Answer transcribed from <a style="color: rgb(17, 85, 204);" rel="noopener noreferrer" href="https://www.brightwayhealth.org/podcast-episodes/7%3A-susan-little-pt%2C-ms%2C-cbis" target="_blank">Brightway's interview with physical therapist Susan Little</a>: ﻿Regarding alternative therapies, as a therapist, I really try to have evidence and the science guide what I'm going to do with an individual. I think that's only fair to my patients. If there's no evidence that something works, it doesn't mean it doesn't work. It means that somebody hasn't had the time or hasn't figured out yet how to study that and how to do the research for that. I do believe there are many things that will help our survivors from a brain injury that we haven't studied. Maybe I'm not going to use it in the clinic, but if it were my son or my grandma that I'm giving a shot, as long as I knew there wasn't a detrimental effect, I think the best way to look at a lot of those things is to certainly run that information past the physician. I think if you have an open-minded physician and an open-minded therapist, they will say “I don't know about that, maybe it's not the safest thing” and certainly take that information. Or maybe they'll say “I don't know if it's gonna help but if you have the means and the willingness to try it, sure go for it”.&nbsp;&nbsp;We don't know everything and I'll never pretend that I do. There's much research out there that's happening about essential oils and recovery from brain injuries. Certainly, a lot of the anti-inflammatory diets are on the cusp of becoming more of mainline interventions for people with brain injury. Keep in mind that none of those things are fully proven and don’t really have strong evidence yet that we can implement them in the hospital or rehab facility. Nonetheless, you can certainly research those yourself and there are definitely safe things to do for yourself. Supplements certainly have been shown to be helpful. Definitely run those past the physician because there can be interactions with your medications that you need to take, and you wouldn't want to put yourself at risk by taking a supplement that alone would be perfectly fine but in combination with medications, might be problematic.

Physical Therapist

Answer transcribed from the <a rel="noopener noreferrer" href="https://www.brightwayhealth.org/podcast-episodes/12%3A-recreational-therapy-for-physical-symptoms-with-recreation-specialist-holly-auth" target="_blank">Brightway Answers interview with recreation therapist Holly Auth</a>: Very cool question. There are a lot of different alternative therapies out there.&nbsp; Some are a lot more evidence-based than others.&nbsp; Some things work great for some people and work terribly for others. One alternative therapy that I personally really like a lot is aromatherapy, which is the use of essential oils to treat different ailments.&nbsp; I personally get a lot of headaches.&nbsp; When I have a headache I diffuse peppermint oil, which is very relaxing and helps my headaches sometimes (though not all the time).&nbsp; Sometimes lavender or eucalyptus oil can be very relaxing and can help with stress and anxiety.&nbsp; Disclaimer: before you go out and buy all these oils, talk to your healthcare provider!&nbsp; Some oils can interact with different medications, so before you try any of these, just make sure that it's safe for you to do so. Other alternative therapies include chiropractic and massage therapy.&nbsp; I've heard that these can be very helpful in some situations.&nbsp; People in car accidents, for example, can get whiplash or spine alignment issues, and these therapies can be helpful.&nbsp; Massage therapy can help with clenching muscles, tension, and stress.&nbsp; But again, before you do any type of alternative therapy, it’s super important to receive permission from your doctor / PCP before you start any of these. I’m less familiar with acupuncture, but I know a few people who said it worked, but I also know a few people who say it did nothing for them.&nbsp; But if you're open to trying things, I would have a conversation with your doctor.

CTRS

Maybe the therapies that you're working on with someone aren't letting them heal as quickly as you would expect? I’ve heard of hyperbaric oxygen therapy or acupuncture, and some of these other things that people have tried. Based on what I've heard, the research isn't quite there for a lot of these. But for some of them, there are a lot of stories saying that they have helped people a lot.

As a therapist, are there ever times where you encourage patients to do some sort of alternative therapies?

