Being a full-time caregiver, I have clients who have suffered many different afflictions of the brain. One particular client I have is diagnosed with Normal Pressure Hydrocephalus. Unfamiliar with this condition, I contacted the Hydrocephalus Support Group in Seattle, Wash. for more information about it. Thanks to Diana for sending me an informative email.
What is Normal Pressure Hydrocephalus?
The build up of cerebral spinal fluid (CSF) puts pressure on the brain itself, causing damage. CSF is there to cushion and protect the brain and spinal cord from minor bumps and shakes. The CSF moves around the brain in ventricles, pockets around the brain, supplying nutrients and removing waste products through the veins in the head.
“Hydrocephalus is a condition in which there is too much CSF in the ventricles. This occurs when the natural system for draining and absorbing extra CSF does not work right. The ventricles enlarge to accommodate the extra fluid and then press on different parts of the brain.” The inside of the cranium is not smooth like the outside we have all seen in science class. There are crags and fairly sharp points which can cause serious damage if the brain is slammed or pushed into them by some outside force.
NPH usually occurs in older adults when a blockage occurs preventing the CSF from being removed. Gradually the ventricles enlarge, giving space for the excess CSF. This is why the symptoms of NPH occur gradually, unlike with other TBIs where there is a clear loss of function or ability. The term “normal pressure” is somewhat misleading.
The damage inflicted by the protrusions of the indside of the skull differs from person to person. Therefore, a neurologist would need to be contacted to determine what damage had been caused on a case-by-case basis.
What are the Symptoms of NPH?
Untreated/unmanaged hydrocephalus (NPH or any of the other types of the condition) causes damage to the brain itself. In some cases that damage can go so far as to cause death.Some of the symptoms of NPH include a shuffling gait and downcast (sunset) eyes, confusion & headaches (sometimes with light or sound sensitivity). Often the sound + light sensitivity are thought to be migraines, but that can also be a symptom of what we call a fluid headache.
Some of the other symptoms include those commonly associated with dimentias, including symptoms of Alzheimer’s & Parkinson’s, which is why 10-15 percent of cases are first midiagnosed as any of these, before proper diagnosis is made. That can leave the person significantly compromised unnecessarily, since the damage is most often permanent.
Most often hydrocephalus affects the legs, the bladder and higher “cognitive” functions, such as reasoning, problem solving, memory and speaking. Most of the time, NPH causes loss of control of the bladder, causing urinary incontinence, and occasionally the bowels.
Is there Any Treatment for NPH?
Often, one of the best ways to manage NPH is to place a shunt (a drain from the head removing the excessive Cerebral Spinal Fluid
There is also a lot fear surrounding hydrocephalus, whatever the type is that a patient has. The fear of having a shunt (the shunt doesn’t go into the brain itself, it goes into the area around the brain where the cerebral spinal fluid (csf) resides. The shunt simply drains excess fluid to maintain a healthy pressure level. Although the placing of a shunt can alleviate many of the symptoms, surgery can often induce anxiety and a sense of panic–especially when it involves the brain.
What are Common Misconceptions about NPH?
- Some think that their head is going to explode. Not going to happen. Some think that they are going to lose their minds. Not going to happen–especially with early treatment. Anyone who has experienced allergies and has had a sinus headache has felt like this. In neither case will the person’s head explode.
- There is also a myth that hydrocephalus means that there is a loss of a quality of life, which doesn’t necessarily have to be the case. Especially with today’s drugs and proper management, Hydrocephalus, including NPH, is a very treatable, manageable condition, especially if found early. My cleint enjoys seeing his grandchildren and performs the typical activities a normal 85 year old man does. He has a sharp wit most of the time, and his family says he’s as stubborn as he ever was. So the quality of life does not change dramatically and the patient maintains many of his characteristics from earlier in life. Unfortunately, this is not the case for many traumatic brain injuries (TBIs). I personally know that I experienced a total personality shift after my car wreck. Prior to it, I was shy, almost introverted. Immediately after, I developed traits of being a “people person” and felt at home in a crowd although I was often distracted.
- There is also the myth that one has to live in fear, at home, behind closed doors. Not true. My client gets out, still goes to church services, and even goes shopping on occasion. The biggest thing hindering him is his mobility which is to be expected with someone of his age.
In essence, these are some of the characteristics of hydrocephalus–both managed (NPH) and unmanaged–and the common fears surrounding the condition. If you have any questions or comments, feel free to leave them below.
Information taken from WebMD/hyrocephalus and the Hydrocephalus Support Group, Inc.
First off, let’s talk language. I don’t know where most people are in understanding the nomenclature of the brain injury world. (Seems like every time I mention a TBI, people say, “What? What is that?”
