While minor accidents are common in the workplace and quickly addressed, higher instances of stress, mental illness, and workplace bullying are being seen across all industries. So who in the workplace is the first responder in issues of mental health? The following from the BBC discusses a way to ensure your company is tackling these workplace issues and improving the work environment for all.
BBC News: Do you need a mental health first aider in the office?
Guest Blogger Jana Maich, Occupational Therapist
Working as an occupational therapist in pediatrics, I am always on the lookout for simple strategies I can offer to parents and classroom teachers that can be easily be implemented. One of the main difficulties expressed to me by concerned parents or teachers is that a child is having difficulty controlling their activity level, focusing or attending, or controlling emotional outbursts. In other words, a child is having difficulty self-regulating.
What does this mean? Self-regulation is our ability to monitor and control our body’s arousal level (in other words, our level of alertness) in order to remain in an optimal state that is appropriate for the current situation. Self-regulation is critical to being able to attend, focus, and learn (1). When our body’s arousal level gets too “high,” we may feel anxious, nervous, or stressed. When our body’s arousal level gets too “low,” we may feel lethargic, sluggish, or tired. Often unconsciously, adults participate in a variety of self-regulation strategies to remain in an optimum state throughout our day. For example, in a boring meeting where your level of alertness may be “low” you may tap your pencil, shift in your chair, apply pressure to your mouth or chin with your hands, or drink water in order to bring your arousal level up. After an intense day of work when you may be feeling too “high” you may take a bath, read a book, or participate in some other sort of relaxation promoting activity (1). There are many ways to regulate ourselves, and just as adults require self-regulation strategies, children do too. Yet, in today’s changing and fast-passed society, children are more stressed than ever before. School demands have increased, daily schedules are jam-packed, and they don’t have as much play or “down” time as kids once did. Unfortunately, unstructured play activities that are critical to a child’s innate self-regulation needs have been replaced by TV and electronics. All of this has ultimately stressed our young generations, resulting in disrupted self-regulation.
Yoga is one activity that has become recognized as a suitable and helpful regulation activity – for people of all ages. (2). For children, yoga offers many potential benefits – both physically and emotionally. Benefits include improved postural control, immune functioning, body awareness, strength and flexibility, emotional control, attention, sleep, and a decrease in stress and anxiety. Yoga is a simple strategy with a variety of exercises that can be completed anywhere including at home, when on vacation, while lying in bed, or as a group in the classroom. Depending on the current needs of the child, there are various poses and breathing exercises designed to bring arousal levels up or down as appropriate. Over time, children begin to develop an enhanced mind-body connection and an improved ability to monitor and manage their own levels of arousal (2).
In my personal experience, using simple breathing strategies and poses in my practice, has demonstrated firsthand how yoga can positively affect children with both physical and mental disabilities including autism, ADHD, emotional difficulties, mental health conditions, and motor coordination difficulties. In older children, learning how to control their own emotions and arousal levels empowers them and creates both self-esteem and self-control.
So what are you waiting for? Search out local yoga programs for you or your child. Try these links: www.yoga4classrooms.com or www.childlightyoga.com. Consider that many places will let you try a class without a commitment, or offer great starter incentives. Or, buy a CD or DVD or check out some poses and breathing exercises via online videos to see if this might work for you or your family.
Check out some of our other resources and articles for kids health here.
(1) Williams, M., & Shellenberger, S. (2012). “How does your engine run?” A leader’s guide to the Alert Program for self-regulation.” Albuquerque, NM: Therapy Works
(2) Flynn, L. (2010). Yoga 4 classrooms. Tools for learning, lessons for life. Dover, NH: Yoga 4 Classrooms.
Julie Entwistle, MBA, BHSc (OT), BSc (Health / Gerontology)
Meat Loaf says it best: “if you are only killing time it will kill you right back”. How true.
As we all try to cram more into our days, weeks, and nights we are creating unsustainable expectations for ourselves and for those that rely on each of us to get stuff done. In a previous post I offered my opinion on what I would consider dangerous and potentially life-threatening “time savers” that seem to be becoming commonplace in our manically productive world. Sleep deprivation, texting or emailing when driving, fast food and avoiding exercise were all on my list.
