Anger

Many specialists will wade in on this issue with confusing double talk that might explain it but could simply confuse the hell out of you and leave you more enraged.  I made issue with the show “Golden Girls” and Stella back in my signs and symptoms section for a reason.  It is now common knowledge amongst the scholars that the last part of the brain to develop and often the first part of the brain to go as we age, is located in the frontal region.  This part is responsible for many things, behavior being one and another is planning.  We often wonder why our children act brain dead and take such dangerous risks that could kill them and the reason is that the wires have not fully developed where they start to take stock in the right and wrong of any given situation.  An example is staying out late on the dangerous streets at night because it is cool or skate boarding without helmets and making the bold statement that it’s my body and if I want to do it then I will.  They do not factor in that if they fall on their head and become incapacitated then society, the distraught parents pay the ultimate price by having to care for them forever.  They do not factor in the cost to their parents, of possibly wiping out their savings and retirement all for the selfish reason of it’s my body and I’ll do with it what I want.  This is normal behavior and fortunately it too does pass and as parents we give a big sigh of relief if they along with us survive until those neurons finally connect and a decent young adult emerges.

            Now think about this for a moment.  If you were to meet me I would look like an average guy.  There are no telltale signs that I am brain injured.  Most psychologists would aptly diagnose my anger as easily managed with some basic coping skills.  If he was not aware of my previous brain injury he would apply the same treatment on me as he would a non-brain injured individual and that would be his first mistake.

            My anger is not an issue that comes from the norm of a bad upbringing where I was beaten but rather because the pathways that once led to my frontal brain have been altered or completely severed.  Many problems are happening simultaneously to a brain injured person and the caregiver needs to fully appreciate this.  Those coping skills of life have to be re-introduced and rewired in many cases.  The time it takes a non-injured person to learn new coping skills will be a great deal shorter than that of a brain injured.  It is a Pandora’s Box of emotions from crying, to depression, to despair, to elation and of course anger.  All of which need to be addressed and it is no easy task.  One cannot separate anger from the rest of the issues.  Anger is a result of the many internal problems that a brain injured is facing.  He/she is angry because they recognize that they cannot speak properly, can’t find the words quickly enough, forget constantly, their balance is lost and the list goes on.  The caregiver has no coping skills to deal with this scenario and may accidentally remark, why can’t you remember and that triggers an anger outburst the likes you’ve never seen before.

            My point is this, the brain injury and anger is very complex.  One cannot separate anger without identifying all the triggers that bring on the outburst in the first place.  This will take months of testing and rehabilitation.  We have to rebuild the pathways and re-educate the brain injured so that he/she has an understanding of what the triggers are and how to better deal with them.  It is imperative that the care giver learn as much about the brain injury as possible if they are to survive this ordeal in tact.  You will employ the same techniques for dealing with the brain injured as for the non-injured however if the instructor is not familiar with brain injury he or she may alienate the TBI patient.  Remember the TBI survivor may be dealing with memory issues or permanent damage to the frontal lobe.  The anger may not be easily controlled as a result and therapy may take many months and not just a weekend retreat that might be prescribed for non injured counterparts.

Half Full is a great starting place

I may have been hard hitting in my last blog with regards to fellow TBI survivors who feel they can make it on their own.
Allow me to clarify my position for you.
In life we do not get to where we are without feedback and help.  We start with our parents guiding us, enrolling us in sports, school, music and from there we begin to network.
We gain employment through our efforts and referrals.
From those referrals we learn of better career choices and climb the ladder of success.
We also have setbacks along the way from scraped knees to broken hearts and someone is always there to help us back onto our feet.
Why should we think it should be any different when we are suddenly brain injured?
After the brain injury it should not matter why or whose fault it was but rather how we can overcome and what resources will we need to tap into to ensure the best outcome for me.
Why in your time of your greatest need would you abandon all that have used in the past, your networking skills, and choose to go it alone?
Yes, it is a new endeavor and yes it is frightening or even embarrassing to admit you need help from the last place you thought you would ever be, however it is a resource and you will benefit.
Let's face it, brain injury will conjure up the "One Flew Over The Cuckoo's Nest" mentality in some less educated people.
Mental health in general has some pretty negative overtones that can frighten some people.  This is born from a lack of understanding.  Some friends may abandon you out of this reason.  Not to worry because throughout life you will gain some friends and lose others. Why would you think it would be any different now?
The new friends will understand your needs and stand by you rather than toss your aside.
You are not a freak show.  You are simply brain injured.  You may have speech, memory or mobility issue but you are still you and are desperately important to your family so you owe it to them and moreover to yourself to at least give it your all.
It is in the end, a new career choice, fraught with all the uncertainties, like riding the bike for the first time or the new job or getting your driver's licence.  Look at it like it is, a challenge, one you will overcome, and most important it is one you will master to the best of your ability.
Is your cup half full?
It is incumbent on you to see that it is because so much is riding on your recovery and your loved ones are counting on you to have great hope for the future like you did before the accident took place.

Help! I have a TBI!

The sooner you can get help for your TBI survivor the better.  I have rarely met a survivor who jumps at the opportunity to join or attend a Brain Injury Group.  Ego being the mother of missed opportunity, will cause your loved one, time when it comes to recovery.

If he, and I mean he because 9 out of 10 times it is the male who will argue, I am not as bad as them why do I need to attend?
This bravado is a defense mechanism.  I actually joined in hopes to help other survivors because it had been 15 years since I had been injured.
To my surprise I learned more about myself in the process and enjoyed my time so much I eventually became President of our Brain Injury Society.
It offers support for the caregivers and lets you know that you are not alone.  The society will also have resources both locally and provincially or state wide, that you can tap into.
Things like attorney's who specialize in brain injury.
Why do I need an attorney trained in TBI?
Some lawyers will settle a case from an MVA, and state that the person will be healed up in 2 years and so you are compensated for 2 years and no clause for long term disability was considered.
What if scar tissue builds up and another surgery is required?

So help is most crucial at every turn.

I found that it was so nice to attend a group where I could contribute to with suggestions like the ones on this blog and in turn receive suggestions that might just work for me.
Yes there are people in the group that are far more injured than yourself and there are those who are less affected. The great thing is you will feel like you belong.  It is a place where we don't mind if you stutter, have mobility issues or anger issues.
The mere fact that when you arrive you are accepted as is, will make you feel at peace.  You don't have to explain yourself each and every time you forget. It's understood.

For the caregiver, it will be a place to network and a shoulder when things get tough.  Our group has assisted from giving food and clothing to getting the right medical assistance for you or your loved one.

If there is not a group in your town then check online to see where one is.  You might even decide to start one.
Ours started out of a home with a handful of people and now has hundreds of clients and is partially funded by the provincial government.  The only thing I can warn you about is that when you decide to start one get ready to be overwhelmed by how many respond.

What if my TBI survivor refuses to attend?

Well there is nothing from stopping you.
Second:  Get him to read this page.
MY SPECIA;L NOTE TO MR. TBI.

I like you are brain injured.  You have everything to gain and nothing to lose by attending your local brain injury support group.  If you truly want to heal, have a productive life, not lose your wife, avoid the 90 percent divorce rate that your fellow brain injured survivors enjoy, then if that is nothing for you to lose continue on with your head in the sand and have a great life.
If you can appreciate the fact that your wife is standing by you trying to help you back on your feet, don't you think you owe her a little respect for all she is sacrificing for you?
Don't hesitate and Join today! It may just save your marriage let alone your life.

Did you know that now that you have suffered from a brain injury you are twice likely to suffer a second before someone suffers their first?  Lets keep it to one and learn how to cope.

Brain Injury...Forever....

The title sounds like a death sentence, but in fact it doesn't have to be.  It is a matter of is your cup half empty or half full?
Obviously there will be many challenges and there will be many triumphs along the way.  Here is my question to you, Does this last sentence define life itself?   We all have challenges we must overcome.  We all have moments of great elation and those all come with a dose of cold hard reality that sometimes have us gasping for a reprieve and then the cycle repeats itself.
I stated in previous writings, that is is how we train our brains to keep our expectations in check that help us mitigate the more challenging moments in our life.  If we set the expectation bar just a little lower then obviously the reaction to not meeting that expectation will be easier to accept.
We have to build up our tool box of coping skills.  In the last blog I mentioned this along with anger management being one of those benefits along with accepting your new limitations.