So a TBI is a Traumatic Brain Injury. TBI. I pretty much use the term “head injury” interchangeably with brain injury. A coma is a loss of consciousness of more than 5 minutes during which time new memories have difficulties in being laid down. The Glasgow Coma Scale is what people typically use to describe the severity of comas. For our purposes, we don’t need to understand the numbers, just realize that the Glasgow Coma Scale starts at 15 and the severity increases as the numbers decrease to 1.
Characteristics of TBIs
- Since the majority of injuries involve coupcontrecoup, the front part of the brain is typically injured since there are sharp edges on the inside of the skull. Coupcontrecoup is the characteristic of the brain to slosh around inside the head like jello. And since the brain “sloshes” from one side of the head to the other, pretty much wherever the head is impacted, it affects the frontal and temporal lobes. The main tasks of the frontal lobes are higher-order, executive functions–essentially, the ability to plan and follow multi-step directions. That’s why so many people who have been either hit in the head with a bat or other object or have been in a car wreck have such a hard time sitting and listening to directions before jumping right into action. Personally, I was misdiagnosed as having adult ADD as a result of my TBI, but was later told–some 11 years later–that in most cases ADD didn’t come from a TBI. It might have been present before, but it rarely comes as a result of having brain trauma.
- The temporal lobes, which are located as the name suggests on either side of the brain just above the temples. The chief responsible of these lobes are concerning language. Both spoken language and the written word. Finding the correct words for appropriate situations or for the appropriate object. For example, a survivor of a TBI may have difficulty finding the word for door, but may think of an umbrella when someone says the word shelf to them. Therefore, patients/survivors who present this injury are often thought of as stoned, high or plain stupid. I know that people have thought that about me–especially when I’ve been trying to recollect a story from the past without omitting any details.
- Often damages to the frontotemporal areas of the brain are also slower visual and tactile reaction times. This may mean that the patient may take longer to truly “know” and understand what a red light means. Sometimes my wife will say, didn’t you see that light change?” I did, but it didn’t mean anything to me. It just didn’t mean anything to me. Similarly, the reaction times may be longer; for example, the survivor may not be able to feel his hand burn when he places it on a hot stove eye the way a non-TBI-er would. Therefore, it would be more likely that his hand could be burned.
What we’ve mentioned here are just a hint of what someone who has a TBI can experience. If you or soemone you know has a TBI, you may find some solace in knowing what they experience. Feel free to leave a comment below of your experience or of someone you know. And of course, if you have any questions, leave them below.
Everyone, parent or not, knows that kids fall. My son ran headlong into doors, fell off tables, and even hit the floor when I fell down the stairs carrying him. (That’s a long story–I’ll try to get to it later…) But did you know how many Brain Injuries (BIs) are caused by falls?
In the Nov. 13 New England Journal of Medicine, the results of a study of more than 43,000 children led by Dr. Nathan Kuppermann, a professor in the departments of emergency medicine and pediatrics at the University of California, Davis School of Medicine were published. The leading cause of BIs for children, individuals under the age of 18, was falls.
For parents, the numbers can be frightening: under 2 years of age, 77% of BI are the result of falls. Seventy-seven! I don’t know if that’s a reassuring fact–Maybe there aren’t that many BIs in infants and newborns. For children between 2 and 12, the number is cut by half, and is only 38 percent.
For children between age 13-17, the leading causes of BI were assaults, sports, and car crashes. Over recent years, we have seen an increase in the use of bike helmets and even helmets when skiing. That’s reassuring. I began wearing a bike helmet–not by choice, mind you–after a bicycle accident I had when I lost my left front tooth.
I was trying to slalom between acorns on the street and lost control of my bike throwing me, teeth first, into the pavement. I don’t remember much after that for several hours just that I thought my parents wouldn’t notice the gap in my smile with my left front tooth was missing. (Duh!) So after that, I was forced to wear a helmet whenever I got on a bike or a skateboard.
“Bike helmets and seatbelts can save your kid’s brain,” Dr. Kuppermann said.
Fewer than half the kids who were injured in car wrecks were wearing seatbelts. The kids injured in bike accidents were wearing helmets less than 20% of the time, he said. While a seatbelt or helmet won’t guarantee you won’t get a BI, it certainly cuts the chances. When I had my car crash, I was wearing my seatbelt. If I weren’t, I’d be dead. The police report said I was unrestrained, but my mother told me I had terrible bruises and abrasions where the seatbelt had been. I figure the police just reported what they saw: I wasn’t wearing a seatbelt at the time they arrived to the scene.
Because of the prevalence of seatbelts over recent years, the deaths from car crashes has dropped dramatically.
Dr. John Kuluz, director of traumatic brain injury and neurorehabilitation at Miami Children’s Hospital, said, “According to the U.S. Centers for Disease Control and Prevention, deaths among children from car accidents has dropped 40 percent.” (Taken from HealthDay News)
While seatbelts cannot take all the credit for this fact, they, combined with airbags, have brought the numbers of severe TBIs down significantly. Kuluz said that 98% of head injuries seen in ERs were classified as “mild.”
