Curiosity…

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Curiosity needs to be defined along with an area of observation. Thus we may have an immediate form of curiosity, a local form of curiosity and a more global form of curiosity. These different forms make up the vast amount of questioning that can be done about subjects known to man which have an answer.

For our purposes here we will discuss primarily the immediate form of curiosity. This subject is of primary importance to everyone, but of ultimate importance to the Brain Injury Survivor. This is because these are the building blocks to forming a lasting productive experience with their own consciousness. This experience will make or break anyone who is recovering from a Brain Injury. This self-talk is the key to promoting a good recovery.

Typically though, curiosity is not seen as a characteristic that is required during a recovery from a Brain Injury. Up until this juncture there has been a lot of importance placed on spontaneous recovery. As more and more survivors go through this system there are bound to be a few outliers. There also has to be room for the directed recovery. This is where curiosity plays a role. This frees the survivor to proceed according to their own ideas however poor they may be due to their own brain injury. For example, there is no harm in doing a search online for the fastest car in the Le Mans race history. Other areas of curiosity may be more laden with consequences, such as seeing if you can drive again. Still others are good tasks to perform for healing purposes. In the end it is these tasks that will serve you the best on this journey of self-directed recovery.

This is where a little discipline comes into play. The ability to stay focused on the task at hand, ie. the restoration of various faculties through activities of daily living participated in through the lens of curiosity. And so the reasoning behind this methodology comes full circle and returns to curiosity as the driver.

 

 

 

 

 

 

 

 

 

 

 

 

t

resilience

New Resiliency Methods

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Take the basics…. Start from curiosity and grow… basic things…

Try activities of daily living.

Its about doing an asset-based needs/deficits evaluation.

Develop curiosity and resilience together…

Unease about rehab….
Professionals need to have some training to manage the rhetoric after the most basic stages…

Summary of  Points

There are two characteristics in particular that hit very hard at survivors: depression and anxiety.

These two will be tackled together thanks to WEB MD.

The main antidotes for these symptoms are:

  • Exercise
  • Diet
  • Meditation, and
  • Relaxation by breathing

Some effort needs to be undertaken to address these antidotes to the survivor’s symptoms. The survivor needs to be organized and set some new goals in these areas. This goal setting should always be done with something meaningful to them.  This may not be an easy task though, depending on the survivor’s background and present abilities/deficits. Be patient and help them work through it though – some of these moments can be real turning points for the survivor as they develop a framework  for accomplishing goals post accident.

 

Exercise
Cardio is at the core of  generating new neurons.  Remember there are many ways to get cardio. Balance   can also be a factor in that perhaps the cardio of choice is unavailable to the survivor at the moment. Circuit training is a way to get cardio also. All but the most severely injured can participate in some form of cardio; this needs to be more generally promoted in the rehabilitation industry.

Not to totally dismiss strength training – it also provides many added benefits such as attention, concentration, memory and planning.

Diet
Having a well-balanced diet is key.  The important thing is to get  into the correct habits initially. Have the survivor relax and take pride in their cooking and the reward of eating after.  To relax and see this as a therapeutic  part of their existence.  Indeed cooking is often used as a method for teaching the survivor transferable skills like multi-tasking and following directions.

This is a large factor and there will be many variables in the working out of this aspect of the survivor’s  existence.

Meditation
This concept is more often called ‘mindfulness’ in the brain injury context these days.  You are all aware of the impact that this is said to have on a survivor. I am here living proof of its effectiveness. I would sit for hours on end and just mull things over in my own space. Choosing not to be anxious about things that were not  in my control.

Relaxation by Breathing
This idea has made its way into our culture when we say ‘take a deep breath’.

There are methods for this involving measured breathing of some sort – for both inhaling and exhaling.

During the beginning of the covid crisis there was an ad on the radio here for stress reduction techniques with these sort of methods.

These beneficial practices are not the focus of this presentation and so I will leave them to you to follow up on.

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There are a number of other areas of interest to a positive outcome for the survivor. These include the self-worth or status, dignity, emotions, drive, purpose, bitterness and forgiveness. These areas are only well known in parts of existence for the survivor. The professional is frequently too busy to focus on any of these items as they are worried about the money in my opinion.

These factors can further be divided into general groups of internal and external.  The internal ones are     how the survivor sees themselves when there are no pressures. The identity if you will – this will be confused at first as they are very lost themselves and likely have a self-awareness difficulty.

The external  ones are those that shape the persons interactions with the outside world. Bitterness is one of these items which can go in both categories. It needs to be dealt with at each stage of the way as new realities  become apparent. One needs to relax and take it in stride as much as possible. Forgiveness is another dual member factor.  These two things will eat you up internally if you do not deal with them effectively.

 

‘Brain Fog’ is a newer term in brain injury that needs to be followed up on in detail here.  It is a term which applies when the person is in a state of anxiety and panic.  This is not a helpful term at all and only gives another reason for the professionals to relegate the survivor to a position where they are not taken seriously at all.  Perhaps you have used this term amid a busy time for the survivor.  As the survivor learns to cope with their new cognitive reality, no matter how transient, there will be a part of their journey where this may apply as they are still learning to cope with their new brain. This is not a helpful term; it signifies only that the survivor is too busy, needs to relax and not be worried any more about possible longer term eventualities.

