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Archive for category: Brain Health

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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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Daily Dose of Inspiration

Brianna suffered a traumatic brain injury at a very young age and was told she would never be able to do the things other kids can do like read, write or even ride her bike. But, like many determined people recovering from something traumatic, Brianna proved them wrong. She has now dedicated her life to helping others who

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have suffered a TBI. See her story here.

 

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Use Your Head: Keep Kids Safe on the Playground

Remember this? If you do, you were probably a kid in the 70’s or 80’s. I remember hanging on for dear life as some teenager would try to spin us so fast we would become sick or fly off at record speeds. I can only imagine the injury rates that prompted the removal of these from playgrounds.
As parents, we all have a different “danger zone” with our kids. Yet, there is a balance between letting them play recklessly and engaging in the new trend of “dangerism” where we are preventing our kids from taking risks – risks that can be so important to healthy growth and development. Playgrounds are a great source of physical exertion and outdoor exploration, but can also be unsafe. Playground injuries account for over 28,000 injuries per year in Canada (Parachute Injury Prevention) and that while many kids suffer only minor injuries, approximately 10% are hospitalized for a more severe injury often involving the head. So, how do we let our kids enjoy the playgrounds, have fun with friends, and explore independently while still keeping them safe? Check out the following from “Caring For Kids” to learn more about playgrounds safety tips.

Caring for Kids:

Playground Safety

 

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Feed Your Brain

How do you fuel the most important organ in your body? Research shows that a diet low in fat and cholesterol, filled with antioxidants from fresh fruits and vegetables, and omegas from fish and nuts, can help fuel your brain and ward off issues later in life. And these diets are also great for your heart and reduce the risks of diabetes. Check out some of these fantastic brain healthy food tips from The Alzheimer’s Association.

Alzheimer’s Association: Adopt

a Brain-Healthy Diet

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Give Your Mind a Check Up

Whether you think your memory is failing you, or other people are telling you so, or you just like brain games, the following “test” created by Baycrest Health Sciences provides an easy way for a quick “check up” on your memory functions. Of course, the results are not a medical diagnosis, but see how you score and if you are concerned, speak with a health professional.

Canada News Wire:  Baycrest memory experts launch ‘thermometer’ for the mind

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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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Protect Your Noggin!

Last month on the blog we shared with you tips on bicycle safety and the importance of wearing a helmet. ( “Don’t Forget Your Helmet!” ) However, if the helmet isn’t the right fit or is not worn properly, it may defeat the purpose. With so many different styles and types, how do you know which helmet to choose and if the fit is right? The following from the Doctors of BC shows you how to properly fit a helmet and what to look for when making your purchase.

The Doctors of BC:  Bike Helmet Safety

 

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Stroke Recovery: “Knowing is Half the Battle”

Do you know the signs of a stroke? Sometimes these can be hard to see, and timing is of the essence, so you must think “FAST!” When a stroke is caught early and treated damage may be less and the recovery may be easier. May is Stroke Recovery Awareness Month and we want to share with you the following video which describes how to “FAST” – identify signs of a stroke.

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A Little Creativity Can Go A Long Way

Are you feeling overwhelmed at work? Do you sometimes find it impossible to deal with your ever-growing inbox and workplace stress? The key here is to realize that your inbox will never be empty and instead of working harder, we need to work smarter by focussing on better productivity. Studies now show productivity at work is linked to how you spend your free time when not on the job. The following from Prevention Magazine suggests that expressing creativity and gaining a sense of accomplishment in your free time may increase your self-esteem helping you to tackle tasks on the job. Check out the following and let us know if you agree!

Prevention Magazine: The Happy Way To Be A Bit More Productive At Work