To help you partake, our favourite Chef Janet Craig has created this easy Pho Soup recipe. Give it a try, and cook up some deliciousness, health and warmth this chilly season. Here’s to soup!
One tetra pack of Pho broth
Four ounce rice noodles
One, four-ounce piece of beef steak, (round, top sirloin), slightly frozen
Two cups of bean sprouts
Shredded carrot or red peppers
Green onions, sliced lime, basil, mint, and /or cilantro to garnish
1. Bring the Pho broth to the boil. If you wish to add more seasonings like fish sauce, ginger, or garlic, this is the time.
2. Cover the rice noodles with boiling water & let sit for 10 minutes.
3. Take the steak & slice it very thin. This is why you put it in the freezer for a bit.
4. Place the steak, noodles, and vegetables into large bowl.
5. Pour on the very hot broth. Meat will turn opaque.
6. Soup is usually served with hot Chili/garlic sauce .
PHOTO: JANET CRAIG
Chef Janet Craig’s recipes are simple, healthy, delicious and ABI friendly. You can find out more about her HERE.
Without lights and sounds associating with gaming apps or consoles, board games are less stimulating than other activities and require very little physical exertion. They were among very few things that I was able to do during the acute phase of my injury.
After my injury, I wanted to avoid my friends, because conversations were exhausting and difficult to follow. But playing board games with friends was perfect. I got the social connection that I needed without having to engage in deep conversation. Also, the pressure and focus was off of me, since everyone’s attention was directed towards the game.
Not to mention, board games are super fun (heck, they’ve withstood the test of time), provide hours of distraction, and can be played solo. I didn’t need assistance or company for entertainment.
The selection of board games is endless, so there’s always something new to try.
How to challenge yourself using board games:
The following guidelines will teach you how to train your brain by gradually increasing the difficulty of your board games. The steps should be tackled one at a time, moving forward only when you are confident with the previous step. Be patient with yourself, as you may need weeks or months before advancing. Regular practice and repetition are the keys to success here.
In the beginning, focus only on learning and following the rules of the game. Don’t worry about speed or trying to win. Simply learn the basics of how to play. Play as many times as needed to become familiar with it. This will improve your learning and memory skills.
If you’re playing a game by yourself, then play with the goal of improving your result, speed, or efficiency. For example, depending on the game, you could try to collect more points, finish the game more quickly, or finish the game using fewer moves. Work through one objective at a time.
If you’re playing a game with others, figure out one strategy that will help you win the game. However, the focus should be on discovering and practicing the strategy, not on winning. This promotes problem-solving skills. If you’re stuck, ask the person you’re playing with to teach you their approach. Once you’re familiar with the first one, see if there are other strategies that could help you win the game. Determine which one(s) are the most effective. Eventually, the goal is to use a combination of strategies at the same time. This is great practice for multi-tasking skills. You might even start winning more games.
Now that you’ve figured out how you like to play the game, it’s time to pay attention to how your opponents are playing. See if they make decisions differently from you, figure out what their strategies are, and try to predict their next moves. Compare their approach to your own, see which one is more effective, and learn from them. Furthermore, think of new tactics that will prevent your opponents from winning. This will exercise your analytical and critical-thinking skills.
Finally, try to improve your chances of winning. You will likely need to change your plan multiple times throughout a game in order to adapt to new scenarios/problems and to circumvent your opponents. Once you become really good at the game, start these steps over again with a different game.
Board games that can be adapted for single players:
While it’s better to play board games with other people, one-player games allow you to practice at any time. Some of the board games listed were not originally designed for single players, but you will find solo variant instructions online. The following suggestions vary widely in difficulty and cost.
Honourable mention: Code Names – Although this game cannot be played solo, it is, in my opinion, the best word-focused, brain training game. It allows you to practice communication, word associations, and different thought processes. The cards could even be used separately for reading and comprehension.
Set – This simple card game is really good for unique pattern-recognition, concentration, and different lines of thinking.
Bingo – even more fun if there are small prizes to be won.
Carcassonne – No language skills are required to play this tile-based puzzle / strategic game.
Enigma – Includes fragment puzzles and 3-D puzzles among other challenges.
Honourable mention: Sudoku – This is not a board game, but it’s great for figuring out number patterns. The difficulty ranges from easy to very hard. Also, you can find free printable sudokus online.
Fine Motor Skills Games
Jenga – Try Giant Jenga if fine motor skills are an issue.)
Perfection – There’s the original version with 25 pieces and a more affordable version with only 9 pieces. This game also has a pattern-matching/puzzle component to it.
