How to Recover: Comebacks from Traumatic Brain Injury

Patients' Approach to Specialists

2009-06-12T12:41:00.006+12:00

A friend recently emailed to me this New York Times article. The final section on How Patients Can Help is right up my alley and I wanted to blog here about it!

The article refers to a few key concepts, some of which I've blogged about before: having lists of questions when seeing specialists, turning up to appointments with at least two people and being (very) familiar with one's condition. The article does warn about "oversearch", but I think that's less of a problem if one keeps in mind that one's own case may always differ from others.

I hope my readers enjoy the article.

Cheers,
Mike

Managing Brain Lock

2009-05-22T21:51:00.000+12:00

In the post, Brain Lock, I described one particular problem I have where I get something in my head and set about doing it... no matter what. In spite of me being aware that I occasionally suffer it, I continue to experience it. Most recently, it happened at work when I continued to (somewhat publicly) argue about a point in spite of it becoming quite disruptive for my team.

Although we ended up with the problem resolved, I was embarassed about the way we got there - good ol' brain lock was at it, again. So, to try and avoid future episodes, I went back to the drawing board once more to reflect on ways to manage this problem. I've thought of a couple that, as yet, are untested. That is, I don't really know if they'll really work. Nevertheless, I wanted to blog about them now so my readers can see an example of a thought process I go through when managing through such problems.

I decided that, in times of brain lock (and perhaps at all times), the best thing is to focus on end-outcomes. What is my end-goal for this situation? What do I want to walk away having achieved? What is the best way to achieve it?

Of course, there's still the problem of knowing when I'm in danger of becoming brain-locked (and, therefore, in need of thinking about alternative methods to achieve end-goals). Here, I'm still a little unsure, but think that the best way of knowing this is to always reflect on one thing: how many times have I raised this issue? How long has it been since I reflected on my end-goal and alternative methods of achieving this?

I'm not too sure if this will work (particularly, my method of trying to realise when I'm at risk of brain-lock), but there you go. I will continue to think about it and revisit it, if I still have problems with brain lock.

Cheers,
Mike

As Good as It Gets

2009-05-17T13:14:00.003+12:00

One recovery idea that I occasionally come across is the concern that, maybe, this is as good as it gets. This is a very understandable thing to worry about. Indeed, this is the very idea that a character with an obsessive-compulsive disorder played by Jack Nicohson battled against in a recent film of the same name. I find myself occasionally wondering about it, too.

A brain injury can cause all sorts of problems, problems that require such a different approach to things that used to be so easy, One can start to feel these problems are insurmountable; feel like there's no way "back to" the way you were before; there are no more improvements to be had. Basically, one can worry that this is as good as it gets!

I don't know about obsessive-compulsive disorder, but I do know a little of recovery from traumatic brain injury. While understandable, I think it a very dangerous thing to worry about. The brain is an immensely adaptable piece of equipment. Worrying that things won't get better almost flatly assumes the brain won't learn how to work around whatever problems it comes across. In my humble opinion, assuming that is almost as bad as ruling it out from ever happening. That is, if you want to learn to recover, start by believing that you are actually able to recover.

Yet, feeling this is as good as it gets is still very understandable; when I start thinking it, what do I do about it? Simple, I do my best to keep in mind specific areas of progress I have made, specific times when my brain has learnt about how to work around things. With that, I can convince myself that my brain can work around things. This is definitely not as good as it gets!

Cheers,
Mike

Having Faith I Will Figure It Out

2009-04-11T21:15:00.002+12:00

In my most recent post, I talked about how I've relearnt heaps just by retrying an activity. I talked about trying to relearn it enough just to enjoy it again. Part of what guides me in that is having faith I will figure it out.

Of course, my injury has affected what I can do. I know what I enjoyed before my accident; unfortunately, I can't do all of it in the way I used to. I get into it, but it (very) frustrating as I often feel I'm starting from the beginning.

I can't give up hope, though. I try and think hard about what, specifically, I enjoyed about doing it. What will I need to relearn to start enjoying it that way again? Often, my constraints from my injury will mean I need to adopt a new approach. Is there an approach that will still allow me to enjoy the activity as I used to?

I guess, once again, my running's a good example of this. Like I said in my last post, I got into it, but then found improvements tailed off. It became more and more frustrating not feeling like I was making any sort of progress with it. What kept me going was having faith that, sooner or later, I would work it out.

