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TBI,ABI,Brain Injury,PTSD

TBI,ABI,Brain Injury,PTSD

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  • 1. A m a g a z i n e f or t h e br a i n i n j ury c om mun i t yIssue #1 April / May 2013Premiere Issue!In This Issue:Who’s Who in This Family Now?by Rosemary RawlinsMapping New Directionsin Caregivingby Janet M. CromerThe Slow Crawl ofBrain Injury Recoveryby David GrantBrain Injury and Grief:Fact or Fiction?by Janelle Breese BiagioniMake Your Life’s Story Betterwith Journalingby Barbara StahuraWhere is the Love?by Matthew and Cassondra BrownFamilies Caught in the Aftermathof PTSD: The InvisibleEmotional Woundsby Marilyn LashTBI and PTSD:Navigatingthe Perfect Stormby Marilyn LashHelping Childrenwith Brain InjuriesSucceed in Schoolby Janet TylerA Better Approachto Finding a Jobafter Brain Injuryby Dawn WestfallReading RoomBook Reviews
  • 2. “Our goal is to provide the highest quality, individualized transitional Table of Contents A m a g a z i n e f or t h e br a i n i n j ury c om mun i t y and long term care for persons with acquired brain injury.” Welcome Nathan D. Zasler, MD from Lash & Associates Publishing/Training Founder, CEO & Medical Director Publisher’s Letter Tree of Life Services, Inc. by Marilyn Lash, MSW…………………………………......5 Issue #1 - April / May 2013 Mission Statement Editor’s Letter Brain Injury Journey - Hope, Help, Healing helps persons with brain by Barbara Stahura, CJF..………..................................5 injury, families, and providers successfully navigate challenges and live a full and satisfying life. We offer empowering personal stories, inter- views with experts, and clinical updates and research findings. Above Family Matters all, we provide a community to enhance hope and foster healing after Who’s Who in This Family Now? brain trauma or disease. by Rosemary Rawlins…………………………………........6 Publisher Lash & Associates Publishing/Training, Inc. Caregiver’s Compass 100 Boardwalk Drive, Ste. 150,Youngsville, NC 27596 Mapping New Directions in Caregiving Tel 919-556-0300 Fax 919-556-0900 www.lapublishing.com by Janet M. Cromer, RN, MA, LMHC………………...8 E-mail: orders@lapublishing.com New Horizons President Marilyn Lash, MSW The Slow Crawl of Brain Injury Recovery CEO Bob Cluett by David Grant……………………………..…………10 Brain Injury Journey Editor-in-Chief Barbara Stahura Graphic Design Bill Herrin Stepping Stones Advertising Bob Cluett, Nick Vidal Brain Injury and Grief: Fact or Fiction? Subscriptions Nick Vidal by Janelle Breese Biagioni, RPC………………………...12 Editorial Inquiries Marilyn Lash Editorial Policy Telling Your Story Brain Injury Journey is published six issues per year. Lash & Associ- Make Your Life’s Story Better with Journaling ates Publishing/Training Inc. does not endorse, support, or recommend by Barbara Stahura, CJF……………………………..14 any specific method, facility, treatment, program, or group for persons with brain injury. Any inquiries or concerns about an individual’s health, treatment, and recovery cannot be addressed and should be discussed Veteran Voices with a health care practitioner. Where is the Love? Advertising rates by Matthew and Cassondra Brown...............................16 Please call 919-556-0300 for information on rates and distribution. Families Caught in the Aftermath of PTSD: Distribution and Subscription Brain Injury Journey is available electronically and in print. The Invisible Emotional Wounds Sign up for free online subscriptions or paid print annual $48 Chief Editor by Marilyn Lash, MSW…………………………………...18 subscription for six issues at: www.lapublishing.com/brain-injury-journey-magazine Nathan D. Zasler, MD Clinical Corner Letter to the Editor Policy TBI and PTSD: Navigating the Perfect Storm We welcome comments and feedback, but please limit letters to 300 by Marilyn Lash, MSW...………..………………......20 words. Published letters may be edited for spelling, grammar, and length. The writer must include name, address, email, and/or phone number for contact. Lash & Associates reserves the right to refuse let- Kids’ Club ters for publication, and submission does not guarantee publication due Helping Children with Brain Injuries Succeed in School to space limitations. Opinions in Letters to the Editor are solely those of by Janet Tyler, PhD.......................................................24 the author and do not represent Lash & Associates. Provider Points Brain Injury Journey©2013, is published six times a year by Lash & Associ- www.Tree-of-Life.com A Better Approach to Finding a Job after Brain Injury ates Publishing / Training. All rights reserved. No part of this publication by Dawn Westfall, MS, CCC-SLP…………………….26 may be reproduced in whole or in part in any way without the written permis- 1-888-886-5462 • Fax 804-346-1956 sion from the publisher. For reprint requests, please contact Bob Cluett, CEO, Reading Room & Resources via email at orders@lapublishing.com Back issues can also be ordered Administrative Offices Book Reviews.……………………..............................28 at http://www.lapublishing.com/brain-injury-magazine/ 3721 Westerre Parkway, Suite B • Richmond, Virginia 23233 Resource Page & Advertisers........................................30 3
  • 3. Letter from Lash & Associates From the Editor-in-Chief by Marilyn Lash by Barbara Stahura Call for our latest catalog, We are so proud to introduce the first issue of Brain Nearly 2 million people annually sustain a brain injury Injury Journey – Hope, Help, Healing. We spent a lot of in the United States, and more than 5 million live with time choosing our magazine’s title because we wanted it permanent disabilities related to brain injury. Fortunately, and we’ll get things in order! to reflect our philosophy as well as the needs, issues, and public awareness of brain injury is growing, and much concerns we hear every day. research is being devoted to Words matter, so we have prevention, treatment, and chosen them carefully. recovery. Yet despite all the tremendous advancements The 2013 Lash & Associates catalog is available by request, and our Brain Injury - We address being made, most do not all types of acquired brain entire selection is on our website 24/7 at www.lapublishing.com Ad address this fact: Brain injury Call or check us out online today, and have a better tomorrow! Catauog l lt injuries with those due to begins and ends in the family. 2 0 internal causes such as brain 1 3 tumors, infections, or stroke as What happens to the family well as traumatic injuries due when so many aspects of to external forces of collisions, their lives have been turned Lash & Associates Publishing/Training Inc. 100 Boardwalk Drive, Suite 150, Youngsville, NC 27596 Tel: (919) 556-0300 Fax: (919) 556-0900 explosions, assaults, falls, or gunshots. upside down and they struggle to live their “new normal”? When many professionals in the field do not adequately 919-556-0300 www.lapublishing.com Journey - Living with a brain injury is an ongoing Call us for a FREE catalog! Leading Source of Information on Brain Injury in Children, Adolescents, Adults and Veterans process or journey that is constantly changing, challenging, understand the changed dynamics and realities of living with brain injury, how can families bridge the gap between Lash & Asso and rewarding for everyone involved. There is no finish what is happening to them and what they need to know to ing/Tr ciates Publish ain Leading publishe r ing Inc. and concussi on brain injury, blast inju on in adults line with a tape to cross, cheering crowds, and a celebratory survive, or even thrive? and veterans ry . party. Rather it is getting up and facing each day with the conviction and purpose of rebuilding one’s life. We strive to fill at least some of that gap in the pages of this magazine. Our mission: Brain Injury Journey - Hope, Hope - This is what survivors, families, and caregivers Help, Healing helps persons with brain injury, families, Lash & Associates Publishing/Training Inc. 100 Boardwalk Drive, Suite 150, Youngsville, NC 27596 tell us is so important. Hope is what sustains them in their and providers successfully navigate challenges and live Hope . . . comes in many forms Tel: (919) 556-0300 Fax: (919) 556-0900 darkest periods. Hope is the vision that lights the darkness a full and satisfying life. We offer empowering personal www.lapublishing.com and creates new possibilities for a better future. stories, interviews with experts, and clinical updates and Help - As the African proverb says, “It takes a village research findings. Above all, we provide a community to raise a child.” The same is true for brain injury. Help to enhance hope and foster healing after brain trauma or comes from many people and in many ways. The individual disease. Helping Brain Injury Victims Lash & Associates who survives a brain injury enters a community that is much larger than friends and family. It includes clinicians, Our writers reflect the brain injury community to whom this magazine is devoted: people with brain injury and their Families Nationwide. Publishing/Training Inc. 100 Boardwalk Drive, Suite 150 therapists, educators, advocates, providers, insurers, and who come from civilian and military backgrounds, family Youngsville, NC 27596 Tel: (919) 556-0300 many, many more. They share the goal of ensuring that caregivers and family members, and expert providers Fax: (919) 556-0900 www.lapublishing.com treatment for brain injury is more than just survival. such as speech pathologists, therapists, educators, and Healing - There is no fixed timetable for recovery. The mental health professionals. We will do our best to cover a healing process after brain injury is much more than a spectrum of topics to provide helpful, valuable information neurological recovery. Healing is multidimensional. Yes, not often available anywhere else, presented in clear, 1-800-4LAW-MED it is physical, but it is also cognitive, emotional, social, familial, and spiritual. reader-friendly language. 1-800-452-9633 For the person who is injured and the family alike, That is our philosophy, and that is the foundation for this coping with a brain injury, especially in the early days, can magazine. We hope you find the articles, information, and feel like the end of the world. You may feel isolated and Thomas Henson, Jr. alone, believing that no one else understands what you are Brain Injury Attorney insights valuable and helpful in your journeys, whether they and Advocate for over 20 Years be personal or professional. You are all valuable members of going through and all the challenges you face. But we do this very special community. understand because we have been there, and we can tell you it is not the end. The journey ahead is not easy, and 2501 Blue Ridge Road • Suite 390 • Raleigh, NC • 27607 • LawMed.com Please help us spread the word and encourage your you likely will be called upon to make many adjustments. THIS IS AN ADVERTISEMENT. Henson Fuerst Attorneys are licensed in NC, VA, GA, NY and DC, and will associate co-counsel in various jurisdictions to assist friends and associates to subscribe at http:// Know that we are here for you and will gratefully share with these claims. Clients not accepted in states where unauthorized by state bar rules. SERVICES MAY BE PERFORMED BY OTHERS IN THE FIRM. www.lapublishing.com/brain-injury-magazine/ what we have learned to help you along the way.4 5
