How functional MRIs can detect brain injury when other scans can’t

electronic brain imagery

BY: AMANDA FORESTIERI

Individuals who suffer from mild to moderate brain injuries often have long-lasting debilitating symptoms, despite the brain appearing ‘normal’ on structural MRI or CT scans.

BIST Social Work placement student Amanda Forestieri, sat with neuroscientist Dr. David Corey, to discuss his work with functional Magnetic Resonance Imaging (fMRI).

Dr. Corey has worked with and treated individuals with chronic pain, PTSD, and mild to moderate TBIs for 40 years. He has worked in interdisciplinary teams, and with many patients who have struggled to prove they are experiencing TBI symptoms. Dr. Corey says this is likely due to metabolic changes in the brain, or changes which are too microscopic for a structural MRI or CT scan to pick up.

Functional MRI’s versus MRI

The functional MRI (fMRI) focuses on oxygen atoms, to give a rough measure of the metabolic activity of the cells in the brain. The fMRI looks primarily at how the brain is functioning, whereas the standard MRI assesses structure only (eg. tumors).  

How the FMRI Works 

The fMRI detects the blood flow in a particular area of the brain when the patient is asked to perform a task. Doctors are able to see if it functions in the same way as in a brain without an injury. Individuals with a brain injury are tested in an activation paradigm, meaning that the individual is asked to perform a task in the scanner as opposed to a resting state. The task is called the Tower Task, and individuals are asked to sort coloured balls in different containers on a screen.

Dr. Corey has noticed different activation in the brain of someone with a brain injury. The brain injury population loses synchronicity between the two hemispheres, and there is more activation in certain parts of the brain compared to a non-injured brain when performing a task. A statistical test is then done to determine whether the patient’s brain function falls into the “normal” or “abnormal” range. This image displays a control groups’ scan vs. someone with PCS (Post Concussion Syndrome).

Patient with PCS (Left) Control Group (Right)

The above shows widespread activation in the brain of a patient with PCS. More research is being done as to why this is the case.

The fMRI can be used as a tool to show evidence of brain injury and clarify diagnosis. It is another tool to show verification that brain function is “abnormal” in a person who experienced a mild to moderate brain injury.

In order for individuals to prepare for an fMRI, one needs to be medically cleared for a standard MRI and be able to lie still for at least 10 minutes at a time. Claustrophobia is something else to keep in mind, as the fMRI is in a closed environment. To conduct an fMRI, patients can’t take medication, such as tranquilizers, before the scan, but many people can learn some calming techniques to manage anxiety.

What is fMRI currently being used for? 

FMRI equipment is expensive, and its analysis is highly complex. Currently, few doctors are trained to understand the data. It is not funded by OHIP at present, nor is it used widely for clinical purposes.

Having said that, Dr. Corey believes that in the future the fMRI may be brought forward as a clinical tool.

“When you produce an objective measure of something, people pay attention to it, especially in the medical profession,” Dr. Corey said. As of right now, fMRIs are mostly being used in a medical-legal context. However, it is exciting to think about the technology that one might see in the future for those with a mild to severe brain injury, allowing those, individuals to receive better diagnosis and treatment. More information is available on Dr. Corey’s work and his contact information on www.brainscaninc.com.


Amanda Forestieri is a passionate 4th-year social work student who hopes to work in social services. When Amanda is not in school, you can find her reading a good book, going for walks or singing and creating music with others. She wants to one day be known as the singing social worker!

 

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Yoga Brain

BY: ALYSON ROGERS

Before my brain injury, I was convinced yoga wasn’t for me; I was a year-round athlete and long-distance running legs were not yoga legs in my mind.

After my brain injury, I was convinced yoga wasn’t for me; I went to a few classes and struggled to keep up and do the poses.  I usually left with a headache and feeling defeated.  Ten years and 6 concussions later, I practice yoga everyday – both on and off the mat.

In 2017, a bad concussion completely changed my lifestyle. In under a year, I went from an active person who went out for drinks with friends after work, to someone who stays home due to fatigue and symptoms; someone figuring out a new life on medication and alcohol-free.

I’d like to say there was some magical movie moment where I wandered into a yoga studio and found my place, but in reality, I dusted off the yoga mat I never got around to donating and rolled it out onto my living room floor because I had nothing else do to at home.  I remembered poses I had learned in classes and did simple stretches. I was pleasantly surprised at how good I felt afterwards and kept coming back to my mat. I’d found a practice that didn’t hurt my brain, but benefited it.