I thought hard about what I needed to enjoy it: it wasn't the speed; it wasn't the hills or the views; it was the endorphins. Running properly was important to get those. In the end, I had to get some expert advice to help me do that from a physiotherapist who specialised in brain injury and running.

It's been quite a journey and, although not over yet, one big help along the way has been the faith that, eventually, I'd figure it out.

Cheers,
Mike

Get Into It!

2009-04-11T19:44:00.003+12:00

It's been awhile, sorry guys. I hope everyones' recoveries have been progressing well! As I said in my post before Christmas '08, I've been thinking about a whole bunch of things on TBI recovery. Unfortunately, I've had a bit of trouble finding time to write about them. Apologies and please wish me luck for finding more time to write from here on.

I'm restarting posting with something relatively simple, Get Into It! Much of the progress I've made in a whole range of activities is due to one thing: just getting back into it.

For the great majority of things, even when I can do them properly, I can't do them nearly as well as I used to before my accident. I need to relearn them and, basically, I want to relearn them enough to enjoy doing them again. If I restart doing it at whatever level, that doesn't normally take too long.

It doesn't matter to me whether I enjoy it less than I used to. Of course, it's frustrating to have to restart learning it again, but only one thing's important to me, am I still enjoying it at some level or other? Maybe I'll one day have my old level of enjoyment back, but, right now, do I still like to do it?

Sometimes, I'll restart something, but have real trouble relearning it. That's when it becomes more important to find the right people to talk to. There must be someone around who can help me with whatever I want to relearn. It's just a matter of finding out who that is.

The best example I have that sets all of this out is my running. I had loved this before my accident; popping out somewhere interesting for a few hours' hard running; the views. the feeling of drive during it, the endorphins afterwards, it was a great feeling. My running afterwards was much less so.

Yet, I got into it and was making progress relearning it. Eventually, however, I stopped making progress and had real trouble with it. In the end, I saw a physiotherapist who specialises in brain injury and running. He made all the difference, improving my form out of all sight.

Even now, though, I'm not sure I enjoy it as much as I used to, but I love it enough to back out doing it again.

Cheers,
Mike

Merry Christmas to You All!

2008-12-23T14:41:00.001+13:00

It's been a long while sine my last post. Obviously, I've been suffering something like the problem I described in it, Brain Lock.

There is more coming, though. My recovery certainly isn't over, yet, and I continue to find out things I'd like to share with you. Perhaps it's a sign that things are going well, though - I lack time to properly write.

Anyway, I will get around to it. In the mean time, I wish my readers a great Christmas and a happy New Year. To all those recovering from brain injury, whatever '08 was like, I wish you a much improved '09!

Seasons Greetings,
Mike

Brain Lock

2008-09-28T16:21:00.003+13:00

I've had another issue that has occasionally cropped up since my TBI. I get something in my head and set about doing it... no matter what! Indeed, I discussed one occurence of it in Mike's Regrets; almost getting another TBI by trying to body-surf dumping waves at a surf beach I went to.

Quite suddenly, I become much less aware of any factors indicating that what I'm doing isn't the best approach. Something else happens, something new crops up, but I just seem to ignore it. It's as if my brain isn't flexible enough to cope with the changing situation. It doesn't happen that often - normally my brain operates more or less as it used to. When it does happen, though, I describe it as brain lock.

For me, brain lock is almost as if I simply forget to think about other stuff. I become focused on the task at hand; on doing (or saying or being) whatever it was I had intended to do. And I seem to ignore everything else, no matter how relevant.

As I've written before on this blog, I can be very determined about stuff when I want to be, but this is different. When I'm being determined about something, I do my best to take in all relevant aspects of ths situation. When I've got brain lock, it's as if I'm simply ignoring everything else. Brain lock seems a great way of describing my problem.

I have yet to come up with a full-proof way of dealing with my episodes of brain lock. I hope that it will be at least a little easier if I'm aware that sometimes I do it. As I get more experienced with the new me, I hope that I'll become better at knowing when I might get brain lock.

