How to Decrease Your Risk of Falling Following a Brain Injury

Along with ringing in the New Year, January is sure to bring plenty of snow and ice! The onset of slippery conditions can cause an increase in incidences of falls. Though the majority of falls only result in mild injuries such as muscle soreness or bruising, approximately 10% of falls result in a trip to the emergency department. Some falls may be unavoidable, but being informed of the risks and actively making changes can reduce the risk of falling. With 30-65% of people with brain injuries reporting balance deficits at some point during recover, it is especially important for survivors to be aware of the facts that make them more susceptible to falling. Factors to Consider: Are you over 65 years old? Approximately 1 out of 4 people over the age of 65 experience a fall every year, with falls being the leading cause of injuries in this population. Do you take multiple medications? Individual medications or interactions between multiple medications may cause an increase in risk of falling. Researchers have found that certain classes of medications including sedatives and antidepressants may contribute to increased falls risk. If you notice an increase in falls with the start of a new medication, be sure to contact your physician. Have you fallen more than once in the last year? Previous falls are an indicator of an increased likelihood for subsequent falls. If you have previously fallen it is very important to take preventative measures to avoid reoccurring falls. Do you have vision deficits? Vision is an important component of balance, and having vision deficits significantly increase the risk of falls. Blurred vision, double vision, and other visual impairments are common after a brain injury; therefore, it is important to follow up with your optometrist or ophthalmologist if you suspect any changes in your vision. They may make changes to your eye glasses or refer you to an occupational therapist for vision therapy. Do you have impaired sensation in your legs? It is common to experience decreased sensation or proprioception, the perception of movement and positioning of our body, following a brain injury or due to other chronic conditions such as diabetes and peripheral neuropathy. This can cause individuals to trip on objects or lose their balance. Are you depressed? Studies have shown a correlation in increased falls with depression likely due to cognitive, sensory, and motor changes that may occur with brain injuries. Consider talking to your physician, social worker, or counselor if you believe you are experiencing depression. Do you experience dizziness? Dizziness can be a symptom of many conditions including damage to the vestibular system, changes in vision, medication symptoms, or other medical conditions. If you are experiencing dizziness it is advised to consult with your physician. They may refer you to an Ear Nose and Throat Specialist, ophthalmologist or to a vestibular physical therapist depending on the cause. Are you mostly inactive? A decrease in activity can lead to poor cardiovascular endurance and flexibility, as well as weakened muscles, which can increase your risk for falls. Ask your physician if you are able to participate in a regular exercise program, and consider consulting a physical therapist or another expert for a custom exercise program to meet your needs and goals. Do you experience incontinence?Incontinence is associated with an increase in falls due to impulsive and unsafe behavior occurring when a sudden urge to urinate occurs. Depending on the type of incontinence and the severity, different techniques such as utilizing caregiver assistance, bed pans, pads, or Kegels may be appropriate. A pelvic floor specialist can aid with decreasing episodes of incontinence. If you answered yes to any of these questions, you might be at an increased risk for falling. Many brain injury survivors may have answered yes to many of the above questions; because of this, individuals who have experienced a brain injury have a significant increased risk of falling. Although some risk factors such as age are out of our control, many others may be modified to reduce your risk. If you believe you or a loved one is at an increased risk for falling, there are some simple modifications that can be made to decrease the risk:
  • Remove tripping hazards such as rugs or uneven thresholds in your home
  • If you use an assistive device, make sure you are using it correctly
  • Wear supportive shoes with a rubber sole to prevent shuffling feet and slipping.
  • Use night lights in order to increase visibility at night. Alert systems can be used for individuals requiring more assistance.
  • Shovel snow and apply salt to reduce the risk of slippery sidewalks
These tips can reduce your likelihood of falling and incurring an injury. If you have notice any recent changes or have questions regarding your balance, please contact your physician. References
  • Kallin, Kristina, et al. "Predisposing and precipitating factors for falls among older people in residential care." Public health 116.5 (2002): 263-271.
  • Lord, Stephen R., Hylton B. Menz, and Catherine Sherrington. "Home environment risk factors for falls in older people and the efficacy of home modifications." Age and ageing 35.suppl_2 (2006): ii55-ii59.
  • Peterson, Michelle, and Brian D. Greenwald. "Balance problems after traumatic brain injury." Archives of physical medicine and rehabilitation 96.2 (2015): 379-380.
  • Thurman, David J., Judy A. Stevens, and Jaya K. Rao. "Practice parameter: assessing patients in a neurology practice for risk of falls (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology." Neurology 70.6 (2008): 473-479.
  • Woolcott, John C., et al. "Meta-analysis of the impact of 9 medication classes on falls in elderly persons." Archives of internal medicine 169.21 (2009): 1952-1960.
Emily Wolf, PT, DPT Physical Therapist, The Lighthouse Neurological Rehabilitation Center

Emily graduated from Arcadia University with a Doctorate of Physical Therapy. Her academic focus was primarily on treatment of adolescents and adults post-concussion. She has been practicing as a physical therapist at The Lighthouse Neurological Rehabilitation Center in Kingsley, Michigan since 2017.