It is not to say that your limitations will be permanent because there will be healing over the first couple of years.  Re-assessment is crucial as you travel the path of recovery.
I couldn't write a full sentence back in 1977, however I now have overcome that obstacle.  Most of my writing skills returned after the initial surgery along with my spelling.  The part that has remained a challenge is my short term memory which I can say without any hesitation is permanently damaged.
My recall of memory is also challenged and some days I remember or recall an event or a name immediately and on other days it is a write-off.
Yesterday started like any other for me.  I got up at 5am tinkered around the house and while I was shaving heard the phone ring.  When I went to see who called I realized it was the Physio Therapy office informing me that I had missed that morning's appointment.  I called them and was raked over the coals because this was the second time in a row that I had forgotten.  What they do not appreciate or understand and I forgive them for it, is this is normal fare, for me.  It is a new event.  I suck at new events because they are not a part of my daily routine.
I had forgotten to add the appointment into my cell phone calendar and was not warned at a timely manner as I usually am.
I left there and got home.  I took my truck to the repair shop and my wife and I walked the dogs, grocery shopped and returned home.  I had an appointment with my boss and went to the meeting that ran a little over and though my alarm sounded about my new afternoon appointment I ended up being about 8 minutes late.  Again I was scolded by the Therapy staff.
I left and went home for a nap as my brain was on overload.
I awoke and decided to go to the store.  I got to the store and low and behold my wallet was back at home.
I usually place it in my hat when I nap and when I got home I realized my hat was still at the physio office.
This explained why I had forgotten my wallet. A simple step or coping skill failed when I left my hat elsewhere and things began to snowball as a result.I have several hats and so I replaced the lost one with a new one.
The point of this exercise is to inform you the reader and possible TBI survivor, that this is a regular occurrence for me.  I am 34 yrs past my injury and still with all good intentions aside, with the memory  prosthesis (cell phone), I still forget.
I am far beyond the point where I let it get the better of me but it still pisses me off when, the medical staff have no understanding (physio), and I spend money in the form of fuel to only have to repeat the trip because my wallet was left behind.
The lesson I want you to take from this is rooted firmly in the title, brain injury is permanent.
How you deal with this new reality will determine whether your trip back will be easy or hard.  In fact you will determine by your action on how tough you want to make it on yourself.
Your cup will have to be half full if you want peace of mind.
The sooner you adopt this attitude the healthier it will be for you.  you stand to drive all your friends, loved ones away which will only go the enhance a negative outcome for you.
I kind of think you do not want a divorce added to your mounting problems.  I am sure you do not want to be alienated  by your friends.
You have so much to gain by a positive attitude.
Will it be easy?
Of course not.
The antithesis of a happy go lucky approach however is a lonely, frustrated and dejected person who has alienated all those who loved and supported him.
Slow and easy helps to win the race.  Next I will explore the area of Help.

Where do I begin?

There are the obvious steps from initial brain injury to when all the fanfare ends and everyone abandons you figuratively, that you soon discover yourself left to your own devices.  This happened to me right after surgery when my Neurosurgeon signed off on the case and said have a nice life.  That of course was in 1977-78.
I was told not to go to school for one year and take it easy and allow the brain to heal.

I was not referred to any other facility, nor were my parents educated on what to expect of their brain injured son.
To them, (my parents), I was cured.  It was like I had a broken arm and in my case it was a broken brain that I had survived, I should be blessed and carry on with life like nothing had happened.

Was that ever a narrow minded view.  Fortunately we have become more aware of the complexity of brain injury and have some techniques in place to assist those suffering from such a tragedy.

I wish to cover the latter scenario, of after you have discovered you have multiple injuries to your brain and what you personally can do or not do to enhance your situation.

I say multiple brain injuries like I am some kind of expert.  Considering that my case is 34 years old and as I muddled through my life discovering several key injuries, I think I am qualified enough to share my findings with you.  When I say multiple, I truly mean more than one and in fact I challenge anyone living with a brain injury to prove to me that they only have one such injury or disability.
The brain like a computer is complex.  If you delete a little code from the hard drive chances are many programs will be affected.  The same can be said with the brain.  Alter speech and see if the the recall ability is not altered.

A brain injury is complex however the way we approach it can make a huge difference in how the disability affects our daily life.

I had the surgery.  My speech was reduced to one syllable words.  The speech came back quite quickly but my spelling took a lot longer.  I also found it hard to keep up with a conversation because I would forget what I was about to say.  My patience took a major blow.  I became easily frustrated and would "lose it" and frighten people by my volatility.

Little did I know that this was directly to my short term memory deficit.  When you are working on assembling a BBQ or installing a ceiling fan and as you fumble for the tool that you forgot where you put it, you start to get annoyed at yourself and then the colorful language appears.  You may toss the tool, punch a wall or even worse take it out on your loved one.

This is why I am writing this installment.

Where does one begin?  If you are brain injured, I highly recommend an anger management course.  I have recommended this before but lets face it.  Even if you do not have an anger management issue yet, you just might and even if you don't there is a greater issue that Anger Management courses will teach.
Coping skills.
When you become brain injured, you are in another world.  What once worked for you no longer holds water so to speak.  You need to learn to analyze yourself when you act or react to a situation inappropriately and learn to find a better response when that same situation occurs again.
Believe me, it works miracles.  You become calmer and better in control of the outcome.

The next tool is acceptance.  Boy is this a hard one to overcome.  I still catch myself getting frustrated at my "incompetence" for forgetting.  I have to remind myself that I am not incompetent but rather I am and will be forgetful so get used to it.
I inform my co-workers of my memory and we get a good laugh at how short it is.  So rather than getting down on yourself, the sooner you can accept your disability or should I say your limitations the sooner the world will accept you as you are and not what you ought to be.

Coping tools.  This is an important one and can play on your ego especially if you are a male where you should be able to perform simple tasks such as installing a light fixture.
I tried this time and time again, whether a light, or assemble a bike or BBQ, I soon learned that the family would head for the hills because it was going to become a gong show.
What did I do.
I surrendered to my limitations and hired someone to do it for me.  It was great!  He could build the deck, he could install the dishwasher, he could install the light or paint the house and I had more time for myself and family.
Sure you can argue the cost but believe me it costs more to lose a family, it costs more to replace that light that you broke out of frustration then it does to have an expert come in and do it for you.

Try it some time you might just like it.  Simply park your ego at the door, invite the repair man in and go outside in the back yard sit back have a beer and watch the grass grow.  It is quite relaxing.  Did I mention that it helps with your sex life too.  Have you ever approached your wife after a day from hell and ask her for some nooky?  It doesn't go far now does it?  It might if your are calm and relaxed.  She might just appreciate you a little more.

Look, the simple fact is, you are still you.  If you have a cast on your foot, you are not going to play soccer anytime soon.  You are not going to run a marathon.  The same goes for your brain.  You may never run the brain marathon like you did before the injury.  If you can accept a cast on the foot and know that there are certain thing you can't do and will need help with,  like cutting the lawn or cleaning out the gutters, then take that same approach to your brain injury.  The only difference is that you may be wearing that cast on your brain forever and not just a few weeks.
It is amazing how helpful people are when they understand your limitations.  My clients call me to remind me to key in an order for them.
I use my cell phone to key in appointments so that I can be reminded on the day of and it alerts me.
This is a good start.  I will examine this and more in my next blog.