  • 4. Family Matters Reaffirming: Telling each other we loved each other often. Staying flexible: Understanding that last minuteWho’s Who numerous, and some had not even revealed themselves yet. changes might happen, and that roles would continually shift and change as Hugh’s health improved.in This Family Now Our twin daughters, Anna and Mary, age 14 and once Life for families will be different and often difficult the center of our universe, were now left off to the side after one member sustains a brain injury. But in theby Rosemary Rawlins or enlisted as caregivers. “Can you stay with Dad while long run, some families may grow closer than they ever I go out to the store?” I’d ask. “Remember to be sure he dreamed possible. It happens without warning. keeps his helmet on.” They both did their best to help out, but I know it was hard—hard to see their father disabled, Ten months after his injury, Hugh earned his driver’s One person takes the hit, the hard to care for a parent who used to care for them, and license back, and one evening, he drove himself to thebullet, or the fall, while lovedones witness the wreckage. hard not to complain about it, because there were so many gym to work out. A while later, a fireman called the competing emotions. In truth, they lost both parents for a house to tell us that Hugh had suffered a seizure. MaryWhen traumatic brain injury period of time because I was focused solely on Hugh and and Anna swung into action. “I’ll come to the hospitalstrikes a family, everybody his treatment. with you, Mom,” Anna said.suffers. Children are forced to grow up fast after a parent has “It will be okay,” Mary said, rubbing my back, and Survivors emerge from a fog that slowly gives way a brain injury. Their needs will not come first and mayto bewildering awareness of limitations, deficits, and a not even seem important. But over time, the experience I knew it would, as long as we all had each other.new way of living. Family members wait out the initial will have taught family members lessons about love,hours and days following the injury in cliffhanger mode, Rosemary Rawlins is the author of Learning commitment, patience, and overcoming adversity. Our by Accident, a memoir. You can learn morehanging onto any branch of hope within reach. family made it through the hardest first two years, and about Rosemary at: One family life ends, and another begins. looking back, here’s what helped us. www.rosemaryrawlins.com Structure: Keeping the children on schedule for Depending upon which family member is injured— school and extracurricular activities so there was afather, mother, child, sister, or brother—roles flip, continuation of familiar past activities. This requiresresponsibilities shift, and stress mounts. Until the extent ofthe injury is known, and healing begins, remaining family family and friends to chip in with driving and other tasks. Ne uro Neuro Community Caremembers take on what added responsibilities they can, Support System: Relying on emotional support and The right support, at the right time • NCC recognizes the complex needs of those with brain injuries and the lifelong challenges they faceand learn to do without—without the counsel, connection, help from family, friends, church, teachers, therapists, andand comfort of someone they once relied on. doctors. • NCC provides cost effective, community based support for individuals with Community Care brain injuries, neurological, cognitive or physical challenges L LC In my case, my husband, Hugh, was hurt. On April 13, Surrogate Parents: Close family and friends stepping Brain Injury Support Services • NCC Case Managers and Life Skills Coaches act as a bridge and advocate on the2002, a car hit him as he rode his bicycle home from an in to give children needed attention and help when parents client’s behalf; exploring community resources, making referrals and providesafternoon workout. He was forty-six years old, athletic, are overwhelmed. ongoing trainingsmart, and seemingly invincible. To his children, he was Open Communication: Being honest and open with • NCC Case Managers work collaboratively with clients, caregivers and providers in“Huperman,” the dad who would always protect and each other’s feelings—venting, laughing, and crying developing goals; accessing services and providing advocacy so that needs are metdefend. He was the main breadwinner in our household. together as a family. • NCC Life Skills Coaches provide ongoing individualized skills training for persons with brain injury or other cognitive impairments in their own environments After two emergency brain surgeries in three days, Reasonable Expectations: Letting kids be kids.Hugh was in a coma. In the space of those first harrowing • NCC has considerable experience providing services and support to military Asking only age-appropriate caregiving help from personnel, veterans and their familiesdays, I became a single parent. Being in charge of his children, and only when absolutely necessary. 12520 Capital Blvd., Suite 401-139, Wake Forest, NC 27587medical care felt like a monumental task to handle alone,but I also had to communicate with his employer, pay our Using Our Strengths: Anna was great at helping in the kitchen. Mary liked to stay up late, so she helped out www.neurocc.com info@neuro.combills, and manage our insurance policies, my part-time when the night nurse was off duty. 919-210-5142 office 888-626-3681 faxjob, the house, and family. Hugh was sent home after thirty-three days wearing a Accepting: Acknowledging that life was different, buthelmet on his head (a chunk of his skull had been removed we’re all in this together. “What makes NCC unique is that our services are provided in the individual’sto relieve brain swelling). I held tight to the gait belt Encouragement: Bolstering each other’s spirits during home or community environment and are functionality based”strapped around his waist for balance. His deficits were hard times.6 7
  • 5. Caregiver’s Compass non-caregivers? We are also vulnerable to traumatic chair, close your eyes, and bring your attention to stress from caring for a person who suffers, is in pain, your breath. Just breathe naturally, in and out a few or very disabled. There is even a form of severe mental times. Starting at the top of your head, slowly draw and physical exhaustion, known as compassion fatigue. your attention down the length of your body, front andMapping New Directions among the diagnoses studied. This condition leads to a depletion of resources and interferes with every dimension of life. back. Keep your mind open and non-judgmental. Just notice any spots that feel sore or tense. Notice anyin Caregiving For adult caregivers, our titles and roles change areas where worry or anger might be hiding out? Let as the journey progresses. In the beginning, most of What helps prevent some of the health hazards your breath flow easily. You might try inhaling into us start as a crisis manager juggling tough medical associated with caregiving? How can we replenish our a sore spot to soothe the area, and then exhaling a bitby Janet M. Cromer, strength, motivation, and empathy at each stage? decisions, family life, and even a job. Then, during of pain. Note any feelings you might want to exploreRN, MA, LMHC months or years of rehabilitation, we become a coach, later in your journal or a conversation with a friend. Realistic resilience skills Welcome to Caregivers maybe even a drill sergeant. A child becomes Dad’s Sit for as long as you like. Breathe, stretch, then smileCompass! Are you a caregiver teacher as he explains how to spell or play a computer No matter where you are along the continuum of and continue your day.for a family member who game. caregiving,has a brain injury? Although there is an We’ll delve Persons who have a severe brain injury might into seriousyou may feel alone, you are essential require complex medical care at home. That caregiver issues such asin good company on your ability that feels more like a nurse and physical therapist than ajourney. More than 65 million fortifies and caregiver trauma, wife as she gives tube feedings, suctions a tracheotomy,Americans care for a family sustains body, compassion and moves her husband’s weak legs through a range ofmember at home. Many of mind, and fatigue, and motion exercises.them care for a person who has one of the many types spirit. I call mental healthof acquired brain injury. The crisis may have begun Brain injury can contribute to problems that affect it “realistic concerns.with a traumatic brain injury, blast injury, hypoxic memory, mood, cognition, and behavior. This means resilience.” Prevention is thebrain injury, stroke, tumor, or infection. The causes are that caregivers often become counselors, behavior Resiliency best medicine.different, but some consequences are universal. In an coaches, and emergency responders. Fortunately, there has been So, we will offerinstant, a family member is plunged into the wilderness is now effective treatment available for conditions such defined as explanationsof intensive care units, rehabilitation hospitals, as depression or post-traumatic stress disorder (PTSD). the ability to along withneurology appointments, and then the community. However, both military and civilian families can feel cope well with proven at a loss to understand and help a son or spouse whose high levels techniques to All of a sudden you are officially declared a of ongoing, minimize the personality and behavior have changed dramatically.caregiver without a compass, job description, or worst kinds Recovery requires a combination of good treatment, disruptivetraining manual. This uncharted territory comes with change. of stress. We time, and effort.a mountain of responsibilities, a foreign language, and Resiliency will show youunfathomable scores. Not to mention insurance limits. By the time you have been a caregiver for a few allows us to new ways toYou are assigned to be the guide and coordinator. No years, you probably summarize your role as “The bounce back, reverse the stresswonder you call out, “Help! I’m lost in here! Where’s CEO of Our World.” You might take pride in your adapt to changes, and move forward. The realistic part response, manage troubling emotions, and approachmy road map?” valuable contributions, even as you worry about finding comes in because resilience requires us to recognize responsibilities more confidently. vocational training for your wife or a supportive place and acknowledge changes and losses, and embraceWho is a brain injury caregiver? The topics that caregivers sometimes consider for your daughter to live as you get older. what is real now. We don’t pretend, or deny our Caregivers are a diverse and dynamic group. We feelings. We push past the edges of our comfort zone to “taboo,” yet dive into with each other, will also find There is one important title that every family a voice in Caregivers Compass. Topics such as theeach bring a unique life story and personality to the enter new territory, even if we feel anxious or insecure. caregiver learns and earns: Fighter and Advocate! We caregiver’s sexuality, anger, and need for an identityrole. We are spouses, partners, parents, siblings, That bravery allows us to use active coping strategies should be awarded trophies for the advanced skills beyond caregiving deserve exploration.children, and close friends. We might not even think of and creativity to solve problems, learn new skills, and and commitment that empower us to partner with theourselves as caregivers because helping someone we care for ourselves and others. survivor to live a full and meaningful life every day. We There are many routes to becoming a resilientlove comes naturally as a parent or husband. Others grow, and promote growth in others. We start support Two key categories of resilience in particular have and masterful caregiver. Join us to forge a strong andprefer the term “care partner” when they collaborate groups to share our experiences. We get involved and been shown to reduce the risk of health problems and inventive community sharing our journey.with, assist, and support the survivor. tell our stories to change the healthcare system. We compassion fatigue—stress resilience and emotional Children are often the overlooked or hidden rally for legislative changes, educational reforms, resilience. You have probably heard the standard advice Janet Cromer, RN, MA, LMHC is a psychiatric RNcaregivers. A survey by the National Alliance for resources, and disability rights. to prioritize time for yourself, set boundaries, and put and the author of Professor Cromer Learns to Read:Caregiving estimates that at least 1.3 million children your own oxygen mask on first. Tried and true advice. A Couple’s New Life after Brain Injury. Janet speaks On one hand, we are strong, powerful and resilient. nationally on family and professional caregiverin the U.S. between the ages of 8-18 care for a sick ordisabled sibling, parent, or grandparent. Many care for On the other hand, we can become exhausted and However, Caregiver’s Compass will supplement issues including stress resilience, traumatic stress, overwhelmed. Did you know that caregivers have what you already know with innovative approaches to compassion renewal, seasons of caregiving,a brother or sister while parents work, or help a parentlearn to read again. Brain injury is well represented higher rates of chronic disease and depression than make your own. For instance, here is a practice, called and creativity and healing. a body scan, to try right now. Sit comfortably in your See more at www.janetcromer.com8 9
