Tag: Activities of daily living (ADL)

Accessible vehicles

After a brain injury, you may find yourself in need of a vehicle with accessibility features not found on standard models. The accessibility features you need may change depending on whether you are a passenger or plan to be a driver.

If you are planning to drive again, please remember that you will have to go through an assessment in order to determine whether you are able to drive again or if you need to get re-certified. This can include multiple assessments, training and tests.

Common accessibility features for vehicles

If you have already received certification to drive again, the assessments will have determined which accessibility features you need, and you will have completed training sessions using adaptive equipment. If you are just beginning to explore the idea of returning to driving or you are going to be a passenger and need some vehicle modifications for mobility, there are some common accessibility features that make using a car, SUV or truck possible.

Accelerating and braking tools
Accelerating and braking are essential for operating a vehicle, and you must be able to do both safely and competently in order to drive again. This can be challenging for people with weak right sides or weaker lower extremities (from the hip to your toes) or coordination issues. There are adaptive tools that can be installed on vehicles to assist with accelerating and braking, such as:

  • Electric parking brakes that allow you to use the power brake through a switch
  • Hand controls
  • Left-foot pedals
  • Pedal block that protects the pedals from accidental pressing due to conditions such as spasms
  • Pedal extensions
  • Park-brake extension levers that convert foot-operated parking brakes into hand-operated ones
  • Quad hand control, designed for people with wrist and hand strength problems
  • Servo controls, that are touch operated
Electronic equipment
  • Airbag control switches and deactivation shunts
  • Gear selector extension lever, which provides more leverage for shifting gears in automatic cars
  • Keyless ignition
  • Powered gear selector, which allows the driver to use a toggle
  • Quad control, which relocates accessory controls
  • Remote wipers and additional controls 
Wheelchair lifts
A wheelchair lift allows you to enter and exit a vehicle with ease when you are in a wheelchair or have additional mobility challenges. There are two main types of wheelchair lifts: platform and rotary (swing). These two lifts come in a variety of operating mechanisms. When ordering or using a lift, it’s important to measure your wheelchair or scooter to make sure that it fits safely.
Steering aids
You may need an augmented steering wheel to help with driving. There are several modifications that can be made, such as:

  • Bringing the wheel closer
  • Using foot operators to steer
  • Decreasing the effort it takes to steer
  • One-hand operation
Adaptive seating
You may need different vehicle seating to use a vehicle safely and comfortably. Adaptive technology such as power bases, removable seat bases and electronic restraints are available and can be adjusted to suit your specific needs.
Wheelchair carriers
If you are able to sit in a seat, but still need to bring your wheelchair or scooter with you, you can have a carrier installed. Types of carriers include automatic car-top carriers, bumper-mounted carriers, hitch-mounted carriers and pick-up truck carriers.

More in-depth information on these adaptive features can be found on the National Mobility Equipment Dealers Association website.

Converting an existing vehicle

Many adaptive technologies can be installed on existing vehicles. This will take time, require an assessment of your needs, and will need to be completed by an auto body and mobility professional that is certified and experienced in making these kinds of modifications.  The National Mobility Equipment Dealers Association (NMEDA) has a map tool that can help you find accredited dealers/installers.

Please note: NMEDA’s services are only available in Alberta, British Columbia, Manitoba, Ontario, Quebec, and Saskatchewan. Your rehabilitation specialists may be able to direct you to local resources, or you can check with your local brain injury association. 

You may not be able to convert your existing vehicle if it is not large enough. For example, sedans are not able to be equipped with wheelchair lifts. An assessment of your needs and existing vehicle will confirm whether or not you need to purchase a new vehicle.

Purchasing an accessible vehicle

There are plenty of manufacturers to purchase an accessible vehicle from across Canada, but you should work with an expert in mobility and transportation to make sure that the vehicle you purchase is the appropriate choice for you.

Rebates and funding for accessible vehicles

Accessible vehicles are expensive. There are rebate programs and funding options to help make acquiring an accessible vehicle more affordable. First, you should check your insurance coverage: a portion of the conversion or vehicle purchase may be covered under your plan.

Activities

There are plenty of possible recreational and leisure activities you can do during your recovery that can keep you entertained while helping build up your endurance. Here are just a few ideas to get you started.

