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Tag Archive for: brain injury

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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

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Occupational Therapy Approaches for Substance Use in Clients with Brain Injuries

Julie Entwistle, MBA, BHSc (OT), BSc (Health / Gerontology)
Co-written by Ashley Best, Student Occupational Therapist

In our previous blog post titled “Brain Injury and Substance Use”, we discussed how the cognitive and emotional changes associated with brain injury can overlap with substance use.  But what wasn’t covered was the role of the Occupational Therapist when working with clients who have these challenges.  While our role is complex in cases like these, we have tried to simplify how we use function and meaningful activity in combination with direct treatment to address some common themes as outlined below.

1. Harm Reduction

Arguably the most important strategy of any professional working with someone who uses substances is Harm Reduction. An Occupational Therapist can work with a client to better understand the process of using a substance with the same skill used for analyzing other daily activities. By breaking down what a client’s substance use looks like, from the trigger to being under the influence, the OT can identify areas of potential harm or danger. Some common concerns with substance use, and some OT intervention examples are:

 

 

 

 

 

 

 

 

 

 

It is important to recognize that the above strategies are not meant to encourage substance use but ensure the safety of the client when they are not willing or able to stop.  Sometimes just reducing the harm is all we can offer until the harm can be eliminated.

Clinical Example: A man with previous regular alcohol use prior to an accident, now has seizures when he does not have alcohol in his system. Thus, it is actually more harmful to ask this client to not use alcohol. Instead, monitoring the amount he drinks and ensuring he has regular supports at home are two strategies that can reduce the harm that alcohol may cause.

2. Recognizing Substance Use as a Barrier to Goals

The financial, behavioural, and health effects of substance use often negatively impact a client’s ability to reach their goals. An occupational therapist can help a client to understand and hopefully address the gap between substance use and being able/unable to move forward in other areas of life. An OT may also strategize ways to achieve goals despite substance use by planning use around occupations and this, in turn, may help decrease use over time.

Clinical Example: An individual with a brain injury has a goal to return to work but does not have the insight to recognize how using narcotics would impact their success on the job. Thus, helping the client break down the requirements of a job, recognize poor fits, and then implementing strategies to change substance use behaviour so that it doesn’t impact work (in the case that abstaining from use is not an option) could be an intervention focus.

3. Using Activity to Avoid Triggers

Often, substance use is time-consuming between acquiring, using, and coming down from the influence. This becomes a major challenge when people stop using because there is a lot of free time that may lead to boredom and relapse. This is an important place for occupational therapists to intervene by helping the client identify meaningful activities to engage in when they are feeling an urge to use. This could involve interests and values, or just discussing past activities that the client would like to resume.

In the case of someone with a brain injury, more guidance may be required to identify triggers (if the client has low insight what is triggering). In addition, activities that the client can perform may be different following a brain injury, and thus they may need support in finding new meaningful activities to fill the time that was previously taken up with substance use.

What is the take-home message?

As the above indicates, implementing any of these strategies will require the client to exercise a high level of control over their addiction. Thus, an OT can help support and accommodate each client’s unique situation by providing remedial and compensatory strategies to help clients transition from the occupation of substance use, to other, ideally more meaningful and healthy alternatives.

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Brain Injury and Substance Use

Julie Entwistle, MBA, BHSc (OT), BSc (Health / Gerontology)
Co-written with Ashley Best, Student Occupational Therapist

As clinicians working in the community with clients who have a brain injury, we all too often see the challenges of recovery impacted by the use of illicit drugs and alcohol.  And while we treat both the brain injury and substance use as they impact function and the ability to participate in life roles, we often wonder, which came first? 

Statistics show that individuals with brain injuries have higher rates of substance use than the general population. However, statistics also show that individuals with brain injuries have higher pre-injury rates of substance use.  While this does not explain a “causal relationship” or answer the “which came first” question, we know the interplay is complicated and that acquiring a brain injury can change the way the brain processes information which may influence substance use behaviours and patterns.