  • 6. New Horizons challenges with my memory. We can add to the list a Life as a survivor of brain injury is vastly different couple of new-found speech impediments: stuttering than I ever expected. Challenges I never considered in and aphasia. my old life can overwhelm me. Akin to learning to drive a new car, I am slowly learning how to navigate through In the days after my cycling accident, I saw doctors Yes, on the outside, I “looked” normal. But under theThe Slow Crawl of Brain of many specialties. The orthopedic doctor let me know hood, it was becoming very clear that something was life with my new limitations.Injury Recovery that my broken arm would heal, that I would be in a wrong. Another trip to the neurologist revealed a new, But there is good news. By being respectful of my cast for a couple of months, and feel a bit of pain for six multi-facetted diagnosis. Grateful that my body was new limitations, and surrounding myself with peopleby David Grant months. Right on cue, at the six month mark, my arm mending, and still confused over some of my newest who love me, who care about me, and who want me as pain stopped. challenges, I was told I have a very clear-cut case of well as I can be, I am building a new life. Yes, much of So much of life happens post-concussive syndrome. At this same time, several it is more difficult. But much of it is surprisingly morebetween those moments of But recovery from a brain injury cannot be defined months after my accident, I was also diagnosed with wondrous. I have slowed down to a pace I never hadnormalcy. The sun rises, the by an end-date circled hopefully on a calendar, though post-traumatic stress disorder. before and now take time to see, feel, and experiencesun sets, many of us go to I thought this at first. As my broken body began its my world with deeper appreciation than I ever thoughtwork, care for our children, slow crawl toward wellness, as my bones knitted, and By nature, I am hard-wired to be a problem solver, possible. as my bruises faded from black to yellow and then an overcomer. Whenever a life event comes to pass, thespend time with those we And for that, I am profoundly grateful.cherish, and never give much to memories, the extent of how my brain injury was optimist in me tries to pull whatever positive I can fromthought to the fact that life affecting my life became clearer. the experience and move on. David A. Grant is a writer based in New Hampshire and the author of Metamorphosis, Surviving Braincan change dramatically in the My journey to my “new normal” may or may not But with a brain injury, there is no end-game. Thereblink of an eye. Injury. A survivor of a harrowing cycling accident in be typical. is no magical date on some future calendar page that 2010, David openly shares his experience, strength, and And so it was for me in Brain injuries is circled in red, perhaps with a smiley face, that I hope as a brain injury survivor. Recently recognized byNovember 2010. On a cold, are like await. I have learned over the last couple of years that the Brain Injury Association of America, David’sblustery day here in New snowflakes— recovery from brain injury is lifelong. I have learned book offers real-world insight into life as a brainEngland, my life was forever no two are that the brain recovers in its own time, sometimes at injury survivor.changed. Local police estimate alike. In the glacial speed. And if I try to hurry the process, I am left www.metamorphosisbook.comthe speed of the teenage driver days after my disheartened and frustrated.at 30-40 mph who broadsided injury, I hadme while I was cycling. In a CAT scan, an EEG, and Unique and Innovative Programstwo ticks of a clock, my lifeunexpectedly and abruptly other tests for Adults with Brain Injurieschanged course. I was thrown to see if my and Their Familiesfrom my trusty bike into the cognitive abilities were Locations in Huntersville and Asheville, NCstrange new world of traumaticbrain injury. compromised. Day Program I passed all Residential Program I did not then know the my early Therapeutic Horseback Ridingscope of “America’s silent tests with Community Support for Veteransepidemic” in today’s society, high honors Caregiver Support Groupsblissfully unaware that more and wasthan 1.7 million Americans a congratulatedyear sustain a TBI. by many within the Recovery from a brain professionalinjury is like nothing I have communityever experienced. If you for dodging aare a survivor, you already bullet.know this. If you are a familymember or a caregiver, you But allknow this as well. But to was not well. Most all of my symptoms, those cues 14645 Black Farms Road Huntersville, NC 28078live life as a brain-injury survivor, there are no past that let me know I had sustained a TBI, came slowly, in 704-992-1424 office 704-992-1423 faxexperiences I can draw upon that have helped me many cases weeks after my injury. Word-finding issues www.hindsfeetfarm.org www.facebook.com/hindsfeetfarmnavigate this new and uncharted life territory. were among my first challenges. Then came significant10 11
  • 7. Stepping Stones these individuals and their families. As stated, the process is Loss associated with brain injury can be physical and/ chaotic. Add to it that the loss is the “death-like” experience or cognitive, but there may also be additional losses in of a person no longer resembling who he or she was prior to relationships, lifestyle, employment, and in the person’s being injured, and the crazy-making is exacerbated. sense of self. Each loss requires reflection, expression, andBrain Injury and Grief: through all five stages and in the order given, or they were Interference with Grief After Brain Injury acknowledgment before healing and acceptance of a newFact or Fiction? grieving wrong. Let me tell you: the only wrong way to life can take place. grieve is to not grieve. Prior to Kübler-Ross’ death in In my work I have 2004, she explained the model was not meant to be a list of Janelle Breese, RPC,by Janelle Breese Biagioni, RPC discovered several reasons that “absolutes” that one had to do in any specific order to heal, interfere with the grief journey is an author, speaker, and Grief is most often but that it was a list of potential grief responses a person counselor with expertise in following a brain injury. Theyassociated with death. While it may experience. I have come to learn, both personally are: grief, loss, life transitions,is true that the death of a loved and professionally, that the list of responses is far more and brain injury. Sheone (family member, friend, or expansive. Dr. Alan Wolfelt’s Companioning Model 1) Society’s incomplete resides with her familypet) and, at times, the death of identifies potential grief responses as shock, numbness, list of loss and an unrealistic in Victoria, BC. She ispeople we do not know (Sandy disbelief, disorganization, confusion, searching, anxiety, timeline to grieve and mourn. the author of A ChangeHook Elementary shooting) panic, fear, physiological changes, explosive emotions, of Mind: One Family’s Society accepts the need towill catapult us into the grief guilt and regret, loss, emptiness, sadness, relief and Journey through Brain grieve and publicly mourn thejourney, death is not the only release, and finally, reconciliation and healing. Injury and the upcoming physical death of a loved one,cause of grief. Although death but there is little understanding book, Life Losses: Healingis an important reason, there are other losses in life that we The grief journey is complex. It is a process and not for a Broken Heart. Visit of the need to grieve thealso need to grieve. These too are life-changing and will an event. It is not time specific, nor is it orderly and www.lifelosses.com and “death of a personality”solicit the same grief responses as death does. predictable. Moreover, the process is fraught with “crazy- follow her blog at when the person is alive. The making” stuff. It is a lonely path. It feels like nobody www.janellebreese.blogspot. Society has slowly recognized significant life events as person may have physical understands what you are going through. That is true. com She can bealso being a source of sorrow and cause for grief. Events and/or cognitive limitations; No one can truly understand how another person feels; contacted at however, those individuals andsuch as divorce and separation, transitional losses (moving however, those who have walked this journey never forget Janelle@lifelosses. their family living with suchto a new community or job loss), and developmental what they felt or experienced. They can be a tremendous comlosses (children leaving home) are also ways in which we profound change are often left source of strength and courage to you.experience feelings of sadness, depression, hopelessness, reeling in unfair comments like, “It could have been worse.” Stop by andand sorrow. To heal from these experiences and to move I mentioned earlier that the only wrong way to grieveforward in life, we must grieve and mourn. is not to grieve. In addition to that, it is important to There is no timeline to grieve and mourn. Unfortunately, remember that grieving is not the end to the means. It is share yours. Furthermore, with the advancement of technology and society operates on the thought that people need only only the beginning! I say this because grieving is about “three days bereavement leave” and/or that in a few monthsmedicine, people tend to live longer; however, many arecompromised with chronic illness, such as diabetes or heart how we feel on the inside due to what has happened in everything and everyone will be back to normal. It doesn’t our life. If one is allowed to truly feel—to grieve, this work that way for both physical and non-physical deaths.disease. While these are often manageable, it is not unusual will lead to mourning. Mourning is the process of takingto experience some level of loss as a result. It could be that Remember this: It isn’t time that heals all, but rather what those feelings from the inside to the outside. It is giving we do with the time that heals us.people are no longer able to work in the same capacity, or expression to how we feel. This may be done in a varietythey may have a substantial change in lifestyle, or the way of ways, such as funerals, talking, writing, art, and music. 2) There are layers and layers of loss experienced bythey view themselves in society becomes grossly skewed, Wolfelt describes it like this: “Mourning is grief gone survivors of brain injury and by each person connected toand therefore they begin to grieve. Then we have what I public.” The only way to move through or reconcile and them.identify as extraordinary grief resulting from a disease mourn feelings of grief is to find a safe and comfortablesuch as Alzheimer’s or a catastrophic injury such as a brain The layers of loss following a brain injury and the way to express those feelings. This applies to all types ofinjury. This kind of grief is profound. People must grieve uniqueness in the realm of grieving are overwhelming for loss, including those associated with brain injury.who they were, and the family also grieves the person who many. To adequately grieve these layers of loss, it requiresis no longer there, albeit physically present. Sadly, I think Understanding the grief journey and its connection with those involved to explore and determine the primary andsociety as a whole is only beginning to understand how secondary losses of the brain injury and how this impacts Come blog with us about brain injury! Interesting, informative brain injury is important for survivors, family members, daily postings by survivors, families, caregivers and even theprofound this type of grief is. friends, and professionals alike. It’s important because if them. This applies to both the survivor and to their loved staff of Lash & Associates. You’ll laugh; you’ll cry; you’ll want you do not acknowledge the losses that arise from having ones. Once the layers are identified, then people can begin to tell your own story and this is the place to tell it! Post yourThe Complexities of Grief to work through their feelings. a brain injury, it will be difficult—if not impossible—to comments on our blog articles and share your experience. In 1969, Dr. Elisabeth Kübler-Ross published a move forward in life. This is true for people who are Reflect on the life losses that you have experienced, It’s easy to join this blog, so come on...give us your two cents!revolutionary model of grief in her book On Death and living with the outcome of a brain injury, and it is true including brain injury. Do you feel that you were able toDying. These five stages, commonly referred to as DABDA, for those in relationships with them, including spouses, fully acknowledge the grief that resulted from your loss?are denial, anger, bargaining, depression, and acceptance. children, family, and friends. And it is especially true for Do you feel that others understood or supported you in Lash & Associates Publishing/Training Inc. 100 Boardwalk Drive, Suite 150, Youngsville, NC 27596 Tel: (919) 556-0300 Fax: (919) 556-0900The flaw was not in her model. It was in society’s the professionals involved because it is our responsibility grieving (feeling) and mourning (giving expression to those w w w. l a p u b l i s h i n g . c o m / b l o g www.lapublishing.cominterpretation of it. It was believed that people had to go to help facilitate the process of grieving and mourning for feelings) following loss? Leading Source of Information on Brain Injury in Children, Adolescents, Adults and Veterans12 13
