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Tag Archive for: brain injury

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Brain Injury: Caring for 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. A few years ago 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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So I Guess Your Kid Doesn’t Wear a Seat Belt Either?

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

I get very confused when I see children riding bikes without helmets.  Over the last many years the safety benefits of a helmet for biking, skiing, skateboarding, ice skating (and many other sports) has been well studied.  Research shows that helmets can be extremely effective in preventing head injuries and ¾ of all cycling fatalities are the result of head trauma.  You don’t even have to hit a car or tree to sustain a head injury – the ground or even your handlebars are often enough.

The laws in Ontario are clear:  since October 1, 1995 anyone under the age of 18 is required to ride a helmet on a road or sidewalk (http://www.toronto.ca/cycling/safety/helmet/helmet_law.htm).  Based on an increasing number of adult cycling deaths by head injury, it is likely that this law will soon be extended to adults as it is in other provinces.

So, considering the laws and the well-publicized risks, why are children (including young children) still seen riding bikes without helmets?

As adults, I recognize that we were not raised to wear helmets.  Adopting this practice has been difficult as we find it unnatural, maybe uncomfortable, and probably uncool.  However, most of us likely wear seat belts when in a vehicle.  Why?  BECAUSE WE WERE RAISED THAT WAY.  Seat belt laws in Ontario were passed in 1976 and so many of us were raised in the era of this as mandatory.  Many of us probably don’t even have to think about our seat belt anymore as it is part of our regular “get-in-the-car” routine and we feel naked and exposed without it.  We need to apply the same concept of “normal” to our children regarding helmets. 

There are two main reasons why children need to wear helmets. 

1. They are safe and have been shown to save lives and reduce disability.

2.  IT IS THE LAW.

As a parent, by not requiring that your child wear a helmet on their bike you are not only putting them at risk, but are also teaching them that laws don’t matter.  And I am not talking about the diligent parents whose children leave the house with a helmet on, to later have this on their handlebars or undone on their head.   I am mostly talking about the young kids in my neighbourhood who are out on their bikes without helmets, often under the supervision of their parents, and are thus not being taught that helmets are law, mandatory, and safe.

I am going to hazard a guess that no parent would put their child in a car without a seat belt.  Heck, child seats are also law and until a certain age, these are five-point and offer more protection than the adult restraint.  So, for the same reasons you put your child in a seat belt (protection and law) you need to ensure they are wearing a helmet for biking (skating, skiing, skateboarding).  And lead by example – get a helmet for yourself and model the appropriate behavior.  And be firm: no helmet should equal no bike.  No discussion.

 

Previously posted June 2016

 

Summer Programming Note:

Summer vacation is here and we will be taking a break from our regular schedule.  We will be posting some of our popular seasonal blogs just once a week throughout the summer but will resume our regular three weekly posts in September, filled with new and exciting content including our popular O-Tip of Week series.

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Brain Injury Recovery O-Tip of the Week: Set Reminders

Our O-Tip of the week series we will be providing valuable “OT-Approved Life Hacks” to provide you with simple and helpful solutions for living. 

June is Brain Injury Awareness Month.  Occupational Therapists are a vital part of a team of professionals that assist with the rehabilitation from brain injury.  Therefore, for the month of June, our series will be providing solutions to assist with some of the common cognitive deficits that can result from brain injury. 

Take advantage of the helpful technology that surrounds us!  Setting a timer on your phone, smart home device, watch, stove or kitchen timer can help you to remember to pause and check in with yourself, preventing you from overexerting yourself.  Smart home devices like Google Home and Amazon Echo are great as you can ask them to remind you of certain things like when to take a break, upcoming appointments, when to take medications, and more.  

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Cognitive Strategies Following ABI

People with an Acquired Brain Injury, or ABI, often have issues with memory or other higher-level brain activity after their injury, and suddenly, completing daily life tasks becomes very difficult. They may struggle with things like remembering names and faces, the things they need to do in a day, or they may even forget or lack insight that they even have an ABI.

Occupational Therapists have the skills to get many people with brain injuries back to everyday life!

