Recovery at Home

In this episode of The Sharing Experiences With Concussions/TBI podcast, Libby Nicholaou, the Manager of Outreach Operations at LoveYourBrain, welcomes Krystal Merrells RD, Vijaya Kantipuly MSW, and Dr. Eric Guillemette to talk about recovery at home after a traumatic brain injury (TBI). 

Listen in as they break down their special roles in the concussion/TBI recovery process, along with advice and insights on nutrition therapy for TBI patients, at-home concussion rehabilitation exercises and strategies, and the powerful benefits of online support groups for people recovering from brain injuries. You’ll also learn tips and tricks for creating a home environment that is conducive to the recovery process.

Transcript

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Narrator (00:01):

What is a brain injury? The answer to this question is more complicated than it may seem.

May (00:07):

I didn't realize the scope and the challenges until I started to struggle.

Stephanie (00:13):

Concussion will change very quickly and rapidly week by week. And we need to adjust very quickly that

Ryan C (00:18):

Pretty hard to self-identify. When you have a brain injury,

Catherine (00:21):

Approximately 80% of adults in the justice system who are incarcerated, have a history of brain injury.

Narrator (00:30):

Our brains are intricate, comprised of billions of neurons, responsible for how we think feel, communicate, and experience life. The significant role our brains play in our everyday life is what makes experiencing an injury to it. Traumatic.

Stacey (00:47):

And I got a call from one of Jake's friends saying that he'd been in an accident

Vijaya (00:52):

Most of the time it's been ignored. So they feel very isolated.

Ryan C (00:57):

I didn't tell anyone. I just mean you just keep going, right?

Blair (01:01):

Light, sensitivity, sensitivity to noise. The irritability, the fact that like things are making you dizzy when they're passing by like all these small signs are things that nobody really understands

Narrator (01:14):

Approximately 165,000 TBIs occur annually in Canada, equaling out to 456 people every day. And one person, every three minutes as the leading cause of death and disability, worldwide brain injury is 15 times more common than spinal cord injury. 30 times more common than breast cancer and 400 times more common than HIV aids. What this also means is that by the time this intro finishes, someone will have experienced a TBI. It is because of the severity of this injury, that two leading organizations in the sector have come together to create a sharing experiences with a concussion or traumatic brain injury podcast, the Ontario brain injury association, and the heads up concussion advocacy network are proud to present yet. Another season of this multimedia series, as we continue our mission to create a deeper understanding towards a varying impacts of this injury, and now a message from the executive directors responsible for creating this series.

Ruth (02:22):

Hi everyone. My name is Ruth Wilcock and I'm the executive director of the Ontario brain injury association.

Ryan S (02:28):

And I'm Ryan Sutton the executive director of the headsup concussion advocacy network.

Ruth (02:34):

I want to welcome you to our multimedia podcast series. The mission of OBIA is to enhance the lives of Arians living with the effects of acquired brain injury, through education awareness and support. We are so excited to have partnered with headsup concussion advocacy network to publish this multimedia podcast series. And Ryan is going to tell you a little bit more about our

Libby (02:58):

Partnership and the series.

Ryan S (03:00):

We are thrilled to be sharing a second season of the series with all of you this season aims to broaden the conversation around concussions and traumatic brain injury by highlighting different perspectives in topic areas that lack representation building off the success of last season. We found new ways to facilitate discussions between people directly impacted by the injury while gaining up to date insights from industry experts. We are very proud to present the second season of this podcast series and hope you enjoyed this episode.

Narrator (03:34):

Thanks to Ruth and Ryan's commitment to education. This podcast will run throughout brain injury awareness month with episodes releasing weekly. During this season, we will explore a wide range of topics by highlighting group discussions that incorporate elements of lived experience and professional expertise in our collective effort to provide a diverse understanding towards a varying experiences of a brain injury. This series has been broken down into five parts, brain injury and justice, concussion, and TBI within the veteran community impact of brain injury on family members, recovery at home and accommodating a concussion in the classroom. Today's episode is brought to you by our sponsor, write rehab and features a group discussion on the topic of recovery at home. This episode was facilitated by Libby Nicolo from love your brain. Yoga. Libby is a community builder with experience in cultivating intentional inclusive spaces for people of various backgrounds and identities to feel seen and heard in wellness settings,

Libby (04:42):

How to fit the these practices in with day-to-day life, which day to day life especially has a lot of different variables that we're juggling.

Narrator (04:51):

We would like to thank all of our participants for their willingness to share these experiences with us and our amazing episode sponsor write rehab for making this podcast possible.