  • 8. Telling Your Story to light nuggets of insight and inspiration that can offer • Stimulate cognitive and executive skills (following hope, healing, and a way forward. (One caution, though: direction, organizing, planning, sequencing, attention, If writing about a traumatic experience makes you feel processing, etc.) deep into your soul, and find release and healing. From excessively frightened or apprehensive, please do notMake Your Life’s Story there, you can begin to envision the possibilities of your write just then. Wait until you’re feeling stronger or can • Promote post-injury self-awareness (deficits andBetter with Journaling talk with a therapist.) strengths) new, post-injury story. You may be surprised by what you discover. In my • Assist in planning for the post-injury future Everything is Storyby Barbara Stahura, CJF journaling groups for people with brain injury and family • Promote dialogue and understanding with family All human beings are born storytellers, and being caregivers, many participants have reached new levels of members and others When a hit-and-run driver injured or being a caregiver doesn’t change that. We self-understanding. They tend to realize hidden strengthsleft my husband, Ken, with a live by story and literally could not survive without it. In and, over time, find more acceptance of their situation and • Encourage self-expression after a trauma and majorbrain injury just nine months fact, “Brains are organs of story, changing to match the use that place as a lift-off point into the future. life disruptionafter our wedding in 2003, I needs of their environment, and specialized to understandwas thrown into the chaos of story, store story, recall story, and tell story,” writes Lewis Not all insights • Prepare forcaregiving with no training and Mehl-Madrona, MD, PhD, in his book Healing the Mind produced by journaling communityno advance notice. Horrendous Through the Power of Story: The Promise of Narrative are dramatic. But they re-entrymonths followed, as Ken Psychiatry. “Everything is story, including our identities, don’t have to be, either.struggled to recover as much of our selves, our meanings and purposes, our theories about By simply letting • Offer communityhis abilities and his former self the world.” yourself write whatever and support whenas he could. I struggled to care for him (and not so much comes to mind, you will done in afor myself) while picking up the parts of our life he had After a brain injury dramatically alters the familiar amass the story of your facilitated group.formerly handled. A counselor told me I had secondary story of your life, it becomes crucial to discover and life over time, in all itstraumatic stress, a condition I had never heard of, but she create a new story if healing is to take place. Learning to Journaling offers a juicy, dull, glorious, andwas right. Fortunately, I had earlier discovered a practice move from your former story to your current one literally mundane details. And as kind of self-expressionthat became my saving grace during this time. changes your life, as well as your brain. You function and self-empowerment you continue, you will better, empower yourself, and open the door to positive that traditional post- Over the years, I had kept a journal periodically, and change. notice patterns, trends, brain injury therapiesthe day after Ken’s accident I began journaling in earnest. and recurring thoughts, do not. By recordingMy journal went everywhere with me—hospital, in- and For instance, say you continually yearn for the way which you can change as our words on the page,out-patient rehab, doctor’s appointments—and I filled you and your life used to be prior to the brain injury. By needed—yes, by writing our journal becomespages every day. This was almost instinctive, since my focusing on your old story—what you have lost and what about the changes you you can no longer do—you lock yourself into a painful want to see and how you a kind of container,confusion, anger, and grief desperately needed an outlet. place where healing is not possible. But when you find holding our storiesAs I later discovered, telling the story of these days—and will make them happen.especially my feelings about them—to the pages of my a way to create or discover a new story—what you still and making themjournal was one of the best things I could have done. have, can create, and are able to accomplish—your life Benefits of more manageable. moves forward. Journaling Journaling is an Unknown to me at the time of Ken’s accident, effective, simple way“expressive writing,” or writing down our thoughts and Use Your Journal to Start Making Changes Journaling with the by which you canfeelings about an experience, has been shown in numerous intention of personal make your story—your Anita Roddick, the late founder of The Body Shop,studies to provide therapeutic benefits for body, mind, growth empowers you. It life—better.and spirit. A journal is an excellent place for this kind said, “Every change begins with a story.” And you can also offers an opportunityof writing, since its pages accept whatever you have to begin the changes required by your post-injury life in the Barbara Stahura, for self-exploration andsay without judgment or criticism. As Kathleen Adams, pages of your journal. The first step is to begin writing certified journal self-expression that simplyLPC and founder and director of The Center for Journal stories of your current life, in small pieces over time talking or thinking cannot facilitator, is co-author,Therapy, says, “In moments of ecstasy, in moments of (you can journal effectively in only five to ten minutes a along with Susan B. do.despair, the journal remains an impassive, silent friend, session). Then you can envision possibilities for the future Schuster, MA, CCC-forever ready to console, to confront, to contain, to cheer and slowly move toward making them a reality. You may The results of the studies of expressive writing show SLP, of After Brain Injury: Telling Your Story, the firston. Its potential as a tool for holistic mental health is be surprised at the many possibilities, large and small, that that it can enhance physical health and strengthen the journaling book for people with brain injury. She presentsunsurpassed.” open up to you. immune system; produce long-term, positive changes journaling workshops around the country to people with in mood; boost working memory (which can improve brain injury, family caregivers, and others, and is a In your journal, you need not be concerned with The way you tell your story need not be fancy or performance at school or work); and improve your social member of the faculty of the Therapeutic Writing Institutebeing a “good” writer nor about spelling or grammar. particularly creative (although you can later revise your and work life. and the Lash & Associates speakers bureau. She livesNo prior experience is needed. All you need is to give journal entries into something more formal if you like). The idea is to let the words flow to the page with as in Indiana with her husband, Ken Willingham, ayourself permission to write, and to write as honestly as For someone with a brain injury, it can alsoyou can. Take precautions to keep your journal—paper or little editing or censoring as possible. This allows your survivor of brain injury.electronic—private, and you can pour out your heart, dive subconscious thoughts to come to the surface, bringing • Enhance written and verbal communication skills www.barbarastahura.com14 15
  • 9. Veteran Voices talking?” I began to feel I could do nothing right and that I was Intimacy only good for sex. Always on edge around him, I didn’t by Matthew J. Brown to outweigh the good days. Making fun of my wife and know what would make him mad. The only form ofWhere is the Love? putting her down became my new unhealthy past time. I attention he ever gave me was constant attempts at sex Here we sitby Matthew Brown and didn’t care—or want to care. I thought the only emotions I or anger. He ignored me if I needed to talk or vent about Side by side needed were my anger and sexuality, which consumed me something. Other times he made me feel stupid for feeling No words pass between usCassondra Brown and began to consume my family. the way I did. I felt completely alone, isolated, and hated. But there is something smolderingMatthew’s Voice There was no love left in our house. No more sweet He didn’t just ignore me; he also ignored our kids. Many Not our love lovers’ kisses or hugs. Just co-existing in the same place. times I saw the kids do everything to get his attention, and But our hate When I got out of the military he either ignored them completely or told them to go away. We still love each other Until it all blew up one night in the fall of 2012.in October 2005, I found myself He just couldn’t be bothered with any of us. But something has changedalone and scared, jumping from I ended up cast out alone, scared, hurt, and confused. My anger has grown worsehouse to house, staying with friends I hadn’t noticed what I was doing to my loved ones. Not By October 2012 I had reached my breaking point. The Becoming hate towardsor sleeping in their cars. Then in knowing what else to do, I manned up and started to get kids were even beginning to mimic the way he treated them The one I loveDecember I met a wonderful woman. help again—the right kind of help. At first I felt strange and and me. That was the final straw. I asked him to leave, and off-balance but soon realized that I was feeling love and we signed separation paperwork. There used to be sparks when Cassondra and I married in July 2007, and soon positive emotions again. I started speaking to my wife as Our eyes metafter, our son was born. Something was wrong with me I thought this was truly the end of our marriage and a real person for the first time in seven years, being truly Now a single momentemotionally. My physical and mental disabilities were attempted to move on. But Matthew was determined to of eye contact honest and in a normal voice. We have started to connect onaffecting me more and more, but I didn’t really think much make things right. He turned to the local Vet Center for help can spark an inferno a level we never have before. It is amazing. I haven’t lovedof it. I was quick to temper and to yell at our puppy. I was her this much ever, to tell the truth. and immediately started therapy. He also stopped drinking. of yellinghaving problems at my job as a prison guard. Screaming PTSD and TBI played such a huge role in my life. I let Through our phone conversations and texts, I could tell And hurtful words So I decided to change my career. But I had no real job he was making amazing strides in the right direction. He them control me, but now I control them. Getting help is Somewhere our lives went astrayskills or trade from the military, and being a prison guard was opening up and expressing his feelings, and he actually the best thing I have done. I am now working on being a from what’s important:doesn’t set you up to join the white collar job field. With listened to me and showed concern for my feelings. I saw real father, the husband I should have been all along. I stillhelp from some veterans programs and a person willing to a whole different side to him. With his guard down, he let get mad or upset here and there, but I don’t explode, and Each othertake a chance on me, I started to work in Federal HR. himself be exposed and vulnerable. For the first time in a when I get mad I have reasons. I want to express emotions very, very long time I could tell that he did truly love the I realized my mental state needed to change. So I went kids and me. He just hadn’t known how to show it.  Then But all I feel is pain, Cassondra’s Voiceto the VA and started medication and counseling. Thinking we started to hang out at the house after the kids went to furyeverything was going to be happy go lucky, I took all the Tension I married Matthew in July 2007. sleep at night, and he actually started to show in person howmedication, pill after pill—which was not the smartest The day seemed to go perfectly, much he cared. It was the little things that meant the most. No remorse for how I actthing I have ever done. After almost being killed by that complete with fireworks and No regret about the stabbing things I saycocktail of meds, I quit taking them altogether, believing I After a week or so of this, he started coming over during Just bringing you down shotguns. It wasn’t your typical the day and spending time with the kids and letting mecould beat my problems on my own. wedding, but “typical” just wouldn’t to my level of misery have a little time to myself, something he had never done fit us. But my roller coaster of hate, anger, and stupidity before. By mid-December he had more than proven his This isn’t a relationshipcharged full-speed towards a brick wall. With no meds and Once Xander was born, Matthew determination to maintain these positive changes and keep Nor partnershipno one to talk to, I started self-medicating, drinking alone started working day shift. He left for working to get better, and he moved back in. With the help Not even a friendshipevery night, sitting on the couch playing video games or work in the morning, then came home of counseling he has come a long way. We actually talk My issuesjust staring at the TV. I spoke to Cassi only when I needed early evening and cracked open a now about everything, anything, and sometimes nothing.a beer or something to eat, or to yell at or insult her or ask beer. He barely acknowledged me or Xander. This pattern We enjoy each other’s company. I want to fix thisfor sex. slowly grew worse over the years, even after our daughter, I need to fix this Xylaih, was born. Lance Corporal Matthew J Brown USMC RET is an Can’t kill off the one thing in my life that I love She begged me to spend time with our son and new aspiring military author who has overcome many of thedaughter. They sat with me on the couch, and I played with In the spring of 2012, things got even worse. Matthew struggles of living daily life with PTSD and a traumatic This time I’m for real began to drink more, one or two beers a night turning brain injury and now has made it his life goal to help others Getting the help I needthem, or simply sat there and looked at them. Someonewould point out that my drinking was getting bad, so I into six or seven. The silence between us was replaced through these same struggles with his writing. No lip service I love you dearwouldn’t drink for a few days. But I always went back to by constant tension and fear. I felt like I was constantlyit—my one crutch I couldn’t cast off. walking on egg shells. Matthew more frequently exploded Cassondra Brown is the wife and caregiver of retired This will get better in anger. Anything seemed to push him from sitting quietly Marine Lance Corporal Matthew Brown. She is a stay- I will get better Some days, I was nice and caring. But the bad days drinking to yelling at the top of his lungs and stomping at-home mom who aspires to help other spouses And treat you like the beautiful young woman you are.when I started picking fights, yelling at nothing, and around. He started making frequent hurtful, rude comments through the struggles of living with someone withscreaming because the kids were too close to me started to me, such as, “Do I look like I care? Why are you still PTSD and traumatic brain injuries.16 17
