Helplines & crisis support

If you’re in an emergency, you should always call 9-1-1.

For crisis centres and supports in your area, refer to the list below.

Canada Suicide Prevention Services is a national crisis and suicide line offering live call and text support. Toll-free, 24 hours a day: (1-833) 456-4566 or Text 45645 from 4 pm – 12 am

The Hope for Wellness Helpline is available for Indigenous peoples across Canada. Call toll-free at (1-855) 242-3310 24 hours a day, 7 days a week, or use the chat box link.

Distress Centre Calgary

Distress Line of Southwestern Alberta

Doctor Margaret Savage Crisis Centre

Salvation Army Hope Line
Greater Edmonton

Distress Line

Wheatland Crisis Society Helpline

British Columbia
Crisis Centre

BC 211

Burnaby Mental Health and Addictions Centre

Canadian Mental Health Association Crisis Line
Kootenay, Vernon, Kelowna, Williams Lake

Crisis Prevention, Intervention, and Information Centre
Northern British Columbia

S.A.F.E.R. (Suicide Attempt Follow-up, Education, & Research)

Vancouver Island Crisis Society
Vancouver Island

KUU-US Crisis Line Society
Provincial – Indigenous

Telecare Crisis and Caring Line>

Fraser Health Crisis Line
Fraser Health region, including Abbotsford, Agassiz, Burnaby, Chilliwack, Coquitlam, Delta, Hope, Langley, Maple Ridge, Mission, New Westminster, Pitt Meadows, Surrey, and White Rock.

S.U.C.C.E.S.S. Chinese Helplines
Richmond and area

CHIMO Services Crisis Intervention Program
Richmond, South Delta, Ladner & Tsawwassen

Crisis Stabilization Unit

Interlake Regional Health Authority
View the area served here

Klinic Community Health Centre

MB Farm, Rural & Northern Support Services

Reason to Live Suicide Line

First Nations and Inuit Hope for Wellness Help Line
Counselling available in English and French – upon request, in Cree, Ojibway, and Inuktut

Northern Health Region

Prairie Mountain Health
Brandon, Assiniboine, Parkland

Southern Health-Santé Sud

New Brunswick
Chimo Helpline
Provincial, bilingual

Tele-care: 8-1-1

Newfoundland & Labrador
Mental Health Crisis Line

Northwest Territories
NWT Helpline

Nova Scotia
Mental Health Crisis Line

Nunavut Kamatsiaqtut Help Line
Provincial, available in English, French, and Inuktitut

Connex Ontario
Providing information on mental health and addiction services

Good 2 Talk – for post-secondary students

Crisis Response Services
Kenora Rainy River District

Cambridge Distress Line

Distress Centre Durham

Hamilton Crisis Line

Telephone Aid Line Kingston (T.A.L.K)

Kitchener Waterloo Distress Line

Distress Centre
Lanark, Leeds, and Grenville

Support Line
London and Middlesex

Distress Centre Niagara

Mental Health and Addictions Access Line

Distress Centre Halton

Distress Centre of Ottawa and Region

Crisis lines

Peel Crisis Capacity Network
Brampton, Mississauga, Caledon

Spectra Helpline
Peel region – multiple languages available

Distress Line – Sarnia Lambton

Six Nations Crisis Services

Distress Centres of Greater Toronto

Torchlight Distress Line
Guelph, Dufferin

The Distress Centre of the Downtown Mission

  • 12 pm – 12 am: (1-519) 256-5000
  • Text 2 pm – 2 am: 258258
  • Online chat from 2 pm – 2 am

York Support Services Network

Prince Edward Island
The Island Helpline
Provincial, bilingual

Centre de prévention du suicide de Québec
Provincial, bilingual

KRTB the Suicide Prevention Centre

Centre de prévention du suicide et d’intervention de crise du Bas-Saint-Laurent
Saguenay/Lac St. Jean

Service Point Baie-Saint-Paul

Suicide prevention centre Portneuf – Arc-en-ciel

Charlevoix Suicide Prevention Centre
La Malbaie

Suicide Prevention Centre of Quebec
Quebec City

Suicide Prevention Centre Les Deux Rives
Trois-Rivières (Quebec)

JEVI Centre de prévention du suicide – Estrie
Sherbrooke, (Quebec)

Suicide Action Montreal
Montreal, (Quebec)

Suicide Detour

Amos Suicide Prevention Centre

Abitibi-Ouest Suicide Prevention Centre
La Serre

Suicide Prevention Centre of Malartic

Suicide Prevention Centre of Rouyn-Noranda

Témiscamingue Suicide Prevention Centre

Suicide Prevention Centre and Crisis Intervention Bas-St-Laurent (for Gaspésie-Îles)

