Finding reliable information about COVID-19 & vaccines

Most of the information we get these days is from the Internet. While this makes information more accessible, it can also make it a lot harder to figure out what is true and what’s not. This is especially true in situations like COVID-19 and vaccinations.

You can use the following tips to figure out how to access reliable and safe information, and avoid spreading misinformation.

Look for citations & sources

Any article or post about COVID-19 and/or vaccinations should have sources for where they are getting their medical information. This way you can see where the information is coming from.

While sources and citations (notes explaining where information came from) are helpful, it’s also important to make sure those sources have a good reputation and are from a safe, factual source.

Check the URL

The URL is the same thing as a web address. For example, our URL/web address is braininjurycanada.ca. It also has a little lock next to it. This little lock means that it is safe and secure for you to visit the website.

Website addresses are normally the names of organizations, businesses, or publications, and have text in them that explain what you will find on the page. For example, braininjurycanada.ca/en/traumatic-brain-injury/ is a page on traumatic brain injury. We include citations telling you where our information is coming from and how you can see that information yourself.

When looking at websites for information, you can look at the web address to learn more about whether the source is a trust-worthy one. The way websites end can also tell you a lot about them [1]:

  • .ca is a Canadian website
  • .com is one of the most common endings for website addresses
  • .org is mostly used by non-profits
  • .edu is sometimes used by universities and colleges
  • .gov is sometimes used by governments

Have a couple sources bookmarked that you can always rely on

Websites like ours are meant to be a reliable source of information that people can come back to again and again to find information and to check their facts. While you may learn information from a wide variety of places, having a couple online sources that you have 100% confidence in makes it easier for you to check facts and to find information you can trust.

For COVID-19 and vaccine information, a few websites you can start with include:

You can also use your province/territory’s health authority website for the most up-to-date information.

Using braininjurycanada.ca as an example

You find our page about COVID-19 and COVID-19 vaccines when searching for information about vaccines.

Your first look at the URL: braininjurycanada.ca/en/covid-19/about/. The URL is clear and matches the information that is on the page – it’s about COVID-19 and the vaccine. The URL also has that little lock we mentioned earlier, meaning it’s safe for you to use this website.

On our website, we make it clear that we source our information. As you read the content, you also see that we use citations to mark a place where we are using a source. On our website, citations look like this: [1], [2], etc.

At the bottom of the page, there is a link that says ‘See Sources’. This means you can see every source we use. When you look at the sources for this page, they are from the Government of Canada and the Mayo Clinic, which is a non-profit medical group that is well-known for its reliable reputation.

Based on this information, you can be confident that this information is trustworthy.

If you find information on social media, double check it

A lot of us find our news and information on social media these days. This can include:

  • Facebook
  • Instagram
  • Twitter
  • Threads
  • LinkedIn
  • TikTok

These are just a few examples of social media platforms. You may see posts, pictures, or videos sharing information. But if you can’t figure out where the post or the information is coming from, that information may not be right (also called misinformation). And unfortunately, it’s easy for misinformation to spread on social media because it’s so easy to share it. This can be really dangerous, particularly when the information is related to health.

During the pandemic, 90% of Canadians used online sources for information about COVID-19 [2]. 96% of those Canadians suspected they were seeing misinformation (false, inaccurate, and/or misleading) [2]. Yet online 20% regularly checked their sources, and most people used or shared the information without knowing if it was right [2].

Social media can be helpful in finding information – but it’s important to use the steps above to make sure the information is reliable. You can also ask yourself the following questions when you see information on social media [3] [4]:

  • Where is this information coming from?
  • Is it trying to get me to click on a link?
  • Is it making statements or claims that seem too good to be true?
  • Can I find a reputable source that I trust that matches this information?
  • Have I read the whole article or post, or did I just read the title/picture?
  • Are there spelling errors in the information? This can mean the information is incorrect

Social media posts in particular can cause you to have a strong emotional response, which may make you more likely to trust the information. But it’s important to check that information, even if it looks right.

You can follow the profiles of organizations and/or sources you trust, which may make it easier for you to find reliable information on your social media.

How can I tell if health information is good or bad? – heretohelp BC has a lot of helpful information on ways to look at health information online

Resources


[1] Michigan State University, “Finding accurate information on the Internet“, 2013
[2] Statistics Canada, “Misinformation during the COVID-19 pandemic“, 2021
[3] Canadian Centre for Cyber Security, “How to identify misinformation, disinformation, and malinformation“, 2022
[4] Ottawa Public Health, “Scams and Misinformation“, 2023

What are the long-term impacts of COVID-19?

You may have seen or heard the term long COVID online or from others. Long COVID is the name given to a condition where people experience symptoms of COVID-19 or lasting effects weeks and months after their initial illness. The Government of Canada also calls this post COVID-19 condition [1]. People may be at risk of long COVID if they have had the COVID-19 virus.

The effects of long COVID

There are a lot of different symptoms for long COVID, but the most common ones include [1]:

  • Fatigue
  • Headaches
  • Abdominal pain
  • Sleep issues
  • Shortness of breath
  • Bodily pain in muscles and joints
  • Cognitive challenges like trouble concentrating or difficulty thinking/remembering
  • Mental health challenges such as anxiety and depression

As we mentioned, there have been lots of other symptoms noted, but this depends on each person.

What does this mean for me?

While there is no sure way to diagnose long COVID, if you are experiencing symptoms a long time after your initial illness, you should talk to your doctor.

Unfortunately, we don’t have any information that is specific to long COVID and existing brain injuries. Based on the symptoms listed above, long COVID may impact the effects of brain injury a person is experiencing – but we just don’t have that research yet. There are some research studies in progress related to long COVID and brain injury [2], but it will most likely be a few years before we have concrete study results.

As more information becomes available, we’ll make sure to share it.

Right now, you can learn more about long COVID from the Government of Canada’s info sheet.

The best way to prevent long COVID is to minimize your risk of contracting COVID-19

Anything you can do to help reduce your risk of getting COVID-19 will help reduce your risk of long COVID. This includes vaccination and keeping up to date with any recommended booster shots.


[1] The Government of Canada, “Post COVID-19 condition (long COVID)“, 2023

[2] Knoebel Institute fo Healthy Aging, “Linseman Laboratory“, 2023

Do I need a booster dose?

The World Health Organization has officially announced that the COVID-19 global emergency is over [1], but that the virus is still a global threat to health and safety. Not only are deaths and severe illness still being recorded, but there are a lot of people who are living with post-COVID-19 effects. It’s still incredibly important for people to take safety precautions. This includes vaccinations.

You’ve probably heard or read about COVID-19 vaccine boosters, but you may not be sure what it is or if it’s something you should get.

