Tuesday, April 25, 2017

Is Brain Injury to Blame?

There is a great organization called "BrainLine" which has resources and articles. I often read the information. Last week, a woman did a blog post about her husband's brain injury. For me, it hit me close to home. Here is the link: http://www.brainline.org/content/2017/04/is-brain-injury-to-blame.html Here is the article:

There’s a lot I didn’t notice about my husband a few years ago – the way he moves his arms when he walks or holds his razor when he shaves, the way he organizes his wallet or sorts laundry or returns voicemails. For seven years, I just wasn’t paying attention to these things. My husband was a grown man leading an independent life. There was no need to observe his every move.

Then came brain injury. And every little thing TC did or said or forgot or struggled with suddenly went under my microscope. I was a probing scientist, and he was my subject. It’s something I remember being warned of at the beginning of my journey—before I was even sure TC had a shot at recovery. A friend in the community wisely remarked, “Abby, you’ll never look at your husband the same way again.”

It took me some time to learn what she meant – that brain injury would become the lens through which I viewed everything: our circumstances, our future, myself, and especially TC. I couldn’t have known back then how difficult it would be to see beyond the injury, to the man inside. After all, how can one reasonably separate a person from his or her brain? They are one in the same – person and personality.

The other day my husband got in a small fender bender on his way to the movie theater. Fortunately, everyone involved was fine, and the car suffered only a small amount of damage. My first question to TC, of course, was “What happened?” But even as he explained the whole ordeal, the confusing turn lanes, and the apologetic other driver, I realized the details didn’t matter. From the moment I heard the words “car accident,” I had already decided he was at fault.

Anytime in the past four years that TC has forgotten a task, misread a text, gotten lost driving, or made any kind of mistake, my mind has attributed it to brain injury. There have been days during our TBI journey, I would ask myself a hundred times over whether TC’s behavior was a reflection of the real TC or the consequence of his brain injury. He couldn’t do something as simple as picking out a button-down shirt without me wondering what part of his brain was responsible for that choice. And in the process, I’ve lost sight of two really important, explanatory facts: no one is perfect and all humans make mistakes.

Even if my husband hadn’t suffered a blow to the head in 2012, it’s incredibly likely that he would’ve misread Google Maps, forgotten to pay a bill, or even gotten in the wrong turn lane while driving at some point over the course of his life. Some aspects of his behavior – like his aphasia or propensity to fatigue – are clear hallmarks of brain injury. But not everything is.

As caregivers, we have to tread very delicately in interpreting our loved one’s behavior. When our default assumption is to blame brain injury, we run the risk of creating self-doubt in the survivor. Mistrust breeds mistrust. So, if we cannot trust our loved ones to make sound decisions, how can they trust themselves?

Pointing the finger at brain injury also creates conflict and feelings of defensiveness between caregivers and survivors. No one wants to live under the microscope all the time and I know I’ve frustrated TC with my inability to give him both space and the benefit of the doubt.

It’s tricky, of course, because sometimes brain injury is to blame. And sometimes the consequences of a simple mistake are significant, such as losing one’s medicine or forgetting to turn off the gas burner. I’ve had enough conversations with other caregivers to appreciate that brain injuries run the gamut of severity and that some survivors really do need 24/7 observation.

The best I can do in my own relationship is try to remember the philosophy that also guides my teaching life: avoid snap judgments. I’ve had many experiences teaching that one kid who always breaks the rules or stirs up trouble. And just when I think I can predict that child’s next move with certainty, he or she does something that humbly forces me to revise my thinking. Teaching, like caregiving, is hard work. 

Sometimes we get so bogged down in the small moment-to-moment decisions, that we become blind to the big picture. Just as kids and survivors err, so do we. And the fairest, kindest thing to do sometimes is to pause, ask questions, and remember our own human fallibility too.