Chaudiere-Appalaches Regional Telephone Service

Suicide Prevention Beauce-Etchemin

Ilot-Laval Crisis Regional Service

Lanaudière Suicide Prevention Centre – Joliette

Centre prevention suicide Faubourg

Crisis and suicide prevention centre La Maison Sous les Arbres

Centre de prévention du suicide de la Haute-Yamaska

Centre de crise L’Accès

Centre de crise et de prévention du suicide La Traversée

Contact Richelieu-Yamaska

Centre de crise et de prévention du suicide du Haut-Richelieu Rouville

Le Tournant
Salaberry -de-Valleyfield

Le Centre d’écoute et de prévention suicide Drummond
Drummondville, (Quebec)

Le Centre de prévention suicide Arthabaska-Érable

Five Hills Mental Health & Addictions Services
Moose Jaw

Saskatoon Crisis Intervention Service

North East Outreach and Support Services

Prince Albert Mobile Crisis Unit

Mobile Crisis Services

Southwest Crisis Services
Swift Current

West Central Crisis & Family Support Centre

Distress and Support Line

Mental health resources

Support group & Network changing routine

If you have been attending a support group, or if you belong to a support network – over time you may be feeling like you might like to make a change to the routine.

Obtaining support through others is an important aspect of brain injury recovery, and can take shape in many ways.  At the same time, it provides social contact as well as an opportunity for you to encourage others.

Regardless of what your situation is, just as it is important to carefully consider your reasons for wanting to join a support group – it is also important to consider your reasons for wanting to change this routine.

It may be helpful to develop a pros and cons list, and to think about some of the factors that may be leading you to want this change.  Some of these factors may include for example:

  • Why did you join this group initially?
  • Have any of the original conditions changed for you?
  • Do you believe you have talked as much as you are able to about your situation at this stage?
  • Does it seem that you are repeating yourself?
  • Do you need some time away from the group to process what you are learning?
  • Are you finding the schedule is too demanding?
  • Are you learning new things?
  • Are you hearing new information?
  • Are you finding that you are leaving feeling drained and/or down?
  • Are you wondering if your energy/effort might be re-directed elsewhere at the moment?
  • Are you beginning to feel that you do not want or need to attend any longer?
  • Have you reached a point where you are talking about goals and hope for the future, versus having the time and energy to practice and apply what you have been learning?
  • Has attending become a habit?
  • Perhaps someone else can benefit from your spot.
  • The social contact is positive for you.
  • It’s valuable for you to have a routine and a reason to get up and out to attend
  • Do you feel you are genuinely offering support and encouragement to others?
  • Have you been connecting with others who are sharing similar experiences?
  • Some in the group have moved on, others have remained
  • Overall, are you receiving positive messages that are moving you forward?
  • Is there an opportunity to apply any new strategies you are learning, and bring this information and awareness back to the group to debrief and/or discuss?
  • Are there other options available for you to obtain support that you might like to explore?
  • Are the people leading your group/network trusted sources?
  • If applicable, have you discussed this decision with your medical/other team?

If you are thinking about changing your routine:

  • How might you approach this?
  • Must it be all in or nothing?
  • Can your attendance, and/or time invested be modified to better suit your situation or schedule?
  • Who should you talk to about this?
  • Can you take some time to carefully consider your options before making a decision?
  • Can you test out/have a trial period to implement a modified schedule?
  • If you stop attending, should you find you are missing and needing the contact and support, can you re-join or reach out to someone?

There are a range of considerations involved in joining a support group and eventually in deciding whether to change up your routine.

Be sure to take the time necessary to consider your options carefully.  Talk to the right people, and on balance decide if attending this group brings you positive reinforcement.

When nothing seems to be working

You feel like you have tried everything. You doctor says you are doing all the right things, but you are still experiencing debilitating symptoms with no relief in sight. This can be frustrating and make you feel a sense of hopelessness.

While there is no magic spell that will make you feel better, there are a few options to explore.

Seek a second opinion

It is within your right to seek medical care from a variety of professionals. Some may have different training or more up to date knowledge on brain injury (or brain injury-related medical topics).

Allied health professionals

Allied health professionals are healthcare and health service providers that are not specifically medical-focused Allied health professionals include: dental hygienists; laboratory and medical technicians; optometrists; pharmacists; physio and occupational therapists; psychologists; speech language pathologists and audiologists . They can provide a range of diagnostic, therapeutic, and support services to aid in your treatment and recovery.

Ask your physician about the benefits of other therapy options.  Some of these services do not require a physician referral, so be sure to do your homework. Please read the next section on Private Clinics for additional information.

Private clinics

The public health care system can be limited and not cover all treatments and services.  You may need to seek the assistance of private providers or clinics. Be mindful that some of these clinics are not regulated in the same way that publicly funded hospitals are, so there is no guarantee the quality of the treatment or whether it will work.  In fact, it they state the treatment will absolutely work, that is a sign you should look elsewhere, as this is an extreme claim.  Brain injury is so individualized and complex, there is no “one size fits all” treatment for everyone and no guarantee that a treatment will work for you.

