Emotions can wear you out, too. No matter how outgoing and social you were before the accident, you will probably find both the cognitive and the emotional demands of being with people exhausting at first, and the difficulty is that these lovely people who really care about you have no idea that they are exhausting you.
It helps to let people know up front that you are struggling with energy and that talking, and even just listening, is actually quite challenging for you right now. So that you can really get the most out of their company, it helps to keep visits short for now, and only gradually increase the amount of time you can spend socializing.
Because you look the same as you did before the accident, people don’t expect you to be any different now. Most people know nothing about TBI’s (though television is exposing us all to bits and pieces of useful information). If you or your caregiver give your visitors a handout about the effects of a TBI and some links for additional information before the visit, it may help you and your visitors do better.
When you have access to the internet, using email may be easier than phoning, because you can take your time and respond when your energy level is higher. Remind your correspondents that you are still struggling with processing speed and energy, and try to keep responses brief. If you enjoy the silly stories and pictures people send you (I certainly do), let them know and forward any to other folks if you feel like it. Even that simple form of reaching out is greatly appreciated. Setting up a group e-mail option is helpful and that way you can keep people informed in “newsletters” which don’t have to be fancy or lengthy. If you want to forward a joke or pictures someone has just emailed you, you can still send to the whole group, and the original sender will probably be pleased to see how much you enjoyed them.
Facebook is an option you might consider in the future, but I would advise against it until you and your caregiver agree that you are ready for this rather higher level of public exposure.
The Mind’s Eye gives a glimpse into the wonders of neuroplasticity – the ability of the brain to adapt in the face of injury or disease. Oliver Sacks reminds us of the power of creativity, determination, and courage with eminently readable stories: a paralyzed woman does the NY Times crossword in her head; an aphasic woman who learned to communicate with gusto in her own way; people who could write although they had lost their ability to read; the author’s own struggles with face blindness (inability to recognize faces, even his own).
These tales of resilience are as encouraging as they are amazing. When one deals with brain injury, it is essential to remember that the brain can adapt and people can recover or learn ways to cope in the face of cognitive difficulties. This gives caregivers and survivors the courage to go on and find their own unique pathways to improved function and better lives.
You will hear professionals make this statement on a regular basis, and you may wonder why these differences exist. Reasons include the severity and location of the injury, the existence of other conditions due to the accident, the resources available for recovery, the amount of stress in the life of the survivor (both before and after the injury), the condition of both brain and body before the accident, and the habits and attitudes of the survivor.
The condition of the brain and the rest of an injured person’s body will vary dramatically, even without taking into account the various types of injuries and the severity of injuries. Age, education, occupation, and lifestyle are important factors in the recovery process.
Age at the time of the injury is crucial because of developmental differences in the brain over the lifespan. Many TBI survivors are adolescents or young adults. The human brain is not fully mature until around age 26; in fact the immaturity of the brain may have contributed to the injury in the first place (judgment, planning, and decision making, all late to mature in humans, are what keep us from making disastrous decisions). Middle aged survivor’s brains are also different from those of older adults. However, recent research tells us that the decline of brain functioning expected in old age is often less important than we used to believe, and that other developments in an aging brain may make up for declines in processing speed and minor memory glitches (check out Barbara Strauch’s amazing book, The Secrets of the Grown-Up Brain). When retraining injured brains, it is helpful to keep developmental differences in mind.
Differences in education, occupation, and lifestyle can create impressive differences among adult brains at any age. Education seems to help the brain create “reserves” which can lessen the impact of Alzheimers and TBI. Occupations that are challenging, complex, and varied can have a similar effect. Lifestyle, including, exercise, diet, and leisure activities (reading, learning to play a musical instrument, taking up new learning experiences, and knitting complicated patterns, for example) can also make a difference.
Attitudes are very important in recovery from a brain injury. Depression and anxiety are frequently problems after a brain injury, which isn’t at all surprising, given the sorts of changes in lifestyle, abilities, and independence faced by a survivor. One of the most useful tools in working with survivors is Martin Seligman’s Positive Psychology, an approach that is straightforward, sensible, and effective.