April is National Stress Awareness Month

     written by Bret K

           Did you know that April is National Stress Awareness Month?  I was unaware that such a holiday existed until recently.  In light of attempting to manage my own daily stressors, I am going to inform you of some possible ways to assist in relieving stress.

            Not all stress can affect you in a negative way. There are some great outcomes from stress when it is handled appropriately.  Stress can lead to personal creativity, learning, and is essential for survival. So how can something that is supposed to help you end up hurting you in the process? The negative effects of stress can be seen almost everywhere today. It can become harmful to the individual when it interrupts the healthy state of equilibrium of a normal healthy body.  When a person is overwhelmed, this is becoming increasingly common; they are unable to face any stressors and can become depressed or anxious. Upon becoming overwhelmed with daily stressors, the body is flooded with chemicals to prepare you for “fight or flight”.  This natural instinct can be very helpful in emergency situations; however it can wear down the body when it is constantly activated by daily stressors. 

            There are multiple techniques used for relaxation. However, lying on the couch or sleeping is not a proper way to relieve stress.  The relaxation response in the body is a mentally active process that leaves the body feeling relaxed, calm, and focused.  Some ways to reach this state of relaxation would be to utilize deep breathing techniques, visualization, meditation, yoga, or rhythmic exercises.  You should try to set aside 10-20 minutes a day for proper relaxation. These exercises can give you an energy boost and improve your mood. 

            There are some important ways to choosing a proper relaxation technique for yourself. Be sure to consider your specific needs, preferences, fitness level, and the way that you tend to react to stress.  Make sure that your relaxation technique fits your lifestyle and you are able to focus your mind.  Consider alternating or combining different techniques for the best personal outcome. This may lead to provide the best results and to keep you motivated.

            Well I sure hope that I was able to give you some helpful hints to managing daily stressors. Remember to stay calm, even in most impossible situations and all will eventually work itself out.  If you have any stress relieving tips or comments please leave them below. Thank you for your participation. Have a happy day

Relationships after TBI

          Forming and maintaining meaningful close relationships after a traumatic brain injury can be very difficult.  You may not be able to recall who important people are in your life, such as your parents, siblings, significant other, or even your children.  I remember after I woke up from my coma, my father asking me if I knew who he was.  All I could do was respond with a very slow thumbs up.  I cannot recall the exact look on his face, but I do remember him being overjoyed with me knowing who he was. 

            Despite having a wonderful family by my side through my recovery, I still have a desire to build meaningful relationships outside of that close knit circle.  My biggest difficulty thus far has been expressing my thoughts and feelings to others.  This can be very common in survivors often leading to feeling misunderstood or feeling isolated.  It is also sometimes difficult for me to understand what others are meaning when they say certain things.  This is a huge barrier, often affecting all relationships post injury.  When participating in open conversation, I sometimes think that others are saying insulting things; this causes me to “emotionally” shut down.  I have read that other survivors can become irritated and may say or do things that they later regret upon misunderstanding a conversation.  Friendships often crumble upon repeated misunderstandings, due to lack of communication.

            Another significant barrier to building new relationships after traumatic brain injury may include difficulties living within a long term rehabilitation facility.   Difficulties in getting from place to place can make it incredibly hard to visit friends or do the things that were once enjoyable.  It may be almost impossible to decide to up and go to the mall for the afternoon, due to staffing issues as well as transportation. Participating in a work or recreational program on top of daily therapies can further restrict your time to partake in solo activities to build relationships.  It can also be intimidating to go out in the community with a large group of housemates.  I often find myself sticking with the group as I should, but reluctant to associate with others outside of the group.  Time restrictions put in place by the facility may limit visits with friends.  This can be aggravating to be an adult and have a curfew so to speak.  I’m not trying to knock living in these facilities, because I do, I just know there are some issues that will always arise. 