Audiobooks, reading, and podcasts

There are so many wonderful stories out there, and plenty of ways to listen to them. If you enjoy reading, setting aside time each day is a great way to relax. If you aren’t able to read, audiobooks are readily available – you can even get them through the library thanks to free applications on your smartphone or tablet. Keep in mind you will need a library card to access the audiobooks.

If you’re interested in something a little different, try a podcast. There are a lot of free services for podcasts and they cover a wide variety of topics. They can be entertaining, educational and a lot of fun.

Arts and crafts

Arts and crafts aren’t just for kids! Activities such as painting, drawing, knitting, paper crafts, and more are great for stimulating your mind, working on fine motor skills, and keeping you busy. There are so many different types of crafts out there, you’ll always have options.

Cooking

For many people after acquired brain injury, cooking can become a difficult task. This is due to the energy required to cook, the difficulty of following multiple steps, and a lack of mobility. Not being able to cook on your own can be frustrating, especially if you enjoy preparing meals.

One of the ways you can get back to cooking as independently as possible is to work with your recreational therapist or occupational therapist on kitchen skills. These could include:

  • Following step-by-step instructions
  • Planning out a meal
  • Practicing kitchen safety such as turning the stove off and on, setting timers, adaptive cutting techniques, and washing up
  • Making a grocery list
  • Re-learning common cooking terms

You may not be able to start cooking by yourself again right away. You may need to start with small, simple meals or have a caregiver, friend or family member help you. You’re probably going to find that you are easily distracted and impatient with the cooking process. This is a normal reaction, especially if you used to cook all the time. But don’t let yourself get discouraged if you miss a step or a meal doesn’t turn out the way it should. Learning to cook again is a process.

Additional tips to help you get back to cooking include:

  • Clear any distractions out of the kitchen and clean off your prep space
  • Find special cook books written to help people with brain injury recover while using their skills
  • Label drawers and cupboards so you can easily find what you need
  • Use assistive devices for cooking such as special knives, cutting boards, and alerts
  • Use alarms and timers that you can carry with you. If possible, give them a unique name such as ‘Waiting for water to boil’ or ‘Take dinner out of oven with oven mitts’

Join local groups

Local brain injury associations and community associations often run various programs that are not only designed to be supportive and recreational but offer much-needed socialization.

Listening to music

Music can be incredibly soothing and relaxing. You can play it through your smartphone or on headphones, and use it to help you meditate, occupy your time, or even before bed.

Puzzles and games

Puzzles and games are an excellent way to improve concentration and attention later on in your recovery. They are also great activities to do with others. If you want to do them solo or are able to spend longer periods of time on a screen, you can find online versions of board games and puzzles.

Volunteer

Volunteering is an excellent way to fill your time, increase socialization, and give back to others at the same time. There are several types of volunteering.

Skills-based volunteering
Skills-based volunteering is when you take a volunteer position based on your specialized skills. For example, accountants may take volunteer book-keeping jobs. Skills-based volunteers can not only provide valuable help to an organization but can help a person hone their skills. This type of volunteering is ideal for survivors who aren’t able to return to work but still want to use their professional skills. Skills-based volunteering can be short-term or long-term, so you can find what works best for you.
Short-term volunteering
Short-term volunteering is ideal for people who aren’t able to commit to continuous volunteer hours. Short-term can mean a set time period or an event. These short-term roles can be faster-paced and require more flexibility and commitment for the allotted period of time or event.
Long-term volunteering
Long-term volunteering is focused more on maintenance and growth. The volunteer commitment generally lasts longer than 6 months, with a set number of hours per week or per month. Long-term volunteering roles are often administrative, mentoring-based, or in communications – but they can be anything an organization needs.
Micro-volunteering
Volunteer Canada defines micro-volunteering as volunteering commitments that are shorter and often require little to no oversight. Activities are designed to be done quickly, and the impact of the volunteer’s actions can be seen more immediately.

Seasonal volunteering
Some places or events run seasonally or require extra help around a holiday. This kind of volunteering can fall into the category of short-term and can require varying amounts of time. Seasonal volunteering can also require certain skills or abilities, so it’s important to check with the organization.

