If you or someone you know has suffered a traumatic brain injury, you may notice that they can remember things from a long time ago – like their birthday. You may also notice they do not remember what you just told them – like what to get at the supermarket. We all need to understand that traumatic brain injury often manifests with impairments to short term memory and not impairments to long term memory. Here is why.

“Memory” is your brain taking in, keeping, recalling, and using information. A brain injury can affect any of these areas of memory. A brain injury can also make it hard to learn and remember things.

Some people with brain injury have a hard time remembering past events such as a telephone message or conversation. It can also be hard to remember future events such as an appointment. People might forget things they need to do during the day. While everyone forgets some things sometimes, people with memory problems forget things more often. They may also forget specific types of information. Most times, long-time memories about family and childhood are not affected.

·       SHORT-TERM MEMORY

There's some variation in how people define short-term memory. I define it as the ability to remember something after 30 minutes. In a head injury, someone's immediate memory may be good, yet they may still have problems with short-term memory. Short term memory resides in a part of our brain that allows quick and immediate access. If you repeat the memory item enough you can move it that portion of your brain that stores information for long term memory. For instance, if you listen to a song long enough to memorize the words, you are on your way to storing it in long term memory. 

·       LONG-TERM MEMORY

Long-term memory is information that we recall after a day, two weeks, or ten years. For most head-injured people, their long-term memory tends to be good. Again using music, have you ever noticed how you remember the words to a song you listened to as a teenager when you suddenly hear it on the radio?

So it important, whether you are struggling with traumatic brain injury or are a loved one dealing with a spouse, friend, to understand the difference in remembering and using short term and long term memory. You can always read more about traumatic brain injury by visiting my Brain and Spine Injury Law Blog or Titolo Law Office website.

Overcoming Loneliness After Traumatic Brain Injury

Common Signs of Loneliness

Traumatic Brain Injury may have physical and medical components. However, it can also change the way you feel about yourself and those around you. This is especially true in cases of mild and moderate brain injury. People often view you as “healed” or “well” and do not relate your change in feelings to a traumatic event. Understanding how brain injury has affected the way you feel and act is an important first step. Next you can learn how to improve old relationships, develop new relationships, and feel better about life.

Do you hear yourself saying…

• "Nobody cares about me.”
• “Why won’t my boyfriend return my calls.”
• “Seems like no one wants to talk to me.”
• “Everyone avoids me.”
• ”I just do not feel like going out.”
  

Are you saying or doing things that cause other people to be uncomfortable? Are you pushing others away by…

• focusing on what is wrong with your life and the world?
• not listening when others speak, interrupting, or talking too much?
• talking about yourself only?
• asking people very personal questions?
• hurting other people’s feelings?
• not going out

Common Feelings After Brain Injury

You may feel very lonely even around family and friends. Loneliness is a normal experience for most people at one time or another. It is when we feel disconnected and feel like something is missing in our lives. After a traumatic brain injury, those feelings can be intensified. Understanding how brain injury has affected the way you feel and act is an important first step.

The following are common feelings experienced by victims of traumatic brain injury…

• Difficulty communicating or relating to others
• Fear of Rejection
• Irritability
• Fatigue
• Anxiety
• Frustration relating to inability to drive or work

Additionally, some survivors find that they lose contact with friends and co-workers because they do not see them as much, especially if they have not returned to work or school.

Ways to Overcome Loneliness

These simple steps will help you overcome loneliness…

●Identify and develop interests in hobbies and activities you can do alone

Being alone and loneliness do not have to be the same. Find some alone time and use it to do things you enjoy like drawing, crafts, gardening, crossword puzzles, reading, listening to or playing music, researching your family tree, writing in a journal or any number of thousands of things. A side benefit is that you will more interesting to talk with since you have positive things to talk about.

●Exercise

We all know that exercise is the great healer. It will increase your strength and help you feel better about yourself. Consider joining a gym, health club, YMCA or YWCA, a mall walker’s club or other physical activity.

●Reduce television time

●Smile more

Greeting people with a smile will likely result in getting one in return which makes the moment positive. Eye contact says you are confident. It makes people like to be around you.

●Eat healthy and eliminate alcohol

Along with exercise, this self improvement suggestion will add energy to your regime. Buy a good diet book and commit to its program.

●Take your medication

Never stop taking prescribed medication if you do not like the way it makes you feel. Everyone has a unique reaction to different medicine. Advise you doctor and she will suggest alternate medicine for you to try until you find one that works best for you.

●Do not let challenges overwhelm you

This is easier than it sounds. Meditation helps produce certain brain activity that becomes a familiar and accessible place during times of stress. Do not let your depression overwhelm you. Talk to your doctor if you feel the need.