Detective Advocate....Caregivers...That's You

At the outcome of any brain injury the role of the caregiver is paramount to the quick diagnosis and treatment of the afflicted loved one.  My hat goes off to these unsung heroes whose job becomes overwhelming, challenging, and fraught with anxiety, tears and eventually resolve.  Your responsibility is nothing less than pure unadulterated, selfless, sacrifice that very few are either prepared or trained for.  Thusly this book will try to alleviate some of the frightening and often confusing factors that plague the caregiver.
I feel there are two roles amongst many that stand out namely the detective and the advocate.  Both roles go hand in hand as you try to disseminate and translate what the doctor has told you and then try to advocate for your loved one ensuring they get the best treatment and rehabilitation possible.  At this juncture I’d like to say good luck!  I say that with some cynicism because chances are, depending upon your coverage, you’ll be banging your own head against a wall to a point of becoming brain injured yourself.
            There is a progression one goes through with regards to any traumatic injury to a loved one.  There is the shock where the world seems to spin out of control.  The doctor may say things to you that you can’t comprehend or understand and or you will be lulled into a false sense that all is right with the world and the loved one will be just fine in a few days or weeks.
            Initially your world will spin and finally after the shock wears off there is a tendency to rely on the words of your doctor.  BIG MISTAKE!  I do not want to cast any dispersions on the medical community, however, many are not prepared nor educated on brain injury in general and furthermore the role of a neurosurgeon is that of patching your loved one up and not that of educating you, the caregiver.  This is why your role is so important.  You have to ask the pertinent questions.  What is in store kind of questions?  Where do we go from here kind of questions?
            One should never downplay any kind of brain injury.  Look at me.  I had 7.5 hours of brain surgery that should have sent up red flags to all the medical staff.  I should have received rehabilitation.  I had a traumatic brain injury where the x-rays show that my brain is atrophied and the left hemisphere is tilted.  It is difficult to explain this clearly, but let me give it a try.  If your loved one receives any surgery to the brain….that is a serious invasion of that organ and therefore it is traumatic in nature and follow up is imperative.  If your loved one has surgery and shows no outward impediment, like memory loss or speech or mobility problems, the injury is still traumatic and should still be treated seriously and follow up is imperative.  If your loved one receives trauma to the face, skull, is knocked out or suffers from whiplash, then the injury is traumatic and should be treated equally to one that requires surgery.  If the trauma is a concussion, a broken nose with no loss of consciousness, the injury is still traumatic and follow up should be imperative.
            In other words all trauma to the head or neck is of great concern and one should not jump for joy if the injury seems less than spectacular in nature.  Never downplay any trauma to the head…period.
            You may run into some detractors in the medical community that say you are over reacting.  Give them a copy of this book because they obviously have their heads up their rear ends and need a lesson in the reality of dealing with the long term affects of brain injury.
            Your second role is that of a detective.  Besides finding the resources available within the community there is yet another important aspect of the detective and that is doing the boring stake out.  It is being the quiet observer of the loved one after the brain injury.  Taking notes and comparing them to the mental ones of how your loved one behaved prior to the injury with those new notes taken after.  You have to paint a picture that can be presented to your doctor spelling out in detail, the differences you have noticed in your loved one.  A doctor cannot examine your loved one in a 10 minute office visit and discover all that might be wrong with your loved one.  Your observations will be of great assistance to getting the right rehabilitation.  Some of the traits may show up immediately after the trauma while others are more transparent and show up gradually over time.  Your loved one will have a moment of momentous healing shortly after the injury as swelling subsides.  Then the finer details of the injury will present itself.  I had anomia prior surgery, couldn’t do math and had quite a temper.  After the surgery those aspects reduced or went away.  The obsessing, the short term memory and to a lesser degree the anger subsided or remained constant in nature.
            Your observation of the changes as listed in the chapter signs and symptoms will make a big difference in the overall outcome of your loved one.  In the less obvious injuries, the behavior may be an increased frustration assembling products.  A sense of mental exhaustion that requires an increased amount of sleeping may be one of the signs.  Depression, lower level of concentration at school or work may be another.  If the performance at the work place or in school decline then one needs to look at testing and follow-up with a specialist.
            I have given a list in the chapter “Getting Help After Brain Injury” however one must know finer details which I will cover here.  Recently on any one of those many trauma style T.V. shows, I often see brain injury patients who show bleeding on the brain but require no surgery.  The prognosis is that he/she will be fine in a few days and as long as there are no medical complications like seizures we’ll (the hospital) will release the patient.
            No one asks the doctor what the long term affects will be.  Let us examine it a little closer.  The loved one suffered a trauma that caused bleeding on the brain.  It stopped and all is right with the world.  We know that brain injury can occur at microscopic levels and here on the MRI or CAT scan we see bleeding which means a little inflammation, contusions usually located in two regions of the brain.  If the front is bleeding then there is a good chance that the exact opposite side will be injured to a lesser degree but nonetheless still injured.  If there is an obvious sign such as blood then the injury is very serious regardless what the doctor states.  If it was your brain and it was bleeding you would take it more seriously than just a cursory glance.  You would probably be deeply concerned and demand all tests available to determine the next preferred action to take in the full recovery of yourself.  This will take 2 neuropsychological tests spaced between 6 months and maybe a third at a year and a fourth at the 2nd anniversary.
            If there was a procedure for post care with regards to all brain injuries the following would occur.  The patient would not fall through the proverbial cracks.  The divorce rate with brain injured would decline by 40% to the national average of 50%.  The crime rate would decline.  Violence to females and children and people in general would decline.  The prison population would decline by up to 90%.  The street crime and the homelessness situation would be greatly impacted and reduced.  With a little preventative education these levels would fall even further.  This means fewer murders, less alcohol and drug dependency and the savings to society would be immeasurable.  In Canada alone the savings would be well over 2 billion dollars annually.
            In the mean time we have this book to assist those who continually fall through those cracks and end up becoming one of those horrific statistics.

Once your loved one has been diagnosed with a brain anomaly of any kind, demand answers.

1)      I am informed that brain injury may occur at cellular level therefore scans are insufficient and I would like additional tests.
2)      I would like a neuropsychological test similar to the Structures of Intellegence (SOI) http://www.soisystems.com/index.html
3)      You want tests to determine their Figural, Symbolic, Semantic, Comprehension, Memory, Evaluation, Problem solving, Creativity, Arithmetic, Math, Reading, Reading Readiness, Reading Concepts, which is even broken down further to the following:

EFU Visual discrimination-judgement skill

CFS Coping Skill-difficulty dealing with change-eg furniture rearranged, papers moved dishes rearranged etc.

CFT Locating and transferring skill, locating objects, reading maps transferring information from one idea to another ie) finding car in parking lot, locating papers, clothing, keys, wallet etc.

NFU divergent thinking- may display an inability to require an alternative point of view.  May obsess or simply quit the activity.

MSUv and MSSv Visual memory skills

MSU & MSSa Auditory Memory Skills

CMUr Vocabulary

The test results may come back in medical jargon the likes you will have difficulty digesting let alone interpret and therefore it is incumbent on you to ask the tester, usually a neuropsychologist, the following questions:  What does this mean?  How will this impact of the patient with regards to daily living?  What can we do to improve on this weakness or disability?  If they cannot tell you what can be done then run don’t walk from his office and find someone else who can.  There are definitive exercises that will improve every aspect of the brain.  After a brain injury, the sooner rather than later you begin the rehabilitation the quicker the recovery.  The brain can and will try to heal on its own.  It will grow new neural pathways around the damaged area and may utilize another secondary region to replace the lost or damaged area.  Naturally there are no guarantees on the final outcome and it may take a long time for the healing to take place.  My 1978 and 1995 tests show that my disability is permanent however I adopted coping skills that have diminished those negative affects.  If I had been treated with rehabilitation and specific treatment focusing on the weak areas, I may have not experienced many of the setbacks that prevailed in the next 25 years.  I may have had better control of my anger if I was made aware of my weaknesses early on.  I would have adopted better coping skills to reduce those frustrations born of a damaged memory.  My auditory dyslexia traits would have indicated my inability to listen properly which caused me to lose my kids because I forgot where they said they went.  Now that they are teenagers I find there are times I wish I hadn’t learned how to remember where they went and would lose them again.  O.K., so I throw in a little levity in a deep subject but I often wonder why I was not informed and placed my children at great risk as a result of not knowing.  A self imposed coping skill evolved from this fear of where the children were by having them tell me and then write down the info so that mom would be satisfied.
            You have to be assertive and virtually move mountains.  If the alleged injury is the fault of another person then a suitable lawyer trained in brain injury needs to be contacted.
A small warning should prevail in the form of common sense when your loved one is tested and that is some and not all results may be a related to the actual brain injury. If you know the individual had learning disabilities, was poor in speech, math or other areas of education then one would be jumping to conclusions if after this first test all negative results were thought to be a direct cause of the brain injury.  How can one tell if it is or isn’t a cause of the injury?
You really can’t, however it is important to factor the past behavior of the patient into the mix so that a realistic view emerges.  I may have had a hearing difficulty before the injury until I look at the region of the brain affected and what its primary functions are and compare that with the results of the test.  It is pretty basic police work that your doctor should be able to perform if they are brushed up on the brain’s basic functions.
Here is a picture and the definitions follow.

                                 
                   Frontal Lobe
Initiation                                                        Smell
Planning/anticipation                                   Motor Planning
Follow through                                              Personality
Impulsivity                                                     Emotional (Affect)
Judgement                                                   Speaking (word Finding)
Reasoning                                                    Integration of thought and emotion
Abstract Thinking                                         Self Monitoring

Temporal Lobe
Memory
Hearing
Understanding Language

Parietal Lobe
Intellect
Sense of touch
Differentiation: Size,Shape color
Spatial Perception
Visual Perception

Occipital Lobe
Vision

Cerebellum
Balance
Coordination
Note: The Parietal and Temporal Lobes have a left and right side.
Many doctors may try to downplay the brain injury for many reasons including lack of funding and long waiting lists in Canada, to poor coverage or that some insurance companies may refuse to cover such testing.  One must factor the motivating factor of the doctor.  It may not be in his best interest to refer you.  The days when doctors put the needs of the patient first are long gone and profits take precedent.

If your loved one was injured in a MVA or at work then your chances are better in receiving the utmost care and prompt response to your request for testing.  This is why a lawyer trained specifically in Brain Injury is critical in receiving both the best treatment and of course compensation.  One cannot expect to discover all the injuries and deficits overnight.  It may take months and months and still complications arise.  Your loved one may go home and be completely fine and then 2 years later, scar tissue grows and seizures begin.  Do not think for a moment that there is clear sailing ahead and end up shooting yourself in the foot when in 10 years post original brain injury, a complication occurs.  Unfortunately you took the buy out or your doctor’s word and the case was closed 2 years post injury and you have no legal recourse and the medical costs wipe you out.

Will this injury cause scar tissue to build up?
Will this trauma cause an onset of Parkinson’s condition (not disease)  caused from trauma to the lower brain stem.
Will this memory problem cause an onset of Alziemers disease?