Private clinics are not always covered by insurance and you may have to pay out of pocket. This is something to keep in mind

When looking at private clinics, make sure you ask a few important questions:

  • Is the treatment evidence-based and could they share the research with you?
  • What is the benefit of the treatment related to the cost?
  • What is the wait time for treatment?

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. 

Support groups

Seek the support from other people who have been in a similar position as you and have found success with other therapies, treatments or recovery methods.  Brain injury associations across Canada offer groups online and in-person for individuals living brain injury. Some are geared towards targeted groups such as women, men, youth. Find your closest brain injury association to see what they have to offer.


We are what we eat, which means that our diet has a big impact on our brain’s health and well-being. Visit the section on nutrition to see how to optimize your diet for brain health.


No matter what stage you are at in your recovery, you need as much restful sleep as possible.  Both cognitive and physical fatigue can affect so many aspects of daily living, including mood, memory, concentration, communication, and your general ability to deal with issues or situations.

Take a step back

Take a step back and slow down. Sometimes we need to pause and listen to our bodies. Look at what may be triggering your symptoms. You may be juggling too many things at once.  It could be something in your environment, such as the lighting in your home or office. It is important to remember that recovery can take time, so you need to be patient and look at the whole picture.

Do something you enjoy

When you are not feeling well, it is hard to focus on the positives. Do something you enjoy or that brings you happiness and relaxation. Try to build this into every day. Doing activities that make you feel fulfilled can help you in your recovery process.

Become educated on your health

Individuals as much as possible need to become their own health advocates.  Becoming as educated as possible on the topics and treatments for brain injury will help you better communicate with your health team and bring new information that might be helpful in recovery.

Here are some helpful tips to help you advocate for your health:

  • Write down some talking point or notes so you don’t forget anything and can speak clearly with the healthcare provider
  • If you have articles or research papers about brain injury you want to share with your clinician, bring copies to your appointment. Try to limit the resources you bring to three or less
  • Ensure your sources of information are reputable, credible and based on evidence.
  • University and medical research centres are examples of reputable sources
  • Be open to their perspective and knowledge of the topic. Take notes (or have someone take notes for you)
  • Ask for more links or resources so you can be more informed

Use your voice

You have a powerful voice as a person with lived experience. You can use this power to advocate in your community. Reach out to your local brain injury association to see how you can share your experience and challenges and contribute to advocacy efforts.

Should you get a second medical opinion?

Sometime people feel awkward about seeking a second opinion about their medical diagnosis or treatment, as there is a perception that some physicians will get insulted or see it as lack of respect from patients or caregivers. In most cases, clinicians understand you want the best care and advice for yourself or your friend/family member.

It is within your right to seek medical care from a variety of professionals. Some may have different training or more up to date knowledge on a topic, particularly in the field of brain injury.

Reasons you or your friend/family member may wish to get a second medical opinion include:

  • You are unsure or have reason to question a diagnosis
  • You are trying to decide about a new treatment or a surgery that may have a high risk and/or high cost out of pocket
  • You are not clear about if or how well a test or treatment may work
  • You need more information about all options available[1]

Another situation which could lead to the desire for a second opinion is if you have talked to someone who had a wonderful experience with another clinician and saw improved health outcomes. While it is certainly helpful to learn more details, you must also keep in mind that each brain injury is different (as are the circumstances leading to the brain injury) so the outcomes for yourself or a friend/family member may not be the same.

Finding a second opinion

There are a variety of ways to find a possible second opinion.

  • Ask the physician for a recommendation of someone else who works in the field but is not closely associated or a direct colleague
  • Use word of mouth. Perhaps there is someone that has been recommended by a friend or acquaintance, or you read about a physician in an article
  • Contact your provincial/territorial College of Physicians and Surgeons
College of Physicians and Surgeons of Alberta
2700 Telus Plaza South
10020 — 100 Street NW
Edmonton AB T5J 0N3
Telephone:(780) 423-4764; public inquiries:1 (800) 561-3899
Find a physician in Alberta
British Columbia
College of Physicians and Surgeons of British Columbia
300-669 Howe Street
Vancouver, BC V6C 0B4
Telephone:(604) 733-7758 or 1 (800) 461-3008
Find a physician in British Columbia
College of Physicians and Surgeons of Manitoba
1000 – 1661 Portage Avenue
Winnipeg MB R3J 3T7
Telephone:(204) 774-4344
Find a family doctor in Manitoba
New Brunswick
College of Physicians and Surgeons of New Brunswick
1 Hampton Road, Suite 300
Rothesay NB E2E 5K8
Telephone:(506) 849-5050 or 1 (800) 667-4641
Find a physician in New Brunswick
Newfoundland and Labrador
College of Physicians and Surgeons of Newfoundland & Labrador
139 Water St, Suite 603
Saint John’s NL A1C 1B2
Telephone:(709) 726-8546
Find a physician in Newfoundland and Labrador
Find a physician specialist in Newfoundland and Labrador
Northwest Territories
Health and Social Services
Government of the Northwest Territories

