Neuroscientist Shane O’Mara believes that plenty of regular walking unlocks the cognitive powers of the brain like nothing else. He explains why you should exchange your gym kit for a pair of comfy shoes and get strolling…
by Elise Morgan
Sleeping after a traumatic brain injury can be problematic. The American Academy of Neurology found as many as 40-65% of people with mild traumatic brain injury struggled with insomnia. Lack of sleep negatively impacts our cognition, mood, and energy levels; unsurprisingly, this can also adversely affect rehabilitation.
Why is Sleep Important?
Sleep plays a major role in physical healing. During active sleep, our brain stem secretes hormones that relax our muscles to prevent twitching. This can play a role in helping muscles to heal. What’s more, during slumber, various hormones and chemicals within our bodies are produced to enhance our immune system responses, repair tissue damage and generally restore our brains and bodies.
Our brain waves also change when we sleep – beginning with a deep slow wave that is accompanied by lowered heart rate, blood pressure and body temperature as well as relaxation of the muscles. This deep slow wave is then followed by REM sleep that involves faster and more active neocortical EEG waves, similar to those observed during waking. We cycle through these stages four or five times, a process that has been shown to improve brain plasticity – the ability to adapt to input.
Tips for getting better sleep this year
Whether you’re suffering from insomnia, excessive daytime sleepiness or other sleep disturbances, the good news is that there are steps you can take to improve your sleep. Changes to your routine and environment often make a big difference.
During the day, get at least 20 minutes exercise. People who exercise have less difficulty sleeping as well as less day time sleepiness, including those with TBI. Working out in the morning can improve these benefits.
Wake up and get out of bed at the same time each day. It doesn’t matter if this is 6am or 10am, simply having a fixed wake up time will help to anchor your circadian rhythms and aid in sleeping better at night. Coupling this with 15 – 30 minutes of sunlight when you wake will reinforce your internal body clock and enhance wakefulness throughout the day. If you have dark winters that make it difficult to see the sun, consider using a light box.
Cut napping time to no more than 20 minutes a day. Daytime napping can make it more difficult to sleep at night and disrupt our natural sleep/wake cycles.
At night, try adding a relaxing practice to your bedtime routine. Mindful meditations, bedtime yoga stretches or simply having a mug of warm milk with these white night cookies while you read before bed can help. Certain foods contain natural compounds like tryptophan and melatonin that work to calm your body and help you sleep, while meditative practices have been shown to trigger a relaxation response in our bodies that make it easier to fall and stay asleep.
Keep your bedroom as calm and relaxing to avoid associating it with stress and restless nights. Don’t work or pay bills in your bedroom, keep the TV and electronics out, and minimize noise, extreme temperatures and light.
Sleeping is paramount to our health, and imperative for our healing processes. Making sure you get enough shut-eye can aid rehabilitation and overall wellbeing. A few changes are well worth the effort.
Some acts are obviously courageous: a person runs into a burning building and saves a life, or a bystander dives into a lake to save a drowning person. These are dramatic examples of courage and bravery, when people make spur of the moment decisions and put their own lives at risk in order to save others
There is, however, another, harder to see type of courage, and to appreciate it you’ve got to pay attention because this isn’t dramatic and doesn’t get lot of press. I am talking about the “we have no choice, wake up in the morning and do your work” kind of courage: the kind exhibited by TBI survivors who get up every morning, and slog through their confusion, frustration and anger to fight the daily brain injury battle with no fanfare and no immediate reward.
Think about that. People like you, TBI survivors, live a brave and courageous life simply by facing the battle, head-on, each day; the difficulty and commitment of which is something few people understand.Your courageous-ness needs to be acknowledged, and that is what I am going to do right now.
The Courage of the TBI Survivor
A courageous person doesn’t usually consider themselves courageous or special. Rather, they act out of a feeling of obligation, or need, and because of this, true courage is often marked by humility. While it is normal and healthy for people to feel pride in themselves or feel good about what they have done, it is a characteristic of courageous people to just do their job because that is what they do, and to not consider themselves especially courageous. They are just trying to live their lives the best way they can and do what they think is right.
In the case of you, the TBI survivor, each one of you exhibits great courage as you attempt to rebuild your life. While it would be nice if others could see that or were able to understand what you go through, it’s much more important that you understand that you are fighting an honorable, courageous battle, and that the rewards you get are a product of being in that battle, and they are priceless. You should also know that other people will probably never understand it.