What is a booster dose?

A booster dose is a vaccination you receive after your first two shots (the primary series). Booster doses give you more protection against severe illness. As the name suggests, it gives your immune system and your primary vaccinations a boost.

Should I get a booster dose?

The Public Health Agency of Canada recommends that anyone 18 years and older should receive at least one booster dose after getting their primary series of vaccinations [2]. Adults 18+ with higher risks of severe illness from COVID-19, as well as people aged 65+, should be able to access a booster dose from the start of fall 2022.

As of spring 2023, the National Advisory Committee on Immunization (NACI) has recommended that the following groups be eligible for an additional booster dose [3]:

  • Adults 80 years and older
  • Adult residents of long-term care homes and other congregate living settings for seniors or those with complex medical care needs
  • Adults 18 years of age and older who are moderately to severely immunocompromised (due to an underlying condition or treatment)
  • Adults 65 to 79 years of age, particularly if they haven’t had the virus before

If you fall into one of those categories, you can talk to your doctor or look into your province/territory’s vaccination clinics.

More information on COVID-19 booster doses by province/territory

You can learn more about what vaccination doses you are eligible for from your province/territory.


[1] The World Health Organization, “WHO Director-General’s opening remarks at the media briefing – 5 May 2023”, 2023

[2] The Government of Canada, “COVID-19 vaccine: Canadian Immunization Guide“, 2023

[3] National Advisory Committee on Immunization (NACI), “Guidance on an additional COVID-19 booster dose in the spring of 2023 for individuals at high risk of severe illness due to COVID-19“, 2023

Music therapy

Music is processed in all parts of the brain (Sacks, 2007). For someone who has had a brain injury, music may be helpful in providing cognitive stimulation, motivation for movement, and emotional and/or spiritual support.

Remember: Brain injury is complex: every situation is different. This means that everyone will respond differently to music & music therapy. Please speak with your physician and the nearest music therapy association for information most relevant to you.

Neurologic music therapy (NMT)

In some cases, neurologic music therapy (NMT) may be helpful as a rehabilitation and recovery tool. Neurologic music therapy is a specific training focused on the use of music and musical elements to motivate and target change (neuroplasticity). It is often used in connection with specific goals that an individual, general practitioner, and/or multi-disciplinary team have identified. These goals could be related to physical movement, communication, cognition, or emotions.

Here are some examples of how neurologic music therapy can be used for different types of goals.

Music therapy & physical independence

If an individual wants to improve their uneven gait (how they walk), live music can be used to motivate them to take more coordinated/even steps. Rhythmic music and different chord progressions engage with the motor cortex of the brain (Alashram et al, 2019). It’s similar to people wanting to dance to certain beats and rhythms.

As an individual improves their gait pattern, the music is gradually taken away. Eventually the goal is for the person to be able to show improved gait without the music.

This same process is applied to most goals associated with activities of daily living (ADLs).

Music therapy & improving speech

Music can be used by individuals who want to improve their speech clarity, tone and/or volume. A neurologic music therapist will use techniques to encourage lip movement; improve soft palette sounds; strengthen diaphragmatic breathing; and improve pitch and volume control.

It’s not about getting the perfect note or singing voice; it’s about using music as an enjoyable and engaging medium to help with speech. The added benefit is that singing is fun and can help build a person’s confidence as they practice.

The music is then taken away with the goal of having the skills carry over in everyday communication.

Music therapy & cognition

For an individual who wants to improve their visual neglect and/or attention span, a neurologic music therapist may apply techniques to target change for these specific goals.

For example, if someone wants to improve their visual neglect, the use of music scales and chord sequences may be used as an auditory prompt to remind someone to look towards their neglected side. If someone wants to improve their attention, a certified music therapist may use different music therapy interventions to prolong attention or practice divided attention.

Music for mental health & well-being

Music is a part of the human experience that tracks back to prehistoric times. Music forms part of an individual’s identity. People listen to music to relax, to exercise, to process emotion, and to spiritually connect. Music can also be associated with powerful memories.

When choosing music, it’s important to ask the following questions:

  • What kind of music do you prefer?
  • What music is familiar?
  • What did you listen to growing up?
  • What music connects to which emotions?
  • What music reminds you of specific memories?

When chosen thoughtfully, music can improve mood and support mental health and well-being.

Accessing music

There are many ways to access music. Many people have existing music collections – this can include records, CDs, or digital downloads.

Some additional examples of accessible music resources include:

  • CDs at the library
  • Spotify/Apple music playlists (precomposed or customized). Please note these are paid platforms
  • YouTube playlists (precomposed or customized)
  • Local performances within your community

More information about music therapy

References

Alashram, A.R., Annino, G., & Mercuri, N. B. (2019). Rhythmic auditory stimulation in gait rehabili-tation for traumatic brain and spinal cord injury. Journal of Clinical Neuroscience, 69, 287-288. doi: 10.1016/j.jocn.2019.08.080

Sacks, O. (2007). Musicophilia: Tales of music and the brain. New York: Alfred A. Knopf.

Content for this page provided in part by Bernice Chu, MA, NMT-F, MTA. Bernice is a certified music therapist currently working with adults who have experienced brain injuries, burns, trauma and long-standing mental health needs. She is the secretary for the Music Therapy Association for British Columbia. 

Statistics

The source for each statistic (or statistical statement) can be found on the source page at this link. Each number next to a statistic below correlates to the appropriate source.


Despite the prevalence of brain injury in Canada, it is difficult to gather accurate statistics on a regular basis because we rely on hospital and doctor reporting. Many brain injuries are not actually reported at the time of injury (or at all), which impacts the statistics.

A key part of Brain Injury Canada’s advocacy plans is to bring more attention to brain injury, its impact, and the need for more up to date information. We have compiled currently available statistics related to brain injury on this page to help those researching or reporting on brain injury in Canada. If you will be quoting any of these statistics, please include proper sourcing back to this page and Brain Injury Canada.

Topics for statistics on this page include:


Traumatic brain injury

Traumatic brain injury (TBI) general statistics
By 2031, traumatic brain injury (TBI) is expected to be among the most common neurological conditions affecting Canadians, along with Alzheimer’s disease and other dementias, and epilepsy [1].

Traumatic brain injury (TBI) is a leading cause of disability globally. In Canada, 2% of the population lives with a TBI, and there are 18,000 hospitalizations for TBI each year. One-third of individuals with a TBI are women, and TBI is particularly common early in the reproductive years (15-24 years), with intimate partner violence and accidents being major causes. Women with TBI are more likely than men to experience mental health problems post-injury [2].

Please note: The following series of stats has been extrapolated from United States data to the population of Canada.

