Headspace-Master-2016

Head Space:
a handbook on brain injury
Claire Freeman
BDes (Hons), PGDip Mktg, PGDip Rehab
Bernadette Cassidy
BA (Hons), PGCRM, PhD

Brain Injury New Zealand wholeheartedly supports the
project undertaken by Claire Freeman and Bernadette
Cassidy to produce the publication “Head Space” A
handbook on brain injury.
New Zealand Spinal Trust is to be commended for encouraging and supporting
them to produce such a publication which will serve all those in New Zealand who
experience a brain injury, their family, whanau and friends. Ninety [90] people a day
are affected by brain injury in some form and many are the result of concussion. That
represents between 24 000 and 33 000 people in a year.
The most challenging aspect is that so often it is a hidden injury, depending on the
severity, and the difficulties experienced by individuals and those around them are
not necessarily obvious to the public in general.
This publication will be incredibly useful as a guide to anyone seeking answers and
gives comprehensive explanations and suggestions that will satisfy the majority
of concerns. It is such a good pointer for people to take the next step in getting
professional help if they haven’t already done so.
Brain Injury New Zealand sees this book as an ideal item to be given to everyone
affected, at the assessment stage or on discharge from hospital.
Congratulations for pursuing such a worthwhile initiative.
Graham Menary
Chief Executive
Brain Injury New Zealand
Disclaimer: This publication has been produced with the support of the Brain Injury Unit, Burwood Hospital and
the Brain Injury Association NZ. It is intended as a guide only and should not be used to replace the medical
opinions of your health professionals. Medical knowledge is constantly evolving and preferred rehabilitation
techniques may differ from region to region. Readers are strongly advised to confirm that information in this
publication conforms to current standards of practice endorsed by your health professionals.
Published by:
The New Zealand Spinal Trust
Burwood Hospital, Private Bag 4708, Christchurch, New Zealand
All rights reserved. No part of this publication may be copied, reproduced, stored or transmitted by any mechanical,
photographic or electronic processes or techniques, for public or private use, without the express written permission of the
publisher.
© New Zealand Spinal Trust, 2009
To learn more about the New Zealand Spinal Trust go to:
www.nzspinaltrust.org.nz
This edition printed January 2010.
ISBN 978-0-473-15091-4

Foreword
by Sir Tim Wallis
Where, before this book was published, could a family get this very
important information?
This book will be a great help both to the people who sustain a brain injury
and to their families and carers. All the different aspects of injury and
recovery are described very clearly and helpfully. My wife says she wishes
such a book had been available when I had my accident in 1996.
A brilliant book.
Well done and thank you, Bernadette and Claire.
Sir Tim Wallis
Acknowledgements
The authors wish to acknowledge the support and encouragement of
the Brain Injury Association Canterbury, especially Sue Wilson for her
enthusiasm and interest in the handbook.
We wish to acknowledge and thank Christine Fry, Charge Nurse Manager
and the staff of the Burwood Brain Injury Rehabilitation Unit for their
contributions and support, Wendy Fulton for help with distributing the draft
for comments and Julian Verkaaik for his original concept of the handbook.
Thanks to John Maasch for his help with the stroke section. Grateful thanks
to Barbara Freeman, Jock Vennell and Cecile Tait for their editorial skills.
Finally, very special thanks to the members of the Christchurch and
Ashburton Brain Injury Association Canterbury ‘Chat Room’ groups,
especially Shane Thrower, Mike St. John, Archie Andrews, Graeme Sudlow,
Brendan, Noel, Cate, Paul & Carmen Lee, Merv and Elizabeth, Noel, Douglas,
Sue Brown, and to all those with a brain injury who gave so generously of
their time in the development of this handbook.
4

Guide to the Handbook
Foreword &
Your Brain
Physical
Thinking
(Cognitive)
Emotional
Life after
brain injury
Personal
Journeys
A brief overview of a brain injury and what
to expect following your brain injury
Physical effects you may experience after
your brain injury
Problems with thinking and communication
you may experience as a result of your
brain injury
Changes in mood and behaviour you may
experience after a brain injury
Getting back into your community and
adjusting to life after a brain injury
A collection of personal journeys from
people who have had a brain injury
Resources
Author’s note, books, videos,
DVD’s, websites on brain
injury and glossary
GUIDE TO CHAPTER CONTENTS
Headaches
Page 23
This is a visual guide
to each chapter’s
contents.
In each of the chapter contents,
there will be a picture to show
you which part of your brain
has been affected.
Guide to page number
and chapter contents.
5
5

Chapter Contents
4 .............. Foreword
5 ............... Guide to the Handbook
6 ............... Contents
9 ............. Chapter 1 - Your Brain
10 .............. Effects of a Brain Injury
11 .............. Coma and Glasgow Coma Scale
12 ............... Post Traumatic Amnesia (PTA)
13 .............. Types of Brain Injury
16 .............. Stroke
19 .............. Left and Right Brain
20 .............. How the Brain Works
21 .............. Frontal Lobe Damage
22 .............. Temporal Lobe Damage
23 .............. Parietal Lobe Damage
24 .............. Occipital Lobe Damage
25 .............. Cerebellum Damage
26 .............. Brain Stem Damage
28 ............. Chapter 2 - Physical
29 .............. Fatigue and Tiredness
32 .............. Headaches
34 .............. Seizures
36 .............. Movement, Balance, Co-ordination and Dyspraxia
38 .............. The Five Senses: Touch, Smell, Taste, Vision and Hearing
40 .............. Swallowing / Dysphagia
41 .............. Bladder and Bowel Issues (Continence)
44 ............ Chapter 3 - Thinking (cognitive)
45 .............. Vision and Perception Issues
47 .............. Communication Issues / Aphasia
49 .............. Planning, Organizing and Problem-Solving
51 .............. Attention and Concentration Issues
54 .............. Memory Issues
6

Chapter Contents
58 ............ Chapter 4 - Emotional issues
59 .............. Anger, Frustration, Depression and Anxiety
62 .............. Sexual Issues
65 .............. Behaviour and Self-Centredness
67 .............. Lack of Motivation
69 .............. Emotional Extremes
72 ............ Chapter 5 - Life after brain injury
73 .............. Brain Injury in New Zealand - Statistics
74 .............. The Rehabilitation Team
77 .............. Family / Relationships
84 .............. Getting Back to Work
88 .............. Driving After a Brain Injury
92 .............. Nutrition / Alcohol
95 .............. Exercise / Brain Gym
98 .............. Socialising / Recreation
102
Chapter 6 - Personal Journeys
103 .............. Mike
105 .............. Cate
107 .............. Graeme
108 .............. Elizabeth and Merv
109 .............. Paul
111 .............. Cecile
115 Chapter 7 - Author’s Note,
Resources, Glossary
116 ............. Author’s note from Claire and Bernadette
117 ............. Resources
121 ............. Glossary
7

Your Brain
Your Brain

Introduction
Brain injury occurs when the brain’s tissue is damaged
or is not working properly. Anything that can damage
brain tissue can cause a brain injury. Brain injuries
can be the result of a blow to the head, such as from
a fall, sports injury, car accident, an assault, cycling or
from any other outside influence.
There are other ways in which the brain may suffer
an injury without a blow to the head. For example,
the brain can lose its blood supply or a blood vessel can break so that
bleeding into the brain tissue occurs. This is usually referred to as a ‘stroke’.
A stroke is one of the most frequent causes of brain injury in older people.
Other causes of injury to the brain can be a drug overdose, a tumour, an
infection, a lack of oxygen or chemical poisoning.
Sometimes the term ‘head injury’ is used instead of brain injury. This can be
misleading as a head injury can include other injuries to the head, such as jaw
or skull fractures, which may not involve the brain.
This handbook is concerned with injuries to the brain and will refer to these
as ‘brain injuries’.
Clinical identification of a brain injury includes
one or more of the following:
• Confusion or disorientation
• Loss of consciousness
• Post-traumatic amnesia
9

Effects of a Brain Injury
The effects of a brain injury are wide ranging
and may result in the following:
Physical disabilities
Sensory disabilities (for example, sight, smell)
Personality changes
Thinking (cognitive) disabilities (for example, difficulty thinking clearly,
planning and following through, memory problems)
Difficulty expressing or understanding language
Many people who have a brain injury continue to have ongoing
problems which may include some of the following:
Aggression
Depression
Anxiety
Impulsiveness
Mood swings
Poor concentration
Difficulty with problem-solving
Passivity
Socially inappropriate behaviour
Changes in thinking processes
Loss of memory
10

Coma and
Glasgow Coma Scale
Eyes
Verbal
Glasgow Coma Scale
Brain injuries are usually classified
according to severity. They can be mild,
moderate, or severe. When a brain injury
occurs, two assessments are used to
measure the severity: the Glasgow Coma
Scale (GCS) and the duration of Post-
Traumatic Amnesia (PTA).
Post-Traumatic Amnesia refers to the
time between injury and the recovery of
full memory for day-to-day events. The
Glasgow Coma Scale is the most widely
used scoring system for measuring the
level of consciousness following traumatic
brain injury. GCS has three parts: an
assessment of eye opening, best motor
response and best verbal response.
1 2 3 4 5 6
Does not
Opens eyes in
Opens eyes in Opens eyes
open eyes
response to painful
N/A
N/A
response to voice spontaneously
stimuli
Makes no
sounds
Incomprehensible
sounds
Utters inappropriate
words
Confused,
disoriented
Oriented, converses
normally
N/A
Motor
Makes no
movements
Reaction to
painful stimuli
Abnormal flexion to
painful stimuli
Flexion / Withdrawal
to painful stimuli
Localizes painful
stimuli
Obeys
commands
A scoring system is used, with the lowest score being 3 and the
highest 15. For example, a score of 8 or less would be regarded as
a severe brain injury resulting in a coma state; a score of 9 to 12
would indicate a moderate brain injury; and a score of 13 to 15
would indicate a mild brain injury.
3 4 5 6 7 8 9 10 11 12 13 14 15
severe injury moderate injury mild injury
11

Post-Traumatic Amnesia (PTA)
If you are in a coma as a result of a brain injury,
afterwards you may have Post-Traumatic Amnesia
(PTA). Even mild concussion can cause a short period
of Post Traumatic Amnesia.
Someone emerging from a coma does not just wake
up, they go through a gradual process of regaining
consciousness. This stage of recovery may last for hours, days or
weeks.
This may be a very confusing time for you. You may not have any idea
of time, talking may be difficult and you may be very tired. Behavioural
changes can also affect you. For example, some people become passive,
or aggressive, abusive and agitated after being in a coma during the PTA
stage. Some people liken PTA to being in a dream-like state.
Some medical professionals believe that the duration of PTA is the best
indicator of the severity of a brain injury.
You will have little awareness of any behavioural and cognitive
impairments and usually will remember nothing of what happened
during PTA, even though you were fully awake. The good news is that
PTA does not last forever.
Symptoms of Post-Traumatic Amnesia:
No idea of time.
Talking may be difficult.
You may be tired.
Your behaviour may change. You may become
aggressive, abusive or agitated.
12

Types of Brain Injury
Many terms are used to describe the different types of brain injuries,
the severity of brain injuries and the causes of brain injuries.
Below are some of the more common terms used.
Concussion:
This is the most common and least serious type of
traumatic brain injury. It is usually as a result of a direct
blow to the head, or when the brain is shaken. It is not
usually associated with penetrating injuries to the head.
Concussion can also be due to a fall or sports injury
(for example, playing rugby).
Acquired brain injury:
This term is used to describe any damage to the brain not present at birth
(for example, from a car accident or a blow to the head).
Traumatic brain injury:
This term is used when an outside force traumatically injures the brain.
Anoxic brain injury occurs when the brain does not receive
oxygen for several minutes or longer. Cells in the brain
need oxygen to survive and function.
Hypoxic brain injury results when the brain does not
receive enough oxygen. An hypoxic injury is not as severe
as an anoxic injury, but brain cells can still die from a lack
of oxygen.
13

Types of Brain Injury
Mild brain injury
A mild brain injury is when there is trauma to the head.
At least one of the following symptoms needs to be
present for a mild brain injury:
• A period of loss of consciousness (no more
than 30 minutes)
• Loss of memory
• Feeling dazed, disorientated or confused
• Initial Glasgow Coma Scale score of 13-15
• Post-Traumatic Amnesia not longer than 24
hours
Moderate brain injury
A moderate brain injury is more severe than a mild
brain injury. Symptoms include:
• Glasgow Coma Scale score of 9 - 13
• Confusion lasts from days to weeks
• Physical, thinking and/or behavioural issues
can last for months. In some cases they may be
permanent
Severe brain injury
• Glasgow Coma Scale score of 8 or less
• This person is generally in a prolonged
unconscious state
• Substantial physical, behavioural and/or thinking
issues as a result of the injury
14

Types of Brain Injury
Open head injury (penetration)
When an object enters the brain, such as a sharp object.
Coup/contrecoup injury
A coup injury occurs at the site of impact. A contrecoup
injury is when there is damage to a part or region of
the brain that is opposite to where the blow is received,
often causing rupture of the affected parts.
Contusion
A contusion is bruising (bleeding) on the brain caused by
small blood vessels leaking into brain tissue. A contusion
occurs as a result of trauma to the brain and in many
cases is more serious than a concussion.
Haematoma
A haematoma is a collection of blood as a result of internal
bleeding from trauma or an aneurysm. An aneurysm is
a widening and possible rupture of an artery, vein or the
heart itself.
Diffuse axonal injury
A diffuse axonal injury can be caused by violent shaking
of the head. The movement of the brain inside the skull
causes extensive tearing of nerve tissue which can cause
brain chemicals to be released, causing additional injury.
15