Honourable mention: Building blocks and sets (e.g wooden blocks, jumbo cardboard blocks, Mega Bloks, Lego, K’Nex, etc.) – These aren’t board games, but they’re great for stimulating creativity.
There are many different versions of matching card games that were designed to practice memory skills. See here for more information, you could also play this type of memory game using a regular deck of cards.
Blokus – This tile-placement game does not require language skills.
Mage Knight – This is the most complex and expensive board game I’ve listed in this article. It is a strategic game that is based in an adventure and story. The game includes instructions for solo play, but there are many pieces and rules, so I suggest watching YouTube videos, HERE and HERE that help explain them.
My Favourite Games Stores:
Walmart doesn’t have a large selection of unique games, but every now and then they have great sales on classic games. I purchased the following games for less than $20 each while they were on sale: Scattegories, Bingo, puzzles, Jenga, Perfection, Sudoku books, and decks of playing cards.
This is my favourite board games store. They have an extensive selection, competitive prices, and incredibly knowledgeable staff. They have a storefront at 518 Yonge Street, Toronto, and an online store as well.
Although their store is wheelchair accessible, their games room for events is not. If you want to avoid a crowd, go before 3 pm or shop online. I suggest ordering your games online and then picking them up at the store to save on shipping. If transportation is an issue, shipping is a flat rate of $8.95 per order. Shipping is free for orders of $150 or more.
Ask any dietitian, and they’ll probably tell you that their clients are asking them about the ketogenic diet more than any other recent ‘fad’ diet. Popular headlines have proclaimed it the miracle diet to shed weight, boost energy, reverse diabetes and send cancer into remission.
But does this diet live up to its hype? What could it possibly have to do with recovery from traumatic brain injury (TBI)? And more importantly, is it safe?
The Ketogenic Diet
The ketogenic diet started out as anything but a fad. It was developed almost 100 years ago to treat children with epilepsy that didn’t respond to anti-epileptic medications. By definition, it is a very low carbohydrate (less than five per cent of total energy per day), high fat (about 80 per cent of energy) and moderate protein (15 – 20 per cent) diet.
This is vastly different from Health Canada’s recommended macronutrient distribution, which is 45 – 65 per cent carbohydrate, 10 – 35 per cent protein and 20 – 35 per cent fat. Since glucose (a carbohydrate) is our body’s preferred source of fuel, this high fat / low carbohydrate diet essentially tricks the body into believing it is in a state of starvation. The liver begins to convert fat into ketones (hence the name), and the brain’s cells are forced to adapt. The result, for someone with intractable epilepsy, can be a 50 to 90 per cent decline in seizures.
Once medical practitioners observed the effectiveness of ketosis for the treatment of epileptic seizures, they started to wonder whether it might help other neurological injuries and neurodegenerative disorders, including hypoxia, ischemic stroke, ALS, Alzheimer’s disease, Parkinson’s disease, and of course, Traumatic Brain Injury.
Benefits of Ketosis for Traumatic Brain Injury
For a multitude of ethical and practical reasons, it is next to impossible to perform randomized clinical trials on humans with TBIs, so the research we have that looks at the role of the ketogenic diet has been done in animals. The findings are promising though, and suggest that following injury, when the brain’s need for energy is high but its ability to metabolize glucose is impaired, ketones might provide an alternative and efficient source of energy.
Following trauma, brain cells are at increased risk of oxidation, cell death and DNA damage, and the presence of ketones and absence of glucose may reduce oxygen available for oxidation and guard cells against free radicals and DNA damage, while increasing cerebral blood flow.
This is an exciting prospect, but we still need a lot of answers before we can incorporate it into practice. We don’t know which type or severity of brain injury might respond well to ketosis, or whether it is best achieved through fasting, the ketogenic diet or even intravenous provision of ketones. It is unclear whether ketosis is helpful only initially after injury, or if it will support brain recovery if used for a longer period of time. It’s possible that a modified and less restrictive form of the ketogenic diet would work just as well as the standard diet, and some studies suggest that it might be even more effective when supplemented with certain nutrients, including medium chain triglycerides and branched chain amino acids.