I don't know if every TBI recoveree suffers from brain lock, but suspect it might be quite common. Whether it is or isn't, though, I write about it here to give readers a better idea of the sorts of problems they might face. I do believe nearly every TBI problem can be solved, or at least substantially helped, with a bit of careful, thorough thinking and problem solving. I hope this one isn't any different.

Cheers,
Mike

P.S. I've now added a post about Managing Brain Lock

Another Approach to Therapy - Learning to Sing

2008-09-20T10:23:00.004+12:00

I've always had a loud, deep voice, but it's become noticeably more raspy since my accident. I've also lost some control over my volume and pitch. Speech language therapy I had early on seemed to give me little relief. Part of that (perhaps a large part!) was that I found the exercises difficult to keep doing because I had trouble applying them in practice.

I'd been conscious my voice still needed work, though, and eventually I came across another way. I've started singing lessons. My singing instructor certainly doesn't have a speech therapy background. She was quite surprised when I explained my plans and hopes with my learning to sing, but we started lessons anyway.

I noticed an immediate improvement in the quality of my voice and I feel there is big potential for further progress. Singing allows me to practice using my full vocal range. As well as that, by it's very nature, singing well involves a much greater need for control over one's voice (compared to speaking). Perhaps because of the way our brains are wired, it's easier to hear when I'm not singing well compared to when I'm not speaking well. So it's easier to feel like I'm making progress.

I don't propose that learning to sing will work for everyone. Instead, I write about this here to discuss the value of thinking outside the box to help TBI recovery. Think about what it is you want to achieve. How have you been working on it so far and how has that been going? What other things, what completely new approaches, might help you out?

Cheers,
Mike

Keeping At It!

2008-09-13T18:55:00.003+12:00

In the post, Breaking the 40 Hour Week Barrier, I showed an Excel graph of my return to a 40 hour week. I guess I'm fairly unusual and not everyone wants to get back to work as badly as me. Whatever your goal is, though, the message is, pay close attention to the progress you're making towards it.

I've often described how TBI recovery takes time! Sometimes it seems so slow, it's extraordinarily frustrating. I've learnt, though, if I pay close attention to what I'm working towards, I might well find I'm still making progress. It might not be happening fast, but, if I keep a record, I can see it's still happening.

Whatever my goal is, even when it's something funny, like talking properly again, I do my best to figure out a way to measure my progress towards it. There's no need to make some fancy graph, just to find some way to measure my progress. For example. to work on my voice, I might well try recording my voice at various points in time and, particularly when I'm feeling down, go back to earlier recordings to listen to my progress.

So I feel better if progress is being made. If no progress is happening, I still don't feel bad. I just think about new approaches. What else could I be doing to improve? Keeping track of my progress is a great way to keep my motivation up, to keep pushing forward.

Cheers,
Mike

P.S. For those interested in my experiences working on my voice, please have a read of my post, Another Approach to Therapy - Learning to Sing.

Tranquilo

2008-09-07T14:04:00.002+12:00

I know a bit of Spanish and one of my favourite words is, tranquilo, which basically means, calm or be calm. I've always been someone who tends to get a little wound up at times, so, as I go about life, I regularly need to remember, tranquilo. Here, though, I want to write about how I think the word's also good for my recovery.

A brain injury often means the brain won't work well. As well as that, it often won't work well in surprising ways; in ways you wouldn't expect. One of the ways my brain, post-injury, doesn't work so well (and I suspect this is quite common) is that it won't quite follow what's happening in social situations fast enough.

Often, I find myself thinking, why did he say that, what will it mean if he does that, or, I'm not even sure what he's talking about. I've come to realise, though, the need for tranquilo; the need to remain calm, to stop and think through what's going on; to wait until things become clearer. Before I realised that need, I would quickly interrupt a situation to clarify what was being said. Then I'd be a little embarassed when that was obvious to everyone else in the room.

If, like me, you're quite an active person, it is a real issue not being active, waiting for clarification to come rather naturally than asking for it, directly. I've found that (not for the first time :-) TBI recovery does require a whole new approach, though: the approach of being tranquilo.

Cheers,
Mike

Making Steps Manageable

2008-08-24T21:50:00.001+12:00

In my post, Small Steps, I described how a close friend and I regularly talk about breaking our recoveries into small steps; each step building on the last, but none building too far. In the post, Mike's World Tour, I described how I took a month-long trip from New Zealand to South East Asia to see how capable I was to travel. I did this before taking a year long world trip while I waited for my brain injury fatigue to reduce enough for me to work better.