            The largest barrier to building relationships, in my opinion, is meeting new people.  This is a must to create any type of relationships, whether it is an acquaintance, or a potential significant other, you will never know if you never meet them.  After injury survivors often stop working, and partaking in community based events; such as sports, church, or other social activities.  This limits the amount of people that the survivor can come in contact with to converse and build a relationship.  Over time, friends and coworkers may lose contact with you, due to their own busy lives. This happens a lot, and if there isn’t a way to replace these relationships, the survivor can end up feeling alone and may become depressed. 

            Now let’s overcome these difficulties!  When conversing back and forth, try to ask open ended questions, so the person is more likely to give a detailed response, allowing you to elaborate on what they are saying.  This is a huge conversational pointer!  Try not to push away the people that care about you, instead let family and friends know your positive and negative feelings to allow them to assist you better.  Attempt to take the initiative to make an acquaintance a friend.  This can be done by inviting someone over for a visit that you regularly see but may not speak to outside whatever you usually do.  Keep in mind that it is much easier to get to know someone if you are participating in an activity that is enjoyed by both parties.    

            Once a connection has been established, it must be maintained and cultivated.  This takes intention, attention, courage, creativity, and love from both parties.  These things take hard work, but the rewards are rich and friends can make the intolerable tolerable. So get out there and make a new friend or get to know a new partner.  Having a positive relationship can help you feel satisfied with your life and give you a sense of belonging and self worth. Something we all search for in life.

Job Opportunites after Traumatic Brain Injury

           There are many work programs offered here at Special Tree’s Day Treatment Services program for persons with a traumatic brain injury.  The DTS program began working with clients about two years ago to get them back to working in the community after acquiring a TBI. The name the work program was given is InPro, standing for Innovative and Productive.  Some of the work offered requires light lifting, janitorial, writing, painting, maintenance, and utilizing your creativity.  

            The work at DTS includes quality support services, laundry, housekeeping, and Chapp’s oil. Quality support services and housekeeping are very similar jobs focusing on light janitorial tasks. The only differences are where the work takes place.  Quality support services are located at the Wabash Center, where housekeeping is located at the NeuroCare Center. There job tasks include sweeping, mopping, dusting, and disinfecting the buildings.  A laundry job is located at the NeuroCare Center. Clients are now working a morning and afternoon shift along side a natural support for guidance in this department. The tasks delegated to someone working in laundry would be to collect soiled linens, sort linens from clothing, wash, dry, and fold all garments, deliver clean linens to appropriate place, and hang client clothing in correct room.  The employee is able to ask for assistance from the natural support when necessary, providing a place for growth of employability skills in a controlled environment.  Chapp’s oil is a seasonal job that provides grounds keeping work for clients.  In the warmer months, clients are able to paint parking lines, parking blocks, light fixtures, and keep the gas station/truck stop looking immaculate. Seeing the great work that they have done, employees are able to get a sense of satisfaction out of their jobs.

            InPro offers a few jobs that work on fine motor skills, detail orientation, and following directions.  These jobs include labeling medical supplies, working at Goodwill Industries, or working at Lumicon.  Each job has there differences but the main similarity is that the employee is counting, sorting, and packaging goods for future use. They are also able to work with a job coach or natural support for guidance, instruction, and answers to their questions.

            Some more positions that InPro offers to its employees are the opportunity to work in the Ceramic Studio or in the Furniture Restoration/Woodshop garage.  The woodshop job builds some strength in the upper body from stripping paint from old wooden objects and sanding them smooth. The pieces are then stained or varnished and topped with a layer of polyurethane before being taken to the store to be sold.  The Ceramic Studio makes various decorative pieces. They mold each piece from wet slip and let it dry then sand the hard edges before placing it in the kiln for firing.  After the first fire, each piece is painted either to order or random and fired again. The pieces are then sold throughout the company and at local festivals and events. Right now, they are working on an alternate location for a store front, but pieces are still available for purchase through the Wabash Center.