  • 10. Veteran Voices The Invisible Wounds of PTSD mood swings, as they hear the arguments and shouting, as they no longer bring friends home, PTSD becomes another Amputated limbs, disfiguring burns, wheelchairs, entity in the home. It’s hard for a child to understand why prosthetics, ventilators—these are the visible evidence of daddy can’t go to the movies because he’s uneasy in a severe injuries. It is the less visible emotional wounds ofFamilies Caught in the What is PTSD? PTSD that can damage relationships. darkened room or why he won’t sit down at the restaurant or why he never gets up before noon. The natural questionsAftermath of PTSD: The It’s an anxiety disorder that stems from exposure to a traumatic event involving actual or threatened death or Anger so consuming and intense that it pushes away of “Why won’t he…? “ and “Why does he…?” too oftenInvisible Emotional serious injury to oneself or others with feelings of fear, friends and family. become internalized and the child believes that, “It’s my fault” and “My daddy doesn’t love me anymore.”Wounds helplessness, or horror. While PTSD is not limited to Avoidance of sights, sounds, or situations that trigger combat exposure or the military, a survey by the Wounded memories and flashbacks leading to self-isolation. The world shifted for the children in the family while Warrior Project reveals the extent of trauma exposure a parent was deployed,By Marilyn Lash, MSW among our returning service members. When asked about Feeling “dead inside” and and it shifted again with a“Be sure to ask your doctor if their combat experiences in the War on Terror, the survey finding no joy in life any more. parent’s return. The happyyour heart is healthy enough tohave sex.” That’s the closing found that... Nightmares, flashbacks, and A personal comment made by a wife homecoming reunion of parent and child can go into a 83% had a friend who was seriously wounded or killedline to a commercial for medi- night sweats that turn nights of a wounded warrior really sums it downward spiral as the effectscation for erectile dysfunction. 78% witnessed an accident resulting in serious injury or death into a siege of horror. of PTSD or injuries becomeYou’ve probably seen the up: “Whoever said time heals is full of apparent. Dr. Jennifer Pricead on TV. Attractive couples 77% saw dead or seriously injured civilians, and Insomnia resulting in such crap.” Recent research on returning OIF has identified three patterns insoulfully gaze at each other physical and mental exhaustion 63% saw these types of traumatic events six or more times. that nothing seems possible. and OEF veterans supports her view. children.and gently sip wine as the sunsets. Despite the long list of The good news is that not every service member Milliken and Auchterlonie’s “Longitudinal She describes the “over- Drinking and self-possible dire side effects, the with this exposure will develop PTSD. The bad news is Assessment of Mental Health Problems identified” child who mimics medicating to “dull the pain,message is clear: A pill will fix everything and restore not that long multiple deployments, shorter times between the feelings and behaviors ofonly sex, but intimacy for these couples. deployments, and multiple threat exposures—the very calm nerves, and fall asleep.” among Active and Reserve Component the parent with PTSD in an If only it were that easy. For so many returning service factors that characterized service in Iraq (Operation Iraqi Unpredictable mood swings Soldiers Returning from the Iraq War” effort to connect or feel closer. Freedom or OIF) and Afghanistan (Operation Enduring from minor impatience to For example, if the parent yellsmembers and veterans dealing with post-traumatic stress Freedom or OEF)—have contributed to PTSD. catastrophic melt downs. published by the Journal of the American a lot, the child yells more;disorder (PTSD), the question if the parent complains ofmay be, “Are your emotions Medical Association in 2007 found there The numbers of service Verbally or physically headaches, so does the child.ready for intimacy?” Sex and members and veterans assaulting or abusing spouses was a cumulative burden of mental healthintimacy are very different.While sex is a physical act, A study by Sayers, Farrow, Ross, and diagnosed with PTSD are constantly changing as more and children. problems affecting these families. In this The “rescuer” child takes on adult roles to fill in forintimacy is an emotional Oslin in the Journal of Clinical Psychiatry attention and resources are Treating the wounds of war study of 88,000 who served in Iraq, there the parent with PTSD. Thisconnection. directed to earlier screening means treating the veteran’s child can be readily identified on “Family Problems among Recently mind, spirit, and relationships was a four-fold increase in interpersonal because he simply acts too and treatment. But there is no As Matthew and Cassi grown-up. This is the childBrown have shared so openly Returned Military Veterans” in 2009 “getting home free” for many as well as the body. Damage problems over six months from the time ofin their article, the emotional looked at those who scored positively combat veterans as PTSD does to family relationships is the first to the second assessment. who now parents the parent, not always have an immediate clear when research compares manages the household,numbness that is symptomatic for mental health issues in VA outpatient onset. Some estimate that veterans with and without or takes on too muchof PTSD is directly connected chronic PTSD. Veterans with clinics. Over 75% of married/partnered between 10-30% of OEF and responsibility, often avoidingto loss of intimacy. Yet it is OIF service members will chronic PTSD have: friends and peer activities.the elephant in the room that service members reported difficulties with develop PTSD symptomstoo often is not discussed with • More severe relationship problems The “emotionally uninvolved” child gets littlefamily, friends, physicians, their partners or children. There was a within a year of leaving emotional support from the parent with PTSD and combat as they transition from • Poorer family adjustmentor counselors. When the strong association with PTSD and major disconnects. This can lead to problems at school, military to civilian life.connection between loss • Higher divorce rates depression, anxiety, worries, fears, and relationshipof intimacy and PTSD is depression and difficult family adjustment. I have often heard veterans problems later in life.not understood, too many comment that, “Life was • Less self-disclosure and emotional expression If you see any of the patterns in your children, it’spartners “take it personally” easier in combat.” The rules • Greater anxiety related to intimacy.and feel unloved, unworthy, important to reach out and support them and consider were clear, orders were given, a chain of command wasunattractive, and rejected. Whether the demands for professional guidance or counseling. Some researchers followed. By contrast, dealing with a spouse and children PTSD Affects Parentingsex are constant or sex is avoided for long periods, loss have characterized the impact of a parent’s PTSD with constantly changing communication, expectations,of intimacy can undermine the very core of a couple’s As Matt and Cassi so clearly show in their story, symptoms as secondary traumatization for the child. and responsibilities is like “negotiating a minefield” everyrelationship. day with no clear path in sight. everyone in the family is affected by PTSD, including Getting help is not something only for the veteran. children. As children witness a parent’s withdrawal and PTSD is a family affair.18 19
  • 11. Clinical Corner Nightmares are so common with PTSD that many Thinking and learning are simply harder. This cognitive individuals dread going to bed and spend long nights fatigue feels “like hitting the wall,” and everything watching TV or lying on the couch to avoid the night’s becomes more challenging. Building rest periods or naps terrors. Waking up with night sweats so drenching that into a daily routine helps prevent cognitive fatigue andTBI and PTSD: Navigating • Shame about what happened and was done sheets and clothing are soaked. Flashbacks so powerful that bed partners have been struck or strangled while sleep restore alertness.the Perfect Storm • Survivor guilt with loss of friends or comrades battles waged. PTSD The cascading effects of PTSD symptoms make it so difficult to get a decent night’s sleep that • Hypervigilance or constant alertness for threats.By Marilyn Lash, MSW Isolation fatigue often becomes a constant companion spilling over Individuals with PTSD are at increased risk for into many areas. The fatigue is physical, cognitive, and So often people talk about TBI Many with brain injuries recall the early emotional. Feeling wrung out, tempers shorten, frustrationthe effects of traumatic brain depression, physical injuries, substance abuse, and sleep support and visits of friends, relatives, and coworkers. mounts, concentration lessens, and behaviors escalate.injury or the consequences of problems, which in turn can affect thoughts and actions. Visits or calls lessened over time. Loss of friends andpost-traumatic stress disorder These risk factors also occur with brain injury. coworkers leads to social isolation, one of the most Depressionas separate conditions—which PTSD is a mental disorder, but the associated stress common long-term consequences of brain injury.they are. But for the person TBI Depression is the most common psychiatric can cause physical damage. TBI is a neurological disorderwho is living with the dual PTSD The isolation with PTSD is different as it is diagnosis after brain injury; the rate is close to 50%. caused by trauma to the brain. It can cause a wide rangediagnosis of TBI and PTSD, it self-imposed. For many it is simply too hard to interact Depression can affect every aspect of life. While people of impairments and changes in physical abilities, thinkingcan be hard to separate them. with people. The feeling of exposure outside the safe with more severe brain injuries have higher rates of and learning, vision, hearing, smell, taste, social skills,Just as meteorologists predict confines of the depression, behaviors, and communication. The brain is so complex,“the perfect storm” when house is simply those with the possible effects of a traumatic injury are extensive andunusual and unprecedented conditions move in to create too great. The mild brain different for each person.catastrophic atmospheric events, so can the combination of person may injuries havePTSD and TBI be overpowering and destructive for all in When PTSD and TBI coexist, it’s often difficult to sort avoid leaving the higher ratesits path. The person with TBI and PTSD is living in a state out what’s going on. Changes in cognition such as memory house as a way of of depressionunlike anything previously experienced. For the family, and concentration, depression, anxiety, insomnia, and containing stimuli than personshome is no longer the safe haven but an unfamiliar front fatigue are common with both diagnoses. One basically and limiting without brainwith unpredictable and sometimes frightening currents and feeds and reinforces the other, so it’s a complicated mix— exposure to injuries.events. it’s the perfect storm. It may help to consider and compare possible triggers PTSD changes commonly seen with TBI and PTSD. of memories. While awareness of PTSD has greatly increased with As a result, the Depressionrecently returning service members and veterans, it is Memory individual’s world is thenot new and not limited to combat. Anyone—children, becomes smaller second mostadolescents, adults, elderly—who is exposed to a life- TBI A period of amnesia for what went on just and smaller. commonthreatening trauma can develop PTSD. Car crashes, before (retrograde amnesia) or after (anterograde amnesia) diagnosisshootings, floods, fires, assaults, or kidnapping can happen the injury occurred is common. The length of time Emotions after PTSDto anyone anywhere. But the rate of PTSD after brain (minutes, hours, days, or weeks) of amnesia is an indicator in OEFinjury is much higher in veterans than civilians due to their of the severity of the brain injury. For example, the person TBI When and OIF the areas of themultiple and prolonged exposure to combat. According to may have no memory of what happened just before