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The second time I walked through the front doors of Headway, I was once again reminded of why I was so uneager to leave the first time. With my first steps inside, I could feel the warm and accepting atmosphere, as I was immediately welcomed by all of the staff and members. Each made it their duty to greet me, with introductions as new friends or handshakes from old ones.

Bingo (Image via Wikipedia)

It was soon brought to my attention that the bingo caller (I) had arrived just on time, because everyone was just beginning to set up for bingo. As an experienced veteran from my previous visit, I did not want to disappoint the larger number of players this time. Because there were more members to play this time, the resulting tournament was livelier, but also more chaotic. However, the staff were very quick to settle members who interrupted the game. Overall, the flow of the game was much smoother, despite having more members that required special attention to ensure they were following along. I would like to think that it was in part due to my superior bingo calling abilities this time around.

During my first visit, much of my attention was focused on the members. Confirming lecture discussions and the literature (Dikmen et al., 1983), I was able to see first-hand the vast differences in cognitive and behavioural abilities of those suffering from TBI. I also noticed the benefits of a centre like Headway, as a positive community-building resource for these members. This second visit to Headway has shown me that a large part of why Headway works is because of the staff and volunteers. What really stood out to me this visit was how well the staff could handle the variety of situations that occur at Headway, and produce this warm, supportive environment. As previously discussed during class facilitations, social isolation can be detrimental to the recovery of TBI patients (McLellan et al., 2010). The staff at Headway ensure that every member is engaged and treated with respect as a regular human being.

Blackfish (2013) (image via Wikipedia)

My previous point of treating members with respect leads me to a conversation I had with one of the members while we were watching Blackfish (2013) on Netflix. This member brought up a variety of interesting facts about killer whales and insights that I had not even considered. This interaction reminded me that although some members suffer from cognitive difficulties, they are still intelligent. In fact, a study by Johnstone et al. (1995) suggests that intelligence is the least declined following TBI compared to other cognitive deficits. People suffering from TBI are still intelligent, and an effort should be made not to speak to them with any less respect than they deserve. I noticed that the staff and volunteers do an incredible job at this, facilitating the amazing atmosphere at Headway.

There were many more members present this week than there were at my first visit, so I was lucky enough to have the pleasure of meeting new faces while doing art. Together we each selected a rock, and then painted them to demonstrate our inner Vincent van Goghs. I soon learned however that many of the member’s artistic capabilities far exceeded my own, as my green-ish/blue-ish/brown-ish coloured rock became the butt of several jokes – it was called everything from a “lump of moss” to a “deformed orca whale” to a “rock that didn’t even look like anyone had painted it.” My artistic inabilities aside, I had a blast joking, chatting and assisting the members to create their own masterpieces, and was fortunate enough to have some members share some really astonishing and personal stories with me.

Rock that closely resembles my art piece (unfortunately).
(image via geograph)

A story shared by one member in particular really touched me, as she began to share some of the frustrating experiences she has had with her physician. She described to me what her life was like with her two children before she had a stroke which has affected her right hemisphere, and how it has changed since. The truly heartbreaking part of her story was that her physician blatantly told her that there is no hope for her getting better, that she will be forever confined to a wheelchair, and that there is really nothing much that can be done to increase her mobility. Despite this incredibly discouraging news, she is determined to prove her doctor wrong, as she does tai chi, swimming, and yoga in modified forms every week. Needless to say, I found her strength and determination to be beyond admirable and truly inspiring. As she was sharing her anger and frustrations with me, another member joined in to say that she was told the exact same thing when she was in an accident at age of 15, yet she defied all odds, and even went back to school a year later despite her doctor’s recommendations. She went on to become the Class Valedictorian and although she was also told she would never be able to walk again, there she was at Headway walking independently, standing by my side helping to clear up paint brushes.

This brought me back to the topic of motivation that we have discussed in class, and how a patient’s outlook and emotional state can make a significant difference with their recovery from a TBI. I did some further research and found that interestingly, some studies suggests that hope is emotion-focused and potentially unrealistic leading to poor outcomes, whereas other studies argue that hope is a positive emotional state that is associated with better outcomes in the early stages of recovery, but ceases to be helpful once patients realize the actual consequences of their injury (Shotton, Simpson, & Smith, 2007). This balance between optimism and realism is something that was also touched upon today by Mr. Daniel Corrin, and is something that in hindsight makes sense to me, given that we have learned that there is no single coping method that works best for every patient, and that the context surrounding the individual’s life must also be considered.