Most doctors will say the injury will not cause this.  Unfortunately for us there is little support either way.  I was going to name this book “The Final Frontier” and truly it is.  We may have a better understanding now than ever before but it is far from being fully understood.  The veil of uncertainty has definitely been lifted and we now appreciate the fact that what once seemed hopeless no longer holds true.  The brain begins to compensate and heal immediately after the trauma and in many cases reverses several of the conditions caused by the initial injury.  We now know that new neural pathways grow and bypass or re-attach to the damaged region.  We know that increased oxygen to the brain improves its healing properties and now even employ the use of hyperbaric chamber to assist in recovery.

The problem lies in the approach.  We should be tackling brain injury before it occurs.  We should educate in every area of life where brain injury may occur such as sports, work and most important in motor vehicles so that we can prevent the injury before it happens.
We should draw attention to the potential of the brain injury by reclassifying all head and neck injuries as that of a potential brain injury.   We should reclassify whiplash, concussion, broken face bone, jaw, nose, and skull as traumatic brain injuries and scrap the term mild or moderate brain injury.  By retraining the medical staff to be cognizant of the potential for a brain injury and raising its likelihood to the forefront, one might reduce the misdiagnosis of it drastically.  I cannot for the life of me understand why in the 20th and 21st centuries, we are even having this conversation?  By diverting away from the whole to a part of the body we risk death.  This was taught to me in first aid and we could lose our first aid ticket if we didn’t treat the whole body and diagnose on the side of the worse case scenario.  In the hospital we throw out that approach and become desensitized to the potential and would be mocked if we tried to treat beyond the obvious.  It’s a broken nose.  The treatment for a broken nose is this.  Let’s not assume that the sinuses may be damaged or that the brain and the frontal lobe may have been seriously compromised by the force that was sufficient enough to break a facial bone.

It is impossible to list all questions without knowledge of the individual brain injury however there are crucial ones you should have in your arsenal and they are:

1) How severe is the brain injury?
2) Where is the damage located?
3) What brain functions will this injury affect?
4)Who would you recommend as a referral for follow up treatment?
    (Neurosurgeon, Neuropsychologist, rehabilitation center, family therapist, support    groups for survivors and caregivers)
While you wear your advocacy hat, one should research the referrals made to you and don’t hesitate to ask the specialist you’ve been advised to see to supply his or her own references.  Ensure that some are from patients.  Most agencies and doctors will gladly make available a list of former clients/patients who have benefited from their treatment programs.  If not go online and enter a chat group and see if there is anyone who has used this specific doctor, therapist or center and make a decision from that.
Some therapies, or medicines may assist in treatment but the side affects may bring about another set of circumstances.  Research the drugs or treatment before embarking on a prescribed regimen that you may possibly regret.
I was recently prescribed by a doctor a medication to aid in quitting smoking.  The medication is not recommended for stroke victims.  Good thing one does research or this book would have never been written and I’d be pushing up daisies.
   Do not fret if one treatment fails or a medication causes a bad side affect.  Each patient will react differently and brain therapy will be fraught with many such set backs and then many more gains.  One has to experiment in a safe manner and by arming yourself with information you and your doctor can make an informed decision on what path to take and truly hope for the best.  Remember this is new ground for both of you, the patient and in most cases for the doctor or therapist.  What works miraculously for one may be the antithesis for another.  I have mentioned Bob in previous pages and he is the flagship for this trial and error.  His medication has been altered more times that I can count.  Sometimes the adjustment is great and Bob responds well, with a new zeal and energy and progress is made in his therapy.  The next adjustment sets him back several steps.  He becomes lethargic and depressed wishing he was dead.  The next month the drugs have been balanced and he is perky and full of humor.  It is this dance of healing that we must continue to engage that can at times seem hopeless.  It is two steps forward and one step back and when you entertain the prospect of dealing with a brain injured person you better like a lot of dancing because you are going to put Fred Astaire to shame.

1

Mild Brain injury if there ever was one?

As you know I am not a fan of qualifying brain injuries and my reason being, EVERY BRAIN INJURY IS SERIOUS, having said that I want to address a area greatly overlooked by the medical community and hopefully others will copy this page and present it to their local hospital....It might just save a life or two.

When a person comes to an emergency ward they are soon questioned about what is wrong.  It's a good place to start, however it ends up classifying your injury into scale of minor or serious.  Obviously we need to triage our patients and treat the most critical first.
It is referred to the "Golden Hour", that first hour post injury, if left untreated, reduces the survival rate dramatically.
When it comes to trauma to the face head or neck a weird anomaly occurs.  We look at the patient and determine that he/she has a bleeding nose.  Recently my 12 year old grandson presented with this very scenario and guess what?
The exact thing I feared occurred.  He was not sent to the hospital by the soccer staff and went for a sleepover at a friends.  His mom saw him the next day with the two shiners and asked what had happened and he said he broke his nose playing soccer.
That was the sum total of his treatment.

What is worse is if he had gone to the hospital he would have been informed that his nose was broken and sent home with an ice pack and that would have been the end of the journey.

If you have a concussion, the rattling of the brain, bringing on temporary loss of consciousness, you are given a list of what to watch for by the medical staff and if a headache ensues or he does not awake easily then you are instructed to return to the hospital.

If you are punched or hit by a base ball or soccer ball, fall off your bike, are in a MVA and suffer whiplash, your are classified by the hospital as Whiplash, broken nose, broken jaw, skull fracture and the list goes on.

NOT ONE CLASSIFICATION MAKES MENTION OF THE FACT THAT ANY TRAUMA TO THE HEAD THAT RENDERS ONE TEMPORALLY UNCONSCIOUS, HAS A FORCE SUFFICIENT TO FRACTURE A BONE IN THE HEAD, OR CAUSES WHIPLASH IS SUFFICIENT ENOUGH TO CAUSE BRAIN INJURY!

All head injuries should be reclassified as a broken nose and possible brain injury.  Every broken jaw should be classified as broken jaw and possible brain injury. Every concussion should be classified as concussion and possible brain injury.  Every skull fracture should be classified as skull fracture and possible brain injury.

To not bring attention to the most crucial organ in the body, the brain, has me questioning the medical community as to why they could overlook this crucial error in judgement?

If we drew attention to the potential of a brain injury we could encourage the loved ones to pay attention to the behavior of the injured and see if there are any signs or symptoms when the patient is released from the hospital.

Brain bleeds can occur from trauma to the neck or head.  This may be a mild bruise however they are now seeing long term affects on sports personnel who have suffered several concussions and their brain has lesions and the entire brain becomes diseased.
The person becomes violent or suicidal later in life from such trauma.
We may not be able to prevent a concussion in sports however we may be able to prevent a second or third by having the person quit the sport before it becomes a life sentence.

It is up to us as individuals to be proactive when it comes to brain injury before it happens.   By wearing helmets, not heading a soccer ball in the younger leagues, and taking all head trauma as a potential brain injury can save someone their life.

Be aware of the fact that head and neck trauma may result in brain injury.

I hope the Doctors in your emergency department will read this and reclassify all head and neck trauma to include potential brain injury.  It may not change the treatment but at least you will be made aware of the potential long term affects of multiple traumas to the head and maybe reduce how many one receives by modifying ones behavior.

A recommended Brain Injury Resource!

I can't say enough about this site when it comes to the wealth of information for anyone who has had any kind of brain injury.  Make sure that you check it out and bookmark it as you will find yourself coming back there often.
http://www.tbilaw.com

Don't be fooled by the domain name as this has everything to do with explaining brain injury and law is truly a sideline to this wonderful site.

On the fringe

Since my aneurysm occurred in the dark ages when 18 year old's were not supposed to suffer an old person's ailment, "A Stroke", a lot has changed since 1977.  Anyone at any age can succumb to a neurological disorder that once fell into the stroke classification.  From infants to Senior citizens and everyone in between.  Whether it is like mine a malformed cluster of veins and arteries, to blood clots to direct trauma resulting in a tear in the artery wall, we are all susceptible.
One of the new treatments is hyperbaric chamber to help increase the oxygen  to the affected region of the body in hopes of speeding up the healing process.
For more info: http://en.wikipedia.org/wiki/Hyperbaric_medicine

Since I have not been treated nor do I know of anyone who has, it is something to ask your doctor about and of course the cost could be prohibitive especially if it is not covered by your medical insurance plan.  I do believe it has been used by the U.S. Military treating head wounds of soldiers but one would have to research this out.
I simply want to let you know that there are alternative treatments.  Their value may vary and I do not promote one treatment over another.  My goal in this blog is to simply present choices that with consultation with your physician may be considered in the overall treatment of your loved one.

Terms

Acquire Brain Injury (ABI)

·   those caused by strokes and other vascular accidents

·   tumours

·   infectious diseases e.g. encephalitis and other degenerative diseases

·   hypoxia, anoxia, drowning

·   metabolic disorders e.g. liver disease

·   toxic products taken into the body through inhalation or ingestion e.g recreational drugs

Aneurysm:  A weakening in an artery wall where the artery balloons out.

