Brain injury in the family: then and now

BY: MARK KONING

In 1978, when I was six years of age, I was admitted to the hospital with a viral brain infection, known as encephalitis. Encephalitis is inflammation of the brain, caused either by an infection invading the brain (infectious) or through the immune system attacking the brain in error (post-infectious or autoimmune encephalitis).

Mark Koning and his mother
Mark Koning and his mother

It was a seizure that alerted my parents to the fact that we needed to take a trip to the hospital, and then another seizure which told the doctors I needed to be admitted. After this, I draw a few blanks. There were many tests, I was in a coma for two weeks, and I received rehabilitation during the course of my stay at this medical facility that acted as my home for the following months. While there was some therapy that I continued to endure for another little bit after I went home, that was it, I was done.

Fast forward 23 years later to 2001 when my mom had an accident and fell, and I see a world of change. After my mom was placed onto a gurney in the hospital, it took only a matter of hours to diagnose the subdermal hematoma/blood clot that my mom had suffered. They first had looked into whether or not it was a stroke which had caused the fall, followed by tests for an aneurism. Turns out it was just a plain old, bad, fall.

My mom went into surgery that night and found herself sleeping in a coma for the next month. When she awoke, it took her quite a while to find the mobility to physically move her limbs, and it took even longer for her to find her voice. A physical therapist helped with her movement, a speech therapist helped with her aphasia and a cognitive therapist helped with everything else. The nurses were great and the doctors took good care to explain things that my sister and I needed to know. My mom was prescribed the appropriate medications to ease any discomforts. Therapy followed us home and soon the Community Care Access Centre (CCAC) got my mom, among other services, a personal support worker.

Currently my mom attends an aphasia program once a week, an ABI program once a week and has a March of Dimes rehabilitation worker come out once a week. She also involves herself in many social activities March of Dimes offers. And her doctors, even though different from years ago in the hospital, treat her very well.

Mark Koning
MARK KONING HOLDS A COPY OF HIS LATEST BOOK, CHALLENGING BARRIERS AND WALKING THE PATH; PHOTO: MERI PERRA

There is quite a bit of difference between our injuries. I was pretty young when I acquired my brain injury,  while my mom was just approaching her 60th birthday when she fell. (Though she would say 49  and holding.) And as much as I don’t want to seem ungrateful for the care I received, I can’t believe the tremendous difference compared to what my mother has access to compared to what I had, back in 1978.

Times have changed and regardless of my occasional questioning about my past, I have no complaints about change when it is for the better.

The one main difference between my mom’s accident and mine is traumatic brain injury (TBI)  versus acquired brain injury (ABI). My mom fell and suffered a TBI where as I was struck with a viral infection from within; no trauma, no physically-seen damage, no bleeding from the head. Does make a difference? I wonder.

To find out more about my life growing up you can do so by reading my book Challenging Barriers & Walking the Path, found here: http://www.markkoning.com/ChallengingBarriers.html


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.

 

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Why seniors are at risk of acquiring brain injury

BY: RICHARD HASKELL

It’s often been said that in life there are two things that are inevitable – death and taxes. Well, to that short list, I’d like to add “aging.” We can’t avoid getting older, and with any luck, old age will be a period in our lives (if it isn’t already) when we enjoy reasonably good health, discover new pleasures and continue to find contentment in the company of family and friends.

Nevertheless, aging can also bring new challenges. Energy levels drop, flexibility, strength and endurance aren’t what they use to be and some may experience issues with hearing and eyesight. As a result, seniors may find themselves more susceptible to head injuries.

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photo credit: 10040059 via photopin (license)

Feminist author Alix Kates Shulman describes in  her novelTo Love What Is: A Marriage Transformed how her husband acquired his traumatic brain injury at the age of 75:

On a moonless summer night my husband fell nine feet from a sleeping loft to the floor and did not die. … He did not die, though X-rays taken several hours later showed that he had broken most of his ribs and both feet; punctured both lungs, causing perilous internal bleeding; and suffered so many blood clots in his brain that each CAT scan of that precious organ resembled an elaborate filigree.

In the U.S., the Centers for Disease Control and Prevention (CDC) reports that more than 1.7 million people suffer brain injuries every year (statistics are not available for Canada, but correlating the differences between the U.S. population and Canada, and including rates of concussion, it is estimated that 587,025 acquire a brain injury each year here.)

People over the age of 75 tend to have the highest rates of ABI-related hospitalization. They are also slower to recover and their ensuing injuries are ultimately more serious and life-threatening. Falls are the leading cause of TBI, and rates are highest for children aged zero to four years and for adults aged 75 years and older.