Tuesday, April 4, 2017

Sensory Overload

I have not posted for a long time. Life is getting in the way. In a good way most of the time! I have joined many Facebook groups dealing with “brain attacks.” One of my favorites is the “TBI Life Coach.” I am posting this whole article because it is very helpful. For me anyway!  
Sensory Overload
Sensory over stimulation
Sensory over stimulation or 'Flooding' occurs after brain injury because the brain's 'filters' no longer work properly.
Sensory over stimulation or 'Flooding' occurs after brain injury because the brain's 'filters' no longer work properly. It is an exhaustive situation if more pieces of information or stimuli are received than the brain can handle. A stimulus is information that we perceive through our senses; see, hear, smell, taste, touch (external stimuli) or through our mind or our body / proprioception (internal stimuli).
In over stimulation feelings of panic can prevail upon the brain-injured. Our study showed that fear can be overcome if the person with brain injury has been exposed frequently to over stimulation.
The person may be sweating, have tremors, can be vomiting, and thinking is difficult.
These are the basic reactions of the body to survive in a situation that is perceived as very dangerous. It is also called the fight or flight response. One person is going to flee from the overstimulation of the noise or stimulus of the moment. The other person faints. Most of them cannot think anymore or are very upset first.
The basic emotion of fear and the ensuing responses are generated and directed by the amygdala. The amygdala is part of the oldest part of the brains, the limbic system. This system is a kind of emotional sentry. All that matters is survival. If there is danger, immediately adrenaline, noradrenaline and cortisol are released into the body to flight, fight or freeze.
Amygdala
At the same time, the neo-cortex, also called the rational mind, will stop the mind from thinking. Because, after all, in threatening situations there is no time to decide what the best plan of action will be.
A rapid response of the amygdala thus ensures that we can avoid the danger before we realize that we find ourselves in such a situation.
On this page you will find some videos about this problem.
Summary: By over stimulation people are no longer able to rationally deal with the situation. Fear can prevail and the amygdala creates a fight-flight-or freeze reaction. After brain injury the processing of stimuli is often disrupted.
This often gives a brain fatigue/neurofatigue.
It's not all in your head,flooding /sensory over stimulation can't be seen, unless sometimes in some individuals signs like sweating or a red head...or people think that you are in panic, for it reminds them in a way of that.
SOUNDS
Overstimulation by sounds occurs in background noise where the sounds cannot be cut out. Not being able to follow a conversation with multiple sounds. Noise intolerance. Irritation in rhythmic sounds, ticking of a clock or buzzing fluorescent lighting. Shoe steps on a wooden staircase or wooden floor, squeaky doors, etc.
Many complaints are reminiscent of or equal to hyperacusis. Hypersensitivity to sound. Many people also experience pain in sound.
Sensory overstimulation occurs when seeing patterns or colors. Seeing a variety of nice stuff at home. Letters that are too close to each other with no blank lines. Seeing movements, seeing moving hands or people who wiggle their legs but also seeing a multitude of people. Seeing a multitude of some objects. Seeing details like prints, shades, bricks etc.
Even seeing unordered higgledy-piggledy or 'for sale' articles can give too much stimuli for the brain to see it in a shop. Like a bargain basement, not stacked shopping baskets, etc., etc.
LIGHT
Sensory overstimulation by light occurs in reflected light, in certain lights (halogen! fluorescent lighting!), Backlight or changes of shadow and light while driving, bright light, lots of light, flickering candles etc.
Notorious is car driving on a road where are many trees and low standing sun behind the trees.
FEELING
Sensory overstimulation by feeling occurs in people who suffer from motion, touch, being moved, vibrations etc..
SMELL
Sensory overstimulation by smell can come about by enhanced sense of smell and can include nature smells, food smells, natural odors, body odors, perfumes and deodorants (including nursing staff and caregivers!)
MULTITUDE OF THOUGHTS OR LISTENING TO WHAT IS BEING SAID
Chronic overstimulation
Chronic overstimulation is not healthy. It is pure stress.
The endocrine system changes (increased stress hormone level) and long-term chronic overstimulation also changes ones nervous system. Actually this can even make an individual more sensitive to overstimulation than he already was. Symptoms include physical symptoms like headaches, stomach problems, decreased resistance, disturbed sleep, extreme fatigue, or even depression, burnout or anxiety.
Our perception takes place by:
Senses
Vision - seeing
Auditory - hearing
Tactile sense - feeling
Olfactory sense - smelling
Taste - tasting
Nociception - sensation of pain
Thermoception - feeling of heat or cold
Sense of balance - balance
Proprioception - body awareness
Cognition – what we learn to know by the senses
Percieve (basic cognition *)
Attention and concentration (basic cognition)
Thinking (basic cognition)
Memory (basic cognition)
Applying knowledge (basic cognition)
Understand (basic cognition)
Language skills (basic cognition)
Assessing (metacognition)
Reasoning skills (metacognition)
Sense of reality (metacognition)
Emotion (social cognition)
Empathy (social cognition)
Practical language skills (social cognition)
Sensory overstimulation is caused by:
Damaged filtering
All stimuli, the important as well as the unimportant stimuli, enter with the same strength. They are not filtered.
Detour = Delay
When stimuli of brain cells need to be guided around brain injury this causes a delay in the perception. This is not only the case with focal, localized injury, but also with diffuse injury that is spread across the brains. It also takes longer to interpret the stimuli. That is one of the causes for a person with brain injury to be flooded by stimuli. This is also called delayed information processing.
There is an abundance of stimuli in idle mode which cannot be processed. Just like a PC that crashes through having a slow processor.
Fragmented perception
Many people with overstimulation by brain injury perceive every independent detail by hyper selection. It is difficult to see connections between details and to see, to oversee or to hear the whole.
This can occur both in the auditory and visual area. As long as there is one sound stimulus, the conversation is central and there is no music playing in the background, there is no problem with experiencing sound. However, in the case of buzz or loud noises in the background, the processing of auditory stimuli is not done properly.
This can also happen in the visual area. People cannot ignore details in the image. In the case of rain, they see each drop on the car's windscreen and the windscreen wiper. They see each individual in a group or every cobble on a cobblestone road.
Distorted processing can cause overstimulation
Hyperacusis - hear too much
Cerebral Visual Impairment CVI - double vision, seeing varying sharpness, depths may be huge or not, spaces may seem larger or smaller
Agnosia - not being able to recognize an object, a sound, smell etc.
Non-synchronous processing of stimuli in the brains. Signals do not enter the brain area synchronously.
Low frequency noise
Some people have problems with low frequency noise.

You may find these links useful https://www.retailmenot.com/…/sensory-overload-while-shoppi…
http://www.oneplaceforspecialneeds.com/…/library_sensory_pr…