For many people with Acquired Brain Injury (ABI), rehab or therapy is a necessary regimen to regain basic skills such as walking and speaking. Few people, however, realize therapy doesn’t always need to be full of weights, exercise equipment or walking aids. These spaces can also be filled with guitars, pianos, or small drums and still help both physical and cognitive rehabilitation.
Music therapy, although relatively new, is a beneficial option for people in a range of circumstances, from developmental disorders to recovery from ABI. In most cases, it works alongside traditional rehab in order to yield stronger and faster results.
From a basic neurological perspective, listening to music activates various areas in the brain. The stimulation causes new pathways to be created as the effects of music spread. This is essential when brain injury has occurred and there are non-functional areas, new pathways are made in order to avoid the non-functional areas and regain skills from creating an initial response through music.
Music therapy involves a non-musical goal that is continuously re-evaluated throughout progress. These are often cognitive goals that musical therapists help patients reach while assessing their non-musical abilities through the different aspects of music.
Have you ever started tapping your foot along to the beat of a song without realizing? That’s because you were aware of the music playing and to matched that rhythm both cognitively and physically (even if you didn’t intend to).
Tempo is one of the most important elements that allows musical therapists to help non-verbal patients. Even if the patient isn’t capable of clapping or tapping along to the rhythm, their internal metronome still ticks and they can react to tempo. Music therapists check if they’re breathing in synch with the tempo of the music to determine if the patient is aware of the music playing.
Other cues from patients include changes in muscle tension or relaxation and improvising music. These demonstrate signal perception in the brain and environmental awareness. They are just some elements that help therapists assess their patients to help them in non-musical ways.
The benefits of music therapy are also diverse. They can range from helping a patient maintain eye contact to helping non-verbal patients enter into dialogue. Some benefits include attention and mental health.
If the patient is aware of their environment enough to perceive the music, their neural pathways remain stimulated throughout the song. The continuous brain activation generates strong pathways that can be used for extended periods of time for other tasks. The patient therefore gradually improves their attention span.
Music therapy can also improve the mental health of patients with brain injury. In a case study of a patient with Multiple Sclerosis, anxiety and depression were reduced and the patient stopped identifying themselves as someone sick. Instead, they recognized their creative identity and were able to improve their self-esteem after music therapy.
Overall, while music therapy is not a popular option for people struggling with brain injury, the effects have been consistently positive for wide a range of conditions. Alongside other rehab therapies, music therapy can help patients develop new skills and reacquire lost abilities through the neural activation of music. So, let’s start the beat and make some music!
One of the struggles I faced after sustaining my Traumatic Brain Injury (TBI) was difficulty focusing. Apparently this isn’t a problem only those who have sustained a TBI face, but also impacts many non-TBI survivors.
The world around us is not helping with this struggle. I observe people bouncing around between the apps on their phones, checking their emails, Twitter, Snapchat, and Facebook, texting, all while working or socializing with friends and families. These are not just annoying habits – it’s a little more insidious than that – these habits are denigrating our ability to focus.
Georgetown professor Cal Newport explains that too much bouncing around doing different tasks degrades our ability to concentrate when we need to.
People who do a lot of attention switching, they believe they can focus when they need to, but the reality is they have lost that ability. When you give them a task that requires focus, they perform worse than people that don’t spend a lot of time fragmenting their attention.
According to Professor Newport, focus is a skill that has to be trained. You can’t just decide, “Now I’m going to go focus intensely for the next three hours on something.” If you haven’t built up your capability to do that, you’re going to have a very hard time. Bouncing around on your apps, checking your email, texting all at the same time has an impact on your ability to focus when dedicated focus is needed. Much like lifting weights at the gym, the more time you spend doing it, the stronger you’ll become. And if you haven’t been spending much time focusing, it can take a little while to get that skill back up to speed.
So to be more focused you need to spend more time focusing. But how do we build up our focus muscle?
