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Change your Attitude and Change your Life

Julie Entwistle, MBA, BHSc (OT), BSc (Health / Gerontology)

I was recently forwarded the below article from a friend. This is about a young man who was facing the amputation of his left leg. Given his situation he had multiple choices. He could choose to be angry, bitter, sad, could feel sorry for himself, be stressed and anxious about the impending surgery, or decide to accept his fate and ultimately “be okay” with it. His choice? Make light of his situation, involve others in the process, accept that he could not change what he was confronted with, and move on. Check out his inspiring story here.

Reading this reminded me of my grandfather. At age 20 he was diagnosed with Polio. This caused atrophy of the muscles in his legs and buttocks and he walked with crutches for 56 years. Eventually his lower body circulation started to fail and his feet became infected. It was recommended that he have both legs amputated above the knees. He accepted this fate as a life saving measure and understood that his legs were no longer of purpose to him, and were actually a hindrance when trying to transfer and go about his day. Luckily my grandfather had a wonderful sense of humor, and an even better attitude, and as such had cultured this into the rest of us. Before his amputations, and even after, we came up with lists of clichés we could no longer say to him: “put your best foot forward”, “pull up your socks”, “if the shoe fits wear it”, “you are a shoe in” etc. He was just as engaged in making these lists as we were.

I remember his jokes continued even days before his death. I was visiting with him and an orderly came in to mop the floor. As she approached the hospital bed where he was lying, he asked her if she needed him to “lift his feet”. She quickly said “no sir you are fine” to which I replied “he is just being funny….first of all he is in a hospital bed that you can mop under anyway, and secondly he has no feet!” This one of my fondest memories of him, and the last conversation I had with him before he passed.

My point? Your attitude can determine your outlook and outcome. While we can’t change the situations that happen in our life, we can change how we THINK about them – for the good or bad. But guess what? If you THINK that a given situation made you angry (or sad, frustrated, depressed) then your FEELINGS AND ACTIONS will follow, mimicking your thoughts. A situation does not cause you to be angry, it is your thoughts about the situation that causes your reaction. So, as obscure as it sounds, if you want to improve your outcomes, change your thoughts. Simple enough? Well, not really. Adopting a new attitude and thinking differently about things is hard work – it requires awareness and a paradigm shift to a new way of being. But I am sure everyone can think of one person that they just don’t want to be around – that negative Nelly, that downer, that person who does nothing but complain, that “Droopy” character in real life. These people are life-suckers, are exhausting to be around and positive people tend to avoid them because that negativity can become contagious. Is that you? Then do something about it to change your approach to things and the result will be an enrichment of your relationships.

Cognitive behavioral therapy is the process of helping people to understand the relationship between thinking and emotion. It involves working with a therapist to sort through the negative thinking patterns that are dictating counterproductive actions and feelings. If you think you need that, consider that occupational therapists often use this in treatment when our assessment uncovers that someone presents with challenging thinking patterns, or we are finding that a difficult attitude is hindering progress in treatment.

Here are some great quotes about attitude that really drive these points home:

“Weakness of attitude becomes weakness of character.”
Albert Einstein

“Nothing can stop the man with the right mental attitude from achieving his goal; nothing on earth can help the man with the wrong mental attitude.”
Thomas Jefferson

“The greatest day in your life and mine is when we take total responsibility for our attitudes. That’s the day we truly grow up.”
John C. Maxwell

So, work to change your attitude and that could change your life!

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Capturing the Moment or Missing it Altogether?

Julie Entwistle, MBA, BHSc (OT), BSc (Health / Gerontology)

I love the song “Scare Away the Dark” by Passenger. Some of the lyrics have powerful insinuations: “we should stare at the stars and not just at screens”…”we want something real not just hashtag and twitter”…”we are all slowly dying in front of computers”. I believe there is significant truth to what he is saying. The technology pendulum has swung so far in the direction of obsession and I am personally looking forward to it bouncing back to some form of neutral.

If addiction is defined as “the state of being enslaved to a habit or practice that is physically or psychologically habit forming to such an extent that its cessation causes severe trauma…or “usage of something that is beyond voluntary control” then I would argue that technology applies, and many people have a serious problem.

On a recent holiday the evidence of this was immense. On one occasion I saw three young women on a horse-drawn carriage ride (a $50 experience I might add) and they were all looking at their phones. Were they texting, tweeting, posting on FB “loving my horse drawn carriage ride”, or maybe playing candy crush, instagramming a photo, taking a selfie? Or the families sitting at dinner looking down, using their devices, essentially ignoring each other. Or the guy at the theme park videotaping his experience – he was even videotaping while a photographer was taking their family photo! I am not sure it matters what these people’s intentions were with their devices, but I felt that in perhaps trying to capture these moments they were missing them completely. Look around, talk to each other, take in the sights, sounds, smells, be mindful of the fragility of life and take a moment to be grateful for the experience. Connect. Engage. Smile at a person, not just a screen.