            There are a few more work opportunities that InPro offers to its employees. They are working on the DTS Blog, the job I’m doing right now, working in the Maintenance department, and traveling to a local elementary school to assist the students.  Working on this blog, is very interesting. I am able to come up with subjects to write about, research them, and compose a short storyline for you all to read.  I enjoy working on this and feeling that I am some how helping others that are in the same condition as myself. The maintenance department employees service the NeuroCare center and the surrounding buildings and offices.  They perform any tasks needed to maintain the integrity of the building.  Employees that attend the elementary school are given the chance to tutor students that present difficulty in class. They also assist in the art room to keep the children focused on their tasks.  Employees that are part of the school, find their job both rewarding and sometimes difficult, depending on the students that day.

            These jobs are all offered by Special Tree’s Day Treatment Service program through InPro.  If you have a brain injury and can do these things, which almost everyone can, I suggest you give it a try.  They will always attempt to work within your means, disability and insurance will most likely not be affected.  We are always looking for ways to improve these services and more people to assist in getting back to work. Please let me know what you think of this by leaving a comment here on this story or any of my other stories.

College after a Traumatic Brain Injury

         Returning to college after a traumatic brain injury can be overwhelming and difficult.  You have to start out slow with an easy class.  At first try taking just one class. After a semester or two you can add more classes to your schedule.  For example, after my accident when I was ready to return to school I took a composition class for the first semester. After I completed the class successfully with an “A”, I took a pre-algebra class. When I finished this class with an “A” as well, I decided to kick it up a notch.

          I am currently taking English 1. This class is a lot more challenging because it is not an introductory class.  I have to study harder and harder and I have to write a paper almost every other week.  I am also tested regularly on the reading material assigned to the class.

          The class I am currently taking meets only once a week and is three hours long.  Luckily, I do not have difficulty with staying focused for this length of time.  If you happen to have difficulty staying focused for this length of time, many colleges offer sessions that meet twice a week for only an hour and a half instead of three hours.  I would recommend this type of class if you have attention span difficulties or are just returning to classes after a traumatic brain injury.

          Despite any difficulties in returning to school after a traumatic brain injury, there is still a light at the end of the tunnel.  Many good things can come from a class.  You get the opportunity to meet new people and obviously learn new things. Confidence is a good quality that can be gained from attending classes.

          By attending a class I was able to defeat many odds that were stacked against me. I am currently planning to continue my education and get a degree, even with my injury.

How Do You Get Around?

            After you experience a life altering event, you might find yourself getting around in different ways.  For example, you could find yourself getting around in a wheelchair or using assistance like a cane, walker, or a person to help you walk.  As in anything, there are pros and cons to each of these.

            One way you might be getting around is in a wheelchair. This could be a manual or power wheelchair. There are positives and negatives to both of these.  If using a manual wheelchair, you are given the chance to build muscle tone in the legs and/or arms while self propelling about. You may be able to transfer to a vehicle and ride in a passenger seat without any concerns because your chair can fold up or break down for storage. However, persons who find themselves in a chair that cannot fold down may encounter difficulties with getting into vehicles. They may require a mechanical lift or ramp to get from one place to another.  Wheelchairs, power or manual, could be too wide to fit through narrow doorways. The great thing about power chairs is that they can provide a way to get around even when a person cannot move themselves in any way. There are specialized chairs that operate by suction. The person can either blow or suck and the chair will propel forward, backward, or turn. 

            Another way to get around would be with the assistance of a cane, walker, or person.  A person may be needed for assistance in walking to reassure balance or pace for you. They could direct you if a step was coming or if the ground becomes uneven in any way. You could also be using a walker for assistance to get around.

There are many types of walkers; we will talk about a few of them. There is the standard walker that may not have any wheels at all, a walker with two wheels in the front, or one with a wheel on each leg.  The standard walker may pose a difficulty if you put a lot of weight onto your arms while walking.  Most can be folded up for easy storage; however, there are some types that cannot be folded.  Most people who use a walker or cane need a railing to help them walk up the stairs. Some people who require standby assistance will need a rail to grab onto for balance as well. A person using a cane or walker would have minimal difficulty when boarding a train, plane, automobile, or most other types of transportation, although they may need some assistance from a helper.

