For Brain Injury month, I have chosen to write about challenging the brain with an acquired injury with the object of sustaining rehabilitation. There are formal Cognitive Training (CT) programs available and at first, after the acute Autoimmune Encephalitis (AE) phase is over, some may need this. Talk to your doctor about such a program as it is out of the scope of this piece. Many people have been helped by such programs, but like all rehabilitation, exercises must be done after the formal program is over to keep things going well. As a rehab nurse, my job was to take residents of a nursing home after Physical or Occupational therapy had finished their program, and make sure the residents used the skills they had learned. Challenging the brain after a formal CT program or during the calm after a flare is no different. So how do we do this? What activities work best and what is practical for the person with an Acquired Brain Injury (ABI)?
Physical exercise when safe and possible, increases blood flow to the whole body including the brain. This can be helpful when you need to calm yourself or are in a brain fog and definitely when you start a brain rehab session. If you are not safe standing and waving your limbs about, which would definitely put me in the ER, then try chair aerobics or chair yoga. I also exercise in the water at an indoor pool where the water is warm. You can follow your own routine for any of these; there are numerous videos to follow on Youtube, put on some music and move, join classes at local libraries or community centers, or if you live near one at a Y. Of course the very first thing you do before starting a new exercise program is to make sure it is safe for you by asking your doctor. DON’T FORGET REST and relaxation is just as important. Napping is good for you, and if you are lucky enough to live near natural beauty get out and enjoy it. I live near the beach and know when I need a wave day.
Neuroplasticity is a relatively new term although they talked about it when I was in nursing school in the early 2000’s. Simply put, we used to believe that as we aged our neurons and neuronal connections decreased and only decreased; now science is seeing that under the right circumstances new connections can form even into old age. So what are those ‘right’ circumstances? Part of it is luck, genetics in other words. I already mentioned physical activities and the rest is challenging your brain as much as possible. The brain has the ability to reorganize itself due to the ability of neurons and neural networks to change physically and functionally due to environment, behavior and thinking. You can learn more about this subject by googling neuroplasticity and neuronal plasticity exercises.
I want to focus on the common symptoms of acquired brain injury and some simple things that you can do to help old neuroplasticity along. The list of symptoms is by no means exhaustive as we all suffer in slightly different ways, but it is compiled from my own symptoms and those of others I have spoken with. Neither is the list of suggested activities complete, just suggestions that have shown to be helpful in any kind of brain injury or dementia. I should say here that most of my information comes from my own practice as an RN working with both dementia patients and those with ABI; also my time in cognitive rehabilitation after my first attack of AE. A phrase I learned in nursing school is that ‘the brain is what it is and does what it does’. In other words the parts of the brain have their functions and it depends on what part of the brain is damaged as to the symptoms the person will experience. Again, the list is not all encompassing and you will not have all the symptoms on the list, but I am trying to be as general as possible. You should be able to find an activity that fits your personal needs in the suggestions.
1. Short term memory loss
3. Fatigue, including brain fatigue
4. Dizziness – balance issues
5. Cognitive deficits – slow processing
7. Over stimulation‐ feeling of turmoil
10. Chronic pain
11. Visual disturbances
12. Impulsiveness – emotional outbursts
13. Lethargy‐ lack of interest in everyday affairs
These are in no particular order of prevalence or intensity.
As to the suggested activities the following are but a few and you can adapt each to suit your own particular needs, talents or interests:
• Activities of daily living or ADLs are the things you do every day like getting showered and dressed, taking care of your hair and teeth, preparing meals and eating them, in general taking care of yourself. You may not be able to do all of these things, but doing what you can for yourself challenges the brain and helps it to remember how to do those things and make those new pathways to compensate for damaged areas.
• There are several programs on line that offer cognitive stimulation some are free, others not. These can be a good resource but remember that sitting at a computer playing games is not enough to stimulate the brain, only a part of the overall picture.
• Likewise, working crosswords, jigsaw puzzles, word search and mazes are all good for concentration, short term memory and processing, but again, this is a sedentary pursuit and does not involve much hand eye coordination.
• The best games or activities are hands on as this involves more senses, and the more of your 5 senses involved, the better for making new pathways in the brain. Things like working with money, playing cards or checkers, chess is beyond me these days, and putting together different sizes of nuts and bolts (you can get plastic ones). One of our members plays bingo regularly’ this is a great activity if you can do it. You get to work with numbers, spatial issues and also socialize which is so important for anyone with a chronic illness.
• Other hands on activities also include your own interests and creativity. If you used to be a painter, then paint. One of our members has found new meaning in her life working with her art and our symbol of the Zebra. If you were a craft person find a way to resume them. If you like to do crafts as I do, but find that ones you used to do are now beyond you physically or mentally, find something simpler but similar. For example, the arthritis in my hands no longer allows to do fine embroidery so I took up fabric painting using large brushes and the markers that are sold for fabrics. With beading and jewelry, I now avoid seed beads and smaller beads, and use larger ones which allow me to still make bracelets and the chunky style necklaces. Adult coloring is all the rage and I highly recommend it. You don’t have to be artistic and it is soothing and challenging; also if you have never done it before then it is something new. Starting something new is a great way to get those connections in the brain working and the neurons firing.
• If you have trouble following directions or issues with spatial relationships, a simple bean bag toss game can be fun and help. Number sequences get me, can’t remember phone numbers etc., so I have my family write down a short string of numbers and try to memorize them. As I get to a string of 5 numbers, they increase by 1 each time. One member uses cooking as a way to help with following directions and spatial relationships as you must measure things out; it’s also hands on. For many of us this activity should be supervised. Picking out new recipes to try is also a great part of the activity. Organizational activities are a good way to use all of your senses. Reorganize a filling cabinet or your craft area, kitchen cabinets or drawers. For both directions and spatial relationships, using a map instead of a GPS while not driving, is good for both. I find refolding the things a challenge! Right/left orientation is good too. As you go along look at things in the environment and say out loud “this is to my right” or “this is ahead of me”. Saying it out loud helps to cement those brain connections that tell us where we are. If you have balance problems stand in a corner and close your eyes; next, have someone tell you when you are standing upright and again say out loud “I am upright”. These exercises should be repeated as often as possible. Make them a part of your daily routine.
• As I said earlier, learning something new is a terrific way to challenge the brain. Take a community class, even better if you can take a physical class such as yoga. If balance is a problem there are chair yoga and chair aerobics classes available. It would be nice if you can join a Y or community center with a pool; balance is easier in the water and it also takes the pressure off of damaged joints. Take a water aerobics class again, good for all the above reasons.
• For short term memory problems looking at recent pictures is a good way to stimulate memory. Reading short passages and telling someone what you have read is also good. Reading in general is helpful. If you have visual problems check out audio books. I use my local library and download them for free there are also other free books available. I find myself rewinding a lot when I get lost, but hey that’s okay. Mindful listening is an ancient concept and simply involves paying attention. When someone is talking to you or you are working on anything, make sure that you are focused on what is going on. Block out distractions. Keeping a journal is a help for many reasons: organization, recall, concentration, processing, Aphasia and a record of your symptoms for your doctor and yourself.
So I don’t have a fix for everything or anything for that matter. My suggestions, as I said, are based on my own experiences on both sides of the blanket so to speak. Don’t forget to rest both your body and your brain when you need to, WITHOUT GUILT. If you are overstimulated in a situation get out of the situation as soon as possible. Take a time out. Anxiety can be helped with deep slow breathing, prayer or meditation. Depression and lethargy will improve with physical activity and creative pursuits. If anyone has a fix for insomnia or emotional outbursts please let me know. I hope something in here helps.