Clear Your Head
You want to focus but you’re worried about all the other things you have to do. So we often decide to work on multiple tasks at the same time. While writing this article, I’m also thinking about the bills I have to pay, getting my income taxes done, what I’m going to make for dinner, etc. I am tempted to go online to pay some of those bills, look up some recipes, and plan my shopping list. I may feel like I’m getting a lot accomplished, but focusing on these other tasks is taking me away from the task at hand and making it harder to complete. Research suggests that when I switch from writing this post to going online to pay my bills, and back to writing, my attention doesn’t immediately follow—a residue of my attention remains stuck thinking about the bills I just paid – did I pay them from the right account, did I get the date right?
When I am thinking about these other tasks it reduces the amount of mental firepower I have to devote to writing this article.
One approach to combating “residual attention” is to get the concerns about all the other tasks out of my head by writing them down. Neuroscientist Daniel J. Levitin explains that writing things down deactivates “rehearsal loops” in my brain.
When we have something on our minds that is important, such as a to-do item, we’re afraid we’ll forget it. Our brain rehearses it, tossing it around and around in circles in what cognitive psychologists actually refer to as the rehearsal loop, a network of brain regions that ties together the frontal cortex just behind your eyeballs and the hippocampus in the center of your brain.
The problem is that it works too well, keeping items in rehearsal until we attend to them. Writing them down gives both implicit and explicit permission to the rehearsal loop to let them go, to relax its neural circuits so that we can focus on something else.
Having a plan for how I’ll take care of these other tasks also helps. Apparently, committing to a plan to complete my incomplete tasks can help me to complete the task of finishing this article. Another neat strategy that I learned from my occupational therapist is to set aside a specific chunk of time to work on the task at hand. My limit for focused attention is an hour. So, I set the timer on my phone for an hour. When the time is up, I will stop working on this post, and consult my recipe collection to plan dinner.
Location, Location, Location
We’ve all heard this adage when it comes to real estate – but it is also important when it comes to focusing.
A number of experts agree that the biggest part of focus is merely removing distractions. Productivity guru and author of The 4-Hour Workweek, Tim Ferriss explains:
Focus is a function, first and foremost, of limiting the number of options you give yourself for procrastinating… I think that focus is thought of as this magical ability. It’s not a magical ability. It’s putting yourself in a padded room, with the problem that you need to work on, and shut the door. That’s it. The degree to which you can replicate that, and systematize it, is the extent to which you will have focus.
…top performers overwhelmingly worked for companies that gave their workers the most privacy, personal space, control over their physical environments, and freedom from interruption.
One of the most powerful ways to improve your ability to focus is to pick the right environment. After my daughter moved out, I converted her bedroom into a den. I painted the room a beautiful grey-green, bought a lovely glass desk, brought in a comfy chair from another part of the house, and hung some of my favourite art work. This is where I go when I want to focus.
Stop Being Reactive
Turn smartphone notifications off. Your computer should not be chiming when you get a new email. You need to stop being in a mode where you are reacting to things. This leads to attention residue, as discussed above; anytime you are reacting to new stimuli it pulls you out of focus. The new stimulus can linger in your head, draining your ability to concentrate on what’s important.
It might seem harmless to take a quick glance at your inbox every ten minutes or so. But that quick check introduces a new target for your attention. Even worse, by seeing messages that you cannot deal with at the moment (which is almost always the case), you’ll be forced to turn back to the primary task with a secondary task left unfinished. The state that almost every knowledge worker spends their day in is a terrible state if your goal is to actually focus with any intensity. I think it’s the equivalent of having a professional athlete who’s coming to most games hungover.
So maybe you try all this and you still can’t focus today. It might not be due to anything going on right now. It might all be the result of what you didn’t do last night …
Get Your Sleep!
What’s one of the main reasons we spend so much time aimlessly surfing the Internet? Studies say it’s lack of sleep. Not getting enough reduces willpower and depletes the self-control you need to avoid bad habits like watching cat videos.