Seizure Disorder and Brain Injury

November is Epilepsy Awareness Month, a time of the year to help promote awareness and educate the general public about epilepsy and seizures. One of the common challenges seen with brain injury is seizure disorder – more commonly known as epilepsy. Epilepsy and seizure disorder are terms often used interchangeably, but there are distinct differences. Seizures are the individual events of a sudden loss of control of functions associated with normal brain activity. They are sudden, temporary episodes of brain dysfunction, caused by the abrupt, non-purposeful discharge of electrical activity in the brain. Typically lasting 1-5 minutes, they are characterized by changes in sensation, emotional experience, motor control, and levels of consciousness. Epilepsy is the general term for a variety of neurological conditions characterized by recurrent unprovoked seizures – it’s the fourth most common neurological disorder in the United States. And, approximately 110,000 people in Michigan are diagnosed with epilepsy. In about 60% of cases, there is no known cause. Among the remaining 40%, brain injury is one of the most frequent causes. Most common with brain injuries are partial seizures, which typically arise from scar tissue from the injury. Partial seizures affect only one portion of the brain and have more limited symptoms such as visual distortions, odd sensations, unexplained emotional experiences, or non-purposeful behaviors or jerking movements. Sometimes, partial seizures spread and become generalized (Grand Mal), before they resolve. Grand Mal seizures involve a loss of consciousness and uncontrolled shaking as all muscle groups receive an overload of messages for movement. If a person has more than one seizure in a short period of time without recovering consciousness, or does not resolve a seizure episode within 5 minutes, it is called Status Epilepticus – and is a medical emergency. There are many types of seizures. Any initial occurrence of a seizure warrants medical attention as it is a sign that something is not right with the brain. Common causes are electrolyte imbalance, dehydration, fever, sleep deprivation or exhaustion, a new neurological injury such as bleeding or hydrocephalus, medication or illicit drug side-effects, or genetic predisposition. Some seizures are idiopathic, not known to be caused by anything in particular. Other times, seizures may have no clear physiological component, thought to be caused by neuropsychiatric features. Careful diagnosis of new-onset seizures is critical to appropriate treatment. Approximately 10% of individuals with brain injuries severe enough to require hospitalization have seizures. Seizures at the time of injury are quite common, but are not always an indicator of later problems with seizures. Seizures associated with the time of injury possibly represent a different type of convulsive phenomena. In later appearing seizures, those with open head injuries are associated with a higher risk. There are relationships between the severity and occurrence of injuries. Individuals with a severe traumatic brain injury are 29 times more likely than the general population to have epilepsy. When seizures appear later in recovery they are often more persistent, with 80% experiencing at least one more seizure. When seizures occur, or where sufficient risk factors are present, medication may be required to prevent or control them. In about 80% of cases, seizures can be controlled with medication. For others, surgery may be used to eliminate the likely source of irritation. Behavioral strategies associated with maintaining a healthy lifestyle such as good sleep, diet, hydration, and appropriate medication use are also critical. The effects of substance misuse, like alcohol withdrawal, and misuse of some types of medicines, can also increase seizure risk. There are many implications associated with seizure disorder including safety risks, loss of driving privileges, mortality risks, mental health vulnerabilities, as well as the social stigma still unfairly endured by persons with epilepsy and brain injury. Accommodations can help minimize these influences on adjustment. Support may include allowing additional time for tasks, pacing activities to limit fatigue, managing stimulation levels from noise or distractions, facilitating transportation or providing safe activity alternatives. Such supports help keep people with brain injury and seizures active and included, participating as part of their communities. First aid for seizures is largely supportive, providing protective monitoring with vigilance to provide assistive resuscitation in extreme events. While sometimes a frightening and challenging symptom to manage, people with epilepsy and brain injury have many resources and treatment options to support the successful management of these symptoms. Web Resources: Martin J. Waalkes, Ph.D., ABPP(rp), CBIS-T
Licensed Psychologist
Director of Neuro Rehabilitation
Hope Network Neuro Rehabilitation

Quality of Life Conference 2018

BIAMI is excited to announce we’re expanding this year’s Quality of Life Conference to include four new, informative, and very timely sessions. Here’s a sneak preview:

  • Dealing with Phone, Mail, and E-scams, presented by the Michigan Attorney General’s office
  • Sexuality and Relationships after a Traumatic Brain Injury, presented by
    Deborah Adams from Eisenhower Center
  • Healthy Eating for a Healthy Brain, with Dr. Sarah Wice and Emily White from Origami Brain Injury Rehabilitation
  • Creating Your Recovery Based on Your Unique Talents, presented by Courtney Wang from Galaxy Brain and Therapy Center and survivor Barbaranne Branca.

