Meditative visualization for Strokes

Catastrophic events such as strokes or traumatic blows to the cranium, often result in neuronal loss, which can lead to a number of deficits such as reduced motor functions, clear cognition and poor perception of reality. Though all of these are negatively life changing, they are however not entirely permanent as the brain is very plastic in nature and is always constantly changing and adapting to what we do or perceive in our daily lives. It should also be reminded that though, neurons are damaged or gone from the initial trauma, other remaining neurons, can still function as a replacement to backup the loss function. To harness, the brain's natural capability of reorganizing and self- repairing would be through physiotherapy as means of recovering loss motor function, however there are other ways to recover loss movements besides moving our limbs. One such method would be through meditative visualization. Often times, the effectiveness of recovery following a brain injury is determined by how effective we can retrain remaining neurons to take over the function of the damaged cells, meditation is one effective way to hone in this ability.

When we meditate, we often assume of not thinking about anything and sitting completely still. This assumption is completely false as most meditation practitioners are still completely aware of themselves and their surroundings. As matter of fact they focus on their internal and external sensations to block mental chatter or distractions, this is called mindfulness meditation and it has become popular in recent years as it's a proven way to remain focus in the present and having a clear view of what we want to achieve. Thus most brain injury patients are encouraged to engage in this practice. When meditating, it's essential to have a clear goal of what most patients want to achieve from doing it, if it's to be able to do specific movements then the focus of the meditation should be movement visualization. Below are guided steps to starting meditative visualization, any changes can be made to these steps to suit the need of anyone:

1. Find a comfortable place to sit down i.e on a chair or on the floor with legs crossed
2. Erect the spine to a straight 90 degree angle.
3. Once the spine is straight, begin closing both eyes, close them gently with no tightness or tension in the eyelid muscles, everything must be loose 
4. Once closed begin to feel the weight or centre of mass of the body, is the weight evenly distributed on both sides? if one side feels more weight than the other, begin to slowly shift the weigh to the side that has less but only slightly, the goal is to have equal sensation on both sides to attain equilibrium.
5. With both sides having equal weight and feeling, focus on the spine again, ensure it's still straight.
6. Focus on the breathing, inhale slowly for 5 seconds and exhale for 5 seconds. Do this for 10 minutes while maintaining steps 2, 3, 4 and 5 
7. After 5 minutes of repeating the process, put both hands on the knees and feel the palms of the hand touching against the surface of the skin, try to feel where the fingers are in space and position. Begin visualizing that all fingers are tapping up and down, do this about 10 times then move only one finger at a time starting from the index all the way to the pinky. repeat each movement for every finger around 10 times.
8. Do the same movements for the wrist, visualize the wrist moving up and down for around 10 times. 
9. Then place all attention on the ankles. imagine them moving up and down, try to tune into the sensation on the soles of the feet, visualize what the sensation would be like when the ankles are moved up and down. if possible imagine both ankles on both legs are moving up down in sync. Repeat this for about 10 times, try to channel the sensation of the healthy leg into the one that's disabled. 
10. Focus all attention on the toes, wiggle them together up and down for about 10 times. the move only the individual toe in the same manner for 10 times.
11. Afterwards visualize walking normally in the mind, pay close attention to how the knees, ankles and toes are flexing. If possible try to visualize the surface of the ground that you're walking on in the soles of your feet. 
12. Arms can also be moved backwards and forwards to add a more realistic feel of the visualized running.
13. If possible shift the weight between the left and right of the body when visualizing as this is what most people subconsciously do when they run. 
14. Continue this exercise for about 5 to 10 minutes and always be mindful of the breath as the movements may cause exhaustion even though they are small compared to actual running. 
15. Once the 10 minute running visualization is over, try to be mindful of external sensations such as the temperature in the room, sounds and smell for about 5 minutes before gently opening eyes and returning consciousness to the present moment. 

When carrying out the steps above. It would be best to do them in an environment with enough sensory stimulation such as light, noises and even temperature fluctuations. Most of these maybe considered disruptive, however they are beneficial to train the mind to not only become mindful of the surroundings but also to find order in a chaotic environment. learning to find balance and order in a sensory chaotic surrounding reflects what most patients are trying to accomplish in their brains after a traumatic injury. If this can be achieved externally then internal clarity will follow suit.