HeadsupCAN (05:04):

The following podcast may contain sensitive material that could be potentially distressing or triggering to some people. If you require support, please call the Obi helpline at 1-800-263-FIVE 4 0 4. The Obi helpline offers confidential and emotional support for those who need a caring, compassionate, and nonjudgmental listening ear.

Narrator (05:29):

And now please enjoy the conversation.

Libby (05:33):

So welcome everyone to our recovery at home edition of the podcast. My name is Libby Alau and I work with love your brain. I'm the manager of the yoga program, as well as our outreach operations and love your brain is an organization that works to build community and resilience for people in the traumatic brain injury community. And I'm excited to be in conversation today. Crystal Vijaya, Eric to talk more about recovery at home and to learn more about their specialties and vice and living to this discipline. So I'd love to go around and if you, each of you could share your first name and your area of expertise, just to introduce yourself and crystal, do you wanna start us off?

Krystal (06:25):

Hi, my name's Krystal Merrells. I am a dietician and I've also had multiple concussions, which is how I got into doing nutrition for concussion and brain injury. And so my area of expertise is really looking at how can we make the nutrition therapy for concussion and brain injury accommodating to the lived experience of brain injury, and if there's any way to make nutrition fun and kind, I am all there for it.

Libby (07:00):

Thank you so much hija.

Vijaya (07:02):

Thank you. Thank you, li my name is Vijaya. I work with Ontario brain injury association and my expertise in concussion. I run online concussion groups which is we've been, this is our fourth year. We've been running online concussion groups just to support groups, which is, I mean, when we concussion, people are feeling isolation connecting with the community and resources. So it's a kind of helping them to take home all the resources and advocacy or learning tools to help them to support in their, at home. That's mainly our focus of the groups.

Libby (07:43):

Wonderful. Thank you. And Eric.

Eric G (07:46):

Hi. Yeah. So I'm Eric. I deal mostly with rehabilitation with patients with a whole bunch of neurological conditions, most specifically concussions. So on the side of, at home care recovery and work, I mean, I think a gross majority of my patients, I'd say probably about 95% of my patients all have at home strategies and exercises that I press upon them. Mainly because the more someone is willing to take upon themselves, some strategies to use to push themselves forward the higher likelihood, their chances of making those those positive recoveries and outcomes.

Libby (08:24):

Wonderful. Thank you. So we have a nice rounded out group, different disciplines and different backgrounds. And I'd love to hear since each of you are experts in your area, how your particular discipline supports people with brain injuries and its unique way. And my let's go the other way. So Eric, if you wanna start us off this time.

Eric G (08:44):

Yeah. So as I am a chiropractor, although most of the training I do is not very specific to chiropractic itself. So a lot of the, the kind of the therapeutic approach in terms of the specialty that I have is mostly based on how well can we accurately diagnose the areas of weakness in terms of which part of the brain has been compromised. And then from there we're able to kind of more appropriately determine what types of strategies are best used to rehabilitate those patients. So the types of skills that we leverage here at our clinic are very different from what you'd see from your typical chiropractic on the basis of you'd probably think that you'd be expecting some, maybe some adjustments or some soft tissue therapies. However at our clinic, you see more things in terms of coordinated skills, challenges memory based or cognition based exercises.

Eric G (09:44):

It's kind of a, I wouldn't say a complete 180, but it's definitely not what you would typically suspect when you kind of associate our profession to what you see typically for re rehabilitative strategies for concussions. But it's definitely it's definitely interesting and quite fun in terms of, I'd like to say when you're thinking of rehab because, well, I mean, I don't know how fun it can be rehabbing from a head injury but we try our best to not make it too hard on the patient, if that makes sense.

Libby (10:14):

Thank you. And I'm curious if people are looking for that particular support and their healing journey through chiropractic services, how would they find an organization like you yours?

Eric G (10:29):

Yeah, that's a great question. So my specific skill sets are more recognized in the United States than they are in Canada, mainly because we are considered so I'm considered a of neurology. So in the United States I'd be considered more kind of like a chiropractic neurologist compared to, we don't quite have that specialty here in Canada or at least nothing kind of recognized under the Canadian association. So in order to find someone with my specific skill sets there's actually not too many of us across Canada, I think here in Ontario, there's probably about, I'd say a handful of us. There's a couple of us here in Ottawa. There's a few in Toronto. I know there's a couple in the Montreal area, so there's, there's very, very few of us. So there are there are certain websites you can actually go to, to kind of I guess doctor locate us.