 For more information on services in your areas, contact your state mental health agency. You can find a psychologist in your area at www.apa.org; a licensed social worker at www.naswdc.org; or a local psychiatrist at www.psych.org.

●Do something for others without expecting something in return

The whole “pay it forward” mentality is a good place to begin. Carry someone’s groceries, walk their dog, visit a nursing home.

●Ask others for help when you need it

Victims often lack insight. Therefore they fail to appreciate that others who may want to help simply do not know what they can do. Tell them. You will be surprised at the response.

●Understand that to meet new people you have to be around other people

●Keep an open mind

It is hard for most people to try new things. But commit yourself to doing that at least once each week. Find community events in your local paper. It may be hard at first but if you put in the effort you will be pleasantly rewarded.

You can find support groups by contacting the Brain Injury Association of America at www.BIAA.org. You can attend community events like theater productions, music productions, art shows, book clubs, sport events, political meetings, adult education, Rotary Clubs www.rotary.org, Lions club International www.lionsclubs.org, Kiwanis International www.kiwanis.org, Soup kitchens, day care centers, nursing homes and animal shelters, to name a few.

●Make a list of things you would like to do

It is true that by writing goals down you are more likely to achieve them.

●Adopt a pet

For information on adopting a pet you can visit your local Humane Society at www.hsus.org or the American Society for the Prevention of Cruelty to Animals at www.aspca.org.

●Write, email or call family and friends

●Volunteer

You can support religious groups, schools, hospitals, and libraries that need volunteer work. You can find such organizations and others in your local newspaper. You can also research at www.volunteermatch.org.

●Join a church

●Learn about brain injury

Go to www.biaa.org or www.nabis.org to learn about traumatic brain injury and related issues.

●Limit the time you spend on the computer and the internet

Plan on developing and interacting personally rather than in virtual terms like chat rooms and the internet provide.

Building Strong Relationships

            Consider these ideas to build strong relationships…

            ●Learn to like who you are

We have all heard this before, “if you can’t like yourself, how can you like someone else?” Well start liking yourself. You are a good person and worthy of good friends.

            ●If you believe that others will like you they are more likely to

A Positive attitude about yourself will rub off on those around you.

            ●Write down your goals about making new and keeping new friends

It is true that by writing goals down you are more likely to achieve them.

            ●Make new friends

Resolve to not be afraid. Accept the invitation to the party, dinner, movie or whatever the opportunity provides. View meeting new people as an opportunity. Think about the possibilities of new things that can be had through making new and exciting friends.

            ●Take care of your physical appearance

Co0mmonly, when people become discouraged about themselves it shows in how they care for their outward appearance. Do not neglect yourself.

            ●Allow friendships to build slowly

Remember good friends are hard to find. Do not become discouraged if everyone you reach out to does not become more than an acquaintance.

            ●Try to listen more and talk less

Be a good listener. Hear the conversation, do not completely occupy it.

            ●Ask questions

A good way to show you are listening is to ask questions about what is being said.

            ●Show interest in what is being said

Participate in the conversation by occasionally nodding or making other sounds indicating you understand what is being said such as “Uh huh.”

            ●Remove distractions

It is difficult for anyone to focus on a speaker all the time. Trying to do so with extraneous noise like a T.V. or radio just makes it more difficult.

            ●Be a good friend that others will like to be around

Similar to people liking you for who you are, you should accept people for who they are. This may not make them a friend, but it will make you more pleasant to be around.

            ●Communicate positively

Some Traumatic brain injury survivors stay very negative about things. You need to focus and tell others about good things in your life or the world around you.

            ●Understand that relationships have good and bad moments

            ●Fight fair

Conflict is likely in any relationship. Be aware of that. Be ready and willing to forgive others as well as to be forgiven.

            ●Be polite, considerate and kind

Language can be sharper than the sword. Be very careful when you disagree to do so politely, respectfully and with a vision that the disagreement does not mean the end of the friendship.

            ●Think of others as much as you think about yourself

Thinking about others is a skill. The more you practice the better at it you become.

            ●Think about what you say before you say it

Along with being polite and respectful of what others have to say, be careful in what you say to others. Brain Injury makes people naturally less patient which can lead to unintended outbursts. Again practice makes perfect.

            ●Prepare yourself to work at building relationships

Building relationships takes time. Be ready and do not give up. Give it time. Accept that it may not have the same priority for the other person that it does at this moment for you.

I hope these basic tips will help you or a loved one cope better and ultimately overcome the tedium and strain of loneliness.

Yes.  Traumatic Brain Injury can affect the motor function of your brain.  This could seriously affect those of us who depend on specific coordination in work or social situations.

Research shows that parts of your brain that are not involved in a direct impact can still be injured.  This is due to the diffuse nature of traumatic brain injury.  A large proportion of survivors of traumatic brain injury (TBI) have persistent cognitive impairments, the profile of which does not always correspond to the size and location of injuries. One possible explanation could be that TBI-induced damage extends beyond obvious lesion sites to affect remote brain networks.

