May 22, 2013
May 21, 2013
Why Skills Coaching for Brain Injury Survivors?
After a brain injury, life changes. One day, everything is fine, and then suddenly one has to deal with a comprehensive shift in reality – neurologically, psychologically, emotionally, socially and even spiritually. Survivors go from life as “normal” to dealing with deficits that extend into all aspects of their existence.
Without helpful interventions, brain injury survivors have their deficits predominate in their personalities. This often renders them socially unacceptable, awkward and unemployable. Many tend to withdraw and isolate themselves. Others may act out or exhibit behavioral issues. Chan, Hudson & Parmenter (2004) found that it is becoming increasingly evident that brain injury and criminal behavior are linked. Certainly, when left to deal with the complications of brain injury alone, the burden on the individual can be overwhelming. Studies also have shown that the tendency for survivors is to self-medicate with drugs and/or alcohol. In Advances in Mental Health’s research, Chan et al. (2004) suggests an urgent need to consider early-intervention.
Gray Matters Survivor Outreach – Support Services
This program proposes a quality intervention of personal, one-on-one coaching.
Gray Matters Survivor Outreach already provides three monthly support groups in San Diego and North County. The coaches are trained and made available to work with survivors after they leave the hospital or after having struggled with living independently for some time. In reaping the benefits from this coaching program, divergent behaviors can be “nipped in the bud.”
Gray Matters’ coaches can be a genuine resource for people who have recently sustained a brain injury. The coaches are long-term survivors of brain injury themselves. Just their simple presence and understanding serves their partners in helping them to cope! They can share what helped for them in regaining daily living skills and they can help the partners strategize how best to get by in their specific circumstances. Coaches can also rehearse and familiarize the partners with the accommodations that suit their needs, so that they can put them to use on their own. Additionally, they (and the Program Director) can refer the partners to local resources for services.
To further a person’s sense of wellness, survivors need to cope with their condition and approach psychosocial issues. Lerner, (2006) thoroughly articulates the psychosocial symptoms of a brain injury in her book, Gray Matters, Brain Injury, the Inside Perspective. Many of these symptoms (see list below) are less obvious to the average eye, they are enduring and hard to address. Psychosocial distress is emotional, social, behavioral, and psychological. The very act of interacting one on one via coaching will help to identify issues that would otherwise be difficult for the brain injury survivor to be aware of. Once the issues are identified, they can then be addressed with useful interventions.
The following is part of a seemingly endless inventory of possible ongoing psychosocial challenges:
• Increased emotionality
• Poor self-awareness
• Social inappropriateness/awkwardness
• Frequent mood changes
• Feelings of unworthiness
• Involvement with alcohol and drugs
• Inability to inhibit oneself
• Inappropriate behaviors
• Takes too many risks or acts impulsively
• Disintegration of self-esteem
• Decreased sense of discernment or judgment
• Poor anger management
• Insensitivity or oversensitivity to others
• Unawareness of how actions impact others
• Lessened ability to interpret emotions & read situations
• Easily frustrated
• Lowered tolerance for frustration
• Inappropriate manners and mannerisms
• Inability to understand humor or “size up” situations
• Inappropriately affectionate or unaffectionate toward others
• Impaired ability to see others’ viewpoint (egocentricity)
• Limited insight into own abilities and behaviors
• Limited ability to correct behavior after feedback
• Gets stuck on one thought or behavior
• Is seemingly unmotivated
• Acts fearful
• Gets angry out of proportion to cause
• Is verbally and/or physically aggressive
• Appears anxious or depressed
• Laughs or cries for no apparent reason
• Isolates self
• Seeks attention, even with negative behaviors
• Is demanding
• Is irritable
• Gets tired easily
• Denies problems
• Seems passive and unmotivated
One characteristic exhibited by brain injury survivors is an extreme sensitivity to others. Because of this sensitivity, coaches, or others who have the experience-base to understand their partners, are so important. Oftentimes, the professionals who are interacting with the survivors appear to be cold and distant. Therapists may know the professional techniques, but they do not understand the personal complexities of brain injury, hence, survivors retreat and often isolate themselves from the very individuals who are trying to help them. The introduction of a coach can help to counter such negating experiences.
A coaching relationship can be a catalyst that helps brain injury survivors rejoin the world. In interacting with the coach, they will learn to proactively socialize. Coaches are not administering a professional protocol, they are there because they care and they are there to individualize strategies to work for their partners. Coaches have a feel for what their partners are going through, because they have walked that path themselves and they can be the connection for their partners to find their way back.
Gray Matters Survivor Outreach
Our name serves as a double entendre. We serve to outreach to survivors and we are survivors reaching out. This country is searching everywhere for solutions to brain injury (and is utilizing a lot of the tax-payers dollars). Gray Matters Survivor Outreach, I say a very effective solution is right in front of us. The supply is available in bulk. That is, other survivors.
The intervention of coaching touches areas that are hard to reach (areas such as social skills, personal attitudes, etc.) and if they are not intervened on, they can become problematic. Survivors are more willing to trust someone who has walked the path they are on. In knowing this, the training for Community-Based Skills Coaches involves teaching strategies and interventions, as well as learning to be an “active listener” and other communication skills.
The protocol for Gray Matters’ is empowering for the coaches and serves in healing for the long-term survivors, themselves. “Give, and it will be given to you.” (Luke 6:38). Such restoration can happen in ability to communicate, self-confidence, self-worth and in better socializing. When matches are made, outreach is in process, Gray Matters Skills Coaching presents a win-win relationship.
Founder and Program Director
Gray Matters Survivor Outreach
May 20, 2013
Right here, in this blog, GRAYMATTERS4U.ORG!!!
Thanks to one of my readers who said:
“This web site is known as a walk-by means of for the entire info you needed about this and didn’t know who to ask. Glimpse right here, and also you’ll undoubtedly discover it.”
May 15, 2013
Sometimes things go bad and people get sad. This is not depression.
Depression hovers. It’s hard to shake off.
The mind can be a hole that just sinks deeper and deeper.
May 8, 2013
We’re up again!
Lets be thankful to that great Magician in the sky (and my web host, Netfirms had something to do with it)!