Here are some examples of how this can happen:

  1. Cognitive Changes: Having a brain injury can result in cognitive changes from mild to severe difficulties with memory and concentration, communication, processing speed, problem-solving, and more.
  2. Emotional and Personality Changes: A brain injury can also result in emotional and personality changes such as impulsivity, irritability, and lack of insight.

The changes and symptoms mentioned above occur as a result of injury to the brain’s frontal lobe. The frontal lobe is responsible for more complicated cognitive processes. It helps us to problem solve everyday challenges and consider the positive and negative impacts of our decisions. When a person hits their head or is jolted quickly, the frontal lobe will often impact against the skull – bruising, damaging, and disrupting the connections between the brain cells in this region.

So how does this relate to substance use?

Well, there are reward pathways in the brain which react and process substance use triggers and the associated emotional response. These pathways respond to the positive feelings associated with substance use and strengthen the more the substance is used, telling the brain to seek more. These pathways recognize triggers of substance use and respond by sending the “craving” to the frontal lobe. The frontal lobe determines whether or not the substance will be sought after, and if so, how the substance will be obtained and used.

When we think about individuals with brain injuries and associated cognitive and emotional challenges, we can see how if a person has difficulty with impulsivity, for example, then ignoring a craving may be more difficult than it would be pre-accident. In addition, when a person with a brain injury decides to engage in substance use, challenges such as poor planning and problem-solving may make the use even more unsafe.

Though we may not have evidence to connect brain injury to substance use directly, the cognitive changes in the brain are likely to make managing, using and even recovering from substance use much more difficult.

So now that we have talked about how substance use behaviours and patterns may change after acquiring a brain injury, the question remains, What can be done to help an individual who has both a brain injury and problems with substance use?  This question will be answered in part 2 of our blog post: The Comorbidity of Substances and ABI – the Role of the OT…stay tuned!

 

References:

Bjork, J. M. & Grant, S. J. (2009). Does traumatic brain injury increase risk for substance abuse. Journal of Neurotrauma, 26, 1077 – 1082.

Ilie, G., Adlaf, E. M., Mann, R. E., Ialomiteanu, A., Hamilton, H., Rehm, J.,… Cusimano, M. D. (2015). Associations between a history of traumatic brain injuries and current cigarette smoking, substance use, and elevated psychological distress in a population sample of Canadian adults. Journal of Neurotrauma, 32, 1130 – 1134.

West, S. L. (2011). Substance use among persons with traumatic brain injury: A review. Neurorehabilitation, 29, 1 – 8.

WETA. (2017). Facts about concussion and brain injury. Retrieved from https://www.brainline.org/article/facts-about-concussion-and-brain-injury

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The A to Z of OT: B is For… Brain Injury Recovery

It is well known that brain Injury is the leading cause of death and disability worldwide. In fact, in Canada, Traumatic Brain Injury (TBI) is more common than breast cancer, spinal cord injury, HIV/AIDS, and multiple sclerosis (MS) combined.  A brain injury can cause many physical, emotional and cognitive challenges.  Recovery from a brain injury can often be a long and bumpy road.  Occupational Therapists help brain injury survivors with all aspects of living including, physical symptoms, their living environment, cognition and memory and more.  Learn more about Brain Injury, methods of prevention and how OTs assist with recovery in this post from our blog, ABI the Silent Epidemic.

 

October is Occupational Therapy Month and to celebrate we will be sharing a new series called the A to Z of OT.  In our attempts to further educate the public about what Occupational Therapists do we will be highlighting twenty-six of the awesome ways OTs provide Solutions for Living.  

We encourage you to follow along with The A to Z of OT and to add to the discussion by highlighting other awesome things OTs help with for each corresponding letter!

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O-Tip of the Week: Limit Distractions

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. 

Occupational Therapists are a vital part of a team of professionals that assist with the rehabilitation from brain injury.  For the month of June, Brain Injury Awareness Month, our series will be providing solutions to assist with some of the many symptoms of brain injury. 