Now don’t get me wrong, I am all for capturing moments. But some moments need to be captured by our eyes and filed in our brain, not just on a device, memory card, or online. The concept of being present includes enjoying moments while you are in them – without living in the past or obsessing about the future. How can we do this? Enlightened Living suggests that being present involves recognizing that we can only do ONE thing at a time and thus we should engage wholeheartedly. Taking a photo while trying to absorb a moment are two tasks that cannot happen simultaneously. Thus why people feel that “life has passed them by”…they were never there to fully experience it in the first place.

So every once in a while check your addiction. Step away from your phone. Take technology away from your children. Leave it at home. Don’t take it on vacation. Set rules for technology behavior. In our house we have significant rules for screen use, including a 17 clause contract our daughter signed in getting her first cell phone at age 14. Rule # 1: The phone cannot be used to be mean to anyone – directly or indirectly. Rule # 2: Proper grammar and spelling must be used when communicating. Rule # 4 and 5: The phone is not allowed upstairs and cannot be used during family or meal times. Rule # 9: I will not use my phone to take photos or video of people without their permission. I will not post or share photos or video without consent of the people in them. Rule # 15: I will follow classroom and teacher rules for phone use when at school. Rule # 16: I understand this is not an appendage and obsessive use will not be tolerated. Rule # 17 is a list of reasons for repossession. My 14 and 12 year olds read the contract together. At the end my 12 year old said “so, what CAN she do”?

Do you feel sorry for my kid? Don’t. The real reason for the contract was not because she needs to be rigidly structured, but because I, as a new parent of a kid with a cell phone, was not comfortable with the entire concept in the first place. At 14 (and younger) kids are not developmentally able to understand and grasp the full impact of this new power in their possession. That is why there are recommended ages for Facebook (14), and age-specific laws for driving and drinking. They are young, naïve, immature, and still learning the ways of the world. I have a responsibility to be her guide, as effortful as that is. In the end, the contract worked to set out the expectations, establish boundaries, communicate about safety and proper use, and helped us recognize the need to adapt as a family to the transition of now raising teenagers, not just “kids”. But my true intent was to make sure that I don’t teach her, or worse, model for her, that technology trumps experiences, replaces in-person relationships, or is a valuable way to tick away the proverbial time bomb that is life.

So, try if you can to capture moments by being present, and by using your born faculties to photograph, store and file your memories – not just a device. Check in with yourself at times about your behaviors, track these, shock your system with some detox, set some boundaries and try to unplug.

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The Brain Injury Rehabilitation of Disorganization

Julie Entwistle, MBA, BHSc (OT), BSc (Health / Gerontology)

Last stop for Brain Injury Awareness Month – my favorite topic – organization!

photo 1

 

Yes, this is my drawer system to store pens, pencils, and markers. And if I find a pencil in the pen drawer look out! Perhaps being organized and knowing how to find what I need when I need it is one of the many ways I manage the demands of being a business owner and mother of four. But the reality is that we all have different levels of energy, tolerance and mental attention and these things can become depleted after a brain injury. So, if you were an energizer bunny with a DD battery before your injury, chances are your new batteries have been replaced with some AAA’s. This means that daily activities will take more time, more energy, and you will need to recharge sooner. So, considering this, do you really want to spend your valuable energy looking for stuff?

Consider that you have 10 units of brain capacity and energy when you wake in the morning. Every activity you have on your “to do” list takes one unit. Going for a walk, preparing supper, managing the laundry, responding to emails, attending an appointment, completing personal care, and having coffee with a friend all drain your battery. Some of these activities are necessary, some can be put off, and others are enjoyable. So what if you spend one unit of energy looking for your phone, keys, that bill that needs to be paid, your agenda, or those new runners you bought yesterday? What activity will come off your list when you have spent your energy to find something that with some organization would have taken you no time at all? Maybe you will call your friend to cancel, or order supper in again. Maybe the laundry will wait to tomorrow, or those emails will just keep accumulating. But this is unnecessary because you had the energy and cognitive ability to manage these things, it just became misdirected.

Often the focus of occupational therapy becomes helping people to organize their activities, their stuff or their time. Schedules and consistency are keys to helping people to understand the size of their battery and the amount of units each activity takes. This can be difficult when working with clients who did not need to be organized before an injury or illness, but the necessity of this following cannot be ignored. Even small steps to help people to be more organized can have a huge impact.

Helping clients with brain injury to become more organized can take many forms, depending on the client, the nature of their problems, and how they previously organized their stuff and their time. What I tend to witness is the time lost and sheer frustration that clients experience looking for cell phones, wallets and keys. Often, cell phones become used as a “second brain” assisting people to maintain a schedule and make appointments (calendar), remember things (task lists), have access to support systems (contacts, calls, text, email), and negotiate their environment (maps and GPS). If this gadget is so important, it is even more important that people know where it is. Having a catch tray by the front door, in their room, or a standard docking station can be helpful. Wallets and keys should also be left in a consistent location. I am sure we can all relate to that feeling of looking for our keys in their usual spot to find they are missing. But if you lack the ability to efficiently look for these, it could completely derail your day.