May 6, 2013
May 2, 2013
April 29, 2013
It’s been quite some time
I’ve been traveling on this route,
No one ever told me
What it was all about,
I’ve been probed to my core,
Sometimes I wonder
What it’s all for,
I’m affected on the inside
Morning, noon and night,
My friends and family
Say it will be all right.
But what do they know?
They’ve never been down this road,
All they know
Are the impressions that I’ve showed.
No one ever told me
How complex all of these difficulties would be.
There are no signs pointing the way,
How can people say it’ll be Ok?
They may know of my problems with memory,
But they couldn’t possibly know
How widespread it affects me!
What about my sense of disorientation
And the disappearance of my dreams?
How come no one ever told me about these things?
There are potholes along the road,
My abilities have seemed to corrode,
No one ever paved this road for me,
I trip over obstacles I can’t even see,
I feel the doctors are only guessing,
Some may need
More knowledge and skill
To be assessing!
I don’t want the doctor
To paint the picture
What my outcome will be…
He may be having a bad day,
I believe much more in me!
I may be making it up as I go,
But I best accommodate for myself,
This I know.
I trust in my instincts,
Get a little help along the way,
Trauma to the brain,
…Blocks do let up
Along the unpaved road.
Sense of self,
Braiding myself back together,
Knowledge rebounds in the aftermath,
Recognizing new parts of myself,
Healing is in flow,
I’m traveling down that road.
GRAY MATTERS – Brain Injury Support Groups
* Circle with other brain injury survivors
* Come to better understand & manage the affects of brain injury
* Covering interesting, fun & relevant topics & modalities
* Your needs are understood
* Learn better strategies & better attitudes
* See that you are not in on this alone
* Get to know each other
* Even have some fun!
Sharp Rehab Support Group
Sharp Rehab Hospital – Conference Room
2999 Health Center Dr.
San Diego, CA 92123
Second Thursday of each month, 5:30-7:30 pm
Mission Valley Support Group
Access to Independence – Conference Room
8885 Rio San Diego Drive, Suite 131
San Diego CA, 92108
First Tuesday of each month, 5:30-7;30 pm
North County Support Group
Del Mar Library – Community Room
1309 Camino del Mar
Del Mar, CA 92014
Third Thursday of each month, 5:30-7:30 pm
GET A COPY OF OUR FLIER:
*** Gray Matters Support Groups
April 22, 2013
Reuters Health, By Kathryn Doyle
NEW YORK | Fri Apr 19, 2013 4:57pm EDT
People who get more fiber in their diet are less likely to have a stroke than those who skimp on the nutrient, according to a new review of existing research.
“A few people in the past have looked at the relationship between fiber and cardiovascular disease, which includes coronary heart disease and stroke,” senior author Victoria Burley told Reuters Health.
But this is the first time all the available results from long-term studies have been pulled together into one analysis, said Burley, a senior lecturer in nutritional epidemiology at the University of Leeds in the UK.
Burley and her coauthors pooled the results of eight studies conducted since 1990 that included close to 500,000 participants. Those people reported on their dietary fiber consumption and were followed for anywhere from eight to 19 years.
The researchers found the risk of suffering a first stroke fell by 7 percent for every 7-gram increase in dietary fiber people reported each day – so that those who ate the most fiber had the lowest chance of stroke, according to findings published in the journal Stroke.
The average U.S. woman gets 13 grams of fiber per day, and the average man gets 17 grams – well below the Institute of Medicine recommendation of 24 and 35 grams, respectively.
An extra 7 grams could come from two slices of whole wheat bread and a serving of fruit, for example, Burley said. But even less than that – just 2 or 3 extra grams per day – might affect stroke risk.
Americans suffer almost 800,000 strokes annually, and strokes cause one out of every 18 U.S. deaths, or 130,000 per year, according to the Centers for Disease Control and Prevention. Most happen when a clot blocks blood flow in a brain vessel.
“Stroke is a very common and chronic disease in our society because the risk factors are growing,” Dr. Dean Sherzai, a neurologist at Loma Linda University in California, told Reuters Health.
The new results are important because at the moment there are limited treatments and preventive measures available for stroke, but diet changes such as adding more fiber are relatively easy, said Sherzai, who was not involved in the study.
The report didn’t look at the effects of different types of fiber on people of specific ages – so it’s possible some may glean more benefit from eating extra fiber than others, he added.
The findings don’t prove fiber directly prevents strokes. Researchers also don’t know why fiber would be linked to a lower risk, although they have some ideas.
“There could be all sorts of things going on,” Burley said.
Foods high in fiber tend to be low-calorie and help people maintain a healthy weight, which reduces stroke risk, she said. Fibrous foods also have vitamins, minerals and antioxidants including polyphenols and flavonoids, which make blood vessels more elastic.
The findings should serve as more encouragement for people to get their daily recommended fiber, Burley said. She’d like to see fiber back on the agenda – since it sometimes falls to the wayside in low-carbohydrate or gluten-free diets.
“Sometimes things like this just aren’t deemed sexy enough,” Sherzai said.
It is obviously better to keep it all in flow!!!!
Life’s troubles are thrown our way -
– Can’t remember that important information just told to me a minute ago
– Don’t remember where I am or what day it is
– Feel isolated from the world
This too shall pass!
Lets stand strong together.
We battle with ourselves to survive.
What doesn’t kill us, makes us strong!
We are not victims of our injury!
We are made victors by our triumphs.
I declare –
No obstacle can defeat us.
Our minds are filled with good thoughts about ourselves, our friends and our family,
not thoughts of defeat.
We are empowered by our Creator. We are blown by the winds of heaven.
Survivors, stand tall and have the courage to love yourselves.
Imagine this -
Look into your mother’s eyes. Love yourself as she loves you.
April 19, 2013
Letter to Congress about EEG-Driven Stimulation (Interactive Light Therapy) for Brain Injury Survivors
EEG-Driven Stimulation (Interactive Light Therapy)
Len Ochs, Flexyx, LLC
Testimony to Congress
By Heidi Lerner
Good morning. My name is Heidi Lerner, and I would like to let you know that nine years ago I had a car wreck; I went flying through the car window and as a result I had a traumatic brain injury. Well, you may think, what does that actually entail? Through time, my symptoms ranged in severity, from not knowing who my parents were after awakening from a coma, to nine years later, having test-taking being an excruciating experience.