Answer transcribed from the <a rel="noopener noreferrer" href="https://www.brightwayhealth.org/podcast-episodes/10%3A-symptoms-%26-approaches-to-care-after-brain-injury-with-speech-language-pathologist-amber-kloess" target="_blank">Brightway Answers interview with speech-language pathologist Amber Kloess</a>: This happens quite a bit in my current position as a speech-language pathologist.&nbsp; We have a lot of long-term survivors - two, three, ten years post brain injury, so they switch therapists a lot.&nbsp; That can be frustrating but it can also be a positive thing - it's almost like a breath of fresh air with new treatment ideas, new areas that they might want to work on. I do a thorough case review prior to the patient’s first appointment. I’ll review progress notes from the last speech pathologist, their recent neuropsychological reports, and feedback from other clinical team members.&nbsp; When I meet the patient, I’ll summarize the case history as much as possible instead of having them repeat their case history again to me. I then ask them or the family member if there's anything specific that is missing. Motivational interviewing, a person-centered approach to assessment, is also important to make the patient feel heard.&nbsp; During treatment I give open-ended questions like “what is important to you?”, “what are your goals?”, “what do you want to improve on?”, and this can guide therapy goals and sessions. Having my patient provide as much input into their therapy as possible is important - if they don't want to work on a certain goal that I have for them, I'm not going to work on that. If they don't want to get better in an area, then we'll find something else that is more meaningful to them. Motivation seems to play a very large part in how successful recovery is.

Speech-Language Pathologist

It's hard to stay engaged with a new therapist because there may be some overlap, or they focus on something tangential to what the patient wants to work on.

As a therapist, how would you handle taking over a case where a patient has worked with other therapists already?

Answer transcribed from the <a rel="noopener noreferrer" href="https://www.brightwayhealth.org/podcast-episodes/10%3A-symptoms-%26-approaches-to-care-after-brain-injury-with-speech-language-pathologist-amber-kloess" target="_blank">Brightway Answers interview with speech-language pathologist Amber Kloess</a>: There are a few things that I see as a speech-language pathologist. One is difficulty following the general rules of conversation, or what we perceive as rules.&nbsp; Some of my patients may not wait and tend to interrupt or jump in whenever they see fit, and that's not always going to fly in various settings that you're in. Sometimes talking too much or too little is a problem.&nbsp; Inappropriateness in conversation is something I see every day. Common goals I work on with my patients are to identify appropriate topics or to be able to carry on that topic without interjecting something completely inappropriate or random.&nbsp; Turn taking and not interrupting, letting others speak, and maintaining topics are also things I work on, as my patients tend to jump around a lot and introduce tangential conversation. I also see perseverations, which is where someone gets stuck on a word or a sentence or even a story and repeats it over and over again.&nbsp; Unfortunately with brain injury comes a wide range of behavioral and emotional changes as well.&nbsp; I see a lot of irritation, anger, frustration, and sometimes aggression during my sessions with patients. I also see some impulsivity - saying before thinking - and that often goes with inappropriate comments. Picking up on social cues is also sometimes a challenge.&nbsp; If someone were to cross their arms, we may think of that as being standoffish or they don't want to speak anymore, but that can be difficult for a brain injury survivor. My patients with a brain injury or who have suffered a stroke also often feel isolated and lose their friendships and social networks, so it's very important to keep those going. Besides awareness, support from friends and family members is a significant predictor of recovery.&nbsp; So you want to maintain those relationships as much as possible and reach out if you do need help. I work with individuals who are five ten you know even more years post their accident and they are sometimes still recovering socially. One of the biggest things that we try to encourage is to join a support group. Being able to at least talk with somebody is very important.&nbsp; Your local Brain Injury Association chapter would probably be a good start to find these groups.

What are the most common social symptoms caused by brain injury?