PO Box 1320
Yellowknife NT X1A 2L9
Telephone:(867) 920-8058
Government of Northwest Territories Health and Social Services 
Nova Scotia
College of Physicians and Surgeons of Nova Scotia
7071 Bayers Road, Suite 5005
Halifax NS B3L 2C2
Telephone:(902) 422-5823 or 1 (877) 282-7767
Find a physician in Nova Scotia 
Department of Health and Social Services – Government of Nunavut
P.O. Box 1000 Station 200
Iqaluit, Nunavut
X0A 0H0
Telephone:1 (877) 212-64382
Government of Nunavut Department of Health 
College of Physicians and Surgeons of Ontario
80 College Street
Toronto ON M5G 2E2
Telephone:(416) 967-2603 or 1 (800) 268-7096
Find a doctor in Ontario
Prince Edward Island
College of Physicians and Surgeons of Prince Edward Island
14 Paramount Drive
Charlottetown, PEI C1E 0C7
Telephone:(902) 566-3861
Find a physician in Prince Edward Island
Collège des médecins du Québec
1250 boulevard René-Lévesque Ouest, Suite 3500
Montréal (Québec) H3B 0G2
Telephone:(514) 933-4441 ou 1 (888) 633-3246
Find a physician in Québec
College of Physicians and Surgeons of Saskatchewan
500-321A-21st Street East
Saskatoon SK S7K 0C1
Telephone:(306) 244-7355 or 1 (800) 667-1668
Find a doctor in Saskatchewan
Yukon Medical Council
c/o Registrar of Medical Practitioners
Box 2703 C-18
Whitehorse YT Y1A 2C6
Telephone:(867) 667-3774
Find a physician in Yukon

Preparing for a second opinion

Becoming as educated as possible on the topics and treatments will help you become a better health advocate.  You will be better able to converse with clinicians and provide information that might be helpful in recovery.

As clinician visits are usually short, you will need to be prepared before and during the appointment. Here are some helpful tips:

  • Write down some talking point or notes so you don’t forget any questions you may have. You can also ask a friend or family member at the appointment to keep notes
  • If you have articles or research papers about brain injury you want to share with the clinician, bring copies to the appointment. Try to keep it to under three as a clinician is less likely to read a stack of articles
  • Ensure your sources of information are reputable, credible and based on evidence.   University and medical research centres are examples of reputable sources
  • Be open to the clinician’s perspective and knowledge of the topic. Take notes so you don’t forget what they have said
  • Ask for more links or resources so you can be more informed

There are some barriers to seeking a second opinion. Their may be limitations due to the number of clinicians in your area, or waitlists that could be anywhere from a few weeks to months. You will also have to ensure you have proper up-to-date medical records. It’s helpful as recovery progresses to request copies of their medical records. This will alleviate the wait time associated with getting a copy made or the possible transfer of care that could happen if the doctors requests the records on the person’s behalf.

What to do with the results

Sometimes the physician will come to the same conclusion for the diagnosis or pathway of care as the first clinician. This should help alleviate any uncertainty from a medical perspective.

In other cases, they will have different opinions. Both options may be good, but what is the best way to make such an important decision?

It is suggested that you take the results from the second opinion back to the initial physician for review.  There will be other factors to consider in the decision-making process.

  • Is one clinician suggesting a surgery that will have long recovery times? What are the benefits?
  • Is there a cost associated with the treatment, and if so, will it be covered by insurance or will there be out-of-pocket expenses?

Take the time to discuss the results. Ultimately it is up to the person receiving treatment, and they need to make the best decision for them and their recovery. Caregivers, friends and family members can help with the decision-making process, offer advice or any support the person with the brain injury might need. If a caregiver is the primary decision-maker for the person with a brain injury, consult with other immediate family members and explain how the decision has been reached.

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. 

Brain aneurysm

A cerebral aneurysm is when there is a bulge in a weak area in a wall of an artery that may leak or rupture. A bulging artery puts pressure on the brain tissue or nerves depending on where it is located. If it bursts – or hemorrhages – blood will spill onto the tissue between the brain and the skull. This can lead to hemorrhagic stroke, brain damage or in rare cases, death.