The TBI survivor’s rewards for being courageous are: 1) be able to live your life in a manner you find fulfilling, and 2) the knowledge and the feeling you get from knowing you have accomplished something great, even though others may not see it.
There have been very few times in my life when I have been acknowledged for what I have done; not because people don’t care, but simply because others just don’t understand. One time, I was speaking with a girl I had just met in college and the conversation shifted to the fact that I had been in a coma for a month. She stopped, looked at me and said, “You must be the strongest person in the school.”
I can remember being completely floored and not knowing what to say. I sheepishly shrugged my shoulders and walked off. That was so nice of her to say, and so completely unexpected.
How I reacted was an example of how we can be affected by our self-image. I couldn’t accept a compliment from her because, in my own mind, I was a long way from what I had been before my TBI, and not worthy of such a compliment.
That is a huge issue. Many of us can feel so unworthy and downtrodden, it is not only hard to let compliments in, we blame ourselves for too much and apologize too often.
When people pay you compliments; try to really listen to what they are saying. Don’t deflect them or refuse to believe them. Try to understand the magnitude of what you are doing. So many of us think we don’t deserve it because we aren’t what we used to be before our Brain Injury, and that we are not worthy of praise.
But you are.
You all are courageous and you are worthy
It’s hard to measure or see, on a daily basis, the results of your courageous-ness. Progress can be agonizingly slow. Add to that the fact that you aren’t performing up to our old standards, and it makes accepting any type of praise difficult. No matter how well you are doing things, it never seems good enough.
However, each day you grow. You learn. You become.
The courageous-ness you exhibit is not for a one-time event. It is on display every day, starting when you wake up and drag yourself out of bed to fight an invisible and silent opponent. In many ways life becomes a grind, one that’ll chew you up and spit you out if you let it; but you battle. You fight for your dignity and your life, and by being engaged in that fight you gain so much.
That’s a hard thing to explain to someone, but you know.Your courage is not rewarded, and is, in fact, many times overlooked, mostly for the following reason: people are unable to recognize it. Most of you heroes toil in obscurity for what you think is important; simply because that is how you need to live your lives.
There is dignity and honor in the way you live your life, and you should be proud of every thing you have accomplished.
It is an honorable battle and an honorable life.
Believe in the battle and believe in yourself.
Linda W Arms gives a very good overview of ‘learning to live with ABI’
I can successfully manage one thing at a time. It is because I have a brain injury that I can no longer multi-task in the ways I did before my injury. C
These days I can recognise several things that need to be taken care of, like a birthday coming up, having someone over for dinner, taking care of a personal business matter and a lot of other small matters. The problem is that I can’t work with a multiple of these things at the same time without difficulty and feeling CONTINUE READING HEREContinue reading
Social Learning, A Brain Injury Rehab Construct
When I applied to the ABI (Acquired Brain Injury) Network for health services, I was immediately referred to day programs. Say what? CLICK HERE TO READ MORE
“I still didn’t understand what had happened or where I was until I saw my mum and she explained everything.”
From the outside, Brock looks like any other 20 year old. It’s a weekday and he’s still wearing work gear from his shift as an apprentice plumber. He’s pretty happy to have recently moved into his own place in Pakenham.
“One of the hardest parts is when you wake up and it all sinks in,” he says.
“You start to feel like you can’t go out and ride bikes or do the things you used to do … you can’t do it again because if you hit your head you’re pretty stuffed.”
A report from the Model Systems Knowledge Translation Center (MSKTC) notes that 60% of people diagnosed with a TBI will experience difficulty falling and/or staying asleep. These sleep issues have been found in people with TBIs ranging from minor to severe; this is largely due to the fact that our brains are responsible for regulating sleep patterns (among many other functions), and TBIs can tamper with one’s circadian rhythm, or the 24-hour biological clock that tells us when it’s time to go to bed and time to get up.
A traumatic brain injury (TBI) occurs when a person experiences violent, physical trauma to their head or body. The trauma can be any kind of impact that jolts the head and body, including a physical object entering the brain tissue as a result of the trauma, such as shattered skull fragments or bullets. TBIs can be caused by a car accident, combat or warfare, physical violence, or sports.