Another important factor to follow between these steps would be hydration, always remembering to drink plenty of water as the brain requires hydration to keep it properly functioning, Practicing mindfulness will most likely deplete the brains energy and this in turn will result in requiring more water to properly function.  

Overnight leave

Patients that are able to make good use of their mobility during their time in hospital are able to apply

for an overnight leave during the weekends, this enables them to leave the hospital's vicinity to stay somewhere else overnight and enjoy a life of temporary freedom before coming back to the hospital on the next day to continue therapies. Patients wishing to apply for an overnight leave can only do so if they inform the hospital's ward coordinator a few days prior to the expected leave. This way the hospital staff can prepare medications and other requirements that patients can take when they leave the hospital. When applying for an overnight leave, be sure to inform the hospital of where you're going to spend the night and provide evidence that the accommodation has a disabled access and accommodate the need of any person with a disability, this includes railings in the bathroom that patients can hold on while having a shower or a commode that allows them to sit while having a shower. Most hotels are already come equipped with such facilities and equipment as they are required by law to be able to accommodate anyone with disabilities.

If patients are not able to provide proof that their desired accommodation is disabled friendly then their request for overnight leave would have to be canceled. Another option would be to ask the hospital to find them a suitable accommodation that they have a partnership with the hospital, this way it will be sure that the place will be able to accommodate a disabled person. Before being granted an overnight leave most patients have to routinely attend their occupational therapy to discuss with their therapists regarding their leave and what to expect once they temporarily leave the hospital and how to approach a new environment. The occupational therapist will also teach patients on how to use certain tools that will help them do certain tasks much easily such as a portable plastic mat that gives the patient the ease to eat their meals without moving the plate and to open bottles or any form of sealed containers. In most cases, this isn't necessary especially if the patients are going for an overnight leave accompanied by a family member who can help them with such tasks, however, patients are always encouraged to be independent when they go for an overnight leave and should learn to do things on their own.

Being able to leave the hospital grounds comes with possible dangers that patients may face such as seizures or further head injuries, therefore it's imperative that both patients and carers are taught on how to handle such events, should they occur. In all likelihood, such things will never occur but in some cases, they do so its good to be prepared. The hospital staff will provide patients and their carers with a first aid guidebook, containing all the essential steps and procedures to handle someone with a seizure or a brain injury. If the patient's mobility is still limited, they may be required to take blood-thinning injections to prevent any blood clots from forming in their limbs and the injections would have to be given, this means either patients or their carers have to learn to give the injections. A lot of times, patients are brave enough to inject themselves without any help but if it proves to be difficult then carers can take over and administer the shot. A lot of the time the injection is given on the stomach or the abdomen, this makes it a little bit painful since the skin covering the abdomen is sensitive, so it's best to pinch it hard before injecting to reduce pain.

Once an injection has been done, it's essential that the used syringes are properly disposed of. In most cases, the hospital provides a container to dispose of the syringes that patients can take with them during their leave. When disposing of syringes, both patients and caretakers are reminded to dispose of all use syringes and that none should be left to avoid harming others or improper misuse at the hands of others. Other necessities that may be taken with the patients include their medication such as Keppra, Baclofen, and pantoprazole. However, these medications are only allowed to be taken with patients who truly require them due to specific medical conditions which may arise after the initial surgery or injury to the head; seizures, extreme spasticity, and high gastric acid. If any of them do not occur after surgery then it's not necessary to be taking them for overnight leave or after discharge.

To determine if any of the medications mentioned are necessary, one must ask the doctors in charge of taking care of the patients. Certain tests may have to de done to determine this. An EEG test may be conducted to rule out abnormal brainwaves that signal epilepsy to stop the usage of Keppra (levetiracetam) and baclofen. Other common medications that may be taken include melatonin to ease insomnia and panadol to relieve headaches or pain, as most brain injury patients deal with reoccurring sleep problems and headaches. Alternatives to these may include promethazine to treat reoccurring circadian issues and ibuprofen to treat pain, however these two may not work for some, therefore best consult your rehab doctor in knowing which option is best. For patients who dislike injections to deliver their blood thinner or have an allergic reactions to them, then they maybe allowed to take aspirin as an alternative but this needs to be consulted first with doctors.