or veterans.O’Connor and Drebing, it is estimated that up to 35% of after the car crash or IED explosion. brain that control It is very emotions arereturning veterans with mild brain injury also have PTSD. treatable PTSD In contrast, the person with PTSD is plagued damaged, the survivor of a brain injury may have what with mental health therapy and/or medication, but veteransWhat’s Unique about PTSD? and often haunted by unwanted and continuing intrusive is called “emotional lability.” This means that emotions often avoid or delay treatment due to the stigma of mental thoughts and memories of what happened. The memories are unpredictable and swing from one extreme to the health care. Symptoms of PTSD include: keep coming at any time of day or night in such other. The person may unexpectedly burst into tears or excruciating detail that the person relives the trauma over laughter for no apparent reason. This can give the mistaken Anxiety • Unwanted and repeated memories of the life- and over again. impression that the person is mentally ill or unstable. threatening event TBI Rather than appearing anxious, the person Sleep PTSD Emotional numbness and deadened feelings acts as if nothing matters. Passive behavior can look like • Flashbacks where the event is relived and the person are a major symptom of PTSD. It’s hard for the person laziness or “doing nothing all day,” but in fact it is an temporarily loses touch with reality TBI Sleep disorders are very common after brain to feel emotions or to find any joy in life. This emotional initiation problem, not an attitude. Brain injury can affect injury. Whether it is trouble falling asleep, staying asleep, shutdown creates distance and conflicts with spouses, • Avoidance of people, places, sights, or sounds that are or waking early, normal sleep patterns are disrupted, the ability to initiate or start an activity; the person needs reminders partners and children. It is a major cause of loss of cues, prompts, and structure to get started. making it hard to get the restorative rest of sleep so badly intimacy with spouses. • Feelings of detachment from people, even family, and needed. PTSD Anxiety can rise to such levels that the person emotional numbness Fatigue cannot contain it and becomes overwhelmed by feelings of PTSD The mental state of hypervigilance interferes panic and stress. It may be prompted by a specific event, with slowing the body and mind down for sleep. TBI Cognitive fatigue is a hallmark of brain injury.20 21
  • 12. such as being left alone, or it can occur for no apparent traumatic brain injury, chronic pain, post-traumatic stressreason, but the enveloping wave of anxiety makes it disorder, and depression; poor continuity of mental health gw summer institutes 2013difficult to think, reason, or act clearly. care; and strain on marital and family relationships. Veterans use guns to commit suicide more frequently thanTalking about the Trauma civilians. TBI The person may retell an experience Summaryrepetitively in excruciating detail to anyone who willlisten. Such repetition may be symptomatic of a cognitive There is no easy “either/or” when it comes tocommunication disorder, but it may also be due to a describing the impact of TBI and PTSD. While each “Educating Schools andmemory impairment. Events and stories are repeated diagnosis has distinguishing characteristics, there is an Students on Brain Injuryendlessly to the frustration and exasperation of caregivers, enormous overlap and interplay among the symptoms. and Concussion”friends, and families who have heard it all before. Navigating this “perfect storm” is challenging for the survivors, the family, the caregivers, and the treatment PTSD Avoidance and reluctance to talk about the team. By pursuing the quest for effective treatment by July 15–19 This multi-disciplinary institute is open to graduate-level students and professionalstrauma of what was seen and done is a classic symptom of experienced clinicians, gathering accurate information, and 8:30am-5pm in the fields of education, counseling,PTSD, especially among combat veterans. enlisting the support of peers and family, it is possible to 3-credit course psychology, social work, medicine, nursing, law, and related therapies. chart a course through the troubled waters to a safe haven.Anger July 17 The Symposium includes presentations 8:30am-5pm and panel discussions on topics such References: as defining recovery trajectories and TBI Damage to the frontal lobes of the brain can Non-credit option expectation of school outcomes aftercause more volatile behavior. The person may be more O’Connor, M. & Drebing, C. (2011). Veterans and (Symposium only) concussion. See website for panelist details.irritable and anger more easily, especially when overloaded Brain Injury. In Living Life Fully after Brain Injury:or frustrated. Arguments can escalate quickly, and attempts A workbook for survivors, families and caregivers, REGISTER TODAY:to reason or calm the person are often not effective. Eds. Fraser, Johnson & Bell. Youngsville, NC: Lash & summer.gwu.edu/brain Associates Publishing/Training, Inc. PTSD Domestic violence is a pattern of controlling, For more information, visit our websiteabusive behavior. PTSD does not cause domestic violence, Ehde, D. & Fann, J. (2011). Managing Depression, or call 202-994-6360.but it can increase physical aggression against partners. Anxiety, and Emotional Challenges. In Living Life FullyWeapons or guns in the home increase the risks for family after Brain Injury: A workbook for survivors, families andmembers. Any spouse or partner who feels fearful or caregivers, Eds. Fraser, Johnson & Bell. Youngsville, NC:threatened should have an emergency safety plan for Lash & Associates Publishing/Training, Inc.protection. Marilyn Lash, MSW With over 35 years of experienceSubstance Abuse working with persons with disabilities and their families TBI The effects of alcohol are magnified after in medical, rehabilitation, educational, and vocationala brain injury. Drinking alcohol increases the risks settings, she is a speaker and author of many articles andof seizures, slows reactions, affects cognition, alters books on the emotional trauma of brain injury. As founderjudgment, interacts with medications, and increases the and president of Lash and Associates Publishing/Training,risk for another brain injury. The only safe amount of she believes that practical and user-friendlyalcohol after a brain injury is none. information is essential for families, survivors, providers, and professionals. PTSD Using alcohol and drugs to self-medicateis dangerous. Military veterans drink more heavily andbinge drink more often than civilian peers. Alcohol anddrugs are being used often by veterans to cope with and How Do I Subscribe todull symptoms of PTSD and depression, but in fact createfurther problems with memory, thinking, and behavior. Brain Injury Journey Magazine? It’s easy. Just go to our website! Spec. Robert Butler served his country in Iraq, Afghanistan, and Kuwait. AnSuicide www.lapublishing.com/brain-injury-journey-magazine/ improvised explosive device left him with Traumatic Brain Injury (TBI). Like thousands of military families, the Butlers received help – and hope – from TBI Suicide is unusual in civilians. Sign up for a FREE online Operation Homefront. Spec. Butler lives with his wife and son at Operation subscription, or pay just Homefront Village, a transitional housing community near San Antonio Military PTSD Rates of suicide have risen among veterans of $48 annually for a print Medical Center. Here, the entire family can heal together.OEF and OIF. Contributing factors include the difficult subscriptionand dangerous nature of operations; long and multiple Learn more about Operation Homefront’s assistance for injured service members and military families at OperationHomefront.net (six issues per year)redeployments; combat exposure; and diagnoses of22 23
  • 13. Kids’ Club college students – but could include after-school tutoring Checklist for a Student with a Brain Injury. Wake Forest, NC: programs offered by school districts, or non-paid tutors like Lash & Associates Publishing/Training Inc. high school or college students in volunteer programs, friends, or relatives. As a special educator, Dr. Janet Tyler has not onlyHelping Children with Brain before they become major crises. Parents and teachers should worked directly with students with brain injuries, but she Parents wanting to learn more about brain injury in school- also trained educators to serve those students. For 23 years,Injuries Succeed in School decide together on the easiest form of communication for all parties, whether it is checklists, notes, emails, phone calls, or aged children are encourage to visit the following websites: she directed an innovative statewide program in Kansas brief meetings, and agree to a schedule for the interactions. www.lapublishing.com/blog/ that provided training and consultation to educators servingby Janet Tyler, Ph. D. students with brain injuries and their families. She is now Learn About Brain Injury to Inform Teachers www.nichcy.org/disability/specific/tbi in private practice providing educational consultation and While children and It is also essential for parents to gain as much knowledge www.brainline.org/landing_pages/features/blkids.html training services to school districts, lawyers, medicaladolescents with traumatic as they can about the effects of brain injury in children, personnel, and parents of children with brain injuries.brain injury are often faced with and for them to understand that their child’s teacher may www.cbirt.org/tbi-education/ Dr. Tyler can be reached at jtyler@kstbi.org.many cognitive, academic, and or may not have had training or experience working with Referencesbehavioral challenges after their such students, as many teachers do not. Since parents ofinjury, parents can employ many DePompei, R., Blosser, J., Savage, R., & Lash, M. (2011). ABI students with brain injury hold a wealth of informationstrategies to help ensure that their about their child’s unique needs, it is extremely helpful for Special Educational IEP Checklist for a Student with a Brainchild has the best possible chance parents to meet with teachers at the beginning of the school Injury. Wake Forest, NC: Lash & Associates Publishing/of succeeding in school. First Training Inc.and foremost, following a brain year and provide them with a short overview of their child’s Education Services, LLC injury, course of recovery, current needs, and behavior and Educate Nurture Growinjury a child should be referred to the school system for a Glang, A., Ettel, D., Tyler, J.S., & Todis, B. (2013). learning strategies that have proven helpful in the past. Thecomprehensive evaluation for special education services. Educational issues and school reentry for students with parent could have the child start with a minor role in the www.ABI-EdServices.comParents should make the request for an initial evaluation traumatic brain injury. In N.D. Zasler, D.I. Katz, & R.D. presentation and then each year take on a greater role inin writing to their child’s school principal or special Zafonte (Eds.), Brain Injury Medicine: Principles and the presentation. This is a great way for students to learn toeducation director. If identified, a child with a brain injury identify their needs and practice self-advocacy skills, while Practice (2nd ed.) (pp. 602-620). New York: Demos. Consultation, training & in-school support for studentscan receive an array of supports to address individual needs conveying the necessary information to teachers. Tyler, J., & Wilkerson, L. (2007). Section 504 Plan with traumatic brain injury, concussions & strokesthrough either an Individual Education Plan (IEP) underThe Individuals with Disabilities Education Improvement Good Parenting Skills Help at HomeAct of 2004 (IDEA) or a 504 Plan under Section 504 of Additionally, parents can help their child succeed inthe Rehabilitation Act of 1973. Services offered under school by carrying out good parenting skills at home. SettingIDEA include, but are not limited to, specially designed clear boundaries and expectations, and being consistent ininstruction, occupational therapy, speech-language therapy, enforcing rules and offering praise have been shown to helpphysical therapy, recreation therapy, psychological services, children with brain injury have better adaptive functioningcounseling services, and social work services. A 504 Plan and social competence. Practices such as having a writtengenerally includes accommodations such as extended time to set of rules for expected behaviors and a list of chores arecomplete assignments and tests, provision of notes for class beneficial for children as well as adolescents. Designatedlectures, preferential seating in the classroom, and special homework times help with organization, and set schedulesmaterials such as large print books. for bed times are necessary to deal with fatigue and sleepDevelop a Relationship with Teachers issues following brain injury. Tutoring Can Help Research has shown that a critical factor influencingschool success for children with brain injury is the degree Lastly, students with brain injury may benefit greatlyof collaboration between the child’s parents and educators. from having someone tutor them after school and during theOnce a child is back in school, parents will want to develop summer. Children and adolescents generally need extra timeand maintain a non-adversarial working relationship with and practice to master much of their academic work. A tutor Therapeutic transition-focused program specializing in brain injury and other neurological and social challenges.their child’s teachers. Parents may find it helpful to research can help the child with specific homework or practice needed • Approved year-round day and residential, age 13-22tips for being a proactive advocate for their child and to skills such as reading and math. Parents have so many • Clinical, educational, vocational expertise THRIVING AFTER BRAIN INJUR Ypractice effective communication skills when working with additional roles after their child is injured that this is one • Consultation and Inclusion Support Servicestheir child’s school team, such as using “I” statements. At place where they could let someone else take responsibility. • Interdisciplinary team approach www.ivystreetschool.orgthe beginning of each school year parents should seek to Often, a child responds better to someone other than the • Monthly family support groups Brookline, MA • 617-620-7779establish a system of ongoing communication with their parent when being asked to do a non-preferred activity, andchild’s teachers, one that will keep both parties abreast of having a tutor gives the parent a little time off. Options forday-to-day happenings and alert all to any minor problems tutors are not just limited to paid tutors—say, teachers or24 25