I tell you all of this because I was a participant in the research study of Electroencephalogram Stimulus biofeedback for people who have sustained traumatic brain injuries. I am presently studying to be a special educator for children who have sustained a traumatic brain injury. I am strongly pro-EDS and I thank you for the opportunity to share my perspective.
“Every year over 90,000 people sustain a severe brain injury leading to irreversible and debilitating loss of function. For survivors, the picture is often grim. A large number of patients with traumatic brain injury (TBI) will have difficulty returning to a productive life in society and will require years of rehabilitation, medical follow-up, and integrated community services. Medical treatment, rehabilitative efforts and disability payments for such injuries are as high as 25 billion dollars a year.” (Committee on Labor and Human Resources[CLHR], 1993, 1-2). We can understand that a person’s rehabilitation from brain injury does not only usurp a person’s life and energy, but it also takes up a significant allotment of tax dollars.
In 1993, the Traumatic Brain Injury Act authorized $5 million dollars to be funded for conducting basic and applied research at the National Institute of Health (NIH). The committee’s intent was to “identify ways to reduce brain injury following trauma and identify treatment modalities to prevent further damage to the brain following a traumatic brain injury” (Committee on Labor and Human Resources [CLHR], 1993). In 1997, the NIH, Department of Alternative Medicine began a research study of the newly developed form of electroencephalogram (EEG) biofeedback called Electroencephalogram Driven Stimulus (or Interactive Light Therapy).
Barbara Aigin, a practitioner of EDS, states that “There are many types of biofeedback. It could be as simple as the alarm clock waking up the body and the sleeper reaching out to turn it off.” (personal communication, June 17, 1998). The Bantam medical dictionary defines biofeedback as “the giving of immediate information to a subject about his bodily processes (such as heart rate) which are usually unconscious.” (Editors of Market House books Ltd., 1996). So giving feedback to the body and monitoring its reactions can be a way of understanding biofeedback. “Biofeedback has been traditionally used to assist with lowering blood pressure, pain control and relaxation. EDS is the next generation of biofeedback equipment.” (personal communication, June 17, 1998).
Electroencephalogram Driven Stimulus
In 1990, Dr. Len Ochs developed both the procedure and equipment of EDS, which adjusts the rate of electrical activity in a patient’s brain as a way of correcting numerous symptoms of various disorders. The process of EDS is best described by Dr. Mary Lee Esty in the research proposal. She states that “EDS uses a combination of electroencephalogram (EEG) and light stimulation technology.
EEG is a method used to measure brain waves through electrodes placed on a person’s scalp. First, the skin is cleansed with alcohol at each electrode site and some electrode gel or paste is put onto an ear clip and a gold cup electrode. A third sensor, a neutral ground is placed on one finger. After the sensors are prepared, people put on a pair of dark glasses with small lights in each lens. The computer measures the EEG which determines the rate at which the lights flash. Patients have only one task aside from sitting as quietly as possible. That task is to report any experiences of discomfort or irritation, as well as pleasant experiences.” (1996, 1).
EDS has been observed to have a rehabilitative effect on various disabilities. Some of them are: attention deficit hyperactivity disorder, attention deficit disorder, behavioral disorders, sleep disorders, learning disabilities, seizure disorders, stroke, brain injury (acquired and traumatic), depression, migraine headaches, addictive diseases, chronic fatigue syndrome, autism, fibromyalgia, post-traumatic stress disorder, and various psychiatric disorders. As my interest is in special education for children, I will be focusing on the benefits that a child may experience if treated with EDS after sustaining a traumatic brain injury.
I happened to be a student at the time of my participation in the research study and I can tell you how it benefited me in my educational process. I had felt that the symptoms I was still experiencing 8 years post-injury were challenges that I was destined to live with for the rest of my life, yet in 2 months of regular treatments (i.e. 5 days a week), these troubles were fully ameliorated. My memory had substantially improved, my attention became more focused (i.e. I went off of Ritalin), personal organization subtly reentered my life, my energy level increased and the time it took me to: process information, comprehend what I read and what was orally communicated to me, all quickened. It also cleared up a seemingly chronic depressive condition and a severe sleep disorder.
Len Ochs reports that after a head injury, EDS has reliably improved irritability and explosiveness, clouding of consciousness, short-term memory, attentional problems, difficulty absorbing verbal and written material, low energy during the day, sleeping problems at night, movement problems, stamina, problems with depression and in initiating activities (1998). Barbara Aigin states that ”Additionally, in my experience, the children I have treated are able to have a better school experience; what I have been told is that they interact more appropriately with teachers and peers.” (personal communication, June 17, 1998).
“Central nervous system symptoms and slow brain waves are related. When people are overly stressed, injured, or traumatized, their brain waves may get fixed or ‘stuck’ in a pattern of predominantly low frequencies. This is called EEG slowing- and is associated with symptoms such as anxiety, depression, irritability, fatigue, hyperactivity, distractibility, mood swings, confusion, disorganization, problems with sleep, concentration, following conversations, reading comprehension, memory and attention” (Esty & Aigin, 1998). Dr. Ochs clearly states that EDS should be seen as “a reliable, and reasonably rapid way to reduce EEG slowing, and not as a treatment magically improving a wide variety of disorders; an outcome ‘’too good to be true’.” (Ochs, L., 1998).
Supplementing the IEP
The treatment of EDS can be used to supplement a child’s Individualized Education Plan (IEP). EDS treatment could act in strengthening some children’s deficit areas. Wondrous leaps can be made in educational performance.
Payment of EDS as a related service
The “Individuals with Disabilities Education Act (IDEA) requires that special education and related services are required to provide a Free Appropriate Public Education (FAPE) at no charge to the parents of students in special education. Nothing in IDEA, however, relieves an insurer or similar third party payer from a valid obligation to provide or pay for these services (IDEA regulations, 34 C.F.R. §300.301(b)).” A 1988 amendment to the Social Security Act permits schools to collect payment for covered services by Medicaid for students with disabilities, even if their services are included in IDEA (Yell, 1998). In a study by Spaller and Thomas (1994), it is noted that “schools can also tap private insurance companies, nonprofit health corporations, and health maintenance organizations (HMOs) to help defray the costs of related services” (Yell, 1998, 217).