Aneurysm Ruptured:  Due to an increase in blood pressure,  a blow to the region the aneurysm is located or simply by continued ballooning of the wall the artery bursts.

Outcome varies:  In the case of a brain aneurysm rupturing oxygen critical to the brain’s survival is compromised.  The part of the brain that the ruptured artery fed oxygen rich blood to is effectively cut and that part of the brain dies within 4 to 6 minutes.  The outcome can be minor in nature to serious causing instant death to the patient.

Arterio-Venous Malformation:  A cluster of poorly formed arteries and veins.  This usually is formed in uterus and is known as a congenital or birth defect.

EEG (ElectroencEphaloGram)

Brain Scan

X-Ray

Cat Scam

MRI

Stroke: The rupture, blockage or hardening of the arteries blocking circulation to parts of the brain.  Nerve Cells in the affected region die having direct impact on the areas of the body those cells were responsible for.  The rupturing of and artery (see Aneurysm) is one form of stroke.  A second form is called an embolism where a blood clot travels from one area of the body and lodges in the brain blocking blood flow to a specific region of the brain.  Arterio-atherosclerosis or thrombosis is the narrowing or complete blockage in a specific region of the brain.  So rupturing, narrowing or blood clot of arteries can cause a stroke.  Slurred speech, hemiphlegia (paralysis of one side of the body) severe head ache and or death are just some of the results caused by stroke.

Coma

Neurosurgeon: A doctor that specializes in brain and spinal surgery.      

Neuropsychologist. 

Neurologist: A doctor that specializes in diagnosing neurological disorders and refers the patient to the appropriate sources for treatment.

GP:  General Practioner:  A family physician who examines a person and diagnoses multiple disorders and redirects or refers the patient to the appropriate specialists who can then treat the patient for his/her condition(s)

Frontal Lobe

Left and Right Parietal Lobe

Right and Left Temporal Lobe

Occipital Lobe

Intra Venous Drip

Angiogram

Femoral Artery

Traumatic Brain Injury (TBI)  Traumatic brain injuries occur from any external force to the region of the neck and head.  The causes range from Motor vehicle accidents, falls, violence, sports, electrical shock, lightning strikes, whiplash, shaking baby syndrome, and any blow to the head.

What kind of help may I receive for mild or moderate B.I.?

“A conservative estimate is that over 4000 people a year have traumatic brain injuries. (That doesn’t include “acquired” injuries such as those resulting from complications during surgery.) Of these, about 51% are eligible for funding through ICBC, WCB or extended or private coverage.  However, some settlements provide for finite amounts of money that may run out.  An alarming 49% of victims are left financially unprotected.” [Restoring Hope, Dr. John A. Higenbottam, CHE, Registered Psychologist,  March 1994]

This study commissioned for the Provincial Government of B.C.
ICBC …….Insurance Corporation of British Columbia
WCB……..Workers Compensation Board

I fell into the no coverage category because I suffered from an acquired brain injury. (ABI)  The most astounding lesson I have learned about moderate or mild brain injury is the apathy given by the medical community in general. The answer to the question of what kind of help can I expect from a mild or moderate brain injury in the year 2012 is simply this, very little or none.  The present excuse will naturally be the fact that the hospitals and medical staff are over worked or understaffed however, since 1977 it has been the same lament and the real culprit is lack of education.  The medical community fails to act on incorporating into the training regime anything at all that will make doctors and nurses alike, aware of the potential for brain injury to exist beyond the first 24 hours post trauma.  The nurse will advise you when a concussion occurs, to wake the patient up every 2 hours for the first night and if he/she does, all is right with the world.  No one asks the caregiver to test the head injured for cognitive responses or to go to a neuro-psychologist for complete testing to determine the extent of the mild head trauma.  The argument boils down to dollars and sense.  It is common sense not to burden the already taxed medical structure with what might be an over reaction by the caregiver when a slight concussion has occurred.  It is common sense that we do not burden an already taxed system with unnecessary tests especially when there are more serious trauma patients standing in line up for the same tests.
There are solutions however there is no quick fix.  Minds have to be changed. Procedures need to be implemented.  At present, 90% of all brain injuries are avoidable.  Awareness and education need to be increased substantially for this to have a positive result.  It has been demonstrated with the advent of the recent bicycle helmet law that has witnessed a reduction in brain injury.  At 1 Billion dollars expected to be spent treating brain injury at all levels, common sense dictates that a reduction of all avoidable brain injuries would go a long way is reducing costs.  From this saving additional funds could be moved into education and into tertiary care facilities where testing for all mild brain injuries could occur saving countless millions later on down the road..
If we reduced brain injury by 10%, that would reduce the statistics from 90% avoidable down to 80 percent and equal to a 100 million dollar reduction in cost which would be more than sufficient to fund rehabilitation and education simultaneously.
John Simpson, studied the male prison population in B.C. and arrived at a 90% rate of those studied of having suffered from multiple brain injuries.  A study of death row inmates in California discovered a 100% rate of multiple brain injuries.  As I pointed in earlier statements, the cycle of brain injury equals divorce, drug and alcohol abuse equals incarceration could be avoided and reducing the amount of inmates would further go to increasing funds for proper medical coverage.  

Several studies have indicated that brain injury and crime go hand in hand yet little is being done to remedy this problem.  I still feel an ounce of prevention would go a long way in saving countless millions of dollars in housing through incarceration if proper attention to initial brain injury assessment and follow up rehabilitation were initiated immediately after the first trauma to the brain.
In Canada the average cost in 1997/98 are listed below.  A staggering $51,202.00 will be spent per inmate in 97/98.
If John Simpson’s study is correct or even we were to cut his estimate in half it would result in a mammoth saving to the tax payer of in excess of $934,851 million dollars annually.
Table: Operational costs for adult correctional services
________________________________________
  Provincial/-
territorial
costs Federal
costs Total costs
(current
dollars) Total costs
(constant
1993/94
dollars)
  ________________________________________
  $'000 $'000 $'000 $'000

1993/94 881,988 996,904 1,878,892 1,878,892
1994/95 913,250 980,280 1,893,530 1,885,948
1995/96 948,887 970,041 1,918,928 1,871,221
1996/97 970,289 998,264 1,968,553 1,886,777
1997/98 1,028,029 1,049,418 2,077,447 1,964,559
________________________________________

Federal operating expenses reached $1.0 billion in 1997/98, a 10.3% increase from 1993/94 when adjusted for inflation. Provincial and territorial governments spent just under $1.1 billion in 1997/98, down 0.4% when adjusted for inflation.
Provincial/territorial governments spent an average of $43,734 on each inmate in their jail systems in 1997/98, up from $40,562 the previous year. The average cost for inmates in federal penitentiaries was considerably higher at $51,202, up from $48,078.

Neuropsychiatric, psychoeducational, and family characteristics of 14 juveniles condemned to death in the United States
DO Lewis, JH Pincus, B Bard, E Richardson, LS Prichep, M Feldman and C Yeager
Department of Psychiatry, New York University Medical Center, NY 10016.
“Of the 37 juveniles currently condemned to death in the United States, all of the 14 incarcerated in four states received comprehensive psychiatric, neurological, neuropsychological, and educational evaluations. Nine had major neurological impairment, seven suffered psychotic disorders antedating incarceration, seven evidenced significant organic dysfunction on neuropsychological testing, and only two had full-scale IQ scores above 90. Twelve had been brutally physically abused, and five had been sodomized by relatives. For a variety of reasons the subjects' vulnerabilities were not recognized at the time of trial or sentencing, when they could have been used for purposes of mitigation.”

Why is this so important with regards to brain injury?  There is a systemic problem with identifying the adverse affects on the population with regards to our diagnosis and long term treatment of those with brain injuries and more so with regards to minor and moderate forms of it.  At present the ball is solely in the hands of the care giver who is likely unaware, poorly informed and overwhelmed by emotional and financial hardships that are about to unfold.  This is the reason for this book.  It will prepare you the caregiver with the tools you will need to break down the barriers and reduce the frustration you will face when dealing with a brain injured relative.  I hope in the end to create political zealots who will rise to the occasion and en masse motivate the powers to be to invest more funds and re-educate the medical community in whatever country you presently live in.  If Aids can usurp millions of dollars in research then Brain Injury which affects thousands more people should be able to earn a respectable place in the minds of others.  There are sports legends, actors and actresses who have either suffered brain injuries or have a loved one who has that can add their name to the cause to change the minds of the leaders as to the importance of early diagnosis and treatment.
Education will save lives and money.  Victims of violent crimes may be saved the pain and suffering or even their lives if intervention occurred immediately after the trauma was diagnosed.  A brain injured person is twice as likely to suffer a second brain injury before a non-brain injured person suffers their first.

More links

 A New Link with more information http://www.trymunity.com/

The Rancho Los Amigos Scale

    The Rancho Los Amigos scale was developed at the Rancho Los Amigos Hospital in California by the Head Injury Treatment team.  This scale is useful to therapists and families to help understand the behavior and progression of the head injury survivor as he goes through rehabilitation.  These levels are applicable in the first weeks or months following the injury and are not intended to predict improvement over the long term.