Answer transcribed from the <a rel="noopener noreferrer" href="https://www.brightwayhealth.org/podcast-episodes/10%3A-symptoms-%26-approaches-to-care-after-brain-injury-with-speech-language-pathologist-amber-kloess" target="_blank">Brightway Answers interview with speech-language pathologist Amber Kloess</a>: As a speech-language pathologist, I see a number of symptoms unfortunately but I'll talk about the most common ones. The biggest thing I look at when I first meet a patient is their attention - so are they able to focus on one thing at a time.&nbsp; It could be two minutes, it could be a half hour.&nbsp; I look at if they’re able to switch between tasks, like if you were working on an email, could you pick up the phone and call someone and then go back to writing that email after.&nbsp; There's also multitasking.&nbsp; So if you're cooking dinner, are you able to hold a conversation with your spouse or significant other? Secondly, memory is a huge component of cognitive communicative functioning.&nbsp; There are different types of memory: immediate, short-term memory, or delayed recall can be a huge challenge and then also the long-term memory side. For cognitive communication, executive functioning skills are huge, and this is where I see a lot of deficits.&nbsp; Executive functioning skills are housed right in that frontal lobe of the brain and can encompass a lot of skills: planning, initiation, problem solving, organization of thought, judgment.&nbsp; Being able to judge a situation is very important in life and often brain injury survivors aren't able to do that.&nbsp; Reasoning, impulse control, time management, and awareness.&nbsp; There’s also metacognition, which is the awareness of one's own thought processing, so like knowing what you know - and that can be a challenge too. Another big thing I work on with survivors is working memory - being able to take in information, manipulate it in your mind, and then express it in a different way.&nbsp; So for instance if you read a news article you can hold on to that information and maybe you're able to answer questions about it later - that's working memory. Two other common things are cognitive rigidity and cognitive fatigue.&nbsp; Cognitive rigidity is the inability to be flexible, so adapting to new situations or understanding the perspective of others.&nbsp; That's one of the biggest things that I see in my rehab practice.&nbsp; Cognitive fatigue is if we work a muscle hard enough we're going to tire it out.&nbsp; Our brain is like a muscle, so we can get what's called brain fog.&nbsp; I’ll talk to my patients about when to take a break and for how long in order to recover to be able to go back to what they were doing.

Let me begin by saying that I don't know if my answers are "common" and happen to every TBI victim. But I do know that I suffered from them after my own injury, and there is substantial research available online for them, so clearly the symptoms aren't solely isolated to me alone. Specifically, the first symptom is (1) memory loss. After asking I had zero memory capacity for about 5 months. Then very poor memory for up to 2 full years. Even still, 6 years later, I'm not confident my memory is fully restored. (2) The most noticeable side effects for me is my right side peripheral vision loss, so I can longer drive or play most sports. (3) Third most noticeable are muscle spasms and involuntary muscle flexion. (My left bicep, shoulder, and ring finger, as well as my jaw all flex involuntarily throughout the day, every day). (4) Perhaps most concerning for third parties is the reduced emotional control and stability. These days I can get really irritated by seemingly irrelevant, almost unnoticeable factors. What's more, during my five months of no memory, apparently I flew into uncontrollable rages for no reason whatsoever and thus alienated some of my best friends from college. (5) Lastly, I incurred seasonal allergy symptoms despite not ever having allergies to anything before. I take some OTC allergy treatmen meds that do seem like they work, so unclear if it really is allergies or not. Also I think that this last symptom is the least likely to be a common problem for TBI victims, but I bring it up because I think alterations in a person's immune response and general body functioning is likely quite ubiquitous. Hope that helps!

What are the most common cognitive symptoms caused by brain injury?

Answer transcribed from the <a rel="noopener noreferrer" href="https://www.brightwayhealth.org/podcast-episodes/10%3A-symptoms-%26-approaches-to-care-after-brain-injury-with-speech-language-pathologist-amber-kloess" target="_blank">Brightway Answers interview with speech-language pathologist Amber Kloess</a>: There is a wide variety.&nbsp; There is aphasia, or the inability to understand or express language.&nbsp; This can be verbally through reading or writing, we can see difficulty following directions, and also expressing thoughts and ideas.&nbsp; Many patients that have had a brain injury have difficulty understanding figurative language and they're very literal in their thinking. Problems with word-finding are also very common.&nbsp; Along those same lines agraphia or dysgraphia can occur - this is the impairment of written language and can range from mild to severe.&nbsp; Finally, alexia which is the impairment of reading out loud or understanding written language. On the speech side, there's apraxia, which is the inability to or difficulty with coordinating muscle movements for producing speech.&nbsp; This can manifest through distorting sounds, slowing your rate of speech, or exaggerated movements, which we call groping.&nbsp; Another one is dysarthria, which is weakness in the muscles, which makes speech difficult to produce and understand. There are a variety of types, but usually we see a slurred speech, their intonation may be off, their rate / rhythm of speaking, and then some breathing difficulties as well. There's also neurogenic stuttering, which is stuttering that is caused from some sort of neurological disorder like a brain injury or stroke.&nbsp; Finally I see social communication challenges on the language side - you may have difficulty following rules of conversation, like talking too much, interrupting others, bringing up inappropriate topics, or trouble initiating conversation.

What are the most common speech or language symptoms caused by brain injury?