Fast forward to November 2018. I was searching Myrtle Beach for a yoga mat while I was on vacation because I couldn’t imagine going four days without one. Yoga had become a huge part of my life. I practiced at least 3 times a week, was seeing improvement in my flexibility, recognized how good yoga made my mind feel, developed an interest in spirituality, began exploring meditation, and was reading yoga books, including Yoga Girl by Rachel Brathen and Yoga Mind by Suzan Colón.

The physical and philosophical aspects of yoga did more than make me flexible and centre self-care in my life; it helped with my concussion symptoms and how I feel about having a disability.  After I started practicing yoga, I noticed improvements in my concentration, balance, spatial awareness and other physical symptoms. I also saw improvements in my mood and overall mental wellness. Learning about the philosophical tools of yoga allowed me to have a healthier and honest perspective of my current concussion issues, and having a brain injury in general. I’d found something that was both beneficial for me, and that I could do no matter what symptoms I was experiencing on a given day.

I’ve written about my brain injury for years and decided I would write about the benefits of yoga for brain injury in the hope of helping other survivors, but I didn’t. If I was going to do this, I would have to be honest about the emotional and mental symptoms of brain injury I had experienced; I was ready to write about it but not attach my name and face to it. Stigma lives on and it was staring me in the face; what if someone from my workplace saw it?  Would people think I’m “crazy”?  Would I be taken less seriously?

This is how Yoga Brain came to life on Instagram (@yogabrain).  I created an anonymous account to talk about yoga and brain injury. At first, I didn’t show my face in any photos; if someone I knew saw it, they would know it was me, so it stayed hidden for quite some time.  Slowly, I started to show me face, and 6 months after creating the account, I put my name on it.  The shame and embarrassment I felt about brain injury symptoms I had never talked about faded away, and I was ready to be a face for more than just physical brain injury symptoms.

Since creating Yoga Brain, I’ve had the privilege and pleasure of connecting with brain injury survivors, yogis, yoga teachers and organizations all over the world. I was invited to be a guest on the Concussion Talk podcast and have been featured by Can Recover, Beyond Concussion and Fierce Calm. Brain injury can feel like a lonely place, but by putting myself out there, I’ve learned from others and used my experience to support other survivors.  My posts document my yoga journey, brain injury journey, and my new life that includes travelling (something I never thought I’d do after my brain injury).

Yoga Brain and my love for yoga took me on a journey I never expected. I recently finished my 200-hours Yoga Teacher Training Certification…in California.  I’m not sure where this will take me next, but I can’t wait to find out.


Alyson is 26-years-old and acquired her first brain injury ten years ago. She graduated from Ryerson University and is a youth worker at a homeless shelter. In her spare time, Alyson enjoys writing, rollerblading and reading. Follow her on Twitter @arnr33 or on The Mighty.

 

 

 

 

 

 

 

Choosing to parent after brain injury

BY: MELISSA JIROVEC

Parenting is hard work. It challenges you in ways you never imagined you’d be challenged, forcing you to think outside the box and re-evaluate everything you thought you knew about pretty much everything.

Add a brain injury to the mix and the experience becomes even more complex and interesting.
Melissa & family Jason and I always knew we wanted children. We discussed and imagined what our future family would look like long before it was time for us to actually consider making it happen. When Jason regained his awareness after sustaining a traumatic brain injury, both of us agreed that a family of our own was an even bigger priority. At 24, we’d become aware of our own mortality and felt willing to attempt the uphill battle we faced, adding parenthood to recovery for him, and caregiving for me.

Fast forward four years and two children later, and we’ve learned a lot about parenting and brain injury. We’ve encountered many challenges, and reaped many rewards. The biggest challenge has no doubt been fatigue. Parenthood is exhausting in and of itself, but the fatigue my husband experiences makes it hard for him to fully participate as a parent.

There are many times throughout the day where Jason needs to escape downstairs for a nap, downtime on his Xbox, or do laundry to get away from the noise and stimulation. This is hard on me as the parent who must care for both children alone.

Our toddler is also incredibly observant. She picked up early on that her Daddy is not able to keep up with her, that he struggles physically to dress or change her, and that he often gives up if she gives him too much of a hard time because of his impulsivity and lack of patience. She uses this to her advantage at every opportunity. The baby is now starting to move around quite a bit and no longer sits still long enough for Daddy to change and dress him. However, of the two, Daddy definitely does better caring for our younger child.

 When things get rowdy around the house it takes a toll on both Jason and myself. Jason struggles to stay focused and calm, while I struggle to corral the kids on my own. Truthfully,  I sometimes feel resentment.