Stroke
When the brain's blood supply is cut off, a stroke can occur.
Blood carries nutrients and oxygen to the brain. Without a supply of
blood to the brain, cells may be damaged or destroyed.
A stroke causes damage to the brain, which affects how the body works
and functions. It can also affect your mental processes, such as how you
think, your emotions and the way you communicate.
The effects from a stroke can be felt immediately.
Infarction
When brain tissue dies due to a stroke, this damage is called cerebral
infarction. An infarct is an area of dead tissue.
Two main types of stroke
Blockage.
The most common stroke is caused by a
clot that blocks an artery. This is called an
ischaemic stroke.
Bleed.
The second type of stroke is caused by a
bleed, such as when a blood vessel bursts.
This causes a haemorrhagic stroke.
Possible outcomes from a stroke
Much like a traumatic brain injury, every stroke is different. For some
people the symptoms may be quite mild and only last a short time as
there may not have been any permanent damage. Other strokes can
cause more severe and permanent damage.
Recovery from a stroke can take months, this is when most progress
will take place. For some people, their recovery can continue for
several years.
16

Stroke
Transient Ischaemic Attack (TIA)
Transient Ischaemic Attack is often called a mini stroke. It happens
when the blood supply to your brain is interrupted very briefly, causing
symptoms similar to a stroke, Generally these symptoms disappear
after a short amount of time, usually no longer than an hour, but they
can last up to 24 hours. TIA can be an important warning sign for a
more serious stroke and preventative measures should be taken as
soon as possible.
Symptoms of TIA are:
Difficulty speaking
Vision problems, such as
loss of sight in one eye or
blurred vision
Secondary Stroke Prevention
These preventative measures may decrease the risk of another stroke
happening. Secondary strokes can be more damaging to the brain, so
prevention is the best way to avoid this from happening.
Control your blood
pressure, make sure it is
not too high
Mild temporary paralysis on
one side of the body, such as
the face, arm or leg
Exercise regularly
Stop smoking
Control and monitor
your diabetes
Decrease your
cholesterol level
Maintain a healthy weight
and eat healthily
Avoid excessive alcohol
Avoid excessive stress
Have regular check ups with
your general practitioner
Take medications as
prescribed by your doctor
which can help reduce the
chances of secondary stroke
17

Stroke
Signs and symptoms
that someone has had a stroke:
Slurred speech
Headache
Problems with vision
Confusion
Numbness or weakness down
one side of the body
Ongoing problems associated
with having a stroke:
Balance problems
Memory issues
Difficulty with swallowing
Weakness or paralysis
Fatigue
Speech and language problems
Problems with bladder and
bowels
Emotional mood swings
Sensation, too sensitive, or
lack of sensation
Visual problems
Pain
Cognitive issues, such
as thinking, learning,
concentrating, remembering
18

Left and Right Brain
The brain is divided into two parts or ‘hemispheres’. The left
side of the brain controls the right side of the body and the
right side of the brain controls the left side of the body.
The right side of the brain takes visual information and
interprets it creatively. The left is the logical and analytical
side. It takes the information collected by the right side and
analyses and applies language to it.
People with right side injuries often deny having an injury as
the brain does not realise that something is wrong. If you
have an injury to the left side, you may know something is
not right. You may find it difficult to solve complex problems
and consequently you may feel depressed because of this.
Left Side of Brain
The left side of the brain controls:
Right Side of Brain
The right side of the brain controls:
Movement of right side of body
Problem-solving
Expression (words)
Mathematical calculation
Seeing in black and white
Speech and language
Reading and writing
Organisation skills
Movement of left side of body
Holistic thought
Intuition and emotional expression
Creativity and thinking
Visual memory, drawing, and music skills
Spatial visualisation
Seeing in colour
Using pictures, not words
1 + 1
19

How the Brain Works
There are 100 billion nerve cells in your brain. On each nerve cell are
two branches:
Dendrites, which receive incoming messages from other cells
in the form of an electrical impulse.
Axons, which carry outgoing signals to other cells.
Interconnected, they provide super-fast communication, allowing the
brain to send messages from one side to the other, which lets you
move and make decisions. This is done by a chemical that is shot from
the axon across a gap (synapse) where it triggers another cell to send
a message.
An injury to your brain can destroy or damage these nerve cells, which
means that some messages will not get through or may get scrambled
along the way.
20

Frontal Lobe Damage
COMMON EFFECTS OF FRONTAL LOBE DAMAGE
Loss of spontaneity
Personality changes
Sexually uninhibited
Inflexible thinking
Repetition of words, gestures or acts
Mood - *Aggressive and explosive anger
Initiative and planning -
*Difficulty sequencing
*Reduced problem-solving skills
Motor function -
*Paralysis and loss of simple movement
Memory - *Selective attention and reduced concentration
Language - *Decrease of verbal expression ability
21

Temporal Lobe Damage
COMMON EFFECTS OF TEMPORAL LOBE DAMAGE
Language - *Difficulty recognising words
*Loss of inhibition while talking
Memory - *Difficulty recognising faces
*Difficulty identifying, locating and categorizing objects
*Short-term memory loss
Mood - *Increased aggressive behaviour
*Increase or decrease in sexual desire
Selective attention -
*Decreased recall of verbal and/or visual content
22

Parietal Lobe Damage
COMMON EFFECTS OF PARIETAL LOBE DAMAGE
Limb / facial movements are affected
Loss of spatial awareness
Changes in feeling / touch
Problems with naming objects
Right/left confusion
Writing and maths difficulties
Difficulty with multi-tasking
Voluntary movement -
*Problems with eye-hand co-ordination
*Lack of awareness of body parts
Visual attention -
*Reading and drawing problems
*Inability to focus visual attention
23

Occipital Lobe Damage
COMMON EFFECTS OF OCCIPITAL LOBE DAMAGE
Vision -
*Difficulty identifying colours and recognising drawn objects
*Blind spots
*Hallucinations
*Visual distortions
*Not seeing some words
*Difficulty reading and writing
*Difficulty recognising the movement of an object
*Difficulty visually locating objects
24

Cerebellum Damage
COMMON EFFECTS OF CEREBELLUM DAMAGE
Difficulty with balance
Equilibrium -
*Tremors
*Dizziness
Muscle tone -
*Inability to grasp objects
*Slurred speech
Movement -
*Problems with fine movement and co-ordination
*Problems with mobility
*Difficulty with rapid movements
25

Brain-Stem Damage
COMMON EFFECTS OF BRAIN-STEM DAMAGE.
Problems with the physical act of talking
Difficulty swallowing food and liquid
Decreased breathing capacity
Sleeping difficulties
Problems with balance and movement
Problems with blood pressure and sweating
Digestion and temperature problems
26

Physical
Physical

Chapter Contents
Fatigue and Tiredness
Page 29
Headaches
Page 32
Seizures
Page 34
Movement, Balance,
Co-ordination and Dyspraxia
Page 36
The Five Senses: Touch, Smell,
Taste, Vision and Hearing
Page 38
Swallowing / Dysphagia
Page 40
Bladder and Bowel Issues
(Continence)
Page 41
28

Fatigue and Tiredness
Why am I tired?
After an injury, your brain uses a lot of the body’s energy to heal
and consequently it needs a lot of sleep to help it recover.
Fatigue is extremely common after a brain injury. The sleep your body
craves may be fragmented and can have little effect on the tiredness you
feel. You may find activities tire you quickly, even ones like reading which
are not that physical but require a lot of mental work.
Fatigue may be caused by damage to the part of the brain that is responsible
for wakefulness, consciousness and sleep rhythm. After a brain injury, it
may take longer to recouperate and ‘recharge’ than before your injury.
Ways of coping
Recognise the early signs of fatigue and take it easy,
stop and rest. Do not keep pushing yourself.
Say no to the excessive demands of others. Be open
about your problems with others but don’t go on about
the issues. Beware of sounding like a ‘broken record.’
Plan periods of rest and take naps. Make naps a regular
part of your day and try to have them at the same time
every day.
29

Ways of coping
Do your most demanding activity in the morning when
you have the most mental energy.
Eating a light meal can sometimes help, and drinking
plenty of water.
8pm
Try to establish a set time to go to bed each night and
get up at the same time each day.
walk
nap
read
Vary your daily activities to avoid monotony.
Do I have the
energy?
Pace yourself, do not rush. Learn to stop and think
before you proceed to do an activity. Ask yourself, “Do
I have enough energy to finish? Do I need to break it
down or do it differently?”
Try to avoid doing too much and getting over-tired. A
really busy day can set you back for several days.
When you get tired, expect that tasks will take you
longer to complete.
30

Ways of coping
Avoid high-stimulation locations, such as shopping
malls on busy days.
Sit down to do tasks that you usually do standing.
Allow time for taking mini-rests within that task time.
Flickering fluorescent lights, television and computer
monitors can cause tiredness in some people.
=
Limit your intake of fluids during the evening to avoid
having your sleep disturbed by a full bladder.
limit drinking after 6pm
If necessary, don’t go alone, and ask for assistance.
If possible, avoid shopping during the school holidays.
Carefully plan activities to avoid doing too much and
be aware of too much stimuli.
Cate’s experience
When someone is taking you somewhere, hand over some of the responsibility
for getting there and back. It will save your energy for useful tasks and help you
to be less stressed.
31

Headaches
Headaches are the most common physical complaint people experience
after trauma to the head or neck. A headache can be the result of a
number of different factors, such as pressure from your neck or the base
of your head. You may also get a stabbing headache that may last a few
seconds. Headaches can also be caused by a lack of water (dehydration)
or stress.
Keep a diary of your headaches. Every time you have a headache, recall
the date, time of day, foods recently eaten, your emotions, level of activity,
and anything else you feel is relevant. A diary can help you to modify
your environment and eliminate potential causes of headaches.
Talk to your doctor about possible solutions or ways of coping with
headaches.
Foods that may trigger headaches:
Chocolate
Alcohol (especially red wine)
Avocados
Bananas
Some types of beans
Cheese
Peanut butter
Peas
Pizza
Sour cream
Chicken liver
Coffee
Cured meats (such as bacon, ham)
Fermented, pickled, or marinated foods
Monosodium glutamate (MSG)
Nuts
Onions
Vinegar (except white)
Yeast-raised breads and cakes
Yogurt
Wheat
Sugar
Dairy products
Nutrition is important - eliminate from your diet any foods
that may trigger headaches. If you are not sure which foods
these may be, use the list above as a guide.
32

Ways of coping
Try not to do too much, especially immediately after
your injury. It may be best to aim to do only 2-3 tasks
a day.
Drink water regularly throughout the day and drink
more if you are exercising. It can also help to take
bottled water with you when you go out.
Take time out, either to go for a walk or sit outside in
the fresh air and sunshine - try to relax.
Physiotherapy to loosen up muscles in the base of the
neck, or swimming gently in warm water can also help.
Aquajogging or aquacise can help too.
Use relaxation techniques, breathing or meditation
exercises.
Cate’s experience
The back of my head still aches all the time. The brain ache feels like my brain is
very inflamed and crashing around to get out of my skull - like a game of squash
going on in there. The skull ache is either all over, in one section, or a fine line
along the left side, or is in the middle of my forehead.
I try walking in the fresh air, drink water, rest or get involved in some activity
that helps take the focus off the ache. Medication is usually my last resort for
really bad headaches.
33

Seizures
What are Seizures?
A seizure is a sudden, temporary, unusual discharge of electrical impulses
in one specific area of the brain that may quickly spread, causing
uncontrolled stimulation of nerves and muscles.
Why seizures can occur after a brain injury
Anything that disturbs the normal pattern or activity of the brain can
lead to seizures, which may also be the result of trauma to the brain.
It is not clear what causes seizures but some neurologists think that
trauma excites the nerves within the brain, causing them to go out of
rhythm. A seizure is the body’s effort to correct this irregularity.
Seizures can generally be classified as either “simple” (no change in the
level of consciousness) or “complex”. Seizures may also be classified as
generalized (whole body affected) or focal (only one part or side of the
body is affected).
Most seizures last from 30 seconds to 2 minutes and do not cause lasting
harm. However, it is a medical emergency if seizures last longer than 5
minutes or if a person has many seizures and does not wake up between
them. Seizures can have many causes, including medication, high fever,
brain injury and certain diseases. People who have recurring seizures due
to a brain disorder have epilepsy. Some types of epilepsy are hereditary.
What is Epilepsy?
One in fifty people have epilepsy at some point in their lives and epilepsy
usually affects 1% to 2% of the population. The people affected have
recurring and spontaneous seizures.
Epilepsy can be caused by a severe head injury, stroke, birth trauma, brain
tumour, toxins, brain infection, brain disease, genetic conditions or drug
abuse. In many cases, the cause is unknown.
34

Ways of coping
Take all prescribed medications as directed by your
doctor. If you are having problems with a particular
medication, tell your doctor.
Make sure you eat well and have plenty of sleep and
rest. Avoid stimulants such as coffee, tea, energy drinks,
soft drinks, chocolate and nicotine (smoking) as they
may trigger seizures.
Taking regular exercise is beneficial for overall health,
(for example, swimming, using the gym, yoga, walking)
but avoid strenuous activity that may trigger a seizure.
Always consult your doctor for advice before you
start on an exercise programme.
If you drive, it is important to talk to your doctor
about whether it is advisable to do so. You may need
to wait or be assessed before driving again. Check
with your insurer also.
Avoid any activities or sports that could be dangerous
to yourself and others until your medication dosage
has been regulated.
Avoid unnecessary stress and lack of sleep as these
two conditions can trigger seizures.
My
Seizures...
Let others know about your seizures as this will help
to make them more comfortable, as well as providing
you with valuable help and support.
35

