Between 30% to 65% of people suffer from dizziness and lack of balance, or disequilibrium, following a traumatic brain injury (TBI). Balance is the ability to keep your body centered over your feet. One’s physical strength, cognitive ability, and coordination all play a role in balance.
Following a TBI, many people also experience difficulties with gait, which is defined as a person’s manner of walking. A common symptom, vertigo, makes you feel like your surroundings are moving, which can result in an imbalance in a person’s gait.
Many factors help gauge the impact a TBI has on a person’s balance, including where the actual injury occurred within the brain, how serious the injury was, and any other additional injuries. Medications used to manage pain can also cause balance problems due to the common side effects of dizziness and lightheadedness.
Eyesight is often a cause of poor balance and, in the case of TBIs, serious accidents can result in injuries to the eyes with resulting double vision, partial loss of vision, depth-perception problems, and/or convergence insufficiency, which is when your eyes don’t work together. In addition to ocular injuries, vestibular (inner ear) impairments can also have a great impact following a TBI. The vestibular system is the sensory system that provides the leading influence to the sense of balance and spatial direction when coordinating movement with balance.
The vestibular system is made up of tiny organs and semicircular canals inside the inner ear. The canals contain fluid and fine hair-like sensors that monitor your head’s rotations. When the head moves, particles of calcium carbonate, called otoliths, pull on the hair cells, stimulating the vestibular nerve, which signals the position of the head with respect to the rest of the body. The particles, or crystals, are sensitive to gravity and linear movement. Any damage to the vestibular system from a TBI will affect your balance and gait.
After the common causes of balance impairment are initially ruled out, an array of different medical providers can assist in the diagnosis and treatment such as physiatrists, neurologists, and otolaryngologists, aka ear, nose, and throat (ENT) specialists. Two tests that are commonly used to identify balance difficulties are the Berg Balance Scale and the Dynamic Gait Index. Both exams will be used to test and keep track of the progress made in the process of regaining balance and gait.
There are multiple methods you can try to improve your balance on your own and/or under the direction of a physical therapist. You can practice walking in different conditions and different inclines, on various structures, such as grass, wood, and asphalt. Challenging yourself to walk longer distances and in different venues such as parks or shopping malls can help.
Every case is individual and each person’s recovery is unique. Research shows that three months is the common timeframe in which people with a TBI can walk on their own, but progress and improvements can continue for years. Individual pre-existing impairments can add a significant time extension to the recovery and the degree of success in regaining one’s balance and gait. The key is to remember every improvement, as small as it may seem, is progress.
James A. Heuer, PA is a personal injury attorney helping individuals with TBI after suffering one himself. He is located in Minneapolis, Minnesota.
This post was previously published on thebrainhealthmagazine.com.
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A traumatic brain injury (TBI) can occur at any time and can have a profound impact on the lives of those affected. While protected by the skull, the human brain is highly susceptible to physical trauma. In some cases, a severe injury can lead to changes in the affected person’s behavior and relationships.
The last item — a decrease in empathy — is one of the most difficult issues to understand for the friends and family members of the affected person. Fortunately, there are things that can be done to regain empathy.
Cognitive empathy: knowing how another person feels which is linked to recognition of facial expressions.
Emotional empathy: experiencing a similar emotion to another person, e.g. feeling sadness when you see another person crying.
Compassionate empathy: responding to others’ emotions by offering help when it’s needed.
One trait that may be connected to a loss of empathy is called alexithymia. This is when a person has difficulty identifying their own emotions or distinguishing them from physical sensations. While some people are born with alexithymia, researchers have identified this trait in patients who have experienced TBIs.
Why Do Traumatic Brain Injuries Sometimes Cause a Loss of Empathy?
Not every traumatic brain injury leads to a loss of empathy, so let’s talk about why some do. There are two key parts of the brain that regulate emotional responses. If either or both are damaged, the injured person’s ability to be empathetic may be affected.
The right supramarginal gyrus is responsible for helping us overcome egocentric bias – an emotional selfishness – before we make decisions. Another way to look at it is that the right supramarginal gyrus helps us to consider the emotions of others before we decide how to behave.