Mild takes on a whole new definition here: it refers to the force or impact causing the trauma; it does NOT refer to the problems attributed to it. A mild TBI is the result of the forceful motion of the head or some other object impacting the head, causing a brief period of unconsciousness (less than 30 minutes). (From TraumaticBrainInjury.com)
Before my MVA, I was athletic, and quite popular–even if I was a bit of a nerd. After my wreck, I lost all my athletic ability, a good bit of my muscle mass. What I gained was a sense of the world revolving around me. I was in the spotlight all the time. And when it was on someone else, I typically acted out–doing something inappropriate to gain the attention of the people around me, whether in a good way or a bad way. I was in the 99 percentile in math, above average in the English/language areas, but I really didn’t excel in English. I could dissect a sentence and my grammar was almost impecible, but I really didn’t enjoy literature or writing.
However, the study did not include concussions, which simply jostle the brain, but rather more serious injuries which caused bleeding inside the brain. Reported in the New England Journal of Medicine, published on Nov. 13, Kuppermann explains what the purpose of the study really was.
“The study gives a picture of how children suffer serious head injuries, and how often they get CT scans and how often they undergo brain surgery,” Kuppermann said.
For the study, the researchers used data collected from 2004 to 2006 from emergency departments in 25 U.S. hospitals. If you have any questions or concerns, feel free to leave a comment below or leave it in the contact us box.
Originally posted on Life After Traumatic Brain Injury:
Because the occipital lobes are located at the back of the skull, they are not as frequently injured as other parts of the brain. However their role is extremely important when it comes to the survivor’s vision or lack thereof. Essentially, this region of the brain is the visual cortex–the portion concerned with all things visual.
The curious thing about the occipital lobes is that no matter which side of is damaged, the field of vision is affected more or less equally on both sides. Unlike the frontal or parietal lobes, where injury to one side or the other has a greater effect on either motor movement or some other ability, any significant injury to the occipital lobes produces more or less a unified change in vision.
And although the occipital lobes aren’t frequently injured, any significant trauma to the brain can cause a…
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Relationships, as most adults know, are a symbiotic balance of give and take–a two-way street, if you will. Where the relationship becomes a problem is when it goes from being a two-way street to becoming a one-way major thoroughfare. Like the clownfish protecting and cleaning the sea anemone. The clownfish, in return, is protected from predators by the anemone’s stinging cells, to which the clownfish is immune. That is a symbiotic relationship. Imagine now, if you will, that the clownfish sometimes wants and even craves the tasty delight of snacking on the anemone’s protective tentacles. Without warning, the clownfish starts to destroy the relationship by satisfying an immediate desire or need. That is what often occurs to families when a member suddenly goes through some sort of trauma.
Those who have suffered some sort of trauma, such as a TBI, PTSD, a stroke, Alzheimer’s, dementia, or any other condition which affects the neurological health of the survivor are particularly at risk of becoming relationship “Vampires.”
- The first sign that the survivor (or the caregiver) is not contributing to the relationship is that one person is not allowed to flourish. For example, many parents may find themselves putting their lives on hold when their child is injured in a car wreck. They become immediate caregivers, even if it means putting a career, education or writing a book on hold indefinitely. The problem is when the survivor keeps expecting to be treated as if he or she is the center of the world. In my case, I can remember being the deciding vote as to where or what my family would have for dinner. If I wanted to go to Houston’s, that’s where we went. If I wanted to have tacos four nights a week, guess what we had four nights a week. But now, some 25 years after my TBI, it would be unreasonable for me to expect to have those same expectations placed on my parents and sisters. But I know that occurs, and it occurs within communities which are not trying to recover.
- If you, the caregiver or the spouse of someone with PTSD, find that the needs of the other party seem to always come before your own, you may need to find a way to satisfy yourself emotionally. It’s kinda like having a cup of coffee. You are happy to share your coffee, but the more you give, if you don’t put anything back into it, you will eventually run out. You have to sit your cup upright, and then replenish the contents. The more you do that, the more you can give. Not only can you give more, but you also give better quality. I’m a caregiver by profession, and when I feel like I’m approaching burnout, I just excuse myself and go outside to make a phone call. When I return to my client, I have more energy and a better attitude than I did when I left.
- Survivors need to understand that it’s not all your fault. You, the caregiver, didn’t decide to have the snack bar close just so the survivor couldn’t get the treat he wanted. I know it’s difficult for the survivor to understand this, but not everything is someone else’s fault. Sometimes life just happens. Survivors often blame their current circumstances on the ones who are closest to them, such as a parent or siblings. However, they need to know that they are the only ones who have power over themselves. I read a book last year call Choice Theory, by Dr. William Glasser. Choice Theory states that we as individuals actually choose to do or feel or think about a particular way. Like if you are depressed, Glasser says that you are choosing that emotion. If you are anxious, Glassser says that you are anxiety-ing. You are choosing to feel anxious. No one else, no circumstance can make you feel that way. The survivor needs to understand that. I can think of a soldier returning from combat overseas blaming his/her spouse for making them feel depressed or anxious, but, in reality, the soldier is choosing that behavior or emotion.