This is why I work hard to maintain my mental, emotional and physical wellness through journalling, affirmations, meditation, goal-setting, strength training, and getting fresh air often. Jason and I both find it crucial to maintain good nutrition for our mood and energy, in order to function well as a family unit. We are also continuously improving the way we communicate, trying our best to ensure that we are being open and honest with each other so as to problem solve as effectively as possible. We are committed to seeking improved personal growth and increased knowledge.

But as challenging as parenting in our situation can be, the benefits of becoming parents far outshine those difficult moments. For example, both of us have become more efficient with our planning and organization. We’ve learned to laugh at the little things. We thoroughly enjoy new experiences with our children and watching their little faces light up. We’ve both begun to challenge our belief systems and have started really questioning our lifestyle and what messages we are sending to our children.

How do we want to raise them? Are we showing them to be compassionate to others and the planet? We’ve realized that the only way to raise smart, kind, compassionate, grounded, aware and successful children is to do our best to model that ourselves. We are both working on that every day.

 In the end, parenting has been everything we hoped it would be and more, despite the added challenges we face. Those challenges have made us stronger and better parents.

I’ve begun to let go of the idea that parenting should be 50-50 between Jason and I, because despite knowing that it wouldn’t be going in, a small part of me still felt frustrated when he couldn’t step up and I knew that was up to me to fully accept.

The brain injury isn’t going away. But we are slowly learning tricks and strategies to help things run smoothly from day-to-day. Brain injury recovery is a lifelong journey, but having something to work hard for has pushed us into seeking the best way not just to survive, but thrive.


Melissa is a caregiver to her husband Jason who lives with a traumatic brain injury, and their two children Emma & Liam. She has authored two books, one an autobiography of her journey as a caregiver titled: ‘Getting Out of the Rut’,  as well as a children’s picture book that promotes awareness of brain injuries titled: ‘My Daddy’s Brain’. She is currently working on a third book, training for a fitness competition, and speaks to various groups about caregiving, brain injury, communication, self-care and resilience. You can follow her journey on instagram @fit.mindful.mom or visit her website at www.melissajirovec.ca.

I. Am. Awareness.

BY: MARK KONING

Here we are into the month of June and Brain Injury Awareness Month.

Every year I wonder of its impact. What minds are being awakened and new things learned? Do people come to an understanding of what it’s like to live with brain injury? Are folks even paying attention?

Are all of those awareness campaigns ever enough?

Over the years I have attended various conferences, and volunteered as a peer support mentor. Of all the survivors I meet and all of the voices I listen to, the common theme I hear over and over is of people feeling alone and misunderstood.

I am misunderstood, often. I feel like people hear me, but don’t listen.

“Hello, is anybody out there?” I want to scream. “Do you get it?”

But when I really think about it, contemplating my own thoughts and replaying conversations, I realize: isolation is not winning. Hopelessness and ignorance do not always come out on top. People care, learn, and adapt.

I am a graduate, I am honoured with diplomas, I own a home and have a good job. From everything I have accomplished, and through all of the challenges I have faced, I have learned.

As a brain injury survivor and advocate, people applaud my presentations; they enjoy my blogs and value my mentorship. A written memoir of my life and challenges with brain injury has gotten respect and admiration.

I. Am. Awareness.

Mark Koning's UnMasking Brain Injury Mask

Everyone who speaks up and moves forward is awareness.

Life is awareness. It is happening all of the time, more often than we, or I, may think.

Is it enough? I don’t know the answer to that. Is there ever a time we should stop moving forward? To stop learning and teaching?

Helping to create brain injury awareness is part of me and who I am. It is part of a lot of us. And it is all of OUR legacy, being aware, creating hope, understanding, and inclusion.


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.

March 2019 Community Meeting Recap: Transforming Your Stress with Michelle Jacob

BY: JULIA RENAUD

BIST’s March Community Meeting featured occupational therapist Michelle Jacob who discussed managing emotions and demonstrated HeartMath technology to our members.

Michelle Jacob
Michelle Jacob

About Michelle Jacob:

Michelle has been an occupational therapist for ten years. She is also currently following her passion as a therapeutic coach, speaker, and author. You can find out more about her on her website, rewiringminds.com, YouTube Channel and Instagram feeds.

The Nervous System & Brain under Stress:

The autonomic nervous system is comprised of two branches that ideally remain balanced:

  • The sympathetic system causes the flight/fight/freeze response.
  • The parasympathetic system permits body restoration and digestion.

When under stress, brain signals travel to the midbrain (the site of emotional processing) instead of to the frontal cortex (the site of decision making).

Why do we respond to stress in this way?