Other factors to be considered of temporary hospital leave is the accessibility of one's home, photographs should be taken of Patient's bedroom and hallways in the house to determine if it is safe for disabled access, however this shouldn't be a problem for a single story house but maybe troublesome for multiple stories as stairways would have to be considered. If this is the case then railings would beed to be fitted to ensure safe access. However such measures would not be necessary if patients are willing to spend the majority of their time downstairs and not attempt to go upstairs especially if they are not confident in using the stairs. If the bed room where patients normally sleep or rest are upstairs, consider sleeping downstairs for the time being to reduce risk of falling and injuring. The same can be said for bathrooms, railings maybe required to be fitted in bathrooms for patients with poor mobility or balance. It would also be beneficial if bathroom access is close within the vicinity of where the patient sleeps as this would make it easier for them to access the bathroom during crucial times such as at night when visibility is low.

Kitchen access needs to be assessed and modified as well, consider placing plastic kitchen mats on the kitchen bench as a tool to assist patients in opening and closing jar lids. Essential cooking utensils such as spatulas, knives, tongs, spoons, cutting boards and etc should be relocated to areas within easy reach especially for patients who are only mobile with a wheelchair, this means placing them in drawers that are up to knee height only. cooking essentials such as spices, ingredients, salt pepper and etc should be placed within these drawers to or inside an accessible fridge. making these adjustments in the kitchen should help patients become independent in cooking and feeding themselves. It should be reminded again that the purpose of an overnight leave is to help patients become independent as possible without any assistance or external intervention.

Self-care should also be done independently starting from showering their own and going to the bathroom unassisted. Certain bathroom modifications are necessary for those with poor mobility and lack of balance, railings must be fitted on shower walls to allow patients to support themselves when standing on the showers, anti-slip shower mats have to be placed on the shower floors to prevent patients from slipping when showering while standing up. All of these essential fittings can be purchased at a hardware store like IKEA or Bunnings warehouse. These are also sold online on eBay and Amazon, especially the portable ones that are used for traveling. Consider the price when buying them but in all likelihood, they are almost always affordable. If not it's also possible to improvise and using something else as an alternative, i.e using a plastic chair or stool as a showering chair instead of a standard hospital showering chair or rubber slippers the patients can wear on their feet while they are showering instead of using a non-slip mat.

The purpose of any overnight leaves to build up patient's confidence in being independent and to stimulate learning, consider doing activities that engage the mind into doing complex tasks to build new neural pathways, below are some examples of daily activities that one may adopt while being at home:

• Language learning: For those with mild to severe aphasia r dysarthria, this can be beneficial in engaging te broncas area of the brain's prefrontal cortex that deals with language comprehension. Studies have also proven that individuals who are multilingual tend to have very plastic brain and are capable of recovering faster. therefore learning a second or even third language helps with neuroplasticity. Learning a language doesn't have to begin from scratch if patients have studied a foreign language before in the past but discontinued or along time, it's best to start learning again and reawaken dormant pathways that were made for the learning of that specific language.
• Journals: Keeping a journal is not only the best way to plan our days ahead but to have a clear and detailed steps on what we want to achieve in a certain period of time. This comes in handy for patients with mild to severe short term memory loss. A journal can help them stay focus and on track with what they're doing.
• mindfulness meditation: meditating isn't just for monks, it's also used by athletes and health professionals to train the mind to be aware of itself and to be intuned with the body and all physical sensations.
• Physical exercise: This may be challenging to most patients especially when they have paralysis, making it hard to do any physical exercises but it doesn't have to be exhausting as ding cardio or weights, it can be as simple as doing repeated movements like singing your arms up and down repeatedly for a few minutes until you sweat. This is already enough to tire the body and brain and stimulates neurons to grow back.
• Adopt healthy habits: This could mean waking up early, sleeping on time and getting more sunlight exposure.
• Adopt a healthy diet: What we eat influences our body and how we use them, Food with a high carbohydrate intake causes too much overactivation of the central nervous system, which may slow down plasticity.