After the day to day items have a place, then we can work to simplify other spaces that are identified barriers to function. Perhaps the kitchen has become too cluttered to allow for efficient meal preparation, or the bills are piling up because these are lost in a stack of papers. In the world of insurance I find that clients become overwhelmed by paperwork and this results in missed appointments, nonresponse to time sensitive material, or failure to submit for expense reimbursement. Slowly, over time and with suggestions and tools (filing cabinets, labels, folders, a pen drawer!) clients become able to more efficiently spend their units of energy on things that are more important, or more fun and ideally, learn to transfer these strategies into other life areas independently – like work, school or parenting.

 

 

To read more of our articles on brain injury check out our section on Brain Health.

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Brain Injury and Executive Functions – When the CEO is on a Hiatus

Julie Entwistle, MBA, BHSc (OT), BSc (Health / Gerontology)

Brain injury awareness month continues…this stop: Executive Functioning.

Simply defined, executive functions are the capacities we require to achieve a goal. These are commonly referred to as the “CEO” of the brain because they provide people with the higher order processes that allow us to plan, organize, initiate and complete tasks successfully.

Practically, think about the last time you moved. Moving, as an example, is a simple goal of just wanting to relocate from one place to another. The goal is not the problem: it is the processes and thinking required to manage the transition effectively that can be difficult. Several months before moving you are searching for a suitable place, weighing the pros and cons of each location, checking your budget. Then you make the decision of where to move and you need to deal with your existing location. When do you need to notify your landlord, or when should you list your house? Then, months and weeks before you move there are calls to make to utility companies, mail to redirect, insurance to organize, movers to book and packing to do. What belongings are you moving? What should be sold, donated, discarded? The day of the move is chaotic, stressful, and exhausting. Then for months after you continue to unpack, move things around, find ways to arrange and store your stuff.

Really, your level of executive functioning, or your ability to delegate and enlist support for your areas of weakness, will determine the outcome of your move. So now imagine that you have a brain injury and as a result you feel the same sense of stress, fatigue and frustration with more simple daily tasks, such as planning a meal, sorting your mail, or scheduling your time. This is often how people with brain injury feel on a regular basis.

So, what can occupational therapy do to help? Well, the treatment for executive dysfunction is both broad and simple. It is broad because everyone experiences brain injury differently, and comes into it with varying levels of recoverability. It is simple because it merely involves taking a goal and breaking this down into component parts, manageable chunks, and smaller tasks within the whole.

Returning to the moving example, as an OT, assisting someone who has executive dysfunction with a pending move may involve making checklists with tasks and timeframes, and checking on progress frequently. Personally, I like to take a project approach: calling the goal “Operation Move” and mapping out – start to finish – the metrics for success. Perhaps in month one an “apartment hunting worksheet” is created to help the client summarize all the places they are looking at, the pros / cons, address, and list of questions that need to be answered (price, utilities included, length of lease etc.). Often I encourage my clients to use a smartphone to take photos of the options then we cross reference these and catalogue them to keep things organized. From there, the process continues with checklists for calls to make, addresses to change, ways to organize packing and management of belongings. Ensuring the client is responsible for follow-up via “homework” between sessions and holding them accountable for completion of this aids to developing independence. Really, the therapeutic goal is far more than just ensuring the client is able to move successfully. Rather, it is demonstrating a model and method that can be used for any future transitions, goals or tasks. This ensures success that is transferrable to other events at later dates.

Often, the above strategies are also helpful for people with other forms of cognitive impairment – not just ABI, but could include stroke, dementia, or degenerative neurological conditions that impact how the brain organizes, processes and works through daily tasks. Ask an OT – we know stuff!

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Brain Injury Awareness – The Caregiver

Julie Entwistle, MBA, BHSc (OT), BSc (Health / Gerontology)

We cannot (or should not) discuss brain injury awareness without spending time recognizing the family and friends that take on the caregiving role after someone they love has an injury of this nature. On June 9 I co-facilitated a workshop for caregivers of brain injury survivors. What a great event! Not only was this well attended, but the speakers provided an amazing amount of education, skills and insight into how to both cope, manage, and achieve success as the care provider of someone with a brain injury. I wanted to take a moment to highlight my personal takeaways from this event:

Everyone has a story. As someone who lost a brother-in-law to the effects of a catastrophic brain injury, I understand how telling our story – be it about loss, change, remorse, guilt, fear, or triumph can bring people together and has immense therapeutic benefit. Caregivers benefit from collaborating, talking, sharing, laughing, crying and growing together. Our health system needs to create these opportunities, or caregivers need to find ways to make this happen.