Learn about some of the strategies Occupational Therapists use to help those who have suffered an ABI in the following episode from our OT-V series, Acquired Brain Injury – Cognitive Strategies.

 

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Brain Injury Recovery O-Tip of the Week: There’s an App for That!

Our O-Tip of the week series we will be providing valuable “OT-Approved Life Hacks” to provide you with simple and helpful solutions for living. 

June is Brain Injury Awareness Month.  Occupational Therapists are a vital part of a team of professionals that assist with the rehabilitation from brain injury.  Therefore, for the month of June, our series will be providing solutions to assist with some of the common cognitive deficits that can result from brain injury.

Remember the old Apple commercials… “There’s an app for that!”  Well, isn’t that the truth.  You can find apps for just about anything, and in fact, there are some great apps that can assist with memory and cognition for those who are recovering from a brain injury.  Some of these apps are summarized below:

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Brain Injury Recovery O-Tip of the Week: This Handy Device Can Help You Find Your Keys

Our O-Tip of the week series we will be providing valuable “OT-Approved Life Hacks” to provide you with simple and helpful solutions for living. 

June is Brain Injury Awareness Month.  Occupational Therapists are a vital part of a team of professionals that assist with the rehabilitation from brain injury.  Therefore, for the month of June, our series will be providing solutions to assist with some of the common cognitive deficits that can result from brain injury. 

This tip definitely does not only apply to those recovering from brain injury… If you’re someone who is always misplacing your keys and/or wallet (or other items) this helpful piece of technology is for you!  Tile is a small Bluetooth tracking device you can attach to a keychain, slip into your wallet or attach to anything you frequently have to search for.  This device syncs with an app on your smartphone that will allow you to easily locate your items when in need – saving you a lot of time, effort and frustration!

Learn more here: https://www.thetileapp.com/en-us/how-it-works

 

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Treating Executive Dysfunction: There is No “One Size Fits All”

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

As a caring professional, I refuse to believe that my clients are not motivated.  All of my clients have goals or I would not be treating them.  However, their ability to achieve their goals independently remains the reason that they require active therapy.  Previously, I wrote about executive functioning (Brain Injury and Executive Functions – When the CEO is on Hiatus), the capacities we require to achieve a goal, and used the example of moving to highlight how people with executive dysfunction may feel on a regular basis when completing relatively simple tasks.

Treatment for executive dysfunction is as broad as it is specific.  It is broad because everyone experiences brain injury differently and comes into that type of trauma with varying levels of ability to start with.  However, treating problems with executive function is really as simple as taking a goal and breaking this down into component parts, manageable chunks, and smaller goals within the whole.

So, returning to the moving example, assisting someone with executive dysfunction with a pending move will involve making checklists, with time frames, 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 a 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 the lease, etc.).  Often I encourage my clients to use a smartphone to take photos of the options then we cross-reference these and catalog 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 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 transferable to other events at later dates. 

 

Previously posted June 2013

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Brain Injury Recovery O-Tip of the Week: Create a Medical Appointment Notebook

Our O-Tip of the week series we will be providing valuable “OT-Approved Life Hacks” to provide you with simple and helpful solutions for living. 

June is Brain Injury Awareness Month.  Occupational Therapists are a vital part of a team of professionals that assist with the rehabilitation from brain injury.  Therefore, for the month of June, our series will be providing solutions to assist with some of the common cognitive deficits that can result from brain injury. 

Recovering from a brain injury, or injury/illness of any kind, often means frequent meetings and appointments with numerous healthcare professionals.  From Occupational Therapists to Physiotherapists, Family Doctors to  Neurologists, it can be difficult for individuals to keep straight who said what, let alone be able to share this information with family and/or caregivers who need to know.  We suggest using a single notebook that has dividers so a section for each healthcare professional can be created.  This book should be taken to each appointment and the important information can be recorded.  This will help keep the patient and their loved ones organized and informed.

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The Importance of Hope

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

June is Brain Injury Awareness Month.  For many who suffer a brain injury the road to recovery is long and filled with many twists and turns along the way.  I wanted to post this popular blog post as a reminder to not give up hope, no matter how difficult the journey may be.