As always, one of our major Conference objectives is to ensure all attendees have access to transportation services should they need it, regardless of location. We’ll pass along further transportation information as we line up sponsors.

The Quality of Life Conference will be held November 5 at the Crown Plaza in Lansing from 9 AM to 3:00 PM. Registration is open to survivors, caregivers, and professionals, so make plans to join us for a positive and rewarding experience!

TBI Survivors and Addiction Risk

Pictured above: Angela Haas, author of blog post

You have likely dealt with substance abuse before, whether it’s in your family, a friend of a friend, or someone you are working with now. If so, you know that substance abuse has an effect on everyone, but that effect is especially dangerous for those who have suffered a traumatic brain injury. For brain injury survivors, alcohol and drugs can increase the likelihood of seizures, and can also have dangerous interactions with individuals’ prescribed medications. In addition, alcohol and drugs affect our brains differently, and can have a much more powerful effect on someone with a brain injury. Just as importantly, alcohol and drug use may increase the likelihood of re-injury, as survivors under the influence are more likely to engage in behaviors such as impaired driving, or suffer difficulties with balance or impulsive decision making. Some of the most bothersome cognitive impacts of TBI include issues with decision-making (mentioned above), as well as problem solving, short-term memory, low inhibition, and decreased awareness. Alcohol and drugs can exacerbate all of these symptoms, unquestionably impacting recovery -- which is why complete abstinence from alcohol and drugs is the healthiest and safest choice to aid in brain injury recovery and sustainability.

Risk Factors for Addiction

  • Alcohol/Drug use or dependence prior to obtaining their brain injury
  • History of mood disorders
  • Current depressive disorder or symptoms of depression
  • Addiction to tobacco
  • Family history of addiction
  • Poor social skills
  • Poverty
  • Early use in adolescence
  • Stress at home
  • Unhelpful support group or lack of natural supports
  • Lack of health insurance or access to health care

Questions to ask if you fear that you or someone you love may have an addiction and need support

  • Do they go through withdrawals if/when they stop using?
  • Do they have to take larger amounts or over a longer time period than intended?
  • Has their use resulted in a failure to fulfill major obligations at work, school, or home?
  • Have they continued to use despite continuous problems with using?
  • Have they made unsuccessful attempts to cut down?
  • Do they have cravings, or a strong desire to use?
  • Have they given up important social, occupational, or recreational activities because of use?
  • Do they continue to use in situations where it is physically hazardous?
  • Do they continue to use despite knowledge of having physical/psychological dependence?
  • Do they spend a great deal of their time obtaining, using, or recovering from its effects?

Want help?

There are many avenues to find support, whether one has commercial insurance, Medicare, Medicaid, or no insurance at all. You can call your local Behavioral Health Authority, and talk to someone who can immediately assess your need for treatment and link you to the appropriate resources. Treatment can involve medical supervision, individual or group therapy, peer support, 12 step recovery, case management, family therapy, and psychiatric services.

Below are several links depending on your need:

If any of these apply to someone you know, show that person that you care, are concerned, and are there to support them! Understand that there are likely reasons they do what they do:

  • Self-medicate for severe/chronic pain from their injuries
  • Cope with the trauma that they have endured
  • Try to combat their symptoms of depression due to a loss they have experienced in their life
  • Escape from their new reality
  • Use due to an underlying mental health condition

You can use the resources above, or contact a professional who can help you get connected. You can also contact the BIAMI staff to help you connect with helpful resources. Stay strong, supportive, and realize that they may be doing the best they can, in this moment, to get through whatever difficulties they may be facing.

Angela M. Haas, LMSW CAADC is a licensed master’s level social worker with her certified advanced alcohol and drug counselor certification. She works with Special Tree Rehabilitation Systems in their outpatient clinic in Midland and Saginaw.

Dignitas
Eisenhower Center
Special Tree
Community Connections
rainbow_logo
Lightouse Neurological Rehabilitation Center