Eric G (11:24):

And one of the main ones is the American chiropractic neurology board which is the, I'd say the kind of the smaller umbrella in terms of people to individuals with my subset skills. And then there's again, there's more subspecialties that you can acquire, which specifically involved traumatic brain injuries, ULAR rehabilitation and all these things. Again the, the greater your knowledge is the more you're able to kind of dive into these I guess more specifics on what's going on with individuals, head, head injuries, and the more specific you get, the more specific you can be with your exercises to try to tailor the, the programs to help these individuals more

Libby (12:06):

Amazing. And I believe in the show notes will have everybody's contact information. So I'm sure if folks wanna find you or others working your discipline, that information will be in there. Vijaya. So the question was in case you forgot specifically, how does your discipline support people with, with brain injuries?

Vijaya (12:26):

We normally, I mean, our groups run for eight week sessions. It's a specifically for concussion educational group. So basically what we focus on understanding about brain injury especially the brain injury individuals at the first time brain injury. They don't they're alone and not recognizing their symptoms, not able to feeling isolation, feeling isolation from the medical treatment because of their injures. There's no visible signs, the visible symptoms for other people. So a lot of most of the time it's been ignored. So they feel very isolated. So finding our groups with the Ontario brain energy association, we are provincially organized concussion group that we provide. We focus on education, understanding about concussion and, and learning about some strategies, learning about pacing and planning and pacing strategies at home, how to manage their symptoms, how to recognize their focusing also more holistically.

Vijaya (13:36):

What we focus on about their cognition, the behavioral changes, modification and emotion regulations focusing on understanding about emotions. How do we recognize our emotions? How do we learn some strategies to manage those emotions? And every week is we focus on very specific topic for next eight weeks. It can be a self-compassion one week. How do we it's okay to take those break it's okay to take that recognizing facing, right. A lot of times the group members feel guilty not taking that time for themselves, especially mothers with the small children, with the group members that work full time, the family responsibilities. So they, what happens in with the no self-compassion, we kind of provide that skills and the strategies recognize that self-compassion work recognizing providing self care strategies. So that's our main focus for eight weeks. At the end of this section, may it is about taking the skills and strategies and not feeling they're not alone in the community taking that education piece to manage their symptoms.

Libby (14:56):

Amazing. and, and after the eight weeks do folks can they come back for another eight weeks or what is the next step for folks?

Vijaya (15:04):

Yeah, right now our provincial our funding is only a one time participation, but we do have a C B anxiety group, which is focuses on their more about emotions. So they can come back to our C B groups for next following eight weeks. But we do have other groups, other support programs, which is peer support program, which they can continue to have that peer support across Ontario if they like to continue.

Libby (15:33):

Yeah. That sounds like you pack a lot into that eight weeks and really your group really does sound like it is intended to set people up for that home care, that self kinda independent care. So that sounds really great. Crystal, how does your discipline really specifically support brain injuries?

Krystal (15:52):

A number of the, my clients who come to me they might be struggling with meal planning because of cognitive issues after the concussion or low energy because of that, they might not be able to eat enough or get to the grocery store and be able to stay there long enough to choose the foods decision making around food can be very, very challenging. And then a number of people come to me also with digestive issues that accompany the concussion or brain injury, and that has maybe led them to have ups and downs with their ability to eat and concerns about certain foods. And this can really limit a person even more during a time when life is quite limited by the injury. And so where my role comes in is about helping someone to really be able to make those food decisions with foods that are gonna help in their recovery to help them with those simple steps, to get back to meal planning to help them navigate the grocery store and then to do the assessment of the, of the gut issues they're having and what, what, you know, course of action and strategies might best help their gut feel better and them feel better and then be able to eat better.

Krystal (17:24):

And so, yeah, also along with the emotional and mental health side of things there are a number of people who may be turning to food to cope, which isn't always a bad thing, but isn't always something we want to do either. <Laugh>. So part of my role is also helping people to understand along, you know, and I, what I love about this is this is where it links in, in crosses with all the other disciplines too, is understanding the nervous system and how the different states affect a person's ability to eat, to sense hunger, to sense fullness their drive, to eat and then how to recognize that, and then make the food decisions they want to make. So, yeah, overall I help with all of those kind of challenges so that people have the energy and nutrition, they need to be able to get out there and do the rehab and, you know, get better moving forward.