This week at Headway was quite a different experience from my last visit. Walking into the lobby, I encountered Heather* who seemed a bit nervous and out of sorts. As we rode the elevator up to the centre, she and I got to know each other by engaging in a bit of small talk. When I asked if there was anything wrong, she confided that she wasn’t feeling well but couldn’t get picked up because she couldn’t remember her ride’s phone number. While we arranged for her to go home by HandyDART, which wouldn’t be for another hour, I realized how little setbacks could easily turn into major problems and knew how frustrated I would have felt in the same situation.

Even though she was feeling sick and under emotional strain, Heather handle it well and took the time to get to know us better while she waited for HandyDART to arrive. She talked more about her life, and showed us some of her sign language skills. Another member, John*, joined in and the two of them happily taught us some simple phrases like “mom + dad”, “no” and “see you later alligator”. Both John and Heather had language deficits, and I could see that they really enjoyed being able to clearly communicate things without using speech. It really sparked an interest for me, and I hope I can learn more sign language in the future. It seems like it would be an incredible skill to possess.

When it was about time for the HandyDART to show up, I really started to notice the inconvenience of having Headway in the upper level of a secluded building (as was pointed out in Ms. Alison Mclean’s presentation). We weren’t able to see the building’s entrance from the windows, so it was really hard to tell when the HandyDart had arrived. Some members had figured out a few tricks to tell if it had come yet, but I still couldn’t help but think that there needed to be a better way to organize transportation for those with disabilities.

When it finally came time for the crafts to start, I noticed that John didn’t join the crafts table, and instead headed into the computer room to knit. He had done the same thing during my last visit, and I decided to find out more about his love for knitting. Spending some one-on-one time with him really opened my eyes to how capable and independent some of the members at Headway are. While I’m sure John had lost some abilities from his accident (which resulted in his language deficit), it was encouraging to see that he hadn’t let his injuries prevent him from doing something he loved. He told me about how he sold his knits through his own label and even let me help knit the scarf he was currently making. Even though my stitches were clearly more messy than his, he encouraged me and taught me a couple of his special techniques.

After the mini knitting session, I went to see how the crafts table was coming along. I was impressed with how innovative the group was; they were decorating mugs with glue and tissue paper, since paint hadn’t worked.

The end results were very cool, and it was nice to see how much effort each member put into their craft. I think that these type of sessions could really act to help the members with their ability to focus on a task and follow it through, whether this is an issue for them or not. And it was really interesting to see how the rehabilitation techniques we have learned in class are useful in real life.

Overall, I had a very enjoyable day at Headway. While it was quite different from my last day there, I really appreciated the chance to spend more individual time with a few of the members. I’ve learned a lot through my interactions with the members there, and hope to go back soon.
*Names have been changed.

Though equally as enjoyable, my second visit to Headway was much different than my first. I would describe my first time at the center as being “light and fluffy,” that is, it was enjoyable and eye opening but I feel as though I failed to integrate my experience with the knowledge I have learned in this seminar. This time however, it was a much “heavier” visit in that there were two moments that stood out to me as important to remember and very nicely captured some themes we have discussed in class.

My day started out quite benign and lovely. I greeted a woman that I had not previously met and we chatted for a while about her daughter, her large blue ring (which I adored), and my plans for the rest of the day. In addition to spending time with new members, Hawaiian shirt remembered me from my last visit and was pleasantly surprised when I was able to partake in his handshake routine without error. We sat down at the tables and waited for brunch to be served; this is when Important Moment Number One occurred.

During our Headway orientation, we were told some members might say things to us that could be considered “inappropriate” or “rude” by our Western World standards. When I politely declined the food, one of the members turned to the group and exclaimed, “she’s what we what we call an anorexic!” I was a little taken aback but I knew that they did not mean anything hurtful by it and definitely hadn’t considered how it might make me feel. As we discussed in our Social Dynamics lecture, a major adjustment for family and friends involves the emotional or behavioral changes that a TBI survivor exhibits. They may display mood swings, say or do things without considering the consequences of their actions, or disregard the feelings of others. I found an interesting article (link at bottom of this post) that explores the touchy subject of personality change after a TBI. It highlights how social-emotional shifts are the most obvious to relatives of a TBI survivor and two salient factors were impulsivity and a lack of emotion perception in others.