What is wrong?
Movement, Balance,
Co-ordination
and Dyspraxia
The movement and balance parts of the brain may have been damaged
which may mean you either cannot move certain parts of your body or
they will not do what you want them to do. In effect, it may be hard to
co-ordinate parts of your body.
With DYSPRAXIA, the messages from the brain to the parts of the
body you want to move are getting scrambled. A person with dyspraxia
may look as if they are uncoordinated, or when given a command, can not
perform that command immediately.
Ways of coping
A physiotherapist can help improve your movement
or adapt the way you perform a movement to make it
easier.
2
1
3
4
Break down tasks into a series of activities.
Rest between activities.
Repeat each specific activity with physical, verbal or
visual cues, such as an instruction board.
When you get better at each activity sequence, then
the verbal, visual or physical cues can be gradually
withdrawn.
36

Ways of coping
Let people know that you have problems with
movement and/or co-ordination as they may think
you are being lazy, clumsy or are drunk. Practise ways
of saying this that you are comfortable with. Role play
if necessary.
Try different techniques such as the Feldenkrais
method - a series of movements designed to retrain
the body’s movement patterns for pain control and
more efficient motor function. Tai Chi and dance
therapy can also be helpful.
Tricia’s experience
I find walking on soft ground (dirt tracks or sand) very beneficial, rather than
walking on solid footpaths. I also have difficulty walking on uneven surfaces
such as stony riverbanks.
I do find that riding a bike is very good for my lower back pain as it seems to
put me in alignment.
Shane’s experience
I have paralysis on my right side so my balance is not very good. If I find an
area of my body that’s not working very well, I keep working on it. When I first
started walking, I practised a little bit every day, setting small but achievable
goals. Gradually I made the ground a little bit uneven and progressed onto that
as my confidence with walking grew.
When I am tired, my balance is worse. You need to be fresh and rested.
37

The Five Senses:
Touch, Smell, Taste,
Vision and Hearing
What is wrong?
You may not be able to see, hear, smell, taste or feel things as you did
before your injury, and fatigue commonly affects your senses too.
Hypersensitivity is when your skin is extra-sensitive and even light
touching may be uncomfortable.
Why can’t I feel things or why
do they feel different?
You might not have actual damage to the sense organs such as the skin,
eyes, ears or tongue. With a brain injury, the damage has happened in
a part of the cerebrum called the sensory cortex, which receives the
sensations you feel.
Ways of coping
For vision problems, tinted lenses may help if your eyes
are sensitive to the light. The use of an eye patch can
help double or triple vision. Ask your OT to refer you
to a recommended Optometrist if you have any vision
concerns.
To help with touch sensation, rub different textures
over your skin.
Be extra careful with appliances, hot objects or fumes.
38

Ways of coping
Use a timer when cooking and make sure you have a
smoke alarm in the kitchen.
If you are cooking, try not to get distracted - it might
pay to keep the phone off the hook or not answer
it. You may want to use simpler methods of cooking
such as a microwave oven.
To help with taste, try spicy foods or foods with
different textures. This will make eating food an
exciting experience.
When rested and alert, you may notice flavours and
taste more of them.
Shane’s experience
My taste and smell is affected. On my first bite, I can taste it, but when I take the
second bite, I can’t, although when I’m fresh and rested, I can taste food better.
Cooking can become an issue as I need to write down the ingredients I put into
the recipe as taste testing doesn’t work. I don’t go on how I think it tastes, as if
I did, it would be too spicy or salty. If I think the food tastes nice, then it will be
too hot for my partner. And although my sense of smell is affected, there are
the benefits of not having smell in some areas!
I use noise-cancelling headphones to block out extra noises such as computers
and buzzing sounds. People just think I’m listening to music so I don’t look silly,
but it cuts out all the background noise, which is great.
39

Swallowing
(Dysphagia)
Dysphagia is a chewing and swallowing disorder which can occur after a
traumatic brain injury which affects the co-ordination of the swallowing
muscles.
If you have dysphagia, you may have difficulty swallowing, or you may
be experiencing pain while swallowing. Some people have difficulty
swallowing liquids, foods or their saliva. If you cannot swallow normally,
you are at risk of not eating the right foods in order to stay healthy or to
maintain your normal weight. Other risks are foods or liquids entering
the windpipe and becoming stuck, which you may be unable to clear by
coughing or clearing your throat.
Ways of coping
It may be easier for you to eat pureed food, soft food
and thickened liquids to get enough calories. Also avoid
dry foods and breads as these may get stuck in your
throat. Also avoid spicy foods as these can produce
acid reflux.
Try eating several small meals instead of three large
meals a day.
Sitting upright when eating helps food go down easier.
Talk to your rehabilitation team members such as the
dietician and speech language therapist about ways to
manage your swallowing difficulties.
40

Bladder and Bowel
Issues (Continence)
Following an acute brain injury, you may have continence accidents.
Continence means voluntary control over going to the toilet, incontinence
means you are unable to control when you go to the toilet. Continence is
both a cognitive and physical skill – in that the person recognises the signs
that they need to visit the toilet and then acts on the signs. After a brain
injury, these basic skills may need to be relearned or extra time may need
to be allowed. Other factors that can affect continence are medication,
physical disability, communication difficulties and embarrassment.
In cases where incontinence is prolonged, people are usually catheterized,
which involves placing a tube in the bladder. Once the catheter is
removed the person will be retrained until he/she relearns the messages
and signs to use the toilet. Doctors and nurses will help you to establish
a routine.
Ways of coping
When you go out, be aware of nearby toilets in case
you need to go. Make a practice of going to the toilet
before you leave home.
Carry spare clothes and soap with you in case of an
accident.
Wear special incontinence pads if you think you might
have an accident. Have spares handy.
41

Ways of coping
Ask your doctor about medication that can help with
incontinence.
Shane’s experience
Early on, I used to write in my diary if I had been to the toilet because I would
forget if I’d gone or not, and think I’d need to go even if I’d just been. A lot of
the time, your body doesn’t know, so I’d think, ‘Do I need to go to the toilet?’,
and if it’s written down, it’s easy to know if you might need to go again. This is
especially important in the initial stage after your accident.
Melinda’s experience
I didn’t have a problem until my stress levels increased. My clinical psychologist
told me that changes in bowel function, such as having diarrhoea or constipation,
can occur from increased stress levels.
Another thing was that I had constipation because of the pills I had to take. A
doctor said to me I can either take more medication to alleviate the constipation
or have kiwifruit juice everyday. It was the best advice I was given. Now when I
take my pills, I have my kiwifruit juice - it is part of my medication routine.
42

Cognitive
Thinking
(Cognitive)

Chapter Contents
Vision and Perception Issues
Page 45
Communication Issues / Aphasia
Page 47
Planning, Organising and
Problem-Solving
Page 49
Attention and Concentration Issues
Page 51
Memory Issues
Page 54
44

Vision and Perception
Issues
You may be confused by similar sounding words or not understand what
people are saying. You may have difficulty with vision and you may have
a lack of awareness of one side of your body.
Why is my brain slower at understanding and
acting upon information?
Your brain may have been shaken and the millions of pathways that
carry information may be damaged, which means they no longer run as
smoothly and quickly as they did before your brain injury.
Ways of coping
Create your environment. If you need peace and quiet,
go where that is available.
If you can only handle short periods of conversation,
let other people know this.
Take a dictaphone to record conversations if you think
the conversation will be longer than what you will be
able to cope with.
45

Ways of coping
If possible, ask for written as well as verbal formats so
that you can check and double-check your work.
Use maps where possible. Mark where you need to go
and where you have come from.
Cate’s experience
If you can’t bear looking at maps, I find it helpful to ask someone to take me there
first and check out steps and stairs etc. The second time I go alone prior to the
appointment and the third time I make the journey, I can function when I’m there
(at the destination).
46

Communication
Issues / Aphasia
What is wrong?
Expressing yourself or understanding what you hear or read may be
affected by your brain injury. Speech may be unclear or it may be hard
to find the words you want. Poor memory or attention may affect your
ability to talk or recall information. It may also be more difficult to follow
the social rules of conversation than before your brain injury.
Aphasia is when you have problems with speech and comprehension
of words. Depending upon the damage to the brain, it may mean you
can speak, but not write, or you may be able to sing, but not speak.
Another common form of aphasia is when you say one word when you
meant to say another, such as ‘Pass me the fridge..’ when you meant to
say, ‘Pass me the butter...’.
Why?
As a result of your injury, there may have been damage to a cranial nerve
in the brain which affects the way you speak or swallow food.
Ways of coping
Look at people’s facial expressions to see what they
are saying.
Try to have important information written down in an
easily accessible place that you will remember.
A speech language therapist can help you with
communication difficulties, such as expressing yourself
clearly.
47

Ways of coping
Pause and take a breath before speaking.
Take your time.
Be aware of repeating yourself or how often you say a
phrase (for example, ‘have I told you about?).
or
Talking is a lot harder when you are tired. Try to rest
if you are having difficulty talking.
Melinda’s experience
In the beginning, I lacked the ability to communicate socially and nicely, so I’d just
come out and say what I thought. There was no social build-up, so no social niceties
such as ‘Hi, how are you?’. I’d just state what I wanted or needed. This came
across as rude to other people but I wasn’t aware of being rude. Your brain is in
survival mode, so you say the minimal amount. All the ‘fluff’ that goes on around
conversations is not there; you have to relearn that again.
Shane’s experience
I really try not to think that I know what the person is about to say. I prefer to
see people in person as I find their body language helps with what they are
communicating to me – it’s easier to interpret what they might be saying if you
can see their facial expressions.
I also try to let people talk. I’m a big talker so I need to let people have a chance
to talk and I try to make sure I hear all sides to the story before making up my
mind.
48

Planning, Organising
and Problem-Solving
If you have damaged the front part of your brain – the frontal lobe - you
may have problems with planning activities, getting things in the right
sequence and evaluating possible errors. Because of this, you may find it
difficult handling multiple activities.
Ways of coping
Your Occupational Therapist can assist in planning and
organising your time to achieve your daily tasks.
Do one thing at a time.
Plan what you are going to do, then write a list and tick
off as you go. Have lists for different activities that you
do on a regular basis. Laminate your list and put it in an
obvious place to remind you.
Do not rush, take your time.
49

Ways of coping
1. Turn on jug
2. Get cup
3. Put in tea bag
4. Pour water
5. Pour milk
6. Drink and
enjoy!
Write down each step or activity.
Break tasks into small steps.
Keep stimuli or noise down to a minimum.
Paper diaries are great for people who prefer not
to use electronic diaries such as a cell phone
or computers.
Do not be too proud to ask for help, and if help is
offered, accept if needed.
Cate’s experience
If I have a plan and someone else makes a change, I am likely to have an
accident, or other symptoms kick in until I can process the changes that I
haven’t made. I cannot carry out someone else’s plan until I have had the
chance to process it.
Melinda’s experience
Before my accident, I loved projects and completing tasks and goals. After
the injury, I lost my ability to multitask. I remember saying to the health
professionals, ‘I’ve become a bit like a man, I’ve lost my ability to multitask’. We
all had a laugh.
50

Attention and
Concentration
Issues
Attention is a process which lets you focus on information coming in
from your surroundings. Concentration requires your attention for a
set period of time. You may not realise that your ability to concentrate
is any different to what it was prior to your injury. You may be more
easily distracted or have trouble keeping track of what is being said or
done. People may mistake your inability to maintain attention as a lack of
motivation or intelligence.
Attention can be divided into five levels:
• Focused attention
This is the kind of attention used when we are actively attending to
something. It is our ability to attend to one thing to the exclusion of
everything else. For example, when you are studying or driving.
• Sustained attention
The ability to concentrate on one task for a certain period of time
without switching off. Many people with a brain injury find they lose
concentration quite quickly.
• Selective attention
This is when you have the ability to avoid all distractions and focus on
one thing. For example, after a brain injury you may not be able to read
a letter when there is a radio playing in the background.
• Alternating attention
The ability to shift the focus of attention and to alter it
between tasks.
• Divided attention
This is the ability to respond to multiple tasks at the same time, or to
give two or more responses simultaneously. For example, you might be
watching television while eating your breakfast. After a brain injury, some
people find that they are unable to concentrate on more than one thing
at a time.
(Referenced from www.headwayireland.ie/)
51

Ways of coping
Keep to regular sleep times and before periods of
attention and concentration, remove yourself from
stimulus to a quiet place.
Be aware of times when you may be more alert, such
as in the mornings.
When setting out tasks, consider what steps are
involved in order to complete the task.
If possible, try to eliminate background noises such
as radios and people talking. Try using earplugs or
noise-cancelling headphones.
Silently tell yourself ‘Pay attention!’.
Ask people to repeat themselves or speak slower if
they are speaking too fast or you do not understand
them.
Have regular breaks.
52

Ways of coping
John
John
John
If someone tells you their name, a way to remember
it is to repeat it back to them. It may also help to
paraphrase what has just been said to you to let the
person know you understood what they have said.
Answerphones are useful as you can keep listening to
them for clarification.
Write down or record distracting internal thoughts
to get them out of your head until you have
time to think them through.
Cate’s experience
I frequently forget mid-sentence what I’m talking about so I usually ask the other
person what was I talking about. I also might say ‘cupboard’ instead of ‘fridge’ or
‘chapter’ instead of ‘page’.
53