 

Curiosity & Resilience in ABI Rehab

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Resilience has many steps to it. First you have to have a little bit of resilience to prime the pump if you will. Once you can do basic things you can begin to start developing some curiosity.  There are many things to be  curious about at first. The professionals’ need to embrace this; I had one therapist whom I would always have good discussions about brain injury rehabilitation.  This started my thinking processes again.  Just analyzing and evaluating in a quiet, calm and relaxed manner did me a world of  good. Then real therapy started and it was all about fulfilling the professionals’ desires – almost  regardless of whether it was good therapeutically for you.  This ability to question the basic practices of the professionals is lacking until you get out of their paradigm a bit and reflect back on it with a broader understanding of what the process is all about.

Curiosity can be nurtured about many other things though. Physical device problems are one big area, another is the culinary arts. Learn to ask   questions. This also needs to be done during therapy; what will this help me with and why do I need to do it this way. This is not singular process though. One area of curiosity leads with drive and problem solving to resilience in that area. Another area of curiosity leads to resilience in this area – and so you come to resilience following many areas of curiosity and  follows through to end up with that most desired result: resilience.

The curious mind is active and open to alternate ideas as well as broadening one’s outlook by giving a different perspective of reality. The resilience definition used for these purposes is “The art of returning to the previous existence”.

Anxiety, ABI & Rehab Funding

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Anxiety is a big problem today in the world of acquired brain injury (ABI) rehabilitation.

I would like to suggest though that it is industry specific and promoted and perpetuated therein.  The rehabilitation funders have set up a system where the survivor of the ABI is totally unconsulted and the process of rehabilitation and recovery is largely unpredictable according to them.  This process which only makes the survivor of the accident suffer with the rehabilitation funders sole goal of lowest cost liability. This is brought to the fore during a process which only promotes anxiety not only by the  recovery process but also by the legal framework behind all the actions of the rehabilitation funders. This is coupled with the fact that post trauma stress disorder (PTSD) is promoted by anxiety and has quickly become another deficit to which the survivor is labeled as having.

The fact that this is yet another deficit that the survivor must work their way out from is due solely, I believe, to the conditions brought about by the rehabilitation funders. This anxiety is a self-fulfilling prophecy as the rehabilitation funder places as many unpredictable variables in the way so as to promote this most common deficit. This is somewhat due the unpredictable way that ABI recovery happens if left to the whim of the survivor. Some general scientific principles need to be  applied here. Given that there will always be exceptions due to the nature of an ABI, however these are general principles that should be applied for the best possible outcomes to be obtained.

Certainly though some anxiety is necessary for life as we know it to exist. Some ways to channel this anxiety are needed now. One way is to put the energy into physical activity, another is to do something easy like read a book or listen to talking books online. A third way to think about anxiety is to see it coupled with anger.  The two are normally distinct in the general population as outlined in the references, however with the  advent of a traumatic Brain Injury this distinction is lost.  Thus some consideration should be given by the rehabilitation funders as to the sort of   paradigm they are setting up for the survivor. It is not lost on the author that some motivation for the survivor to get better is required, however this need not be done necessarily at the expense of all else. The frontline professionals need some further training in order for the rehabilitation paradigm to move forward towards a more balanced perspective on life.

A fourth way to think about anxiety is as a starter to get the mind working again. This core starter of the process of the mind being engaged again is needed to be recognized at an early stage.  In order to start to put coherent thoughts together one must have some ability to process a thought about something that is not regulated automatically. This should start basically with the activities of daily living such as toileting and eating.

The energy involved in anxiety should then be harnessed and channeled into a thought process which then proceeds to develop the memory and executive areas of the brain. This shift in focus of the anxiety should be done with some encouragement, patience, and gentleness.

For example take a situation that is ideal for anxiety at first – will the toilet flush. The therapist could then walk through the steps that the person’s thinking and help them to thereby develop their own self sufficient process for directed questioning.

The who what when where, why and how questions should all be  asked initially to get the mind working again. The base curiosity can be developed also during this timeframe. This process might seem slow for the professionals but then again they are there to serve the survivor and not the other way around as some of rehab has evolved to be working. The professionals should at this stage try to get the survivors mind working again by harnessing some of the old skills that the survivor was using in their everyday life – bonus to those who had a problem solving profession. There is a lot of room to develop curiosity. Some have even made a business of it and now it is seen as a desirable characteristic to have as a keyword on a resume or as a team characteristic/goal in a larger organization.

The long time periods while waiting for a settlement after formal rehab is over comes to mind of a place where anxiety can be bred unnecessarily, both from my own experience and from that of others I see around me. Although each accident is different as well as individual recoveries there are still some common points which must be promoted by the survivor organizations. As this must be by the professionals, I look to you for development of this sort of team. I am willing to aid in whatever capacity is required.

 

Appendices

 

Dr. Melanie Badali, registered psychologist and board director at AnxietyBC, says in general, anger is not usually considered to be a symptom of anxiety.