            These are some ways that you may find yourself getting around if you have experienced a life changing event.  It might take you a while to build up the strength to “graduate” from a wheelchair to a walker, or maybe you won’t even need a walker.  It will be hard work and you need to be determined to accomplish your goals.  Don’t ever give up; good things come to those that are willing to work their butt off!

Dietary Restrictions with Traumatic Brain Injury

               

Written by Bret K.

              Do you or somebody you know have difficulty swallowing, chewing your food, or both? If you have experienced a stroke, head or neck injury, cancer, cerebral palsy, or dementia this could be a side effect of your condition. Difficulty with chewing and swallowing can also be due to the average aging of a person.

                Difficulty swallowing and chewing of the food is clinically named dysphagia. Dysphagia should be evaluated and treated by a multidisciplinary team consisting of a radiologist, a speech pathologist or occupational therapist, a dietitian, and a nurse. When swallowing difficulties arise there may be a number of problems occurring. There are four types of swallowing difficulties; esophageal phase dysphagia, oral preparatory dysphagia, oral dysphagia, and pharyngeal phase dysphagia. Oral dysphagia is defined as presenting a difficulty controlling the food bolus while in the mouth. Oral preparatory dysphagia is defined as difficulty taking food, chewing, mixing with saliva, and creating a food bolus. Esophageal phase dysphagia is a difficulty with the food bolus when it reaches the esophagus. There may be a delay in action due to the person’s condition. Pharyngeal phase dysphagia defined is difficulty swallowing food due to it becoming trapped at the top of the pharynx of the throat. Aspiration, or the inhaling of food particles into the lungs, is a result of inadequate chewing and/or swallowing. It is said to be a major contributor to respiratory infections and pneumonia in adults that are institutionalized. This poses a large problem to the brain injury community as a whole.

                 If the person has a large difficulty swallowing, they may be on a non oral feeding method for the majority of their nutrients. There are three ways the person may experience a tube feeding. Mostly used for a short time to deliver nutrients to a person is the Nasogastric Tube, or NG. This is a long tube that passes through the nasal cavity and down to the stomach. Liquid nutrients are then given either several times daily or throughout the night while sleeping. As you can imagine, this is not very comfortable, which is why it is used only for short term. The second method is a Percutaneous Endoscopic Gastrostomy or PEG tube. This is used for long term delivery of nutrients directly into the stomach. Nutrients are given in the same manner as a NG tube would be. The only difference is that a PEG tube is surgically placed through the abdominal wall, directly into the stomach. The last way to receive nutrients into the body for a non oral feeding person would be through an IV. An intravenous catheter is placed directly into a vein and nutrients are pushed through the blood.

                After a person has experienced a life altering event that leaves them with a brain injury, they often find themselves with some sort of non oral feeding method in place. They must then work their way back to a regular diet of eating normally. But first they must go through many scans to see if the body is working properly to transport the food bolus from the mouth to the stomach. If difficulty arises in chewing of the food and transporting it to the back of the throat a puree diet may be put in place.  A puree diet is designed for patients presenting a difficulty chewing and swallowing food. All foods should be blended until smooth, and may need to be thickened with a gelatin based food thickener. Thickeners may be useful for adapting pureed foods to meet individual needs. When food is pureed a spoon should be able to stand up in the center without falling to the side of the bowl or cup it is served in. The person is allowed some foods and should avoid the following. Breads and crackers are typically not permitted while a person is on this diet. Nuts, dried fruit, seeds, and desserts that crumble should be avoided. Raw, tough, or vegetables with skins will not easily blend and should be avoided. Tough meats, cheese, and peanut butter pose a difficulty while blending and should be avoided as well while on a puree diet.  Some foods that are allowed while on this diet consist of pudding, yogurt without fruit pieces, applesauce, and blended canned fruit. You may need to thicken the applesauce and canned fruit after blending.  Well cooked vegetables without skin or seeds are allowed but may need to be blended and thickened to pureed consistency. All meats must be blended until smooth. Fish, poultry, and ground meat may be tender enough to puree well. Gravy can be used to maintain a smooth consistency while blending meat. These were examples of foods that may or may not be consumed while on a pureed diet.