Volunteer activities could be:

  • Physical activities
  • Administrative activities
  • Working with animals
  • Working with children

There are plenty of volunteer opportunities across Canada. Ask a caregiver or support worker to help you find some options that would be right for you.

Walking

Walking is a wonderful way to get fresh air and exercise and is a nice way to boost your mood. You can do it alone or with a friend/family member or caregiver. You can also choose alternative ways to travel if walking isn’t an option for you at the time.

Yoga

Yoga is an excellent way to relax and gently move your body. It also promotes proper breathing, mediation, and mindfulness. You don’t need a lot of room or equipment to do yoga either. Love Your Brain has several videos specifically for people living with acquired brain injury.

Activity planning assessment tool

Over time, an acquired brain injury survivor may experience some challenges with mapping the progress of their recovery. In some situations, things may seem muddled in together, perhaps creating a sense of distress as it becomes difficult to identify the real progress that is being made.

As individuals evaluate how things are going overall, on a specific activity basis, it can also be helpful to acquire some concrete assessment information.  This data will help to map the gains being made.

The following Activity Planning Assessment Tool can be used as a companion throughout the recovery process.

Objectives:

  1. Track progress
  2. Identify activities that bring positive results overall
  3. Understand how participating in various activities might bring on symptoms
  4. Identify activities that may be challenging, yet overall are beneficial to engage in
  5. Develop strategies to manage symptoms

The first part of this assessment is to build awareness about the types of activities you typically engage in, and to determine how your participation in these may affect you and others.

You can choose to answer these questions by recording your responses, or you can go through the list and make a mental note of your thoughts. You can also discuss your responses with a trusted partner; family member; friend or colleague.

The debriefing questions will bring to light any comparisons, challenges and/or gains that you are making, and will allow you to prioritize which activities you might like to engage in.

Using this information, you can choose to invest your time and energy where you believe is the most appropriate for you at this point in time. It’s important to note that while you may choose not to participate in something now, you may feel like you will want to in the future. With this in mind, the assessment is also a good opportunity to help you to identify these activities for the future.

Building Awareness:

  • What is the activity that I am considering?
  • Overall, is this an activity that I want to engage in?  Why?
  • What positive results might this bring to me?  How will this affect me and/or others?
  • What negative results might this bring to me?  How will this affect me and/or others?
  • Will participating in this activity affect my energy level?  In what way?
  • If this does drain my energy, what are the energy management strategies that I can develop to address this?
  • Is this activity something that I have participated in pre-injury?
  • In my estimation, this is how I will be feeling after this activity
  • In my estimation, the recovery time following this activity will be
  • What is the value that I am contributing to this activity?
  • What value will this activity bring to me and/or others by my participating?

Debriefing:

  • If you have participated in this activity pre-brain injury, how does this time compare overall?
  • What were you aware of this time?
  • How did you feel when you were participating in this activity?
  • In reality, this is how I felt after this activity.  Compare this to your estimate above.
  • In reality, this is the recovery time following this activity.  Compare this to your estimate above.
  • Were there any specific symptoms brought about as a result of engaging in this activity?
  • At what point, if at all, did you begin to feel your energy drain?
  • What do you believe contributed to this?
  • Describe specifically how you knew your energy was draining/what was happening?
  • What did you do?
  • If you pushed through it, what happened next?
  • Describe any gains, no matter how small or big that you experienced.
  • Did you receive any comments/feedback/encouragement from others either prior to, during or following the activity?  What were they saying?
  • Did participating in this activity give you any confidence?  In what way?
  • What, if any adjustments could you make in order to improve the results for next time?
  • Would you participate in this activity again in the future?
  • On balance, is the activity worth your time investment and engagement?