Grieve. In my undergrad I studied grief and loss and even worked in hospice. What I realized at our workshop, however, is that the permanence of death allows people to grieve their loss, achieve acceptance, and eventually move on. When dealing with survival from a traumatic event, however, grief is not always experienced as our loved one is still present, albeit different. Yet, our speakers emphasized the importance of grieving: the life that once was, the life that may never be, and the changes and adjustments that have occurred. Caregivers need to let this grief process happen, or should seek support from a trained professional to experience this important emotion.

Find a new normal. Clients, caregivers, and health care professionals need to always consider that the old “normal” may never return. In that case, we all need to collaboratively look ahead to creating a “new normal”. Different does not always have to be bad, and it requires an open and optimistic mind to think that way. For OT’s that means taking the abilities of the individual, considering their resources, and helping them to create that new life of function, fulfillment, meaning and productivity.

Put on your own oxygen mask first. We spoke extensively about the importance of caregivers taking the time to attend to their own personal needs, to have positive coping mechanisms and sources of support. Then, at break I was speaking with a man whose wife suffered a brain injury. He talked about the “airplane analogy” and how this applies to caregivers – put on your own mask before helping another. I smiled and told him that I wrote a blog on that exact topic, with that exact title last year. As he found that analogy practical and helpful, I thought I would share the contents of that previous blog here, to highlight this important third point:

Posted September 25, 2013

If you have ever travelled by air you are familiar with the drill. Instructions on how to buckle and unbuckle your seatbelt, where the life vest is located, emergency exits, and “should cabin pressure change, an oxygen mask will fall from the overhead compartment…passengers should always put on his or her own mask before assisting children, or a disabled passenger”.

I read a mommy blog the other day that called this the “airplane example” and the writer related this to how moms should approach motherhood. Ultimately the message is this: as a mom, put your own health first because you are useless to your kids and spouse if you ignore your own needs. Really, you can’t help a child with an emergency escape from a crashing plane if you pass out helping them with their mask.

While I do agree that mothers (and fathers for that matter) need to consider their own needs in providing for the family, this is also true of people that provide care to a disabled person. My experience is that often caregivers do not really “elect” that role. They are not trained to be a caregiver, and really just try to do their best with the skills and resources they possess. However, where many fall short is maintaining their own health and wellbeing in dedicating their physical and emotional time to another person: a person with challenging and multiple needs. The job of a caregiver is often 24 hours, and resources don’t often permit, nor does the government provide, sufficient relief from this responsibility. Caregivers are often sleep deprived, suffer from muscle and joint pain in fulfilling their role, and can become isolated and depressed due to the changes they have made to take on these new responsibilities. Sound familiar? This very closely mimics motherhood (especially for new moms).

The answer? Put on your own oxygen mask first. What can you do to breathe easier? What helps you to feel clear-headed, energetic and optimistic? What gives you that ability to stay positive, appreciate and take on your responsibilities with some enthusiasm? The answers are often different for all of us. In the end, figuring out how to wear your oxygen mask first requires you to be honest about your abilities and skills, to utilize the resources available, and to ultimately ask for help if this is needed.

And for us health care professionals? We need to be very careful of the responsibilities we place on caregivers. This is especially true in the medical community where we repeatedly discharge people into the care of family, without family really knowing what the responsibilities will entail. As health care providers our responsibility is always to the client, yet we need to take that extra time to check in with the caregiver, talk about how they are coping and managing and if needed, offer them an oxygen mask.

I hope the caregivers that attended our workshop felt that by spending a day focusing on themselves, expanding their knowledge, and learning the keys to success, that this was one step towards them being able to put their own mask on first. This was highlighted at the end of the day when the caregiver of a survivor, whose loved one was injured 13 years ago gave this advice: “If I could do it again, my priorities would be self, family, then my loved one with a brain injury”. What a great lesson for me to take forward in my practice.

For more posts related to brain injury please visit our Brain Health Archive.

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Concussions – Bungee Jumping Meets My Face

Julie Entwistle, MBA, BHSc (OT), BSc (Health / Gerontology)

Brain injury awareness month continues…next stop – concussions!

If you ask a crowd of people if they have ever had a concussion, about 1/3 will raise their hand. Direct hits to the head, and closed head injuries, are not uncommon in children and young adults, decrease in frequency in adulthood, but increase again in seniors. My last blog on prevention discussed the statistics and outlined that the most common causes are falls, motor vehicle accidents and sports.

Personally, while I didn’t know it at the time, my own concussion experience comes from a high school graduation trip where I decided (against my mother’s advice) to try bungee jumping. I was jumping over water and the goal was that I would dip my hands in the water as the rope became taught – just before it would fling me back into the air. They told me to “tuck my chin and close my eyes” as I approached the water “just in case” I get submerged. So, I am flying through the air, have no concept of distance to the water (it comes up fast when you are free falling), and think “oh I better tuck my chin and close my eyes” but of course doing so not only reduces the thrill of the experience, but causes you to become further disoriented. So, eventually I think I have missed the water and open my eyes, lift my head up to look around and SPLAT – smack the water with my face. Awesome. For the next few days I was in a bit of a fog, had some bruising around my eyes, and a headache. Soon after I developed vertigo – a condition I have been living with ever since. At the time, the word “concussion” was not the buzz word it is today, but I hindsight I think my bungee-face episode qualified (oh, and for the record my mom was only half right – she said I my ovaries would end up around my ears and they didn’t – four kids proved her reproduction theory wrong, but I guess vertigo proved her caution right).