    Progress is rapid at first.  The patient will move between the levels quickly.  However, as the months go by, progress will slow and at some point the patient may seem to plateau around level VI or VII.  The level at which the patient plateaus cannot be predicted beforehand.  Patients may also have characteristics of more than one level at a time.

Level 1 - NO RESPONSE: Does not respond to voices, sounds, light, or touch; appears in a deep sleep.

Level 2 - GENERALIZED RESPONSE: Limited, inconsistent, non-purposeful responses; first reaction may be to deep pain; may open eyes but will not seem to focus on anything in particular.

Level 3 - LOCALIZED RESPONSE: Inconsistent responses but purposeful in that reacts in a more specific manner to stimulus; may focus on a presented object; may follow simple commands.

Level 4 - CONFUSED, AGITATED: Heightened state of activity; confusion; unable to do self-care; unaware of present events. Reacts to own inner confusion, fear, disorientation; excitable behavior may be abusive or aggressive.

Level 5 - CONFUSED, INAPPROPRIATE, NON-AGITATED: Appears alert; responds to commands; follows tasks for 2-3 minutes but easily distracted by environment; frustrated; verbally inappropriate; does not learn new information.

Level 6 - CONFUSED APPROPRIATE: Follows simple directions consistently; needs cueing; can relearn old skills; serious memory problems but improving; attention improving; self-care tasks performed without help; some awareness of self and others.

Level 7 - AUTOMATIC APPROPRIATE: If physically able, can carry out routine activities but may have robot-like behavior, minimal confusion, shallow recall; poor insight into condition; initiates tasks but needs structure; poor judgement, problem-solving and planning skills; overall appears normal.

Level 8 - PURPOSEFUL APPROPRIATE: Alert, oriented; recalls and integrates past events; learns new activities and can continue without supervision; independent in home and living skills; capable of driving; defects in stress tolerance, judgment; abstract reasoning persist; many function at reduced levels in society.

References:
Lake Erie Institute of Rehabilitation, 137 West Second Street, Erie, Pennsylvania, 16507

Mitiguy, J.S., Thompson, G.T., & Wasco, J. (1990). Understanding Brain Injury. Massachusetts: New Medico Head Injury System.

National Head Injury Foundation. "Coma: Its Treatment and Consequences."

Click here to find out more about:

The Glasgow Coma Scale

    The Glasgow Coma Score is the most reliable of the various coma scales currently in use. It also requires only a brief examination of the patient and can therefore be obtained early on by non-professional people, such as paramedics. Because it is easy and quick to determine, it can be repeated frequently. Scoring the patient often and regularly can help make predictions about the outcome. Predictions made on the outcome of the patient are typically very accurate and when they err, they do so on the optimistic side.

     The Glasgow Coma Scale was designed to meet a need for a standardized initial evaluation. The scale assesses three components: eye opening, best verbal response, and best motor response. The lower the mark is, the more severe the brain injury. The lowest mark possible is 3. The highest mark possible is 15. As a patient comes out of coma, the mark rises. The scale is as follows:
Motor Response Example Score
Commands Follows simple commands 6
Localizes Pain Pulls examiner's hand away when pinched 5
Withdraws from Pain Pulls a part of body away when pinched 4
Abnormal Flexion Flexes body inappropriately to pain 3
Abnormal Extension Body becomes rigid in an extended position when examiner pinches him 2
No Response Has no motor response to pinch 1
Eye-Opening .
Spontaneous Opens eyes on own 4
To Voice Opens eyes when asked to in a loud voice 3
To Pain Opens eyes when pinched 2
No Response Does not open eyes 1
Verbal Response (Talking) .
Orientated Carries on a conversation correctly and tells examiner where he is, who he is, and the month and year 5
Confused Conversation Seems confused or disoriented 4
Inappropriate Words Talks so examiner can understand him but makes no sense 3
Sounds Makes sounds that examiner cannot understand 2
No Response Makes no noise 1

A chart that may be helpful to track a patients' progress may look something like this:
DAY 1 2 3 4 5 6 7
Motor Response
Eye Opening
Verbal Response
TOTAL

If the patient is receiving drugs, it may impair use of the scale.

If the patient rises four levels on the Coma Scale within the first 24 hours, this is considered a rapid improvement.

If the patient rises four levels in the Coma Scales in three days, this is considered a moderate improvement.

If the patient rises four levels on the Coma Scale in the first week, this is considered a slow improvement.

Some patients remain on their original coma score, without a change for weeks. This is called a prolonged coma.

Those patients who do not come out of coma may pass into a vegetative state. This state is often characterized by periods of the day during which the person's eyes are open, giving the appearance of wakefulness, but shows no signs that he or she is aware of the environment around him or her. The person is awake, but not aware.

References:
Freeman, E.A. (1987). The Catastrophe of Coma: A Way Back. Queensland, Austrailia: David Bateman Ltd.

Ivan, L.P. & Bruce, D.A. (1982). Coma: Physiopathology, Diagnosis and Management. Springfield: Charles C. Thomas.

What is Coma?

    Coma may be defined as "a prolonged unconsciousness caused by disease, injury, or poison" (Gage Canadian Dictionary, 1983).  It is commonly known as a state similar to sleep, but in which the person cannot be aroused and does not respond to any type of stimulation.

     People in coma may still be able to hear and to understand what others are saying around them.  For this reason, it is important to be aware of what is being said in their presence.  It is recommended that friends, family, and staff refrain from speaking negatively about the patient or his progress.  It is also recommended that staff be encouraged to speak to the person and explain what they are doing to him or her.  For example, before conducting any type of test, explain that a test will be done, what it is, what they have to do in order to take the test, and why it is important.

Levels of Coma

    There are several levels of coma defined by the patient's increasing awareness to his surroundings. Professionals measure levels of coma by the Glasgow Coma Scale or the Rancho Los Amigos levels of cognitive functioning. Generally, there are four possible awareness states when coming out of coma.

1. The Comatose and Unresponsive State
In this state, the patient makes no response to stimuli.  He has no facial expressions and there is no movement of any kind.

2. The Comatose but Responsive State
In this state, the patient makes a response when his senses are stimulates (that is, sight, hearing, touch, smell, and taste).  His breathing rate may increase, his heart rate may increase, he may make facial expressions, or he may have some movement of his body.

3. The Conscious but Unresponsive State
This is also known as the "locked in" state.  The patient may be able to see, hear, touch, taste, and/or smell but is unable to respond.

4. The Conscious and Responsive State
The patient has emerged from his coma in this state and can respond to simple commands.

Coming out of Coma

    When coming out of coma, a patient may make incomprehensible noises and/or move one or both arms or legs in a random, uncoordinated, and repetitive movement.  They may often try to pull any tubes out, have facial expressions, groan, cry, or shout.  They may also try to move and may resist people doing anything to them.

     One belief in terms of why a patient may make such noises or movements is that he is attempting to express himself.  He may be expressing that he is trying to get better, that he doesn't like what has happened, or that he doesn't like what people are doing to him.  He may also be expressing that he wants out of the situation he is in.

References
Freeman, E.A. (1987). The Catastrophe of Coma: A Way Back. Queensland, Austrailia: David Bateman Ltd.

Ivan, L.P. & Bruce, D.A. (1982). Coma: Physiopathology, Diagnosis and Management. Springfield: Charles C. Thomas.

The Different Tests

CT Scan or CAT Scan (Computerized Axial Tomography Scan)

    The CT Scan, or CAT Scan has been in use since 1973. It takes x-rays of the brain and then combines them to form a 3 dimensional picture on the computer.  In doing this, it can examine thin sections of the brain at different depths and therefore show much greater detail than a regular x-ray.

    The CT Scan is useful for testing for a variety of damage.  It shows if there is bleeding in the skull, tumors, hemorrhages, fluid collection, and can also determine the amount of swelling.  In depressed fractures, the CT Scan has the advantage of showing the amount of depression more clearly than the regular skull x-ray.

    Some advantage of the CT Scan over other tests include such factors as it is painless, it can be performed much faster than many other tests, and it can be repeated with little risk to the patient (that is, repeated changes can be monitored).  One major disadvantage, however, is that the CT Scan sometimes shows normal in patients who have seizures.

PET Scan (Positron Emission Tomography)

    A PET scan differs from a CT scan in that while a CT scan is limited to distinguishing anatomical features, a PET scan measures metabolic processes, thus allowing an appraisal of how the brain is functioning.

     It tracks natural compounds, such as glucose, as the brain metabolizes them.  By showing the areas of different metabolic activity, it then makes it easier to make diagnoses, such as determining the areas responsible for epileptic seizures.

EEG (Electroencephalograph)

    The EEG is a recording of the electrical activity of the brain.  Its computerized printout looks similar to that of an EKG which monitors the heart. Brain activity is represented by a graph which shows peaks and valleys which lessen with decreasing levels of consciousness.