Challenges of the Ketogenic Diet
There are several challenges with the ketogenic diet, the first being compliance. Since it is extremely restrictive, it is difficult for most people to stick to the diet long-term. It excludes entire food groups (grains, fruits and many vegetables), increasing the risk of nutrient deficiencies including sodium, potassium, chloride, vitamin D, calcium, magnesium, selenium and zinc. Among other issues, these deficiencies can impair bone healing and increase the risk of osteopenia and bone fractures. For people with pre-existing kidney disease or renal failure associated with trauma, the high protein intake that usually accompanies a high fat diet may not be appropriate. And of course, with a high fat diet there is concern about elevated cholesterol levels. Studies evaluating the use of the ketogenic diet in children found elevated triglyceride, and total, HDL and LDL cholesterol levels at 6 months and 10 years, making this diet risky for people predisposed to coronary artery disease. Long-term use has also been associated with growth retardation in children, low-grade acidosis, constipation, dehydration, vomiting and nausea.
The Future of Ketosis in Brain Recovery
So, is the ketogenic diet the future for TBI treatment? Will it minimize brain injury and help to rehabilitate cognitive function, memory and recall? Maybe. We don’t have enough information yet to make it standard practice, and it certainly should never be implemented without careful monitoring from a physician and dietitian.
More research in humans is needed before we can give a final verdict, but what we know so far about ketosis and the brain is promising!
Melinda Edmonds is a Registered Dietitian with Aimee Hayes & Associates. She is a registered member in good standing with the College of Dietitians of Ontario and an active member of Dietitians of Canada. The focus of her practice is on the application of evidence-based nutrition therapies to optimize clients’ health, nutritional status and well-being in order to augment their quality of life and rehabilitation outcomes.
Aimee Hayes and Associates provides nutrition rehabilitation services to individuals with acquired and traumatic brain, spinal cord, and orthopedic injuries. Our diverse and dynamic team of Registered Dietitians works collaboratively with clients, families, caregivers and interdisciplinary rehabilitation teams to optimize nutrition in order to promote our clients’ wellness and recovery.
I remember the last thing we did as a family. A week before everything happened we celebrated Eid Al-Fitr.
For those of you who are not aware, Eid is a Muslim festival that happens twice a year where we get together with family and friends, and share a big meal. Both Eids have distinct connotations. In particular, Eid Al-Fitr represents the celebration of 30-days of fasting known as the month of Ramadan. Eid is one of the happiest days of the year and to top it off, that Eid occurred on a hot summer day.
My family has nine children, and a total of 11 people, so traveling together is always challenging. That day, for the first time in a while, we all went out together. It was an amazing experience, one that we spoke of for days after.
I’ll never forget the way I felt when I first heard the news about my brother. I can vividly recall it as if it were yesterday. The same couple of moments and memories consistently flood my mind, and even though it has been over three years since it happened, I think about it every single day because it completely affected and changed all aspects of my life.
I can remember seeing him leave the house, and every time I closed my eyes I saw my brother’s face at the forefront of my mind. I can speak for everyone in my family when I say that my brother’s traumatic brain injury changed our lives because it affected every aspect of our daily living. Having said that, I always felt like it affected me the most.
Because of who I am as a person, and the role I play in my family dynamics, I spent every day at the hospital for two and a half years while my brother received care. I saw things I can never un-see. My time at the hospital changed every aspect of my life, and how I perceive the world.
With so many siblings in my family, naturally, some of us are closer than others. My brother and I were, and are, very close. We told each other everything, and we always trusted one another. All of that factored into how much it really impacted my life, emotions, and day-to day-thinking.
Imagine one day you woke up in a hospital bed not able to do many or most of things that you were once able to do. How would you feel? Now imagine knowing that what happened to you was the result of a violent assault. These thoughts never left my head and I would constantly put myself in his shoes and think, “How would I feel if this were me?”
The doctors said my brother had an extremely poor outlook, and a slim to none chance of a meaningful recovery. These were the exact words that were used. It seemed as though everyone was treating him like he would not have a future, I never took that to heart. I could not give up hope.
There was and is still not a lot known about the brain. During this time, nothing else mattered but making sure my brother was doing well and being looked after. I did not feel comfortable leaving him in the hands of strangers, especially considering they did not believe he would get better or have a ‘meaningful recovery’.
I went on the Internet every day and looked for more information on traumatic brain injury. I read stories that people have shared based on their experiences. At the time, I felt like I was the only one who believed and had hope my brother would get better. It was the hardest situation that I have ever faced in my life as every day was a constant battle in making sure that his voice was heard, and he received the best care possible.
As the eldest daughter of nine children, and the daughter of immigrant parents, I felt as though it was my responsibility to always look out for the family by using my voice and knowledge to help them make decisions.
Everyone always came to me for support and advice. Yet, in this situation I did not know what to do. It felt like life was moving 200km/hour, much faster than I can actually process what was going on.