When recovering from a brain injury distractions may be more significant than pre-injury.  Because of this, it can be difficult to get anything done. When attempting to complete a task try to minimize all distractions allowing your full concentration to be focused on the task at hand.  Turn off televisions, radios, your cell phone and attempt to focus fully on what you need to do.

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Yoga for the Healing Brain

Guest Blogger Samantha Hunt, Student Occupational Therapist

In celebration of Brain Injury month in June, we wanted to highlight the benefits of yoga and mindfulness meditation as a solution for living with traumatic brain injury (TBI).

What is Yoga and Mindfulness Meditation?

While there are many different types of yoga practices, in general yoga involves physical movement, breathing exercises, meditation, and moral observations in a set period of time, with the goal of connecting the mind and body. Likewise, mindfulness meditation is described as “paying attention on purpose, in the present moment, non-judgmentally”, in order to help train us in awareness, concentration, and acceptance. Yoga can be practiced with one-on-one instruction, or in a wheelchair or sitting down as well, through adapted yoga.

Yoga, Mindfulness Meditation and TBI

After experiencing physical trauma, there is a severe body and mind separation that impacts the abilities of the nervous system and alters the pattern of the body, breath, and mind structure. This is where the practice of yoga and mindfulness meditation can assist the recovery. By consciously and consistently focusing the mind, we are reprogramming the neuropathways in the brain that have been impacted. By quieting the mind and focusing on building strength and flexibility, practicing yoga can also assist with the mental distractions and stressors that commonly occur after TBI, such as over excitement and anxiety.

Benefits of Yoga and Mindfulness Meditation for TBI

·       Improved concentration

·       Decreased stress, anxiety, and depression

·       Better sleep

·       Improved attention abilities

·       Improved working memory

·       Reduced mental fatigue

·       Improved strength, balance, endurance, and flexibility

Where to Begin

There are several simple ways to start incorporating yoga and mindfulness into your life. Some suggestions include:

·       Reading for inspiration (mindfulness books, yoga books)

·       Joining a group or taking a class

·       Free apps (such as “Headspace” or “Happify”)

·       Practicing 4-8 minutes of mindfulness breath each day

·       One-on-one adapted yoga with an instructor, such as (in the Hamilton Ontario area):

o   Christina Versteeg, Paradigm Rehabilitation (Christina@paradigmrehab.ca)

·       Following yoga practice videos online, such as:

o   http://www.loveyourbrain.com/yoga-videos/

o   https://www.youtube.com/user/yogawithadriene

 

References:

www.braininjurycanada.ca/yoga-webinar/

www.tbitherapy.com/yoga-meditation-brain-injury/

www.ontarioabiconference.ca/wp-content/uploads/2017/11/C2-Yoga-Therapy-for-Acquired-Brain-Injury-.pdf

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Tips for Communicating with Brain Injury Survivors

A brain injury can cause many physical, emotional and cognitive challenges.  Due to memory issues, fatigue and emotional stress communication challenges may exist.  Understandably, it can also be difficult for family, friends, and co-workers to learn ways to effectively communicate with their loved one who suffered a brain injury.  The following article care of Michelle Munt of My Jumbled Brain gives some wonderful insight on how to communicate with brain injury survivors.  Michelle, a brain injury survivor herself, has created a fantastic blog filled with articles and insight for brain injury survivors, caregivers, and healthcare professionals.

My Jumbled Brain:  Understanding how to communicate with brain injury survivors

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O-Tip of the Week: Break it Down

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. 

Occupational Therapists are a vital part of a team of professionals that assist with the rehabilitation from brain injury.  For the month of June, Brain Injury Awareness Month, our series will be providing solutions to assist with some of the many symptoms of brain injury. 

With a brain injury, many will have symptoms that include lack of focus, fatigue, poor concentration, forgetfulness and more.  These symptoms make it difficult for someone to complete daily tasks whether big or small.  It is often beneficial to have someone, like an OT, work with you to help break down tasks into smaller more manageable parts allowing for rest and providing multiple opportunities for accomplishment!