If you find yourself with a blow to the head, or in a traumatic event where you are uncertain if you hit your head, pay attention to things like balance, coordination and subtle movement changes.  You may have injured the motor function of your brain.

Research Using Functional MRI

Researchers at Columbia University Medical Center conducted tests with Functional MRI (fMRI). Observations suggest that patients display compromised activation and connectivity patterns during the finger-thumb opposition task, which may imply functional reorganization of motor networks following TBI.

Functional MRI versus Positron Emission Tomography

Functional MRI is based on the increase in blood flow and neural activity in the brain.  The main advantages to fMRI as a technique to image brain activity related to a specific task or sensory process include 1) the signal does not require injections of radioactive isotopes, 2) the total scan time required can be very short,  and 3) the in-plane resolution of the functional image is very small.

To put these advantages in perspective, functional images obtained by the earlier method of positron emission tomography, PET, require injections of radioactive isotopes, multiple acquisitions, and, therefore, extended imaging times. Further, the expected resolution of PET images is much larger than the usual fMRI pixel size. Additionally, PET usually requires that multiple individual brain images are combined in order to obtain a reliable signal. Consequently, information on a single patient is compromised and limited to a finite number of imaging sessions.

 See the article in Neurology.

headache
mental confusion
lightheadedness
dizziness
double vision, blurred vision, or tired eyes
ringing in the ears
bad taste in the mouth
fatigue or lethargy
a change in sleep patterns
behavioral or mood changes
trouble with memory, concentration, or calculation
symptoms may remain the same or get better; worsening symptoms indicate a more severe injury

With moderate or severe TBI, the patient may show these same symptoms, but may also have:
loss of consciousness
personality change
a severe, persistent, or worsening headache
repeated vomiting or nausea
seizures
inability to awaken
dilation (widening) of one or both pupils
slurred speech
weakness or numbness in the extremities
loss of coordination
increased confusion, restlessness, or agitation
vomiting and neurological deficit (e.g. weakness in a limb) together are important indicators of prognosis and their presence may warrant early CT scanning and neurosurgical intervention.

Small children with moderate to severe TBI may show some of these signs as well as signs specific to young children, including:

* persistent crying
* inability to be consoled
* refusal to nurse or eat

Anyone with signs of moderate or severe TBI - Traumatic Brain Injury should receive immediate emergency medical attention.
 

In the year following a traumatic brain injury, roughly half of survivors likely experience a bout of clinical depression -- a rate almost eight times higher than that found in the general population, says a study published  in the Journal of the American Medical Association. And those whose head trauma was followed by depression reported significantly more pain, greater mobility problems and more difficulty carrying out their usual responsibilities than those who were not plagued by post-injury depression.

Traumatic brain injury, or TBI, is sometimes called concussion. Often called the "silent epidemic," it affects some 1.5 million Americans yearly. Its symptoms are often subtle -- including personality changes, problems of memory and concentration, headaches and mood disturbances. While for most, the effects of a head trauma will clear within a year, many have more lasting effects. For at least 80,000 people a year, major disability will follow.  

The 559 participants in this study had all come to a trauma center in the Seattle area with a head injury, signs of brain trauma that could be detected by a CT scan, and at least a few complications -- including loss of consciousness, disorientation or other factors that qualified them as scoring at most a 13 on the 15-point Glasgow Coma scale. Over the next six months, and then again at eight, 10 and 12 months after the participant's injury, researchers conducted a detailed telephone interview to gauge his or her mood state and ability to function. The result, said the researchers, was likely to yield a conservative picture of how many suffered from depression.

LA Times reporter Melissa Healy interviewed Dr. Hovda, a UCLA biologist who said, "the study made clear what clinicians had long suspected: "Major depressive disorder can have severe consequences for recovery from TBI."

But the study didn't explore some important distinctions, said Hovda, who was not involved in the research. Among those are whether repeated concussions — like those suffered by some U.S. troops and athletes — might make depression more likely than a single, severe brain trauma.

Other factors were also correlated with depression after Traumatic Brain injury including being African-Amreican, being involved in litigation, not completing high school, or when the injury was caused by violence (as opposed to a vehicular crash, fall or recreational injury).

It is still questionable whether depression is related to organicity of the injury or psyhological affects of the injury.  The latter being more susceptible to treatment.  But the myth that depression is "all in your head" (seriously - no pun intended) continues to dispelled.  It a serious consequence of traumatic brain injury that can severly affect a persons ability to function.

To learn more about TBI and its sometimes-persistent effects, this comprehensive website can't be beat. To learn about local support groups and national and state efforts to improve life for those with TBI, check this website out.