With that aside, I would now like to share the seemingly effective strategies I personally try to utilize for managing and maximizing time. But to be clear, I don’t have a degree or certificate in time management from any reputable institution. I am just a busy working mom of four kids who has been able to stay fit, get a Master’s degree, and run a business all because I can get lots done in a day. I have also read numerous books on productivity, health, happiness and personal development and have been able to incorporate many of the strategies I have read and learned into my world. So, here are what I would call my “tricks of the trade”…
1. I prioritize. What are your time priorities? If you answer “clearing my inbox, answering and responding to calls, getting projects done” then you have not looked at your life from the proverbial 30,000 feet. You are missing the big picture. Personally, my priorities (in order) are my health, my family, my career, and my personal development (yes, health comes first – without this the others are jeopardized!). So, my time spent always aligns with those. My health time includes sleeping, preparing healthy meals and exercising. My family time includes all that is involved in being a mother, wife, daughter, sister, cousin, grandchild, etc. My career is all that I do to manage my clients and business. And my personal development includes many of my social relationships, reading books and attending school, conferences and workshops. I make sure that every day includes at least one activity under each domain and recognize that some weeks my time shifts between these unevenly, but that in the next week I will find a way to correct course. Nothing I ever do under any of these priorities can be considered a “waste of time” as that would put me in a negative mindset (i.e. having to take a day off to manage a sick kid is never met with angst – “sick kid” falls under the family priority). Having set and firm priorities allows me to dictate how to schedule my time ensuring the right balance over a day, week and month between the four pillars of my life.
2. I live in the non-urgent but important quadrant. I love Stephen Covey’s thoughts on time management from the “Seven Habits of Highly Effective People”. Consider that if everything on your list is “urgent and important” you are doing something wrong and have not planned your time properly. While urgent things may creep into our day, ultimately being proactive and planning effectively means that you can focus on important things and manage these before URGENT happens. To balance my priorities I ensure that nothing “unimportant” lands on my desk or in my schedule. After all, I just don’t have time for “unimportant”.
3. I am proactive. Being reactive is a time waster. When we “react” we enter a different head-space, are required to shift our focus from the events of the day to something unplanned, and often spend more time picking up the pieces than we would if things didn’t crumble in the first place. Do you have a warning light on in your car? Get it into the shop before you are stranded at the side of the road spending hours dealing with roadside assistance and not having access to a vehicle. Or better yet, schedule your car for regular maintenance to keep it running smoothly. Feeling sluggish or unwell? Take a day off to recharge, make some changes to your routines, or get into your doctor before you enter full-blown illness. Taking one day off to feel better is more effective than the week you will need when the illness spreads.
4. I use technology wisely. Technology is a tool, but it is also a trap. My phone has a few productive apps but no games. Personally, “playing video games” does not align with my priorities as these have nothing to do with my health, family, career or personal development. I also don’t use my phone to conduct business – more to just be informed about it. Trying to conduct business on a smartphone often leads to errors in typing, autocorrect, and changes the response to something shorter, even curt. I would prefer to respond on my computer, or make a phone call versus emailing on a device. I also don’t watch TV – unless it involves a family movie or show we can all enjoy together. Technology for me is an information tool for my business, and an “in the moment” way to communicate, but otherwise I think use of those gadgets are a waste of time, not the opposite.
5. I plan ahead. Proper planning is always an effective use of time. Leaving your home to realize your meeting is thirty minutes farther away than you expected, driving somewhere to realize you forgot something, going to the grocery store without a list, arriving to a meeting without reviewing the agenda beforehand, or cramming your Powerpoint the night before are all signs of poor planning. In our personal lives being unprepared wastes time and money, in our professional lives these jeopardize our professional reputation. Make time in your schedule to proactively manage your “to do’s”.