In approaching Medicaid with the interest in advocating for the reimbursement for EDS treatments, Barbara Aigin and other EDS practitioners, would ask that they take the above information regarding the effectiveness of EDS for children with brain injury into consideration. At this point in time, EDS services are conducted through personal payment. Only a few insurance companies will finance EDS therapy. EDS practitioners hope that in the future, services may be reimbursed through interagency funding.
EDS will serve to benefit: children and adults who have sustained brain injuries (i.e. as well as those with many other disorders), the field of research, the school system, as well as the tax payer. As was already mentioned in detail, EDS will undoubtedly benefit people’s lives that will participate in this therapy. NIH has found what they have searched for, a means “to reduce brain injury following a trauma” (Committee on Labor and Human Resources[CLHR], 1993, 1-2). This therapy can benefit the school system by facilitating the educational process of those that are educationally impaired. It can also serve in reducing the amount of money that will be needed in the process of rehabilitation from brain injury, thus it can be an influence which reduces the taxpayer’s financial responsibility for brain injury rehabilitation.
- EDS has been proven to be effective for adults and children and would be a great asset to the school system. We are thus asking Medicaid to fund EDS services in the schools.
Esty, M. L. Interactive light therapy using EEG driven stimulation (EDS) for symptoms of autism, depression, head injury, fibromyalgia, chronic fatigue, and post traumatic stress (1998) . [Brochure] . Chevy Chase, MD: Esty & Aigin .
Committee on Labor and Human Resources . (1993) . Traumatic brain injury act (103rd Congress, 2nd session, report 103-243) . Washington DC : Mr. Kennedy .
Editors of market house books ltd. . (1996) . The Bantam medical dictionary (2nd revised edition). New York : Bantam books .
Esty, M. L., (1996) . Research proposal: EEG-driven stimulation in the treatment of traumatic brain injury in the post-acute stage West Orange, NJ: Kessler .
Ochs, L., (1998) . Flexyx neurotherapy system and post-concusive problems . [On-line] . Abstract from: www.flexyx.com
Ochs, L., (1998) . Flexyx neurotherapy system and post-spinal chord injury/cerebral accident paralysis and aphasia . [On-line] . Abstract from: www.flexyx.com
Ochs, L., (1998) . Flexyx neurotherapy system home page . [On-line] . Abstract from: www.flexyx.com
Turnbull, H. R. III, & Turnbull, A. P. (1998) . Free appropriate public education: The law and children with disabilities (Fifth edition) . Denver, Colorado: Love .
Yell, M.L. (1998) . The Law and Special Education Upper Saddle River, New Jersey : Prentice-Hall .
April 14, 2013
Insurance Company Blindness Posted on January 5, 2012 There has been a great deal of advancement in the field of traumatic brain injury in the past twenty years, but unfortunately the insurance industry would just assume go back in time to the 1970′s and stay there. This is because the recent advances in neuroscience and study of the brain have shown us that many of our earlier ideas about the brain were wrong. Insurance companies continue to defend brain injury cases as they did twenty years ago by relying on medical ideas that are no longer valid – that someone must be rendered unconscious to suffer a traumatic brain injury, that a person with a normal CT or MRI cannot have a brain injury, that there is no mechanism by which brain injury can occur in the context of a mild traumatic brain injury. How do they get away with treating claimants in this way, as if science had not progressed in the last twenty-years? They do it, in part, by relying upon hand picked doctors to perform their compulsory medical exams (CME’s). These examinations are part of every significant case that goes into litigation. The court, the claimants and plaintiff’s attorney have no say over which doctor is chosen. In most cases, even involving moderate or severe TBI, their doctors will find a way to blame the victim or ignore part of the medical evidence. How is this done? Hiring older or retired doctors who went to medical school and got their training before these discoveries were made. They can then attempt to ignore more modern ideas unless plaintiff’s counsel forces them to do so; Doctors rely upon “cherry picked” facts out of the case, ignoring data consistent with TBI and relying upon data of limited quality to make opinions. An example of this, in one of my trials, was that a psychiatrist based his opinion that my client had a pre-existing personality disorder based upon a single sentence written in my client’s third grade school chart. This was despite the fact that in 11th and 12th grade she was noted to be “well adjusted and well liked.” This was despite ten independent witnesses that spoke to her ongoing character and work abilities. Which is more reliable, a single sentence written thirty years ago, or the testimony of current friends and co-workers? Another example is the issue of loss of consciousness. When Plaintiff is claiming TBI and the medical records indicate that there was no loss of consciousness during or immediately after the accident, that fact is treated as the most important thing since the invention of the wheel by the defense doctors. Yet, if the initial medical records show that the plaintiff was unconsciousness and had a diminished Glasgow Coma Scale (GCS), that fact will hardly ever make it into the doctors report. Many of them feel that, while a lack of loss of consciousness can disprove a brain injury, a period of unconsciousness after an accident does not prove a brain injury. Fortunately, a combination of the influx of our brave men and women from Iraq and Afghanistan, as well as new findings regarding NFL players, have sensitized both the public and younger doctors to the fragility of the brain. What a wonderful and positive change it has been for our soldiers. In the bad old days, and you might remember the movie Patton, when he slapped a “shell-shocked” soldier, there was no such thing as a mild or even moderate brain injury. If you could walk and talk, you were not hurt. There are many sad tales from these years of neglect, many lives in ruin through addiction, or criminal behavior following an injury. However, the armed forces are currently doing a magnificent job studying mild traumatic brain injury, blast injuries and utilizing the latest tools such as DTI (Diffusion Tensor Imaging) to identify and rehabilitate traumatic brain injuries. Likewise, the NFL players whose brain autopsies have come to light, have shed light on the terrifying damage done during football careers. The “old” notions about brain injury will live on in TBI litigation, and because of this, attorneys involved in these cases need to be unceasing in their efforts to drag all insurance companies into the bright lights of the 21st Century, so the can see reality, clearly.
Insurance Company Blindness
Posted on January 5, 2012
There has been a great deal of advancement in the field of traumatic brain injury in the past twenty years, but unfortunately the insurance industry would just assume go back in time to the 1970′s and stay there. This is because the recent advances in neuroscience and study of the brain have shown us that many of our earlier ideas about the brain were wrong.