Memory Issues
What is memory?
Your brain has suffered damage and as a result you may have difficulty
remembering things in any of the three categories below. Things that
may make your memory worse are a lack of sleep, stress and fatigue. It
is important to remember that the memory is like a muscle - the more
you use it, the stronger it gets.
There are three types of memory:
Immediate/sensory memory
Short-term memory
Long-term memory
held for a few seconds
held for a bit longer
consists of memories of personal
experience, learned behaviour
and knowledge and information
Loss of memory is also called amnesia.
Types of amnesia include:
Anterograde amnesia
Retrograde amnesia
Global amnesia
memory loss that occurs following
the event that caused the brain injury
memory loss that occurs prior to the
accident or event that caused the brain
injury.
a total loss of memory
Ways of coping
Use a diary, notebook or dictaphone everyday.
54

Ways of coping
Wall calendar planners or computer calendars are
very useful.
Label things such as household items, rooms or
anything you have difficulty remembering.
Write ‘to do’ lists for each day.
Have a place for everything in your home, such as a
filing system for bills and letters.
Make sure you keep it in an easily accessible place.
Keep a pack of post-it notes with you to remind you
of tasks.
Use a watch with an alarm to help you remember
things such as when your dinner is cooked. It may also
be helpful to use an oven-timer.
Repeat things to help you remember them, such as
people’s names. Try not to take it personally or think
badly of yourself if you forget.
55

Ways of coping
Create an association with a name by relating it to
something else - maybe a picture.
Put things back in the same place after use.
Shane’s experience
I have a little diary or notepad and find they are better than pieces of paper
everywhere. I use my reminder on my cellphone a lot too. My memory has
been affected like a lot of people with brain injuries. My short-term memory is
OK, but my mid-term memory is bad, so I have problems remembering, anything
around five hours ago, but my long-term memory is OK. I also try to associate
words with people’s names, like if they are tall and their name is Tanya, I think,
‘tall Tanya like a tree’. Plus I’ll repeat people’s names back to them to help me
remember their name.
Melinda’s experience
My memory is coming back as it’s getting better all the time. I found the worst
thing affected was my short-term memory with my medium and long-term
memory not so much. When I get fatigued, I turn into what I call ‘brain-injured
Melinda’ . I know it is just me, but I really don’t like ‘brain injured Melinda’. She
has no tolerance for others and no short-term memory.
In the beginning, I had trouble recalling things. A major problem I was having was
that I’d have breakfast and wash my dishes, then I’d have breakfast again and do
this sometimes up to six times. I put on two-and-a-half stone, until I realised what
was going on. Now I wash all my dishes from the day before, have breakfast, and
leave the dishes to let me know I’ve eaten already.
My brain injury likes routine. Routine means the brain can conserve energy. Now
I have lots of ways to save energy.
56

Emotional
Emotional

Chapter Contents
Anger, Frustration,
Depression and Anxiety
Page 59
Sexual Issues
Page 62
Behaviour, including Self-Centredness
Page 65
Lack of Motivation
Page 67
Emotional Extremes
Page 69
58

Why do I feel like this?
Anger, Frustration,
Depression and
Anxiety
After a brain injury, you may experience feelings of anger and irritability.
This is because there is often direct damage to the parts of the brain that
are involved in controlling behaviour. You may feel as if you are on an
emotional roller-coaster and little things may upset you.
The middle section of the brain is quite primitive, much like an animal’s
brain. This is the automatic response area of the brain which means that
you do something without consciously thinking about it. The front part of
the brain is the bit that rationalises before you ‘act upon your emotions’.
It may be this part that is damaged, making it hard for you to control the
way you act and feel.
Ways of coping
When you feel very angry and want to hit out at
something or someone, try to redirect your thoughts
away from who or what is making you angry.
Some people find that deep breathing and relaxation
techniques such as yoga can be helpful. These can be
particularly helpful before you sleep.
Sorry
If you have upset someone as a result of your actions
or words, make them aware that it may be as a
consequence of your injury. It might be helpful to also
apologise to them.
59

Ways of coping
If possible, begin a light, daily exercise programme.
Try not to be too hard on yourself. Lowering your
expectations of yourself and/or others will lower
anxiety.
1 2 3 4 5
6 7 8 9 10
Count to ten. It’s simple and a good distraction.
If you feel you are ‘losing it’, remove yourself from the
situation and calm down before returning.
Express yourself assertively. Talk it out, rather than
bottling it up and allowing resentment to build.
Find someone who is prepared to listen.
Identify the triggers - recognise the situations that
wind you up, then either avoid them or work out a
better way of coping.
Take time out for at least 15 minutes if you feel you
are about to lose control. The more time out you
have, the more you learn to control your feelings and
outbursts.
60

Ways of coping
Talk through how you feel with somebody who is a
good listener.
Get involved in a brain injury support group, as talking
to others in a similar situation helps.
Ask yourself ‘What can I do?’, not ‘What can’t I do?’
Try not to focus too much on yourself and be more
aware of how others are feeling.
Melinda’s experience
After my accident, people such as bus drivers and supermarket staff often
thought I was angry at them as I’d raise my voice, but I was just frustrated
at myself, at my inability to communicate with them effectively. However, I
found ways to avoid that, such as sitting down to rest for 5 minutes before
catching a bus. I also go to the supermarket at less busy times, such as early
in the morning or late at night.
Shane’s experience
I was placed on depression tablets after my accident. I hate medication
and I like to do things as naturally as possible, so I tried to get off them as
soon as possible. Doctors told me I’d never play sport or work again, so I got
depressed and for good reason! I remember I went for a walk into a part of
the hospital where there were people worse off than myself and I actually
felt lucky. I try to concentrate on the positive aspects of what I can do and I
do the things I enjoy, such as gardening. I really love the feeling of dirt on my
hands, it’s very relaxing.
61

Sexual Issues
Sexual difficulties can occur after a traumatic brain injury which will
depend on the severity of the injury. Some people may feel embarrassed
or uncomfortable talking with hospital staff about their concerns. So
information about sexual difficulties and problems is very important.
Why is sexuality affected by a brain injury?
In the centre of the brain there is a structure known as the hypothalamus,
which plays an important role in regulating sex drive by controlling the
release of sex hormones. Following an injury, this part of the brain can be
damaged and result in sexual appetite and behaviour being affected.
After a brain injury some people may find that they are
experiencing changes to their sexuality which may consist of
the following:
• A lower sex drive: some people comment that they have a lower
sex drive after a traumatic brain injury. While others comment
that there has been no change or that their sex drive has
increased.
• Disinterest in sex or not having sex as often as before the injury:
This can be due to sexual problems, relationship break-ups,
problems in forming new relationships, depression or stress, and
physical disability.
• Problems with erections: some men experience erectile
problems or impotence for a short time after a traumatic brain
injury.
• Problems with orgasms: some men may have problems with
having orgasms. This does not appear to be a significant problem
for women after a brain injury.
Certain medications can lessen your sex drive, you will need to talk to
your GP about whether the medication you are taking may be a cause.
Other factors are fatigue, stress, depression and anxiety. Depression,
anxiety and stress are common after a brain injury and can affect a
person’s sexuality by lowering their sexual response and desire.
62

If the brain injury occurred in a car accident, the person may have
sustained other injuries, e.g. spinal cord damage, injuries to the pelvis and
hip bones or nerve damage. Any of these injuries will have an affect on a
person’s sexual functioning.
Other factors that can affect your sexuality after a brain injury is
something called ‘sexual disinhibition’ this is where the person with a
traumatic brain injury does or say something that is inappropriate or that
may cause offence.
People often ask the question, when is it ok to resume a sexual relationship
after a brain injury. Like any other activity, sex can make your heart beat
faster, if you have been having regular exercise then this should be ok.
Fatigue is probably the biggest problem as you may tire easily after sex.
Communicate with your partner, let them know how you feel and share
any worries that you may have. If you feel that you are not ready physically
and emotionally then wait until you feel that you are ready.
It’s important to discuss any concerns that you have with your doctor
counsellor or family member. If you are a member of a Brain Injury
Support Group, the support worker will be a valuable source of help.
Ways of coping with DECREASED sexual interest
Try some relaxation techniques such as meditation,
yoga or tai chi.
Communicate openly with your partner. Maybe ask
them for physical contact of a non-sexual nature.
Sometimes counselling or other therapies can help.
Making an effort with your appearance can help to
boost confidence and self-esteem.
63

Ways of coping with INCREASED sexual interest
Accept and acknowledge any inappropriate behaviour
you may be displaying to others.
Communicate and be open with your partner about
your increased sexual desire.
If someone you like does not share the same feelings
you have, do not worry too much as this can happen
to anyone.
For further information, ask a counsellor or
psychologist to recommend books or other sources
of information that may be helpful.
Melinda’s experience
There was a man and a lady living in an old persons’ home. They had liked each
other for a long time. One day, the man finally plucked up his courage and said,
‘Mabel, would you like to go upstairs and make love?’.
Mabel replied, ‘Oh Arthur, I can only manage one or the other!’
- and I thought “That is so brain injury - only one task at a time!”
64

Behaviour, including
Self-Centredness
Why am I acting like this?
Because of your injury, you may behave in a way that others around
you feel is childish or inappropriate. Perhaps you have been resentful
of people telling you what and what not to do. Appropriate behaviour
will need to be relearned. Be aware of what others say to you, because
although you may think what you are doing is fine, it may not seem
appropriate to those around you.
Ways of coping
Consult a therapist if you have concerns that people
are ignoring you. They may be able to help with advice
on how to engage with others.
If others tell you that you are acting inappropriately,
listen to them. Ask your friends to be open and
honest.
Practice stopping and thinking things through before
acting them out.
Keep a diary and record details of your thoughts and
feelings - this will help you to become better at sensing
when you are about to do something inappropriate.
65

Shane’s experience
Behaviour and self-centredness – that’s a big one with people with a brain
injury. People are quite self-centred, so I always tried to think of other people.
I try to take time out before I act and not tell people about my injury as you
don’t need to tell everyone everything. Try not to get angry when people say ‘I
forget all the time’, because often people do forget things. I find it helpful to
think that I’m not the only one with a problem.
Cate’s experience
Yeah, I think I got self-centred after my injury. I regret it afterwards and wish I
had listened to others more.
When you are with others, try to gauge when it’s OK to talk about yourself, and
just enjoy being with others. You can recover later without others knowing, and
you’ll still be able to enjoy their company at other times too.
I’ve also found that it’s good to be aware of what other people may be feeling
or coping with. Their load may be as difficult, yet different from yours.
66

Lack of Motivation
Lack of motivation is a direct result of frontal lobe damage. You may
be unable to plan activities or ‘think about the future’. Thinking about
goals can often be overwhelming. It may seem easier to sit back and do
nothing.
As time passes, a lack of motivation can lead to friends not contacting
you, a lack of pleasure and a kind of ‘depression’ or numbness of the
mind. A lack of motivation can lead to isolation.
Ways of coping
Break down activities into small steps - this will make
them seem less overwhelming.
Focus on each step, one at a time.
Get involved with a brain injury support group. This
will lead to support from other members with similar
issues.
Structure your day and get into a regular routine. This
will encourage you not to rely on your own motivation
to do things.
67

Ways of coping
Recognise that your lack of motivation is not a sign of
depression and help make family and friends aware of
this.
Set short-term and long-term goals.
Write down your goals and put them in an obvious
place.
10 min
of
Tell people about these goals. This will ensure that they
keep asking you about how they are coming along and
provide accountability.
Donald’s experience
I might not be as quick doing jobs or other things now, but I do get them
done. I don’t pull out halfway through, or what I’m doing will never get done.
It’s about just getting things done.
Shane’s experience
I set myself goals, even if they are small ones like setting a time to get up.
I plan ahead and then I’m motivated to get up, even if it’s to do some cleaning
or helping the neighbours. I try to ask busy people to do things for me as they
are usually well organised so tend to get things done!
I also tell people my goals, and then there’s a high chance they will ask you
about them down the track which motivates you to carry out the goals.
68

Emotional Extremes
Why do I feel like this?
Emotional extremes are generally due to damage to your frontal lobe, or to the
parts of the brain that produce certain mood neurotransmitters, such as serotonin.
You may also suffer from frequent mood swings.
Due to your injury, your emotions may be affected. They may be either really intense,
or may seem to have disappeared. Some people say it feels like you are a robot.
At the other extreme, you may want to laugh or cry at the smallest of things.
Ways of coping
If you feel flat, keep a diary monitoring your emotions
and try to link your thoughts to feelings. This will help
link up the pathways between thought and emotion.
If you are highly sensitive to emotions, change the topic
of conversation or distract yourself with an activity.
As a way of distraction, try to do the opposite of what
you are doing physically (e.g. change from sitting to
standing).
Explain your situation to others and make a joke of it
if you can.
69

Ways of coping
Be open about the situation. People should understand
that your actions are due to your brain injury.
Do not be afraid to get professional help.
Shane’s experience
Since my accident, I get very emotional – I love watching “chick flicks” with
my wife now. I actually find with action ones, there’s too much happening, too
much of a story line, whereas chick flicks are just about love and it’s quite slow
paced – my wife thinks it’s great! I do cry though, and I’m not embarrassed as
it’s actually a beautiful emotion.
Melinda’s experience
Before my brain injury, I only ever cried if something, or someone died. Now I
have found myself bursting into tears, for example when I went into a car repair
place, they did a small repair and didn’t charge me and I burst into tears with
gratitude, and that’s so not me. It’s like I can’t control these little outbursts. Also
I freak out if my routine is changed unexpectedly, especially if I’m fatigued.
70

Life after
brain injury
Life

Chapter Contents
Brain Injury in New Zealand - Statistics
Page 73
The Rehabilitation Team
Page 74
Family / Relationships
Page 77
Getting Back to Work
Page 84
Driving After a Brain Injury
Page 88
Nutrition / Alcohol
Page 92
Exercise / Brain Gym
Page 96
Socialising / Recreation
Page 98
72