                The next step up in dietary restrictions would be a mechanical soft diet. This diet is designed for individuals who have difficulty chewing food but are able to tolerate a wide variety of foods. It includes foods that are soft in texture, semi-solid, moist, and can stick together. Foods must be presented to the person in bite size amounts. A mechanical soft diet gives the person some chewing ability while eating. While on this diet bread is avoided along with dry, hard, crumbly, crispy, or sticky foods. Some foods that are allowed are sugar and sugar substitutes, bite sized, chopped canned fruit, bananas and juices. Watermelon should be avoided if the person on this diet also restricted by thickened liquids. Foods that should be avoided are jams, preserves, all candies, and any items with seeds, nuts, dried fruits, hard/dry toast, and French toast. You may change the consistency and texture of foods to fit this diet by cooking, chopping, mincing, or mashing them.

                There’s another step on the dietary restriction list. It is the edentulous soft diet. This diet is very particular as to what may be consumed by the individual. There is some debate surrounding this diet due to it being so similar to a mechanical soft diet. The only difference in the two would be the foods allowed and avoided. If you have been placed on this diet please ask your team of specialists for a list of foods you are allowed to have.

                After you have made the progress necessary you may be able to eat a regular diet without any restrictions. These foods would be prepared normally without any mechanical alterations necessary. But you may not be able to consume regular thin liquids.

                Often times when a person is diagnosed with Dysphagia they have problems with consuming thin liquids. These drinks must then be altered by a thickening agent to be consumed by the individual. Thin liquids may be thickened to nectar, honey, or pudding consistencies depending on the needs of the person. Nectar thick liquids are a bit thicker than thin liquids, much like a glass of eggnog, tomato juice, or peach nectar would look.  Honey consistency liquids are easily offered on a spoon to the individual. They may be controlled in the mouth easier than thin or nectar thick liquids. There are no natural liquids this consistency without a thickening agent. Pudding thick liquids are used when a person has little to no control over their tongue and mouth movements. These liquids should be given by a spoon to the individual; each bite should be no more than a half of teaspoon of the liquid. It should be kept in mind that there are many things that have “hidden” liquids. These items would be jello, ice cream, watermelon, and any other substances that possibly melt from a solid to a liquid. There are many ways to thicken thin liquids, utilizing bread crumbs, instant apple or potato flakes, instant baby cereal, instant flour, and instant pudding mix. Commercial agents such as Thixx, ThickenUp, and Thick It, may also be used to thicken up foods and liquids.

                If you or somebody you know is having difficulty swallowing or chewing food, I hope this article gave you some insight as to what could be happening.  If you have any questions please see your doctor or speech pathologist to confirm or deny any type of dysphagia. I wish you the best of luck in the future with any difficulties swallowing or chewing food or drinking liquids.

           

Things To Do

            Looking for something to get you out of the house this weekend? I can tell you a bunch of ideas for things to do despite the cold. The following shows, concerts, and events are sure to get your blood pumping and keep you warm.  

            Let’s start with local events and festivals happening in Detroit and the surrounding area.  The North American Auto Show will continue to be on display at Cobo Hall through the end of this weekend, January 27, 2013.  Not interested in cars? No problem, in Frankenmuth there will be the 22nd Annual Zehnder’s Snowfest. This festival features ice carvings, multiple snow sculpture championships, a firework display, and many activities for children.  The cost to attend is free. The Ferndale Blues Festival will also be going on January 25 through February 2. There will be various venues throughout Ferndale participating in this event, hosting dozens of live bands daily throughout the festival. The Rochester Fire and Ice Festival will be January 25th through the 27th. Located on Third and Water in Rochester this festival is free to all attendees. They will also be featuring ice and snow sculptures, a firework show, dog sledding, tube sledding, and cross country skiing exhibits. The two firework shows will be Friday and Saturday evenings at 8pm.  Lastly the Ann Arbor Folk Festival will be held at Hill Auditorium in Ann Arbor on January 25 through the 26th. Admission for one night will cost $35 per person.  All proceeds will benefit The Ark, Ann Arbor’s non-profit home for folk,roots, and ethnic music.