Important Moment Number Two happened during a conversation I had with one of members after brunch. He relayed to me that one of the physical symptoms of his TBI was seizures that prevented him from visiting his relatives in his hometown. We’ve talked a lot in class about how the integrity of the neural tissue changes after a brain injury and our Pharmacology lecture described how neurotransmitter levels can be vastly altered post-TBI. However, we haven’t talked a lot about posttraumatic seizures and I was curious to find out if this was a common symptom. I found a short informative video (which is attached at the end of the entry) that details posttraumatic epilepsy at a very basic level and learned that it is most prevalent after a brain injury in which the skull has been penetrated.

I greatly enjoyed my second visit to Headway and was glad I could learn more about some of the behavioral and physical symptoms that accompany a traumatic brain injury.

Link to article: http://gw2jh3xr2c.search.serialssolutions.com/?ctx_ver=Z39.88-2004&ctx_enc=info%3Aofi%2Fenc%3AUTF-8&rfr_id=info:sid/summon.serialssolutions.com&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Factors+triggering+relatives’+judgements+of+personality+change+after+traumatic+brain+injury&rft.jtitle=Brain+Injury&rft.au=Weddell%2C+Rodger+A&rft.au=Leggett%2C+Janice+A&rft.date=2006-11-01&rft.issn=0269-9052&rft.eissn=1362-301X&rft.volume=20&rft.issue=12&rft.spage=1221&rft.epage=1234&rft_id=info:doi/10.1080%2F02699050601049783&rft.externalDBID=n%2Fa&rft.externalDocID=10_1080_02699050601049783&paramdict=en-US

In my second visit at Headway, the centre was quite empty, ranging from none to two users. As I found out, yoga just got cancelled for the day, so instead we folded calendars to send by mail to all members. It felt good, for me and a user, to do something useful for the rest of the community. Mr. X told me of lemonade he made and brang to Headway last week, and how he learned many new recipes since his injury. When the second user arrived, they both got very engaged in a conversation about hockey. Conversations were lively, but overall it made up for a very different experience than my first visit.

On my first visit, the group conversations I got complemented some of the issues we saw in class. An example is how challenging may it be to get back to work after TBI. Some members were trying to find a suitable job unsuccessfully; another was happy about her weekend job at a supermarket, for which the ride there was one and a half hours long from her home. She wished they could give her more hours, but she enjoyed being productive and self-providing. This is consistent with a study that showed a higher- subjective well being among people who succeeded to work after TBI than those who didn’t (O’Neill et al 1998).

Two of the members were training for the Paralympic Summer games. We talked about the training process, methods of para-athletic classifications (medical vs functional), as well as the inequalities between the Olympics and the Paralympics. Not only is the latter less covered by media, but I was surprised to be told that the COC compensate Canadian Olympic medallists with a cash prize, but not the Paralympic medallists–-even though they may need it more.

Canada got 16 medals in the Paralympics, entering the top three countries in number of gold medals.

But what impacted me the most was the move beyond group conversations. In my first visit, quickly some of the members trusted me as to have a more private conversation in which they shared with me their personal stories, their life pre-injury, the injury, and how everything changed since then. No amount of class can prepare one for these personal moments. It reminded me how important it is to enjoy life, as it comes. How false group dichotomies are: we will all be elderly, and it really takes some seconds to be in the position of members at Headway. Their issues are our issues: we can’t look away.

Something that has been troubling me is the low number of members I often see at Headway. Last week when I was volunteering, there were even more volunteers than members! I wonder if this is something you’ve noticed too.

Why are there so little members visiting? (Image via Flickr by Tim Samoff)

When I was a volunteer last summer, it seemed like there were more members. Perhaps this has something to do with seasonal affective disorder (SAD), as Jazon described during his facilitation on emotional outcomes. Maybe less sunlight during the winter leads to depressive symptoms and general fatigue that then makes it too much to go to Headway. After all, I hear members say they’re tired and have low energy all the time. To be honest, I even suspected they were using it as an excuse sometimes to not participate in activities. But I know now after our discussions on symptoms that I shouldn’t make this assumption.

