Normal age-related changes in the brain can slow some cognitive processes, making it a bit harder to learn new things quickly or to ward off distractions.

1. Believe in yourself (People who believe that they are not in control of their memory function are less likely to work at maintaining or improving their memory skills and therefore are more likely to experience cognitive decline.)
2. Economize your brain use (If you don’t need to use mental energy remembering where you laid your keys or the time of your granddaughter’s birthday party, you’ll be better able to concentrate on learning and remembering new and important things. There are a number of strategies that help. )
3. Organize your thoughts
4. Use all your senses  (The more senses you use in learning something, the more of your brain will be involved in retaining the memory. So challenge all your senses as you venture into the unfamiliar.)
5. Expand your brain (Use multiple modalities  when learning: reading, saying things aloud, drawing pictures and creating things with your hands. it helps create more in depth memories.)
6. Repetition (Repeat, repeat … repeat: Repetition is potent - When you want to remember something you’ve just heard, read, or thought about, repeat it out loud or write it down. That way, you reinforce the memory or connection.)
7. Spacing (Repetition is most potent as a learning tool when it’s properly timed. It’s best not to repeat something many times in a short period, as if you were cramming for an exam.)
8. Mnemonics (Mnemonic devices can take the form of acronyms, sentences or stories.)
9. Keep learning (Experts think that advanced education may help keep memory strong by getting a person into the habit of being mentally active. Challenging your brain with mental exercise is believed to activate processes that help maintain individual brain cells and stimulate communication among them.)

Source: Harvard Medical School

Just about everyone reading this has gone to and will again visit a grocery store. All of us bring our wallets or purses. In this day and age of electronics, we are sure to bring along our cell phones and maybe even some reusable bags. How many of us though, bring along a checklist? Some might refute the basic utility and say, “I don’t need one”.

Towards the other end of the spectrum we have some intense fields, filled with complex tasks that indeed benefit from the advent and use of checklists. The British Medical Journal published a recent study offering support for the efficacy of using checklists to reduce complications and improve patient outcomes. The study looked at mortality and length of stay in Michigan area ICUs, comparing those that had implemented a safety checklist for the placement of central lines with local ICUs that had not implemented the project. They found a 10% decrease in overall mortality. Another study utilizing checklists had even more dramatic results. After implementation, cases of ventilator-associated pneumonia dropped by 70%. The investigators pointed out that the checklists in and of themselves do not tell the whole story. A program was put in place to allow all those involved to learn from their mistakes. A sense of teamwork and a “culture of safety” were developed.

Atul Gwande, in his book, The Checklist Manifesto beautifully blends evidence with anecdote towards a call to action to improve not only patient care but care in general. Malcolm Gladwell reviewed the book:

Atul Gawande … makes a distinction between errors of ignorance (mistakes we make because we don’t know enough), and errors of ineptitude (mistakes we made because we don’t make proper use of what we know). Failure in the modern world, he writes, is really about the second of these errors, and he walks us through a series of examples from medicine showing how the routine tasks of surgeons have now become so incredibly complicated that mistakes of one kind or another are virtually inevitable: it’s just too easy for an otherwise competent doctor to miss a step, or forget to ask a key question or, in the stress and pressure of the moment, to fail to plan properly for every eventuality.

What is it about these lists that make them so effective, mind you when they are used? Some choose to ignore a checklist, but you really can’t dispute its content. Even if there is no definitive right way to complete a task, checklists can help people avoid blind spots in complex environments. Checklists can ensure you don’t forget a step, especially when the steps are many and complicated. The foremost reason why checklists are so useful, we forget things.

In the field of brain injury rehabilitation, memory aids of various kinds are used to compensate for cognitive deficits. Teaching people with brain injuries to compensate or bypass challenges with memory will improve their lives. People with brain injuries often cannot rely on their own memories, particularly for prospective events. Checklists can serve to avert the blind spots, which after a brain injury can be quite broad. Checklists can enable the person to focus on the task, on carrying out the task by relying on a dependable aid to progress through from beginning to completion.

How many of you out there use checklists? Do you recommend checklists as part of therapy?

Fish, J., Manly, T., Emslie, H., Evans, J.J., & Wilson, B.A. (2008). Compensatory strategies for acquired disorders of memory and planning: differential effects of a paging system for patients with brain injury of traumatic versus cerebrovascular aetiology. Journal of Neurology, Neurosurgery & Psychiatry, 79, 930-935.