TBI occurs at an annual rate of 500 out of 100,000 individuals.  That is approximately 165,000 in Canada. This equals 456 people every day, or one person injured every 3 minutes in Canada [3].

TBI occurs at a rate of 100 times that of spinal cord injury [4].

When injury due to stroke or other non-traumatic causes is included, close to 4% of the population lives with brain injury. That equates to over 1.5 million Canadians living with acquired brain injury [5].

A comparison of TBI and other prevalent disease, illness or injury
26,900 Canadian women will be diagnosed with breast cancer [6].

An estimated 4,300 new cases of Spinal Cord Injury occur each year in Canada [7].

4015 Canadian will be diagnosed with Multiple Sclerosis in the next year [8].

165,000 Canadians will have a traumatic brain injury this year [9].

Indirect economic costs due to working-age disability will increase and will be greatest for hospitalized traumatic brain injury (rising from $7.3 billion in 2011 to $8.2 billion in 2031) [10].

Falls are the leading cause of traumatic brain injury (TBI) among seniors [11].

Teens, young adults and seniors are at higher risk of TBI as a pedestrian. Across the life course, the data provided evidence of increased TBI risk among pedestrians leading up to and during the teenage years; risk declined during early adulthood before increasing in middle-age and climbing to high levels among seniors [12].

Female pedestrians have a higher frequency of TBI than males, although the highest risk group is males aged 65 years or older [13].

Brain injury is also identified as a risk factor for Alzheimer’s disease and other dementias in men, and for epilepsy in both sexes [14].

  • Falls are the most frequent reason for TBI hospitalizations and emergency department (ED) visits among children under 5 years of age.
  • Among children and youth aged 5 to 19, sports and recreational activities emerge as a leading cause of TBI-related hospitalizations and ED visits.
  • Assaults are a leading cause of TBI hospitalizations and ED visits among males 20 to 39 years of age.
  • From age 40 years and onward, falls not related to sports and recreation take over as the predominant mechanism of TBI-related deaths, hospitalizations and ED visits, with especially high rates among those 85 years and older [15].

Concussion

Current statistics on concussion are most likely an underestimate of the true burden of concussion. This “invisible injury” is under-reported due to a lack of public education and awareness. Many concussions are seen in doctors’ offices and walk-in clinics, placing them outside of the standard hospital reporting data collection surveillance process; some are ignored and are not reported at all.

Please note: many of these statistics are related to sports

Children & youth
Ice hockey was the most common sports and recreation-related activity with reported concussions or other TBIs among males aged 5 to 14 years. Rugby was the most common for the older males.

Ringette was the most common sports and recreation-related activity with reported concussions or other TBIs among females aged 10 to 19. It is also worth noting that among females in all age groups shown, equestrian sport/horseback riding was also among the most common non-contact sport with reported concussions or other TBIs.

Sledding/tobogganing was among the most common sports and recreation-related activities with reported concussions or other TBIs for children aged 5 to 9 years (3rd most common after ice hockey and physical education class among boys, and 2nd after ice hockey among girls).

All-terrain vehicle (ATV) use was the leading cause of moderate to more severe TBIs (i.e., showed the lowest percentage of concussions among all TBIs) among almost all children and youth, with the exception of females aged 5 to 9 (for whom it was equestrian sport/horseback riding) and males ages 10 to 14 (for whom it was baseball) [16].

In 2013, Hockey Canada implemented a new rule to prohibit body checking in the peewee age group (11 and 12-year-olds) and younger. This change has resulted in a 70% reduction in the risk of concussion, or about 4,800 fewer concussions across Canada [17].

Children under five were the most likely demographic to experience a concussion, followed by women over the age of 65 [18].

The number of physician office or emergency room pediatric visits for concussion-related complaints has quadrupled in Ontario since 2010 [19].

General concussion statistics
There are 200,000 concussions annually in Canada [20].

Sports-related concussion is “among the most complex injuries in sports medicine to diagnose, assess and manage [21].”

There is no single test that can definitively provide a diagnosis of concussion. There is no blood test, no saliva test, no picture test or even no eye-tracking, pupil size or balance test. None exists yet that on its own can objectively diagnose concussion [22].

People living in more remote communities were significantly more likely to experience a concussion than those based in cities, noting rural rates could be as high as 1,400 per 100,000 people [23].


Stroke

General stroke statistics
Stroke is the third leading cause of death in Canada [24].

Stroke is the tenth largest contributor to disability-adjusted life years (the number of years lost due to ill-health, disability or early death) [25].

Stroke predominantly affects older people with about 10% of adults aged 65 years and older having experienced a stroke [26].

The absolute number of people having survived a stroke continues to increase mainly due to population growth and aging [27].

First stroke and all-cause mortality rates have shown a steady decline in recent years. Raised awareness, better stroke care and improvements in the management of risk factors have likely contributed to this decline over several decades [28].

Stroke in women vs. men
The occurrence and rate of first stroke are consistently higher among men than women over time. However, more women than men have a stroke each year, in part because women have a longer life expectancy [29].

The following group of statistics is from the report “Lives disrupted: The impact of stroke on women.”

  • More than 62,000 strokes occur in Canada each year; over 30,200 of these happen to women.
  • One-third more women die of stroke than men in Canada; of all deaths from stroke, 59% are women, 41% are men.
  • Women who have had a stroke have worse outcomes than men; there are more activity limitations and lower overall levels of mental and physical well-being.
  • Women are less likely to go home after stroke; almost twice as many women as men go to long- term care instead.
  • Approximately 405,000 people in Canada are living with the effects of stroke of which 214,000 are women and 191,000 are men.
  • Less than half of stroke survivors who participate in rehabilitation are women (46%), putting them at a disadvantage for making the best recovery possible.
  • Elderly women are particularly over-burdened by stroke and are missing out on access to treatment, care and rehabilitation [30].

Brain tumour & cancer

Tumour statistics
It is estimated that 55,000 Canadians are surviving with a brain tumour.

There are over 120 different types of brain tumours, making effective treatment very complicated.

In the first year after diagnosis, it is estimated the average patient will make 52 visits to their health care team (could include surgery, radiation, chemotherapy, blood work etc.).

Non-malignant tumours account for almost two thirds of all primary brain tumours.

The most common type of primary malignant brain tumour is glioblastoma. Average survival, even with aggressive treatment, is less than one year.

Metastatic brain tumours occur at some point in 20-40% of people with cancer. The incidence of metastatic brain tumours is increasing as cancer patients live longer.

Brain tumours are the leading cause of solid cancer death in children under the age of 20, now surpassing acute lymphoblastic leukemia. They are the third leading cause of solid cancer death in young adults ages 20-39.