Libby (18:35):

Amazing. That sounds so great. And it reminds me so at love your brain, we do retreats and we have a chef that's on site for each of those that has brain friendly foods. And, and just how important that nutrition, that what you put in your body is like your body starts to work with. And so what you're doing is really fantastic as well,

Krystal (18:56):

And that connection with food, right. I, I always like to say too, you know, you know, we should be eating at least three times a day. That's three times a day. We get to have a connection with something and the way we connect with our food can also be very healing. So yeah, that's cool that you that there's a chef with those retreats. I'm sure that is, I'm sure that is super fun. And I'm sure we would all love a chef <laugh> on hand routine. <Laugh>

Libby (19:25):

Definitely thank you for that. Yeah. Mindful eating. That's what that reminds me of just having that, that time with your food to really experience it and go a long way. I wanted to circle back, Eric. I was curious with chiropractic work, with the take home part or the kind of recovery at home part, do you give your patients exercises or stuff to take home with them? Like how does that carry over?

Eric G (19:53):

Yeah. So definitely give a lot of exercises in terms of what kind of exercises there. It definitely crosses a lot of by, I like to say spectrums. So there's always some nutritional advice that we give them. Of course, it's not gonna probably compare as much to the, how much emphasis or how much depth that Crystal's going into things being her specialty and all, but there's always certain recommendations that we need to make in terms of nutrition, just because any healthy cell in terms of function, there's three main components. You always have to think about which the, the three are oxygen, glucose and activation. So making sure that those, that nutritional component is always well filled is, is a must for our patients. So we always have to make sure that we really emphasize that in terms of one, making sure they are eating two nutritious food.

Eric G (20:44):

If they're having some more of those difficulties with the, they just can eat or problems with regards to what they're eating. So that's definitely one aspect of things that we often touch on. But in terms of therapeutic interventions themselves it can be anywhere from exercises where they're playing with the ball on the wall exercises where they're following targets with their with their eyes. So sometimes you do a simple exercise, kind of like it's called a gay stability exercise, where essentially you would be staring at your thumb and moving your head in a, kind of a lateral motion like this while your eyes are trying to maintain a fixation on your thumb. So there's definitely different types of therapeutic exercises that we kind of, we perform with them in office. And then once we say that they're doing them appropriately, we get them to kind of continue those at home.

Eric G (21:36):

With small repetitions of these exercises, we can plastic size, those brain centers a little more and facilitate improvements within those, those fields. So there's, there's kind of exercises like that with a thumb where you're kind of doing motions with either your head or your eyes. I know a big one that a lot of people have heard about is vision therapy, which is kind of a, a hotter topic when it comes to head injuries now. So there's a certain amount of vision therapy that you do in office, and then there's a certain amount that you can definitely provide the patient for at home strategies to kind of help push those head injuries along. So the, the types of therapies we use, that's why I say they're kind of large and scope because even just touching on the mental health aspect of things, just making sure that depending on the severity of their conditions, they either have a good circle of care where they can get some some social connections or some help if they require a super important too.

Eric G (22:34):

Because obviously we have to keep the patient motivated enough to keep wanting to push themselves on those exercises. Now, depending on what kind of head trauma you have, you might have actually lost a lot of that motivation. So giving some, some at home strategies where you're trying to push someone to whether it's just going to socialize for a coffee or you make, 'em do an exercise where they're trying to learn how to sing a song something just to kind of changes their mindset, just motivates them a little bit more. And you kind of leverage those things to maybe make the, the memorizing a song or learning a new song can become a therapeutic intervention on its own, which is kind of a little bit more practical because it could be a little bit more fun, right? It kind of hits home a little bit more on people who are maybe a little bit more musically inclined. So that, that's why it's, it's hard to put an actual pin on exactly what I give frat home strategies, but we try to tailor them as much as we can to the specific case of the patient that's for sure.

Libby (23:31):

I feel like you touched on that really important piece of what people can stay motivated on or inspired to do or compelled to do. I think that is such an important piece because that plays a big part. And I think that really well into Viji your support groups since that is so much that connection and that kind of empowerment, the support group, what have you found have been some of the best ways to kind of plant that seed of wanting to keep growing with the material in the support group at home, on their own, even during and after the eight weeks

Vijaya (24:06):

Mm-Hmm <affirmative>. I mean, we usually, what we do is the planning and facing strategies we focus on. This is where our clients from the group members, lot of group members expect that planning and PAC help me a lot when I go home. And we kind of create a journaling, just, I mean, everyone, everyone comes from as a brain injury is a spectrum. Everyone needs an individual treatment plan or managing symptoms, but we follow gentle guidelines of planning and pacing, so they can create their own journals and keep track of recognizing their symptoms, recognizing their intensity and writing them down so that they can follow planning and pacing strategy parting with their symptoms intense level. So they bring it back the following week. Oh, that helped greatly. If I notice, if I pay attention to my symptoms, like that's keeping a journal is very important in the planning and pacing. So the group members do really appreciate and follow that. But however, there is a challenge, big challenge to maintain that planning and pacing.