Brain Injury in
New Zealand – Statistics
10,000 to 17,000 people per year
acquire brain injuries in NZ.
50% of severe brain injuries
are due to car accidents.
According to the Brain Injury Association,
brain injury can be caused by the following:
• In 2006, the New Zealand Guidelines Group
and ACC, estimated that approximately
10,000 to 17,000 people needed hospital
care for a brain injury.
•
• 8% to 10% of those admitted to hospital
with a brain injury will be in the moderateto-severe
category.
•
• 50% of those admitted to hospital with a
severe brain injury will be due to motor
vehicle accidents.
traffic accidents
injury at birth
sporting accidents
tumours
accidents at home
drug and alcohol abuse
industrial accidents
near drowning
strokes
other factors
Some groups in the community are more likely to have a brain injury than others:
Young adults aged 15 - 19, especially males.
Children in the age group 0-4 years as a result of falls from
playground equipment, windows and stairs, and physical abuse.
The elderly aged 60 or over, mainly from falls in the home.
73

The Rehabilitation Team
These are some of the people who may be involved in your recovery.
They are here to help you become as independent as possible.
Doctor
The doctor is the team member responsible for your
rehabilitation programme and for taking care of the medical
aspects of your treatment. The doctor keeps you, your family
and referring doctor informed about your progress.
Key/Primary Nurse
Nurses work with the rehabilitation team to solve problems
and manage medical issues. Key / primary nurses are experts
in bladder, bowel, nutrition, pain, skin integrity, breathing, selfcare,
co-ordination of medical regimens and related issues.
They provide ongoing patient and family education and help
you set goals for maximum independence.
Occupational Therapist
An occupational therapist (OT) is skilled in helping you
learn, or relearn, the day-to-day activities needed to achieve
maximum independence and quality of life. OTs offer treatment
programmes to help you with bathing, dressing, preparing a
meal, house cleaning, arts and crafts activities or gardening.
They make recommendations and offer training in the use of
adaptive equipment to help with issues related to your injury.
OTs also help with any changes you might need to your home
or workplace.
Physiotherapist
A physiotherapist’s aim is to help you increase your physical
strength as well as improve your co-ordination, reduce
spasticity, maintain muscles in paralysed limbs, protect skin
from pressure sores and help you gain greater control over
bladder and bowel function. They can also teach you to use any
assistive devices you may need, such as a wheelchair.
74

Speech and Language Therapist
A speech and language therapist (SLT) helps with problems you
may have with your speech, language, and communication skills.
You may need help in making your speech easier to understand
or in being able to say what you want in speech or writing.
You may be having a hard time understanding what people are
saying to you or you may have some difficulty reading. The SLT
will work with you to improve your skills and will also help
you learn ways to deal with these changes. You may also
have problems with swallowing as a result of damage to the
brain stem. A speech and language therapist can help in this
area too.
Dieticians
Dieticians are specially-trained experts in food and nutrition
and aim to promote good health through good nutrition. They
will advise you about your nutritional requirements which are
important in promoting recovery and healthy living.
Clinical Psychologist
Clinical psychologists are involved in dealing with the emotional
and behavioural problems that occur after a brain injury.
Neuropsychologist
Neuropsychologists are clinical psychologists who specialise
in brain injury and behaviour. They will carry out assessments
to identify problems you may have with thinking, memory and
perception. A Neuropsychologist can help you to understand
the changes in your thinking, memory or behaviour that
are due to your illness or injury. You may be given tests to
assess a range of thinking and memory skills. The results of
these tests can help to create the right treatment for you.
The Neuropsychologist can also assist you and your family to
understand how changes in thinking and behaviour may affect
living in the community.
75

Social Worker
The social worker will help you to maintain and strengthen
links with family, friends and the wider community and assist
with access to community resources and entitlements.
Social workers are responsible for arranging social security
benefits, and ACC benefits and also arrange appropriate
living accommodation once you are ready to return to your
community.
Other therapists you may find in the rehabilitation
unit include:
• Recreation therapists/officers who can help you discover the wide
range of recreation options available in their community.
•
•
• Vocational rehabilitation specialists who can help you assess your job
skills with a view to returning to work. A vocational rehabilitation
specialist will arrange additional training and educational opportunities
to help you achieve your vocational goals. They also work with other
agencies to obtain equipment, training and placement.
76

Family / Relationships
Your brain injury will have a big impact on your family, especially if you are
experiencing emotional or behavioural problems because of your injury.
Families that cope better with a brain injured member, seem to have a
more flexible attitude and embrace change, seeing it as a challenge rather
than a problem. It helps if there is open communication between all the
parties involved, from the person who has had the injury to the family
and the professionals involved in the rehabilitation process. The family will
also need to have a positive attitude, treating the person with warmth and
respect and not seeing him/her as a burden.
Family members will generally go through a series of emotions after you
have had your injury. These are:
Shock and panic.
Seeing you injured can create feelings of anguish, confusion,
hopelessness and frustration at having no control over
the likely outcome.
Relief, elation and denial - there is
disbelief at what has happened.
Once the life-threatening phase has passed, there
is often a sense of relief. Your family will be full of
expectancy, optimism and hope for a full recovery.
They may want to deny or ignore changes in you.
Denial of the consequences of your injury may be
strengthened by a number of factors. Medical predictions about your
recovery may be different to what has actually happened in terms of your
recovery. Doctors may have said you would remain comatose or never
walk or talk again and yet, in reality, you may have made a better recovery
than predicted. This may cause you to lose faith in the medical profession
and what they tell you. In reality, it is extremely difficult to predict your
outcome, especially over time. An awareness of the reality of your injury
usually comes after you leave hospital and are back home.
77

Hope - things are hard but
they will get better.
Due to the uncertainty surrounding the exact outcomes
of your brain injury, family members will often focus
on a physical disability that may show relatively rapid
improvement, rather than cognitive and behavioural
changes, that tend to take longer to show an improvement.
They may assume that with faith, determination and hard work, problems
will be overcome. Alternatively, there may be an expectation that medical
science will find a cure for your injury.
Realisation, anger, depression
and mourning - the family
member may not get better
The reality of how your injury has affected your life will
become apparent once you leave hospital and go home.
You may start to feel angry at either yourself, your
family, medical staff or anyone involved in your accident.
There may be feelings of guilt or regret over what could
have been done to prevent the injury. There may be disruptions in the
relationships you had with different family members, such as your partner,
your children or your parents. They may find that they also need to help
you with your recovery.
Acceptance and recognition -
it’s time to get on with life, even
though things may be different.
Although this stage of your recovery may take a long
time to arrive, it will happen. That’s not to say you will
not revisit past stages, but a form of acceptance should be possible for you
and your family.
78

Ways of coping for YOU
Avoid triggers that may make you angry,
such as a specific person or place.
Breathe,
count to 10
If you feel that you are getting angry, try to calm
down by taking a few deep breaths, count to
ten and talk to the person about the issue or
problem.
Sometimes your family may be right and their ideas
may be good ones - be open to their suggestions.
You may need to prove your abilities to your family
members a few times (for example, driving a car).
Other responsibilities and privileges will return
once you have shown them your capabilities.
Be patient.
Communicate respectfully with family and friends.
This may be hard if the part of your brain that
controls anger is damaged. You may need help
with retraining in communication skills.
Support Group
Encourage family members to join a brain injury
support group with you.
If your relationships with family members and
friends are strained, seek outside counselling.
79

Ways of coping for YOU
Generate fresh friendships and networks.
Ways of Coping for
FAMILY AND FRIENDS
Acknowledge that in the early medical stages,
the situation is out of your hands. Trying to take
control will only lead to frustration and panic.
Express how you are feeling and make sure you
do not bottle your feelings up.
Learn relaxation techniques. It is important you
take time out in order to be there emotionally
and physically for the affected family member.
Delegate responsibilities as people will often want
to help but do not know how.
Take one day at a time - this makes it easier to see
the small signs of progress.
Ask the health professionals to share information.
The more informed you are about the condition
of your family member, the better equipped you
will be to deal with the situation.
80

Ways of coping for FAMILY AND FRIENDS
You will need to work through a series of emotions
as you go through each stage. If possible, talk to a
counsellor.
It’s normal to feel down
Acknowledge that acceptance of the situation may
not come for a while. It is normal to feel upset,
angry or depressed. Crying helps and is normal.
I can not change what happened
Accept that you are not responsible and that taking
the blame will not alter what has happened.
Talk to your family member the way you used to.
but understand that they will be different.
Future
Accept that the past is behind you and the future
is what is important.
Past
Make the most of what your family or friends can
do. Do not concentrate on what they cannot do.
Look after yourself first and foremost. You are no
good to anyone if you are tired and grumpy.
81

Ways of coping for FAMILY AND FRIENDS
Put off until tomorrow what is not absolutely
necessary.
What do
you think?
Let the person with the brain injury make as many
decisions as they can cope with and ask their
opinion even if that is not totally necessary.
Do not give up your job unless it is absolutely
necessary.
Both carer and cared-for need time on their own.
This is extremely important and may need to be
strictly scheduled.
help?
Discuss role changes with other family members
and ask for help if necessary.
You may need to take responsibility for
implementing changes in roles, and in other areas
such as time out. Be aware that the person who
has had the injury may still see themselves as they
were before the injury.
View change as a challenge and an opportunity
rather than a problem.
change
82

Ways of coping for FAMILY AND FRIENDS
Recognise that in order for your family member to
make progress, they will need to take risks such as
travelling alone. These risks will need to be taken if
real progress is to be made.
Allow the person to make a few mistakes, but not
too many so that they lose confidence and dignity.
Make some tasks easily achievable to build up their
confidence.
Try to create a stable, consistent environment,
especially in the beginning stages when confusion
may be commonplace.
Always keep the injured family member informed
about what is going on.
Carmen’s experience
Sometimes it’s useful when you and the family member who has a brain injury are
talking to other people to have some kind of cue, such as tugging on your ear, to
let the person with the brain injury know they are talking too loud, too fast or too
much.
83

Getting Back to Work
Returning to work is possible for some people who have had a brain
injury. After you have recovered and been assessed by a vocational
support specialist, work options will be discussed with you.
This may require you and the vocational specialist visiting your former
work place or new work placement and discussing with the employer
your options with regard to work, hours and support needed.
Ask yourself ‘What can I do?’ and ‘What am I going to have difficulty with?’
Studies have shown that it is not the severity of injury that will affect
your return to work, but whether you have a realistic insight into your
condition accompanied by self-acceptance.
Returning too early to work can be both a positive and negative experience
for you. Positive elements are that it will give you a realistic insight into
your own capabilities, and negatively, you may find it emotionally and
physically difficult during the initial period, especially with the effect on
your fatigue levels.
The best thing you can do is to start small and work up from there.
1 Acute care - rest and gain strength.
2 Initial rehabilitation - work on getting better, physically, mentally
and emotionally.
3 At home, establish a routine and increase your participation
around the home.
4 Work out what you can do and what kind of job you would like
to do.
5 Work on stress and anxiety management levels and apply those
to your work place.
6 Analyse your work environment - what is involved and sort
out how to make things easy on yourself - talk to a
vocational consultant.
7 Start your job part-time and if you feel able, increase your hours gradually.
84

Supported Employment
You may find supported employment is an option that
could work for you. Supported employment includes
job placement, training and advocacy, ongoing assessment
and continuous monitoring. It may also involve educating
employers and colleagues about your needs. Usually,
supported employment works best if you have had a severe
brain injury. It may continue indefinitely or diminish over
time, depending on your needs.
Ways of coping
Ask for a support person to attend interviews
that you may have with ACC or WINZ, such as
a member of your rehabilitation team. Your local
Brain Injury Association may have a support person
who could help.
Employment help
Ask to be referred to a vocational support
service.
Start with small steps and work up from there (for
example, from part-time work to full-time).
Part time
Full time
Make sure the job you get is right for you and that
you will not become over-stimulated.
Assess your capabilities for the job you want.
What can I do?
85

Ways of coping
Lifeline
Try volunteer work as this can be a good stepping
stone to paid work.
Limit multi-tasking in your job as taking on too
much will increase your fatigue levels.
Aim to work at your own pace. Limiting tasks that
have deadlines should help lower overall stress
levels.
Limit new learning in the beginning. Try to utilise
old familiar skills and knowledge.
An interesting job will be a lot more stimulating
than something dull and boring. An interesting job
will lower frustration levels.
Your employer will need to be educated about
your capabilities. Make sure they are fully aware
of your limitations as well as your capabilities.
Information may need to come from a member of
your rehabilitation team.
Use coping mechanisms such as lists, wall planners,
diaries, dictaphones and any tools that will help to
compensate for shortcomings you may have as a
result of your injury.
86

Ways of coping
Arrange for monitoring and feedback from your
employer on how you are progressing.
I’m ready for work
Return to work when you feel you are ready to
do so.
Cate’s experience
I was expected to suddenly go back full-time, as well as go to other appointments.
That was a regressive step and I just couldn’t manage.
Shane’s experience
In 2008, I did a course five years after my brain injury. This was one week
full-time, then five alternate Saturdays, then another week full-time. I managed it
with significant difficulty all the way, but I got to the end by pushing myself.
Don’t rush into things. Take it in small chunks. Take your time and make sure
you’re healed and ready to go back to work as you may find you hit big obstacles,
which may lead to depression. I found that part-time work in the beginning was
important, and I also think it is important that you find a job you enjoy, because
working makes you feel good.
I have a meeting every six weeks with my supervisor and we go over how I’m doing.
I find that because I’ve had this injury, I often think, ‘Am I doing a good enough job?’
and seeing my supervisor helps clarify that. I’d hate to think my workmates are
doing extra work for me, so seeing the supervisor is reassuring.
87