Because brain tumours are located at the control centre for thought, emotion, and movement, they can dramatically affect an individual’s physical and cognitive abilities and quality of life [31].

Brain cancer statistics
In 2020, an estimated:

  • 3,000 Canadians will be diagnosed with brain and spinal cord cancer.
  • 2,500 Canadians will die from brain and spinal cord cancer.
  • 1,700 men will be diagnosed with brain and spinal cord cancer and 1,400 will die from it.
  • 1,350 women will be diagnosed with brain and spinal cord cancer and 1,050 will die from it [32].

Hydrocephalus

It is estimated that 120,000 Canadians are living with hydrocephalus. 90% of people with spina bifida, also have hydrocephalus [33].


Caregivers

According to a 2019 study published by the Ontario Caregiver Organization (OCO) and health policy think-tank The Change Foundation, more than half of caregivers admit feeling overwhelmed by their responsibilities. Slightly more than half of the 800-plus caregivers who took part in the study also said they felt anxious or worried, while more than 40% struggled with feelings of frustration [34].

An estimated 8.1 million Canadians aged 15 years and older provided care to a chronically ill, disabled, or aging family member or friend [35].

The following statistics are form the Workplace Mental Health issue brief

•    Over 40% of Canadian physicians report that they are in the advanced stages of burnout.
•    An equal percentage of Canadian nurses reported burnout.
•    14 percent of general nurses have tested positive for symptoms of post-traumatic stress disorder.
•    Healthcare workers are 1.5 times more likely to be off work due to illness or disability than people in all other sectors [36].


Brain injury in the Indigenous community

Indigenous populations are disproportionately affected by traumatic brain injury [37].

Injuries are the leading cause of potential years of life lost in indigenous population, with rates 4 times higher than in the rest of Canada [38].

Aboriginal status appears to be negatively correlated to recovery, with poorer outcomes for Aboriginal people possibly attributable to fewer formal and informal supports, such as professional translators or the loss of social support when a patient relocates away from their home community [39].

The risk of poor outcomes after injury increases, due to factors such as geographical isolation, socioeconomic status, and psychosocial factors, which all already affect the health needs of Aboriginal peoples [40].

A survey of health care practitioners exploring rehabilitation challenges for Aboriginal clients recovering from acquired brain injury (ABI), identified the following areas of interest and concerns that surround Aboriginal communities:

  1. Practitioners’ experience with brain injury;
  2. Practitioners’ experience with Aboriginal clients;
  3. Specialized needs of Aboriginal clients recovering from brain injury;
  4. Culturally sensitive care; and
  5. Traditional healing methods as part of recovery [41].

A key challenge experienced by Aboriginal peoples recovering from ABI was that protocols for rehabilitation and discharge planning are often lacking for clients living on reserves or in remote communities. Other challenges included lack of social support; difficulty of travel and socio-cultural factors associated with post-acute care; and concurrent disorders [42].

The following group of statistics is from the report “Lives disrupted: The impact of stroke on women.”

  • Although the rate of stroke and heart disease has been declining in Canada among most age groups, the opposite is happening in Indigenous populations where prevalence and mortality are increasing. Rates of cardiovascular disease among Indigenous women in Canada are rising and are nearing or surpassing those of non-Indigenous women.
  • First Nations, Métis and Inuit peoples are more likely to have high blood pressure and diabetes – both risk factors for stroke – and are at greater risk of stroke than the general population, and twice as likely to die from it[43]

Incarceration statistics

The incidence of incarceration was higher among study participants with prior traumatic brain injury (TBI) compared with those without a prior TBI. Men and women who had sustained a TBI were about 2.5 times more likely to be incarcerated than men and women who had not sustained a TBI [44].

TBI is more prevalent among males than females in incarcerated populations [45,46] .

Majority of the incarcerated study sample reported having a TBI prior to their first criminal offence  [47,48].

The average age of first TBI was 19.6 years for men and 21.9 for women inmates. 55% of women reported TBI prior to first crime. 41% of men reported TBI prior to first crime [49].


Mental health statistics

In a national population health study of neurological disorders, illness and injury, the highest prevalence of self-reported diagnosed mood disorders was seen in those with a traumatic brain injury (38.3%) or brain tumour (35.5%) [50].

An individual has a significantly greater chance of developing a diagnosable mental illness after sustaining an acquired brain injury (ABI)  [51, 52].

About half of all people with TBI are affected by depression within the first year after injury. Even more (nearly two-thirds) are affected within seven years after injury [53].

Traumatic brain injury is reported to increase the risk of post-traumatic stress symptoms [54].

A Canadian longitudinal cohort study found adults with concussion committed suicide at three times the population norm [55].

50% of patients experience personality change, irritability, anxiety, and depression after concussion. These neuropsychiatric symptoms are not unique, but part of the natural course following concussion [56].


Employment statistics

Indirect economic costs due to working-age disability will increase, however. These costs will be greatest for hospitalized traumatic brain injury (rising from $7.3 billion in 2011 to $8.2 billion in 2031) [57].

The majority of individuals (estimates range from 73-88%) who experience mTBI are able to return to their principal occupation within a year of the injury [58].

TBI’s that occur in the workplace are highly gendered. Serious and fatal injuries occur predominantly among males, however, when all levels of severity are included, women make up more than 40% of injuries [59].

The Ontario Workplace Safety and Insurance Board’s (2016) Statistical Report showed that injuries coded as ‘concussions’ have increased from 0.6% in 2002 to 5% in 2015, indicating an 800% increase [60].

Male workers – especially those in the youngest and oldest age groups – working in the primary (e.g., agriculture, forestry, mining) or construction industries were more likely to sustain a work-related TBI, with falls being the most common mechanism of injury regardless of injury severity [61].


Homelessness and traumatic brain injury statistics

Research shows that over 235,000 people experience homelessness across Canada each year [62].

Approximately 50% of people experiencing homelessness have a brain injury [63].

A recent meta-analysis – which looked at 38 studies published between 1995 and 2018 — is the first to look at the prevalence of TBI in people who are homeless or in unstable housing situations. The results suggest that one in two (53% of) homeless people experience a TBI, and one in four (25%) experience a TBI that is moderate or severe [64].

53% of homeless adults with a history of mental illness have a reported history of brain injury. This population is more likely to:

  • Report unmet health care needs
  • Have contact with the criminal justice system
  • Be suicidal or have previously attempted suicide
  • Use emergency departments
  • Finding housing for people with mental illness and head injuries is essential to helping these people more forward with their recovery [65].

The lifetime prevalence of TBI is high among homeless and marginally housed individuals, and a history of TBI is associated with poorer health and general functioning [66].


Intimate partner violence (IPV) statistics

TBI is common amongst women survivors of intimate partner violence (IPV) [67].

