TBI What Now?

Dresser Organization

Some TBI patients experience a variety of physical limitations. Recently our family came up with an idea that proved to be a big help and making it much easier to deal with clothing retrieval from a dresser for a wheelchair bound person. Instead of folding clothing in a traditional flat folded way, we decided to fold clothing in a rolled manner. This allows for clothing to be placed in the dresser drawers next to each other, not on top of each other, making selection and retrieval much easier for a physically handicapped person.

PROVIDER INFO - TRANSFERS

Some individuals with severe traumatic brain injuries need assistance in many ways. For those of you that provide help, first of all, thank you!!!!!

Many of us providing help and assistance are not trained professionals and learn through taking classes, watching videos, and talking to medical professionals.

There are a variety of ways transfers can be achieved, with or without assistance from the injured. Here are some videos that we found very helpful in the beginning, so I thought I'd share. You can also find more information at Tbiwhatnow.com.

Chronic Traumatic Encephalopathy (CTE)

What is CTE? It is a brain disorder likely caused by repeated head injuries. It can cause nerve cell death in the brain, called degeneration. CTE gets worse over time. Unfortunately a definite diagnosis is currently not only possible with an autopsy. The disorder is not well understood at this time. It is thought that the impact of a head injury happens prior to the healing of a previous head injury. CTE has been found in brains of football players, boxers, and military personnel exposed to explosive blasts. Symptoms include trouble with thinking, emotions,as well as physical problems. It is thought that the problems arise years to decades after the actual trauma occurs. Researchers are working on developing diagnostic biomarkers, but none have been validated so far.

Since there is currently no definitive diagnosis during life, experts have developed clinical criteria for traumatic encephalopathy syndrome (TES). This diagnosis is used for individuals who are at high risk due to repeated head trauma.

If you'd like to learn more about this condition, you can go to

Chronic traumatic encephalopathy - Diagnosis and treatment - Mayo Clinic This type of brain degeneration is likely caused by recurrent concussions, but the disorder isn't well understood.

OCCIPITAL LOBE DAMAGE

If you look back at the previous post titled “The Brain” (2/21/2024), you can see where the Occipital Lobe is located (in the rear portion of the cerebral cortex). Brain injuries affecting this area often lead to vision problems as well as processing information obtained through vision (space for example). From the occipital lobe information is obtained by the dorsal and ventral streams. The ventral streams supply information to the temporal lobe. This lobe is responsible for interpreting information related to object form, color, size, and recognition. So, if information can not be properly obtained by the occipital lobe, the temporal lobe cannot determine these facts. The dorsal stream sends information to the parietal lobe, where information is also further processed. As one can see, all of these interactions are closely related. CT or MRI scans can often assist in determining precise brain damage.

Symptoms of Occipital Lobe Damage:
• Not being able to interpret what is being seen (a pencil may
look like a toothbrush for example).
• Partial Blindness – Hemianopsia – Vision loss of half of the
visual field, horizontally or vertically
Quadrantanopia – Vision loss of a quarter of
the visual field.
Peripheral - Vision loss of outer edges of
visual field.
Central – Vision loss of the middle of the
visual field.
• Word Blindness (Alexia) – An inability to read or recognize
written words.
• Color Agnosia – Loss of color knowledge (not to confuse with
color blindness)
• Motion Blindness (Akinetopsia) – Inability to perceive motion
in the visual field, might see motion as a series of still images.
• Simultanagnosia – Involves identifying parts of the visual field
at a time and not seeing it as a whole. Individuals may only see
one object a time. (for example: Looking at the house, they
may only see the door). A person might also have difficulty
reaching for an object, even though they see it. Individuals may
also suffer from not being able to move eyes in a coordinated
way.

Treating these issues involves text-to-speech software, and learning new body techniques to scan the environment. These exercises can stimulate the brain to rewire itself to improve vision (neuroplasticity). Neuro-optometrists, vision rehabilitation therapists, and occupational therapists have specialized skills in dealing with vision impairments and can help in many ways.