All in all the key to an effective and productive overnight leave is persistent mind and body stimulation. Being idle is a negative habit that should be reduced, if not avoided at all times, always keep the mind engaged with anything. Below are some habits to be avoided  or reduced,

• Excessive screen time: prolonged usage of electronics, isn't just bad for the eyes, it also inhibits some of the neural synapses in the brain as it reduces the brain's capability to concentrate and focus another more important task and it may even cause addiction, too much screen time is also linked to the release of excess dopamine and delta-foss B, two neurotransmitters responsible for addiction. 
• Excessive sitting/ resting: If possible, patients should spend the majority of their time standing instead of sitting, the human body was not designed to sit, this further worsens atrophy in muscles and puts pressure on your intestines.When standing patients must be able to distribute their weight evenly on both legs, while maintaining a good centre of mass.    
• Favoring dominant side: Patients with hemiplegia are encouraged to use their weaker side more to find alternative neural pathways to retrieve lost motor function, this could mean opening and closing doors using the affected arm, using affected leg to carry all of the body weight when climbing on stairs or turning on the lights using fingers on the affected hand.
• Excessive time in dim places: how much light we are exposed to also affects the brain, places that are bright stimulates neurons to fire synapses, thus increasing communication between one neuron with another, increasing the chances of plasticity better than spending time in dark places. 
• High intake of carbohydrates and sugar: Excess consumption of sugar and carbohydrates can cause neurons to become over stimulated and fire synapses too fast, causing disorganized communication in the brain, this eventually inhibits necessary chatter for neuroplasticity.  

With the list of do's and don'ts of overnight leave mentioned above, patients or care takers are free to plan out their activities and how they want to approach them, it's best that any planned activity is first consulted with doctors to ensure safety and effectiveness, if any suggestions mentioned here do not correspond with the individual need of a patients then adjustments and be made and the list of suggestions can be amended.
   
                               

             

Ankle Foot Orthosis

If you have a brain injury either a traumatic one like a car accident or being hit by a blunt object or an acute brain injury such as a stroke. The chances are you may be subjected to severe damage to your brain which leaves you disabled in either side f your body, thus your mobility severely affected and you may struggle to walk. When this happens it's most likely that you will need a wheelchair to move around, however, this all depends on the severity of your disability. If you still have some movement left after the injury it's most likely that you'll be given walking cane instead of a  wheelchair. When using the cane to walk, you will most likely use your functional side of the body to carry the stick and to project yourself forward when walking as well as aiding your body weight to maintain stability as you move. Thus this leaves your affected side virtually unattended and idle, which could cause it to wither away through muscular atrophy. The only way that you can prevent this to reduce the effects of atrophy is to try and use it more often. For most patients, this can be a difficult task as the affected side will be weak and have little or almost o strength at all to carry the body weight, however with a little bit of help from walking aids like an AFO (Ankle Foot Orthosis) patients are able to make use of their weaker side to carry the weight of their body. If you think you still have a bit of movement and strength in your affected leg then it's best that you inform your rehab doctor or anyone that is in charge in your war that you would like to request for an AFO to be made for your leg.

When creating the AFO, patients will be asked to have their leg cast for a mold, which will be used to create the AFO. During this process, clay will be placed and covered all over your leg and you would have to sit still for a few hours to wait for the mold to dry and harden. Once it has completely dried off and solidify, the mold will be removed and you can go back to your room. It takes about a week for the AFO to be completely formed using the mold. By the end of a week, you'll be able to try it on for a test walk. When trying this new device, be sure to wear your pressure stockings underneath to prevent blood clots and keep the circulation of blood going. The proper footwear is also needed when using the AFO especially shoes with a bigger size to allow both your feet and orthosis to fit in together which will help you give traction when walking. With the AFO firmly placed on your weaker leg, you would have more support now to take on the weight of your body using the weaker leg. Along with the walking stick, patents must learn how to shift their weight between legs. It's best that they put more emphasis and focus on the weaker one to strengthen both the neuronal connection to the weaker leg but to also strengthen, the muscles as a means of avoiding muscular atrophy.

Using both an AFO and a walking cane can be difficult a first, especially when patients don't know which limbs they should move first so they can walk. most physiotherapists would recommend placing the cane in front first to establish the distance that patients wish to make then move the affected leg the AFO forward to make the first step, then the unaffected leg can follow suit. When moving the healthy leg be sure to shift your weight on your affected leg and vice versa when moving. Try to swing both the healthy and affected leg using your hip and pelvis to ensure that they swing forwards instead of sideways, this will be difficult at first since the initial damage from the brain may affect the vestibular, part of the brain that controls balance and spatial awareness. however with a bit of practice, and getting used to the brain is able to readjust itself ad the vestibular can slowly recover its lost function. So to all patients out there who are struggling with their balance and not knowing where they are in space, I urge you all to keep trying and to keep pushing yourself to get your balance back on your feet. This may take several tries to accomplish and it's best that you're accompanied by a physiotherapist or doctor that could watch over you in case you ever fall down.