Martelli, M., Nicholson, K. & Zasler, N. (2008). Skill reacquisition after acquired brain injury: A holistic habit retraining model of neurorehabilitation. NeuroReabilitation. 23(2), 115-126.

Wilson BA, Moffat N. Clinical management of memory problems. 2nd ed. California: Singular Publishing Group Inc; 2005.

Photo Credit

Over the past year there have been numerous studies, articles, videos, blogposts on brain injury and brain injury rehabilitation, too many to list them all here. The articles range from in depth research, to cutting edge technology, and from advocacy and legislative changes, to touching stories of overcoming barriers and pursuing new dreams. We have collected some highlights from various sources over the past year. Suffice it to say, with each passing day we are understanding a little bit more about our own brains, how injury impacts functioning and finding evidence for cutting-edge treatments in rehabilitation.

Computer Technique Could Help Partially Sighted ‘See’ Better

Thousands of people who are partially-sighted following stroke or brain injury could gain greater independence from a simple, cheap and accessible training course which could eventually be delivered from their mobile phones or hand-held games consoles, according to a new study.

Link to the research article: Visual exploration training is no better than attention training for treating hemianopia

Virtual Reality Tele-Rehab Improves Hand Function: Playing Games for Real Recovery

Remotely monitored in-home virtual reality videogames improved hand function and forearm bone health in teens with hemiplegic cerebral palsy, helping them perform activities of daily living such as eating, dressing, cooking, and other tasks for which two hands are needed.

Link to research article: In-Home Virtual Reality Videogame Telerehabilitation in Adolescents With Hemiplegic Cerebral Palsy

New CATCH Rule to Determine Need for CT Scans in Children With Minor Head Injury

A new tool may help standardize the use of computed tomography (CT scans) in children with minor head injury and help reduce the number of scans, according to a new study in CMAJ (Canadian Medical Association Journal).

More than 650,000 children with minor head injuries resulting in loss of consciousness, amnesia, disorientation and/or vomiting are seen each year in emergency departments at North American hospitals. CT scans are important for diagnosing serious brain injuries but they expose children to the potentially harmful effects of ionizing radiation and significantly add to health care costs.

Link to research article: CATCH: a clinical decision rule for the use of computed tomography in children with minor head injury

Pacemaker for Your Brain: Brain-to-Computer Chip Revolutionizes Neurological Therapy

By stimulating certain areas of the brain, scientists can alleviate the effects of disorders such as depression or Parkinson’s disease. That’s the good news. But because controlling that stimulation currently lacks precision, over-stimulation is a serious concern — losing some of its therapeutic benefits for the patient over time.

A two-way conversation

The idea that a chip can interface between inputs and outputs of certain brain area is a very new concept in scientific circles, Prof. Mintz notes, although movies and TV shows about bionic humans have been part of the popular culture for decades. The researchers say that their ReNaChip could help people whose brains have deteriorated with age or been damaged by injury and disease. The chip will not only provide a bionic replacement for lost neuronal function in the brain, under ideal conditions, it could significantly rehabilitate the brain.

Researchers Urge Reclassification of Traumatic Brain Injury as Chronic Disease

Traumatic brain injury, currently considered a singular event by the insurance industry and many health care providers, is instead the beginning of an ongoing process that impacts multiple organ systems and may cause or accelerate other diseases and disorders that can reduce life expectancy, according to research from the University of Texas Medical Branch at Galveston.

As such, traumatic brain injury should be defined and managed as a chronic disease to ensure that patients receive appropriate care and that future research is directed at discovering therapies that may interrupt the disease processes months or even years after the initiating injury.

Link to research article: Traumatic Brain Injury: A Disease Process, Not an Event

Rewiring a Damaged Brain

Researchers in the Midwest are developing microelectronic circuitry to guide the growth of axons in a brain damaged by an exploding bomb, car crash or stroke. The goal is to rewire the brain connectivity and bypass the region damaged by trauma, in order to restore normal behavior and movement.

Pedram Mohseni, a professor of electrical engineering and computer science at Case Western Reserve University, and Randolph J. Nudo, a professor of molecular and integrative physiology at Kansas University Medical Center, believe repeated communications between distant neurons in the weeks after injury may spark long-reaching axons to form and connect.

Link to Case Western article: Rewiring a Damaged Brain; Researchers look for ways to bridge gaps left by injury.

