Mobility aids

You may find that you need help navigating the world after your injury. There are several mobility and environmental aids that can make moving around easier. You should only use a mobility aid if it is recommended by a physiotherapist or occupational therapist. The therapist will make sure the aid fits you and will show you how to use it properly. Using an ill-fitting aid or using an aid improperly can increase the risk of injury (e.g., due to falls or repetitive strain).

Canes

Canes are an excellent aid that offer support if you have a deficit on one side of your body and only require a small amount of help moving. They are meant to help with balance and should be used when a person can mostly walk on their own.

Walkers or rollators

A person uses a walker when they require more stability. A walker has four legs. Rollators are like walkers but have wheels for ease of use. Walkers and rollators are sturdier than canes and allow people with more significant balance problems to continue walking, building up their strength and stability over time. In some cases, a person may need to use a walker or rollator permanently for safety.

Wheelchairs

In some cases, a person with a brain injury may not be able to walk. This could be temporary or permanent depending on the cause. Some people may find that they can walk short distances or indoors but need a wheelchair to travel longer distances or outdoors. When a person is unable to walk, they use a wheelchair. There are several different kinds of wheelchairs ranging from basic manual models to more advanced motorized chairs. Wheelchairs can provide you with the ability to move around, but it does mean that some places may be inaccessible, and your home environment will need to be adapted.

Walking poles

For some people, walking on uneven ground (typically outside) can still pose a challenge, even if they are able to walk indoors with no trouble. This is where walking poles can come in handy. Also called urban poles, these walking poles can be used for increased activity and for balance by people in rehabilitation. Some sticks even come with special ‘feet’ or ‘grips’ that can be changed depending on the environment and purpose of the walk. Many models are also collapsible for easy storage. If you would like to try using walking poles, you should consult with your doctor first, particularly if you are currently using a walker or cane. You should also be aware that if you have joint pain or are unable to grip the poles that they may not work for you.

Orthotics and proper shoes

When a person experiences mobility issues, there is the possibility that the way they walk, and their posture will change as a result. This can cause additional health problems, including pain. Doctors may recommend orthotics or special shoes that provide more foot and arch support in order to alleviate related pain, correct skeletal positioning/posture, and overall help improve balance [1].

Some people with brain injury have ‘drop foot’. These people will have difficulty flexing the foot when swinging the leg forward during walking. The toes may drag on the ground and increase the risk of tripping. An ankle-foot orthosis is a device that fits around the ankle and helps to keep the toes from dragging while walking. Alternatively, a functional electrical stimulation device can activate the muscle at the front of the shin during the swing phase of walking to flex the foot. If you think you have drop foot, you should speak to your doctor or physiotherapist about getting an ankle-foot orthosis or functional electrical stimulation.

Stair lifts

Stairs can be difficult to use if you are experiencing problems with walking, lifting your legs, and balance. If your home has stairs and you are not able to live entirely on one floor, a stair lift is a safe alternative. These are mechanical chairs that move up and down on a track. They can be installed in your home to make the environment more user-friendly.

Ramps

If you have a wheelchair, you will need to use ramps to access places, including your home. There are companies that make these modifications and will be able to recommend appropriate ramps for you.

Wider doors

If you are using a walker or in a wheelchair, you may need wider doors to navigate easily. This is an additional renovation you may need to complete.

Bathroom adaptations

Using the washroom with mobility issues can be frustrating and unsafe. There are several modifications that can be made to make it easier, including:

  • Grab bars
  • Higher toilets
  • Walk or wheel-in showers
  • Shower seats

Your bathroom is just one area that may need some modifications. An occupational therapist will be able to help you identify problem areas in your home and how best to adapt them to suit your mobility needs.

There are renovation grants available if you need to adjust your living environment. Available funds depend on provincial programs.


See sources

Tips for improving mobility

Most physical recovery gains will occur in the first 6-24 months – but that is not a strict rule. Every brain injury is different and will require its own treatment plan and timeline. There are actions you can take to help increase your mobility over time.

Work with physiotherapists, kinesiologists and occupational therapists

The best way to improve mobility is to work with experts. Physiotherapists, kinesiologists and occupational therapists specialize in helping people improve their gross motor skills and fine motor skills. By having the support of professionals and following a tailored rehabilitation plan, you will be able to make progress.