Insurance companies continue to defend brain injury cases as they did twenty years ago by relying on medical ideas that are no longer valid – that someone must be rendered unconscious to suffer a traumatic brain injury, that a person with a normal CT or MRI cannot have a brain injury, that there is no mechanism by which brain injury can occur in the context of a mild traumatic brain injury. How do they get away with treating claimants in this way, as if science had not progressed in the last twenty-years? They do it, in part, by relying upon hand picked doctors to perform their compulsory medical exams (CME’s). These examinations are part of every significant case that goes into litigation. The court, the claimants and plaintiff’s attorney have no say over which doctor is chosen. In most cases, even involving moderate or severe TBI, their doctors will find a way to blame the victim or ignore part of the medical evidence. How is this done?
Hiring older or retired doctors who went to medical school and got their training before these discoveries were made. They can then attempt to ignore more modern ideas unless plaintiff’s counsel forces them to do so; Doctors rely upon “cherry picked” facts out of the case, ignoring data consistent with TBI and relying upon data of limited quality to make opinions. An example of this, in one of my trials, was that a psychiatrist based his opinion that my client had a pre-existing personality disorder based upon a single sentence written in my client’s third grade school chart. This was despite the fact that in 11th and 12th grade she was noted to be “well adjusted and well liked.” This was despite ten independent witnesses that spoke to her ongoing character and work abilities. Which is more reliable, a single sentence written thirty years ago, or the testimony of current friends and co-workers?
Another example is the issue of loss of consciousness. When Plaintiff is claiming TBI and the medical records indicate that there was no loss of consciousness during or immediately after the accident, that fact is treated as the most important thing since the invention of the wheel by the defense doctors. Yet, if the initial medical records show that the plaintiff was unconsciousness and had a diminished Glasgow Coma Scale (GCS), that fact will hardly ever make it into the doctors report. Many of them feel that, while a lack of loss of consciousness can disprove a brain injury, a period of unconsciousness after an accident does not prove a brain injury.
Fortunately, a combination of the influx of our brave men and women from Iraq and Afghanistan, as well as new findings regarding NFL players, have sensitized both the public and younger doctors to the fragility of the brain. What a wonderful and positive change it has been for our soldiers. In the bad old days, and you might remember the movie Patton, when he slapped a “shell-shocked” soldier, there was no such thing as a mild or even moderate brain injury. If you could walk and talk, you were not hurt. There are many sad tales from these years of neglect, many lives in ruin through addiction, or criminal behavior following an injury.
However, the armed forces are currently doing a magnificent job studying mild traumatic brain injury, blast injuries and utilizing the latest tools such as DTI (Diffusion Tensor Imaging) to identify and rehabilitate traumatic brain injuries. Likewise, the NFL players whose brain autopsies have come to light, have shed light on the terrifying damage done during football careers.
The “old” notions about brain injury will live on in TBI litigation, and because of this, attorneys involved in these cases need to be unceasing in their efforts to drag all insurance companies into the bright lights of the 21st Century, so the can see reality, clearly.
April 4, 2013
This summer at George Washington University:
Video of injury at cellular levelhttp://www.youtube.com/watch?v=AmAML1-F2LE
April 3, 2013
March 27, 2013
December 9, 2012
November 29, 2012
November 28, 2012
November 27, 2012
I allow all thing to be healthy
I allow all thing to be peaceful
I count my blessings at least once each day
I forgive those who have offended me
And I forgive myself for what I have done
And let go of what I have failed to do
That which is done, there is no need to speak of
That which is past, there is no need to blame
I possess self-control, self-knowledge, self-respect
and the courage to dare
I am tranquil and the light of intelligence shines
I make the spot where I stand beautiful
And beauty and harmony follow me
In all my ways and through all my days
Amen and so it is.
November 24, 2012
November 21, 2012
I am writing this just for you,
Because I intend to give you a clue,
My poetry comes from my own inner construct,
I give you markings so you can at least draw dot to dot,
I want to personally disclose this to you,
Because I want you to better understand what I speak to,
I’ve been through some life experiences that do awaken,
Well, I’ve had my nagen shaken,
That is a Traumatic Brain Injury,
And I want you to discern what it does to me,
Cerebral bruising, tearing, bleeding & swelling,
Not just mental impairments, there’s much more to be telling,
I’ll translate this into real life,
So you can understand my neurological strife.
I want you to better see,
So you can more competently talk with someone like me,
Perhaps, for me it is quite healing,
For others to have more of this feeling,
I’m not going to be playing the cosmic trickster,
I want to point you to the holistic picture,
I’m going to communicate what I can,
So people with brain injuries you can better understand -
I talk straight from the heart in my chatter,
I say this to you, because GRAY MATTERS!
November 19, 2012
If I were in the U.S. and you were here, in Israel, I’d be very anxious to know what you are feeling during these tumultuous times. Hence, I’m writing to share my feelings and to tell you how we spent the last three days of operation Cloud of Defense
During this time, we continued with our normal activities, while using every available minute to absorb the television news. It was as though we were watching these scenes from abroad, yet mindful of the fact that Tel Aviv is but twenty minutes driving time from our home. Yesterday, Friday, the situation changed. We were entering into Shabbat and had a decision to make. How could we learn of any announcement to enter a shelter, while not being connected to TV or radio on Shabbat. We heard that there is a “silent” radio station for Sabbath observing Jews which allows the channel to be open throughout Shabbat, and only makes emergency announcements. Try as we could, we were unable to find that station. So, we decided that we would keep the radio on in a separate room and listen to it every hour when the news is generally announced. Throughout Shabbat we heard about sirens that were going off in Tel Aviv, Jerusalem and of course, the South. We learned of the three untimely deaths of our brothers and sister in Kiryat Malachi, and of the three children who were wounded, two of them babies. Today we heard about 10 others being wounded in the South. Nonetheless, we went to Shul today and along with the entire Shul recited Tehilim for the soldiers. Tonight there is a concert at our Shul, which we chose to forego in order to adequately supply our safe room (shelter). In addition to the gas masks, cans of beans, crackers and water, it was suggested that we include a pail and toilet tissue, in case we have a prolonged stay. We put twenty-four rolls into that room. We believe in preparedness.