Sustaining a brain injury can be likened to scattering pieces of a jigsaw puzzle across a table.
As a result, individual pieces may make little sense.
Little sense to us as we go about trying to make sense of our brain injuries
The severity of symptoms related to an acquired brain injury can differ significantly due to the part or parts of the brain that are damaged. Symptoms can be physical (problems with movement/balance, speech, seizures, and altered sensations), cognitive (memory, planning, judgment, attention, communication) and/or emotional or behavioural (depression, anxiety, loss of emotional control, personality changes, lack of self-awareness).
Benjamin’s family was told that he would never walk, talk, or play the piano again. Perhaps even more distressing, they were told that he would not be able to experience emotion as a result of his injury.
Hi, my name is Peta Ferguson and I have an acquired brain injury (ABI). My
presentation today will be a combination of PowerPoint and the spoken word. I’m
not silly enough to think you’ll understand every word so you’ll probably need the
screen to get the main points. Of-course you can ask anything, anything at all at
the end of the presentation.
You can get an ABI from any number of ways; eg. a coward’s punch, disease,
anything that negatively affects the brain after birth. The long-term effects differ
widely; from being stuck in a wheelchair unable to talk to appearing totally
‘normal’. I didn’t have a car accident, a fall, was beaten up or have a stroke; no, I
took a deliberate overdose of prescription medication when I was 24. I didn’t
think of possible consequences, I just wanted out. Why? I don’t know. My parents
were both doctors, I lived in a nice house, went to a good school where I did well
and had lots of friends. Later I went to Melbourne Uni where I did Arts/Law.
I must say I am happier now than immediately before the OD but I certainly don’t
recommend trying it. It took thirty years (with a couple of exceptions) of deeply
depressing crap to get to this point, and thirty years is a long time.
Let me tell you how I got to this point:
As I said I had a really easy time at school; I was a house captain, leader of the
school orchestra and I had no problems academically. In year 12 there were
rumblings that all was not right – twice, just for a few weeks at a time, I was
admitted to psychiatric hospital for depression, but it wasn’t too earth-shattering
and I think the general consensus was teenage problems and I’d grow out of it.
I did quite well in my final exams and went straight to uni. The freedom went to
my head and studying was out of the question. I dropped out during my first year,
went straight back the following year and dropped out again. (There were no such
things as fees.)
A0fter I left the second time, I did a series of soul-destroying jobs (for me) –
mainly bar-tending. I then decided I wished to get away and hitch-hiked out of
Melbourne. I remember getting to Adelaide and tossing a coin; heads for WA and
tails for NT. It was tails so I headed up the Stuart Highway to Darwin. Now it is far
too dangerous but back then it was less so and ignorance is bliss. I hitched a lift
with a truckie just out of Alice Springs and about twelve hours further on he
stopped at a place called Daly Waters and said he was turning off the main
highway and traveling inland for about three hours to a cattle station called
McArthur River. I had no burning desire to see Darwin at that stage so I went too.
I was welcomed at the station and immediately employed as a governess for six
kids aged from five to fourteen. I only got the job because I had completed year
12, I wasn’t a great teacher, there were a lot of swimming lessons. I also worked
as a meat worker at night; they had an abattoir on the station. Back then I tied
the best sausages, not any more – fine movement problems. There’s a quick story
I must relate; I’m quite sure it wouldn’t happen now – we’re talking ages ago. I
drove into the local aboriginal town, Borraloola, a couple of hours drive away. I
said to the local cop “I want my license”. He asked me how I got to Borraloola and
when I told him I drove I got my full license for three years for $3. No P’s. After a
few months I grew bored – my father flew up and picked me up.
Back in Melbourne a guy I’d met on the station came down and asked me to move
in with him. He came on a motor bike with a mate, both wearing leathers and
beards. One look at my mother’s horrified face and I said “sure”. (I’d hate to have
me for a daughter.)
I lived with him for three years, again doing what I now view as soul-destroying
jobs, eg. waitressing and bar-tending. Then we split. I had the travel bug again only
this time I drove, as far north into Queensland as I could go before the car carked
I wound up in a place called Cunnamulla, a few hundred kms west of Brisbane.
There were three pubs in town and I worked at all of them. I kept my dog behind
the bar, anyone getting too friendly had the dog to deal with.