Brain aneurysm causes

Causes and risk factors of a brain aneurysm include:

  • Age – older individuals are more likely to develop aneurysms
  • Excessive alcohol or drug use
  • Family history/genetics
  • Gender – specifically, females are more likely to develop aneurysms
  • High blood pressure
  • Past aneurysms
  • Smoking

Aneurysms can develop after head trauma or infection – but these causes aren’t as common.

Symptoms of aneurysm

In many cases, there will be no visible symptoms of an aneurysm. When symptoms do appear, it is because the brain aneurysm has burst. The symptoms will appear suddenly. Emergency services should be called at 9-1-1 immediately. First-responders are necessary because they may have to use life-saving measures quickly. Symptoms of an aneurysm include:

  • Sudden, severe headaches
  • Blurred vision
  • Changes in speech
  • Neck pain
  • Nausea
  • Sensitivity to light
  • Fainting
  • Seizures

Brain aneurysm treatment and recovery

An unruptured brain aneurysm is normally found during unrelated tests/screenings. A ruptured brain aneurysm will be diagnosed using computerized scans and dye tests. Once a ruptured brain injury is diagnosed, there are a few different treatment options. Doctors will recommend the one(s) best suited to your situation based on factors such as age, location and severity of the aneurysm. These treatment options include:

  • Open surgery which enables the surgeon to place a clip around the base of the aneurysm, preventing blood from entering it
  • Endovascular surgery which happens within the blood vessels. It’s a smaller, less-invasive surgery to implant shunts or coils

Alternatively, doctors may recommend observation and spend more time monitoring the aneurysm.

Coping with changes after a brain aneurysm

A brain aneurysm can have a variety of effects depending on how much blood there is and the damage it does to the brain tissue or other arteries. There can be changes to cognitive and physical abilities, vision, balance, and more. It’s important to keep in mind that treating the brain aneurysm will not reverse the effects it has caused.

That means that once you’re in recovery, you may have to learn new ways to complete activities of daily living (ADLs).

See sources

Cognitive effects

Individuals with acquired brain injuries experience cognitive impairments that can impact them for the rest of their lives.

Topics in this section include:

Changes in cognitive abilities

Attention & concentration
Attention is being able to focus on something. There are several different types of attention, including:

  • Selective (focused) attention: This is being able to ignore distractions. Examples of challenges with selective focused attention may include being unable to focus when there are multiple people talking or being easily distracted while driving. Other examples include forgetting what you were going to get from the bedroom, or trouble preparing a meal.
  • Sustained attention: This is how long you can concentrate on an activity or task. Sustained attention depends on factors such as the task, how tired you are, and environmental distractions.
  • Spatial attention: This is your ability to be aware of specific locations in the environment.
  • Alternating (divided) attention: This lets you switch from one task to another without losing track of what you’re doing, and to keep track of several things at once. This may be difficult to do after a brain injury.
  • Attentional capacity (‘working memory’): This is how much information you can take in at once without getting overloaded and your ability to use that information. For example, the average adult can hear and repeat a 7-digit phone number but usually won’t remember it 5 minutes later. After a brain injury, you may not be able to take in as much information.
  • Prospective memory: This is the ability to plan, retain and retrieve an idea as planned. For example, if you need to run an errand, you need to plan to stop at the store, remember to stop at the store, and complete your errand. This memory can be challenging for someone with an acquired brain injury because planning can be difficult.

The changes in attention that can happen after a brain injury can make it hard to follow a conversation, hard to work, or make it unsafe to cook a meal or drive. In the early stages of recovery, you might not be alert enough to communicate or be fully aware of your environment. If you can focus on something, it may only be for a short amount of time.

At times, one small detail or focus on the wrong information may cause you to be distracted. These distractions could be internal: for example, you might be distracted because you need to go to the bathroom. The distraction could be external: for example, while talking, your attention may be on someone’s tone of voice or clothing rather than what they are saying. You could be trying to pay attention to words, how you look, noise from the street, and other activity in the room all at the same time.

If you can’t concentrate, it’s hard to finish a task. You might know what you need to do, but have trouble keeping track. We all have problems concentrating, especially when we’re tired or don’t feel well. For individuals with a brain injury, it can be so difficult to pay attention or concentrate that it’s hard to do even the simplest task like washing your hands or dressing.

Tips to help with concentration and attention

  • Ask people to repeat the things they say to you and break it up into small bits of conversation. This will help you absorb the information.
  • Break tasks into small steps.
  • Engage in hobbies or activities that you enjoy and can do. Card games, puzzles, and reading help develop concentration and are entertaining at the same time.
  • People who have trouble focusing may get tired quickly. Make sure you take short breaks to give your brain a rest.
  • Reduce distractions; have only one person in the room, turn off the TV or radio, and try to limit the number of things you’re doing at the same time.
  • Take away time pressures. Don’t rush through a task or expect it to be done perfectly.
Judgement and problem-solving
Problem-solving and judgment may be impaired after a brain injury. You might have trouble judging a situation, figuring out what the right response should be, or act on your first impulse. Your thinking style may not be flexible – in other words, once you make up your mind, it can be hard to change it.