Sleepiness slows down your thought processes. Scientists measuring sleepiness have found that sleep deprivation leads to lower alertness and concentration. It’s more difficult to focus and pay attention, so you’re more easily confused. This hampers your ability to perform tasks that require logical reasoning or complex thought. In his book The Brain’s Way of Healing, Norman Doidge explains that during sleep our sympathetic nervous system (our fight or flight reaction) is turned off, allowing for our parasympathetic system to turn on. When our parasympathetic system is turned on, a number of chemical reactions that promote growth and reenergize our neurons occur, leading to relaxation and preparing for the growth of new neural pathways and connections.
Sleepiness also impairs judgment. Making decisions is more difficult because you can’t assess situations as well and pick the right behavior.
To Sum Up
Post completed! Now off to deal with all those other ‘to-dos!’
Since acquiring her traumatic brain injury in 2011, Sophia has educated herself about TBI. She is interested in making research accessible to other survivors.
Barker, E. (2014) How To Focus: 5 Research-Backed Secrets to Concentration. Retrieved from www.bakadesuyo.com
Cain, S. (2012) Quiet: The Power of Introverts in a World That Can’t Stop Talking. Danvers, MA: Crown Publishing Group.
Doidge, N. M.D. (2015) The Brain’s Way of Healing. New York, N.Y.:Viking.
After my concussion, I lived in ‘stimulation jail’ for several months (and, when my symptoms require it, I still do.) The boredom I felt was at times more insufferable than the plethora of pain and other concussion-related symptoms I experienced.
During the acute recovery phase of a brain injury, patients are often instructed, quite literally, to do nothing. Some endure this ‘jail’ for a few days to weeks. Others remain confined for much longer with no foreseeable end in sight.
I would risk worsening my symptoms just to do something, anything to help pass the time. My family would then get angry at me for overexerting myself. I didn’t know how to explain to them that boredom was causing me real pain and suffering. They assumed that I was exaggerating, until now.
Subjects were placed alone with their thoughts in sparsely furnished rooms for 15 minutes. As to be expected, most of the subjects indicated that they did not enjoy “just thinking” and preferred to have something else to do.
What surprised the investigators (but not me), was that a majority of the subjects preferred to have an unpleasant activity than no activity at all. Prior to the start of one experiment, male and female volunteers received a single electric shock.
42 volunteers said that they would pay money to avoid being shocked again. However, when those same volunteers were left alone for only 15 minutes in a room devoid of distractions other than the option to receive electric shocks, 67 per cent of the males and 25 per cent of the females chose to self-administer at least one shock.
So the next time someone invalidates your experience with boredom or confinement, you can smile and politely tell them about this study.
Mind Yourself with Alison is a collection of self-help tips, research, and personal experiences dedicated to helping people thrive after brain injury (or other trauma). You can read her other articles HERE.
One of the many things we lose during recovery from an ABI is structure in our day-to-day routines.
While rehab and specialist appointments may maintain a facsimile of structure to your day or week, what are you doing with the rest of your time? Have you fallen into a routine of sleeping the morning away, followed by an afternoon marathon of talk shows, soaps and game shows? Does your wardrobe consist of pajamas or sweat pants? By supper time do you start thinking about all the ‘things’ you should have done – only now you are beyond tired, and you remember you didn’t really eat anything (does a chocolate and left over pizza count?), and you’re now counting down the time until you move from your sofa to your bed – only to start the cycle again tomorrow? Unless of course there is a medical appointment you need to attend.
This type of day I call unplanned structure, in the early days of recovery you went from bed to medical/rehab appointments and back to bed, because that’s all your body and brain could handle. Over time, this became unplanned structure, as it was easier to do nothing than to think and make a decision about how you were going to carry out an activity, which may take more planning now than before you acquired a brain injury.
Know, I’m not judging. I‘ve lived this, but I’m here to let you in on a little secret – planned structure is key to getting back to adding more fun and enjoyment into your day.
For many people the word structure can conjure up visons of rigidity, being controlled, or being stuck in a boring routine. But structure can be a very powerful tool to help you get back to functioning on a regular basis and enjoying life. When you have structure in your life you know ‘what’s next’, which enables you to get on with your day. As ABI-survivors we can use up valuable energy trying to figure out what to do next. We might not do anything because we can’t decide or figure out what to do.