6. I know myself. Are you in tune with your capacity? Personally, I know my limits and recognize when I work best. For example, I am most effective at writing (reports, documents, blogs, etc) in the morning. From 8am to noon I can fly through written tasks quickly. After noon, my focus wanes and it is easier for me to work on emails and calls as these require more short-term attention. This is how I try to structure my workdays. I also know things that I am good at, struggle with, and those things that I have taken on before with poor outcomes. Knowing this helps me to stay in my strengths as this is where I am most effective.
7. I use lists. In “The Art of Stress Free Productivity” and even “The Four Hour Workweek” both authors suggested that each day should start with a list of the top 3-5 things that need to be done that day. No exceptions. I find this strategy exceptionally helpful and each morning, or even the night before, I write a short list of “to do’s” and enjoy crossing things off as I accomplish them. Sometimes the list is separated by “personal, kids, work” etc. to match my priorities. And if I find myself wandering from my list to other tasks (i.e. my email inbox), having this in front of me grounds me back to the tasks that need to come first.
8. I take notes when reading. When I read educational or development books I always have a note pad and pen with me. Why? Because to read a book about personal development and to not take away or implement any of the strategies after makes reading a waste of time. If there is information I can benefit from, I want to capture that in a place where I can incorporate it into my life and review it later. This optimizes my reading time and self-development priority.
9. I manage my energy levels. Maximizing my energy levels maximizes my productivity. I do this by eating well, sleeping well, managing stress, and exercising.
10. I delegate. To effectively delegate you need to look at the resources available to you and determine who might be able to take some of the responsibility and run with it. If you know you don’t have time to take on a new project, say no, or figure out who you can enlist to support you in getting the job done.
11. I practice self-discipline. It is easy to be distracted, coerced, or tempted by other, maybe more fun, but usually less productive, tasks. That phone conversation with a friend, google wandering, checking Facebook, that lengthy lunch. While these may ultimately align with your priorities, the things you are neglecting during your productive hiatus will only work to move things from “important” to “urgent” in no time. Self-discipline allows you to firmly focus on the tasks on your “to-do” list versus those other enjoyable activities that might sway you in a less productive direction. So, get the “to dos” done first before being pulled in other directions.
Do you have other time maximizing ideas? I would love to hear them.
Julie Entwistle, MBA, BHSc (OT), BSc (Health / Gerontology)
I have been asked a few times to write a blog on time management. While I don’t profess to be an expert in this, people often do ask me how I “fit it all in” and my answer is always “I have learned how to effectively management my time”. What still surprises me though is those people that have not yet shifted their focus to “managing time”, but instead try to “save time” or wish there was just more of it. For me, that thinking is disillusioned. We can’t find or get more time – time is constant. What we need to focus on then is using the time we have optimally and in line with our priorities. This takes insight and self-discipline to accomplish, and in a future blog I will speak to some of my personal strategies here.
But before I do that, I wanted to start with the list of “time savers” that I don’t endorse. Ones that I feel are, in the extreme, life threatening and yet have become staples, patterns and habits by many, bragged about by some, and only work to help people shove more stuff into their already hectic schedule without forcing them to realize the real problem is prioritizing. So, here is the list of the time savers that I feel could kill:
Sleep Less. I will admit that I have previously considered cutting a few hours of my zzz so I could steal a few more hours of “productive” time. This is not an uncommon thought. Many people speak openly, or even brag, about how they “worked until 5am” or “only got a few hours of sleep last night cramming to meet a deadline”. Entrepreneurs are the worst. Our minds don’t tend to shut off and you will often find us emailing in the late hours or very early mornings. However, evidence continues to mount that “adequate sleep” is one of the key predictors of health and happiness, and the age old 7-8 hours per night still applies as a recommended dosage. Even napping is now being encouraged as a way to shut off the mind and to cognitively and physically reboot mid-day (I keep my naps to 20 minutes to not interrupt my sleep cycle). What research is showing is that inadequate sleep actually worsens brain capacity, making people less productive. So, the time you gain from sleeping less you then lose (and then some) in productivity. I would rather sleep thanks! Thus, stop thinking that sleeping is a hindrance to your ability to get things done. Reducing your zzz will only be a detriment to your health in the long run.