Traumatic Brain Injury Causes Loss of Smell and Taste

The ability to taste and smell can be lost or impaired after a head injury, according to a new study by scientists from the Université de Montréal, the Lucie Bruneau Rehabilitation Centre, as well as the Center for Interdisciplinary Research in Rehabilitation of Greater Montreal.

Published in the journal Brain Injury, the investigation established that mild to severe traumatic brain injury could cause olfactory loss.

Link to research article: Traumatic brain injury and olfactory deficits: The tale of two smell tests!

Brain Injuries May Result in Trouble Sleeping, Study Finds

People with brain injuries may produce low amounts of melatonin, which affects their sleep, according to a study published in the May 25, 2010, print issue of Neurology®, the medical journal of the American Academy of Neurology.

Link to research article: Sleep disturbance and melatonin levels following traumatic brain injury

New Technology Allows Medical Workers to Better Assess Brain Injuries

A Queen’s University neuroscientist is launching a medical tool at the world’s largest neuroscience conference in San Diego on Nov. 15. The KINARM Assessment Station will greatly improve the way healthcare workers assess patients suffering from brain injuries and disease.

The new technology, invented by Stephen Scott, is the only objective tool for assessing brain function, and clinical researchers need this tool to develop better therapies for treating brain injury or disease.

Helmets Reduce the Risk of Head Injuries Among Skiers and Snowboarders by 35 Percent

Helmets reduce the risk of head injury among skiers and snowboarders by 35% with no evidence of an increased risk of neck injury, according to an article in CMAJ (Canadian Medical Association Journal). Some suggest that helmets may increase the risk of neck injury in a crash or fall, particularly in children because of their greater head to body ratio. Skiing and snowboarding are popular winter activities. Estimates from numerous countries indicate that head injuries account for up to 19% and neck injuries up to 4% of all injuries reported by ski patrols and emergency departments. Traumatic brain injury is the leading cause of death and serious injury among skiers and snowboarders.

Link to research article: The effect of helmets on the risk of head and neck injuries among skiers and snowboarders: a meta-analysis

Head Injuries: Why Motorcycle and Bicycle Helmets Should Be Mandatory

In this Huffington Post article, Richard C. Senelick, MD is a neurologist who serves as Medical Director of RIOSA makes a case for bicycle helmet laws.

The American Academy of Orthopedic Surgeons issued a position statement on the use of motorcycle and bicycle helmets. Similar position statements have been issued by the professional organizations of neurologists, pediatricians and neurosurgeons. The AAOS believes “that the issues of personal freedom should be seen in the context of the fact that the public at large incurs a major part of the cost for injuries to motorcycle riders. Society must evaluate the claim of infringement on freedom versus the funding of these costs.” The need for a helmet law is a public health issue, proven in the data of past mistakes. It is a broader issue than motorcycles and stands to threaten the rapid growth in bicycle helmet use.

Man Gains Musical Ability After Brain Injury, Learns To Play Piano Instantly

Watching Derek Amato play the piano would make you think he had been playing his whole life. But he says this is a talent he acquired in an instant. “I’m considered an ‘acquired savant’ from a brain injury,” Amato said. He says he gained all of his ability after a concussion. “I dove into the swimming pool and dove into the shallow end and hit the bottom of the pool,” he said.

Rewiring the brain with Constraint-Induced Therapy; Applications in Rehabilitation

There are a number of approaches to cognitive rehabilitation that include

* restoration of damaged function,
* optimization of residual function,
* compensation for lost function, and
* substitution of intact function.

Compensatory measures and strategies are often the focus of rehabilitation. Constraint-induced therapy (CI), a technique that aims to optimize residual function and if possible restore function, is emerging as a treatment modality for both motor dysfunction and cognitive rehabilitation.

Never Settle: How I Beat the Odds and Overcame a Traumatic Brain Injury

Picture this; a nine-year-old boy, lying unconscious, in a coma, in a hospital room for six weeks. The picture is bleak. The chance of a normal life outside of the hospital is small.

This was me almost 17 years ago. Today, I live a relatively normal life for someone who had such an accident at a young age. After having a traumatic brain injury, I was in a coma for six weeks and hospitalized for five months. After that I was still even barely able to hold my head up for a few months. I learned how to do everything over again: walk, talk, tie my shoes, even eat. After leaving the hospital five months after the accident, I used a walker to get around, but not for long.