Libby (25:15):

Yeah. I was at a, another great brain injury symposium and there was a woman who said that basically does her specialty is journaling and writing for brain injury healing. And and I also am a big believer in journaling and just feel it is very potent tool. So that's great. Can you tell, can you tell us more about planning and you had two peas and it sounds like it's a, it's like a thing. So I'd love to hear a little bit more about that. Mm-Hmm <affirmative> planning and pacing.

Vijaya (25:46):

Yeah. I mean, it's, the planning and pacing is how, what we do is there's a, we follow concussion treatment presentations about it's a concussion treatment clinic in London, Ontario sys concussion program. That's what the presentation, I, we reference it most of the time. It's about facing it. It's not about being quiet, taking rest and actively participating, shifting the brain from one activity to another activity. If there is a physical activity, then we can shift it to something to rest and listen to music. It's pacing is basically, it's not to go to sleep. It's about actively participating with a different activity. So that's what the planning and pacing is. We shift. So it's, it's a great strategies for group members find it helpful in their recovery.

Libby (26:42):

Sounds like that would really well with Eric's take home stuff as well of kind of that intuition or that, that self-awareness of when to maybe shift exercises or to take us to slow down and then when to come back up. So that's great. If someone was able to work with all three of you, they would be in such good hands

HeadsupCAN (27:03):

With experience helping thousands of people through their rehabilitation, right? Rehab is Ontario's rehabilitation experts for brain injury and spinal cord trauma patients and their caregivers, right? Rehab's focus is to connect you to highly trained rehabilitation therapists, personal support workers and behavior therapists that will help you mentally cope and physically navigate along your recovery journey. They also provide expert caregiver assistance with a clear recovery action for your loved one, as well as educational tools to support you. You can learn more about their work by visiting www dot, right rehab.ca

Libby (27:49):

Crystal. I'd love to hear more about kind of, I feel like you touched on it a little bit before, but if you have anything else to add about some of the stuff that you give patients to take home and, and really kind of give them that runway to, to move on with, with the material.

Krystal (28:05):

Yeah, I think the most like practical, tangible thing I can think of is in terms of meal planning. So I tend to walk my clients through what I call like a seven step meal planning guide. And to some people, some people are like, yes, broken down to seven steps. I love it. And other people are like seven steps sounds like a lot <laugh> so we take it one chunk at a time. And from that just going along with this, with this train of sort of like journaling, you know, food decisions and deciding what to eat is a very common challenge amongst my clients. And so instead of overhauling their diet and now choosing all new things, we'll be like, first of all, just for a week, just journal what you do eat. This will give us an idea of what food you have access to of what cooking methods you're comfortable with about what food's like <laugh>, which is also very important.

Krystal (29:13):

And then from there, once we have that sort of foundational list, now we're gonna try to flush it out and be like, okay, you know, during the week you're gonna have some hard days. So let's call that, you know, your emergency food days, what are your emergency foods that even if you have like two appointments and maybe your lawyer calls, you're not gonna be able to do anything else that day. What's like the one meal, you know, you can put in your body regardless. And then there are other days of the week where, you know, you're gonna have a bit more bandwidth and maybe that's the day that we now try to try to push the boundary. You know, just a bit. So is there one of these recipes that we can modify? Do you wanna try one of these other recipes that we've talked about, or maybe it's or maybe it's a traditional family food I've had, I've had clients who jumping off of the motivation theme, where for them getting motivated to cook again, part of that was like, I haven't made this traditional food that my family typically eats in a long time.

Krystal (30:33):

And I wanna try to do that, or I've decided I wanna reconnect with some of my family members because I've been so isolated and aunt, so, and so makes this awesome dish. So I'm gonna like ask her for her recipe. And that can be, and so we will like, okay, so now let's make a list of the things that are sort of you're motivating foods and meals. And we can start like plugging in the days that way.

Libby (31:03):

That's awesome. I feel like it, it brings back to like the personalized care and the personalized approach, which Eric and I've mentioned of like, look, you know, assessing each person. And but I feel like that's just, that's definitely so resonant even for like, for me as well. Like if it, if I can find a personal connection to something I'm definitely more drawn to it than just thinking, oh, seven step plan. So yeah, really thoughtful, amazing. Well, so within all of that, within these kind of ways of helping people be set up for success, I'm curious to learn about any challenges through this supporting people experience at home care and some solutions that you found to these challenges, or maybe you wanna offer up for someone else to provide a solution if they found one for your challenge, but just anything challenges that you all have worked through and solutions that you found for them. And why don't we go back to, since you've been in the middle every time we'll get, we'll start out with you.