35-80% of women affected by IPV experience symptoms of traumatic brain injury [68].

Up to 92% of IPV incidents involving hits to the head and face, and strangulation [69].

It is reported that up to 75% of women do not seek medical care for suspected brain injury [70].

Survivors and care providers can also mistake brain injury symptoms for the emotional distress brought about by the abuse itself [71].

Strangulation is one of the most dangerous forms of IPV, increasing the risk of death in following assaults. These results show non-fatal strangulation as a risk factor in homicide for women, underscoring the need to screen for non-fatal strangulation when assessing abused women in emergency department settings [72].

Strangulation can also cause brain injury, due to the brain being deprived of oxygen. Some victims can die weeks after being strangled because of the underlying brain damage, even if there is no visible injury [73].

Aboriginal women are 3.5 times more likely to experience violence than other Canadian women [74].


See sources

Journaling Workbook

Journaling is a beneficial tool for supporting an individual’s mental health. It encourages self-reflection and connection. This is especially important for people who have experienced significant changes in their lives, and may want to use tools to cope with those changes. This includes brain injury.

We have created journaling workbooks designed specifically for the brain injury community that can be viewed, downloaded, and used at your pace.

Journaling Introduction

This PDF guidebook explains the benefits of journaling; how to journal; and what you may expect from the journaling process.

Watch this video from a journaling expert on the start of the journaling process

Acquired Brain Injury Journaling Workbook

Now that you have read the introduction, you are ready to begin. This workbook includes recommendations for journaling; guided prompts; and more journaling activities you can use after you have completed this book.

Watch this video from a journaling expert upon the completion of your workbook

Balance

Balance is the ability to keep yourself centered as you walk, sit, and engage in other movements. It allows you to control and adjust your body before, during and after movement to keep from falling.

Balance requires functional muscle strength, vision, vestibular function (inner ear), sensation in the skin, muscles, tendons, and joints (known as proprioception). It also requires cognitive function and movement planning. When you are keeping your balance, your brain is continually processing inputs and information from multiple senses and body parts. The brain then sends directions out to the body’s motor and sensory system (muscles in the arms, legs, core, and eyes) to keep you centered.

  • Common causes of balance problems after a concussion include:
  • Changes in blood pressure
  • The actual injury to the brain
  • Medications
  • Mental health issues like depression, anxiety, fear of falling, or fear of moving
  • Sensory impairments, such as blurry vision
  • Impairments in motor control
  • Dizziness, which is a sensation of light-headedness, spinning, or nausea.

Balance is important not only for walking but for doing all daily activities. Poor balance can keep you from taking part in activities such as sports, driving, and work. Issues with balance and dizziness can increase the risk of falls and injuries, including another head injury. It can have an impact on your abilities and your mental health and well-being.

How can I improve my balance?

Balance problems will usually improve over time with activity and exercises. The more you move, the more you improve. You may be referred to a physiotherapist or other specialist who can help you with your balance. Many people with a concussion will have problems with quick movements, running, sports, and high-level balance activities. Some people will recover completely, while others may have lasting deficits that change their daily lives.

If one or more of your balance systems are not working well, you can try to improve your balance by focusing on areas that are working. For example, if you have poor vision, make sure you have good shoes, optimal lighting, and vision aids

Other ways to cope with balance problems include:

  • Avoid alcohol or other substances that can impair your sense of balance
  • Clear high-traffic areas in your home
  • Hold onto a family member or caregiver’s arm if you feel unsteady
  • Use adequate lighting and nightlights (for example, smart lights that can be controlled by voice or by phone).
  • Use mobility aids such as canes and walkers, if recommended by a healthcare professional
  • Wear proper footwear (closed toe and heel, well fitting, flat-heeled)
  • Work with an occupational therapist to make changes to your home environment such as railings on stairs, installing railings and safety chairs in the bathroom, and removing rugs or other tripping hazards

If this is happening to you, start tracking when you get dizzy or lose your balance. Write down what you were doing and how you were feeling before the episode and share these notes with your doctor. They may want to complete tests to check your balance, coordination, vision, and hearing. Depending on your doctor’s findings, they may recommend some types of therapy or specific exercises

Circle of support

People living with brain injury often feel isolated and alone. This may not be the case immediately after acquiring a brain injury: people drop by to visit or deliver food, there are lots of appointments to go to, and many call and texts asking for updates. You may find that you’re getting a lot of attention.

As time goes by, you may realize your social circle has decreased significantly from what it was before your injury. Offers of help may have dwindled, and you may be spending a lot of time by yourself. This may lead to feelings of loneliness.

People who are in recovery and living with a brain injury most often need the support of others – but it’s easy to think you are alone when you can’t picture your support network. However, it’s likely you have a whole group of people who can all play a part in building what we call your ‘circle of support’.

An easy way to think of your circle of support is to draw a circle you at the centre. Depending on your relationships, your circle of support will have several different levels, like the diagram below.

Circle of support diagram. A heart at the centre with 3 rings around with icons of people

Inner circle

Your inner circle is usually those closest to you. This can include a spouse; a caregiver; children; parents; siblings; or close friends. These are the people you rely on the most and are more intimately involved in your recovery and care.

Middle circle

The next layer in your circle of care is the middle circle. These people are involved in your life, but perhaps not on a day-to-day basis. There may be a broad range of people here depending on your situation. Examples include:

  • Aunts and uncles
  • Grandparents
  • Friends and their spouses or partners
  • Neighbours
  • Family friends
  • Spiritual/faith-based supports
  • Peers or classmates and their families
  • Colleagues
  • Part-time caregivers
  • Rehabilitation therapists

Outer circle

The outer circle is made up of supports that may not be specific to you or used daily, but can still be relied on. These can include:

Additional circle of support members

Your circle of support can also include more formal supports such as paid caregivers.  Depending on where you are in your recovery, they may be in your middle circle (such as a case manager or personal support worker), or your outer circle (like a psychologist or your family doctor).

The following people could be considered formal supports:

  • Doctor
  • Nurse
  • Physiotherapist
  • Occupational therapist
  • Social Worker
  • Case Manager
  • Speech-Language Pathologist
  • Psychologist
  • Chiropractor
  • Community pharmacist
  • Lawyer

Identify your circle of support

To help identify your support team, list all the people who have been in your life and have shown an interest in maintaining a relationship. Ask for help from the people who are close to you.

Identify areas where you need help

Having a list of the tasks or activities where you may need support is helpful to have on hand. Break the list up into different categories such as daily tasks, weekly tasks, or occasional tasks. For example:

  • Help with getting to appointments
  • A one-to-one visit over coffee
  • Going outside for a walk
  • Help with caring for a pet

You may often hear people say, “let me know if there is any way I can help,” and not take them up on the offer. You may find that people DO want to help; they just don’t know what you need. Do not be afraid to let them know how they can best help you.