Some journals on brain injury and rehabilitation:

Disability and Rehabilitation

Official journal of the International Society of Physical and Rehabilitation Medicine (ISPRM). Disability and Rehabilitation publishes 26 issues a year and, in addition, a further 6 issues in a separate volume of Disability and Rehabilitation: Assistive Technology.

Journal of Head Trauma Rehabilitation

The Journal of Head Trauma Rehabilitation is a peer-reviewed journal that provides information on clinical management and rehabilitation of persons with head injuries for the practicing professional. It is the official journal of the Brain Injury Association of America (BIAA).

Brain Injury

Brain Injury publishes critical information relating to research and clinical practice, adult and pediatric populations. The journal covers a full range of relevant topics relating to clinical, translational, and basic science research. Manuscripts address emergency and acute medical care, acute and post-acute rehabilitation, family and vocational issues, and long-term supports. Coverage includes assessment and interventions for functional, communication, neurological, and psychological disorders. Brain Injury is the official research journal of the International Brain Injury Association (IBIA).

Some blogs on brain injury

Brainline

Every 19 seconds someone in the United States sustains a traumatic brain injury (TBI). That adds up to 1.7 million people each year. Brain injuries range from mild to moderate to severe. Every injury is different, but when your brain is injured, it can affect everything: your ability to speak, focus, remember, and relate to other people.

BrainLine is a national multimedia project offering information and resources about preventing, treating, and living with TBI. BrainLine includes a series of webcasts, an electronic newsletter, and an extensive outreach campaign in partnership with national organizations concerned about traumatic brain injury.

BrainLine serves anyone whose life has been affected by TBI. That includes people with brain injury, their families, professionals in the field, and anyone else in a position to help prevent or ameliorate the toll of TBI.

The Brain Injury Recovery Network

The Brain Injury Recovery Network is non-profit organization dedicated to helping survivors and families of brain and other serious injuries. The Brain Injury Recovery Network is a non-profit corporation. Their goal is to see that survivors of brain injuries are given every chance possible to recover.

Brain Injury Network

Advocacy by and for People with ABI

The Brain Injury Network (BIN) is the first survivor operated international and USA national Survivor of Acquired Brain Injury (ABI) nonprofit advocacy organization. We members at BIN are people with abi in its various forms which include but are not limited to aneurysm, anoxic or hypoxic injury, brain illness, brain tumor, stroke, or traumatic brain injury (TBI). ABI is an umbrella term that encompasses all of the acquired brain injuries.

Neuro Notes

NeuroNotes is an informational web log that brings you the latest articles, news, events, and oddities relating to the brain and brain injury.
Two contributors to the blog:
Rolf B. Gainer, Ph.D., Diplomate ABDA, is the Chief Executive Office at Brookhaven Hospital and the Vice President of Rehabilitation Institutes of America. Dr. Gainer has been involved in the design and operation of treatment programs since 1977.
Michael Mason is author of the book Head Cases: Stories of Brain Injury and Its Aftermath, and is a Brain Injury Projects Manager at the Neurologic Rehabilitation Institute.

Realistic Hope: A Traumatic Brain Injury Community

Realistic Hope began as a vision by Mark Palmer using his 45 year experience as a TBI survivor to help others understand that they were not alone, create hope and empower everyone touched by a TBI to help others strive to be a little better tomorrow than today.

Realistic Hope started as a model to create an understanding, facilitate communications and empower supporting organizations to make a difference to everyone touched by a TBI at a very difficult if not the most difficult part of the journey. The life ever after part when your care, your needs and your growth are no longer determined by trained professionals. A life where the survivor, family, friends and caregivers whose life has changed.

Everyone knows someone whose life has been touched by a devastating injury or loss.

Brainworks is raising awareness about injury prevention, offering hope to trauma survivors, and helping people reach their full potential. You can help us get the word out. We are building an online community for everyone who knows someone whose life has been touched by an injury or loss. That is all of us. We invite you to join our facebook page and suggest our page to your friends.

Clinical Excellence, knowledge, evidence-based practices ... We are on the cutting edge

Twitter: For those of you that might not know, Twitter's motto "Discover what’s happening right now, anywhere in the world". Twitter is a rich source of instant information. Stay updated. Keep others updated. It's a whole thing. Brainworks stays current with the latest news, developments & research in rehab. We invite you to follow us on our Twitter page.