Back when our ancestors were hunters and gatherers, there were many threats they had to be prepared to encounter. If they were being chased by a tiger, it was helpful to have the fight or flight instinct. While we rarely have to outrun tigers these days, the stress we experience still causes the autonomic nervous system to react in a similar way, preparing our bodies to fight, run away (flight) or freeze.

What about the heart?

The heart responds directly to stress. Have you ever noticed your heart beating faster when you’re feeling nervous or concerned? During times of stress, the heart tends to have a variable/chaotic rhythm. When relaxed, it beats in a more consistent and smooth pattern. It’s all about balance!

Managing Stress

Several factors that can help manage stress are:

  • Breath
  • Emotions
  • Thoughts
  • Sleep
  • Nutrition
  • Physical activity

We will explore the first three factors in more detail below.

Breath

Breath is affected by awareness, so paying attention can help you recognize how you are breathing (i.e. fast, slow, irregular). Having this awareness can help you to modify your breath to gain a sense of calm.

Here are three different methods of conscious breathing that you can try:

Abdominal Breathing

Abdominal breathing is a technique that brings attention to your abdomen by contracting the diaphragm.

  • Breathe in while pushing your belly out; breathe out while pulling your belly in.
  • Place a hand on your stomach to feel the rise and fall with the breath.
  • Sit tall and pay attention to your posture;  this is so the diaphragm doesn’t get compressed.

Heart-Focused Breathing

Brings attention to the area of your heart as a stress reduction technique.

  • Breathe in carrying the breath through the heart area, to the stomach.
  • Breathe out from the stomach, through the area of the heart, and out your nose or mouth.

Rhythmic Breathing

Involves breathing to a count, or setting a rhythm to your own breath.

  • Breathe in to the count of four, and out to the count of six.
  • Alternatively, breathe in to the count of four, hold for four, and out to six.
  • If you would like, pick your own numbers. The out breath is generally slightly longer than the in breath.
  • Do what feels right to you!

Emotions

Emotions are central to the experience of stress, they are a reaction to something we perceive.

When under stress the body releases a hormone called cortisol. Cortisol regulates a   body functions such as: metabolism, immune response, memory and sleep. Having a cortisol level that is too high can be bad for the body.

Here are some different methods of to help ease stress:

Notice and Ease

  • Close your eyes and think of a situation that you would consider to be 5 / 10 on the stress scale.
  • Notice what is happening in your body and the emotion that is tied to it. Name the emotion (i.e., frustration, anger, resentment).
  • Imagine the emotion in the area of your heart; breathe into your heart, into your stomach, and out of your heart.
  • With each exhale, think of the word ‘ease’ and feel the emotion melting away.
  • Breathe until the emotion has been neutralized and you no longer feel it. When ready, open your eyes.

Quick Coherence Technique

Quick coherence technique is a combination of heart-focused and rhythmic breathing, while including a lovely memory.

  • With your focus on your heart, breathe through your heart, into your stomach, and out through your heart.
  • Breathe in for a count of five, and out for a count of five.
  • Bring to mind a memory that you cherish (this can be of a person, place, or thing) and hold it in your heart.
  • Stay with the positive feelings in your heart. When ready, open your eyes.

Taking It All In

Hopefully, you are now feeling re-energized and ready to tackle the world; but you may be wondering, how often should these exercises be done? Michelle recommends doing one exercise three times a day; morning, afternoon, and night. Using these techniques can help form new neural pathways to keep you cool under stress, but that doesn’t mean that you need to feel stressed to do them!

In case breathing exercises aren’t yet your thing, consider starting a Gratitude Journal: Write and/or draw the things that are going well for you in your life while focusing on feeling grateful.

With the weather warming up, I feel as though it’s even more fitting to sign off by saying, breathe deep and keep cool everyone! – J


Julia Renaud is a very talkative ABI survivor with a passion for learning new things, trying new activities, and meeting new people – all of which have led her to writing this column. When not chatting someone’s ear off, Julia can be found outside walking her dog while occasionally talking to him, of course!   

Next Community Meeting:

Osteopathy with Osteopathic Manual Practitioner Riki Richter

Wednesday May 29, 6-8 pm

January 2019 Community Meeting: Vision Boards with Celia Missios

BY: JULIA RENAUD

I’ve been getting lots of good feedback about the Quick Facts section, so this month I am condensing the recap in hopes of better tailoring the article to the entire brain injury community. For this post, there is no need to scroll to the bottom of the article, just find the headings you like and read on! Also, don’t forget to let us know what you think!

Celia Missios
Our inspiring speaker and leader of the evening, Celia Missios.

Rolling into a new year or season is exciting and can usher in endless possibilities. For BIST’s January Community Meeting, we got our creative juices flowing to make Vision Boards. Celia Missios, ABI survivor, BIST board member, and founder of  the self care website Reslientista, stopped by to teach us what vision boards are all about. 