Close to half-a-million Ontarians currently live with an ABI, with 18,000 new cases added every year, at an estimated cost of $1 billion annually. The Canadian demographic itself is aging, and as a result, medical practitioners are not only witnessing a greying of the population, but also a greying of the ABI-survivor population

photo credit: as if time stops.. and stay via photopin (license)
photo credit: as if time stops.. and stay via photopin (license)

Seniors with newly acquired brain injuries – how does it affect them?

Evidence is not entirely conclusive, but medical practitioners have come to feel that ABIs may accelerate the aging process. Those living with an ABI may suffer from increased losses in strength, greater fatigue, difficulties with problem solving and memory, and may also experience an increased loss of hearing and vision. In addition, any psychological and behavioural problems which follow an ABI will undoubtedly persist into older age and will increase as an individual ages.

But what about people who suffer an ABI as an older adult? Does the trauma affect them any differently than it would a younger person?

A 2008 study by the CDC found that in 2005, acquired brain injuries resulted in nearly 8,000 deaths and 56,000 hospitalizations for those aged 65 and older. That was ten years ago, and the numbers have risen since.

Dr. Ileana Arias, the Director of the National Center for Injury Prevention and Control (NCIPC) in Atlanta, Ga., agrees the incidents of seniors acquiring brain injury is rising.

“As more baby boomers reach retirement age, these types of injuries will increase demands on the health care system unless action is taken to prevent the injuries,” Dr. Arias said.

Most of the injuries are caused by falls, with traffic accidents a distant second.

Elderly people with an ABI may also have a higher risk of serious complications such as a blood clot on the brain and because they lack the physical strength and stamina of a younger person, the process of rehabilitation may take considerably longer.

photo credit: No Photos, Please via photopin (license)
photo credit: No Photos, Please via photopin (license)

Symptoms of an ABI in an elderly person may include the following:

  • Headaches that get progressively worse
  • Increased confusion
  • Listlessness, tiring easily
  • Crankiness
  • Sad or depressed mood
  • Change in eating habits
  • Change in sleeping patterns
  • Lack of interest in routine activities
  • New vision problems
  • Loss of balance or unsteady walking
  • Failure to identify brain injuries is a common problem: a mild traumatic brain injury diagnosis is often missed when other serious injuries are present.

Another problem is that many seniors tend to ignore the warning signals, relegating them to another sign of getting older. In older adults, brain injury symptoms may take days or weeks to appear. Over that time, the signs indicating a decline in mental facility may appear only gradually. But symptoms which interfere with the basic tasks of day-to–day living such as bathing, dressing, routine chores or taking care of financial matters should be taken seriously and should be dealt with by a specialist.

Older adult ABI survivors are also at risk a greater degree of social isolation. If they happen to be living on their own they may be dependent upon others for help but what happens when the caregivers become sick themselves and are unable to provide the help needed?

Living with ABI as an older adult

An ABI is life altering and even more so for older adults. Physical recovery is only half the battle, and the survivor must be ready to deal with the possibility of cognitive or behavioural changes down the road. But there are an enormous number of resources available in Ontario, all of them geared to helping those affected regain a degree of independence.

Elderly people with an ABI should be treated in a manner that allows them as much independence as possible and there are a number of ways to make life easier. For example, the contents of drawers or supplies in a medicine cabinet might be labelled to help with memory issues. Simple steps for tasks or a written schedule could be created thereby providing the ABI survivor some degree of flexibility while helping them to remain as active as possible. The schedule might include activities such as therapy, visits to medical practitioners or socializing with family and friends. As with many ABI survivors, there will likely be days when a senior with an ABI may not feel like doing anything, so it is important that they be kept engaged as much as possible.

How seniors can reduce the risk of falls and improve safety in the home

There are certain steps seniors can take to reduce the risk of falls, which in turn may lead to brain trauma. Here are some tips via Brainline:

  • Encourage Exercise. Exercise is one of the best ways to reduce older adults’ chances of falling. Exercises that improve balance and coordination are especially important, but check with the older adult’s doctor about which exercises are safest and best for them
  • Remove items from stairs and floors that might cause tripping
  • Remove small throw rugs or use double-sided tape to keep the rugs from slipping
  • Place items used often within easy reach, so that a step stool is not needed
  • Install grab bars next to the toilet and in the tub or shower
  • Place non-stick mats in the bathtub and on shower floors
  • Add brighter lighting and reduce glare by using lampshades and frosted bulb
  • Be sure there are handrails and lights on all staircases
  • Be sure the older adult wears shoes that give good support and have thin, non-slip soles.
  • Remind loved ones to avoid wearing slippers and socks or going shoeless

 

Sources: BrainlineCenters for Disease Control