The device also comes in handy when trying to et upstairs, so if any of you stroke patients out there are having trouble going up and down the stairs then the AFO should help you a lot in making this task easier. If you are going upstairs then start first by using the healthy leg to put yourself on the first step then the affected leg can follow suit, do this for every time you are going upwards, however when you are going downstairs you should do the opposite, the affected leg goes first then the healthy leg follows suit. You should only practice going up and down the stairs under supervision to prevent any mishaps from happening, try this alone if you really feel confident with your affected side or if you have railings on the stairs that you can grab a hold of fo support and stabilize yourself when using the stairs. However, if there are no railings to grab on then it's best to use the walking cane as a substitute. When using the cane, the cane would have to be moved first for establishing the predicted distance or steps that would be taken, then the healthy leg can move to put you on the first step. The opposite is done when going downstairs, the cane is moved first to measure the distance and support then either leg can move to stabilize yourself when going downwards.         

It should be noted that when using the AFO for walking, the device has to be maintained properly after every use so that it remains durable for every use. This can be achieved by placing the device in a dry and clean area. Keeping the interior of the orthosis clean may require a small application of cleaning alcohol to clean the area that has been in contact with the skin, this is one to prevent any bacteria or fungus building in that area which may cause skin irritation when you wear it. However, this cleaning isn't necessary if you wear your pressure stockings all the time when using the AFO. Another way that you can get around this is by attaching a piece of styrofoam in the orthosis that can be used as a shock absorber that can soak up any sweat or moisture from your leg as you are using it all day. Another benefit of attaching styrofoam is that it strengthens the grip of the Orthosis when wearing it so that it won't detach itself easily when patients are moving around with it. It also allows blood circulation in your legs to take place easily when using the device as at times it's worn on the leg too tight and cause a blockage on the blood circulation of the leg, so styrofoam softens the grip of the device while being used. The cushioning with the foams should also be given on the straps that are keeping the device in place as these are areas where pressure is being exerted on the leg.

With the extra padding that is added, it should make it easier and much firm when walking with the device and patients should feel more confident at putting more weight on the weaker leg. Once you have the paddings attached, the structure of the orthosis becomes stronger and can even be functioned as a deterrent to anyone who passes you by in public to let them know that you have a disability. If they don't recognize your disability and disrespect you by going towards you at full speed you have every right to kick them in the shin or groin with your orthosis to let them know that they're being a dick. If you have a cane with you then you can use it to jab their foot to stop them from continuing to walk towards you or hit them in the head to make them stop completely.

To avoid the need of unnecessary hitting of civilians in the public, it's best to go to places that are not crowded to avoid harming anybody or request the hospital for a nurse or an allied health assistance to escort you as you explore the outside world to protect you from people. It's best to start training yourself with the AFO by walking around the hospital courtyard, this way it would be safer and you are already familiar with the hospital surroundings and can utilize the disability facilities if needed. When walking around the hospital with the AFO, always be mindful of your surroundings as you will most likely walk slowly and hit a few things along the way, so try to remember that there are other people in the vicinity that you have to respect and give way to especially if they are severely handicapped and using a wheelchair.                                                                              

Chaplain/ Psychologist

After having attended the dysarthria group, I was escorted back into my room by Ellie the nurse. As I approached my room, I noticed that the door was open and as I looked in, I saw a man standing near my bed. It appears he was waiting for me while I was away in the group. But who this man was is still a mystery, so I entered my room and asked Ellie to roll me a bit closer on my chair to inquire him on who he was and what he wants. Having asked him a couple of questions, I discovered that he was the hospital chaplain that was on duty within my ward. Though he was a chaplain and his main duty was to provide spiritual guidance, particularly to those of the Christian faith. He assured me that he had no intent in preaching me about the bible, rather he offered himself as a counselor that I could approach anytime If I ever have any problems, in other words, he was being my personal psychologist. I asked him for his name and he responded, "Dennis" We became good friends immediately and would often bump into each other in the hallways.