  • 14. Provider Points do for employment. We changed our approach and began looking at careers that matched her interests and skills. Then We Wrote the Book on Choosing,Finding and Keeping we came up with a plan to get around the potential problems.A Better Approach to Finding Remember, however, that these are only general rules and In the end, she got a job working at a craft store and teaching classes. I am pleased to say that she went on to a Job After Brain Injury ISBN 9781 9311 17517a Job After Brain Injury 90000 > may change due to varying circumstances. own a craft store and eventually had a craft show on a local A workbook and training program by Janet P. 9 781931 Item: JOBS 117517 Niemeier, Ph.D., ABPP (RP), Jeffrey S. Kreutzer, Library of Congress Control Numb Choosing, er 20099351 television station in her home town. Copyright © 60 by Lash & 2009 Associates Fin a Job afte ding and Keeping Publishing Ph.D., ABPP (RP), and Shy DeGrace, B.S. This /Training All rights Inc. reserved. or by any No means, electrpart of this book Once you have helped your client find a job that interests Choosing prior writte may be repro n permission onic, mechanica r Brain In l, photocopyi duced, stored inby Dawn Westfall, CCC-SLP Published Tel: (919) walk Drive, Suite This book 556-0300 of the publis 100 Board by Lash & Associates 150, her. vocational training program for adults (with trau- Publishing Fax: (919) Youngsville, NC 556-0900 /Training ng, recor Inc. 27596 a retrie ding, or other val system, or jury wise, excep transmitte t for brief d in any form reviews, without the A workbook and traini ng progra m her and requires using her strengths, then you can begin For a free is part of a series This interaction taught me a lot about job placement, , Finding catalog, conta on brain injury amon When finding the perfect job Tel. & Fax matic and other types of acquired brain injuries) ct Lash & g children, (919) 562-0 Associates adolescent 015 or visit s and adult our web site s. www.lapub lishing.com includes 20 structured sessions with a work- and Keepifor a person who has sustained to look at her weaknesses and how these might impact especially two very important facts: For local informati book, and CD with worksheets. Part One helps on conta ct: 1. Focus on the person’s strengths and work around the ng a Joba traumatic brain injury, most her success with employment. You should develop a survivors of brain and blast injuries explore after Brainspeech therapists and vocational list of potential problems, including physical, cognitive, weaknesses. their interests, and readiness for finding a job, emotional, and social weaknesses. Next in line is to develop 2. It is more than acceptable for people to do better after an or returning to work. Part Two covers steps of Injuryrehab counselors look at the injury than they did prior, so don’t hold them back! looking for a job, with attention to disclosure Lash & Ass ociatesperson’s weaknesses so she can a plan that works around these potential problem areas. Publish 100 Boa rdwalk ing/Train Writt Janet P. Niem en by Drive, Suit ing Inc of a disability, on the job accommodations, Tel: (919 e ) 556-0300 150, Youngsvill . Jeffrey S. eier, Ph.D., ABPP (RP) Kreutzer, e, NC 2759 Your client may need strategies, equipment, therapy, (919) 556- Fax: Shy DeGrace Ph.D. www.lapu 0900 6 blishingfind a job that does not require .com resume preparation and interviewing. Lash & Ass ociatesthese skills. This has been a training, and other accommodations to help get around Dawn Westfall, MS, CCC-SLP, received her Master’s Part Three covers strategies for keeping a Publish ing/Train ing Inc .common approach in vocational these issues. If there are parts of the job she is unable Degree in Speech-Language Pathology from Eastern job, and avoiding problems on the job. Part Four demonstrates strategies for problem solving. The curriculum includes simple surveys and questionnaires thatre-entry for years. Although it is to perform due to these weaknesses, and they cannot be Illinois University. She works at HealthSouth Deaconess allow the participant to relate personally to the content and enhance self-awareness.important not to set up anyone with a TBI for failure, basing overcome, then job carving is an option. Job carving is Rehabilitation Hospital in Evansville, Indiana, where she Item: JOBS, ISBN# 978-1-931117-43-2, Pages: 168 pgs, 8½ x 11, perfect bound with CD, Year: 2009a job search on avoiding weaknesses is often a very limiting simply identifying the aspect of the job she cannot perform has specialized in treating adults with traumatic brainapproach. I propose a better one: Look at people’s strengths and “trading” it for a part of someone else’s job she can injuries for the past 22 years. For 12 years she assistedand interests, and build the job perform well. with developing and managing a community rehabilitation Lash & Associates Publishing/Training Inc.from there. program that assisted individuals with a 100 Boardwalk Drive, Suite 150, Youngsville, NC 27596 Tel: (919) 556-0300 Fax: (919) 556-0900 Call to order, or request a FREE catalog! www.lapublishing.com 919-556-0300 A Real-Life Example traumatic brain injury in getting back to work, I once worked with school, and living independently. http://www.lapublishing.com/brain-injury-vocational-workbook/ Leading Source of Information on Brain Injury in Children, Adolescents, Adults and Veterans Let’s face it—we spend a lot a woman who hadof time at work. We also know been a receptionist forwe are better at jobs we love, a small office prior toand we love jobs we are good a significant injury to KNOWLEDGE. SKILL. EXPERIENCE. RESULTS! Lash & Associates Publishing/Training Inc.at doing. So step one is to find her brain. We worked 100 Boardwalk Drive, Suite 150, Youngsville, NC 27596 Tel: (919) 556-0300 Fax: (919) 556-0900 www.lapublishing.comout what the person loves. diligently at getting herThis can be accomplished skills back so she couldby doing a comprehensive return to her previousinterest inventory. Next, we job with her previousneed to find out what she can employer. She was not Lash & Associates Publishing/Training Inc.do well and ask what strengths very responsive to treatment, and the chances of being able If you or someone you know has experienced a TRAUMATIC BRAIN INJURY you need 100 Boardwalk Drive, Suite 150 Youngsville, NC 27596 Tel: (919) 556-0300she has. We do this by looking at her skill sets. to return to that job were looking dismal. Then one day I Fax: (919) 556-0900 advice you can rely on from someone you can trust: Charles G. Monnett III & Associates www.lapublishing.com brought in some silk flowers to put in a vase in my office. Now comes the fun part, which is finding jobs that At Charles G. Monnett III & Associates, we believe that personal injury deserves personal attention. When a traumatic brain injury She came in and said, “May I arrange those flowers foryour client finds interesting and which require skills she you?” occurs, many people will offer advice. Advice that is sometimes confusing, many times contradictory and very often wrong. When a trau-possesses and performs well. If she was employed prior to matic brain injury has changed your life, you need advice you can rely on from someone you can trust. Choose only the best, a qualifiedthe injury, this must be taken into consideration. Generally, Immediately, it struck me that this was the first time I trial attorney with demonstrated expertise in representing people who have experienced life-altering injuries.it is preferable to keep people with their previous employer, had seen her initiate anything since starting the program. So, if you’ve been injured, ask your friends and loved ones about us. We believe you’ll like what you hear. When you’re ready, call us,since they have already established rapport and relationships She also showed more affect than ever before. She we’re here to help you. We handle cases throughout the state of North Carolina, and also have attorneys licensed in NC, SC, GA and TN.with the boss and co-workers. They also have a long-term arranged the flowers, and they looked amazing. But moreworking memory of the policies and procedures. importantly, she was smiling and looked quite proud of her accomplishment. w w w. c a r o l i n a l a w. c o m The general rules are to return people to: 1. the previous job with the previous employer We began talking about her hobbies. I found that she 1-800-977-3077 2. a different job with the previous employer loved many crafts and was skilled at them. I also found out 6842 Morrison Boulevard, Suite 100, Charlotte, NC 28211 3. a previous job with a different employer she hated her receptionist job prior to the injury and never 4. a different job with a different employer. Phone: 704-376-1911 • Fax: 704-376-1921 • Email: cmonnett@carolinalaw.com felt she was good at it, but she did not know what else to26 27
  • 15. Reading Room Good Things Come In 3s Living Life Fully after Brain Injury: A My Parent Has a Brain Injury Lash & Associates is Proud to Announce Their 3-Book Package on The Wounds of War workbook for survivors, families and caregivers Jo Johnson, Ph.D. BOOK 1: Living with Blast BOOK 2: Caregiving BOOK 3: Pocket Lash & Associates realizes how necessary (and Injuries, PTSD and TBI on the Homefront Tips for Caregivers functional) a collection of books like this could be - and by Robert T. Fraser, Ph.D., CRC, Kurt L. John- Reviewed by Janet Cromer, RN, MA, LMHC Information for Veterans, Family A guide for caregiving Pocket guide for caregivers the positive emotional impact they could make on families that really need them most...our veterans, their son, Ph.D., CRC, and Kathleen R. Bell, M.D., Editors and Caregivers ~ 2012 women. Marilyn Lash, of wounded service families, and caregivers of wounded service men and How many kids want to read a book about brain Item: LBITP 170 pp., 8.5” x 11”, M.S.W. ~ 2013 members and veterans women everywhere. This valuable workbook provides practical sug- injury? My Parent Has a Brain Injury takes on a topic softcover Price: $35.00 Item: CHFW 20 pp., with PTSD or TBI, on When a loved one is wounded, many families struggle gestions to help persons with TBI and their family kids might dread in an inviting, companionable, and 8.5” x 5.5”, softcover coping. Marilyn Lash, to cope with the effects of a brain injury on behavior, understand and cope with the effects of brain injury. It Price: $7.50 M.S.W. & Janet Cromer, empowering style. In a slim volume packed with in- R.N. ~ 2013 thinking, emotions, communication, social skills, etc. These three books deal with symptoms of concussion, raises many issues that can be the basis of discussion  formation, Dr. Johnson focuses on the topics that most LIVING WITH BLAST INJURIES,  Item: PTCA 116 pp., blast injury, post traumatic stress disorder (PTSD), post      when seeking help from a  PTSD AND TBI     bother kids and teens. Those topics include what hap- VETERANS, FAMILIES INFORMATION FOR  AND CAREGIVERS 5.5” x 3.5”, softcover traumatic headaches, substance abuse, and more. variety of rehabilitation         Item: LVL Price: $7.50 Item: CH F FW pens in brain injury, changes in the parent’s personality Copyrig by Lash ht © 2011 First Edi Make a lasting impression on the people who need Living Li & Associa Copyr tion tes Pub igh lishing/Tra by Las t © 2013 specialists. I certainly All rights ining Inc. h & Ass rese ociate in any form rved. No s Publish f rain part after Be Fully brief revi or by any mea of this boo All righ ing/Tra it most, with this practical and essential set (available ts ining Inc ews, with k may be system reserved. out the ns, electronic, reprodu