Repeat exercises and activities

Our muscles and body will learn movements the more we repeat them. The more you practice an exercise, the more your body will respond. However, practicing exercises should be spread out over time. This is a long process requiring a lot of patience. You do not want to go too hard or too quickly: that can result in diminished returns. In other words, you probably will not see progress as quickly. This can cause frustration with the process, which also has the potential to impact your progress.

The best way to see results is to follow the program set by therapists and use exercises or activities that mimic actions you enjoy and do in your day-to-day routines. Engaging and interesting activities will produce more dramatic and meaningful recovery as you are more likely to successfully repeat the action.

Medications

Medications may be used for controlling muscle tone, seizures, pain management (headache, central pain), dizziness and nausea. Medications should only be prescribed by and taken on the recommendation of your doctor.

You will benefit from having a good working relationship with your doctor. All aspects of brain injury recovery take time, and this will be a long-term relationship with many check-ins. You should feel comfortable telling them about any changes to your health and well-being throughout your recovery. They will be able to adapt your treatment plan as needed, helping you progress as much as possible.

Use mobility aids as needed

To both improve your mobility and keep yourself safe, you should always use any mobility aids your therapists or healthcare team recommend. Many individuals with brain injury continue to use some sort of aid like sturdy shoes or walking sticks to reduce the risk of further injury.


See sources

Emotional effects

When the brain is injured, a person’s emotional processing and responses can change. Major life changes and stressors associated with brain injury can add to emotional difficulties. You may experience less emotion or more intense emotions. You may feel and act in ways that are out of character for you. For example, a person who was mostly calm and cheerful before an injury may get angry more easily after the injury.

Like with all parts of brain injury recovery, it takes time to learn how your emotions are affected and what you can do to manage them.

Topics in this section include:


 Changes in emotions

Anger/irritability
It is common for people living with brain injury to get frustrated, angry or irritated more often or more quickly. They may even become aggressive. This can lead to yelling, cursing, and physical outbursts. This is often distressing both for the survivor and their loved ones.

These episodes of anger or an increase in irritability can be triggered by:

  • Confusion
  • Frustration with a task that is harder than it used to be
  • Fatigue
  • Misunderstanding another person’s intentions
  • People telling you what to do or pointing out mistakes
  • Too much stimulation (e.g., light, noise, and movement)

If you’re experiencing periods of anger or irritability, try some of the following coping methods.

  • Engage in calming activities – listening to music or reading are some examples
  • Practice deep breathing
  • Remove yourself from the situation and go to a more calming location
  • Work with a doctor who is familiar with acquired brain injury and emotions on some self-calming methods and communication strategies – being able to communicate what you’re feeling to others can be extremely helpful when it comes to emotional situations. Cognitive behaviour therapy can provide support and tools to help manage anger/aggression and understand why you have these reactions.
Anxiety
Anxiety is a common emotion related to your mental health. It stems from feelings of worry and fear. After a brain injury, people commonly worry about recovery being too slow, getting back to school or work, not having enough money, and relationship difficulties.

Depression
Depression is common after a brain injury. Adjusting to your new self and your experiences is difficult and can result in decreased motivation and feelings of sadness, loneliness, and even despair. When these feelings last for weeks or longer, a person may be diagnosed as having Major Depressive disorder, a health condition that requires treatment.

Emotional control
A lack of emotional control means you speak or do something before thinking it through, reacting solely based on your emotions. You don’t consider the outcome/consequences of what you say or do. You may also do risky or dangerous things. Emotional control and behavioural (or impulse) control are closely linked because they are both managed by the same brain systems.

If you have a decision to make, even a simple one, give yourself a reminder to stop, think, and ask if you really want to do or say something. You can also ask someone to be your safety net – ask them about what you want to do and listen to their advice.

Mood swings
Mood swings – also called emotional lability – are when you go from one emotion to another quickly, often for short periods of time. It can also mean you experience emotional outbursts – for example, laughing or crying a lot even if you don’t feel very happy or sad.

Mood swings are common when the parts of the brain that control emotion are injured. Sometimes there is an obvious reason why your emotions suddenly change. At other times there is no specific event that causes a change in mood: it appears random to other people. Mood swings can also be unrelated to a situation or the way you feel. This can be confusing.