Vijaya (32:07):

The most challenge that I find that from the group members is some of the group members are working, right. It is the working that they need to work full time. They need to meet their necessities, basic paying bills. And at the same time with the concussion symptoms, I mean, if I can give any homework and recognizing planning and pacing, paying attention to symptoms, but if they're, they need to meet their employment, that becomes a very challenge. That becomes a very challenge all day, working in a work environment, coming home, their symptom levels are so high and intense. And some of the group members do have a small children and they come home still after all day working and coming home with the taking care of children, caring for children is another big challenge. By the time they go to sleep, I mean, it is they're highly symptomatic and they wouldn't be able to sleep, whether there's a sleep dis disturbance and that makes us anxiety. And that makes us depression, everything is increases, you know, like it becomes a very challenging their lifestyle. It becomes a challenge in their own lives. That's the most challenge that I notice in a group member. I mean, it's, it's not easy, especially with the small children and caring.

Libby (33:33):

Yeah. That's so real. This doesn't these ways of caring for ourselves are not, do not exist in the vacuum. So I appreciate you bringing that in and, and really the reality of how to fit the, these practices in with day to day life, which day to day life, especially with the pandemic is has a lot of different variables that we're juggling. And I'm guessing that no solution for that is probably the planning and pacing and the compassion practices to still have that, that grace for oneself.

Vijaya (34:02):

Yeah. I mean, that's where we, we bring in self-compasion focus. I mean, it's allowing ourself taking the time, not feeling guilty about taking that break, especially it's very, self-compassion, it's very important in the recovery.

Libby (34:19):

Yeah. Thank you for that. Eric, so challenges.

Eric G (34:23):

Yeah. So I definitely agree with the work being a very, very big challenge for most with regards to a lot of our patients, I, it's kind of funny cuz it's, I find it's a little bit of a double edged blade with regards to work because oddly enough, when you're trying to help someone who has a head injury, if they can be well rested and not working their chances for recovery definitely go up. But of course that's definitely not possible for everyone right. In terms of financial stresses. So it's kind of a, sometimes it's, it's one of the biggest hurdles or obstacles for people in their recovery. And sometimes people, it's definitely not as much of a hurdle where they get to take that, that time off of work and really focus on getting themselves better. So I kind of, you, you see both ends of the spectrum for sure.

Eric G (35:11):

Another, I find obstacle, if you would that I common commonly see with a lot of my patients is the the aspect of just maintaining motivation. So a lot of patients it's it's it's months or years, or it's definitely extended timeframes that they're dealing with their head injuries. So a lot of people lose motivation after a certain amount of time. So of bringing back circle to the whole pacing pacing, an individual definitely is a a good aspect in terms of trying to I guess find a solution for it. So one of the things that we always do is we try to schedule our patients within a certain timeframe that puts a certain amount of accountability on them. Not that we want to stress them, but you wanna try to give just enough stress so that individuals still have that motivation to, I can still do this.

Eric G (36:09):

I can still attain these goals. There's motivation. And there's a little bit of an accountability at the end of it, knowing that someone's going to be kind of overlooking them again and saying, I'm kind of watching to see if you're doing your exercises. If you're pushing yourself the way you should be doing those things. One of the ways we also like to kind of help with the motivational factor is when we originally see a head injury patients, we take a lot of statistical data on them. So we'll have values. And from these values we can kind of ascertain or set goals for the patient to be able to see am I making progress, are things changing? And that in of itself gives that motivational factor. So if you, if they kind of know, they're like, okay, well, if I have to reach a reaction time of of minimum 200 milliseconds and they're sitting at around 400, well, that's kind of, sometimes it's, it's a data that kind of like we touched on the starting that they maybe haven't seen since they've been on their journey for head injury.

Eric G (37:10):

So that kind of gives 'em a little bit of motivation towards being like, okay, so if I do these exercises at home, if I push myself, I should see these kind of these numbers or these values progress in a positive way. And if they do, that's kind of great because once they start seeing that kind of that, that trend, it's kind of like all the dominoes fall, right. In terms of people, are they, they start saying like, okay, I I've made some progress here. That means I can make more progress if that's changed, maybe something else can change. Right. So that's, that's one way where we like to kind of or try to work with the patient in terms it's showing them, maybe things have been like this for quite some time now, but now we see some numbers, we see some goals, we have some objective things that we can kind of follow and hopefully by staying on top of things and by doing your side of the work in terms of just a little bit of work at home, little bit of push here and there with some pacing not overdoing things because that can often be problematic.