The orbitofrontal cortex is responsible for how we react to other people’s emotions, specifically how we recognize facial expressions and tone. If this part of the brain is damaged, it can be difficult to correctly identify emotions in other people and therefore impair empathetic responses.
A loss of empathy may be temporary or permanent. In many cases, empathy will return over time. However, it may be necessary to work with the patient to restore empathetic responses.
How to Regain Empathy After a Traumatic Brain Injury
While a loss of empathy can be upsetting to both the patient and their friends and family, there are things the patient can do to restore empathy and improve their relationships.
It is important to understand that a patient may not regain all three kinds of empathy. For example, a severe TBI to the orbitofrontal cortex might permanently alter one’s ability to recognize the facial expressions identified with strong emotions. However, it is often possible to restore compassionate empathy at the very least, which allows people to act with empathy even if they don’t feel it in the same way they did before the TBI occurred.
Here are some the things to help TBI patients regain empathy:
Providers and clinicians treating patients with TBIs should evaluate them for empathetic responses, including their ability to identify emotions and to feel similar emotions. Evaluation is an essential tool for identifying the extent of empathetic impairment.
Patient education can help people who have experienced TBIs understand how their brains may have changed.
Clinicians can discuss with patients how to respond compassionately to their loved ones even if their emotional responses have changed because of the TBI.
Finally, it can help the patient to ask their friends and family to be more specific about the way they are feeling to help them appropriately respond empathetically. For example, a patient with a TBI may not be able to recognize a sad expression but can still respond accurately if someone says, “I feel sad.”
With proper education and assistance, a patient who has experienced a loss of empathy can still respond empathetically and have healthy, happy relationships after a traumatic brain injury.
Tracey Coad helps her 12-year-old daughter Asha with most aspects of daily life, from getting out of bed in the morning, to eating and going to the toilet.
Tracey Coad says navigating the NDIS was “very traumatic” for her family
A WA report found the NDIS planning process is complex and stressful
Advocates say more training for NDIA planners and more flexibility is needed
But when it came to planning for Asha’s transition to the National Disability Insurance Scheme (NDIS), Ms Coad was the one needing help.
In the process of transitioning to the NDIS, she had to navigate a system that WA’s peak disability advocacy group has described as stressful, confusing and bureaucratic.
In preparation for their first planning meeting, she had to gather evidence of Asha’s disability — a rare condition called Pitt-Hopkins Syndrome — and prepare an impact statement to demonstrate the effect this had on the family’s daily lives.
“I felt before going into the planning meeting that we had to become experts on the NDIS, which is a whole job in itself, and just adds another layer of stress,” she said.
“Leading up to the planning meeting was very traumatic.
“We had to ask for letters of confirmation of diagnoses from our doctor, a neurologist, specialists and therapy providers.
“I cried during the planning meeting.”
Ms Coad said the family chose to self-manage Asha’s funding — one of three options for participants — because it allowed the most flexibility.
Asha’s first NDIS plan included more funding for care support — and more flexibility to choose her therapy providers — than what she had under the previous state-run system.
But there were also omissions, such as Asha’s $1,500 ankle foot orthotics, which the family had to pay for shortly after she got her plan.
Support coordination — which is help navigating the complex system, something they were grateful for in the planning process — was also not included.
“I will be strongly advocating for support coordination in [the next] plan,” Ms Coad said.
Feedback suggests NDIS is ‘stressful, confusing, clunky’
Asha is among 32,770 West Australians who have transitioned to the NDIS, almost half of whom are receiving disability supports for the first time.
But a recent report from People with Disabilities WA (PWdWA) showed the Coad family’s experience of shifting to the national scheme was far from unique.
And although WA should have been fully transitioned to the NDIS by June 30, the transition process still awaits roughly 3,817 West Australians living with disability who are still under the old system.
PWdWA surveyed more than 350 people about how they had found the process, and concluded that even when a person ultimately had a good outcome from the NDIS, “the process to get there is stressful, confusing, bureaucratic and clunky”.