Texting or Emailing when Driving. Illegal or not, this is still happening and now texting and driving is the leading cause of motor vehicle accidents and deaths. STOP IT (yes, I am yelling at you guilty folks). Newsflash: the only thing you should be doing when driving is, well, driving. If we are talking about time management here, then think about the time you could lose from making this mistake. Lost work time while you are recovering from an accident. Loss of career if you can never return to work due to a disability. Lost productive time when you are dragged into a lawsuit when you cause a collision and are sued as a result (worse if you are driving a company car and take your employer down with you). Lost ability to emotionally manage when you know you caused another person’s (maybe someone in your own car) injury or death. The list goes on. And remember too that if you are emailing or texting when driving – what is the nature of the message anyway? Short and curt, fraught with spelling errors, auto-correct problems, or even those catastrophic email errors that are caused from forwarding the wrong message to the wrong person or “replying to all” when you meant to reply. There are both health and reputational risks from texting or emailing when driving and thus the time it might “save” you could cost you everything. The solution? If you have to multi-task driving with communication, use the phone with a hands free device. Then at least your eyes are still on the road.
Fast Food. I need to preface my comments here with the reality that I was raised in a fast food family. This was our business and I worked in our restaurant chain from when I was 13 to 19. So, believe me I get the appeal of fatty and good tasting food that is provided quickly. But this too is killing us. Obesity, diabetes, heart disease, and many other chronic illnesses are caused from poor dietary habits. Yet, people continue to think that using the drive-through will save them time. My experience with “fast food” is that it is rarely fast (just time your drive-through and walk-in experiences) and some of what is served is not even really food. Processed, frozen, overcooked, stale, loaded with additives and preservatives. Yummy. Also consider that when eating “out” people tend to overeat and consume significantly more calories than if they ate at home or prepared a snack before they left. Several years ago I used to love to grab a Tim Horton’s before my first client of the day. After all, I would be in the car for 30-60 minutes and drinking my tea was an enjoyable beginning to my morning. Then I became cognizant of the time I was spending in line. 5-10 minutes per morning was 25-50 minutes per week of just “waiting”. Not to mention the accumulating cost of some hot water in a paper cup with a tea bag. So, I decided to go “Tim’s Free”. It was liberating. I could (and still do) drive by Tim Horton’s and smile at the drive-through line while I drink my home-made tea that takes me 1 minute to make and costs a nickel. While I still understand that “fast food” is a treat, and can be used as such, I will argue that too many people who proclaim to be “so busy” actually waste time waiting for crappy food. The solution? Have some ready-made meals or snacks in the fridge and grab these on your way out the door. Put them in a cooler bag, or store them in your work fridge. Forgoing the fast-food habit will save you time, calories, and ultimately your health.
“No Time” to Exercise. This one drives me batty. So many people claim to “not have the time” to exercise despite the ample evidence proving that exercise is a #1 predictor of health. This “no time” excuse needs to stop. We all have the same amount of time in a day, so the reality is that people don’t MAKE the time, or this is just not a priority. That is not a judgment. If exercise is not a priority then people can just admit this and stop using “time” as the shield. Personally, I believe that the time spent exercising pays itself forward in productivity. Reduced stress, more energy, increased mood, better time management, improved ability to prioritize, and of course all this on top of the fact that this could lengthen life. Avoiding exercise to “save time” is a fallacy. I don’t buy it. Personally, I think I qualify as “busy” but still exercise 1-2 hours daily. So people need to be honest with themselves, their priorities and recognize that avoiding exercise to “save time” could have the opposite effect.
In the end, consider your “time savers” and project these over the next 10 years. What will that look like for you? Don’t wait to suffer the consequences of sleep deprivation, a car accident, a health issue from poor eating habits, or physical decline from a neglected body to realize that being productive at the cost of your health is not productive at all.
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!
Julie Entwistle, MBA, BHSc (OT), BSc (Health / Gerontology)
Last stop for Brain Injury Awareness Month – my favorite topic – organization!
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.
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!
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.
Knute suffered a TBI at age 11 due to a car accident and had not walked in over 22 years. The following is a truly inspirational story of how hard work, and perseverance can help change lives. See Knute’s amazing story here.
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