To download the “Vision Problems After Traumatic Brain Injury” fact sheet by msktc.org, you can go to Tbiwhatnow.com and obtain it from the resource tab.

Do you, or do you want to use a service animal to assist with a disability? The rules and regulations surrounding this topic are often misunderstood. And while dogs make great companions for a disabled person in many ways, here are some basic guidelines to consider.

SERVICE ANIMALS

Animals that can be a service animal are:
• Dogs only
• Any breed and any size of dog
• Trained to perform a task directly related to a person’s
disability.

Owners of Service Animals are not required to:
• To be certified or go through a professional training program.
• To wear a vest or other ID that indicates they’re a service dog.

Emotional Support or Comfort Animals of any kind are NOT considered “Service Animals”.
• Because of providing emotional support or comfort, and this
is not a task related to a person’s physical disability.

Examples of Service Animal Tasks
• A person who uses a wheelchair may have a dog that is trained
to retrieve objects for them.
• A person with short-term memory loss may have a dog that is
trained to perform a task to remind them to take their
medication.
• A person who experiences seizures may have a dog that is
trained to detect the onset of a seizure and then help the
person remain safe.

Where may Service Animals Go?
Generally, service animals are allowed to be with their person, even in places that don’t allow pets. For example, service dogs can go into:
• Restaurants
• Shops
• Hospitals
• Schools
• Hotels

This rule also applies to certain types of housing, including:
• Housing at public and private universities.
• Public housing programs run by state, county, and city
governments.
• Emergency shelters.

Other Laws that Apply to Housing:
The Fair Housing Act applies to many types of housing, both public and privately owned, including housing covered by the ADA. Under the Fair Housing Act, there may be different rules that apply when a resident or applicant with a disability uses a service animal or other animal to assist with their disability. The U.S. Department of Housing and Urban Development is responsible for administering the Fair Housing Act. Learn more at the U.S. Department of Housing and Urban Development or contact your Regional Fair Housing and Equal Opportunity Office.

Other Laws that apply to Airplanes:
The Air Carrier Access Act, not the ADA, protects the rights of people with disabilities in air travel. For information contact the U.S. Department of Transportation, Aviation Consumer Protection Division: 202-366-2220.

Other laws that apply to Employment:
The Equal Employment Opportunity Commission (EEOC) is responsible for administering the ADA in employment settings.

What Qualification Questions can be asked?
If it is unclear to a business or state/local government facility whether someone’s dog is a service dog, the following questions may be asked:
• Is the service animal required because of a disability?
• What work or specific task has the dog been trained to
perform?

A business or state/local government does not need to allow a service animal if the dog’s presence would fundamentally alter the nature of the goods, services, programs, or activities provided to the public.

State/local governments can:
• Require service dogs to be licensed and vaccinated, if all dogs
are required to be licensed and vaccinated.
• Offer voluntary service dog registration programs.

For more specific information, visit the ADA.gov (Americans with Disabilities Act) website. https://www.ada.gov/topics/service-animals/.

The Brain:

Let’s get a quick overview of the brain. Understanding a little bit about how the brain functions can help with understanding how to overcome TBI obstacles.

The brain, sometimes called the “Master Organ”, connects to the spine and is part of the central nervous system (CNS). Various parts of the brain are thought to be responsible for personality, physical abilities, breathing, and critical processes of the body. Think of the brain as the body’s command center.

Traumatic brain injury can be caused by a serious jolt to the brain or a stroke. In some cases, it can cause brain death. This is when a person cannot regain consciousness.

