Return to a New Normal

The road to recovery following a brain injury can be a long one, be it a stroke, concussion, or a traumatic head injury from an accident. Some patients may be followed by a revolving door of doctors, therapists, nurses, and caregivers for weeks or even years following their initial injury. Treatment for pain, physical injuries, weakness, swallowing, cognition, and prevention of accompanying diseases or disorders is commonly managed during this period of time.

There comes a point in time when patients or family members wonder…”When will things return to normal?”. What consists of “normal” is different for us all, and is dependent upon where you are currently functioning in life. Perhaps you are:

• Working full-time or part-time
• A student who is pursuing post-secondary education
• Retired, and typically engaged in personal leisure activities or hobbies
• A community volunteer 
• Trying to start your own business 
• Caregiver to a friend or family member

Thus, “normal” might consist of returning to school or work; re-entry into community-based activities; or supporting a friend or household with caregiving needs. Doing so requires certain skills and habits that are often not thought about pre-injury, but become much more apparent following an injury due to changes which can impact  daily functioning. There are several considerations you should make and discuss with a medical or clinical provider before you return to pre-injury activities or responsibilities.

1. Fatigue: After a brain injury, your body uses a tremendous amount of energy and resources to help you heal. Processing information, listening, remembering, organizing and formulating thoughts all require significant effort and energy, often resulting in cognitive fatigue or mental exhaustion post-injury. Activities that took no effort before an injury may leave you feeling wiped out only after a few minutes. It’s important to consider your level of endurance and if you have adequate energy to get through a day or even half a day of pre-injury activities. If not, consider modifying activities by taking frequent breaks or reducing the time intervals allotted to them. Monitor fatigue over time to note any improvements or plateaus, the latter of which should be discussed with your physician to determine if other methods can help manage your energy levels (e.g., medication). 
2. Sleep: Are you getting enough of it, and at the right time? 7-9 hours of sleep is the recommended allotment of hours we should all strive for, but often don’t attain. With a brain injury, patients can often have issues falling asleep, staying asleep, or sleeping too much. Connections within the brain may be misfiring or not firing at all, impacting if and when the body is able to regulate itself for rest. Setting a structured sleep routine is important for brain health and to engage in the responsibilities you desire to participate in. Try setting consistent sleep/wake times; reducing use of technology 1-2 hours before bed; and avoiding stimulants 3 hours before bed (i.e., coffee, soda, vigorous exercise). If you still find that you are napping frequently during the day, you may not be getting the sleep you need at night, which can throw off your internal rhythms for rest. Talk to your physician or a licensed clinician regarding medications, practices, or habits that can also be utilized to support a more stable sleep pattern at night.  
3. Language: Chances are your pre-injury responsibilities relied on some form of written language, verbal communication, listening, and/or reading comprehension. All of these skills are related to language, which can experience mild to severe changes following a brain injury. Changes in language may impact your ability to communicate fluently verbally or through writing; and difficulty with processing or understanding content presented aloud or on paper. Being referred to a speech-language pathologist will be imperative to help manage language skills for everyday functioning. Speech-language pathologists can help individualize therapy in a manner that focuses on both current and future functioning, as some patients may have greater reliance on different language skills post-injury. For example, a patient may have communicated verbally pre-injury but has either lost or significantly reduced ability to do so post-injury. A speech-language pathologist can help a patient explore whether or not alternative methods can be used to still engage in communication (e.g., writing, typing, pictures, speech generating devices). 
4. Cognition: This is defined as the mental processes of the mind - attention, memory, problem solving, organization, planning, decision-making, and self monitoring. Returning to a job, work, or even home-based activities require all of these skills. Reduced attention can cause you to leave food unintentionally unattended on a stove. Challenges with memory can impact memorization of notes needed for a class. Reduced self-monitoring could lead to errors being missed in a work report. These challenges should be identified and treated before determining if return to pre-injury activities is feasible. Patients should receive proper education on different cognitive skills, how they present in daily life, and how to demonstrate improved awareness of them (if able to do so). Speech-language pathologists are also trained to work on cognition for the purposes of remediation (improving skills) or compensation (supplementing other tools/strategies for an area of need). Additional referrals to a neurologist or physiatrist can also support the medical needs of patients experiencing changes in cognition following brain injury. 
5. Social, Emotional, Behavioral Factors: Have you noticed changes in how you engage with friends or family? Are you more withdrawn, or are you oversharing? Do your emotions change rapidly during the course of the day? Is it challenging to inhibit what you say or do? Regulation of social communication, emotions and behaviors can be impacted by brain injury, thereby affecting your responses to situations. You may overreact or even under-react to circumstances you would typically engage in a more logical manner. Such responses can impact family dynamics, friendships, and work or community-based interactions. A team consisting of the patient, family/caregivers,  speech-language pathologist, neurologist, and/or a psychologist can help craft a plan that consists of structured treatment and medical management. Such care can support improved social, emotional, and behavioral control which is needed for making and maintaining connections in society.

This is not intended to be a comprehensive list, but hopefully these factors serve as a starting point as you approach returning to a new, and different “normal”. If you would like more insight into treatment after brain injury and return to daily activities, contact Cognition, Speech & Language for a free consultation. 


References:

Fatigue After Brain Injury: https://www.brainline.org/article/fatigue-after-brain-injury-brainline-talks-dr-nathan-zasler 

What do practicing psychologists do?: https://www.apa.org/topics/psychotherapy/about-psychologists 

What is a neurologist?: https://www.aan.com/tools-and-resources/medical-students/careers-in-neurology/what-is-a-neurologist/

What is a physiatrist?: https://www.aapmr.org/about-physiatry/about-physical-medicine-rehabilitation/what-is-physiatry


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