Discovering the power of manifestation – Celia’s Story:

While recovering from her ABI, Celia was looking for something to do to bring meaning to her life. She discovered scrapbooking and decided to create a scrapbook of her own about where she wanted her life to go and what she wanted it to look like. A couple of years later, while looking through her scrapbook, to Celia’s surprise, she realized that the things she had included in her books were coming to fruition!

A Vision Board
One of the many vision boards of the evening.

What’s a vision board? 

A collage of images, phrases, and quotes specifically made to help you manifest your life’s desires. They act as a reminder to envision your goals and take steps toward achieving them.

Why use one:

If you have dreams, goals, enjoy creative activities, or are interested in trying something new. If you like scrapbooking and/or motivational mind mapping, making a vision board is likely right up your alley.

Materials:

  • A canvas or thick paper backing (even cereal box cardboard will do!)
  • Scissors
  • Glue
  • Markers
  • A few magazines or pictures

Materials for Vision Boards

Steps for making your own:

  1. Assemble all of your materials.
  2. Decide on the type of vision board you’d like to make:
  • Themed: Can help you hone in on a specific area of your life for a more focused manifestation. Examples: Nature, Career, Family, Travel, Design, etc.
  • Life: A smattering of everything and anything that resonates with you!
  1. Flip through magazines or browse the internet to find pictures, words, or quotes that you are drawn to.
  2. Get cutting and gluing, arranging your chosen clippings in a way that is pleasing to you.
  3. Make sure to leave a blank space somewhere on your board. Here you will write, ‘This or something better’
  4. Once complete, look, appreciate, and become inspired!

A person places a large cut of of a picture of an eye on her vision board

One of the BIST members how to arrange their board.

Work together:

Making vision boards as a group activity is quite fun! Not only can it help save time, but if you are working on a themed board, you can make your theme known to the group so they can send found pictures, words, or quotes your way.

Three Steps to using your vision board:

Step 1:  LOOK! 

Hang or prop up your vision board someplace you will see it every day (think bedside table, beside your television or computer, or, if you’re anything like me, near your fridge!)

Step 2:  IMAGINE!

Spend a few moments every day looking at your vision board and imagineyourself experiencing all of the wonderful things on your board.

For example, if I have a picture of a person crossing the finish line of a race, I would envision running (or walking, or rolling – whichever suits you) toward the finish, and paying attention to how I feel while doing so.

Step 3: ACT!

Do something to align yourself with your vision.

Using the race example, I would go for a walk as a way of working toward my goal in hopes of manifesting the act of crossing the finish line.

Not feeling crafty? You could try this instead:

  • Make a Vision Board on Pinterest!
  • Prefer words to pictures? Make a word-only vision board by displaying words that resonate with you. Alternatively, write a vision journal where you describe what you would like more of in your life.

BIST members hold up their completed vision boards

The BIST Social Learning Attendees holding up their (mostly) completed vision boards. Great work everyone!

My Experience:

I have been looking at my vision board every day since I have made it. It was really fun to make and I find it beautiful, inspiring to look at. While I’m still working on manifesting my dreams and desires, I’m definitely enjoying the process!


Julia Renaud is a very talkative ABI survivor with a passion for learning new things, trying new activities, and meeting new people – all of which have led her to writing this column. When not chatting someone’s ear off, Julia can be found outside walking her dog while occasionally talking to him, of course!   

 

 

Welcome spring with Balinese cucumber salad

BY: JANET CRAIG

Looking for a new salad idea to welcome spring?

This is a gluten and oiĺ free vegan salad which is really refreshing. Make it using the new Spiralizer tool, which is available in several dollar stores.

 

Balinese Cucumber Salad

Ingredients

  • 4 oz of dry roasted peanuts unsalted or raw peanuts toasted
  • 4 oz (100 grams) rice vermicelli
  • 1 English cucumber, spiral cut
  • 1 bunch of green onions chopped
  • 2 tbsp fresh cilantro or parsley chopped
  • 3 tbsp rice vinegar
  • 2 tbsp sugar
  • 1 tsp salt
  • 1 tsp chilli paste or dry red chilli flakes – optional

Directions

  1. Cover noodles with boiling water let sit for 3 minutes (drained).
  2. If you need to toast nuts, place in dry stir-fry pan on low and shake for five minutes. Be careful – they tend to toast quickly.
  3. Spiralize the cucumber then add all ingredients topping with peanuts.

Chef Janet Craig recipes are simple, healthy, delicious and ABI friendly.  You can find out more about her HERE.

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