My friend and I have an ongoing debate about whether this month long trip was a small step. I admit that, from the outside, it looks a fairly massive thing to take on. Yet I still argue strongly that it was a small step. I do so because it was very manageable.

It was manageable because I had a reasonably clear idea of what the difficult areas would be for me: coping with fatigue, coping with lots of very unusual situations. It is true that, although I had a clear idea of what the problems might be, I didn't know how big they might be. But, if my "small step" had gone badly, it wouldn't have been the end of the world. I was on a tour and could have holed up in my tour bus and hotel rooms and got through any big problems. In addition, I was lucky enough to have members of my family along with me to help me out if any one situation went wrong. In the end, though, my "small step" went well and I got enough confidance to embark on my longer trip.

I guess, to me at least, that's the true definition of a small step, It's small because I've made it manageable. I know the issues will likely be and, if things go wrong, it won't be the end of the world.

Cheers,
Mike

Small Steps

2008-08-24T21:23:00.006+12:00

I have a close friend who's also a recoveree. She's recovering from various issues related to depression. That sort of recovery is no less is a long road than a recovery from TBI. As we go through our recoveries, one thing her and I often talk about is the need to break recovery into small steps; each step builds on the one before, but none builds too far!

We both think about where we'd like to end up and then break that goal into a series of small steps to get us there. Each step is taken with a very clear structure in mind if things go wrong. When you're taking small steps, it doesn't matter so much if you have to take a step back down.

Of the many things I've become able to do using small steps, probably the best demonstration of it is my return to full-time work. My goal was always to work full-time as a competition economist and my Occupational Therapist helped me break this into small steps. I took on a support role, doing a few hours a week of background work supporting other competition economists. I gradually built up my hours and the pressure I faced until, finally, I was once again working fulltime as a competition economist. As the graph in this post shows, it wasn't a fast process, but I did, in the end, get there.

In many ways, my slow progression just happened naturally. I would handle one bit of work ok and then accept a little bit more. I initially found stress difficult to handle, but, by increasing is slowly and with supports in place should I find any one bit too much, I gradually became accustomed to it.

Having a process in place to gradually become accustomed to things is key. Nothing should be rushed! Everything should be in small steps!

Cheers,
Mike

P.S. I've written another post on this topic, Making Steps Manageable.

Unsympathetic Reactions to Brain Injury

2008-07-26T18:40:00.002+12:00

In the post, Sympathetic Reactions to Brain Injury, I described how peoples' reactions to the effects of a brain injury commonly fall into two groups. That post discussed the first and this one the second.

Not all comments that fall into the unsympathetic group are negative. Often, people are just going about their business, see something unusual and comment on it. Assuming I was already drunk (instead, I was well fatigued), a nightclub doorman once stopped me from entering his bar and said, "how many drinks have you had tonight?"

I admit, though, that more negative comments are sometimes made. I once was told (in no uncertain terms) that I shouldn't be using disabled carparking spaces because, to the speaker's eye, I looked completely healthy. I've heard about other recoverees who, for instance, have been berated for not filling out forms at the library quickly and correctly.

It is a strange fact of the human pysche that, for many recoverees (me included), even the more negative comments can be significantly less annoying than the sympathetic comments that I 've described. No matter how negative, though, unsympathetic comments get made because everyday people don't come across brain injury very often at all. They're just not aware of why my brain mightn't work quite right. It's easier for them to just think I'm a bit slow or a bit stupid.

If people react unsympathetically, I think it's pointless blaming them. Instead, I need to think about what I can say to make them see there's more to it than meets the eye. To the nightclub doorman, I can say, "Actually, it's not that I'm drunk, just that I had a bad accident a few years ago and my balance isn't so good now." To the library receptionist, I might say, "Forgive me, but filling in forms isn't one of my strengths. Can you help me out?"

Some have labelled unsympathetic comments with the much maligned word, discrimination. That seems silly to me as I can have so much influence over how people react to stuff about me. Why blames others without first thinking about what I can do to help?

Cheers,
Mike

Sympathetic Reactions to Brain Injury

2008-07-26T18:37:00.001+12:00

Commonly, when people unused to brain injury see the effects of a TBI, their reactions fall in to one of two groups: sympathetic and unsympathetic. This post discusses the first group while (somewhat obviously) the post, Unsympathetic Reactions to Brain Injury, discusses the second.