In the early years of recovery from ABI, I too was against structure, just ask my rehab girl Catherine. My reasoning was that I couldn’t predict what my energy level was going to be on any given day, so why plan anything? This left me doing nothing most of the time.
I also wanted to feel like I had control over my own day. Boy, was I wrong! When I finally gave planning structure a try – with the caveat that it was OK to re-schedule an activity if I didn’t have the energy for it (without guilt, or feeling like a failure) – it was such a liberating feeling!
Planned structure became my ticket to freedom, independence and a sense of accomplishment. Knowing what came next in my day helped reduce my daily struggle with anxiety and stress. I made sure there was always built in rest time between activities, and the more I repeated an activity on a regular basis the more it became a habit. My brain started to automatically know ‘what’s next’, and before I knew it I was doing my morning grooming without having to stop and think about it.
I’m not going to sugar coat it – it takes time, and some things will continue to need to be written down (that is a post for another day) but, know that each small step (no matter how trivial and small it may seem) will get you to where you want to be, living life to its fullest no matter what your new abilities may be.
When our food, exercise and sleep patterns are consistent our body and brain function better. This makes it possible to enjoy not only the tasks we need to do but to enjoy activities we like and try new activities too.
Benefits of structure
You know ‘what’s next’ and don’t waste energy thinking about what to do next
You habituate a new task or behavior
Automates activities in your day
You feel more in control being able to enjoy your day and your life
Eight tipsthat helped me add planned structure into my day that included activities to make my day and life more enjoyable:
A regular wake up time
Morning rituals to prepare for the day ahead (showering, dressing, breakfast etc.)
Evening rituals to prepare your mind and body for rest (unplug from computers, television 1-2 hours before your bedtime; read a book, have a bath, meditate/pray, etc.)
A regular bedtime
NOTE: there will be times where you will need to add your daily structured planned activities around your medical / rehab needs, and there will be times that you will be able to add your medical rehab appointments around the things you enjoy in life. With patience and time you will find balance between the two – this is when the magic of planned structure happens.
Allow for flexibility, especially on days you find your energy supply low
Its ok to add/remove activities as your likes change
Seek the help of a rehab team member, friend/family member, or psychologist in creating your daily structured plan if you are not sure how to get started.
Today, I have more enjoyment in my days and life in general because; I have created a daily structured plan that works for me. I encourage you to give adding structure to your day a chance. And let’s not tell Catherine that she was right about structure, that will be our little secret. ☺
Celia is an ABI survivor who is dedicated to helping others move forward in their journey and live the life they dream of. She is the founder of the internationally read blog High Heeled Life – inspiration for living a luxurious and balanced life; featured author in Soulful Relationships part of the best-selling series Adventures in Manifesting; a Peer Mentor with BIST; a regular speaker for Canadian Blood Services – Speakers Bureau; Self-care advocate; Lifestyle writer/blogger. In 2016 Celia launched the website Resilientista to inspire women to put themselves in their day, practice self-care on the daily and live their version of a High Heeled Life. Learn more about Celia and be inspired: visit http://www.HighHeeledLife.com or http://www.Resilientista.com
Since my injury, I’ve had a difficult time letting go of negative thoughts and feelings, especially after unpleasant encounters with people. Rehearsing comebacks to conversations that would never happen and singing the Disney song, ‘Let It Go‘ wasn’t helping, so I revived an old technique that worked for me years ago.
Meditation is often thought of a silent experience, but our new columnist Krista Schilter shares how an active singing meditation can help boost your memory. Read the first post in Krista’s new column – Root to Rise: A Mindful Approach to Living After ABI.
When Joanne Smith acquired her spinal cord and brain injury at the age of 19, after the initial recovery, she says she spent 10 years feeling “lousy.” On top of dealing with her injuries, additional challenges such as weight gain, fatigue, digestive pain, neuropathic pain and migraines had a big impact on her quality of life. Then she took a look at her diet.
Smith said she was eating the same convenience and processed foods she ate as a teenager, prior to her injury. And when she changed her diet to more nutritious, whole foods, she says, she changed her life. She lost weight, and her headaches and pain went down. She felt better. That’s when she decided to go back to school and learn more about nutrition.