            Want to do something else besides attend a festival? Try a concert! Detroit and the surrounding area have plenty to offer you this weekend! Nelly Furtado will be performing on January 26 at 9pm at Caesar’s Windsor. Cost to attend this concert will moderately cost you $40 per person.  The Filmore in Detroit has plenty going on this weekend. Concerts include FUN, Flogging Molly Green, and Soundgarden. FUN and Soundgarden are currently sold out, but Flogging Molly Green has some seats still available. The show will start at 7pm on the 25 and tickets range from $27 to $36 per person.  Harpos will be presenting the 10th Annual Metalfest on January 26. Doors are scheduled to open at 5pm with tickets costing $10 per person. If rock and roll is up your alley, the Magic Stick will have Emancipator/ Eliot Lipp performing on January 24 at 8pm. Tickets will cost $15 in advance and $18 at the door. They will also have The Darkness playing on January 25 at 8pm. Tickets for this show will cost $25 per person.

            If live shows and plays spark you interest, you’re in luck because there are plenty to see this weekend. Downtown at the City Theatre there will be a show called “Conned”. This show will be playing from January 17 through January 27. Tickets are available at ticketmaster.com and will cost between $32.50 and $37.50 per person. Also downtown this weekend at the Detroit Opera House will be the stage show Shen Yun. From Thursday January 24 through January 27 the show will start at 7:30 with additional matinees on Saturday and Sunday at 2pm. Ticket prices range from $80 to $180 per person depending on where you want to sit. The Purple Rose Theatre Company of Chelsea will be having a show called “The Meaning of Almost Everything” by Jeff Daniels January 10 through March 9. Tickets for this show will vary in cost with student prices being $21, seniors and teachers $39, and a regular adult ticket will cost $42. If you are in the mood to laugh Eddie Griffin will be performing at the MotorCity Casino on Thursday January 24 at 8pm. His stand up performance will cost between $27 and $30. A play named White’s Lies will be performed January 9 through February 3 at Meadowbrook Theatre in Rochester Hills.  At the Macomb Center for the Performing Arts you can see Luna Negra Dance Theatre at 8pm on January 25. You may also choose to view Midtown Men on January 26 at 8pm or January 27 at 3pm.  If you are trying to entertain little ones, Sesame Street Live will be performing at the Fox Theatre January 24 through February 18. Tickets will cost between $12 and $65.

            If nothing you have read above strikes you as something entertaining to attend, think about an expo, convention, or trade show. You can browse multiple vendors at these shows. The Novi Suburban Collection Showplace will be hosting the Home Improvement Show January 25 through the 27.  There will be a $5 parking fee for all vehicles as well as an admission of $8 for adults and children 13 and above, $7 for seniors. Children 12 and under are admitted for free into the showplace.   The Gibraltar Trade Center will have two events within their two locations this weekend. The Mount Clemens location will be hosting the WPC Winter Swap Meet on Sunday January 27. Admission will be $3 per person plus $2 per vehicle to park. To enter the event early it will cost you $10. The Taylor location will be hosting a Sports Cards, Antiques, and Collectables trade show over the course of the weekend. Admission will vary for this location with a $2 fee for parking.

            Last of all, we have sporting events. Although there will not be a nationally recognized sports teams playing in Detroit this weekend, you can still visit the Palace of Auburn Hills for a Cheer and Dance Competition. The festivities will begin at 10am on January 27. It will cost $12 for general admission in advance. Tickets may also be purchased at the door for $15. Keep in mind that children two and under will be admitted for free.

            I hope I sparked some interest in you with all this stuff you could do if you live in southeast Michigan. Whether you plan to head to the auto show or are going to the     Metalfest I hope you will have a blast. Please comment below if you attend any of these activities or have any other events to recommend.