Back-up Plans and Developing an Exit Strategy

  • Part of deciding to engage in an activity will depend on whether you have a back-up plan and/or if you have an exit strategy developed. Following are a couple of examples of this.
  • Rather than commit to attending a full event, perhaps you can agree to attend on a reduced timeframe. This plan balances out having to take an all or nothing approach. You are signaling that you are interested in attending, yet at the same time you may not be able to manage the full event and the potential sensory overload.
  • If you would like to attend a concert or a ballet – but you are not certain if you can sustain the energy required, or manage the sensory stimulation – have an exit strategy pre-arranged. Tell your partner or whomever you are attending the concert with that you would like to experiment by attending. However you may not be in a position to remain for the full concert. On a pre-arranged signal, should you need to leave, you can exit the concert when suitable.
  • For pre-planning, when you purchase your tickets, plan to sit on the end of a row. This way, you will know that you are not disrupting anyone should you have to leave.
  • If attending a movie, plan to arrive just as the movie begins. Avoid the trailers as they can be noisy and visually disturbing. Pre-plan as much as you can. Step out if you have to. Try this out to see how long you can stay in a movie theater. In the beginning, attend a quieter movie and build from there.
  • Go to the concert or movie prepared, bring sunglasses, earplugs or other noise dampening devices.
  • If you normally bowl three games, if you feel ready – try one game.
  • Sudden energy crashes can occur. To the extent possible rest or sleep prior to attending an event. On the way there, reduce any noise and/or distractions. Remain as calm as possible and connect to the positive aspects of taking this step.
  • If you are somewhere alone and you need to leave unexpectedly, always have a back-up plan developed. Whether this is a pre-arranged ride that you can contact; money on-hand for a cab or a ride-share, it will be important for you to know that you will have some support with returning home. This step will give you confidence as you begin to experiment with re-engaging in social and/or other activities.

The benefits of pre-planning are far reaching:

  • Opportunity to experiment with re-engaging in social and/or other activity; assess and adjust as may be required for the next time.
  • Maintain control over the factors you can control – and on your own terms.
  • Allows for energy mapping strategies to work in your favor.
  • Brings enjoyment and fulfilment back into your routine.
  • On a holistic level, it will balance out your overall outlook.

 

Driving after brain injury

An acquired brain injury impacts cognitive abilities (such as attention, memory, and reaction time), vision and depth perception, and physical abilities such as strength and range of motion. This means that a return to driving isn’t always possible right away – or at all. This is a challenge for people who are used to being independent. It can also pose a challenge for people who need to travel for errands, visits or rehabilitation appointments. Although adapted transport services may be available, for many people following a brain injury, the convenience and independence that comes with driving makes it a common goal for those in rehabilitation.

A comprehensive driving evaluation will be required to determine if it is possible for you to drive after a brain injury (if driving independently is one of your rehabilitation goals). This service is provided by occupational therapists (OT) who specialize in driver rehabilitation or Certified Driver Rehabilitation Specialists (CDRS). They can either be in the private sector or working in a public rehabilitation centre. You will need to be referred to a driver rehabilitation program or to an occupational therapist/Certified Driver Rehabilitation Specialist in private practice offering comprehensive driving evaluations. Ideally, your rehabilitation team will have discussed this with you. But if not, you can contact the rehabilitation centre nearest  to you to request a referral form. Ask if they require any other documentation; they will likely require a form filled out by a physician regarding driving and may require documentation from a vision specialist.

What is involved in the driving evaluation?

Once you are scheduled for a driving evaluation, the OT/CDRS will determine:

  1. Your capacity/potential to drive
  2. The class of vehicle that will be most appropriate for your needs
  3. The equipment you will require to access your vehicle
  4. The adaptive driving controls that will best meet your needs
  5. The training that will be required to ensure you are able to drive your adapted vehicle safely

A physical assessment, a cognitive/perceptual screening, and a visit with a specialized garage/dealer are all likely components of the comprehensive evaluation. You will also need to complete trials in an adapted vehicle and using adaptive driving equipment both in a controlled environment and then on the road. Once the adaptive driving controls that best meet your needs are determined, a report will be sent to the provincial driver’s licensing body regarding your driver’s license. Specific conditions will be placed on your permit (i.e. left foot accelerator, automatic transmission, hand controls, etc.) to ensure you only drive a vehicle that is compatible with your abilities.

How long will the process take?

The process from beginning to end may require as little as 2 months. For those with more complex needs, this can be extended to 12-18 months. The time required will be dependent on many factors. You may require adaptive driving equipment/techniques or training may take longer than expected. The timeline of returning to driving is difficult to predict. It’s important not to rush to drive again if you’re not ready. You can work with your rehabilitation specialists and a CDRS to determine when you are ready.