     An EEG is given by attaching small electrodes (flat pieces of plastic with wires attached to them) to the scalp.  The wires running from the electrodes are connected to a computer which then interprets the signals it is receiving and produces a print-out of the electrical activity.  EEGs are often given to patients who have seizures.  They are very useful in locating the areas of the brain where there is abnormal electrical activity.

MRI (Magnetic Resonance Imaging)

    The MRI is similar to the CT Scan; however, it uses magnetic fields instead of x-rays to produce a three-dimensional picture of brain tissue.  The MRI is useful for minor brain injuries in that it shows very small changes in the brain which may not be detected by a CT Scan or an x-ray.

X-Rays

    The patient is placed underneath the X-ray machine and a special photographic plate which is sensitive to X-rays is placed under the patient.  The X-ray photograph is then taken.  X-rays pass through the flesh and are absorbed by the bone.  An image of the bone is therefore left on the photographic plate and is extremely useful for diagnosing the extent of an injury.  X-rays are used to identify the presence and the extent of fractures in the skull.

References:
Carson, R.C., Butcher, J.N., & Mineka, S. (1996). Abnormal Psychology and Modern Life, tenth edition. New York: HarperCollins.

Freeman, E.A. (1987). The Catastrophe of Coma: A Way Back. Queensland, Austrailia: David Bateman Ltd.

Ivan, L.P. & Bruce, D.A. (1982). Coma: Physiopathology, Diagnosis and Management. Springfield: Charles C. Thomas.

Service Coordinators' Contact Information
________________________________________Northwest Region
Northern Alberta Brain Injury Society (NABIS)
#406, 9728 Montrose Avenue
Grande Prairie, AB T8V 5B6
Tel: (780) 532-0477
Fax: (780) 532-5361
________________________________________Northeast Region
St. Paul Abilities Network
4915-51 Avenue, Box 457
St. Paul, AB T0A 3A0
Tel: (780) 645-3441
Toll Free: 1-866-645-3900
Fax: (780) 645-1885 Blue Heron Support
Services Association
4925-51 Avenue, Box 4238
Barrhead, AB T7N 1A2
Tel: (780) 674-4944
Fax: (780) 674-6294
Email: admin@bhssa.com

________________________________________Central Region
Catholic Social Services
5104-48 Avenue
Red Deer, AB T4N 3T8
Tel: (403) 347-8844
Fax: (403) 342-1890 Canadian Mental
Health Association (CMHA)
#4, 5015-48 Street
Red Deer, AB T4N 1S9
Tel: (403) 342-2266
Fax: (403) 342-5684
________________________________________Edmonton Region
Northern Alberta Brain
Injury Society (NABIS)
#301 10106-111 Avenue
Edmonton AB, T5G 0B4
Tel: (780) 479-1757
Fax: (780) 474-4415 Edson Office - NABIS
Box 20027
Edson, AB T7E 1W4
Tel: (780) 712-7560
Fax: (780) 712-2449
Email: nabis1@telus.net

________________________________________Calgary Region
SABIS
137, 2723-37 Avenue NE
Calgary, AB T1Y 5R8
Tel: (403) 521-5212
Fax: (403) 283-5867
________________________________________South Region
REDI Enterprises/Brain Injury
Relearning Services
828-11 Street SE
Medicine Hat, AB T1A 1T7
Tel: (403) 528-2661
Fax: (403) 528-2647
www.redi.ca

________________________________________
Alberta Brain Injury Network PDF
Alberta Brain Injury Network
Brain Injury Message Line: (780) 415-2747
Post Office Box 476,
Edmonton, Alberta T5J 2K1
Email: braininjury@gov.ab.ca