Anatomy of the brain :

CEREBRUM - Includes the cerebral cortex. Responsible for controlling movement, thinking, emotion, problem solving, and learning.
CEREBRAL CORTEX - Has 4 lobes:
FRONTAL LOBE: Language, motor function, memory,
personality, and other cognitive functions.
TEMPORAL LOBE: (Wernicke area) Understanding
language, memories, emotions, hearing and visual
perception.
PARIETAL LOBE: Processes what is seen and heard.
Interprets sensory information.
OCCIPITAL LOBE: Interprets visual information and
contains the visual cortex.
CEREBELLUM - Called “Little Brain”. Regulates balance, learned movements (walking, fastening buttons, etc.) The cerebellum is highly affected by alcohol or drug use.
BRAIN STEM - Has 3 parts:
MID-BRAIN: Coordinates hearing and movement.
Formulates response to environmental change (hot/cold)
and potential threats (being attacked/stalked).
PONS: Enables bodily functions (tears, blinking, focusing,
facial expressions … )
MEDULLA: Regulates biological functions essential for
survival. (Heart rhythm, blood flow, breathing.) Detects
changes in blood oxygen and carbon dioxide levels and
causes reflexes like vomiting, swallowing, can coughing.

Now that we know a little bit about the brain, it becomes clear why TBI can affect many different areas of the body depending on which part(s) of the brain were damaged.

For a good view of the brain that allows to see it in layers, click on this link (Medical News Today website). https://www.medicalnewstoday.com/articles/brain

Also helpful is the "GCSE Biology - The Brain #30" video on YouTube. https://www.youtube.com/watch?v=jvIr7b0roYI

Left Side Brain Damage:

Depending on what area / areas of the brain are affected will impact TBI recovery. Left side brain damage can lead to difficulties with language, speech, and reasoning skills. Learning about left hemisphere brain damage can help you to identify complications and seek early interventions to maximize your outcome. Here are some specific examples of functions controlled by the left side of the brain:
- Logic and reasoning
- Number skills
- Analyzing
- Language and speech
- Right-side body movements
- Sequential thinking
A previous post explained a little about Aphasia, which can be prevalent with left-side brain damage, but it can go further than that. It can also manifest itself in speech related Apraxia (lack of facial muscle control), Dysarthria (weakness of the mouth and tongue), Dysphagia (inability to swallow and control muscles used for speech), Right-side Hemiparesis (loss of movement control on the right side of the body) and Sensory Loss. .
Cognitive deficiencies from left hemisphere damage will manifest themselves by the way of concentration problems, memory issues, ability to gather and sort information, prioritizing, as well as being able to plan ahead.
The good news is that the brain possesses a remarkable ability to change and adapt. We know this process as neuroplasticity. This enables the brain to create new ways to complete tasks previously known to it.
To combat the effects of this type of brain damage it is important to understand Left Hemisphere Injury and to follow through with speech therapy, physical therapy, occupational therapy, constraint-induced movement therapy (focuses on the affected side of the body). Persistence can bring progress. Many exercises for both cognitive and physical therapy can be managed at home to create a complete therapy program in addition to professional therapy. For at-home therapy ideas, check out the resources at Tbiwhatnow. com.

TBI and Behavior Changes:

Individuals with moderate to severe TBI often experience behavior changes after their injury. These changes usually manifest themselves by having problems with managing emotions, being restless, problems with social behaviors, refusing to do things, feeling unmotivated, and difficulty with starting tasks. The good news is that behavior changes can get better over time.

Experiencing these problems can be taxing for the injured person as well as caregivers. TBI can cause problems with thinking skills and impulse control. There is also the fact that often individuals facing the everyday frustrations of TBI related issues experience depression, as they feel a sense of loss.

To help with behavior changes it is recommended to follow the "A-B-C" method of therapy. A = Antecedent, B = Behavior, C = Consequence". This therapy advocates to recognize what causes the frustration before it causes a behavior problem. If you need help with this issue, it would be advisable to seek help from a counselor trained in TBI behavior issues. For more information you can also visit Tbiwhatnow.com. Of special interest would be the "Behavior Changes and TBI" fact sheet on the Resources Tab, by TBIMS, and the Tab that discusses the stages of TBI recovery (Rancho Los Amigos Scale).

My personal advice is "patience" and "consistency".

If you have experience with this issue, send a note from the email tab of the Tbiwhatnow.com website, or email [email protected] to share. Insights are always great to encourage others. If you follow this page, you can also comment here.😉

Aphasia:
Loss of ability to understand or express speech, caused mostly by brain damage to the frontal lobe.