Eric G (38:09):

We can hopefully get to the goal we're trying to reach.

Libby (38:12):

That's great. I, I love that goal setting and that transparency into the progress that they're making. I think that's really helpful and inspiring probably for a lot of folks. So thank you for that. And crystal challenges, solutions.

Krystal (38:27):

Yeah, I think, I think I see maybe like three main challenges that, that come up and they would be like access to food time and energy. And then a restrictive mindset. So access to food is, you know, the difficulty of just getting to a grocery store, being in a grocery store and then, you know, looking at a shelf and trying to choose one item off of it, it can be very overwhelming and taxing and then they get home and they don't have the energy to put the food away or to make it so accessibility to just get, getting the food can be difficult. Some ways that have helped clients with that or I suggested has been like, okay, we can ask for help. A lot of people are like afraid to ask for help, but that's definitely something we can ask the, do neighbors, friends, family.

Krystal (39:33):

If I'm working, I have a handful of clients through like motor vehicle collision insurance every now and again, we can get food delivery covered for them which is really great. Cause then that' just takes away that barrier. But yeah, so access to food is definitely a challenge time. Lots of people have like rehab schedules that are like part-time full-time jobs <laugh> and it's like, all of these therapies are important and we can't, you know, deny that that takes up a lot of time. And so does planning your food and cooking your food and learning about food and doing all the, you know, nutrition therapies, what if those rehab things? So then you put that with, you know, the conflict like has already been brought up about, wow. Yeah. If they have kids, if they need to try to maintain an income, you know, if they're trying very hard to like maintain their job and whatnot, and there's all these other priorities.

Krystal (40:40):

Yeah. I mean, there's only a finite amount of time and energy we all have. And then I would say the LA the last one being like a restrictive mindset. So I've had a number of clients come to me and I I'm usually like the last one people get to, that's just, that's just the way it is at the moment. I would love to get to people sooner. But by then, they've maybe already been given lots of nutrition advice by family or friends or support groups or done research online. Which you know, again just pull back the double edged sword, right? Often that advice is super restrictive. Don't eat this, don't eat that, cut out this, cut out that. And so a lot of people come to me and the amount of food they eat is very little. And the number of foods that they feel is safe is very little and that contributes to them being undernourished, which affects their mood, which affects their recovery. And then they might be like, oh, it's the food. And then they'll restrict the food more and it's quite a vicious cycle. So with that that takes some time to build up confidence again and to ex and to expand their repertoire of foods.

Libby (42:03):

That's great. And I feel like there's a great article that you can write about all of that. <Laugh>, I mean, through all of your responses, I feel like that's a, it's a very comprehensive kind of awareness that you're providing. So we're about to close. And our last question, I think that will be helpful to close with is what advice can you provide for people in how to build an environment at home that is conducive for recovery? Eric, why don't we start with you?

Eric G (42:31):

I mean, that's, that's a great question. Also kind of, <laugh> a little bit of a hard one. So with regards to the best at home environment to have, I mean, it really, it really does depend on the individuals with struggles they're having with their head injuries. So I always try to say you want to limit, but not isolate. So with a lot of things, it's always, yes, there's, there's gonna be things that always make your, your head a little bit dizzy, or maybe they cause a little bit of you get the light SENSIT or sound sensitivity. But it definitely does not help anybody to be isolated in the basement without any light sound to social interactions. So I always say, it's trying to get yourself set up into an environment where you can still kind of maintain a normal amount of normalcy if you will with regards to the day to day.

Eric G (43:24):

So if you do have those kind of light sensitivities, maybe getting either some sunglasses or some filters to put on either the computer screens or you're definitely trying to limit some maybe some TV time or if there's, you're living with someone else where you can either have them drastically lower the television, or maybe they can listen to the TV with headphones on. So it's kind of finding strategies that are not as symptom provoking in your environment. So I feel like that's definitely one thing that you always wanna kind of keep in mind. But also setting yourself up with, I always like to get, make my patients have a journal. So writing things down where you can kind of keep track of things, we all know that memory is often problematic when it comes to head injuries. So if they, the more you write things down, the more you can kind of keep track of what you did or didn't do, or maybe things that provoke your symptoms, or sometimes the Journal's great too, because it gets to show you that great progression with things.