“It is evident that people feel that they are having to navigate a complex system that does not appear to be fair and equitable across the board for people with disability, their families and carers,” the report stated.
PWdWA executive director Samantha Jenkinson said while many people had good outcomes from the NDIS, the planning process was not working well.
“It is very anxiety-provoking,” she said.
“The case studies in our report really highlight that the diversity and the flexibility and transparency is missing.
“The language and the bureaucracy are making it really hard for people to understand what their rights are, what they need to do to be able to proceed and to have that flexibility, to know that they are not going to be going backwards or missing out on supports that they used to get in the [WA] system.
“We know that there can be some really great outcomes for people, so it is really disheartening when we are hearing that people are afraid to go into that planning process.
“So we want it to work and I think people still have faith that they want it to work.”
Advocacy group calls for simplified, more flexible process
The PWdWA report made several recommendations to the NDIA, including simplifying the bureaucratic language, increasing training for NDIA planners and improving flexibility.
It commended the NDIA on changes made during the COVID-19 pandemic, pointing to this as evidence the scheme can be made more user-friendly and flexible.
An NDIA spokesperson said the NDIA had announced several initiatives over the last year to support NDIS participants and providers in WA, including a $20 million expansion of the National Community Connector programs to assist people to access the scheme.
The spokesperson also pointed to the Federal Government’s plan for the NDIS, which included goals such as quicker access, quality decision-making, and equitable and consistent decision-making.
In a speech outlining this plan in November last year, NDIS Minister Stuart Robert said rolling out the scheme had not always been easy.
“The image of a plane taking off while still being built remains an apt description,” he said at the time.
“We will take a flexible, yet determined, approach to implementation, guided always by people with disability, their families, carers and other stakeholders along the way.”
WA’s acting Disability Services Minister Francis Logan said more than $1.8 billion would be invested in the NDIS in WA for 2020-21 — almost double what the state would have had under the old system.
“The NDIS is the most significant social reform of our time and the McGowan Government is making sure it works for Western Australians,” Mr Logan said.
“The State Government is considering the recommendations contained in the PWdWA report.”
The first time Caitlin Amey began hearing things, she called the mental health crisis team in a panic.
“I was told by someone who was on the line [from the Crisis Assessment and Treatment Team]that in order to stop the hallucinations I needed to eat bananas, and that would cure me,” Caitlin said.
“Obviously that was not helpful at all.”
A spokeswoman for Canberra Health services said recommendations to eat food, shower or take a walk were internationally accepted de-escalation strategies.
“There are clear procedures in place to support those in crisis,” the spokeswoman said.
But Caitlin said that was just one of her encounters with Canberra’s mental health system that had ultimately traumatised her and driven her from treatment.
WARNING: This story contains images that readers may find distressing.
Since first experiencing mental health issues at 13, the now 20-year-old has been to several different programs, had multiple admissions at different mental health wards in Canberra and Sydney, and seen a number of health professionals, both public and private.
She described some of those experiences as great, saying staff were amazing.
But she said an admission to the Canberra Hospital soon after she began having auditory hallucinations was so bad that she began to avoid intensive treatment “at all costs”.
“Being there traumatised me … flashbacks, nightmares,” Caitlin said.
“At some points I’ll be lying in bed and my entire room will change to [the mental health unit], and I just panic.
After asking to be admitted, Caitlin waited a week as she bounced between Calvary Hospital and Canberra Hospital, before being admitted to the ACT’s Short Stay Unit, a small ward designed for people to stay just a few nights.
“Our meals wouldn’t show up, we would be refused our medication — that was the only admission where that happened,” she said.
Caitlin also raised a serious allegation about a nurse, which Canberra Health Services said they could not find a record of.
Caitlin said she was shocked by the experience, and that she raised it with Canberra Health Services (CHS) through a feedback form at discharge, though she did not make an official complaint.
A spokeswoman for CHS said a search found no record of a written complaint or feedback form, and that the directorate had no prior knowledge of it.