Fatigue alone is unlikely to be causing the low number of members, according to a study by Cantor et al. (2008). The authors suggest that while post-TBI fatigue is associated with health-related quality of life, it is not related to participation in major life activities. Curiously, it was not made clear what counts as being a “major life activity”. Here’s an interesting legal briefing on how major life activities are interpreted in court.

Another explanation for the low number of members is just not enough people knowing about Headway. Especially after Alison’s convincing talk on how Headway can increase life satisfaction, I feel that Headway Vancouver is very underutilized. After speaking with the manager, I learned that reaching more potential members is a high priority. However, the Headway manager is newly hired and not from the Vancouver area. As such, she does not yet have many connections with the Vancouver health care community.

I think we have the capability to really help out here! From our undergraduate careers, we’ve likely networked with many health professionals and community workers. Whether through directed studies, co-ops, summer studentships, clubs, jobs or volunteer programs. Lets put together a resource with potential contacts that may be able to refer their patients/clients/members. I’ll start a document on Google drive next week so we can compile our connections together. This will count as bonus participation marks for your course grade. If you don’t personally know any contacts, another idea is to search online. Places like Vancouver General Hospital, St Paul’s Hospital, psychology/physiotherapy centers and private clinics are a good place to look.

I don’t expect new members to come pouring in by the time this semester ends. But if we manage to reach even a few individuals that can benefit from joining Headway, I think it’ll be worth our efforts. It’d be pretty cool to walk away from this experience leaving a lasting impact on a Center that has been so welcoming and generous with us.

When I walked into headway for my second volunteer experience I noticed something was off… there was no one there! Well there were a few people, but the volunteers for that day outnumbered the members 2:1. Was this just case of craft day not being very popular or was something else wrong? I think the occupational therapist that came to our class a few days later may have revealed the real reason. HandyDARTs cost quite a bit of money. With each round trip to headway (or anywhere else for that matter) costing $5.50, and the members having a very limited living allowance, I doubt the members can make it to headway as much as they would like to. It’s upsetting to hear that HandyDART fare is as much as a bus fare. I thought it was a free service provided by the government, but it turns out it is a part of Translink, which explains the ridiculous price. To add to my frustration I found out they don’t accept Government Funded Annual Bus Passes (http://www.eia.gov.bc.ca/PROGRAMS/bus-pass.html). Considering many of the members rely on headway for their social and recreational needs and many are unable to work to make enough money for the bus, changes should be made.

As the volunteers were meeting in the office one of the members came in saying she didn’t feel well and needed to head home. As one of the staff called for a HandyDART I got her a glass of water and chatted with her. This member had a language deficit but she knew sign language, and was happy to teach me a bit of it. I’ve always wanted to learn American Sign Language (ASL). All I knew before hand was how to say “yes” (https://www.youtube.com/watch?v=Zo1ErhNEWDU) or “no” (https://www.youtube.com/watch?v=KFRuI1OzzBk), but she sowed me a bunch of signs from the whole alphabet (https://www.youtube.com/watch?v=9M1ky9_nm4Y), to “family” (https://www.youtube.com/watch?v=4sqq90cBOOA). She said she has had to relearn ASL 3 time since her injury. It must be frustrating not being able to retain something you work hard to learn, but she didn’t seem discouraged. It was lots of fun learning from her, and I wish she could have stayed longer.

When it was time to start the crafts we still had more staff/volunteers than members. We were supposed to paint coffee cups, but the paint wasn’t sticking to the cups! Instead we glued coloured paper to them, which seemed to work better. One volunteer helped a member with impaired fine motor movements. I cut some extra paper into small squares, and decorated the half finished demonstration mug. As usual the conversation was great. We talked about our favourite movies and books, to current events. Some members had a hard time keeping up with the conversation, but it was nice how everyone was so inclusive in keeping them connected to the conversation.

Time flew by and before I knew it, it was time to head home. I hope we have a chance to go back again before the course is finished.

My second visit was interestingly, nothing like my first visit. My first visit was during the baking time as well but everyone there was new to me, except for one individual, Ann*.