Ok, sympathetic responses. Other recoverees out there will know what I'm talking about; things like: "You think your memory's bad, you should see mine and I don't even have your excuse of a brain injury!" or "Don't worry about it. I'm always forgetting peoples' names, too." Because of all my fatigue problems following my TBI, this one's my personal favourite: "You're tired? Yeah, I found that day/night/event really tiring, too!"

Such things have been said to me by some of the nicest, most kind-hearted people I know. Yet, at times, I've struggled not to find them incredibly condescending and very annoying. How could such kind things possibly be taken that way? Your brain injury could well be the hardest thing you've ever dealt with (mine is and, hopefully, always will be). The problems mine caused were unlike anything I'd come across before.

They were so different and so hard to deal with, it felt like no one could possibly claim to know what it was like. Comments implying otherwise seemed utterly ludicrous. How could any normal person understand how difficult this is? How can they try to make me feel better when they've got no idea what it's like?

My instant reaction was to grit my teeth and take the statement badly. What I needed was to relax! The person saying it certainly doesn't mean it to cause such anger. They are trying to make it a bit easier, to make the recoveree feel better about their troubles. Most important of all, they say it because they're being sympathetic and they're trying to their best to understand. Of good friends or anyone else, it's difficult to ask for more than that.

I realised this early on, but it still required effort to make myself relax when such things were said. Upon hearing them, I had to remember to think first, what does the speaker understand about brain injury, and then, second, how do they intend I take what they've just said. Making that a habit made it a lot easier to deal with overly-sympathetic reactions.

Cheers,
Mike

Escaping TBI Escapism

2008-07-19T19:46:00.000+12:00

In the post, TBI Escapism, I set out why I think Mike's World Tour wasn't about about escaping my TBI. Yet I talked about how I could understand wanting to run away from it all. How can I understand it, but not have similar desires, myself?

I guess, as you may be picking up, a big chunk of it is the sort of person I am: forever positive and upbeat. That doesn't mean, though, that I entirely avoided having escapist thoughts. When they came on, I guess I was able to focus on what I still had: a reasonable amount of health (that is, at least my accident wasn't worse!), a close and loving family and, yes, something of a life to be had; a life just waiting for me to figure out how best to live it.

I know times can be tough and the mountain looks massive for recoverees to scale. I guess it's almost a given a recoveree will have times when they'll want to run away from it. Thinking about the amount I still had helped get me through times when that feeling came on. It helped me escape TBI escapism!

Cheers,
Mike

TBI Escapism

2008-07-19T19:14:00.004+12:00

TBI Escapism: the desire to get away from one's brain injury, to escape its effects, to have a day when things are 'back to normal' - the way they were before the accident. I have written about the concept before in the post, Wanting to Leave Care. As I said in that post, the feeling is very understandable. Departing on a holiday might seem a way to get a break, to relax, to return and feel better placed to carry on the struggle that is recovery.

Unfortunately with brain injury, though, there ain't no where to hide. Your brain is something you take with you everywhere. There isn't any way you can leave it behind, even for just a few short days.

People might well read about Mike's World Tour and wonder, was it TBI escapism that motivated me to take it. I can assure the reader that it was not. Right from the word, go, I was very conscious of the effects of my brain injury on my travel. That is what made me take a month-long trip first just to see how I got on travelling with the effects of my brain injury. While I was away, of course, I was still recovering, still learning about my new brain worked, still trying to think of ways to make it work better. In that way, Mike's World Tour was very much part of my recovery.

I think there is one main trick for others to take away from this when thinking outside the box: never let go of the brain injury. Always be aware that your brain might not work the same anymore; alternative approaches might be required. But always believe that any TBI problem can be solved, or at least substantially reduced; always believe that you can and should be determined to recover.

Cheers,
Mike

P.S. I've written a bit more on this subject in the post, Escaping TBI Escapism.

The Use of this Blog

2008-07-15T18:37:00.004+12:00

The first thing I want to say here is, with a bit of help from a few valued friends, this blog is my donation to you! You're absolutely welcome to view it, read it and take from it what you will. I ask for neither reward nor compensation for this. Instead, I regard it as the best way for me to repay all those who have helped me along the way and, yes, there have been an incredible number of them. I think I have a lot to repay!