A friend asked me to visit a colleague of his who was in the hospital following a spinal infection.  The spinal infection and resulting surgery caused paralysis and the gentleman was told he will not walk again.  During our visit we spoke of the non-profit organization “Spinal Cord Injury Ontario” and the client’s wife told me the story of their first meeting with a Peer Support volunteer.  She recalled that the volunteer (a paraplegic) entered their room and introduced himself.  The wife politely thanked him for coming but told him they would not need his services as they strongly believe that her husband will walk again.   The volunteer’s answer was brilliant – he told them that even though it has been years since his own accident, he too has not given up hope that one day there will be a cure for paralysis.  He explained that he keeps himself in great shape as to always be prepared for that day.  He told my friend’s colleague to never give up hope.

This conversation reminded me that hope is essential.  As a health professional, I realized early that one of the key roles I play in the lives of my clients is to foster hope.  Hope for a better future, for a solution to their current problems, and for a better way to manage.  Even just discussing problems and brainstorming solutions elicits hope.  Health professionals should never undervalue the importance of fostering hope – even if that is in the face of one huge challenge after another.  Where hope becomes dangerous is when people are so busy waiting for “the cure” that they forget to manage in the meantime.  Hope, like goals, is essential to survival, but so is survival in between.  To forgo opportunities, solutions and help in the hopes of a future “fix” will only cause secondary problems that may be larger than the initial problem in the first place.

This philosophy is supported by most Chronic Pain Programs – they will not admit people to participate if that person is banking on a surgery, medication, or other therapy to “fix” them.  Some problems are chronic, and learning to manage with the trials of life despite the problem is the only therapy.  This should not squish hope – but rather should allow hope to live and breathe among optimal function.  

I always try to remain hopeful.  Hopeful for a better world for my children, for resolution of pain and suffering for my clients, for the health of others, and for my industry to remain a place where injured people can be adequately supported during their recovery.  But I recognize that it is not always easy to feel hopeful.  So, if you ever find yourself running on empty in the hope tank, try calling a supportive friend or family member, looking online (or on this blog) for inspiration, watching a funny or uplifting movie, getting some exercise, changing your scenery, or seeking support from a health professional.  We are here for hope and help. 

 

Previously posted July 2013

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A Place Called Vertigo

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

I am not sure what the word “vertigo” refers to in U2’s hit song, but as someone living with vertigo, I can tell you it is not a place you want to be.  Vertigo is highly unpleasant and can be caused by multiple factors including visual or auditory problems, or more commonly, head injury.  I best describe my vertigo as my eyes and ears sending different messages to my brain regarding the position of my body in space.  So, while my eyes tell me I am sitting still in a chair, my ears tell me I am on a boat in the middle of a hurricane.  The result of these mixed messages is spinning, nausea, dizziness, problems walking, and ultimately dysfunction.

For me, my benign positional vertigo (BPV) lives in my right ear.  As a result, I cannot lie on my right side, laterally flex my head to the right, lie flat with my neck extended, or look down into extreme flexion.    While I can tolerate these movements momentarily, I cannot hold these positions for more than a few seconds otherwise I am sent into a spin that can last for days.  I am fortunate to know my triggers and do my best to avoid them (no yoga for me).  I have also learned, after living with this problem for two decades, how to catch my symptoms early to prevent a slight episode of dizziness from turning into days of bed rest.

When my clients experience vertigo and describe this to me, I can fully appreciate where they are coming from.  The story is a book I too could write.   But, like other “hidden” ailments, I get concerned when the medical community does not take this complaint seriously.  This is especially true in my industry where insurers and their assessors often want “proof” of a health problem to support someone’s recovery. While I recognize that people can be dishonest, my experience is that people don’t make this stuff up.  Health professionals need to give people the benefit of the doubt, including insurance situations. To understand, or better yet, support someone with any “invisible” problem like vertigo, health professionals need to be compassionate and should care enough to listen, to research and learn, and ultimately believe.  Empathy, TRUST, and understanding will go a long way to support those that need it. I can only imagine how frustrating, devastating and angering it would be for someone to assume or opine that my “place called vertigo” is not a place at all: because, believe me, I live here.

 

previously posted August 2013