More than 300 rockets have slammed against our people in less than 72 hours. This is the message that should begin every correspondence. This is the message the media must get. Israel is RESPONDING to the murderous barrage of rockets that have befallen our people continuously.
Although people seem cautious, they are continuing with their activities. It is almost like being in a hospital room and waiting for the operation to finally take place. Now I know why the Israeli defense force calls this an “operation”.
Israel has called up 75,000 reserves. The air force is doing its part in destroying many of the stores of rockets that the Chamas gangsters have been using to target Israeli civilians, However, the enemy has many more rockets that they have stored in deep tunnels; rockets that have been supplied to them by Iran, Hisballah and by Syria. Israelis hope that the air force can do the job. However, Israel is preparing for the possibility of a ground war. We can, unfortunately, anticipate casualties in that event. From our perspective it appears to be an imminent event.
It hurts to see CNN broadcasts from Gaza that are filled with the same lies and distortions that have been shown in the past. They are blaming Israel and showing scenes of children in the arms of their mothers, who have been killed by Israeli bombs. The staged screaming and wailing seem to be a scene that propels Arabs into action. It is a scene that they have staged before and they are unfortunately experts in producing this propaganda. This is as dangerous as their rockets and if unanswered will once again turn the world against us The pen (or the internet) is mightier than the sword..
Having been a psychotherapist, I know that in a situation like this, the important thing is to take action. Consequently, I have been thinking of what we can do that will give us a feeling of control in a situation where one doesn’t have control. At this moment world opinion is extremely important. We are seeing Arab protests throughout the world, yet no word of support from organization like the Federations, and other Jewish organizations. We would like to see people writing to newspapers saying that Israel is responding to over 1300 rockets during the past year. The European media are starting their news with the fact that Israel attacked Gaza without identifying the previous history of rocket attacks. Those who are on Facebook and Twitter should begin their own media campaign. Time is of the essence, since this campaign may be short lived or last for weeks we cannot allow world opinion to demonize us again as they have done in the previous incursion into Gaza during the Cast Lead offensive. in 2009.
As I share these feelings, I wonder if American Jews have the will to act. American Jewish organizations must galvanize the community as in the days of our demonstrating for Soviet Jews. Do we have the same will and determination or have we gotten too tired to care and too uninvolved for it to matter?
With prayers to Hashem and hope in my fellow Jews, I remain,
October 26, 2012
Eat some tasty pumpkin pie this week and stay smiling! Truly, the origins of Halloween are pretty grizzly. Have some fun, be someone you aren’t or maybe someone who you really are inside, but stay safe!
October 25, 2012
Today marks 23 years since my injury. Oh no, there is no forgetting. It’s not a big drama, that circle has been closed. Twenty three years ago, I walked on the boundary lines between life and death. A depth of appreciation blossoms a little fuller. Am strong with empathy, beyond ordinary comprehension. I am what I want to see in this world.
Survivors inspire one another to look deeper inside. In there, the key lays hidden. Seek and ye shall find. The key will open the door to your resources of strength, knowing yourself and inner healing. Have faith. You are being guided.
It’s Mom’s birthday,
A day to rejoice in her arrival,
It’s a day for my life to celebrate,
A day to give praise for my survival.
It’s now been twenty three years,
And there’s no more gloom to clear,
No, not this year,
Less need to reflect,
No hidden pains to dissect.
I’m building a new life,
Helping people out
With strategies and hope
What a pair
With them, possibilities are infinite out there.
The day’s meaning I actually forgot,
Mom called and reminded me,
How she’s grateful,
That me she’s got,
And that I’m here,
To celebrate another year…
The toils & strife that I’ve endured,
I’ve earned the right to be heard,
Its not such an internal commotion for me,
I can work with others objectively,
I smile knowingly and sweetly,
Feeling ready to approach new frontiers,
Because I’ve survived,
Listen, real poetry doesn’t say anything; it just ticks off the possibilities. Opens all doors. You can walk through any door that suits you.
- Jim Morrison
People fear death even more than pain. It’s strange that they fear death. Life hurts a lot more than death. At the point of death, the pain is over. Yeah, I guess it is a friend.
- Jim Morrison
There are things known and things unknown and in between are the doors.
- Jim Morrison
Gray Matters, Brain Injury: The Inside Perspective is a book filled with poetic insights of a woman who lived through a near-fatal brain injury. Her intimate knowledge and sense of humor can help survivors cope, as well as better understand their injuries and themselves. This book gives a personal sense or Inside Perspective of brain injury, thus enabling readers to better understand brain injury survivors.
Brain injury occurs around the world in a variety of circumstances; in sports events, motor-vehicle accidents, terrorist attacks & war (and the list goes on)… According to the International Brain Injury Association, head injury is the leading cause of death and disability worldwide. Thirty percent of the soldiers that have returned from Iraq and are returning from Afghanistan have Traumatic Brain Injuries; more than two percent of the United States’ population has sustained a Traumatic Brain Injury. Even with brain injury being so widespread, it is still hard to identify people living with the complications of this “invisible disability.”
Ms. Lerner knows that the lack of awareness regarding brain injury makes survivors’ lives quite problematic. Writing Gray Matters was aimed at easing the integration of survivors back into the community. With a creative flair, she informs her readers about brain injury; she strikes a chord by sharing personal changes, loss and challenges, thus giving readers a sense of what it is like to walk in the shoes of a brain injury survivor. The chapters of the book cover topics including: brain injury, the symptoms of injury, rehabilitation, the brain, academic rehab, recreational therapy (including nature & the ocean’s healing influence) and brain injury peer support.
This book will considerably help brain injury survivors to better understand their injury and themselves, it will also aid them by being better understood by others. Gray Matters has helped family members and friends to better understand their loved ones. This book can also be a great asset to rehab professionals, by giving them a more intimate understanding of the dilemmas of a brain injury; for only when you know what an individual’s problem is, can you treat it.
Gray Matters offers an articulate, introspective and sometimes humorous view of what it is like to suffer a near-fatal blow to the head and live with its complications. The author presents a thorough, subjective viewpoint as well as a professional and objective understanding of brain injury. Gray Matters presents a deeper understanding of the inner-workings of the mind and how in many ways, brain injury effects life as we know it.
October 17, 2012
October 11, 2012
This is a school paper, written over 13 years ago. I am including it on the blog, because it reveals a lot about recovery.