The individual person and your relationship with them will determine where they fit in your circle of support. If they can help with smaller occasional things such as picking up your mail; dropping off a meal; driving you to appointments; or fixing a broken item in your home, they may belong in your outer circle. If the person can help with things that happen more often such as activities of daily living (ADLs), such as meal prep, cleaning, and personal care, they may belong in your inner circle.

Fostering your circle

It’s important for your circle to come together and understand how important they are to you. If you choose, you could introduce members of your circle to each other. By doing this, you are turning your circle of support into a true community.

You can also foster your circle by helping people understand what you need. Friends, family members, and caregivers may not realize it can be more difficult for you to communicate in noisy and busy environments of that you get tired/fatigued more easily.

There are a number of resources that may be helpful for those in your inner circle:

We all need people who can support us and building a circle of care is one of the best ways to ensure that you get the support and compassion you need.

Journaling prompts for brain injury

Telling your story

You are the author of your life story. By understanding the power of story, you can change the way you carry your life circumstances, no matter what has happened to you… You have the power to shift your perspective from victim to victor, from survivor to thriver, from loser to winner.

— Sandra Marinella, MA, Med, The Story You Need to Tell

Journaling our stories is writing or recording thoughts, feelings, and experiences. Doing this can show us how we perceive and interpret what we have experienced. It can also help us shift our perspective on events to move forward more positively.

In their journaling workbook, After Brain Injury: Telling Your Story, Barbara Strahura and Susan B. Schuster write,

Telling your story helps you to cope with new situations and make decisions. It is also vital. You need to be able to express yourself in open and honest ways for your mental, emotional, spiritual, and even physical health.

They go on to write,

A brain injury can turn a life upside down. Before it, you had a story of your life. After it, you began a new and unfamiliar one. How do you learn to live within this new reality? If you can’t go back to the way you were, how do you figure out who you can be now? The answer: you tell your story, and it will show you how.

For many people who live with brain injury, journaling their story has provided the opportunity to build upon the strengths they have and helped them work towards goals.

Before you begin

Journaling is not just expressing the sad or traumatic events of your story. It’s important to write about that, but it may make you feel worse instead of better if that is all you include.

Make sure to include happy events and moments that took place. Including what you’re grateful for is an excellent practice, too.

By including all aspects of your story, journaling can help you begin to move through, forward, and further away from trauma, negativity, and sadness and towards a more optimistic, positive, and centred place.

Relaxation techniques

“…writing can make pain tolerable, confusion clearer, and self stronger.”  — Anna Quindlen, Newsweek, Jan. 22, 2007

There are a few things you should do before you begin journaling:

  • Before you begin, gather your journaling tools (journal or paper, pen or pencil, tape-recorder, or sit in front of your computer etc.)
  • Put on music, that you find soothing. If this is distracting for you, you can also focus on creating a silent atmosphere
  • Sit comfortably with both feet on the floor if possible and your hands in your lap
  • Close your eyes, and take a deep breath through your nose. Hold the breath for as long as it’s comfortable. Exhale through your mouth. Repeat this a few times
  • With your eyes still closed, let your breath return to your normal rhythm. Slowly begin to notice your body starting at the top of your head and travel down slowly to your toes. Relax any places that feel tense
  • Now, imagine the tensions, concerns, and anxieties of your day exiting from the top of your head and entering a balloon. When you’ve filled the balloon and your feeling calmer, seal the balloon and watch it float away
  • Know that you are safe, and that your journal is private and just for you if that is your choice. Take your time and begin when ready

Prompts for journaling

These journaling prompts will guide you in writing your story, exploring yourself, and your life to gain insights. They will help you to learn more about yourself each time you journal.

Remember to date each entry and revisit the relaxation techniques before you begin.

1. This is what it feels like to be me today…
Reminder: Begin with the relaxation technique and date your entry.

Try to use as much detail as you can. Write about what’s on your mind, what emotions you are feeling, how you feel physically, etc.

Examples:

What it feels like to be me today is, frustrated. I’d feel fine if people would just stop telling me I’ve changed. I’m just me. Most of the time, I don’t know what they’re talking about. Why can’t they realize that I can’t be anyone else? It’s frustrating, and it makes me really angry. Get over it, man. – Jerome
What it feels like to be me today is hopeful. Everything lately has felt really hard, but today I went for a 10 minute walk and I didn’t get tired. That made me feel happy– Anne

2. I wish I could feel this way today instead…
Reminder: Begin with the relaxation technique and date your entry.

It’s sometimes possible to improve your mood and outlook when you write about how you would like to feel. Also, it sometimes helps provide you with a roadmap to get there. Try to include something you’re grateful for.

Examples:

I want to feel like everyone has accepted the new normal. I guess it just takes time. I’m grateful things aren’t worse. – Jerome

I want to feel like there’s been more progress. There has been. It’s small, but it’s there, and I’m grateful for at least that. – Anne

3. Here’s how my brain injury happened
Reminder: Begin with the relaxation technique and date your entry.

Your brain injury happened as a result of an event. Record as much as you can, in as much detail as you can, about the event as you remember it happening. Begin just before the event took place. Stick to facts; feelings will be covered in the next prompt.

Examples:

I remember standing at the top of the mountain. It was a beautiful day, and I was excited to ski with my daughters. The next thing I knew, I was laying in a hospital bed. I was told a few weeks had passed since I was at the top of the mountain. I’d had a bad ski accident. I had a long cut on my face that had mostly healed. My chest was sore – they said I’d fractured my sternum. My face looked different in the mirror. They said I’d fractured my occipital bone, so one eye was a little lower than the other. Plus, they told me I’d had two brain hemorrhages in the front of my brain. I felt fine. Maybe I had a little left-side weakness, but that didn’t last long. One day I found my way to the rehabilitation floor on my own. That shocked them. I could cook my own breakfast, too. I was told I’d been in the hospital for more than a month. My brother had been there for two weeks. I don’t remember any of that. Next, I was sent to a rehabilitation centre. I didn’t think that I needed it. I wanted to go home to be with my family.. — Brian

I was reading at home one night and started feeling pain behind my eyes. I thought maybe the lighting was too dim & it hurt my eyes. I got up to turn on lights. I remember thinking that the ache had been there for a couple of weeks, now it felt stabbing. It was weird, but I kept reading. About 15 minutes later, I had to run to the toilet. I vomited. My head was spinning, and I started seeing double. Thank goodness for my husband. He insisted we call the ambulance. The siren was so loud on the way. I kept holding on to my head so it wouldn’t explode. Charles kept his hand over my eyes. It was so warm. The air conditioning when we got in the hospital felt like such a relief. I remember feeling like I could breathe better. Turned out I had a brain aneurysm with a subarachnoid hemorrhage. I was rushed into surgery that saved my life. I got some neurological problems now, but I’m alive.
—Dorothy

4. List what you recall feeling during and/or after the event that resulted in your brain injury
Reminder: Begin with the relaxation technique and date your entry.