Since there are so many factors involved in returning to driving, the costs of the process can vary. A typical assessment with a CDRS will require at least 2-6 appointments. Learning to drive with adaptive equipment (such as hand controls, a left foot accelerator or relocated turn-signals and windshield wipers) may be another 4-8 hours of on-road training with a specialized driving instructor, while learning techniques to compensate for a visual field loss or decreased information processing speeds may require 10-15 hours of training.

This is a general timeline: it can vary depending on available services, scheduling, and your capacity. If driving safely is one of your goals, remember to be patient with the process and don’t rush.

Adaptive vehicles

If you can drive after a brain injury, your current vehicle may not work depending on any adaptations you need. You may need to get a specially-made vehicle or have your vehicle outfitted with adaptive technology (such as hand controls, etc.) If you don’t require adaptive technology and you can access your vehicle and safely load the mobility devices you need (i.e. walker, cane, manual wheelchair), almost any model of vehicle will work. If you have difficulty transferring yourself, or you use a motorized wheelchair/scooter for mobility, you will need a larger vehicle such as a van, truck or a sports utility vehicle (SUV). It is strongly advised that you do not purchase any vehicle until you have consulted with an OT/CDRS specializing in driver rehabilitation.

The costs associated with any vehicle modifications or adapted driving equipment required to make a personal vehicle accessible (for a driver or a passenger) can vary. There are programs available across the provinces and territories  that can help minimize the cost.

The actual vehicle modification and installation of adaptive equipment will be carried out by a specialized garage or a mobility dealer.  Ideally, the dealer is a member of the National Mobility Equipment Dealer’s Association (NMEDA) which ensures that the garage follows current guidelines within the industry and is governed by a quality assurance program. Information about NMEDA and the accredited specialized garages across Canada can be found at their website: www.nmedacanada.ca/

Once the driver’s license has been updated, the subsidy/payment has been received, the vehicle has been adapted and the driver training has been completed, you will be ready to enjoy the freedom of driving your own vehicle. You will however need to repeat the process either when it is time to change vehicles, or if your vehicle no longer meets your needs.

Whether it is via public adapted transportation services or by modifying your own personal vehicle to meet your current abilities (as a driver or a passenger), having a mobility solution that enables you to get out into the community independently is an important part of creating a high quality of life.

Tips for coping with hearing loss

Avoid noisy environments

If you have some hearing, avoiding noisy environments can make it easier for you to hear and understand conversation. The more background noise there is, the harder it is for your auditory systems to filter out what’s important, making it harder for you to communicate.

Hearing aids

Some hearing loss is permanent, but can be helped with hearing aids. There are a few different types of hearing aids your audiologist may recommend [1].

In-the-ear (ITE)
This type of hearing aid fits inside the ear canal and on the outer portion of the ear. This type is best for mild hearing loss.
Behind-the-ear (BTE)
This type fits behind the ear. This hearing aid works for all degrees of hearing loss, including severe. Behind-the-ear aids work with other assistive devices including FM systems, telephone adaptors, and television amplifiers. This is a good option for people who have small ear canals or get ear infections.
Open fit hearing aids
These are similar to the behind-the-ear aids because the amplifier and electronics sit behind the ear. There is a slim tube and tip that sit inside the ear canal. This is a more comfortable option for people with small canals. Open fit hearing aids work for severe hearing losses and are best for persons with mild to moderate high frequency hearing loss.
CROS (Contralateral Routing of Signal)
This system is for people with one ear that is unable to be helped by a hearing aid. A microphone on the ear with a deficit can feed sound to the stronger ear.

Lip reading

Lip reading is a difficult skill to learn, but it can come in handy for communicating with others on a daily basis, particularly since the majority of people don’t know sign language.

Subtitles for videos

Subtitles for videos and films make it possible to still enjoy visual content without having to rely on audio to understand what is happening.

Use American Sign Language

American Sign Language (ASL) is an effective way for people with hearing deficits to communicate. Like learning any new language, it will take a lot of time, hard work, and patience to learn. It may also require other members of your household or close community to learn it as well so that they can communicate with you in a way that’s easy for you. There are courses you can take.

Use writing as a communication tool

Reading and writing are effective tools of communication. You can have others write out what they want to say if you’re having quick conversations. There are also dictation programs available that generate words based on what a person is saying. This can be an effective tool if you aren’t using sign language or are communicating with someone who does not know sign language.