“CHS has undertaken a significant investigation to determine if any feedback forms were submitted that canvassed a complaint of this nature. We have not been able to identify any feedback forms to that end,” the spokeswoman said.
“If evidence were to come to light to substantiate allegations of this nature, the appropriate disciplinary actions would be taken.”
The directorate has invited Caitlin to speak to them directly in relation to the incident.
Caitlin has since been in the Short Stay Unit again, and at the Adult Mental Health Unit (AMHU), both times as an involuntary patient.
She said those admissions were comparatively uneventful.
But, like several former patients of the AMHU that the ABC has spoken to, the admissions were such unpleasant experiences that she has avoided treatment in Canberra for fear of being admitted again.
“It’s not like anything particularly bad happened to me, I was never restrained or forcibly medicated or anything, it was just the …isolation,” Caitlin said.
Caitlin said she does not have a vendetta against the health system, and described conversations with caring nurses, and well-run programs — even if those programs did not suit her.
But she said she was speaking out so others who did not feel comfortable standing up knew that they were not alone in their experience.
Staff gave patient’s clothes to wrong person, left him in unsecure room
Andy is another former AMHU patient who said a “traumatising” admission led to him withdrawing from his wife Sam, and his friends and family.
He first entered the secure facility after being moved from a general ward in the middle of the night, where he was recovering from a suicide attempt.
“It was a bit daunting … they took me in, they took all my belongings, they took my phone charger, so my phone was dead, I had no way to contact Sam or anything,” Andy said.
“It felt more like a prison than anything.”
Andy was in the ward for about a month — but after the first week, he was moved into a room with a broken lock.
“Anyone could have walked into my room at any time,” he said.
“I raised it with staff multiple times, and was frequently told there was nothing they could do about it.
Andy said he began telling doctors that he was “fine” and ready to leave, “just to get out”.
A spokeswoman for CHS said it was an error made by the maintenance team not to urgently fix the lock, and to allow Andy to remain in the room.
“It is not accepted practice for a patient to remain in a bedroom with a broken lock … Canberra Health Services apologises to the patient for that,” the spokeswoman said.
“Systems have now been revised so that where there is an outstanding maintenance issue like this, the room will not be used.”
Andy’s wife Sam said staff also gave clothes that she had brought in for him to another patient by mistake.
“She was walking through the ward with a jumper on that was two times the size of her,” Sam said.
Fortunately, Andy was able to get his clothes back from the patient.
Andy said the whole experience was so unpleasant he began to hide his mental health issues.
“It got to a point where I didn’t talk to anyone about my mental health because I didn’t want to be put back in AMHU again,” he said.
Worker says some staff ‘disrespectful’, unwilling to be there
The ABC has heard several complaints of patients not getting some medication on time, not being able to see psychologists, patients answering ward phones, and staff ignoring simple requests.
One worker, who has worked in multiple wards in Canberra, said the AMHU was partly staffed by trainees who seemed to be unequipped for the work.
“A lot of them didn’t know how to communicate with the residents, with the patients,” the worker said.
He said some trainees appeared to be there “in sufferance” as part of their training.
The worker was clear that on the whole staff were professional and tried their best, and long-term staff “knew their stuff”.
However, he said some security staff made hurtful comments to patients.
“Some of the things they say to the guys there isn’t great, not very respectful,” the worker said.
Mental Health Minister Shane Rattenbury acknowledged some patients had “dissatisfying” experiences, but said the Government was working to improve the system.
“I would hate to think that people might not seek out treatment, and I would encourage people to keep coming forward, knowing there are new options being opened up all the time as we better understand people’s needs and we put more resources into the mental health system,” Mr Rattenbury said.
He citeda new role to help patients access nurses at the AMHU, who sit behind a glass barrier known within the unit as “the fishbowl”, as an example of the Government listening to patient concerns.
“There’s been significant patient feedback that they feel that’s a real barrier,” Mr Rattenbury said.
“So we have now just introduced a concierge model, where one of those staff members operates outside of that staff area to be a point of engagement.
“That’s the sort of example where [we have responded] to the patient feedback that’s come through and they’re the sort of improvements we need to keep making.”