Driving after a
Brain Injury
You may be keen to return to driving and regain your independence after
you have had a brain injury. However, driving is an activity that requires the
co-ordination of both mental and physical skills. Even if you are confident
that your driving skills have remained intact after an injury, it’s still important
to take the necessary steps to ensure safe driving.
Land Transport New Zealand (LTNZ)
and Medical Advice
Following a traumatic brain injury, it is difficult to provide a simple answer
as to how soon after your brain injury you can start driving again.The
recommendation will depend on the individual’s circumstances, the degree
of injury, and subsequent recovery. Generally the LTNZ is guided by the
advice of the medical personnel concerned.
How will a brain injury affect my driving?
Brain injury will affect people in different ways. The LTNZ lists on their
website some of the consequences of a brain injury that could affect
someone’s driving. These include:
Altered vision
• Not seeing signs or traffic hazards on one side of the car.
• Misjudging distance and speed.
Altered thinking patterns
• Slowed thinking, making it difficult to make decisions at busy
intersections.
• Trouble coping with too much sensory information at once.
• Loss of concentration resulting in a decrease in driving
abilities.
• Short-term memory loss affecting driving.
88

Epilepsy
• Brain injuries severe enough to have caused
• unconsciousness or loss of memory may result in epilepsy.
(This does not include seizures immediately after the injury,
which are considered part of the injury process).
Physical challenges
• Reaction time may be slowed.
• Co-ordinating hand and feet movements may be difficult.
• Ability to steer may be reduced due to muscle weakness.
• There may be problems using foot pedals.
When can I start driving again?
Whether a person can return to driving will depend on the type of licence
(and any endorsements) they hold, and the nature and extent of the brain
injury. Higher criteria apply where commercial classes and endorsements
are concerned.
For serious brain injuries, Land Transport New Zealand usually requires a
neurologist’s report and an occupational therapist’s assessment before a
person will be allowed to start driving again.
If you have an ACC case manager, check whether funding is available for
driving assessments and/or specialist medical assessments (if required).
Medical assessment
If you would like to start driving again, you need to consult your
GP who can determine if you are fit enough to drive. The doctor
may recommend (or require) an additional assessment from an
occupational therapist.
An occupational therapist will:
• Give advice on licence issues following an injury or crash
• Look at how any physical or cognitive changes might affect
your driving abilities
• Ensure that you are likely to satisfy driving standards
• Determine if lessons are required to improve your confidence
or to help you become a better driver
• Help a learner-driver develop the skills needed for driving.
What does the driving assessment involve?
The driving assessment is divided into two sections:
• An off-road assessment
• An on-road practical driving assessment 89

Each section takes about 90 minutes to complete and you can have a
family member, friend or support person with you. Usually an appointment
for the on-road assessment will be arranged at the end of the off-road
assessment. You can request that both assessments take place in the one
appointment if you prefer.
Off-road assessment
The off-road assessment starts with an interview, where you will have the
opportunity to discuss any issues or concerns that you may have with,
about your driving. You will also be asked to provide the following
information:
• The type of car you drive
• Where you drive (what areas/ locations you drive to)
• Your current licence status
• Any difficulties you may have when driving
The occupational therapist will also check your vision, your physical
abilities (your movements, strength and co-ordination). They will also
look at other factors which may be affecting your driving such as muscle
strength, endurance, pain and fatigue.
On-road assessment
The on-road assessment records your ability to drive in real-life situations.
It is normally undertaken in a dual-controlled car provided by the driving
service. Both manual and automatic vehicles are available. On the drive, you
will be accompanied by an occupational therapist and a driving instructor.
The instructor will sit beside you to give you directions about where to
drive.
Ways of coping
Don’t rush - remember that if you are not ready to
drive, you will be putting yourself or others lives in
danger.
90

Ways of coping
Guidelines
Check the Land Transport New Zealand guidelines.
These highlight the process involved in getting back
on the road, and give reasons why brain injury might
compromise your driving.
Listen to your family members if they have concerns
about you returning to driving.
Ask the rehabilitation team when you would need
to arrange a driving assessment and how to obtain a
referral.
Melinda’s experience
• I drive at less than 100km/hour in the country now, because my reflexes
are slower. I feel I have a better chance of stopping in time for a child or
animal.
• To remove time pressure, I aim to arrive everywhere five minutes early. This
means I can cope with unexpected delays such as roadworks.
• If I begin to feel fatigued while driving, my right eye goes out-of-focus. This is
my body’s signal to stop and rest, so I always carry a sleeping bag and pillow
in the car. I may even need a one-hour nap.
• Extra distractions hamper my concentration, so I don’t play music in the car
or chat to passengers while driving (I let them know when they get in the
car).
• Driving in the rain or in the dark used to be difficult. It took time to build up
my driving tolerance, concentration levels and multi-tasking ability.
• I pre-visualise my driving route so I’m in the correct lane well before I need
to be. This means I can also choose to avoid big roundabouts as the amount
of visual information can be over-whelming.
91

Nutrition / Alcohol
After a brain injury, you may notice some changes to your eating patterns
and how you feel about food. Some people find that problems with their
memory can affect how much food they eat. For example, they may forget
that they had eaten breakfast. Brain injury may affect your capacity to feel
full or hungry, which may cause you to eat too much or too little. Some
people notice that their sense of taste or smell has changed. This may
be the case in the earlier phase of your recovery and should improve
gradually. A change in your sense of taste or smell can also be due to the
side-effects of medication.
Breakfast
The human brain needs good quality fuel, so eating
a well-balanced diet that is low in cholesterol
and saturated animal fat is important. The saying
‘what is good for the body is good for the brain’
is very true. Most healthy eating and nutrition
books stress the importance of eating a healthy
breakfast to start the day.
The brain needs vitamins and minerals particularly
the antioxidant vitamins E and C which protect
the brain. People who have experienced a brain
injury often describe the food available in hospital
as bland. Some have even enlisted family and
friends to supplement their hospital diet with
nutritious meals.
Eat Omega-3
foods, like
salmon, sardines,
mussels and
walnuts.
When you have a brain injury, you will need to
give your brain every bit of extra help, including
nutritional help, so it can recover to the best
of its abilities. Omega-3 foods (such as oily fish
like salmon and sardines), flax seeds and walnuts,
should be included in your diet. A diet high in
Omega-3 avoids excess sugar and starch and is
high in anti-oxidants which will maximize the
function of the brain cells and promote the
healing and recovery of damaged cells.
92

If you have problems with swallowing, a speech
and language therapist can help with this. If you
have a food allergy, get advice from a dietician.
Physical activity and exercise will help you to
maintain a healthy body weight. Exercise is also
good for general well-being. However, be aware
that when it comes to exercise or any physical
activity, you may be restricted due to poor balance,
fatigue, poor vision or other complications as a
result of your brain injury.
Alcohol
People recovering from a brain injury are advised
to avoid alcohol. This is particularly important in
the early recovery phase. Alcohol can affect the
brain’s ability to function and can also affect the
brain in other ways. For example, alcohol can:
Increase the possibility of becoming depressed.
Increase the possibility of a seizure.
Limit your recovery.
Interfere with your ability to think and learn new things.
Cause impulsive behaviour.
Cause problems with balance, walking and talking.
93

Nutritional tips
Limit your intake of fried food and processed foods.
Choose low-fat dairy products and lean meats.
Eat foods rich in antioxidants (for example, fruit,
vegetables, seeds and fish) and good amounts of
cereal, grainy bread and other grains.
Avoid foods containing hydrogenated fats, such as
some margarines and cooking oils, as they are a
major source of chronic disease.
Glucose is important as it provides the fuel needed
to keep the cells alive and functioning. If you
notice that your concentration declines in the late
morning or afternoon, eating a snack containing
glucose such as fruit can help.
Reduce the amount of salt you consume as this
can help to control high blood pressure and fluid
retention.
Some people find caffeine, which is found in coffee,
tea, chocolate, and in some energy drinks such as
coke, difficult to tolerate after a brain injury. Drink
no more than four cups of coffee per day and avoid
it altogether after your initial injury.
Try setting up an eating diary or chart and record
what you eat each day. This can help you to
remember the foods you have been eating and
identify the times when you have felt full or hungry,
and other changes affecting your body and mind.
94

Exercise / Brain Gym
Establishing an exercise routine can be very beneficial. We all know that
exercise is good for us. Some research studies show that regular exercise
can help improve memory.
Whatever form of exercise you choose, it does not have to be exhausting.
Mild aerobic exercise, such as walking for 20 minutes at least three times
a week, stimulates blood flow and the delivery of essential oxygen to the
brain.
Another advantage of physical exercise is that it encourages sleep, which will
help to give your brain the rest it needs to concentrate and remember.
NOTE: Always check with your doctor before beginning a new exercise
program.
Types of exercise you may like to try:
Walking three times a week.
Light yoga.
Tai Chi – recommended for balance and posture.
Light gym routines.
Light jogging.
Cycling.
Swimming.
During the development of this book a number of focus groups were held
with people with brain injuries about what they found helpful during their
recovery. Some of the above activities were mentioned as being beneficial.
Brain gym was also mentioned for helping with physical co-ordination,
memory and reading etc.
95

Brain Gym
Basically, brain gym is a programme of 26 repetitive movements which claims to integrate
body and mind to bring about improvements in concentration, memory, reading, writing,
organizing, listening and physical coordination. Brain gym was developed in the 1970s
by Paul and Gail Dennison and called Brain Gym or Educational Kinesiology (Edu-K)
“learning through movement.” The programme has been widely used in British State
schools and in parts of the United States and Canada.
The Dennisons claim that any learning challenges can be overcome by finding the
right movements, the use of which will create new pathways in the brain. They claim
that the repetition of the 26 Brain Gym movements “activates the brain for optimal
storage and retrieval of information.”
Below and on the next page are a few
exercises you might like to try
Stretch out
your toes
with your feet
crossed. This
lessens tension
in your hips
and pelvic area
and improves
posture.
Cross your
left ankle over
your right one.
Intertwine
your fingers
and bring them
to the chest.
Move your legs
in the opposite
direction to
your arms then
vice versa.
Massage your ears from top
to bottom with both hands.
96

Massage the
area where
the skull is
attached to
the neck and
at the same
time massage
your navel area.
Rest one hand
on your upper
lip while the
other hand
lies on your
back-bone.
One hand
massages
the area to
the side, just
above the
chest, while
the other
hand rests
on the navel.
Pull your head
outwards with
your thumb.
Sketch two
images with
both hands at
the same time.
Rest one hand
on the lower
lip and one
hand on the
pubic bone.
Draw
horizontal
eights with
each hand
in the air.
Stretch one
arm up and
grasp in the
middle with
the other arm.
97

Socialising / Recreation
You may feel anxious about returning to a social life or taking up leisure
activities after a brain injury. However, it is important to join in these
activities where possible and where practical.
To begin with, there may be certain situations or environments which
you may find stressful, tiring and uncomfortable. It is important to know
your limits, what works and what does not. Noisy environments, like pubs
and clubs, may create too much stimuli and confuse a person with a brain
injury.
In her book ‘Just a Bang on the Head’, Rosie Belton describes how, after
her head injury, she found conversation at parties very difficult, especially
if there was music in the background. She also describes how patterned
carpets in hotels or other buildings would create problems for her
visually.
No two people with a brain injury have the same experience. It is very
individual, so you have to decide what will work best for you and try to
gradually acclimatise yourself to particular situations.
Ways of coping
Small steps are important when socialising again. You
may encounter new surroundings and new people and
this new stimuli will make you feel tired.
If you decide to see a movie, make sure it is not too
stimulating as this may make you fatigued.
98

Ways of coping
Parties are also environments that may make you
tired - communicate this to key people before you
reach ‘crisis point’.
Picking up a sport (if you are able) is a great way to
improve your physical fitness and stamina.
If you have difficulty walking, try handcyling. Various
sports organisations for the disabled such as
Parafed, hire out bikes.
Take your time and return to activities gradually.
You’re talking
too fast....
Establish cues with your family and friends. For
example, a tug on the ear can let you know if you
are talking too fast.
What were the activities that you enjoyed doing
before your injury? Listening to music, visiting the
library or being a member of a book club? Get
friends and family to help you establish some of
those activities again.
Resource Book
Start a ‘resource book’ with information about
your personal interests, days and times of activities,
contact people, accessibility etc. This ‘resource
book’ can help with cognitive problems (for
example, memory loss).
99

Shane’s experience
I keep socialising to a limit, just because of fatigue. I choose where I go because
a lot of places have too much stimuli and are too noisy. I still like to go out,
but if we do go out to a bar, I make sure it’s not too loud, but I don’t make an
issue of saying to people ‘Turn the music down’. If I don’t like it, I need to go
somewhere else. I need to accept that there will be others who do like loud
music and I shouldn’t get my way just because I have a brain injury. You have
more control in your own home, but not out at a restaurant or bar.
Mike’s experience
Be aware that following a brain injury, your friends are likely to change. Many
who were not true friends in the first place may find the changes in you too
difficult to cope with and may want to distance themselves from the situation.
It’s not your fault and those who are true friends will stick by you.
It is normal for a person with brain injury to undergo many different physical
and emotional changes and be in a completely different “head space” than
they were before the head injury. That former head space is what the friends
you lose were relating to, but the new person you are may hold less appeal to
them and they move on. It’s a simple fact that life changes result in changes in
associates and friends. That’s life!
At the end of the day it doesn’t matter that you no longer see certain friends
because you will always make new friends who can relate to whatever head
space you are in and these are the friends worth having!
From my own experience I can say that many of the friends and associates I
regularly “hung around” with, went their own way and didn’t keep in touch. In
those early times, that did cause me a little concern but after my accident in
the end it did not matter because I have since found a few really good, close
friends with whom I love spending time.
100