In general, these mood swings are outside a person’s control. It’s important not to be hard on yourself. Mood swings happen. Instead, celebrate the times you feel calm and in control. Other ways to cope with mood swings include:

  • Calming activities
  • Deep breathing
  • Distract yourself from the thing that is making you laugh or cry more than you want to
  • Speaking with your doctor – they may be able to help with mood stabilizing medications and tools. If you do take medication, remember that it may not work right away and you will need to work closely with your doctor to find the right medication and dosage

You can ask a caregiver or family member to help you with calming strategies like deep breathing, exercises or calming activities. Over time, many people find that their mood swings happen less and less as their emotions balance out and they use coping methods to help.

Personality changes
Personality changes can come from both emotional and behavioural changes. Personality traits may become exaggerated or more intense after a brain injury. For example, a quiet person may become even quieter; an assertive, active person may become aggressive and outspoken. The opposite can happen too, where a normally quiet person becomes very outgoing or outspoken.

These changes can happen with all brain injuries. While some people find that their emotions and personality changes fade as they recover, some changes may be permanent.

I’m feeling upset over my brain injury – how do I cope with my new reality?

It’s normal to feel upset, angry, and sad about your brain injury. It’s also easy to get swept up in your grief over what has changed. It’s important to let yourself feel grief – but don’t dwell on it. Instead, do your best to focus on the improvements you’re making, things you’re looking forward to, and things that make you happy. Try breaking your goals down into smaller pieces – you’ll more easily be able to see your progress.

It’s going to take a long time, and some days will be better than others. If you are having difficulties, make sure to share them with your family, caregivers, and doctors.

Identifying and managing emotional changes

Working with a cognitive behavioural therapist (CBT)
One of the most effective ways to manage the emotional effects of brain injury is to work with your healthcare team. Cognitive behavioural therapists develop a personalized program that will address your areas of need. This includes coping with emotional challenges. Cognitive behavioural therapy is goal-oriented, meaning you have specific things you want to achieve, and you actively participate to reach those goals. These plans can adapt over time as new goals are set, but in general cognitive behavioural therapy is meant to be a short-term treatment that teaches you the skills you need to cope with cognitive, emotional, and behavioural changes.

If not available at your local rehabilitation hospital or mental health clinic, this kind of service may have a fee. While cognitive behavioural therapy may be covered under some insurance plans, this can be an out-of-pocket expense.

Psychiatrists and psychologists specialize in talk therapy and mental health, which can have a huge impact on emotions. The main difference between them is that psychiatrists have medical degrees rather than primarily academic degrees and can prescribe medication. Working with either a psychiatrist or a psychologist can help you share your feelings, access feedback, and understand the relationship between mental state and emotions.

Deep breathing
If you’re feeling overwhelmed, pausing and taking deep breaths is a good tool to help you focus. This is something your caregiver or family member can help you with by talking you through it. Deep breathing sounds relatively simple but there’s a lot more to it than just “in and out.” There are additional steps you can take to bring more mindfulness to the exercise.

Take a rest break
When we’re tired, we tend to get more emotional. After a brain injury, many people experience fatigue. Make sure you take all the time you need to rest or have some alone time.
Remove stressors
Are there things in your house or in your life that are stressing you out? If so, try to find ways to remove them. Depending on what your stressors are, you’ll need to come up with different ways to handle it. One example: if you get stressed because you can’t remember what house cleaning needs to be done, a checklist can help manage that stress.
Visit support groups
Many communities have local brain injury associations or support groups with activities and resources. Participating in support groups is a great way to build up your community; it also gives you a place where you can feel safe and welcome, which will have a huge impact on your mental health. Support groups are also a great place to hear about other experiences and learn new tips/strategies that have helped others in recovery.

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. 

Create a routine
Since you’ve experienced a lot of changes, creating a schedule for each day or each activity you have to do can take a lot of stress away. When you know exactly what’s happening and what to expect, you can mentally and emotionally prepare yourself.
Exercise
Exercise can have a positive effect on both the body and the mind. Even if it’s just a few arm circles, a walk, or leg stretches. It’s a great way to occupy yourself and focus your energy.

Please note: You should only do exercises that have been doctor-recommended.

Spend time outside (if possible)
Fresh air is a great way to boost your mood. Even if you’re only outside for a few minutes at a time, this change of venue and activity can be incredibly stimulating.
Medication
In some cases, it might make sense to take medication to help with depression or anxiety. Please note: only your doctor can recommend and prescribe you with medication.

See sources