Smith became a certified nutritional practitioner, work she continues to do to this day. She’s also been the host of two TV shows focussing on disability issues (the Gemini-award winning Moving On and Accessibility in Action) and co-authored the book, Eat Well Live Well with Spinal Cord Injury. And on a Monday night in March, she came to the BIST community meeting to teach us about eating well on a budget.
Smith began her presentation with this somewhat disturbing statistic:
The bodies of ABI survivors, Smith said, are more susceptible to inflammation. Diets with too much salt and sugar (basically, the average North American diet) can trigger inflammation, leading to swelling, headaches and mood changes. Changing your diet, Smith says, can improve these symptoms.
Smith acknowledged that changing your diet can be challenging – especially for ABI survivors who may have a limited budget, accessibility challenges getting to the grocery store and energy issues. But she said that while many people think it’s more expensive to eat healthy it doesn’t need to be. For example, making your own food is cheaper than buying it, as per National Geographic’s article, What Can You Get for Ten Dollars?
Smith’s tips for healthy grocery shopping on a budget
Make a list before you go out, and stick to it
Avoid the centre aisles of the store, they tend to have the processed, more costly food
Buy whole foods (foods which have been through very little processing and do not have additives) – they’re cheaper and healthier
Avoid pre-chopped produce, which tends to be more expensive
It’s cheaper to buy in bulk
Double or triple salad recipes so you can have prepared food for the week ahead. Put salad portions in individual serving containers in the fridge for a quick grab and go. (Smith says dollar stores are great places to get Tupperware.)
Organic is not necessary, Smith says. Just wash your produce really well by filling your sink with water and a splash of vinegar, rinse and rub. (And here’s some motivation, Smith says the average apple is sprayed with pesticides 17 times.)
If you are going to invest in organic food, Smith says it’s best to spend your money on organic meat.
If possible, avoid shopping during peak times (such as the weekend). Produce is often marked down on Monday mornings and Saturday nights, afer the rush.
Reading labels and ingredients is crucial to healthy eating, Smith says. Watch out for trans fats, which can lead to inflammation. And beware of ‘no sugar added’ labels, some foods with these labels can still be loaded with naturally occurring sugars which still count as sugar. A single serving of food should have no more than five grams of sugar.
Artificial sugars are worse, Smith says they irritate the nervous system, can set off your mood and induce headaches. They can also stimulate your appetite, and there is evidence that people who use artificial sweeteners may consume more calories than people who don’t. (Smith says if you have to use artificial sweeteners, use stevia, which is 200 times sweeter than sugar and has “no horrible side effects.”)
Beware of foods which claim to have Omega-3, we need three to four grams of omega-3 a day to be useful. To get that amount from margarine, for example, Smith says you’d need to eat the whole container. (Best-news-ever: butter is way healthier than margarine, and good for your immune system.)
If you’re buying fish, avoid any fish that is farmed. (Smith says she doesn’t buy fish unless it says ‘wild’ on the label.) Farmed fish are fed grains, and can acquire diabetes as a result of their diet. As a result, farmed fish do not have the essential omega-3s which wild fish have.
And here’s one that may be a shocker: don’t heat olive oil. Olive is wonderful to use on raw foods, such as salads, or to poor on pasta, after it has been cooked. Instead Smith recommends cooking with coconut oil or rapeseed oil. (If you want to read more about the cooking with olive oil debate, go here.)
Finally, Smith says drinking your nutrients is a great way to get your nutrition. Smith uses the Nutri Bullet to make her smoothies, which go for about $90 to $100. She says she’s not a fan of juicers, since they tend to remove most of the fiber. But the point is, Smith says, you don’t need to invest in an expensive juicer or blender to get the benefits of drinking your nutrition. At the meeting we made a great smoothie consisting of: almond milk, peanut butter, spinach and banana.
Most importantly, Smith says, take things one step at a time. “You’ll be amazed at how much better you feel.” We felt better just listening to her – and sampling those smoothies.