Personal
Journeys
Journeys

Personal Journeys
Mike
Page 103
Cate
Page 105
Graeme
Page 107
Elizabeth and Merv
Page 108
Paul
Page 109
Cecile
Page 111
102

Mike
As a young adult living in Christchurch, I used to be one of the pit crew for
a guy named Rob who raced a six-cylinder Super Saloon car at Woodford
Glen each Saturday evening. Also living at the same place as myself was
my best mate, Tony, who worked with Rob. Along with a group of a few
others we were your typical bunch of young friends. We used to hit the
town and do many things together - drinking, weight-training, carousing
and partying etc, including working on the race car at Rob’s place and
pit-crewing on the weekends.
One week, Tony informed me that Rob wanted to travel with the car and
the pit crew down to Dunedin for some special racing with international
guests and that each of us would get the opportunity to drive the car.
I was keen to go, despite the fact that I had previously agreed with my
brother, Peter, to take part in gate marshalling and security at an upcoming
Split Enz concert. Peter and I had been part of a similar arrangement for
another concert a few weeks previously and had had a great time. Peter
and I had also done a fair bit of weight training together with some very
encouraging results. Tony and I had also been weight training together
for most of the previous year and were both very fit and muscular at the
time.
A few days before Tony and I were to leave on that trip, Peter telephoned
me to talk about the concert. I could hear the dismay in my brother’s
voice when I told him that I was going down to Dunedin instead. I also
felt a painful knot in my stomach right at the moment I told him that I
was going down south rather than going with him to the concert. That
unfamiliar pain was my intuition that my decision was terribly wrong and
the consequences would be devastating.
Eight of us went in two vehicles. The first a V8 ute towing the race car
on a trailer, with Rob and his girlfriend and another mate driving, and the
other a Holden HQ sedan with two in the back and three across the
front. Tony was driving, another guy named Greg was between us in the
middle and I was on the passenger side with the seat belt-on.
On February 3rd, 1984, we began the journey south, calling into my
mother’s house in Geraldine to give her the good news about my fitting
and turning career taking a definite turn for the better.
103

We travelled on from Geraldine to Winchester where we stayed the night
at someone’s farm, then got under way again the morning of February
4. Around 3.15pm, I had been snoozing but awoke just as we rounded
a long left-hand bend into the township of Wakouiti. For some reason,
Tony had at that moment pulled onto the other side of the road and was
accelerating in a passing manoeuvre. In the split second that I’d opened
my eyes, an unseen car popped over a rise in the road before us, and
that’s where my memory ends until I came around in hospital weeks later.
Apparently we’d had a high-speed head-on collision with that oncoming
car. The front-left side of my forehead had struck the left metal roof pillar
and left me in a coma for 22 days.
As well as severe head injuries, I had a smashed left femur, a broken bone
and destroyed ligaments in my right foot, a wrenched spine and neck.
The type of head injuries I suffered are classed as ‘coup, contra coup’,
where after impacting the inside-front of my skull, my brain had bounced
backward and against the rear of my skull, damaging the sector of my
brain associated with vision thus causing ongoing problems.
All in all I was in pretty good shape considering the high-speed crash had
killed two of the four people in the other car. Out of both cars, the only
person without serious injuries was a rear passenger in our car named
Gary. The other rear passenger, his girlfriend Fiona, also suffered a broken
left femur. Greg in the front with no seat-belt had hit the dashboard pretty
hard and had some internal injures, but the windshield had exploded out
on impact so he suffered no head trauma. He was out of hospital in a
couple of weeks. Tony’s head had hit the top of the steering wheel and he
suffered a minor head injury.
Since that day Tony is the only one out of that group I have remained
in touch with. That accident caused major changes to everyone’s life in
different ways, including that of my family. I have often wondered to myself
what would have happened if I had not made the decision to travel to
Dunedin but stayed in Christchurch with my brother. Obviously what’s
done is done and can never be changed, but these days, with so much
free time on my hands, I just can’t help wondering.
104

Cate
I hit my head at work on 20 September 2002. It happened like this: I was
asked after lunch to clean the laundry. I knew it was a big job and I was
tired so said it was too much for a Friday afternoon. I was then asked
to make a start on it and continue the job next week. I was tidying and
cleaning in the laundry for a while, then went to the area under the
stairs. I got down on the floor before realising I hadn’t brought a cloth to
wipe the floor in the corner. I immediatly put my hands on the floor and
sprang upwards forgetting that I was under the stairs. The impact to the
back of my head was so huge I could never forget it. I actually thought all
my teeth were gone! I then tried to stand up away from the stairwell, but
fell over on my left side, breaking my glasses frame and going unconscious
for about forty-five minutes.
I remember the first aid staff member, asking me what day of the week
it was and other questions and I laughed because it seemed I was in
a ridiculous situation, being aware of only part of what was going on,
and (asking) what day of the week it was seemed irrelevant to my
predicament.
At that stage (after the accident) it felt like I was struggling through an
impossible fog, partially floating with no idea where my feet would land,
seeing things moving that were not, and experiencing a great collection
of unmanageable and very frightening symptoms. In those early weeks, it
would take half a day to get out of bed, get showered and get breakfast.
Because I was not capable of getting myself safely to and from work, my
older sister came to stay with me for a couple of weeks, walking me to
the bus stop each morning. Actually she didn’t stay a week, because I
needed so much dark and quiet time that I couldn’t bear to have anyone
in the house. I walked strangely - sort of spastic (only partially affected by
gravity it seemed) falling to one side or the other, falling into gutters, and
against power poles and fences. After a while, I began vomiting onto the
grass on the way to the bus in the mornings and that was a sign to me
that it was stupid to try and carry on. My doctor gave me a certificate,
and I went on the sickness benefit and eventually the invalids benefit.
105

One of the things I was told (after my injury) was not to give up on things
I did prior to my injury. I tried to cycle a few blocks occasionally, though
I was no longer prepared to bike through town as I had been doing. On
one occasion (January 2004) I had planned to walk with a friend to her
place, taking the bike, but someone in the neighbourhood offered her a
ride, so I had to bike to her place instead. I have great difficulty coping
with a change of plan, especially if it comes from someone else. As I rode
along, having not been able to process the information around the change
of plan, I hit the back of a parked car, bashing my head several times on
the back window and falling down off the boot to the road, getting very
bruised on the tow-bar as I fell. I am no longer safe on the bike as there
seems to be a delay between the brain wanting to use the brakes and my
hands actually carrying out the task.
It was after this second accident that I began dropping and over-filling
everything. I seemed to have no idea where my head was in relation to
fixed objects like the letterbox, the fence, the gate or shelves.
It’s been six years now, since the first accident. It took me five years to
accept that I am the way I am, and that I have to plan and live my life
around the symptoms as safely as I can. I no longer spend a huge amount
of energy attempting to hide the symptoms in shame at being disabled in
the way that I am. Early on, I made myself a motto, - ‘get up, get out, and
get on with it’. Each part of it is a challenge, but it has helped me to have
a sense of purpose each day, and I’ve learnt quite a lot.
106

Graeme
I was involved in a car accident in 1993 which resulted in serious brain
injury. My life changed in a flash and I had to learn how to walk, talk and
breathe correctly again.
The doctors said they had done all they could, so I put my thinking cap
on and thought ‘natural medicine’, as there is so much we don`t know
about the brain. I got involved in massage therapy and they (natural health
specialists) tried different herbs and oils on me. It was amazing, the herbs,
especially basil, seemed to stimulate the brain.
I also found that after massage therapy I would walk a lot better. That was
a big help because early on I had a lot of trouble walking and had terrible
balance. Massage made all the difference. What was really good was that
once I was mobile again, I was able to go walking.
Key point: I found the fitter I got, the better my brain worked and I
became more aware of my surroundings. But the best thing I did for my
brain injury was Whole Brain Learning, nickname “brain gym”. That`s
where they teach you how to use both sides of the brain, but also how
to believe in yourself, and that there is no such word as ‘can`t’.
Through visualization you can achieve anything and I became very positive
about myself. I now believe nothing is impossible and I can do anything if I
believe in myself. I told myself to do what I could and enjoy life. I believe
in living life to the full and to be prepared to try new things.
Today I can partially run and have a part-time paid job, which a few years
ago I thought was impossible. So my advice is NEVER, NEVER GIVE UP!
107

Elizabeth and Merv
Elizabeth had an epileptic seizure and a resulting brain scan found that
she had a brain tumour, which had to be removed. Further tests revealed
21 nerve endings had not knitted together and her short term memory
is now terrible.
“For about two years I had bad, bad headaches and no-one wanted to
know me,” she said.
“My GP said he couldn’t help me anymore so he sent me to a psychiatrist,
which I found degrading.”
A person with a brain injury can often be mistaken as having a mental
illness, or that they are drunk. People being pulled over by police while
driving because others had reported they were slurring their speech
prior to driving their vehicle was not unheard of. Consequently, people
with a brain injury now carry a card which includes a list of the signs of
brain injury.
Anger can be another consequence. For Merv, (Elizabeth’s husband) the
best policy when his wife gets angry is to walk away. Learning to accept
that they could not do things they used to be able to do with a click of
their fingers was one of the hardest things to deal with.
Elizabeth and Merv first met 50 years ago but only got married seven
years ago, after Elizabeth had her brain injury. For Merv, Elizabeth was
just Elizabeth, and while her memories were often lacking, one thing was
for sure, as a team, they have a very capable brain.
108

Paul
Fourteen years ago I was hit as a pedestrian by a car. I was not expected
to survive. I was in post traumatic amnesia (PTA) for ten months. To this
day, I still don’t remember the event and I have been told I never will. I
could walk with assistance after ten weeks, but it required eight months
of intensive hospital therapy before I could go home.
I had to do what most brain injured people have to do; relearn how to
walk, talk, write, read, dress, run and learn. After my accident all of my
medical knowledge was lost, so in a matter of seconds, I lost seven years
of work and study. I also lost a lot of my old memories which meant I had
difficulty remembering family and friends.
In short, almost all of my old friends have basically drifted away and some
have not been able to accept me as I am now, they remember the old me,
and only want that person. I have, however, made a few new friends.
It took a very long time to retrieve a lot of the things I knew pre-injury.
I get confused about some of my thoughts and whether I am retrieving
old memories from before my injury, or whether they are new memories
I have gained from recent discussions.
I was told post injury I would not be able to learn new things. However
I went to Whole Brain Learning and learnt to juggle before it was two
years post injury. This showed me that if you try hard, you can learn new
things. This led me to do bursary accounting and a few other subjects. All
of it was new to me and although I passed, I had to work much harder
than what I had been used to.
I found loneliness to be a big problem as I often feel quite isolated which
makes it important to be involved in either courses or activity groups.
I do remember that in the early stages of my recovery, no one, including
myself, knew if today was going to be a leap-forward day, a fall-back day,
or a no-change day. During my recovery, I have found that sometimes I
will have fall-back days.
109

Because my injury was over fourteen years ago, I can honestly say that
I have never stopped improving. As long as you continue to believe in
yourself and try new things all the time, you will notice improvements.
Now I am one of the assistant coachs for the Special Olympics Basketball
Team. I also play the piano at Woodchester Hospital Resthome and I have
enrolled to do a University paper next year which will be a good test of
my learning ability.
110

Cecile
I was nearly there, driving home with my carefully contemplated purchase
of potted flowers for Mothers’ Day. I remember everything up until the
split second before I reached that intersection, then nothing…. for three
weeks.
I don’t remember the vehicle travelling at speed at me through the
compulsory stop sign and fourteen of my ribs breaking. I don’t remember
the ambulances and the police at the scene. I neither remember the jawsof–life
the firemen used to prise open the roof of my car, nor the bodyboard
I was attached to when I was pulled up and out.
It’s all a mystery to me - the two operations the ambulance staff
performed on me so I could breathe air not blood, before their trip
back to Christchurch Public Hospital…I’ve never slept for two weeks
before!
My months in Burwood Hospital, where I was transferred after Public,
are a bit of a blur but I was well looked after. After a while, I had my own
room and it felt like a second home. A multitude of family and friends
came to see me.
I remember the doctors’ rounds, the week before my discharge. “Good
morning, Doctors!”, I gleefully exclaimed in the corridor. On arrival at
my bed, one of the doctors informed me, “We’ve decided to prescribe
something to calm you down, you’re too happy.”
Well. I thought quickly and then in a flash of insight: the doctors were
spending the majority of their day with people who were ill, in pain,
traumatized. A cheerful, optimistic patient was not what they were
expecting. I apologized and explained I was feeling well that day. They
decided not to drug me.
In the dining room at Burwood, I recall attempting to talk to another
patient. I can’t forget him, because he burst into tears with every question
I asked. Adapting to change can be difficult. I know that I focused on what
I still had, not on what I’d lost. I’m still building on that.
111