See sources

Disclaimer: There is no shortage of web-based online medical diagnostic tools, self-help or support groups, or sites that make unsubstantiated claims around diagnosis, treatment and recovery. Please note these sources may not be evidence-based, regulated or moderated properly and it is encouraged individuals seek advice and recommendations regarding diagnosis, treatment and symptom management from a regulated healthcare professional such as a physician or nurse practitioner. Individuals should be cautioned about sites that make any of the following statements or claims that:

  • The product or service promises a quick fix
  • Sound too good to be true
  • Are dramatic or sweeping and are not supported by reputable medical and scientific organizations.
  • Use of terminology such as “research is currently underway” or “preliminary research results” which indicate there is no current research.
  • The results or recommendations of product or treatment are based on a single or small number of case studies and has not been peer-reviewed by external experts
  • Use of testimonials from celebrities or previous clients/patients that are anecdotal and not evidence-based 

Always proceed with caution and with the advice of your medical team. 

Living with brain injury

A brain injury can affect every part of a person’s life. In many cases, the effects of brain injury are invisible to others, this can make it even more difficult to find help. Since a brain injury differs from person to person and recovery depends on several factors, in many cases it’s difficult to know what long-term behavioural, cognitive, physical or emotional effects there will be.

When you acquire a brain injury, you will have to learn how to live with the challenges and changes it presents. This includes changes to your independence, abilities, work, and relationships with family, friends, and caregivers. This may cause a lot of emotions including stress, anger, depression and even grief. These new challenges will not only affect your life, but will also be a big change for your family and friends.

As you go through the stages of acute care, rehabilitation, and learning to manage and live with brain injury, you’re going to have a lot of questions. This is where it’s helpful to have supports and services.  With the help of others in healthcare, your community, your family, and your local brain injury association, you can begin to understand brain injury, the effects it can have, and how to manage changes.

This section of our website covers the kinds of changes you may experience, management tips, and information on the kinds of tools and services that can help you and your family navigate living with brain injury.

Adjusting to the new normal
After a brain injury, things will forever by changed. It will take some time to adjust to what is commonly referred to as the new normal.

Relationships after brain injury
Relationships with family, friends, and partners will be different after a brain injury. It’s important work with the other relationship members to navigate those changes.

Social life
After a brain injury, many people struggle to maintain a social life and social relationships. Socialization is incredibly important for a person’s overall health and well-being. Socializing after a brain injury can be challenging, but it is not impossible. There are ways to interact with others that can create a rich and fulfilling social life while still being mindful of changing abilities and needs.

Hearing loss
Hearing loss after brain injury can impact a person’s activities of daily living (ADLs). This can be quite an adjustment, but with time and patience, you can establish new practices.

Vision loss
Vision loss can drastically impact how a person lives their day-to-day life. Changes to vision are difficult and require many adaptations.

Dysphagia
Dysphagia is a condition that causes difficult swallowing. This makes eating and getting enough food more challenging. There are several ways to manage dysphagia.

Brain injury & language
After a brain injury, some individuals experience challenges with language. This includes troubles with speaking, thought processing, reading and writing.

Nutrition
Nutrition is an important part of brain injury recovery because both the brain and body need proper nutrients in order to heal. Understanding and cultivating a healthy diet can help with overall health and well-being.

Sleep
It is common for individuals to experience challenges with sleep after brain injury. A lack of sleep can in turn make symptoms of brain injury worse. That’s why it is important to develop a healthy sleep hygiene routine.

Assistive devices and technology
Assistive devices and technology are anything that helps make activities of daily living (ADLs) easier and increase quality of life.

Housing
 Depending on the severity of an individual’s injury and the extent of their needs, there are several housing options available after brain injury.

Substance use
Substance use can both increase the risk of brain injury and exacerbate symptoms post-injury.

Finances
Finances can be a stressor after brain injury, particularly if the individual is not able to work. We have compiled some information on managing money and accessing financial support.

Aging
The process of aging can both impact people with brain injury and increase the risk of acquiring a brain injury.

Driving after brain injury
After a brain injury, you may need to be re-certified to drive. You may also need accessibility features in order to use a vehicle.

Insurance
Depending on the cause of your brain injury, you may be eligible for some insurance coverage. This section covers different policies available in Canada through personal and work plans.