- Another condition for the caregiver to be aware of is being needed. As a caregiver professionally, I know it makes me feel good when I help one of my clients get dressed or shave. They are able to do it themselves, but I realized that I feel better, like I’m needed, when I do it for them. I can remember when I was in in-patient rehab my mother tied my shoe after a PT session. I immediately untied it and said, “I love you, but I wanted to do it.” She wanted to help me, although I could do it myself. (Well, that part is debatable.) The caregiver needs to be careful not to become codependent and need to feel needed.
- Read inspirational quotes. Each and every day, there are loads of inspirational quotes on Facebook. I think there is even an app to have the sent to you, if you happen to need that.
- Realize that each day is a gift, and that tomorrow is never guaranteed. I have a friend who has had a brain aneurysm years ago, but she is always so happy. I questioned her about that, and here’s what she told me: “Because I have had an aneurysm, I’m much more likely to have another one, which would kill me, totally out of the blue, with no warning. I’m not gonna waste my time or energy being unhappy or angry about something just because someone cut me off in traffic.” A little morbid, I think, but when I think about how amazing and unbelievable that I can do all the things I do, it makes every day seem like a good day.
- Make an effort to go the extra mile. Be altruistic. I have recently come to the realization that when there’s someone not pulling his own weight, I tend to get a little resentful. I can overcome this feeling by really making an effort to do more than my share. By making a point of doing something for someone else, I’m able to change my thinking from resentment to that of joy. Thanks, Anne.
- Google happiness. Peruse through some of the images. It’s almost impossible to keep from smiling at some of them. I suppose you can also look at another search engine, but it’s really up to you.
- Watch what you eat. If you eat only fast food and Twinkies for dinner, you will feel like crap. Last summer, I did just the opposite and had kale smoothies for a few days. For three days bananas, kale, apples and strawberries were the only things I was eating, or drinking, rather. I felt amazing! It gave me a boost to the immune system and it cleaned me out. I’ve never eaten that much fiber in three days in my life. And yes, it does turn green.
Well, these are a few more ways to improve your mood, and if you know of any others, please tell me about them! Remember, you are the only one completely responsible for your own happiness.
I know that when I was just going through life without a sense of purpose, I had a hard time being happy. Sure, I had more than most people, but that still wasn’t enough, something was missing. Although I now know that I wasn’t happy because I wasn’t really “following” Jesus, there are things we all can do to make ourselves more positive. This is especially poignant for the BI survivor. We all find what we cannot do what we once did without hardly trying. Everything we lost looms in the forefront of our minds. I’ve come up with five things that I try to do on a daily basis to make myself positive—to help me from becoming so blue that it actually becomes a depression.
- Thank God. Everyday, I thank God (substitute your chosen Higher Power) because I woke up. I’m able to get up and get dressed, and I am able to start my day as normally as most people do.
- Make a List of Gratitudes: When I start to feel down, I take a moment to make a gratitude list. I don’t deserve to have anything I have, but sometimes it’s good to just get my head in the right place by making a list of all the things I’m grateful for. Doing this keeps you from taking things for granted and wishing you had things you don’t.
- Give back. There is something inherently good about giving your time. Teaching someone to read, helping with Habitat for Humanity, serving at a local soup kitchen. These are all things you can do which will help others, but they will help you even more! Take my friend Eddie. He is one of the most giving people I know. Whatever someone needs him to do, Eddie does it. And only a few times since I’ve known him in these past 10 years has Eddie ever not had a smile and a laugh for those around him. Those were the times when he was in tremendous pain from a kidney stone.
- Think about everything you can do! When I feel blue, I think about the awesome things that I can do. Not like the other things that anyone else can do, but things like “I’m the best father to my son possible.” Notice, I didn’t say I’m better than anyone else, I just said that I’m the best possible. Or, you could say you’re better than you used to be.
- Get a pet. Studies have shown that having pets significantly lowers blood pressure of owners. And generally, pets are excellent secret keepers. I talk to my dog all the time, and I think, “If you ever learn to talk, I’m in trouble.” Play with your animal. This is the reason I think dogs are better than cats, but kittens love to play, too. Pet rocks don’t reciprocate love in most circumstances.
Although sometimes it can be easy to find yourself in the dumps and just want to wallow there, these 5 ways to improve your mood are easy and, best of all, free! Let me know if you know any more ways, and how these work out for you!
Keep getting better, and I’ll talk to you soon!