Problem-solving skills are incredibly important for living independently and safely. You may need to work with specialists or caregivers to develop these skills.

Tips for judgment and problem-solving

  • Ask for feedback on your behaviour. You can ask your psychologist, occupational, or speech therapist for ideas on how to do this
  • Consider the possible reactions of people that would be affected by your decision
  • Make a list of choices – or ask your caregiver to give you choices – when it comes time to decide. For example, have your caregiver ask if you want to go for a walk, practice exercises or watch TV instead of asking what you want to do
  • Reduce distractions that could affect your decision-making process
  • Take extra time to clearly think about your decision
  • Try planning and reasoning out loud so you can more clearly think about your decisions. You can also have a caregiver listen to you and make suggestions
  • Work with a caregiver, friend, or family member on decisions whenever possible
  • Write down the important things to think about when making a decision. This gives you a guide to refer to during the process
  • Write down problems or situations from the past – they can help with decision-making in the future.
Language & communication
After a brain injury, it’s common to have trouble with speaking, understanding language, writing and reading. This includes:

  • Difficulty expressing yourself
  • Difficulty finding words
  • Difficulty understanding others
  • Trouble with conversation
  • Trouble with facial expressions or tone
  • Difficulty organizing your speech
  • Not being able to respond appropriately

These challenges can come from physical issues with control over your tongue, mouth and throat muscles. They can also arise from damage to the parts of the brain that control and understand language (this is called aphasia).

Tips to improve communication skills

A speech-language pathologist can help identify the best strategies for successful communication when a person has a brain injury, but there are a few general guidelines that can help you communicate:

  • Find a place where you feel comfortable talking and listening, where you don’t feel pressured or distracted
  • Don’t turn on a TV, radio, or other noisy items when you want to communicate with someone
  • Talk and listen to one person at a time. Group conversations can be overwhelming and hard to follow
  • If you don’t understand someone, ask them to repeat themselves or use different wording
  • Take your time to think and speak – there’s no rush

It is also important to show patience and understanding. This is an adjustment for everyone and tempers and frustration can run high. It’s normal to experience those feelings, but it’s important to make sure you are doing what you can to address those feelings appropriately.

Memory is generally divided into two categories: declarative and non-declarative. Declarative memory is things that can be clearly remembered such as specific past events (episodic memory) or knowledge and facts (semantic memory). Non-declarative procedural memory is memory that is retained as a skill or a motor response.

How memory is affected depends on the brain injury. Some individuals lose their memories of time before or immediately after the injury. Others are unable to make new memories, while still others forget skills or motor responses that used to be second-nature, although this is less common.

The most common types of memory loss after a brain injury are:

  • Short-term memory loss: This means you can’t remember things that just happened and are often influenced by problems with attention.
  • Amnesia: This most commonly refers to loss of declarative (episodic) memory after damage to specific areas of your brain’s memory system. Amnesia can be divided into anterograde and retrograde.
    • Anterograde amnesia: This means the inability to form new memories, after the time of injury, and is often the result of short-term memory loss.
    • Retrograde amnesia: This means you’ve forgotten what happened before your brain injury.

On rare occasions, a person with memory loss may remember things that did not happen or twist events. This is called confabulation, and it’s done automatically without the person realizing it: they don’t know that they are making up information and tend to not fully recognize the impact of their brain injury.

Problems with memory can affect progress in all areas. If memories fade quickly, you won’t be able to learn from new experiences, remember that you’re making changes or remember that you’re improving. This can have a huge impact on rehabilitation. In therapy, you’re learning mobility skills, how to use assistive devices, how to communicate and how to process information. If you have trouble remembering what you learned from one day to the next, progress may be slower.

During the assessment stage of therapy, therapists will test memory for events that happened:

  • Before the accident (remote or retrograde memory)
  • In the past few minutes (immediate memory)
  • In the past few minutes, hours, or days (recent or anterograde memory)

Immediate and recent memory tends to be more affected by a brain injury than remote memory.

Memory recovery is often slow, and in some cases a person may never fully recover. This can be incredibly frustrating and upsetting for both you and family/friends. It’s important to be gentle with yourself, and as you cope with the changes surrounding your brain injury that you do what you can to take care of your mental and emotional health.

There are steps you can take to help with any memory changes you may be experiencing.