“Anger and anxiety are generally regarded as different emotional experiences with some overlap. They have both unique and common biological, cognitive, and social features,” she tells Global News. “Anger is usually connected to some type of frustration [and] anxiety is usually connected with an overestimation of threat and an underestimation ability to deal with that threat.”

 

Joshua Nash, a counsellor based in Austin, Texas, wrote an article for GoodTherapy.org in 2014 about anxiety and anger in particular.

“The point of my article was to show that anger is usually the emotion that people might identify in the moment, but that another emotion (anxiety for example) might be ‘underneath’ the anger, so to speak,” Nash tells Global News. “You won’t know anxiety underlies your anger until you’ve 1) fully felt the emotion first and then 2) introspected sufficiently to determine that the cause of your emotional upset was something you were afraid of.”

 

anx·i·e·ty

/aNGˈzīədē/
noun

  1. a feeling of worry, nervousness, or unease, typically about an imminent event or something with an uncertain outcome.

“he felt a surge of anxiety”

synonyms: worry, concern, apprehension, apprehensiveness, consternation, uneasiness, unease, fearfulness, fear, disquiet, disquietude, perturbation, fretfulness, agitation, angst, nervousness, nerves, edginess, tension, tenseness, stress, misgiving, trepidation, foreboding, suspense; More
  • desire to do something, typically accompanied by unease.

“the housekeeper’s eager anxiety to please”

synonyms: eagerness, keenness, desire, impatience, longing, yearning

“her anxiety to please”
  • PSYCHIATRY

a nervous disorder characterized by a state of excessive uneasiness and apprehension, typically with compulsive behavior or panic attacks.

 

 

Medical News Today – Oct 26, 2018
Anxiety is a normal and often healthy emotion. However, when a person regularly feels disproportionate levels of anxiety, it might become a medical disorder. Anxiety disorders form a category of mental health diagnoses that lead to excessive nervousness, fear, apprehension, and worry.

‎What causes anxiety? · ‎Social anxiety disorder · ‎What is separation anxiety …

 

 

Brainline.org
Anxiety is a feeling of fear or nervousness that is out of proportion to the situation. People with brain injury may feel anxious without exactly knowing why. Or they may worry and become anxious about making too many mistakes, or “failing” at a task, or if they feel they are being criticized.

Following a life-changing event like a brain injury, it’s normal to feel intense stress. But sometimes stress can build up and lead to anxiety. The main symptoms of anxiety are fear and worry. In turn, anxiety can cause or go hand-in-hand with other problems including:

People can express anxiety in both emotional and physical ways — from being inordinately irritable to experiencing shortness of breath or feelings of panic. Anxiety becomes a significant concern when these feelings intensify to a point where they interfere with the tasks of life. Anxiety can also be a symptom or effect of post-traumatic stress disorder.

 

Traumatic Brain Injury Anxiety Disorders: How to Take Back …

https://www.flintrehab.com/2019/traumatic-brain–injury–anxiety-disorders

2019-05-24 · Traumatic brain injury anxiety disorders can make it almost impossible to function in everyday life. In today’s article, we’ll be taking a closer look at some anxiety disorders after TBI and some of the best ways to manage them

 

Logistics

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Logistics is the art of moving products around.

This was covered under differing titles over the years like shipping and receiving, now however, the label logistics has surfaced as the new more sophisticated term for the movement of goods. This is another topic which everyone with a brain injury is involved with and has become or is becoming more aware of. It’s all the facets of their own movement during the passage of time. The facets involved will change with time over the
course of rehabilitation.

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The Components of Healing

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Start with the basics known for healing after a brain injury. Eat well, sleep well, exercise and have an active mind.

An active mind is actually a mind that has heightened awareness as well as frequent, frenetic, factual executive functioning episodes.

Additionally, some traits of the survivor should be nurtured from the earliest stages. These include curiosity and flexibility as well as consideration for others. Curiosity to get the mind engaged and sustained in any number of thought processes. Flexibility to work around any particular deficit to see alternative ways to approach the need at hand. For example, if the person has trouble tying their shoes at first perhaps a Velcro pair are easier to manage.

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The Redevelopment of Abstract Reasoning

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This is primarily addressed to those who have already completed their education and have started working. It seems to me that in the absence of any other information that the beginning of abstract reasoning is mulling. This has as a pre-requisite some working memory if one is to complete this task in their own mind without the aid of pen and paper.

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Executive Functioning Heals Itself…

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The pre accident executive function of the survivor will play a role in that this is the gold standard; that elusive restored executive. The survivor should not be expected to return to a state that they did not occupy prior to the accident. The process of thinking about something, in my experience, has become much more mechanical after an accident. What you think about is, of course, your choice, however, a good starting point is one’s activities of daily living. The situation should be allowed to remain in active thought for a longer period than had previously been expected.

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Executive Overview

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‘Executive Functions’ are frequently listed as a fundamental problem with all survivors. ‘Executive Functions’ is an umbrella term for the management of cognitive processes, including working memory, reasoning, task flexibility, problem solving, as well as planning and undertaking.

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