Saskatchewan

http://www.sdh.sk.ca/kcc/ABIServices.htm

http://www.braininjury-sbia.ca/

Directory of Programs and Services
Provincial Education and Prevention Co-ordinator
The Provincial ABI Prevention and Education Co-ordinator is responsible for the development and implementation of two provincial strategies, one for the coordination of prevention activities related to ABI and the other in regards to the educational needs of survivors, families, caregivers, professionals and the public. The Provincial ABI Prevention and Education Co-ordinator can be reached at (306) 787-0802.
Sask North Education and Prevention Co-ordinator
Funding is provided for a designated ABI education and prevention co-ordinator for the North. This individual will develop and co-ordinate prevention and education initiatives in the North in collaboration with the provincial ABI education and prevention co-ordinator and other stakeholder agencies. This person is located in the Mamawetan Churchill River Health District. For more information call (306) 425-8546.
Saskatchewan Institute on Prevention of Handicaps
The Saskatchewan Institute on Prevention of Handicaps is a non-profit organization with a mandate to raise awareness of preventive measures that can reduce the incidence of handicapping conditions in children. Funding under the ABI Partnership Project has been provided to the child injury prevention program. Efforts have been to raise awareness, share information, educate and provide programming to build skills. In these efforts, the institute has partnered broadly throughout the province with agencies and individuals that have experience and expertise in pertinent areas. The institute continues to work to decrease brain injury in children by focussing on four areas: shaken baby syndrome, falls, child passenger safety and bicycle safety. For more information, call (306) 655-2512.
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Outreach Support Teams
• Each outreach team consists of a variety of rehabilitation professionals experienced in the field of acquired brain injury.
• Teams provide individual and family support to people with acquired brain injury so that they may live successfully in their communities with improved quality of life.
• Teams accept self referrals as well as those from health facilities, physicians, any rehabilitation program or professional support services, schools or community agencies.
• The outreach teams are located in Prince Albert Health District (Sask North), Saskatoon Health District (Sask Central) and the Regina Health District (Sask South). The teams are responsible for providing services in the following health districts:
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Sask North ABI Outreach Team
• Parkland, Prince Albert, North Central, Pasquia, North-East, Athabasca Basin, Keewatin Yathé and Mamawetan/Churchill River
• Contact:
Sask North ABI Outreach Team
Gail Graham
Outreach Team Coordinator
1521 - 6th Avenue West
Prince Albert, SK S6V 5K1
Phone: (306) 765-6631
Fax: (306) 765-6617
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Sask Central ABI Outreach Team
• Northwest, Twin Rivers, Lloydminster, Battlefords, Saskatoon, Gabriel Springs, Central Plains, Greenhead, Midwest, Prairie West and Living Sky
• Contact:
Sask Central ABI Outreach Team
Sharon Babcock
Outreach Team Coordinator
Saskatoon City Hospital
701 Queen Street
Saskatoon, SK S7K 0M7
Phone: (306) 655-8448
Fax: (306) 655-8454
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Sask South ABI Outreach Team
• Southwest, Swift Current, Rolling Hills, Moose Jaw-Thunder Creek, South Country, South Central, South East, Moose Mountain, Regina, Touchwood Qu’Appelle, Pipestone, North Valley, East Central and Assiniboine Valley.
• Contact:
Sask South ABI Outreach Team
Betty Lou Whitley
Outreach Team Coordinator
Wascana Rehabilitation Centre
2180 - 23rd Avenue
Regina, SK S4S 0A5
Phone: (306) 766-5580
Fax: (306) 766-5144
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Saskatchewan Brain Injury Association (SBIA)
SBIA is a provincial, grassroots organization providing services for families in the form of support groups and other resources. Its functions include developing family support groups, providing a means of interacting with individuals with similar issues and problems, decreasing the social isolation that families sometimes face after a family member incurs a brain injury, providing information that aids in coping and adapting, and offering social support during crisis periods. You can reach SBIA at (306) 373-1555.
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Career Headways, Inc.
Career Headways is a non-profit community-based agency dedicated to improving the quality of life for people living with acquired brain injury. Community integration is maximized through holistic programming and specifically trained staff and volunteers. Program participants work to improve everyday functional living skills, thinking and communication skills, self-esteem, interpersonal-socializing skills, level of independence, roles in the community and employment readiness. The program provides structure and flexibility for participants to explore and maximize who they are at home, in the community, at play and at work. Participants attend six hours per day, Monday through Friday, for up to two years. Staffing includes Psychology, Occupational Therapy, Life Skills, Social Work, Recreation Therapy, Assistant Coaches and Volunteers.
Career Headways' offices are located in Regina’s downtown core, close to a major city bus line. You can contact Career Headways at (306) 352-8768.
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Phoenix Residential Society
The Phoenix Residential Society has an eight-suite apartment block staffed on a 24-hour basis, incorporating respite and crisis accommodation. In addition, a supportive living service is provided for 10 to 12 individuals who are living in a home of their choice and do not require 24 hour in-house support services. The goal is to enable individuals with ABI to live more independently in the community by assisting in the restoration of as much functional ability and quality of life as possible. Contact the Phoenix Residential Society at (306) 569-1977.
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Saskatchewan Abilities Council, Regina Branch
The Life Enrichment Program is designed to promote and facilitate personal and social rehabilitation of adults who have ABI living in the community. The program is client-based, individualized and flexible to meet the specific needs of each participant. Program activities take place in the community and, when required, in the individual's home environment. The Supported Employment Service is available to persons with ABI who are deemed ready to work. Individualized services to meet the specific vocational needs of the client are available. Contact the Saskatchewan Abilities Council, Regina Branch, at (306) 569-9048.
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Saskatchewan Abilities Council, Saskatoon Branch
The Supported Employment Service provides paid employment at a rate equal to or exceeding minimum wage, with training and/or support provided. Supported employment is made up of three components: job development, job coaching and ongoing support. Individuals with ABI applying to this program must be able to function independently in terms of personal care, demonstrate a willingness to participate, be capable of some form of two-way communication, have completed a vocational evaluation, have established realistic vocational goals, including at least two occupational choices, have a family physician and be medically stable. Contact the Saskatchewan Abilities Council, Saskatoon Branch, at (306) 653-1694.
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Saskatchewan Abilities Council, Yorkton Branch
The Yorkton Branch offers a program providing coordinated community-based activities that assist an ABI survivor to develop and maintain life and leisure skills. For further information, call (306) 782-2463.
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Prince Albert Health District Residential Options Program
This program provides residential options for persons identified as having an acquired brain injury. The program helps individuals find and maintain appropriate accommodation and ensures they receive supervision and skill development. Individuals are assisted in exploring and accessing vocational and prevocational options within the community and encouraged to participate in rehabilitation services. For more information, contact (306) 922-2969.
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Lloydminster and Area Brain Injury Society (LABIS)
The Life Enrichment Program helps participants deal with many different and difficult issues related to accepting their acquired brain injury and living a life of quality. The program offers a place for participants to come where they are accepted and can grow in terms of self-acceptance and self-confidence. This two-day per week program consists of exercise, mental aerobics, reality orientation, current events, basic life skills, crafts, games and cards, music, special guests, special events and field trips. Applicants must be more than 18 years of age, not aggressive or hostile and not severely confused or wandering. The Lloydminster and Area Brain Injury Society can be reached at (780) 875-2975.
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Saskatchewan Association for the Rehabilitation of the Brain Injured (SARBI)
SARBI provides a one-on-one rehabilitation program, individually designed for adults with an acquired brain injury. Volunteers, under the guidance of staff, professional therapists and consultants, play a central role in the rehabilitation services provided to the client. SARBI can accommodate up to 16 clients. For further information, call (306) 373-3050.
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Radius Community Centre for Education and Employment Training
The goal of this program is to facilitate re-integration of children and youth with ABI into age appropriate activities within their own community. The program provides intensive support to individuals and their families during re-integration into community age appropriate activities, develops volunteer/peer supports in a client's normal community environment, encourages independence amongst these volunteer supports and is available to increase support if required by the volunteer support network. The program serves children between the ages of six and 14 and youth between the ages of 14 and 21, with an ABI, who are enrolled in an educational program within the Saskatoon service area. The program will also provide consultation at a program level to programs outside the Saskatoon service area. For more information, contact (306) 665-0362.
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Saskatoon Crisis Intervention Service
In the city of Saskatoon, SCIS provides additional service co-ordination and/or case management assistance to individuals with acquired brain injury and their families, when crises persist and a high level of risk is present. They co-ordinate services and provide intense proactive community assistance to this group until mainstream services can be arranged. In the event these individuals require follow-up service co-ordination and practical assistance, crisis management services will respond. The Saskatoon Crisis Intervention Service can be reached at (306) 933-8234.
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Mobile Crisis Services, Inc. Regina
This program extends the services currently provided by the Crisis Management Services program (case management and service co-ordination) to include survivors of ABI who are unable to have their needs met through mainstream treatment programs. The overall goal of this program is to facilitate community re-integration by linking with the appropriate community resources. For further information, call (306) 757-0127.
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North Central Health District Speech Language Pathologist
Based in Melfort, this position serves the entire area of the North Central Health District. In addition to specific speech/language services, this position also acts as a case coordinator and facilitates community development initiatives, working closely with the ABI Outreach Teams. Contact (306) 752-8821.
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North West Health District
This program is offered as a partnership between the Northwest Health District, the Meadow Lake School Division and Multiworks Corp., an organization that offers vocational and residential options to persons with developmental disabilities. The program addresses life skills, vocational/avocational, social and educational initiatives. There is no age restriction for these support services. The health district also provides for a part-time rehabilitation assistant dedicated to providing services to people with acquired brain injuries. For more information, call (306) 236-6615.
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Swift Current Health District ABI Community Co-ordinator
This program includes community development and case management activities to facilitate effective community reintegration of individuals with ABI. Contact (306) 778-5260.
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Moose Jaw-Thunder Creek Health District ABI Community Co-ordinator
The Community Co-ordinator helps bridge the gap in service between acute care/rehabilitation and the community. The co-ordinator assists the survivor of ABI through the re-integration process. Key roles of the co-ordinator include identifying, coordinating and supporting community programs and resources that meet the individual needs of the ABI survivor; family support and education; and identifying and supporting appropriate residential options. The Community Co-ordinator for the Moose Jaw-Thunder Creek Health District can be reached at (306) 691-6442.
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East Central Health District ABI Community Co-ordinator
As an advocate for the ABI survivors, the Community Co-ordinator coordinates and implements community resources. This ensures a continuum of health care from the inpatient facility to the home and into the community.
The ABI Support Group is designed to ensure personal contact to survivors, families, and/or caregivers affected by an ABI. Through shared experiences the members are able to provide compassion and support to each other. For further information, contact (306) 786-0460.
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Central Plains Health District ABI Community Co-ordinator
The ABI Community Co-ordinator provides case management services to individuals and their families who are affected by an acquired brain injury in the Living Sky, Gabriel Springs and Central Plains health districts. The co-ordinator is responsible for the development, implementation, coordination and evaluation of a rehabilitation program for persons affected by an acquired brain injury. For further information, call (306) 682-1374.
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South Central Health District ABI Community Co-ordinator
Based out of the South Central Health District Client Services Division, this case co-ordinator/rehabilitation nurse co-ordinates and provides the supports and services necessary for ABI clients to remain in their own homes or the homes of their families. The coordinator also facilitates education and training of health professionals and families. Community awareness is promoted in association with the provincial program and SBIA. This ABI specific program will allow individuals to work towards independence. Programs are designed to be flexible, meeting individual needs. The co-ordinator can be reached at (306) 842-8315.
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South East Health District ABI Community Co-ordinator
The Supportive Services for Families Program strengthens the support available to the ABI client and family by building collaborative relationships between the health district, the client and the family. The work of the ABI Co-ordinator includes assisting ABI clients to regain or obtain their highest achievable level of independence and control over their lives and minimize the frequency of admissions to institutional care. The co-ordinator plays a vital role in community development in order to implement individualized care plans. For more information, call (306) 637-3643.
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Keewatin Yathé Health District ABI Rehabilitation Assistant
The therapy assistant provides hands-on care and rehabilitation services throughout the district. The individual in this position works closely with the Northern ABI Outreach Teams and is involved in community development, case management and education and prevention activities. The rehabilitation assistant can be contacted at (306) 235-5815.
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Mamawetan Churchill River Health District ABI Rehabilitation Assistant
The therapy assistant provides hands-on care and rehabilitation services throughout the District. The individual in this position works closely with the Northern ABI Outreach Teams and is involved in community development, case management and education and prevention activities. For more information, call (306) 425-4821.
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Parkland Health District ABI Rehabilitation Assistant
This part-time position is responsible for co-ordinating the Brain Walk resource, which is an interactive series of stations that lead the child through the different regions of the brain and explore the various functions. This position will also assist in other prevention activity and community development. For more information, call (306) 747-2471.
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Prairie West Health District Community Co-ordinator
The ABI Community Co-aordinator provides case management services to individuals and their families affected by an acquired brain injury in the Midwest, Prairie West and Greenhead health districts. The Co-ordinator is responsible for the development, implementation, coordination and evaluation of a rehabilitation program, for persons affected by an acquired brain injury. For more information, call (306) 463-8284.


Manitoba

http://www.escape.ca/~mhia/

http://www.smd-services.com/information/brain_injury.html


Ontario

http://www.obia.on.ca/

http://www.abinetwork.ca/links.htm


Chatham-Kent ,On
http://www.biack.com/

London, On
http://www.braininjurylondon.on.ca/

Niagara

http://www.niagara.com/bian/

Peel and Halton, On

http://www.biaph.com/



Nova Scotia

http://www3.ns.sympatico.ca/bians1/

Newfoundland

http://www.nbia.nf.ca/




Legal

http://www.braininjurylaw.ca/resources.html

http://www.neurolaw.com/

http://www.tbilaw.com/

Resources

http://braininjurychat.org/

http://www.tbichat.org/

http://www.waiting.com/

USA
http://www.biausa.org/Pages/splash.html




Washington
http://depts.washington.edu/rehab/

International

http://www.internationalbrain.org/

New Zealand

http://www.head-injury.org.nz/

United Kingdom

http://www.headway.org.uk/