The good news is that over the last few years the media has exploded the discussion of concussions and these are now strongly on health care, sports, and motor vehicle accident radars. The bad news is that I think many people have become confused by the lingo, types, symptoms, and management.
With the help of fellow Occupational Therapist Jayne May who has special interest and training in concussion assessment and management, we will do our best to provide some clarity as follows:

Concussion – a traumatically induced physiological disruption of brain function, as manifested by one or more of the following:

• Any period of loss of consciousness for up to 30 minutes.
• Any loss of memory for events immediately before or after the accident for as much as 24 hours.
• Any alteration of mental state at the time of the event (e.g., feeling dazed, disoriented or confused).
• Focal neurological deficit(s) that may or may not be transient (e.g., poor balance, blurred vision, headache).

Post-concussion syndrome – diagnosed 4 weeks after a concussion when 3 or more of the following symptoms remain: fatigue, disordered sleep, headaches, vertigo or dizziness, irritability or aggression, anxiety, depression or affective instability, changes in personality, apathy or lack of spontaneity.

Chronic traumatic encephalopathy (CTE) – a progressive neurodegenerative disease that is a long-term consequence of single or repetitive closed head injuries for which there is no treatment and no definitive pre-mortem diagnosis. It has been closely tied to athletes who participate in contact sports like boxing, American football, soccer, professional wrestling and hockey. The exact mechanism for CTE has not been precisely defined however, research suggest it is due to an ongoing metabolic and immunologic cascade called immunoexcitiotoxicity.

Second-impact syndrome (SIS) – when the brain swells rapidly, and catastrophically, after someone suffers a second concussion before symptoms from an earlier one have subsided. This second blow may occur minutes, days or weeks after an initial concussion, and even the mildest grade of concussion can lead to SIS. The condition is often fatal, and almost all people not killed by this are severely disabled (1).

With medical definitions aside, it is important to look at the clinical signs, and the ways that these can be managed through occupational therapy. To highlight what we experience as therapists, our clients with concussions or PCS often say:

• I have frequent headaches.
• I have pain behind my eyes.
• I find shopping difficult.
• I feel foggy.
• I am sensitive to light.
• Loud noises that never bothered me before now make me irritable.
• I can’t focus long enough to enjoy a movie, conversation, or to read.
• I feel sick when I am a passenger in a car.
• My balance is terrible and I bump into walls and furniture all the time.
• It takes me hours to fall asleep. I may get 4 hours of sleep a night.
• I am always tired.
• I feel like I am floating.
• I keep losing things, forgetting events, and missing appointments.
• I feel worse after I exercise or exert myself.
• Technology (computers, TV) bothers my eyes and makes my headache worse.

As you can see, these types of complaints and symptoms dramatically impact on someone’s ability to work, drive, go to school, manage daily routines, or even participate in social or leisure activities.

So, as occupational therapists, what do we do to help our clients through this? The first step is always education. Rest, rest and rest are so important to give the brain the time it needs to recover. Our job is to help people achieve the balance of cognitive and physical rest, while still helping them to manage their important life roles. This involves pacing education, trial and error, and tracking of activities so people can strike the right balance now, while increasing demands slowly as symptoms improve. Often, we are responsible for setting return to work / school / sports / fun guidelines for clients and employers, teachers, and parents.

We are also integral at helping to address the specific concussion and PCS symptoms that clients find so troublesome. This includes how to manage head pain (ice, rest, facilitate medical consults), noise and light sensitivity (noise reducing headphones, ear buds in public, dark glasses or shades or blinds in the house), dizziness / floating (suspenders, weighted vest, tight underclothing), memory strategies (smartphones, calendars, planners, lists, drop spots), visual changes (bi-nasal occlusion, vision therapy), fatigue (timers, sleep strategies, scheduling changes), to name a few.

The role of occupational therapy in helping people to manage concussions or post-concussion syndrome is becoming more and more recognized by both the medical and rehabilitation communities. So, if you are struggling to recover from a concussion, or insure or represent a client that has these problems and is struggling to participate in important life roles, consider occupational therapy for helping them to return to work / home / school / fun!

(1) Wikipedia

 

 

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P is for Prevention

Julie Entwistle, MBA, BHSc (OT), BSc (Health / Gerontology)

In recognition of Brain Injury Awareness month, I thought it would be fitting to start at the very beginning. PREVENTION. Really, it is the best medicine. For now, let’s forget about the symptoms of brain injury and its’ impact on work, home, school, and quality of life. Let’s not talk about how it is assessed and treated. Instead, let’s focus on trying to stop it from happening in the first place.