Tips to help with memory

  • Be patient with yourself. It’s frustrating to not be able to remember things, but you’re working hard. Take the time you need, ask people to repeat themselves if needed, and be kind to yourself when you’re working on your memory
  • Choose activities that are familiar to you – this will help you form memories, and create enjoyable experiences
  • Having routines helps all of us remember, so consider creating routines for events that are repeated everyday, like when you have meals or where you put the housekeys
  • Try to use one calendar system for keeping track of events, rather than several different systems in different rooms or situations
  • Use any calendar or routine consistently – consistency helps make habits and avoids confusion
  • It’s a good general rule to write things down if you need to remember them. Have paper and a pen or pencil with you so that you can write down important points, or ask the person with whom you’re speaking to write down what they want you to remember
  • You can buy devices that shut off stoves and other appliances automatically. This can help to prevent safety hazards
Planning skills
Many people with a brain injury find it hard to plan, begin, and finish an activity. You may not be able to think ahead or lack follow-through to finish a task. Your thinking may be disorganized and incomplete. This may show up as repetitive movements or comments. You might act impulsively by doing something quickly without thinking or need a lot of time to understand information and respond the right way.

Planning is an important part of building independence. For example, you need to be able to do laundry, so you have clean clothes. This means you need to know when to add soap, how to set your washing cycle, and how to set your drying cycle. You may not be able to plan out all the steps right away, but by setting goals and working with rehabilitation specialists, you can develop your planning skills.

Tips to help with planning

  • Break down the task into small steps. For example, when making a salad, first prepare the lettuce. When this is done, proceed to the next step, and so on
  • Have a caregiver, friend, or family member clearly and briefly explain the activity before you start
  • Read instructions or have directions read to you slowly so you have time to understand and respond
  • Reduce distractions, reduce the demands, and give yourself extra time to problem-solve
  • Routines and schedules outlining future events help with better organization
  • Use a checklist so that you can check off each step of a task as you do it
  • Use a calendar or whiteboard to provide visual cues and reminders
  • When possible, help with household chores (as much as you can do). Things like setting the table, washing the dishes, or preparing a salad need planning but may be familiar enough that you can do them easily. These kinds of activities will help you practice step-by-step planning
  • Daily activities tracker
It’s common after a brain injury for a person not to be as self-aware as they were before. For example, an injured person may not be aware of what they can’t do anymore. They may not notice or remember the changes in themselves, be in denial, or grieving those changes, which are emotional responses. Or they feel pressure to return home or return to work even if they are not completely ready. This may lead to the person overestimating their abilities and underestimating their problems.

Self-awareness is difficult to spot in yourself. This is when you need the help of therapists, caregivers, family, and friends. Your support team will help you figure out the best ways to receive feedback and identify ways to improve self-awareness. For example, perhaps you’re more likely to listen to a sibling vs. a parent, or a doctor over a family member when receiving feedback.

It’s important to note that these symptoms of cognitive changes after a brain injury won’t happen in everyone. They can also happen for people with mental health disorders, the aging population, and people with different illnesses. People who experience cognitive symptoms following an acquired brain injury (ABI) should be referred to a neuropsychologist for formal neuropsychological testing that can provide insight into the root cause of the symptoms. These results and the profile of your cognitive needs will be used to create individualized treatment plans.

Cognitive rehabilitation and recovery

Every person is unique, and so is each brain injury. For that reason, it is impossible to predict how recovery will impact your cognition (thinking skills). Cognitive rehabilitation is a tool that can have a positive impact. Cognitive rehabilitation is a collection of treatments that work to improve a person’s cognitive functioning in everyday life after injury. A variety of different professionals are involved in cognitive rehabilitation, but the most common therapists are licensed Speech-Language Pathologists (SLPs) or Occupational Therapists (OTs). Sometimes therapy is delivered by a person called a “cognitive rehabilitation therapist” (CRT).

For cognitive rehabilitation to be effective, it must be designed specifically for your needs and your goals, with a focus on both your cognitive strengths and areas you find challenging.  Each person is different, which means rehabilitation plans needs to be as well.

Cognitive rehabilitation can be helpful even years after injury. It’s never too late to seek support to develop cognitive skills and address challenges you may be facing.

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A person with a first-time concussion typically recovers fully within a few days to weeks after the injury. No two concussions are the same. This means that recovery is different for everyone.

The Ontario Neurotrauma Foundation guidelines for Concussion/ mTBI and Persistent Symptoms was developed to improve patient care by creating a framework that can be implemented by healthcare professionals to effectively identify and treat individuals with persistent symptoms following a concussion/mTBI.

The patient version of the Guidelines for Concussion/mTBI and Persistent Symptoms is for adults over the age of 18. These were developed to make communication between healthcare provider and patient easier. Starting in 2019 these guidelines will become living guidelines to ensure that the most current research literature is incorporated into the recommendations.

Topics in this section include:

Concussion recovery tips

The symptoms you experience can be difficult to manage and have an impact on your daily life. Some symptoms may come and go, and your recovery may take longer than expected. It can be frustrating, debilitating, and scary. You’re not alone – recovery can be challenging for many people. With the right education and support, you’ll be able to face those challenges and make positive progress.