I would most likely want to educate my partner or whoever it is on causes and effects of traumatic brain injury.&nbsp;I have a few groups that I wrote down that would be really good to join - these are on Instagram but I'm sure they're also on Facebook:<ul><li>@lifebeyondbraininjury</li><li>@brainhealthsummit</li><li>@thestrokestoryteller</li><li>@thebrainpossible</li></ul> They share a lot of TED talks and experiences of surviving brain injury, compensation, making gains, and growing relationships.&nbsp;I would really recommend using something like that. It’s very difficult to understand an individual's struggles if you're not in their place.&nbsp;It's very difficult to understand - “what does that mean you don't remember?”,&nbsp;“what does that mean you're getting tired and anxious and agitated?”.&nbsp;But I think education is key - reading about it and joining groups and hearing other individuals is a big plus.

speech language pathologist

Any strategies to cope with someone not believing you can't remember something?

Apraxia is a careful diagnosis.&nbsp; I am certain that they were diagnosed correctly.&nbsp; As a speech-language pathologist, I would want to know what kind of damage was sustained, I would need to know if it was a hemorrhagic event or anoxic event.&nbsp; What kind of damage was there? What hemisphere?&nbsp; Was it diffused or is it focal? For example, if the imaging shows you that it's a left frontal lobe damage, that would go hand in hand with the diagnosis of apraxia.&nbsp; If they exhibit behaviors like groping or inconsistent errors or importantly, if they’re able to imitate.&nbsp; The number one most important thing is if your child is able to imitate the sound that family members are giving them. If they can repeat, that's a really good positive prognosis.&nbsp; That's something that I would say might not be of an apraxia type of origin.&nbsp; So number one is to get the right diagnosis. Let's say we know it is apraxia. We’d start with visual sounds - they're called bilabial - so that would be sounds like “ba”, “pa”, “ma” - something that you're producing with the front of your mouth. After the individual masters the bilabial sounds, we go into the alveolar sounds.&nbsp; That means t's and d's and s's and z’s - so we're going back in the mouth where it's less visual.&nbsp; So you could say “tie”, “tee”, “top”, “door”, things like that. After the individual masters alveolar sounds, you go further back in your mouth and start with the velars. which is “kuh”, “the”, etc. Everything that speech language pathologists do to treat apraxia is really structured, and consistency is key.&nbsp; It can feel very robotic in nature, but it’s effective because you're retraining by taking the sound classes and building and applying to the other words.

Great to hear he is making steady gains! Try to start with bilabials, then move the sounds to alveolArs, then velars. Singing helps:) I'm sure you already know that. Best of luck, and it was a pleasure.

Thank you so much for answering. My son was kicked by a horse on the left side of his  cheek right where you feel the cheek bone, across to his ear. It was a diffused injury. He was left handed before the accident and they said that might be beneficial but that his speech woul most likely be the last thing to return. He has made a remarkable recovery per his neurosurgeon but he still has a long way to go. We know for sure that his speech problems are motor related but everything points to apraxia from what I've researched as well. His cognitive skills are great, right side hemiplegia/weakness. He is only making vowel sounds and N,M and G sounds usually but cannot imitate the same sounds that we say. He tries so hard but you can see that the conn is lost. Thank you agai!

Answer transcribed from the <a style="background-color: rgb(255, 255, 255);" rel="noopener noreferrer" href="https://www.brightwayhealth.org/podcast-episodes/10%3A-symptoms-%26-approaches-to-care-after-brain-injury-with-speech-language-pathologist-amber-kloess" target="_blank">Brightway Answers interview with speech-language pathologist Amber Kloess</a>: This is really difficult, especially with a seven-year-old because he probably wants to communicate and talk and say all the things that are going on in his world. Very frustrating for you as a parent because you might not always know what your child is trying to communicate. I would definitely consult his speech-language pathologist first. I don't know the background of your son’s case - apraxia has different levels of severities and treatment.&nbsp;But as a speech-language pathologist, my goal for treatment typically is to help someone achieve their highest level of independent functioning, whether it's communication or language or swallowing. We want to make someone as independent as possible to participate in conversation and communication with others. My thought, without the background information, would be has your child trialed any AAC devices (augmentative and alternative communication)?&nbsp;Is he able to gesture or sign?&nbsp;You can train using a communication board or a low-tech or high-tech communication device - those are all options that don't necessarily replace verbal communication, but can help to support communication. You may also find that he can verbalize more when he hears that model first from a high-tech communication device - to be able to repeat it. Low-tech can be pretty much anything.&nbsp;It might be a piece of paper with a yes and a no on it - so being able to point to yes or no to answer a question. For high-tech, there are a variety of companies that produce communication devices. Usually an iPad or a tablet that has built-in software for communication.