Eric G (44:22):

So as you, maybe weren't able to do something originally you look back maybe a month down the road and you're like, you know what, now I'm able to do this exercise. And I was never able to do that before. So kind of having those strategies set in place where you kind of take those notes, or maybe sometimes I like to make my patients in terms of we give them little exercises, what they can stick on their, their bathroom mirror. So it's kind of, it's there, but it's not something that they see too often throughout the day, but it gives them just a little reminder, right? When they wake up, they brush your teeth before they go to bed, they kind of see it again. So it's kind of trying to help yourself as much as you can, I guess, with eliminating stressors, but also putting strategies in place to make your day and your life as easy as possible.

Eric G (45:05):

I guess the last thing I would say is I stress having family members or significant others come to their examinations so that one, they can see if they're a little bit reluctant, cuz sometimes head injuries are, someone may look normal on the outside, but things are a little bit more severe on the inside. So it kind of sheds a little bit of light to the partners or the significant others or the friends that there is something going on here and that more than likely the more help that those, those inner circles can give or provide, whether that's in terms of social circles or nutritional advice or just helping with some of the exercises they have at home, it can be huge in terms of placing yourself in a in a good position to help recovery.

Libby (45:51):

Yeah, those are all great. And the, the note sticking out fan of that, just that kinda like a, could a love letter to yourself, cheer on cheering you on to yourself and generally brings a nice smile and one person sees it, but thank you for those. And

Vijaya (46:09):

I'm just, I'm just going to Eric almost just said everything. What I <laugh> I was going supposed to, that's what we do. In our group. We actually, most importantly, we focus on recognizing their symptoms that brings their needs. They can set up their environment at home, especially with the sensor issues, the light sensitivity and the sound sensitivity and the visual, the TV minimizing the TV watch if they have a sun light coming in, making sure that they have minimizing some curtains on the window, just giving them that strategies, being mindful, being aware of their sensor issues, the minimizing, the less sensors it helps them in their recovery. I mean the most is every day we in a group, we practice mindfulness that actually brings them to grounding and being mindful with their sensors. And it helps them to every day to maintain at least a recovery, you know, holistically. Yeah. Lot of grounding exercises and practices. Thank

Libby (47:15):

You. And it's a, what you're both sharing also is a great reminder of sometimes we can, we need that extra reminder of, oh, I could turn the lights down or, or I could maybe even buy new blinds or just close the blinds at a certain time of day or dim the screen. So sometimes those things that are readily available need that little reminder or, or helps helpful to have that little reminder. And then crystal, once you love to hear from you.

Krystal (47:39):

Yeah. I guess like on, on a very like tactile practical food level supporting someone's environment is obviously gonna be having food around <laugh> that you like, and that's good for you. So here going back to before, like, like asking for help in terms of getting access to that food and preparing food also provides that social connection that was brought up as well, as well as I know, I've had some people say to me that, you know, because it's like, well, I'll buy the food, but then I'll go bad in my fridge cuz I won't use it cause I won't feel good. Yeah, you can buy frozen, you can buy canned and have some of those things on hand and ready for those days when you just really can't and you know, having some of those easily accessible foods are gonna be great.

Krystal (48:38):

But yeah, I totally also just wanna echo like having a friend, a family member, like join you for your appointments, support you in that way. But yeah, it's a, as, as kind of Eric mentioned, it's like, it's a tricky one. And I think if we really do want to see change, like changing the environment is often is often a, a better strategy or could be a better strategy than trying to change one habit. And so I don't know, it's, it's tough. And I, I also just wanna acknowledge that just at least in terms of food. When we talk about building an environment, I, I have to acknowledge the fact that it's not just the environment in the home. All nutrition would be so much easier if people did have easier access to affordable food. I don't know about you, but have you looked at the food cost of food lately? It is. It's like it's sore and that is so challenging. So I feel like part of my job, there's part that I do with my clients, but there's the advocacy piece that I just, when I can just, I get on my little pedestal and be like, whatever we can do to, to make food more affordable and make you know yeah. Just different foods, more accessible.

Libby (50:03):

Yeah. That sounds like a great topic for the next podcast. <Laugh> I think that's like a whole, there's a lot there and it's so important to touch on. So thank you for bringing it in. Well that rounds out our time today and I'm just so grateful for each of you and the wisdom you share the knowledge. I'm sure. I know other folks are gonna get a lot out of this and that your information will be in the show notes so that they can also look you up and if possible, perhaps connect with you, the next podcast will be on accommodating. Aion a teacher's perspective and it's gonna be facilitated by Stephanie McFarland on an occupational therapist with Holland law view kids, rehabilitation hospital. So for all those listening, please tune back in for the next one. And you for joining us today with, with great group, have a good rest of your day.

HeadsupCAN (50:56):

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