By Dr Giselle Roberts
I was doing ordinary things on an ordinary Thursday morning. Making lunches. Feeding the cat. Finding that list of interview questions I had stashed in the back of my handbag. I picked up my keys for work, opened my wardrobe door to get my coat, and the top shelf gave way in a heaving, split-second implosion. Folders and books pummelled me as they flung themselves to the floor.
At first I thought I was fine. But what followed was months of extreme nausea, brain fog and exhaustion, where going to the supermarket to buy bread seemed like an impossible task. I couldn’t remember the most basic things. I couldn’t work or drive. Fluorescent lights made me ill. And my brain felt like it was working thirty times as hard to read a recipe or write a sentence.
Every five minutes, an Australian suffers an acquired brain injury (ABI). In May, I became one of those people. Mine was a mild traumatic brain injury. Other people have strokes, or brain tumours, falls or car accidents that leave them with mild, moderate or severe injuries.
Neuropsychologist, Dr Dana Wong, is an expert on ABI and brain injury rehabilitation. I talked with Dr Wong to find out how her research is helping people with ABI to find new ways of navigating their brains, and the world around them.
GISELLE ROBERTS: Dana, it is a pleasure to interview you. Tell me, what is an ABI?
DANA WONG: ABI is an umbrella term that covers a range of conditions. Acquired means that the person wasn’t born with it and the brain injury refers to any impact, insult or illness of the brain. ABI includes traumatic brain injury (where an injury has occurred from an impact to the brain), stroke (where a blood vessel has been blocked or has burst in the brain), hypoxia (where there is a lack of oxygen to the brain), and benign or cancerous tumours.
GR: What physical changes happen when a person suffers an ABI?
DW: The physical impact depends on what part of the brain has been damaged. In a stroke, it is quite common for people to have a hemiplegia, or paralysis on one side of the body. They may have difficulty with fine motor control, such as writing. After traumatic brain injury, the physical symptoms aren’t as defined because the damage often affects the whole brain. In these cases, there is a stretching and shearing and breakage of the neurons in the brain which causes more widespread effects including difficulties with balance, walking and depth perception.
GR: What thought-related, or cognitive, changes occur?
DW: The most common problems are with memory, particularly with remembering new information. Filtering out background information or concentrating for longer periods of time can be difficult. Frontal lobe damage may result in difficulties with organising, prioritising and making decisions. And the speed of processing information is often compromised because the messages going through the brain have to navigate around the damage. If we think about the brain as a road network, injury results in potholes and road blocks in that network. The brain has to work harder to achieve the same level of performance. This causes significant fatigue.
GR: And with stroke?
DW: Stroke can be slightly different because the damage is often restricted to a specific part of the brain. It can result in spatial neglect, where a person pays attention to only one side of space. They might, for example, only eat food on one side of their plate. Focal damage to the left hemisphere can cause aphasia, difficulties with language and communication that can be quite profound.
GR: Even a slight change in capacity can significantly impact what a person does in their life. What are the emotional challenges that confront people with an ABI?
DW: An ABI can change a person’s capacity to do the things that bring them self-worth. It is hard for people to shift their expectations about who they are and what they are capable of, and to move that bar to account for this new reality, where the brain has to work so much harder to do the same thing. We know that depression and anxiety occur at much higher rates after brain injury than in the general population, and this emotional distress can hamper recovery. It gets in the way of the brain trying to rest.
GR: Some ABIs may resolve in a matter of weeks, others may require lifelong management. How do you determine the likelihood of recovery?
DW: Our research field is trying to grapple with this. There are so many individual differences that will impact somebody’s recovery journey. We know that people who were high functioning before their injury and whose brain networks have been well developed through education, for example, have what we call cognitive reserve, a greater capacity to manage an impact to that reserve. They often have a better recovery. But there are other factors including a person’s pre-existing coping style, or history of depression and anxiety. We know that somebody’s family and support network will also have a big impact on their recovery.
GR: Dana, you have specialised in developing programs that help people with ABI. Your most recent program, Valued Living After Neurological Trauma (VaLiANT) targets both the cognitive and emotional challenges of living with ABI.
DW: The idea of valued living is about doing things in your life that are consistent with your personal values. We know that higher levels of valued living are associated with better outcomes after brain injury. VaLiANT is an eight week program that has been running at La Trobe Psychology Clinic since the beginning of the year. Each session focuses on a particular life domain such as health, work, study or relationships. We help people to identify what is important to them and what they can do that is in line with those values. We then look at cognitive and emotional strategies to help enable those actions to occur. Strategies to help them manage difficulties around memory, planning and organisation, or dealing with emotions and anxieties that might get in the way of them undertaking those activities.
GR: And your Memory Rehabilitation Initiative will soon be in eight health sites across Victoria.
DW: That six week program helps adults experiencing memory problems after stroke or an ABI to understand how memory works and equip them with internal memory strategies, external memory aids, and lifestyle adjustments to improve their lives. There is a big focus on compensatory strategies, or doing things to work around the memory difficulty. Time-dependent reminders such as calendar alerts are one example. We have a session on using different apps for things like shopping lists. None are particularly revolutionary, but if you haven’t been using those strategies in everyday life, it helps to be shown and reminded that this is something that can help.
GR: It must be very rewarding to help people with brain injury to realise that recovery is related to identifying a range of different strategies to get to the same outcomes.
DW: I love to hold up a mirror to someone with an ABI and say, “I understand what’s going on with you and why you are having some of these issues. This is what we can do about it.” I find that really rewarding.