But even before that, we need to know what we are dealing with. It is well known that brain Injury is the leading cause of death and disability worldwide. In Canada, Traumatic Brain Injury (TBI) is more common than breast cancer, spinal cord injury, HIV/AIDS, and multiple sclerosis (MS) combined. There are approximately 18,000 TBI hospitalizations annually. In the province of Ontario, 25% of the two million people diagnosed with a neurological condition have suffered from a TBI. In 2000-2001 brain injuries accounted for $151.7-million in direct costs to Canadians (1).

By way of distribution, TBI is most common in children (0-19) at 30%, followed by seniors (60+) at 29%. In kids, falls are the most common cause followed by motor vehicle accidents and then sports. In adults, motor vehicle accidents cause the most TBI’s, and in seniors the causes include falls (76%) followed by car accidents (2).

Knowing the causes helps to look at how we can engage in preventative strategies. As an occupational therapist with a background in health promotion, a parent of four, and athlete, here are my thoughts:

Falls

Kids fall all the time, so how can we prevent that? Well, there is a difference between a child falling when walking, running or jumping, versus falling from, say, a shopping cart, off of a playground structure, or from a tree they tried to climb. Falls from bikes, skateboards and scooters are going to happen – and a helmet can mean the difference between a head injury and not. The bottom line is that falls in kids are best prevented by proper adult supervision. Yes, it is that simple.

In seniors, falls take on a different form. They are not from carefree or reckless behavior, but often happen when someone is just trying to go about their day by having a shower, coming down the stairs, or taking a leisurely walk. Seniors need to be attuned to the physical, balance and vision changes they are experiencing as they age, and need to consider the importance of anti-slip mats in the bathroom, removing scatter mats, installing grab bars or railings, and the benefits of a walking stick or cane when outdoors. Seniors need to engage in regular exercise and activity to maintain bone density, mobility and intact balance. They have to be very careful when living with pets or when trying to negotiate places that are cluttered or dark. Awareness of declining abilities is the first key to addressing these properly such that a prevention plan can be developed that will ultimately improve safety and reduce the risks. Note that the services of an occupational therapist can be pivotal in creating this safety plan.

Motor Vehicle Accidents

Like falls, despite our best intentions, these can and do happen. The issue here is trying to minimize the risk and optimize the outcome. Safe drivers are attentive, undistracted, and alert. They travel at safe speeds, approach intersections with caution, stop behind the line, pass when appropriate, and recognize that rushing to get somewhere on time is useless if it means you never get there at all. Safe drivers don’t text or hold a phone to their ear, don’t eat a hamburger and steer with their knees, and don’t drive when tired. If you are one of these drivers you are going to increase your chances of avoiding a collision, and lower your chances of being the cause. Unfortunately, however, not everyone is a safe driver. So, all the rest of us can do is wear our seat belt, buy a car with a good safety rating, make sure everyone in the car is buckled properly, make sure the headrest is at a proper height, put loose belongings in the trunk (I know of a child who got a head injury from a flying jar of pickles that escaped the grocery bag during a collision), and follow the rules for child seats.

Sports

I am an avid athlete and have pretty much played or tried every sport. There are very few sports I dislike and I honestly feel that sports can be the most positive and influential outlet for young people, and one of the most engaging and social outlets for adults. The issue is that sports seem to be becoming more and more competitive, kids and adults are getting bigger and stronger, and the culture of some sports has changed from friendly competition to all-out war. Preventing head injury in sport can include outfitting your kids with proper equipment (many hockey parents spend more on a stick than a helmet), ensuring they are playing at their level, monitoring the coaching influence and team culture to make sure this is appropriate, and my favorite is from the book “The Secrets of Successful Families” and includes that the only job of a parent in organized sport is to “shut up and cheer”. No parent should be on the sidelines encouraging reckless, mean or harmful behavior. The results can be devastating. And if you are concerned about your child’s risk of head injury in sport, know that there are many other sports that reduce the risk but are equally as challenging, competitive, fun and have the same physical, cognitive and developmental benefits.

So, let’s start our recognition of Brain Injury Awareness Month by practicing prevention. It does not have to be easier said than done.