I was just trying to get through each day not knowing what would happen the next second, minute, or hour. Comforting everybody else was my way of coping because it was one thing to see a sister or brother cry but to witness my parents falling apart only meant what was happening was actually real, and I needed something to hold on to. Positive thinking, and remaining optimistic was the only way I would have been able to get through it all without losing my mind.
I often felt like I was alone but I always remained optimistic. I wanted to give my brother every chance to come back to who he was, and if I did not believe that it could be possible, I felt like I was robbing him of his potential to successfully recover.
Consequently, I would spend 18 hours a day in the hospital, every single day for the past two and a half years that he was hospitalized. It never occurred to me how much time I spent being in a hospital.
I never once thought about myself as a I sought comfort from knowing what was going on in each step of his care. Without giving it any thought, I made the decision to never leave his side and put everything else in my life on hold. I felt guilty if I was doing something that made me happy but did not involve him. I couldn’t think about myself knowing my brother’s suffering.
At the time when this happened I was an undergraduate student. During my free time I used to volunteer at hospitals, engage in various extracurricular activities, and enjoy time with family. Since this happened I felt like I lost all motivation to continue living my “normal” life as nothing about it was normal anymore.
I put the word normal in quotation marks because it is a subjective term. It was extremely difficult to see someone I knew all my life suddenly go through all these struggles, challenges, and difficulties in everyday activities that as able-bodied humans we took for granted.
Furthermore, I found it particularly difficult to balance out what was important to me as I constantly thought of his well-being and would spend most of my hours at the hospital. My rationale for why I was happy to take on such a role was that I wanted everyone in my family to feel content, and not be overwhelmed with what was going on.
Most importantly, I did not want to see everyone miss out on life, friends, and the things that they use they use to do on a regular basis. It was easier for myself to take on this role and still be in high spirits with missing out on the daily things that I used to do, however, the rest of my siblings were just kids, and I did not want to rob them of their childhood. It seemed as though everyone was able to get back into their daily routines and still do what it was that was important to them such as school, and work but I just could not move past this part of my life.
As a caregiver, it is easy to forget about yourself as you are constantly caring for another individual day in and day out. I tended to bury my emotions and how I really felt from others. I never spoke to anyone about how I felt because I did not want to consciously think about it. Everything seemed surreal, and I could not come to terms or accept the situation.
Whenever I thought of the circumstances, I felt lost, out of place, and that nobody knew how I was feeling or what I was going through as most of the time I would be alone at the hospital. Nothing in life prepares you for this nor do I think there is a manual out there that explains how to feel, what to do, and to how to cope when situations like this happen. Even if information like that exists, I strongly believe that every situation is unique in its own respects and that there are many other variables to factor into the equation.
“So the hospital phase is over, isn’t that awesome, now you can finally get back to your normal life!” This is what most people said, and the reality is that after you leave the four walls of the hospital, another chapter of the rehabilitation journey begins. It is a whole new world when you have been away from your ‘normal’ one for such a long time, and many people are not aware, or understand what that means. What happens next? What is life going to look like in the next five years, or even two? Nothing is certain, and every day should just be taken as it comes. Recovery is a lifelong process, no matter what the gains.
Fast forward to over three years since it happened, and about 11 months after leaving the hospital, I can say my brother is doing very well and is much happier to be home. He looks very healthy, much like his old self. I am dealing with the challenges of returning to my old, previously ‘normal’ life, which doesn’t seem normal anymore.
Motivated to return to the life he once had, my brother never gives up. He works hard every day, challenges himself to new lengths, in therapy sessions with his occupational therapist, and physiotherapist, and in everyday tasks.
He once said, “What is it that I will do for the rest of my life? I want to do this, be this, and go here. There is nothing that I cannot do if I work hard. Yes, I had a TBI, but that does not define me, it is just a part of me. I’m still the same person, do not treat me any different.”
I am an avid believer of this quote from Indian author Ritu Ghatourey:
Everything happens for a reason. That reason causes change. Sometimes the change hurts. Sometimes the change is hard. But in the end its all for the best.
I want to take this moment to say that given how horrible and scary this situation was, I am deeply grateful for all that I have witnessed, and learned over the past three years. If it was not for this situation, I would not have known how little people know and understand about the nature of TBIs, the various stigmas and assumptions that society fosters, and how this shapes and influences the ability to successfully reintegrate back into the community, and work as rehabilitation is a lifelong process.
The lack of understanding and awareness in society is a major barrier to successful reintegration, and is a public health concern, considering that TBI will be one of the major leading causes of death and disability by the year 2020.
I made meaning of this situation by believing that for me what had happened was a turning point to help me realize where my passions lie, and what it is that I want to commit to for the rest of my life.