After my encounter with the chaplain, I realized that there were many ways to stay socially engaged in hospitals without always having to go to certain therapy groups. I could remain socially active by chatting with just anybody. Dennis the chaplain was a good example of a person that I could rely on if I have any problems. So I advise any current inpatient that are reading this to get in touch with their chaplain/ psychologist on duty in the hospital to talk away all your concerns. Another benefit of being in touch with the chaplain or psychologist is that they also serve as an occupational therapist. A lot of times when you meet them, they would give you tests to evaluate your cognitive function just like in occupational therapy. I remembered one of our meetings where Dennis offered me for lunch outside of the hospital but I have to be the one who plans the transportation to get to the restaurant and make an estimation on how much money will be needed to eat at a particular place. He also asked me to remember what we do on that day and be able to report it to my occupational therapist, Jescinta the next day during my OT session with her.

Another good reason to get in touch with the hospital chaplain is that you have someone to play games with when no one else is available. I've done this many times with father Dennis as we casually meet up at the guest lounge of the hospital with other nurses or patients and play a game of Uno or chess or blackjack. Not only is it fun but it also provides a sense of escape from the dull and yet sad reality of being stuck in the hospital. Another thing that we can learn from being engaged with the chaplain, psychologist or any other members of the hospital staff is that they can give you insight on how to better recover yourself and excel yourself in all your therapies to accomplish your discharge criteria much faster. Since they have dealt with multiple patients n the past, they are more likely to know better the right kind of habit or attitude that will lead to a better recovery.

Father Denis told me that the best discharge criteria for a brain injury patient are always independence, being able to do things on your own and taking care of yourself. Once you're able to do all this, they'll let you out of the ward since the main goal of rehab is to return you to a normal life without any assistance just like when you were healthy. If you must, you should take all your medication by yourself without asking to show the doctors and nurses that you know your routine a be able to do things independently. The same goes for hygiene, patients should at least be able to carry themselves into the bathroom and shower themselves. This task may be easy for patents without any motoric disabilities but for those who have such problems, it's best to use a showering chair that you can sit on while you're showering.

Another advice that father Dennis has given me is to take frequent excursions on your own and come back. If you're able to able to achieve this then it shows you are capable of navigating the outside world unassisted. This also proves you are able to find your direction, something that most brain injury patients find difficult especially when they have a lack of spatial awareness. It's also best that patients engage in other daily activities such as shopping, paying taxes, planning an event or meeting and etc. These are all activities that require the brain to plan and process information. Engaging on these activities more often will speed up the brain towards homeostasis, the new state of normal for the brain.                                                                             

Dysarthria group

From reading the title of this post, I'm pretty sure that many of you have no idea on what dysarthria is. To put it simply, it is the inability to normally articulate clear speech. In other words, people having difficulty explaining things due to them always slurring what they explain. This is very common amongst patients that have brain injuries as they often end up with facial paralysis that weakens muscles used for communicating. This leaves some patients frustrated as they aren't able to talk like they used to. However such effects after a stroke especially dysarthria tend to get better with time and practice as long as patents keep on improving their speech.

One of the ways that patients can practice their speech is through dysarthria groups, which are essentially where patients with the same speech problems meet up to talk about something they like or to practice learning to talk together using programmed speech exercises. An example of these exercises includes breathing techniques to train our diaphragms to expand and contract to synthesize speech. Patients are asked to both inhale and exhale their breath during this exercise and take notice of how their diaphragms move when they are breathing. When we inhale the lung expands and the diaphragms push downwards t allow the lungs t increase its size to hold the air in. When we exhale, our lungs will contract and the diaphragms would contract as well pushing the lungs upwards to push out all the air. it's at this moment of exhalation that we use the escaping air from the lungs to form our voice and create speech. In most breathing exercises, patients are often asked to mirror each other to see if they have followed the right breathing steps needed to talk and to correct one another if they made a mistake.

In some cases, patients are asked to make an "aaaaa" sound when they exhale to strengthen their vocal cords so that they can amplify their voice volume much better when they talk or that they are asked to take a deep breath before reading a small text on a piece of paper or book. These exercises help improve not only speech but also reading comprehension, which is essential for someone experiencing aphasia. So to anyone out there who have slurred speech and difficulty reading or articulating a coherent conversation then this group is for you. If you've never been to a dysarthria group before then it's best that you prepare yourself by having a topic prepared that you could talk to your mates during the meetup. Some topic suggestions would be on your favorite hobbies, food, vacation destinations, and even movies or TV shows. As previously discussed in my last post, I went into the city to watch Doctor Strange with my mum. This excursion can be used as a topic of discussion that you can ask your friends at the group about. therefore it would be beneficial if you prepare yourself with some topic before coming in.

