so.

1. Keep going.
Don't let life's changes throw you off track, but remember that most extenuating circumstances are temporary. Gain more clarity by staying the course and channeling your energy in a positive direction.

2. Trust yourself.
Believe in your inner resources, no matter what, and you'll grow from the experience. I believe that the answers usually lie within and you are probably smart enough to figure out what you need to do. Give yourself a little time and have patience.

3. Be friends with life. 
Remember that the world is not out to get you and it does not punish you. You do that to yourself. Learning to focus on other opportunities or in another direction can give you some perspective.

4. Watch your thoughts.
Your thinking will never be 100 percent positive. You must learn to dismiss the negative thoughts and stay open to other ideas that will help you move in a positive direction. Start recognizing negative thoughts and use your mind to quell them.

5. Summon the strength you have inside.
Learn to access and direct your strengths to the highest good for all concerned. Believe that your strength and intelligence can help you deal with anything. Remember that you have survived worse.

6. Learn to love yourself. 
You do not have to be who you are today, and your life is not scripted. Changing how you feel about yourself means creating a strategy, gathering some new tools, and making yourself into the person you want to be. A good way to start is to stop doing things that hurt.

7. Don't want too much. 
Desire can be a powerful motivating tool, but wanting something too much can be very painful and very expensive, so don't live beyond your means or covet the unattainable. Seek your desire, but keep your integrity.

8. Don't get insulted.
It is wise to be dispassionate about critical comments. Human's will always bump heads, but consider the source, and if it's the other person's issue, ignore it. Learn to respond instead of react, and don't show your ire.

9. Recognize that disappointment is part of life. 
Even the most successful people have to deal with disappointment, but they've learned how to use it to get to the next level of life. The trick is to process your feelings, then take some kind of action.

10. Deal with your fears.
Overcoming fear makes you stronger, and being a little scared can make you better. You want to have butterflies; you just want them flying in formation. It helps to understand and admit your fears. Then you can kick them to the curb.

Feel good about yourself, no matter what life brings. 

Know that each time you wake up, you have another chance to make things better. Don't waste it.

A True Story | Education Is Key: "What Used to Be Natural Had to be Relearned"

By Jodi Schellenberg
The Prince Albert Daily
Published on June 23, 2014

SASKATCHEWAN, CANADA |  After experiencing a brain injury herself, Emilia Becker decided to share her story with others to raise awareness.

Becker came to Prince Albert to bring awareness to Brain Injury Awareness Month and spoke to city council about her own experiences.

Although you wouldn’t know to look at her, Becker was in an accident when she was only 11 years old.

The school bus she was riding at her hometown near Regina ran the yield side, hitting a Canadian Pacific Railway vehicle, causing the bus the flip and hit the opposite ditch.

Emilia Becker, a brain injury survivor, came into Prince Albert
 to talk to city council about Brain Injury Awareness Month.
© Herald photo by Jodi Schellenberg

“I actually don’t remember the day of the accident or three months prior,” Becker said. “I remember waking up in a truck and asking what happened and I remember waking up in the hospital and being asked to draw a straight line but I couldn’t do that.”

She received some physical injuries as well as a diffuse axonal injury, which is a type of moderate brain injury.

Not all brain injuries have the same symptoms -- Becker had physical, intellectual and emotional symptoms.

Becker said one of her physical symptoms was related to her right side, which was partially impacted and her right foot would turn in as she walked.

“I also lost a lot of memory,” she said. “I couldn’t do math to the same level as I could before, I forgot all of my Spanish and my French and I couldn’t read at the same level as I could before.”

To work on her physical symptoms they used reciprocal motion to relearn some skills.

They found her a bike to ride in the winter to retrain her brain to do some reciprocal motion activities that used to be fluid and intuitive.

“What used to be natural had to be relearned, such as actions like running and throwing,” Becker said.

In addition, she was an A-plus student before the accident, involved in activities such as tap, jazz, ballet, Girl Guides and voice lessons -- all of which changed overnight.

“I was somewhat embarrassed to have an injury like this and not be able to do any of the activities I could before,” Becker said. “Eventually I came to the point where I realized that just because you have an injury doesn’t mean that you’re any worse of a person or worse off.

“You can relearn things and you can do things in a different way if not in the same way as before,” she added. “You can retrain your brain and you can learn new ways to do things.”

Read the rest of this inspiring story by visiting The Prince Albert Daily Herald.

Or click here: 

http://www.paherald.sk.ca/News/Local/2014-06-23/article-3774141/Education-key-to-understanding-brain-injuries/1