Here are some ways you can proactively assist your concussion recovery. You should make sure to listen to your doctor if they have more specifics steps for your recovery plan.

Appropriate rest and activity
The concussion guidelines say you should slowly become more active after 24 – 48 hours of rest. This is a change from ‘cocoon therapy’ – the practice of long periods of rest in low lighting with little to no activity.  Recent research indicates that long periods of rest may do more harm than good [1].

Daily activities of living should be re-introduced gradually. Overtime as symptoms decrease, the more active you can become [2]. You should always consult with your doctor before resuming activity that includes a significant risk of injury. If your symptoms get worse when you’re active, try scaling back. Every person has a threshold for activity, and it may take awhile to find yours.

There is no set timeline for when you’re supposed to be able to return to regular activity. The important thing is that you take your time and consult with your doctor.

Return to work gradually
Like with physical activity, your return to work should be gradual, building up over time. Depending on the severity of your concussion, your return to work could begin a few days to a few weeks after your injury. You should make sure to talk with your employer about your concussion, any symptoms you’re still experiencing, and how best to transition back to your full responsibilities [3].

Keep a journal of how you’re feeling both at and after work. This will help track your symptoms and whether you’re ready to take a step forward and increase your workload. While working, you should take frequent breaks to give your brain time to rest. You should also plan for additional time to finish tasks and try to find a quiet environment to complete your work.

If you’re ready to return to work, but need a little help getting the process started, visit the return to work section for tips and resources.

Ask for help
If you are having trouble with household tasks like cooking or cleaning, ask a family member or friend for assistance. Return to activities gradually according to doctor recommendations.
Bring someone with you to appointments
When you experience a concussion, symptoms can make it difficult for you to keep track of information or get to appointments. Bringing a friend or family member with you to appointments can be helpful. They can write down information and communicate with your medical team.

Risk factors

There are several risk factors that are taken into consideration when doctors are mapping out your recovery.

  • History of previous brain injury
  • Previous neurological or psychiatric problems
  • Effects of other health issues like medications, bodily injuries, etc.
  • Anxiety
  • Depression
  • Insomnia
  • The number of symptoms you are experiencing
Personal or environmental factors that may negatively affect recovery
  • Mechanism of injury (e.g. motor vehicle accident, assault)
  • Significant delays or not returning to work following the injury
  • Being a student
  • Life stressors
  • Older age
  • Lack of social support
  • Female gender
  • Lower resilience
  • Returning to a contact sport too early
Multiple concussions and second impact syndrome
Getting another concussion while still recovering from a previous one may increase the risk for long-term problems. Second impact syndrome is an extremely rare event where a second concussion in close succession to a previous, not yet healed concussion leads to uncontrolled brain swelling. Most reported cases have been in teenagers and young adults. In a few cases worldwide, it has even been linked to death [4].

It’s important to fully heal from a first concussion before returning to any sport or activity that could put you at high risk of getting another. When you do return to a sport or activity, you should speak with your coach/leadership team about safety precautions.

What if my symptoms aren’t going away?

All these factors will impact how quickly you recover from your concussion [5].

If you still have symptoms 1 month after your initial injury, these are called persistent symptoms (sometimes referred to as prolonged symptoms or post-concussion syndrome). Every person’s recovery is different, so don’t be alarmed if you do have some symptoms after the 1-month period. Talk to your doctor about what symptoms you are experiencing.

Persistent symptoms include:

  • Headaches
  • Fatigue or difficulty with sleep
  • Unsteadiness or decreased balance
  • Memory or concentration difficulties

If you’re experiencing seizures, slurred speech, or numbness you should consult with your doctor prior to the 1-month mark.

Prolonged symptoms can affect your daily life and make it difficult for you to perform regular activities. Your doctor may want to do more tests and check in with you more often if it turns out you have persistent symptoms. Their tests and medical investigations will tell them how best to manage your symptoms. Check the ONF guide for more information on managing prolonged symptoms.

What is Chronic Traumatic Encephalopathy (CTE)?

CTE is a neurodegenerative disease that has been found posthumously in a small number of athletes and veterans with a history of multiple head injuries. Research is continually evolving on CTE.

Private concussion clinics

There are many private concussion clinics across Canada offering a wide variety of concussion recovery methods and therapies. These private clinics have no federal or provincial oversight or regulations and there are no assurances of the services they provide. When figuring out whether a private clinic is right for you, ask the following questions [6]:

  • Does the clinic have a medical doctor?
  • Does the clinic have a team of licensed health care professionals?
  • Does the clinic follow the most up-to-date standards of care for managing a concussion?
  • What tools, tests and recommendations is the clinic using?

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. 

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