Besides improving speech, these groups also build a support community for those facing depression after an injury. most of the time you re free to express your problems and worries to anyone at the group, one of the best way to get your problems or feelings of anxiety of your chest. This helps build bonds between you and your friends at the group and you won't feel alone afterward. The group also prepares you for the real world when you are fully discharged from the hospital and back to society. Your new friends in this group can role play as your relatives so you can practice what you'd like to say to them when you actually see them. If you're a business orientated person, the group gives you the chance for networking and you can add new people in your business contacts that you can use to further expand your business activities once you're out. Some of the greatest friendships or business partnerships happen in the most unlikely places, so why not give it a go?

Dysarthria group is also a great way for entertainment if you're always stuck in your room with no one to talk to or play games with then the group offers you the chance to do so. Most of the time, patients are allowed to bring board games or cards that they could play with the other patients, an example would be Blackjack, UNO, and cards against humanity. Chess is also another great game for patients as it trains them to think ahead of what will happen and to devise a strategy to defeat the opponent. You could say that chess is the perfect brain game for those willing to improve their cognitive planning skills, something that not a lot of patients could do after a brain injury so chess can help train these skills.                                                                     

Patron hero of disability

On an early Saturday in the month of November, I woke up inside my room with a lot of joy and eagerness as it was on this day that the hospital had finally given me a chance for a day leave with my mother to go outside of the hospital grounds and into the city to do whatever we wanted to do. By this time I had already changed roommates for the fifth time and the fifth one wasn't as social as the first one so it was good timing to leave the room and explore the city. My mother and I opted to go to Fremantle to visit the Hoyts cinema to watch a movie that I had long waited for, "Dr. Srange", A Marvel superhero that tells the story of an arrogant Neurosurgeon by the name of Stephen strange who became master of the mystic arts and a powerful member of the Avengers after an accident that left his hands crippled rendering him useless with his job as a neurosurgeon and soon loses his career. One day a man told him that his cure lies at a place in the Himalayas called Kamar TaJ, a place where travelers go to to to find both healing and spiritual enlightenment. 

Desperate for a full recovery, Strange heads off to the Himalayas in search of this place. Sure enough, he finds it and embarks on a spiritual journey of both self-discovery and enlightenment. Upon arriving he was greeted by Mordo, A member of the Society who was living in Kamar Taj and a disciple of The ancient one, The spiritual guru who promises Strange that he could get his hands back if he follows the teachings of the ancient one. To Strange's surprise, the ancient one was a bald woman in robes of white. She approached him and gave Strange a brief summary of the program that he is going to do with her. The teachings are somewhat contradictory to what he had learned n medical school as the teachings of the ancient one is mostly about the mind, the power of belief, suggestions, chakras, energy healing, the soul, and manipulation of reality. To a surgeon like Strange, this all sounds like superstitious pseudoscience mumbo jumbo. He quickly rejects the teachings and walked away from the ancient one. Before he could do so the ancient one hit strange with her fist and Strange's Astral body was thrown out of his physical body and he traveled across the multiverse seeing a plethora of different form of beings and places that exists in other dimensions.

After the experience, he was convinced that her teachings are true and had the potential to fix his disabilities. Over the next few weeks, and months Strange was taught how to manipulate energy from around him to move objects, create weapons out of thin air and teleport to places through opening extradimensional gateways to access other multiverses. All of these feats have been accomplished by  Strange, which made him powerful at the end of the movie and was able to defeat the antagonist, Kaecilius and Dormammu, dark entity living in the dark dimension. Despite his victory over the villains he was still paralyzed in both of his hands. Nearing the end of the Movie the ancient one told Strange that his healing lies in his choice on how he wants to heal himself, either through the standard medical treatment or using his mind to channel his beliefs into his hands and recover them by faith.

Strange eventually chose the second option and uses his mind to slowly recover the severed nerves in his hands. The movie teaches us that the mind is very powerful and has the capacity to shape who we are and the realities we perceive on a daily basis. At some point, it can even affect our physical bodies and the environment around us, surprisingly there is even a metaphysical term or this phenomenon, it's called the law of attraction, meaning we become what we believe and receive what we desire most in both our thoughts and emotions. As the great French philosopher, Renee de carte once said, "I think, therefore I am" This lesson is even taught in the Bible with Jesus's parable of words turning to flesh meaning being mindful of what we say or think as it might just happen.