List what you recall feeling during and/or after the event that resulted in your brain injury. Use the following categories if they apply:

  • Emotional
  • Mental
  • Physical

Physical feelings can be easy to identify and name. Emotions and mental states can be more complicated to identify and name. Here are a few examples of each:

Emotional:     Mad, sad, scared, afraid, peaceful, joyful, happy, overwhelmed, anxious, nervous, cheerful, hopeful, content, proud, optimistic, frustrated, calm, relaxed, curious.

Mental:      Foggy, confused, clear-headed, bewildered, disoriented, fuzzy, dizzy, coherent, alert, lucid, rational, levelheaded, well-oriented, balanced, clear-headed, numb.

Physical:    Tender, sensitive, bruised, achy, sore, tense, tight, nauseous, tingly, burning, prickly, twitchy, shivery, quesy, itchy, shaky, knotted, sweaty, cold, hot, numb.

An important step in telling your story is working to name what you felt and feel. This may come easily to you but if not, be patient with yourself. Give it time, and don’t linger if you find yourself getting distressed or frustrated: you may want to come back to this prompt later and add more.

Examples:

I can’t remember anything during the accident yet. The nurses say some of it might come back to me eventually.
Right now:

  • Physical: Itchy (leg in a cast), sore (laying in bed). Lower back killing me.
  • Mentally: Lost (can’t remember words a lot, sometimes I can’t sort out what day it is),
  • Emotional: Frustrated and mad for not being more careful. Scared about getting better in my head.

— Andy

How I felt during the accident:

Physical: I totally tensed up and froze when the headlights were coming at me. Then I felt something burning but couldn’t identify what. I felt myself kinda floating. I think that was me passing out.

Emotional: It happened too fast, I think, to be emotional. I was just stunned.

Mentally: Brain-freeze.

Afterward (in the hospital):

Physical:    Dry-mouth, but I was on too many painkillers at first to feel anything.

Emotional:    Kind of a weird peacefulness. A limbo.

Mentally:    Dazed, semi-conscious most of the time.
— Mandy

5. List anything good or positive recall feeling during and/or after the event that resulted in your brain injury
Reminder: Begin with the relaxation technique and date your entry.

List anything good or positive in these categories that you recall feeling during and/or after the event that resulted in your brain injury.

Emotional:

Mentally :

Physical

EXAMPLE:
I was and am grateful just to still be alive. Isn’t that the best thing?  – Mandy

My friends have been here for me. – Andy

6. Lost and Found
Reminder: Begin with the relaxation technique and date your entry.

Consider what you’ve lost because of your brain injury and make a list. Write numbers 1-10 and fill in as many as you can.

  1. My car
  2. Bunch of words
  3. My old personality
  4. Memories
  5. Balance (sometimes)
  6. Independence (for now, I hope)

Now consider what you’ve gained or learned because of your brain injury and make a list. Write numbers 1-10 and fill in as many as you can.

  1. The brains complicated
  2. How much my wife loves me
  3. What friends can handle this
  4. Got humble
  5. Better appreciation for my home
7. Dialogue: Have a conversation with your brain about what caused your injury
Reminder: Begin with the relaxation technique and date your entry.

Dialogue is a journaling technique that has been utilized by journaling experts such as Ira Progroff and Kathleen Adams. The technique is having a (written) dialogue with an issue, subject, emotion, or person, and you ‘play’ both parts.

The technique can feel awkward at first, like talking to yourself. But trust the process: use your imagination, and stick with it. It will become more comfortable as you practice.

Begin writing by asking a question. Use the word “what” rather than “why.” This way, you’re prompting yourself to provide an answer and thus begins the two-way written dialogue.  Keep the conversation going as long as you can.

EXAMPLE:

ME:  I’ve made that move a million times in my (hockey) career. What the hell happened?

CRASH: The circumstances were just right for your helmet to fly off and you to hit the boards in that way.

ME:  Could I have avoided it? Was it my fault?

CRASH:  No. It didn’t just involve you. Other players were part of the circumstance.

— Stan

8. Who are you now?
Reminder: Begin with the relaxation technique and date your entry.

Write out what you know for sure about yourself at that given moment. Are you tall or short? A parent or a sibling? Employed? In therapy? These are details that can help ground you in your journaling and your day.

EXAMPLE:

I’m still a woman, Mom, single, daughter. Hard to be a good friend right now. I’m a patient in rehab. I’m not sure of much more than that, but I’m working on it. Guess that means I’m determined.
— Beth

9. Who do you want to become?
Reminder: Begin with the relaxation technique and date your entry.

EXAMPLE:
I’m thinking this means goals, maybe. So, independent – employable – nice. That’s good for now.
—   Jamie

More suggested journaling prompts
  • I will…
  • I feel…
  • I believe…
  • I won’t…
  • I can’t…
  • I can…
  • Yesterday was…
  • I’m most worried about……
  • My goal is…
  • I always feel sad when…
  • I always feel happy when…
  • I have recovered from…
  • I am getting better at…
  • I can’t help thinking about…..
  • It’s okay to keep thinking about…
  • My family is driving me crazy because…
  • My family takes good care of me by…
  • I have recovered from…
  • I believe in miracles because…
  • I am grateful for…
  • I am losing my temper because…
  • I am tired of…
  • I will be more positive because…
  • When things don’t go my way, I will…
  • A dream I had last night was…
  • I wish I could explain…
  • I understand that…
  • In the future, I will…

“In my journal, I don’t just express myself more openly than I could to any person; I create myself.”
—    Susan Sontag

NOTE: Examples are based on some facts but are primarily fictional to protect people’s privacy. The names are fictional as well [1].


See sources 
 

 

Mindfulness and mental health

Sometimes life does not turn out as we expected. Coping with all the changes that accompany living with the effects of brain injury can be overwhelming. If you find yourself, or someone you love, dealing with depression or anxiety, you are not alone. Nearly half of all people with brain injuries experience depression and anxiety at some point in their recovery journey [1].

Studies have shown that mindfulness meditation can help decrease depression symptoms and improve anxiety among people with brain injuries [2, 3].