No . and behavior, differences in the family, and the child’s Publish prior writ mec ced photoc , or transmitte par t of this ed ten perm hanical, pho , stored in a opying d in any book ma 100 Boa by Lash & Ass ission of toco retrieva written , permis recording, or form or by y be rep rdwalk Driv ociates the pub pying, recordin l system, or roduce will encourage patients Tel: (919 lisher. g, or othe sion of oth any ) 556-030 e, Suite 150 Publishing/Tra tran rwise, excsmitted the pub erwise, exc means, ele d, stored separately too). Save $5.00 when you order the whole set Publish lisher. ept for ctro in 0 , Youngs inin ed by brief rev nic, mechaa retrieval This boo ville, NC g Inc. ept for 100 Boa Lash & iews, with nical, k 27596 Tel: 919 rdwalk Drive, AssociatesFor a free is part of a seri out theTel: (919 catalog, con es on brain A Workb -556-0 Suite 150 Publishing prior Injury 300 Fax confusing emotions. Even complex topics such as : 919-55 , Youngsville/Training Inc ) 556-030 tact injury 0 or visit Lash & Associa among children ook for This boo , NC 275 . Survivors, 6-0900 - for just $45. Order online or call today! our web tes , adolesc and vet k is par t of that I see to utilize it. ~ 96 site www erans. a series .lapublishin ents, adu lts and vete Families on bra g.com rans. and Ca For a free in injury among regivers Tel: 919 catalog, -556-0 con childre n, ado Living Li 300 Fax tact Lash & lescen ts, adu : 919-55 Associ cognition and executive functions are described in clear 6-0900 ates lts or visit George P. Prigatano, our web site ww  w.lapub Pocket   lishing .com and direct language. fe Fully  Lash & Associates    Ph.D., Newsome Chair, Tips for Publishing/Training Inc. 100 Boardwalk Drive, Suite 150 Youngsville, NC 27596 Item: HVPT Copyright © 2013 Department of Clini- Caregivers Lash & Associates Publishing/Training Inc. by Lash & Associates Publishing/Training Inc. after Br All rights reserved. No part of this book may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, pho- Item: MP By Marily tocopying, recording, or otherwise, except for brief reviews, without the prior BI Over half of the book is 919-556-0300 Copyrigh written permission of the publisher. by Las t © 2012 n Lash, M Published by Lash & Associates Publishing/Training Inc. 100 Boardwalk Drive, Suite 150, Youngsville, NC 27596 Tel: (919) 556-0300 Fax: (919) 556-0900 cal Neuropsychology, h & Ass Lash .S.W. 100 Boardwalk Drive, Suite 150, Youngsville, NC 27596 ain Inju ociates & Asso Tel: (919) 556-0300 Publishin All righ ts reserv g/Train ciates This book is part of a series on brain injury among children, adolescents, adults Call us for a FREE catalog! ing Inc Publis www.lapublishing.com retriev ed. No . 100 Bo and veterans. al ardwalk hing/ mecha system, or tranpart of this Drive, Sui For a free catalog, contact Lash & Associates devoted to the child’s withou nical, pho smitte book ma te 150, Traini Tel: (919) 556-0300 or visit our website www.lapublishing.com t the prio tocopying, d in any form y be reprod Youngs ng In Marilyn Lash, M.S.W. & Janet Cromer, R.N. Barrow Neurological ville, NC c. ry r written record or by uced, sto 27596- ing, or Published permis sion of otherw any means red in a 7761 100 Bo by Las the pub ise, except , electronic, ardwalk h & Associ lisher. for brie f review Tel: (91 ates Pu 9) 556 Drive, Suite blis s, -0300 150, You hing/Train emotions and build- ngsville ing Inc Institute This boo , NC 275 . Lash & adults k is part of a and vet For a free erans. series on bra 96 Leading Source of Information on Brain Injury in Children, Adolescents, Adults and Veterans Associ Tel: (91 catalog, in injury among www.lapublishing.com ates Pu 9) 556 -0300 contac t Lash childre 100 Bo blishin or visit & Associ n, ado lescen g/Trai ing adaptive skills. our we ate ts, ardwa Robert T. b site ww s Tel lk Drive , Suite : (919) 556 ning 150 Inc. Fraser, w.lapub lishing -0300 Fax , Youngsville Ph.D., CR Editors .com This thought- : (919) 556 , NC C, Kurt www.l -0900 27596 L. Johnso apublis n, Ph.D., hing.co CRC, and m Kathleen Kids will like all the R. Bell, MD ful and helpful Lash & Associ ates Pu colorful lists of tips to blishin book...is much g/Trai ning Inc. needed and long over- hone specific coping due after ten years of war whose signature Lash & Associ skills and make family Lash and Associates products are Lash & Associates Publishing/Training Inc. 100 Boardwalk Drive, Suite 150, Youngsville, NC 27596 ates Pu injury is Traumatic Brain Injury. Vets returning from 100 Bo ardw alk Dr Tel: (91 ive, Suite 9) 556-0 30 www.la blish 150, Yo ing/T un Fax: (91 rainin 0 g Inc. vil 9) 556-0 le, NC 2759 gs life easier. Creative ap- available in the UK , Tel: (919) 556-0300 Fax: (919) 556-0900 www.lapublishing.com Iraq and Afghanistan and also vets from earlier wars as publis 900 6 hing. proaches to taking care of and Europe, from sole distributor com well as their families, loved ones and caregivers will |1 yourself are balanced by benefit from this guide to recovery. ~ Shad Meshad, Ann Arbor Publishers. reminders of when to ask President and Founder, National Veterans Foundation adults for help. Both par- Lash & Associates True to its subtitle, this is indeed a “workbook” full ents and kids will appreci- Publishing/Training Inc. 100 Boardwalk Drive, Suite 150 of useful forms, charts, graphs, website information, etc. ate the honest discussion of depression, embarrassment, Youngsville, NC 27596 Tel: (919) 556-0300 An accompanying CD contains all forms in the book, so Fax: (919) 556-0900 resentment, guilt, unfairness, and anxiety. Riveting www.lapublishing.com they can be downloaded for permanent storage – an ex- stories and quotes from kids will open adult eyes to cellent idea, as the paperback book itself may well even- children’s experiences, worries, and resourcefulness tually disintegrate from frequent use. The editors and while making kids say, “Yeah, just like me!” contributors are owed a huge debt of gratitude from the The mission of the Navy-Marine Corps Relief Society is brain injury community. Families will want this informa- My Parent Has A Brain Injury is a terrific book to provide, in partnership with the Navy and Marine Corps, tion close at hand for years to come and rehabilitation for a child or teen, and a valuable resource in many Tests and resources for professionals financial, educational, and other assistance to members specialists can recommend it with enthusiasm. ~ Bruce of the Naval Services of the United States, eligible family settings. Support groups and schools can use the book members, and survivors when in need; and to receive and Caplan, Ph.D., ABPP, FACRM Senior Editor, Journal of to raise awareness, prompt discussion, and provide ac- buy-online at www.annarbor.co.uk manage funds to administer these programs. Head Trauma Rehabilitation curate information. Every library should have a copy! PO Box 1, Belford, Northumberland, NE70 7JX Lash & Associates Publishing/Training, Inc., 2011 Item: LVLF 211 pages softcover plus CD with 46 Lash & Associates Publishing/Training, Inc., 2012 ann arbor NMCRS CCA Visiting Nurses 875 N. Randolph St., Suite 225 worksheets, $35 Item: MPBI 73 pages, softcover, $20 www.lapublishing.com/brain-injury-parent-book/ T: 01668 214460 publishers Arlington, VA 22203 703-696-0032 www.nmcrs.org www.lapublishing.com/brain-injury-recovery/ 28 29
  • 16. www.lapubli Looking for Information, Support, Brain Injury Association of Brain Injury Alliance of Washington Hope for the Home Front Leading Source of Information on Brain Injury i South Carolina http://www.braininjurywa.org/ http://www.hopeforthehomefront.com/ http://www.biausa.org/SC/ and Resources on Brain Injury? Brain Injury Alliance of South Dakota http://www.braininjurysd.org/ Brain Injury Alliance of West Virginia http://www.biawestvirginia.org/ Military One Source http://www.militaryonesource.mil/ Brain Injury Alliance of Wisconsin National Center for Post-TraumaticNATIONAL RESOURCES Brain Injury Association of Tennessee http://www.biaw.org/ Stress Disorder Brain Injury Association of Delaware Minnesota Brain Injury Alliance http://www.braininjurytn.org/ http://www.ptsd.va.gov/United States Brain Injury Alliancehttp://usbia.org/ http://biaofde.org/ http://www.braininjurymn.org/ Brain Injury Alliance of Wyoming Lash & Associates Publ Texas Brain Injury Alliance http://www.projectbrainofwyoming.com/ Operation Homefront Boardwalk Drive, Suite 1 100 Brain Injury Association of Florida Brain Injury Association of Mississippi http://www.texasbia.org/ http://www.operationhomefront.com/ 556-0300 F Tel: (919)Brain Injury Association of Americahttp://biausa.org http://www.biaf.org/ http://www.msbia.org/ MILITARY AND www.lapubli Texas Division Wounded Warrior Project Brain Injury Association of Georgia Brain Injury Association of Missouri http://www.biausa.org/Texas/index.htm VETERAN SUPPORT http://www.woundedwarriorproject.org/INTERNATIONAL http://www.braininjurygeorgia.org/ http://www.biamo.org/RESOURCES Brain Injury Alliance of Utah After Deployment http://biau.org/ http://www.afterdeployment.org/ Brain Injury Alliance of Hawaii Brain Injury Alliance of MontanaInternational Brain Injury Association http://www.biausa.org/hawaii http://biamt.org/http://www.internationalbrain.org Brain Injury Association of Vermont Brainline Military http://www.biavt.org/ http://www.brainlinemilitary.org/ Brain Injury Alliance of Idaho Brain Injury Association of NebraskaBrain Injury Australia http://www.biane.org/ Lash & Associates http://www.biaid.org/ Publishing/Training Inc.http://www.braininjuryaustralia.org.au Brain Injury Association of Virginia Defense and Veterans Brain Injury Center Brain Injury Alliance of Nevada http://www.biav.net/ http://www.dvbic.org/ 100 Boardwalk Drive, Suite 150 Brain Injury Association of Illinois Youngsville, NC 27596Brain Injury Association of Canada http://www.biail.org/ http://www.bianv.org/ Tel: (919) 556-0300http://biac-aclc.ca/ Brain Injury Services (Virginia) Hearts of Valor Fax: (919) 556-0900 Brain Injury Association of New Hampshire http://braininjurysvcs.org/ http://www.heartsofvalor.org/ www.lapublishing.com Brain Injury Association of IndianaHeadway United Kingdom http://www.biai.org/ http://www.bianh.org/www.headway.org.uk/ORGANIZATIONS Brain Injury Alliance of Iowa http://www.biaia.org/ Brain Injury Alliance of New Jersey http://bianj.org/ Advertiser ListingsBY STATE Brain Injury Alliance of New Mexico Thanks to our advertisers...Their generous support makes this magazine possible. Brain Injury Association of Kansas and Greater Kansas City http://braininjurynm.org/ Advertiser Name Website Page No.Alabama Head Injury Foundation http://biaks.org/ ABI Education Services www.ABI-EdServices.com/.................... 25www.ahif.org/ Brain Injury Association of New York http://www.bianys.org/ Ann Arbor Publishers www.annarbor.co.uk................................ 29 Brain Injury Alliance of KentuckyAlaska Brain Injury Network www.brainline.org/.................................. 7 http://www.biak.us/ Brainlinehttp://www.alaskabraininjury.net/ Brain Injury Association of North Carolina Chuck Monnett www.carolinalaw.com/............................ 27 Brain Injury Association of Louisiana http://www.bianc.net/Brain Injury Alliance of Arizona HensonFuerst, P.A. www.LawMed.com ................................ 4 http://www.biala.org/http://biaaz.org/bia/index.aspx Head Injury Association of North Dakota Hinds’ Feet Farm www.hindsfeetfarm.org........................... 11 Maine Brain Injury Information Network http://www.braininjurynd.com/ Ivy Street School www.ivystreetschool.org ........................ 25Brain Injury Alliance of Arkansas http://www.biin.org/ Lash & Associates Publishing/Training, Inc. www.lapublishing.com ........................... 4, 13, 22, 27, 29http://www.bia-ar.org/ Brain Injury Association of Ohio Brain Injury Association of Maryland http://www.biaoh.org/ Learning Services www.learningservices.com .....................32Brain Injury Association of California Navy-Marine Corps Relief Society http://www.biamd.org/ http://biacal.org/ Brain Injury Association of Oklahoma Neuro Community Care www.neurocc.com .................................. 7 Brain Injury Association of http://www.braininjuryoklahoma.org/Brain Injury Alliance of Colorado Operation Homefront www.OperationHomefront.net ............... 23 Massachusettshttp://biacolorado.org/ Brain Injury Alliance of Oregon Semper Max Support Fund www.SemperMax.com ........................... 23 http://www.biama.org/ http://www.biaoregon.org/ The George Washington University www.summer.gwu.edu/brain ................. 23Brain Injury Alliance of Connecticut Brain Injury Association of Michigan Tree of Life www.Tree-of-Life.com ........................... 2http://biact.homestead.com/ Brain Injury Association of Pennsylvania http://www.biami.org/ http://www.biapa.org/ 30 31
  • 17. Learning Services is a national provider of post acute neuro- rehabilitation, neurobehavioral rehabilitation, day treatment rehabilitation and supported living services. Regional Centers of excellence located in the Southeast, Midwest, Rocky Mountains, and Pacific Coast. For more information on our programs, please call 888.419.9955 or visit learningservices.com32

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