The most significant loss that I have ever had, almost cost me my life. Seven years (23 years, to this date)ago I was in a severe car accident. I was diagnosed as having a traumatic brain injury and I sustained a comatose state for 10 days. I can best described my experience in a series of images:
Impact, disruption of life, chaos; stillness, silence; my eyes cracked open from a long rest of consciousness. Loss of self, movement, people, no attachments, no memories, spiritual presence, hospitalization. As time passed, memory, identification and pains emerged from the depths.
From a purely introspective point of view, the emergence from the coma was my greatest loss. The return to waking consciousness from the comatose state, can be likened to the ripping away of a baby from its mother’s womb (Viorst,1987, p. 9). In my experience, an extreme and startling transition took place – going from a state of ecstatic oneness to a condition of internal diversity. I tasted a personal and supernatural union, one in which I could feel a great Love in my bones. In awakening, I was jolted back to a world of diversity, where love is encrusted with hate (Viorst, 1987, pp. 65-69).
After waking from the coma, in the early stage of my recovery, I was totally disoriented (Savage and Wolcott, 1994, 41-43). I did not even acknowledge that the people in my room were my parents, for two to three weeks. My acute losses included the loss of: identity, long and short term memory, as well as basic survival skills, such as speaking, swallowing, and toileting. Although my loss of a sense of self lasted for a relatively short period of time, it facilitated a long term sense of dis-ease with myself .
Middle Stage of Recovery
When the acute losses, which were the focus of my early recovery, were substantially restored, I then became aware of other losses. The middle stage of recovery was characterized by impaired attention, the inability to process information, partial loss in the ability to comprehend, difficulty organizing thought processes and expression, partial loss of the ability to articulate ideas (i.e. a condition called expressive aphasia), and extreme difficulties with short term memory.
Late Stage of Recovery
In the latter stage of my recovery, I returned to my parent’s home, and started at a rehabilitation center (The Palm House). Some of my long term deficits at this stage included a general slowness – in movement, thinking and processing information, distractibility, disorganized thinking and acting, inefficient learning, weakness in self regulation, and unawareness of cognitive strengths and weaknesses, (Savage and Wolcott, 1994, pp. 41-43).
The Palm House helped me in starting to rehabilitate my long term problems. When I first started attending The Palm House, I began to socially interact for the first time since my injury. It was at this time that I started to become aware of psychosocial problems. Some of these problems were:
- Having limited insight into my own abilities and behaviors
- Problem inhibiting behavior
- Misunderstanding what others mean
- Appearing depressed
- Changing moods rapidly / laughing or crying for no apparent reason
- Getting angry out of proportion to cause
- Isolating self
- Breaking into uncontrollable laughter
- Denying problems (Savage and Wolcott, 1994, p.241).
The Palm House helped to direct me on the way, yet personal rehabilitation is a tedious journey.
Long-term Status of Difficulties
After rehab, certain cognitive tasks were particularly hard, and a few psychosocial impairments still present themselves. Reading and writing take me an inordinate amount of time, and notetaking often comes out incomprehensible. My impaired capacity to organize affects many different academic tasks. The psychosocial impairments which at this time still presented difficulties were self-confidence, isolation and depression; in my schooling, it is also hard for me to discern the meanings of teachers in assignments and test questions.
Reaction to injury
My parents first reaction to knowledge of my injury was devastation. The day that my accident occured just happened to be my mother’s birthday, yet within a few hours of when they found out about it, they were on a plane to where I was at. It is certainly every parent’s nightmare to find out that their child is in a coma; to then be by her side until she awoke takes a lot of inner strength. They were already mourning for their daughter, that according to what the doctors were telling them, they thought they would never know again.
After four months of working hard on myself, I decided it was important to me to separate myself from the rehabilitative traps (Viorst, 1987, p. 36). I stopped attending the rehabilitation center; independence is what I needed in order to claim myself. Viorst says “And yet we pull and pull and pull away. For the need to become a separate self is as urgent as the yearning to merge forever.” (1987, p. 35).
My insistence on the need for independence hurt my family and eventually, myself. At a certain point my self-responsibility and freedom led to my realization of separateness, and I was alone, and there was a large psychological distance between me and them. Yet Viorst comments that “Love is our attempt to assuage the terror and isolation of that separateness.” (1987, p. 19).
What I could have done differently is that I could have continued my rehabilitation for a longer period of time. Out of a demand for separation or individuation (Viorst, 1987, p. 36), I reacted; I did not want to be considered “brain injured” the rest of my life, I wanted to be – myself. I quit attending the rehabilitation center, and moved from my parent’s home to my home in North Florida. My parents, although they didn’t think it was the best thing for me to do and were concerned about my being able to get along, they supported me in doing what I wanted to do. Later, I needed to work around some of my impairments, in my studies, These impairments may have been alleviated if I continued my rehabilitation for longer.
A Helping Pat on the Back
Others could have been more helpful by encouraging my sense of self-esteem and self-confidence. They did not tend to encourage my confidence, unless they were fully behind what I was doing. This left me working on self-confidence and self-esteem on my own. After my injury, when I really needed this support, I did not receive it. THIS SHOWED ME HOW IMPORTANT PERSONAL SUPPORT IS IN REHAB YEARS! Self confidence is very important, it is how a person thinks about him/herself. It is on this foundation, that all abilities are built. If I were a parent of a child who had endured a traumatic brain injury, I would be sure to continually point out his/ her special talents and unique qualities, I would also help to redirect my child’s negative self-thinking.
The lessons that I have learned regarding self-esteem and self- confidence through my experience after a brain injury, will be very useful in my work with people going through very similar sequelae. A common reaction of a person after traumatic brain injury, is to isolate oneself, even from friends and family. I believe if a person is supported so that he/she will develop a bit more self-confidence and self-esteem, a person’s interactions with his/her family will be more steadfast and sharing, and he/she will shy away less into his/herself.
In the following example, Elkind illustates the difference brought about by verbal behavior which does no harm to the child’s sense of self vs. verbal or psychological abuse which does cause harm to the child’s sense of self. “If a child were to spill a glass of milk, I would say to him, ‘I see the milk spilled,’ and I’d hand him a sponge. In this way, I avoid blame and put the emphasis where it belongs on what needs to be done.