(1) Brain Injury Association of Canada
(2) Canadian Institute of Health Information

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Spinal Cord Injury 101 – Julie’s Picks

Julie Entwistle, MBA, BHSc (OT), BSc (Health / Gerontology)

I think this is a great story.  My husband and I were in Orange County New York.  My husband was knocking “flying in a MIG” off his bucket list and I was there to watch (nervously).  The pilot of the MIG was telling us that the guy whose plane was in the neighboring hanger was an unassuming and humble Hollywood director with multiple Oscars.  Cool!  Well, just before take-off the director arrives.  Amazing!  He never comes on a Friday.  As my husband launches away at some crazy speed, I approach the director and tell him that I am a fan of his movies.  He is flattered and we enter into a conversation that he somehow turns into being about me.  When I tell him I am an Occupational Therapist he discloses that his son was recently diagnosed with a SCI after spinal surgery.  How awful.  I explained that this is actually my area of practice.  We spend the next hour talking about SCI and I filled him in on all the latest research from the Rick Hansen International Conference I had just attended.  I tell him about some of the great devices available, American organizations to talk to, and specialists in the field, and he gives me his personal email to send him links and to stay in touch.  He was elated.  He had no hope, no knowledge about his son’s condition, and didn’t know where to start.  I was shocked.  Shocked that a man with that kind of money, connections, and seemingly unlimited access to resources would not know where to turn, and more shocked that someone so famous found something I said useful.  Since then we have kept in touch by email and every once in a while I send him resources and magazines I think he will find helpful.  I am still blown away by that encounter, and definitely found that exchange more exciting than some plane that flies really fast.

According to Spinal Cord Injury (SCI) Ontario, there are 600 new cases of SCI in the province per year, and 85,000 people living with SCI across Canada.  Of new injuries, 42% are the result of trauma (falls, accidents, or violence), and 58% from non-traumatic causes (tumors, infections, diseases).  The extent of a SCI injury is classified by the resulting impairment, with tetraplegia (or quadriplegia) indicating that all four limbs and the trunk are involved, and paraplegia is when the trunk and legs are impacted but the upper extremities are not.  Contrary to popular understanding, quadriplegia does not mean “no use of the arms” it just means the arms are involved, and the amount of usage will depend on the level of injury.  The incidence of SCI is highest in adolescents and young adults from sporting injuries, car accidents and violence, then peaks again in seniors as the result of falls.

While the direct consequence of SCI is severe – mainly the inability to walk, bowel, bladder, and sexual dysfunction, and sometimes reduced use of the arms and hands, the secondary consequences can be just as devastating.  Physiological changes in temperature regulation and circulation, pressure sores from reduced sensation, weight gain, repetitive strain on the upper extremities as they become used for transfers and mobility, urinary tract infections, bowel issues, and of course the emotional side of adjusting to wheelchair use and reduced physical abilities are all common.

As a clinician with special interest in the field of SCI, spending the last 10 years of my career treating individuals with these problems, I have been able to gather a list of very helpful resources and equipment that most clients find useful.  In recognition of SCI Awareness Week, I wanted to share my top picks here.

Standing Wheelchairs – these chairs provide significant benefit to an individual with a SCI.  Allowing people to stand and bear weight through the legs is known to improve circulation and bone density, along with the added benefits of allowing someone to reach upper cupboards again, or to look people in the eye when talking (as an example, check out the Lifestand Helium chair online at http://www.permobilus.com/heliumls.php.

Free Wheel – for manual wheelchair users, terrain such as snow, gravel or sand can be difficult, if not impossible to manage.  The free wheel is a simple add-on that elevates the front wheelchair casters to make these terrains easier (http://www.gofreewheel.com/).

Smart Drive – manual wheelchairs can be difficult to use for long periods as our arms were never designed to be our source of mobility.  So, some people use a manual wheelchair indoors and for short distances, and a power wheelchair for longer distances and outdoors.  The Smart Drive bridges the gap between manual and power chair by providing a power-assisted method of propelling a manual chair.   This is helpful for long distances, up inclines, or to just get places faster. This is another simple add-on and only weighs 11 pounds making it easy to take on and off.  In Ontario it is also now approved by the Assistive Devices Program.  Check out http://www.quarthealthcare.com/index.php/smartdrive for more information.

Sensi-Mat – Pressure sores can be a significant problem for people with SCI as they lack feeling in their lower body that would normally tell them to shift their weight to relieve pressure.  Without pressure relief, areas of the skin can die due to lack of blood flow.  If not treated, the sore can bury deep into the skin and underlying tissue, become infected, and treatment usually involves sitting restrictions, significant bed rest, or even surgery to correct and cure.  The Sensi-Mat works to prevent pressure problems from occurring by providing the wheelchair user with data about their sitting patterns, including cuing about when to shift their weight.  If an ounce of prevention is worth a pound of cure, the Sensi-Mat is a must for all people with SCI.   This new product will be available in June 2014 (http://www.sensimatsystems.com/).

SCI University – This is an online resource created by people with SCI to help others understand how to manage the many aspects of this condition.  Covering everything from nutrition to catheterization, this is also a “must check out” anyone with a SCI (www.sci-u.ca).

Abilities Magazine – This circulation is packed with useful resources, inspiring stories, and solid examples of people with SCI who are achieving amazing things.  Each issue highlights things from travel to sports and work, and includes helpful tips for not only disabled people, but is also very informative for the general public and rehabilitation professionals (http://abilities.ca/).

People in Motion – this free show, held on the first weekend of June in Toronto is packed with vendors highlighting the many wonderful products that exist for people with disabilities, including those with SCI.  From vehicles to home accessibility and wheelchairs, this is worth the drive to Toronto (http://www.people-in-motion.com/).