I was twenty-four but still that big ogre of depression sometimes made its
presence felt. I tried to gas myself; I’m not sure what happened next, one of the
locals must have contacted my family. My sister drove up, collected me and I was
admitted to a looney-bin in Melbourne.
Even there I was a social butterfly, ingratiating myself with people but certainly
not developing any meaningful connections.
A couple of months down the track I took ‘THE BIG OD’. Events immediately
following are a bit hazy. I think I was in general hospital for about one month – I
wasn’t in a coma, just stupefied and totally non-communicative. I didn’t talk for
four years or walk for five years.
After general hospital I was admitted to Caulfield Rehab. As you can imagine I
wasn’t full of joy, life was over for me. To hammer home the point my boyfriend
at the time visited me with his new girlfriend and brought me a giant pink teddy-
bear because he thought of-course my mind had gone along with my speech and
my ability to walk. (Please be very mindful of this when interacting with someone
who doesn’t speak and is in a wheelchair. Steven Hawking is a good example.)
I was quite resigned to rotting in Caulfield but for some mysterious reason about
one year later I was transferred to M7, the brain trauma unit at Mont Park
Psychiatric Hospital. It has since been pulled down. It was declared unfit for
human habitation ten years before I was admitted so I wasn’t living in luxury.
I spent the next five years in this place so I have clear memories. I shall describe
the layout and my usual daily routine. M7 was one of many separate buildings
sitting on the outskirts of a large treed oval. (The buildings were hideous but the
grounds were magnificent.) M7 was a little brick building, locked to prevent
people going AWOL. There were fifteen male ‘patients’ and three females.
Because there were so few girls our beds were put at one end of the covered-in
veranda and separated from the main space, the lounge-room which had the TV
going 24/7, by a sliding screen. This proved to be a problem; there was a blind guy
who could walk, he used to tap his way along the veranda, push past the sliding
screen, lie down on the first bed he came to (mine) and promptly piss on it. As I
didn’t walk and was transferred to a stationary chair during the day I had to feel
my bed just before I got into it each night.
My daily routine; I was woken at 8, showered, breakfasted and then put in front
of the TV. My day was broken up by regular bouts of physiotherapy, I also had
weekly sessions with a psychologist and a speech therapist for a few years and at
that stage I didn’t even emit a squeak! One inmate whom I absolutely loathed (I
think this was partial motivation for me walking and talking – I wanted to get
away from him) owned the only TV so we had to watch what he wanted to watch.
‘Here’s Humphrey’ was on thirty years ago. That and the cricket; I wasn’t a fan
then but now I’m really keen. I was a captive audience, unable to walk away.
In my fifth year in Mont Park I was walking and talking. A visiting Christian couple
fell in love with me, thought I’d be a great charitable project and offered me a
room in a share house. I repaid that belief by hoarding all my medication for one
year and taking yet another OD. No negative physical consequences this time but
I again was admitted to Mont Park, this time a purely psychiatric ward.
I was sitting in the lobby with a few other patients. A guy was brought in flanked
by two psychiatric nurses. One of the patients said “He can’t be brought in here –
he’s a psych nurse himself”. I couldn’t help myself “He’s got as much right to be
looney as anyone else.”
From then on we were friends and eventually after both exiting hospital we
moved in together.
One year on, his ex-wife and mother to his three sons, handed full custody to us. I
found it ok having an instant family, though the four year old was at that stage
just strange. Several years and bulk appointments later he was diagnosed as
having Aspergers, a form of autism.
We married in 1990 (?) and six years later I had a biological child who is now 19.
In 1999 we decided to call it quits and since the total absence of kids (youngest at
school) I decided to do something for me and commenced studying Cert IV in
Disability. There I heard about the existence of Brain Injury Matters, a group, the
only one of its kind in Australia, possibly the world. It is what is called a ‘self-
advocacy group’, in other words by grouping together we learn and become
empowered, able to speak up for ourselves. I joined BIM in 2004, now I’m the
president. BIM has really helped me find my voice; when I first left the institution I
was so paranoid being heard in public I used to hand shopkeepers typewritten
notes with a list of things I wanted. Now I’m giving presentations.
My existence now is pretty good but as I said at the beginning I had to go through
thirty years of crap to reach this stage and when I say ‘crap’ I mean it.