In spite of my motivation of goodwill, I have no wish to see my donation used in any substantial way without my approval. Feel free to pass on my messages, but, please don't republish them or repackage them for consumption by others without asking, first. If you wish to do so, please email me and I should respond promptly.

If you've come to take a look at what I have to say, please feel more than welcome to read on! And make sure you tell your friends and loved ones too!

Cheers,
Mike

Mike's World Tour

2008-07-13T11:29:00.008+12:00

As I explained in the post, Reasons for My Travel, I had become determined to travel. Yet, I was hardly in a state to throw caution to the wind and jump straight in to such a thing. So I invented Mike's World Tour.

The Tour started with a month long trip to the South East Asian countries, Cambodia and Vietnam. I had always wanted to see those places, they were reasonably close to New Zealand and a trip to them was long and difficult enough for me to work out how able I was to cope with my fatigue and other problems related to my brain injury.

Although not quite flawless, that month went extremely well. I managed to work out how to avoid getting truly fatigued and how to avoid many of the traps that can catch out tourists (particularly brain injured tourists :-). I arrived back home and immediately started planning the proper Mike's World Tour.

I had always been tempted by travel to South America and planned out a 7 month spell there before heading to the northern hemisphere to see friends and travel to Spain and Italy. I had a 12 months away, all up. Again, it wasn't quite flawless, but the trip went wonderfully well. I'll write a lot more about it shortly.

I'd been wondering what to call the post label for posts about Mike's World Tour. I decided that there is one thing I most want readers to take away from hearing about my trip. Don't accept that a TBI confines you to anything. Think outside the box!

Cheers,
Mike

Reasons for My Travel

2008-07-13T11:11:00.007+12:00

One part of my graph in the post, Breaking the 40 Hour Week Barrier, has a period of me not working. It is marked out as Mike's World Tour and I want to better explain it here.

Picture my situation: I'd taken one hell of a knock to the head and was busy recuperating in hospital and rehabilitation. I wrote here how so many of my friends had either left or were about to leave my home country of New Zealand on international trips to "see the world". In my state, doing such a thing seemed a dream to me.

Eventually, I recovered enough to leave rehabilitation and return to part-time work. I found part-time work exceptionally frustrating: to be so close to the work I loved, but never quite able to properly get involved; to always be leaving work early; to be less of a help and more of a hindrance to the boss I respected so much.

I was fortunate to have options other than work. Savings from a previous job allowed me to think about following my friends on my own trip to "see the world". And so I came up with Mike's World Tour.

Also, I've written more about a thing that was definitely not a motivation for me to travel, TBI Escapicism.

Cheers,
Mike

Breaking the 40 Hour Week Barrier

2008-07-12T19:19:00.009+12:00

I'll start this post with something that will be fairly obvious: I love my job! Getting myself into a position where I could properly do it has been a focus for me right from the word, go (or maybe the words, severe brain injury :-) !

And by properly doing it, I do mean full time work. The problems with fatigue caused by my brain injury meant, for a long time, all I could manage was part time work: a few hours a day. After my accident, my first week back at work was only three hours long (for the entire week!). I could never enjoy doing my job part-time the same as I had doing it full-time. So my target was always a normal week's work for economic consulting: 40 hours!

It's taken awhile, but, with care and attention (using things like neuro-resting at work), I finally achieved it, three years and a bit years after my accident. It is difficult for me to communicate here how important a milestone this was for me.

I've prepared this graph to celebrate my rise of the phoenix. It sets out the billable hours worked (that is, those hours I could charge someone else for) since my accident, combined with a few important post-accident dates for me.

I think it is this graph that does the best job of setting out the progress I have made coming back since my accident. I've written one more post about it, Reasons for My Travel and Mike's World Tour. I'll also write another discussing the trends in this graph.

Cheers,
Mike

The Plateau and 'Bedding Down' Gains

2008-06-14T18:52:00.003+12:00

I introduced the idea of a plateau in a previous post, Beware the Plateau! I have two reasons for not liking the concept of a plateau: the first I discuss in the post, The Plateau and Switching Activities, and the second here.