When we are in pain – whether it is physical or emotional – our instinct might be to avoid or deny it’s happening. This is often done out of fear.  “The root of all fear is the fear of our strong emotions,” says Kaira Jewel Lingo, a long-time student of Thich Nhat Hahn, the Buddhist monk who initially brought mindfulness to the West. “If we lose the fear of any emotion, then we lose the added layers of suffering. All emotions are workable.” [4]

One way of working with emotions is through mindfulness practices. Informal mindfulness involves paying attention to the activity you’re doing and engaging all your senses to fully observe your experience in each moment.
For example: slowly eating a meal, paying full attention to each bite. This includes looking, smelling, tasting, even hearing the crunch of food – with no distractions like television or a smartphone.

Often the experience is more enjoyable because you can really take in the small moments that are often missed. Another example is eating a meal without talking. With less stimuli and when your attention is not being divided, the experience is more restful.

How does mindfulness meditation work?

Mindfulness meditation is the practice of learning to sit with our experiences – including thoughts, emotions, and bodily sensations – to observe what we are feeling as it is happening. This is done with kindness, not through self-judgement or storytelling.

Although mindfulness meditation has its roots in Buddhism reaching back 2,500 years, Jon Kabat-Zinn, founder of the Mindfulness-Based Stress Reduction program [5] developed non-religious mindfulness meditation programs available in clinical settings to help patients.

Mindfulness practices can be particularly helpful after brain injury by learning to focus on the present moment by attending to one thing at a time. “For someone who has had a brain injury, it can come as a big relief to learn ways to cope with frustration, poor concentration, and memory issues. It is easier for the brain when we pay attention to one thing at a time to increase focus and concentration which is helpful for making and recalling memories,” says Melissa Felteau, who after struggling with her own brain injury recovery, adapted Mindfulness Based Cognitive Therapy for traumatic brain injury (MBCT-TBI) [6] and was a co-investigator on a number of research studies.

“Practicing mindfulness meditation can also help with improving low mood and feelings of anxiety, that can lead to mood swings and angry outbursts. All of us feel badly when our emotions get the better of us,” said Felteau. Learning how to sit with difficult emotions and diffuse the level of reactivity can go a long way in befriending the mind. “I am not talking about denying or covering up real issues or pretending everything is fine when it is not. Rather, it is about turning towards the experience and learning to build capacity to develop a different relationship with difficult emotions,” said Felteau. “Learning to extend kindness and compassion to oneself in the face of hardship can be a transformative game changer to improving overall quality of life.”

Benefits of mindfulness meditation

The benefits of mindfulness meditation include:

  • Slowing down to observe the moment and appreciate the feelings and sensations that are present
  • Allowing an openness to embrace what is here, building resiliency for difficult moments
  • Learning how to receive see your thoughts and self with kindness, compassion, and non-judgment
  • Helping to step away from repetitive negative thinking
  • Addressing apathy and helping to cope with feelings of loss of self and isolation
  • Recognizing warning signs of depression and actively taking steps to prevent decline [7].

The mind is always active – but you can still meditate

If you are thinking, “I can not meditate!  My mind is always active!”, you’re half right.  Minds are continually active: full of thoughts, feelings, observations, judgments, planning, daydreaming, analyzing, and a whole lot more. According to Felteau, “One myth worth busting is that learning to meditate will not “empty” the mind – you will still have a steady stream of thoughts, emotions, sensations – but you can learn how to have a different relationship to them to settle the mind, so it is not so anxious, sad, reactive, or all over the place.”

The practice of mindfulness meditation teaches us to sit with moment-to-moment awareness, returning from mind wandering time after time, while detaching from memories or worrying about the future.

It is easy to be hard on oneself when comparing to what was possible pre-injury. With mindfulness, you come back to just the moment. You let go of thoughts where comparisons are made. You try not to waste energy worrying about something in the future that may or may not happen. Instead, you try to develop the perspective that all thoughts and feelings are viewed as passing events in the mind [8].

Soon you will learn that all things – good, bad, or neutral – are flexible. Thoughts arise and pass away just like each breath. That’s why the first object of attention in meditation is the breath.  You will notice the same arising and passing away of emotions, sounds, and bodily sensations too.

Mindfulness meditation teaches that being with each moment is different, so you learn each moment brings another new experience, another fresh opportunity to begin anew.  “Practicing this form of acceptance and self-compassion invites us to soften our negative reactions and encourages tolerance for imperfection and failure much needed after a TBI,” [6].

The ‘Sitting Like a Mountain’ exercise
Practicing patience when thoughts come up, allowing them to pass like clouds moving across the sky, helps the mind to quiet naturally.

Using the image of sitting like a mountain is a classic meditation. Sitting solid, stable, and dignified as all forms of weather pass by including countless clouds, beating hot sun, rain showers, threatening thunderclouds, flashes of lightening, and snowstorms. These forms of weather all come and go but the mountain just sits, enduring it all – trusting in the knowledge that all weather phenomena arise and pass away. Just like life, all things come and go.

Two wings of a bird
Another traditional teaching sees mindfulness like two wings of a bird, with one wing being wisdom and the other wing being compassion. Without both wings, the bird cannot fly. The wisdom that comes with awareness of thought patterns is important to bring understanding, kindness, and compassion to the experience of meditation. Self-compassion is like the love and care one would extend to a small child but turning that nurturing on yourself. These moments of generosity and self-care are the heart and foundation of mindfulness.

Ways to practice

There are several ways to practice mindful meditation. The key is consistency in your practice, and not being afraid to change if something isn’t working for you.

Examples include:

  • Finding a compassionate teacher in person or online to help answer questions and guide you
  • Schedule a time every day, often at the same time so it becomes a habit to meditate
  • Start with 3 minutes of breath practices like the 4 by 6 breath or the 3-7-8 breath to settle the mind
  • When you can, do 3 minutes of mindfulness meditation without interruption. Next time try for 5 minutes. Then 10 minutes. Set a timer so your mind is not distracted by the clock. Work up to 20 minutes daily
  • If you’re having trouble sleeping, try doing a slow check-in with the different parts of your body while in bed to drift off to sleep
  • Use a free app like UCLA Mindful, or Healthy Minds Program from the University of Wisconsin Madison – both based on evidence-based research of MBSR/MBCT
  • Start small and begin again if you lose your daily momentum

Practicing mindfulness may help you to cope with the changes and challenges that brain injury brings. Learning mindfulness is like learning to use a new muscle. The more you “flex the muscle” the more you strengthen the neural connections in the brain.

Learning to intentionally view difficulties and discomfort as passing events in the mind [9] like weather passing a solid, stable, and dignified mountain can bring stability. Offering yourself openness, kindness, compassion, and acceptance in a way that befriends the mind and builds a sense of wholeness can be helpful and offer a sense of hope.


See sources