The first time I was there, I was told to be wary of Ann since she did not usually like other females, and was often found to be even a little hostile and aggressive towards other females. I made sure to be exceptionally nice to her – although this almost upset me that I needed to be extra nice to someone simply because of my gender…

Before the baking started, we played a quick game of Trivia. Another classmate and I were in charge of asking the trivia questions. It was amazing to see how the members were so good at answering the questions. I’m ashamed to admit, I originally picked the easy ones thinking that their intelligence was altered. One individual (who was amazing at getting the questions right) actually commented that after his brain injury, he was significantly better at remembering facts than anything else. Ann was almost as good as the trivia-master and I would congratulate her every time she answered correctly.

We were all split into teams for baking banana bread – one wet items and one dry items. Funny enough, Ann and I were put on the same team. I was rather hesitant about this pairing but hoped for the best.

Ann was exceptionally knowledgeable in the art of baking, and I like to think that I’m fairly good at it but honestly, she blew me away. She took control and was handling everything like a pro. In fact, I had trouble cutting the butter and she gently took over and helped me out (the butter was rock-solid, I SWEAR!). Essentially, everything was cordial and it was a really great time.

The issue of emotional changes hasn’t really been brought up in class, but rather the emotional impact of going through a TBI for both the victim and the family. However, I thought that permanent emotional changes is something equally as important.

Why was Ann so hostile towards other females? Was she always this aggressive? She definitely displayed a huge difference in appeal to males so what was triggering this aggression towards other females? Did her injury cause her to be this way? So many questions that I want answered but unfortunately, cannot be. Baguley et al.  performed a study on the commonality of aggression and found that it is surprisingly common! Roughly 25% of their participants were classified as aggressive. However, does Ann’s situation fall within this spectrum? Again, it is difficult to answer these questions so perhaps someday there will be more information on specific aggressive personality changes.

All in all, it was an entirely different experience, but one that opened my eyes nonetheless!

Mmm Banana Bread

*Changed name to protect privacy

In my second visit to Headway, it wasn’t as crowded as last time I had been there. I was greeted by a staff member I hadn’t met yet, and she commented on the fact that not many people had attended yoga class that morning (perhaps because of the sunny weather), but that they were expecting three people to show up for baking. As I waited for the time for us to start, I chatted with Mr. Z, who used to be an F1 aficionado and knew a lot about the sport. I was impressed by the amount of past facts about racing that he knew, and we talked quite a few about Ayrton Senna (who he was convinced was the best F1 racer there ever was). As two more community members and a classmate arrived, we rolled up our sleeves and prepared to bake some banana bread. We divided ourselves in groups that were responsible for each part of the recipe. Tasks were divided according to how each one could help. Ms. Y, who had difficulty moving, was in charge of mashing the bananas, while the rest of us prepared the dough, mixed the ingredients and managed the oven.

While we waited for the bread to bake in the oven, we all talked a little bit more. Mr. Z and Ms. Y started leafing through the newspapers on the table and would make funny or cheeky comments about the things they found interesting in the papers. Ms. Y was particularly insightful and was able to express her ideas and opinions. At one moment, one member of the staff pointed out Mr. Z hadn’t filled out an online satisfaction questionnaire about Headway, and asked if he could do so. They also asked if I could sit beside him, in case he needed assistance with the computer.

Whereas Mr. Z was articulated and able to express his opinions just a few minutes earlier, I realized he wasn’t being so successful collecting his thoughts in order to answer some short open-ended questions on the computer. As for the multiple choice questions, I had the impression that he answered them without much reflection. Not that he didn’t seem to care, but perhaps having to sustain attention for a somewhat long period of time and to think about his impressions about Headway might have been a little cognitively demanding. That is when I remembered Ms. Alison Mclean’s presentation a few weeks earlier. She spoke of the importance of checking if brain injury drop-in centres fulfill their role in positively affecting TBI survivors’ social outcomes (in this paper, she and her colleagues found support that in most cases they are). This means Headway’s initiative to have it’s own questionnaire is important, but I wonder what would be the best way to the obtain the opinions and reflections of the people who attend the centre.

My impressions are that some people need some support to be better able to reflect on the role of Headway in their lives and the reasons they keep coming back. While I was able to help Mr. Z in that opportunity, I can’t know if this is consistent for other members. I suspect having a brainstorm session with a few people who regularly attend Headway, with someone leading them to elaborate their thoughts would get some detailed and valuable insights on the function of that particular Headway centre and how it could improve.