If I were to say instead, ‘Stupid. You always spill everything. You’ll never learn, will you!’ we can be sure that the child’s total energy would be mobilized for defense instead of solution.” (1994, p. 109). This reaction is demoralizing to the child.
A supportive environment would be ideal for demoralized people and for the people deficient in self-confidence or self-esteem. The creative arts can be used in a psychologically supportive manner. I plan on supporting my teaching curriculum for brain injured children with the arts. I will gracefully weave academic knowledge into the creative process. As it is known that brain injured children learn most efficiently via incidental learning, my teaching strategy is particularly applicable. Viorst adds that “We each are artists of the self, creating a collage – a new and original work of art – out of scraps and fragments of identification.” (1987).
Another issue which I have learned through my own experience is the importance of the “me” in rehabilitation. I believe that the “self-improvement” of the rehabilitative process should be tempered with activities that promote “self-appreciation”. In this way, a survivor can best come to closure within him or herself.
Elkind, D. (1994). Ties That Stress . Cambridge, Massachusetts: Harvard University Press.
Savage, R. C., & Wolcott, G. F., (1994). Educational Dimensions of Acquired Brain Injury. Austin, Texas: Pro-ed, Inc.
Viorst, J. (1987) Necesary Losses. New York: Ballantine Books.
October 10, 2012
Brain injury is confusing to people who don’t have one. It’s natural to want to say something, to voice an opinion or offer advice, even when we don’t understand.
And when you care for a loved one with a brain injury, it’s easy to get burnt out and say things out of frustration.
Here are a few things you might find yourself saying that are probably not helpful:
1. You seem fine to me.
The invisible signs of a brain injury — memory andconcentration problems, fatigue, insomnia, chronic pain, depression, or anxiety — these are sometimes more difficult to live with than visible disabilities. Research shows that having just a scar on the head can help a person with a brain injury feel validated and better understood. Your loved one may look normal, but shrugging off the invisible signs of brain injury is belittling. Consider this: a memory problem can be much more disabling than a limp.
2. Maybe you’re just not trying hard enough (you’re lazy).
Lazy is not the same as apathy (lack of interest, motivation, or emotion). Apathy is a disorder and common after a brain injury. Apathy can often get in the way of rehabilitation and recovery, so it’s important to recognize and treat it. Certain prescription drugs have been shown to reduce apathy. Setting very specific goals might also help.
Do beware of problems that mimic apathy. Depression, fatigue, and chronic pain are common after a brain injury, and can look like (or be combined with) apathy. Side effects of some prescription drugs can also look like apathy. Try to discover the root of the problem, so that you can help advocate for proper treatment.
3. You’re such a grump!
Irritability is one of the most common signs of a brain injury. Irritability could be the direct result of the brain injury, or a side effect of depression, anxiety, chronic pain, sleep disorders, or fatigue. Think of it as a biological grumpiness — it’s not as if your loved one can get some air and come back in a better mood. It can come and go without reason.
It’s hard to live with someone who is grumpy, moody, or angry all the time. Certain prescription drugs, supplements, changes in diet, or therapy that focuses on adjustment and coping skills can all help to reduce irritability.
4. How many times do I have to tell you?
It’s frustrating to repeat yourself over and over, but almost everyone who has a brain injury will experience some memory problems. Instead of pointing out a deficit, try finding a solution. Make the task easier. Create a routine. Install a memo board in the kitchen. Also, remember that language isn’t always verbal. “I’ve already told you this” comes through loud and clear just by facial expression.
5. Do you have any idea how much I do for you?
Your loved one probably knows how much you do, and feels incredibly guilty about it. It’s also possible that your loved one has no clue, and may never understand. This can be due to problems with awareness, memory, or apathy — all of which can be a direct result of a brain injury. You do need to unload your burden on someone, just let that someone be a good friend or a counselor.
6. Your problem is all the medications you take.
Prescription drugs can cause all kinds of side effects such as sluggishness, insomnia, memory problems, mania, sexual dysfunction, or weight gain — just to name a few. Someone with a brain injury is especially sensitive to these effects. But, if you blame everything on the effects of drugs, two things could happen. One, you might be encouraging your loved one to stop taking an important drug prematurely. Two, you might be overlooking a genuine sign of brain injury.
It’s a good idea to regularly review prescription drugs with a doctor. Don’t be afraid to ask about alternatives that might reduce side effects. At some point in recovery, it might very well be the right time to taper off a drug. But, you won’t know this without regular follow-up.
7. Let me do that for you.
Independence and control are two of the most important things lost after a brain injury. Yes, it may be easier to do things for your loved one. Yes, it may be less frustrating. But, encouraging your loved one to do things on their own will help promote self-esteem, confidence, and quality of living. It can also help the brain recover faster.
Do make sure that the task isn’t one that might put your loved one at genuine risk — such as driving too soon or managing medication when there are significant memory problems.
8. Try to think positively.
That’s easier said than done for many people, and even harder for someone with a brain injury. Repetitive negative thinking is called rumination, and it can be common after a brain injury. Rumination is usually related to depression or anxiety, and so treating those problems may help break the negative thinking cycle.
Furthermore, if you tell someone to stop thinking about a certain negative thought, that thought will just be pushed further towards the front of the mind (literally, to the prefrontal cortex). Instead, find a task that is especially enjoyable for your loved one. It will help to distract from negative thinking, and release chemicals that promote more positive thoughts.
9. You’re lucky to be alive.
This sounds like positive thinking, looking on the bright side of things. But be careful. A person with a brain injury is six times more likely to have suicidal thoughts than someone without a brain injury. Some may not feel very lucky to be alive. Instead of calling it “luck,” talk about how strong, persistent, or heroic the person is for getting through their ordeal. Tell them that they’re awesome.
Written by Marie Rowland, PhD, EmpowermentAlly. Used with permission.www.brainhealthconsulting.com.
I have asked people in the support groups I facilitate if they wanted to add to this list:
“This is a good as you can expect things to be. Your recovery will not progress any more than it has already.”
“This is too difficult for someone like you.”
“People like you should not be allowed to…”
On the other hand, a brain injury can come in handy. When my wife tells me to clean the garage, I just look at her with a blank stare and say “What is a garage?”
September 9, 2012