Before this happened, I learned about TBI in my studies but I never once imagined what it would look like first hand. I never understood what it meant to be able-bodied, and to be able to do day-to-day things that we normally do not think of and have taken for granted. Furthermore, I never realized how difficult it was for someone to get around if they were on a wheelchair, and this includes going to the grocery store, the park, or even the bank.
It is through this experience that I have found something that I am immensely passionate about, and it is improving and enhancing the lives of TBI survivors, and their caregivers.
Samira is an MSc Candidate at the University of Western Ontario, in the Health and Rehabilitation Sciences Program, specializing in Health Promotion. Her current research focuses on oral health in traumatic brain injury, where she is qualitatively exploring the lived experiences of health professional students in various rehabilitative programs such as occupational therapy, physiotherapy, speech-language pathology, and nursing.
I remember lying in my hospital bed and looking out of the window at the smokestack that illuminated a soft purple glow when it got dark. I was six-years-old and recovering from encephalitis which had landed me in a coma for two-weeks.
Low level light therapy (near infrared) may have beneficial effects in the acute treatment of brain damage injury.– Dr Michael Hamblin
But, it is documented that: a number of individual cases in which patients with chronic mild brain injury showed marked improvement in cognition, executive function, memory and sleep with light emitting diode (LED) treatments. – BioFlex Laser Therapy: Shining light on brain injury – Benjamin Yuen, DC, MSc, MCC(UK); Fred Kahn, MD, FRCS(C); and Fernanda Saraga, PhD
Source: Meditech International Inc.
Fast-forward almost 40 years, and I still find comfort in lights, especially at Christmas.
I enjoy hanging Christmas lights around our house (though I try to finish it up before the weather gets too frigid and I freeze my hands and fingers.) Once they are all plugged in, I find it calming and almost mesmerizing to look upon them in awe.
Is this brain injury related? I don’t think Dr. Hamblin and the others were referring to Christmas lights when they spoke about light therapy. But they are a comfort.
We’re big on Christmas at home: our house explodes with Christmas decorations, we host an annual open house, I do the lighting inside for the tree and fireplace mantle, but my favourite are the outdoors lights.
I am no Clark Griswold in National Lampoon, but I like setting up a fair decent amount of lights on the exterior of our home. I may even think how to out-do myself, every so often.
I like the glow that shines in the darkness of night. Wrapping the lights around our flag pole like a giant candy cane, outlining the windows and doors with colour and thinking, yes, “What can I add this year?”
Maybe there is something to the effect of lights like this on my damaged brain, I don’t know. Or maybe it is the memory of the purple tower that I am drawn back to, something that made me feel safe and secure during a very vulnerable time of my life.
But maybe, too, it is simply the festive time of year.
Mark’s passion to lend a helping hand, offer advice and give back has developed into a moral and social responsibility with the goal of sharing, inspiring and growing – for others as well as himself. His experience as a survivor, caregiver, mentor and writer has led to his credibility as an ABI Advocate and author of his life’s story, Challenging Barriers & Walking the Path. Follow him on Twitter @Mark_Koning or go to www.markkoning.com
My husband, Norm, has lived in a long term care home since acquiring his brain injury six years ago. Each holiday, be it Easter, St. Patrick’s Day, Halloween or Christmas, the facility decorates the common areas, in attempt to give residents and their families a more festive experience.
To be honest, since Norm’s accident, I really haven’t felt like celebrating the holidays. Norm and I don’t have kids so why bother? It seems as though I am just going through the motions.
Thankfully, Norm and I have good people around us. We get a crew together to decorate Norm’s room each year. His brother, sister-in-law and friends come to help. They help bring out the holiday spirit – which is hard, as Norm doesn’t show many emotions.
As much as possible, we try to keep things the same as before the accident. Christmas Eve we go to our parish church for mass. On Christmas Day we go to Norm’s brother’s to open presents and see the rest of the family. In the afternoon, Norm and I head over to our friends to wish them a Merry Christmas.
Despite this, our trips are more complicated now and planning is essential. When Norm and I go anywhere, I have to book the mobility van that is at his long term care facility. If the van is booked, I have to phone the taxi company. I have to strap Norm in with seat belts for safety. When we go out for Christmas dinner, to a restaurant or to friends, I have to make sure that Norm has a pureed meal to eat.
At the end of the day, I think having family and friends around is all Norms needs as when they are around, he just beams.
After her husband’s injury, Theresa went back to school to become a Personal Support Worker. She has taken courses in brain injury, and is now a full time caregiver. You can follow her on Instagram, HERE