He is seven and almost a year out from his severe TBI.&nbsp; He can say mom, dad, and hi.&nbsp; He tries so hard but it's not coming easily for him.

What can I do to help my son with apraxia?

We need to view the brain as a muscle, and unfortunately short-term memory is often the thing that goes first.&nbsp; With brain trauma, long-term memory is usually preserved and short-term memory is the one that's affected most. I recommend external aids like calendars and writing things down.&nbsp; I would use color associations - let's say writing something in one color and another task in a different color.&nbsp; This allows you to use the artsy ability of the right visual hemisphere and we're applying it to memory.&nbsp;&nbsp; I would also use verbal reminders.&nbsp; For example, you could tell Alexa to remind you about a certain thing. And I know it seems vague and open, but try to be aware and take down notes to help yourself memorize a little bit better. There are a lot of apps that you can try.&nbsp; There's something called Tactus Therapy, which is a wonderful app that lets you work on a number of different disorders.&nbsp; You could try Lumosity, which is a cognitive type app.&nbsp; You can also check out Brain HQ and Constant Therapy.

One of the only known ways to improve memory capacity in the large picture is by doing daily meditation. It's been scientifically proven that meditation increases brain health, both for memory capacity and for problem solving. For more immediate memory results, simply repeat to yourself in your head (or by saying it out loud if there's no one around) the thing you want to remember. And for somewhat intermediate-term memory, simply write down all your thoughts on other, unrelated topics so you can clear your mind and focus only on remembering the things that are most immediately needed.

I read a lot. It uses my memory muscles and helps improvement.

It seems like I can't remember or retain information, especially when trying to remember, problem solve, train people, run a business, etc.

How do I improve my memory, problem-solving, etc.?

Let's take apraxia for example, as this is a deficit where the connection between the brain and your verbal output is disturbed.&nbsp; There's an execution issue, not a muscle weakness - it's just there's no connectivity between what the brain tells you to do and your verbal response. We would train the right hemisphere using something called melodic intonation therapy, which applies the musicality of the right hemisphere to take over the language in the left hemisphere. This means we use singing to facilitate verbal responses and to alleviate the struggle to produce language.

How can you go about training a different part of your brain to accomplish a task that was damaged during an injury?

Answer transcribed from the <a rel="noopener noreferrer" href="https://www.brightwayhealth.org/podcast-episodes/12%3A-recreational-therapy-for-physical-symptoms-with-recreation-specialist-holly-auth" target="_blank">Brightway Answers interview with recreation therapist Holly Auth</a>: I love to take naps. Current research says if you are going to nap you shouldn't nap longer than 30 minutes (no snoozing!)&nbsp; I know it's hard to do, but that's what the research says.&nbsp; I’m not a sleep expert, but I believe it starts to mess with your sleep cycle (falling asleep, staying asleep) if you sleep longer than 30 minutes during the day. If you're totally against napping, there are other ways that you can help with energy conservation. One thing that is very important is pacing yourself throughout the day. Find out the length of time you can complete a task before you start to feel fatigued, and take a break before the fatigue starts.&nbsp; Then you can resume your task after a break.&nbsp; This practice avoids front loading your day with all your tasks and avoids a major crash at the end of your day. So take a break, do something, take a break, do something. You'll find that at first you might only be able to do a task for 10 minutes and then you have to take a 10-minute break. But you're working on your cognitive endurance, so down the road you might be able to do 40 minutes of a task then take a 5-minute break. Building up your cognitive endurance is easy to do when you pace yourself. Some people find it very helpful to set alarms and reminders on their phones to assist them in remembering to take these breaks throughout the day.&nbsp; This will help you to avoid feeling totally drained by the end of the day.

That's a hard question.&nbsp; Diet modification is something to look into.&nbsp; There's a lot of research suggesting your gut and your brain are in a direct relationship.&nbsp; So I would recommend tapping into diet modification - what kinds of food you eat.&nbsp; The diet has a big impact on energy, so perhaps some elimination of certain foods i would talk to a dietitian a nutritionist and get an opinion. Naps are very common especially after trauma.&nbsp; It's also important to see how many hours you sleep during the night.&nbsp; Do you sleep too many or too few hours?&nbsp; Exercise and meditation are also worth looking into.

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