Of course, no person will experience a SCI the same, and the recovery from this, and ability to function safely and independently following, will depend on multiple factors.  Custom problems need custom solutions so if you have a SCI considering contacting an Occupational Therapist with experience in your condition to get solutions for living!

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Turtle Twins (Part 2) – Treating Auditory Processing Disorder

Julie Entwistle, MBA, BHSc (OT), BSc (Health / Gerontology)

In my previous post I explained that auditory processing disorder (APD) is like a game of “Operator” where a message is misinterpreted when travelling between the ears and brain.  This causes problems with communicating in noisy environments, following multi-step instructions, and wrongly hearing words, sounds and sentences.    The good news is that APD can be improved organically and through modifications to the functional environment.

Personally, my daughter was diagnosed in Grade 3 (age 8).  To understand her problems, I read several books on APD and copied some chapters for family.  I disclosed fully to my daughter the results of her testing and explained that sometimes her ears and her brain are hearing different things.  I wanted her to understand that at times, when things people say might seem funny, confusing or strange to her, she might have heard them wrong.  She was encouraged to ask questions about her ADP, and to never be shy about asking people to repeat themselves if needed.

At school, the teacher started wearing an FM unit to help best deliver instructions and teachings to my daughter who wore corresponding headphones.  The teacher and I put tennis balls on the classroom chairs to reduce noise.  My daughter was relocated near the teacher’s desk and away from the busy hall.  The door was closed (reducing background noise) during lectures.  She was allowed to write tests in the quiet resource room.  The teacher was provided a list of other classroom modifications to implement, including ways to breakdown instructions into smaller chunks to improve her retention and follow-through.  I talked to the teacher about the fact that when my daughter was reading in class (when she was supposed to do other things) to tune out classroom noise and / or because she missed the directions.

In sports, we noticed an issue with her playing basketball.  The sound of the balls bouncing on the floor made it difficult for her to hear her coach and the background noise in the gym during practice was a struggle for her.  At Karate, she would look around to see what the other kids were doing as she would miss instructions.  All of her coaches and Sensei’s were advised of her APD and started speaking more directly to her, asked her to repeat instructions, and tried to reduce background noise when possible.

We also made changes at home.  We took extra time to reduce background noise (difficult in a family with four kids), would reduce the number of instructions we gave her at one time, had her repeat these back to us, and developed a “roger that” mantra that she would say to indicate she got her instructions.  Our audiologist recommended Fast Forward, an online game designed to help improve APD.  While research does not conclusively confirm that this is helpful for APD, we decided to give it a try and she found it very helpful.  Ultimately, and for reasons other than just her APD, we moved her to a small school with very low class sizes and she is now thriving.  We still notice her APD at times, but she is very aware of this and is mature enough to understand that if something sounds wrong (i.e. turtle twins) she should politely ask for clarification.

 

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Turtle Twins (Part 1) – Auditory Processing Disorder

Julie Entwistle, MBA, BHSc (OT), BSc (Health / Gerontology)

In recognition of Speech and Hearing Month, I wanted to tell the story of my personal experience as a mom of a child diagnosed with auditory processing disorder (APD).

APD is best explained using the example of the game “Operator”.  If the first person is the ears, and the last the brain, everyone in between is the channel by which the message travels.  And remember what happens?  By the time the message reaches the “brain” it has been altered.  So, really APD is just that – when a message or sound changes as it travels from the ears to the brain resulting in the brain getting the wrong message.

Signs of APD can include difficulty with: communicating in noisy environments, following multi-step instructions, and wrongly hearing words, sounds and sentences.  As an overlap exists between the signs of APD and other disorders, and this may coexist with other problems, it can be difficult to diagnose.

Being a clinician, I recognized early that my daughter struggled with “hearing”.  Yet at 18 months her hearing test was “fine”.  When she was three I remember telling her that her “ears and brain were not talking”.  In school she would become easily distracted, would struggle with multi-step instructions, and did much better in classes that were smaller, less chaotic, or when she sat closer to the teacher.  At home the presence of her APD was apparent when my instruction “change your shirt” would be met with the response “I am not wearing shorts”.   Or, when the instructions “brush your hair, grab your lunch and put your coat on” might result in one, maybe two, but rarely three of those instructions being followed.  But my favorite remains when my daughter told her sisters they were “turtle twins” as she had misheard the word “fraternal”.

The diagnosis of APD is made by an audiologist when the child is at least 7 or 8 years old.  However, psycho-educational tests can also be helpful to rule out other or comorbid problems.  In adults, APD also exists, and can be the result of many factors, including acquired brain injury.  Also, some research suggests that men start to struggle with APD after age 35 and women after menopause.  My next blog will focus on ways we managed our daughter’s APD at home, in sports and school, and these same strategies could also be used by others who have, treat, or know someone with APD.