Both the metaphysical and moral lesson of this superhero movie can be applied in real life for most patients with disabilities especially those with brain injuries. The movie is a reminder to all of us that the mind goes beyond the limits of the physical a that our brains are nothing more but vessels that houses our very thoughts. If we are mindful of this lesson and fully tune in into our recovery with not only positive thinking but a strong belief of recovery, then complete healing can indeed take place. Just remember the advice that I've mentioned i "Tips on stroke recovery" What we imagine or believe shapes the neurons in our brains as if we are doing what we imagine.

Another great lesson that we can derive from this movie is the transformative power of tragedy and the beauty of failure. It's not only after the accident which severed Strange's nerves that he could find the drive to search for a cure and ultimately gain something else as an addition which made him more than the average new yorker or humans like you and I. The movie is also a reminder of the importance of time and how to use it wisely. During the fight scenes, the ancient one finally dies from a falling injury. Before she died, she told Strange that she had always believed in him and that he was capable of accomplishing great things not because he was a qualified and experienced surgeon but because he believed in himself. we are also reminded in this movie that time is short it goes by fast when you least expect it, especially with a brain injury from a stroke, all those precious seconds are stolen from you and it will never be retrieved again so you have to appreciate the little things in life and make use of our time wisely as not to waste it.                                                                                   

Books to read and videos to watch

As previously discussed in my last post. I spend the majority o my free time at the hospital reading informative nonfiction books regarding neuroscience and applied neuropsychology as means of not only occupying my time to escape the boredom in my room but also to engage my brain with processing information. I would recommend all patients in the hospital to do the same and be proactive in using the grey matter in their brain. This post will be dedicated to discussing the list of books, videos, and websites for those with brain injuries.

List of neuroscience books to read:

• The brain's way of healing:  Written by Norman Doidge, a Canadian Neuropsychiatrist. This book is a collection of real-life cases of people that have overcome some of their mental and physical disabilities through a rigorous form of self-training and therapies that are both conventional and non-conventional. The chapter starts off with a man by the name of John pepper who regained his lost movements from Parkinson's disease with a form of conscious movement that he developed by always being conscious of where limbs are in space. Other cases include the application of the Feldenkrais method that was developed by an Israeli engineer and physicist, Moshe Feldenkrais which promotes reconnection between the brain and body to improve movement and overall mental wellbeing. 
• The brain that changes itself: Written by Norman Doidge as well, this book is similar to the one mentioned above but focusing more on the biological mechanism of how certain therapies work and how certain neurological illnesses affect the body. This book may be a little it more complicated to understand as a lot of scientific jargons will be used to describe the cases that are mentioned in this book. Best to read this book slowly and take down some notes on scientific terms and concepts that are hard to comprehend, so you can research them later to better understand
• The body keeps the score: A comprehensive guide written by Bessel Van der Kolk on how trauma is stored in both the brain and body and how one can make use of their biology to turn off its negative effects and to maintain and develop a healthy mental state afterward. Some cases that are mentioned in this book also describes the treatments that are applied to resolve the issues. Some treatments that are mentioned include the following: Neurofeedback, EMDR therapy, Yoga and acting.

List TED talks on Neuroscience to watch:

• You can grow new brain cells, here's how: An informative TED talk delivered by neuroscientist Sandrine Thurette on the biological mechanism of Neurogenesis, the brain's natural ability to grow new cells. The talks also discuss the importance of maintaining a healthy lifestyle and diet which all play a contributive role in fostering cell growth. Link: 
• The brain changing benefits of exercise: This talk discusses the healing capabilities and benefits of physical exercise on the brain as well as how exercise plays a role in determining the quality of recovery after a brain injury.
• One more reason to get a good night's sleep: A talk that discusses the important role of sleep in memory consolidation and recovery.
• Power foods for the brain: Discussing the role of diet in shaping our brains ad how they function with a comparative example of how bad diet leads to the development of certain brain diseases such as Alzheimer's.
• The brain may be able to repair itself: A Swiss neurosurgeon delivers a talk on some methods to improve a patient's well being and overall function after surgery or trauma to the brain. The methods mentioned include deep brain stimulation and implantation of cultured stem cell.  

Lst of brain training sites:

• Jetpunk: A quiz website on general knowledge and logical reasoning
• Lumosity: A brain training website that is specially designed to test the brain's neuroplastic capability in terms of memory, planning, and reaction.
• Sudoku: A number games website that tests your reasoning with arranging numbers.