I’ve always loved a challenge. This may be what saved me, when my
subconscious took over all of my brain’s functioning. Does survival depend
on the strength of the will to live?
What a wonderful learning opportunity this has been. I’ve learned how
to pace myself, how to survive on an Invalid’s Benefit, and how to come
to terms with the thought that I may never work again.
I never knew that traumatic brain injury existed before it became a major
part of my life. There’s a long list of how it affects a person. It causes
fatigue, loss of balance, loss of co-ordination, short-term memory loss…
….I can’t quite recall the rest of the list.
I can no longer do the things I love as often as I’d like, but now I value them
more. Recently, I’ve found it gratifying that I come across as a “normal”
person to strangers.
For a long time, I felt vulnerable - a new experience for me. I was also
frustrated by my inability to express myself effectively, my lack of energy,
my forgetting and fumbling. I have now engineered a masterful ‘mind
library’ of compensatory techniques, strategies and options I can access,
when required.
I have no regrets. Before this happened, I used to assess my life every
six months. I would ask myself - ‘ What would I really want to do if I
discovered I only had six months to live?’ Then I’d go out and do it.
The lengthening list of what we as humans take for granted, continues to
dumbfound me. I took my senses for granted. Now they’re shimmering
shadows, hinting, and I miss them.
I did make one mistake while driving that day - I assumed the vehicle
would stop at a ‘stop’ sign. I won’t be making that mistake again.
This wasn’t my first near-death experience and I don’t wish to make a
habit of it. I joke that I arrived at the pearly gates and exclaimed “Take
me back. I’ve got things to do”. Now, I don’t know whether I’ll get them
done or not. I do know though, that I’ll keep on trying. I’ve learned that
my personality thrives on achieving goals. I have returned to feeling
productive as a human being.
When one person has a serious accident, it’s as if a pebble is projected
into a pond. There is a ripple effect, as other lives are affected. Friends
have just begun confiding in me the dramatic impact my event has had
on their lives.
112

In retrospect, I feel lucky that I had already packed so much into my
life. I’ve travelled, I’ve loved, and I’ve lived. I’ve hitchhiked alone across
the Sahara Desert - memories enough for a lifetime and I still have a
life. ‘Growing old’ will be a familiar gust of warm desert air. I’ve decided
to remain a bachelorette. My hands are full with just one person to
nurture.
I almost feel as if everything in my life was preparing me for what has
happened. I am handling it. I adapt easily, I embrace change as a learning
opportunity and I love meeting people. It has taken an event of this
magnitude to get me to slow down. I’m fine, but when it happened I only
hope that I was wearing a nice pair of knickers….
‘Brain injury is about living with two faces’
Cecile Tait
113

Resources
Resources

Chapter Contents
Author’s note from Claire and Bernadette
Page 116
Resources
Page 117
Glossary
Page 121
115

Author’s note - Claire Freeman
Author and Illustrator
Compiling and illustrating this book has been a journey for me. I have
met some inspiring and incredible individuals who, despite their brain
injuries, have gone on to lead phenomenal lives. Many who were given
bleak outcomes by health professionals, have gone on to run world class
races, enrolled for university courses, provide support for others with an
injury, and just live their lives with grace and integrity.
As someone who had a spinal injury at age 17 as a result of a motor
vehicle accident, I know first-hand how important information is for those
with the injury and their family and friends. Having an injury, whether it
be a spinal injury or brain injury, can be such a confusing and terrifying
time for everyone. What makes it worse is not knowing or understanding
the injury. My hope for this book is that it helps the person with an injury
understand their condition and provides support for that person.
Lastly, I want to say thank you to everyone who has been a part of this
process. The information contained within it has come from the consumers
themselves, which I feel gives the book its consumer-based authenticity.
Author’s note - Bernadette Cassidy
Author and Editor
According to the Brain Injury Association of New Zealand, everyday 90
people sustain a brain injury, which is staggering. If you are recovering
from a brain injury or you have a loved one with a brain injury
- you/they will need access to a wide range of information and resources.
This handbook is the first step in providing that information in a format
that is easy to understand. Having the appropriate information about a
brain injury and the impact it has on a person can help remove the fear
and stress associated with it.
It has been a privilege to have been involved in the development of
this handbook and to have had the opportunity to work closely with
the Canterbury Brain Injury Association and its members who gave so
generously of their time.
116

Resources
Book
Video
Website
CD / DVD
Books
Resources – all the following are held in the Allan Bean Centre Library, Christchurch. Contact
the Library on 03 383 9484 or email abclibrary@burwood.org.nz for further details. These
resources can be borrowed anywhere in New Zealand. Many will also be available at your
local library.
Brain injury workbook: exercises for cognitive rehabilitation
(2003). Powell, Trevor. Speechmark Publishing Ltd.
Brainlash: maximize your recovery from mild brain injury 2nd edition
(1999) Denton, Gail.L. Demos Publishing.
Conversation and brain damage
(2003). Goodwin, Charles. Oxford University Press.
Coping with mild traumatic brain injury
(1998). Stoler, Diane Roberts. Avery Publishing Group.
Cracked: recovering after traumatic brain injury
(2003). Calderwood, Lynsey. Jessica Kingsley Publishers.
The Everest within: life with brain injury
(2000). Brain Injury Association of New Zealand. Clarity Publishing.
Gray matters: brain injury, the inside perspective
(2006).Lerner, Heidi. AuthorHouse.
Head injury: a practical guide
(2004). Powell, Trevor. Speechmark Publishing.
Head injury and the family: a life living perspective
(1994). Dell Orto, Arthur E. PMD Publishing Group
I had brain surgery, what’s your excuse? : an illustrated memoir
(2004). Becker, Suzy. Workman Pub.
117

Resources
Just a bang on the head: living with a brain injury
(2005). Belton, Rosie. Craig Potton Publishers.
Interrupted lives: rehabilitation and learning following brain injury
(2005). Rees, Roger R. IP Communications.
Ketchup on the baseboard: rebuilding life after brain injury
(2004). Rocchio, Carolyn. Lash & Associates Pub./Training Inc.
Life after Brain Injury: who am I? 2nd ed
(1996). Boskey, Dana S (ed). HDI Publishers.
Life after head injury: the experiences of twenty
young people and their families
(1995) Hubert, Jane. Avebury Publishers,
Life after stroke: a guide for people with a stroke and their families
(1998). Stroke Foundation of NZ.
Listening in the silence, seeing in the dark:
reconstructing life after brain injury
(2002). Johansen. Ruthann Knechel. University of California Press.
Living with brain injury: a guide for families and caregivers
(1998) Acorn, S (ed.) University of Toronto Press.
My stroke of insight: a brain scientist’s personal journey
(2008) Bolte-Taylor, Jill. Hodder & Stoughton
Normal again: redefining life with brain injury
(2001). Swiercinsky, Dennis P. Writer’s Showcase.
Over my head: a doctor’s own story of head
injury from the inside looking out.
(1998). Osborn, Claudia L. Andrews McMeel Pub.
Sexual difficulties after traumatic brain injury and ways to deal with it
(2003). Aloni, Ronit. Charles C. Thomas.
Stranger in the mirror: a true story of stroke survival
and transformation: written with insight, compassion and
humor for brain injury survivors and their families
(2006). Little, M. E. Author House.
118

Stroke-free for life : the complete guide to
stroke prevention and treatment
(2002). Weibers, David O. Cliff Street Books.
Stroke Rehabilitation: guidelines for exercise
and training to optimize motor skill
(2003). Carr, Janet H. Butterworth-Heineman.
The Omega-3 connection: the groundbreaking omega-3
antidepression diet and brain program
(2001). Stoll, A. L. Simon & Schuster.
Traumatic brain injury: rehabilitation for everyday adaptive living
(2002). Ponsford, J., Sloan, S and Snow, P. Psychology Press.
Traumatic brain injury rehabilitation : children and adolescents 2nd ed
(1998). Ylvisaker, Mark. Butterworth-Heinemann.
Working after brain injury: what can I do?
(1996). DeBoskey, Dana S. (ed). HDI Publishers.
You and me: an education program about sex and
sexuality after a traumatic brain injury
(1999). Simpson, Grahame. Brain Injury Rehabilitation Unit
Videos
Head on: a film about life after head injury
(2000) Producer: William Fairbank. Willstone Productions
Stroke in midlife
(1998) Brain Foundation Australia. Tribal Productions.
A stroke survivor’s guide to independence: wheelchair
transfers for families and caregivers
(2001) Producers: Jane Champion and Jan Davies. International Clinical
Educators
119

Websites
Brain Injury Association New Zealand
www.brain-injury.nz.org
The Brain Injury Association New Zealand provides information,
advocacy and support to people with brain injury and their families.
Centre for Neuro Skills – Traumatic brain
injury resources and information.
www.neuroskills.com
Traumatic brain injury: a survival guide (2000). Johnson, Glen.
www.tbiguide.com/
Head Injury Association of New Zealand
www.head-injury.org.nz
The Head Injury Society of New Zealand was formed in 1987 to raise
head injury issues at a national level, to increase understanding and
recognition and to help address the needs of those who have suffered
head injury and their families.
DVDs and CD-ROMs
Best intentions: how to remember things you need to do
(1998). Practical Memory Institute.
Brain anatomy and function CD-ROM
(2005). Traumatic Brain Injury Educational Series. Centre for Neuro
Skills. USA
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Glossary
Amnesia: Loss of memory.
Anoxic: A severe deficiency of oxygen in tissues or organs.
Anterograde amnesia: Memory loss that occurs before brain
damage.
Anxiety: A feeling of distress, apprehension and unease that may be
caused by fear, danger, mental disorders or psychological imbalance.
Aphasia: The loss of a previously-held ability to speak or understand
spoken or written language, due to disease or injury of the brain.
Axons: Nerve fibres that can rapidly conduct impulses away from the
neuron cell body.
Brain Stem: The section of the brain that joins with the spinal cord,
responsible for the control of reflexes and such essential internal
mechanisms as respiration and heartbeat.
Cerebellum: A large section of the brain, serving to coordinate voluntary
movements, posture, and balance in humans, being in back of and below
the cerebrum and consisting of two lateral lobes and a central lobe.
Cerebral cortex: The outer layer of gray matter of the cerebral
hemispheres, largely responsible for higher brain functions, including
sensation, voluntary muscle movement, thought, reasoning, and memory.
Cerebral hemispheres: A cerebral hemisphere is defined as one
of the two regions of the brain that are on the left or right side of the
brain.
Cognitive abilities: The mental process of perception, memory,
judgment, and reasoning.
Coma: A state of deep, often prolonged unconsciousness, usually the
result of injury, disease, or poison, in which an individual is incapable of
sensing or responding to external stimuli and internal needs.
Concussion: Injury to the brain due to a blow, fall, or sudden impact
with another object or surface.
Continence: The ability to voluntarily control urinary and faecal
waste.
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Contrecoup: An injury to a part of the brain opposite the site of
the primary injury.
Contusion: An injury that doesn’t break the skin but results in some
damage to underneath tissue.
Dendrites: Any of several parts branching from the body of a neuron
that receive and transmit nerve impulses.
Dysphagia: Difficulty in swallowing.
Dyspraxia: Impairment of the ability to perform co-ordinated
movements.
Epilepsy: A neurological disorder characterized by a sudden recurring
attack of motor, sensory, or psychic malfunction with or without loss of
consciousness or convulsive seizure.
Fatigue: Physical or mental weariness resulting from exertion.
Frontal lobe: The part of the brain lying directly behind the forehead.
Glasgow Coma Scale: A scale that is used to assess the severity of a
brain injury, that consists of values from 3 to 15. The scale is obtained by
measuring the ratings of how the person with a brain injury responds to
certain standard stimuli by opening the eyes, giving a verbal response, and
giving a motor response, and that for a low score (as 3 to 5) indicates a
poor chance of recovery and for a high score (as 8 to 15) indicates a good
chance of recovery.
Global amnesia: A total loss of memory.
Haematoma: A localized swelling filled with blood resulting from a
break in a blood vessel.
Haemorrhagic stroke: A blood vessel bursts within the brain causing
bleeding (haemorrhage) into the brain.
Hypoxia: Diminished availability of oxygen to body tissues.
Ischaemic stroke: Most common stroke caused by a clot that blocks
an artery that carries blood to the brain.
Infarction: An area of dead tissue. A cerebral infarction is the ischemic
kind of stroke due to a disturbance in the blood vessels supplying blood
to the brain.
Neuron: A nerve cell.
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Neurotransmitters: Chemicals made in the nervous system that act
as messengers, helping or interfering with the function of nerve cells in the
nervous system.
Occipital Lobe: The back section of the brain having the shape of a
three-sided pyramid and containing the visual centre of the brain.
Paralysis: Loss of the ability of muscles to activate.
Parietal Lobe: The upper middle lobe of the brain located above the
temporal lobe. Complex sensory information from the body is processed in
the parietal lobe, which also controls the ability to understand language.
Passivity: The trait of remaining inactive that may be due to a lack of
initiative.
Rehabilitation: An active process whereby the person with a health
concern works to optimise their physical, mental and social abilities.
Retrograde amnesia: Memory loss that occurs after brain damage.
Seizure: A sudden unusual discharge of electrical impulses in a specific
area of the brain that causes uncontrolled stimulation of nerves and
muscles.
Sensory cortex: The region of the cerebral cortex concerned with
receiving and interpreting sensory information from various parts of the
body.
Serotonin: A neurotransmitter that is involved in sleep, depression,
memory, and other neurological processes.
Stroke: A blockage or hemorrhage of a blood vessel leading to the brain,
causing inadequate oxygen supply. Depending on the extent and location
of the abnormality, can cause symptoms as weakness, paralysis of parts of
the body, speech difficulties, and, if severe, loss of consciousness or death.
Temporal Lobe: The lobe of each cerebral hemisphere lying to the
side and rear of the frontal lobe. The temporal lobe controls hearing and
some aspects of language, perception, emotion, and memory.
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Empowering New Zealanders
with a spinal cord impairment
to live independent,
productive and
confident lives – right now!
Head Space: a handbook on brain injury – published by the New Zealand Spinal Trust.