Regaining the ability of proper speech can be problematic for some individuals with Aphasia. Speech therapists and pathologists can help develop therapy for individual needs. But there are also many self-help guides available by professionals that can enhance the effectiveness of the therapy when used in addition to professional sessions. To enhance speech, home therapy involves completing worksheets that include word drills, synonyms, antonyms, homonyms, rhyming, nouns, and sentence completion. On the cognitive level it involves question and answer worksheets, and analogies. Due to the fact that many affected by Aphasia also deal with short-term memory loss, home therapy can also include worksheets that can work with this issue.

The Cleveland State University offers the downloadable "A Workbook for Aphasia" by Cat R. Kenney at no cost in PDF format. It offers 116 pages of a variety of worksheets and memory exercises as the ones described above and provides a valuable resource.

The workbook can also be obtained on the "Resource Tab" at Tbiwhatnow.com

TBI and Exercise.

With serious TBI it is often difficult for individuals to remain limber. Paralysis or Spastic Paralysis can be hard to deal with. Exercise to the best of ones abilities is always recommended by medical professionals. Low impact is the key. I posted a new "At-Home Physical Therapy Exercises" pamphlet on the website (Tbiwhatnow.com) created by MDA. Though created for Spinal Muscular Atrophy, the atrophy problems faced by TBI patients is very similar. This pamphlet has some excellent exercise ideas that might help, if you are dealing with this issue. Many of the exercises are the same as those advocated by physical therapists when dealing with atrophy caused by TBI mobility issues. Check it out! 🤩

TBI What Now? | Traumatic Brain Injury (TBI) Resources. Traumatic Brain Injury. TBIWhatnow.com. - Research and Information (TBI) Resources. - My Site

Brain Injury and Fatigue. Many that suffer from TBI report struggling with fatigue. It is believed that this due to the fact that the brain has to work harder to overcome inefficiencies and changes to brain structures caused by TBI. Scientists are still learning how to understand all of the reasons as to why this happens.
It is recommended to keep a regular sleep schedule and to go to sleep / awaken the same time every day to assist the brain to recognize a rhythm. 30 minute breaks or naps are a way to refresh during the day. Drugs and alcohol distort brain function and make fatigue worse. Only use medications as prescribed and discuss problems with a doctor.

Find more information at

TBI What Now? | Traumatic Brain Injury (TBI) Resources. Traumatic Brain Injury. TBIWhatnow.com. - Research and Information (TBI) Resources. - My Site

Atrophy -- Atrophy can be a major problem when TBI causes a lack of mobility. Much of it can be lessened by exercise as well as massaging affected areas. Therapists can share specific exercises, but there are many general exercises that are recommended overall. Patients and caregivers can check out info on this subject on the website. (Tbiwhatnow.com).

Atrophy is muscle decline due to non-use. Common with spastic paralysis caused by TBI.

tbiwhstnow.com

What is the Rancho Los Amigos Scale?
This is a 10-point scale used by medical professionals and rehabilitation providers to measure cognitive recovery after a traumatic brain injury. Each of the 10 stages is identified by specific cognitive behavior.

Also see

TBI What Now? | Traumatic Brain Injury (TBI) Resources. Traumatic Brain Injury. TBIWhatnow.com. - Research and Information (TBI) Resources. - My Site

Here is an idea to help with spastic paralysis in toes. Toes often curl into each other which can be painful, especially when exercising. Some relief might be possible by wearing a thick silicone toe separator. The ones that allow for toes to be inserted into a round hole, and which provide a thick layer of silicone on the bottom and on the top of the toes seem to work well for some experiencing this problem.

You can also make your own pillows for spastic hands. Use bubble packing for stuffing. Sew a tube that ends up to be about 6 inches all the way around and about 5 inches long. Roll the bubble wrapping (bubbled mailing bags work well also and you may get them for free from items you ordered) and stuff the tube, sew shut. Voila!

New idea for spastic paralysis in hands. Saw these at Dollar Tree and they are actually dog toys. But they work great for keeping fingers from curling up, and they are fun.