The discussion of the Concept of a Plateau under Myth 3 of Debunking Ten Myths of Brain Injury Recovery makes a further point. It's that TBI recovery can be made up of "fits, starts, and bursts, often interspersed with periods of apparently little change, or even falling back."

My sister has spoken to me before about a 'bedding down' period that happens as the brain properly absorbs new information and starts changing behaviour. Obviously, when the brain gets injured, bedding down can take longer. Accordingly, the times of "little change" can just be times of bedding down. Further gains will happen after the ones already made are bedded down.

In my balance example, the bedding down of gains came as I slowly realised that a lack of core strength in my trunk was contributing to my poor balance. What was required to help that was sticking with exercises that improved that strength. The 'bedding down' happened as I realised one cause of my problems and then set about working on specifically on that.

The bedding down of gains makes it dangerous to write off the possibility of more changes just because changes slow down. There is nearly always more scope to recovery, there is always reason to think about how to recover!

Cheers,

Mike

The Plateau and Switching Activities

2008-06-14T18:48:00.003+12:00

I introduced the idea of the plateau in my previous post, Beware the Plateau! I have two reasons for not liking the concept of a plateau: the first is below and the second is in the post, The Plateau and 'Bedding Down' Gains.

So things had been working out well for me in my TBI recovery. When I write about it now, it seems obvious that eventually they wouldn't go quite so well. Somehow, I convinced myself that all that was required was more effort, all I had to do was "stay the course."

So I kept at what I'd been doing. Unfortunately for me, I was caught out by the old adage, you do the same thing, you get the same results. I was trying the same old things long after they'd stopped working, as if I expected them to magically start producing results.

Belatedly, I realised one thing that might help was a new approach, a new way to try and improve my skills at whatever the activity was. Back to my balance example, an alternative way to work on my balance more was to start relearning how to juggle a soccer ball. To juggle a soccer ball, you need to stand well on one leg while using the other to kick the ball in just the right place with just the right amount of force. Your balance must improve.

Ball sports have never been a natural thing for me and, even after heaps of practice, I'm nothing special at juggling. But I am better than I was and, more importantly, my balance is better than it was.

That's consistent with the discussion of Myth 3, the Concept of a Plateau in Debunking Ten Myths of Brain Injury Recovery. It talks about how "energizing environmental events" can lead to sudden leaps forward. Trying something different, getting the brain to think in a different way can cause it to 'wake up' a little bit more!

The discussion suggests, even years later, a new, committed counsellor or more social contact can bring about enough change to break from the plateau.

Cheers,

Mike

Beware the Plateau!

2008-06-14T18:43:00.008+12:00

My TBI recovery went on well for a long time, but eventually I felt like it was reaching a plateau. Suddenly, I started noticing improvements came more and more slowly; I felt I had less and less to look forward to; I found myself wondering how I could keep going with the daily grind of recovering.

I'm trained as an economist and I wondered if the economic concept of diminishing marginal returns had set in. You put the same amount of effort in, but you start getting less and less out.

Worrying about plateaus can relate to many aspects of TBI recovery. The one particular problem that I think best sets out the concept is my balance. My balance wasn't good right from the start of my recovery. I was very lucky not to further injury myself in a fall I had in rehabilitation while relearning how to walk. Even well after properly doing that, my balance was very poor and didn't improve much.

My poor balance eventually resulted in a fall while hiking one day that badly broke my arm, which is one of my regrets. The question was, though, was that the limit of my recovery of balance? Was I always going to have to deal with poor balance? When you're the one doing the recovering, such thoughts are scary, to say the least.

In the majority of TBI cases, the concept of a plateau is not only misleading, it can be downright dangerous. A "plateau" can be used as an excuse by TBI recoverees, by families, even by therapists and specialists to stop making an effort; to slacken off; to "take it easy", when doing so can lead to the recoveree missing out on valuable care.

I discuss two reasons why I don't like the concept of plateau in the posts, The Plateau and Switching Activities and The Plateau and 'Bedding Down' Gains.

Cheers,

Mike

Tipping the Odds in My Favour

2008-06-01T10:06:00.003+12:00

In my post, The Full Court Press, I talked about one approach I take to TBI recovery: if I'm having difficulty understanding a particular problem, I seek out the right specialist or therapist to help me with it. That approach means that, since my recovery from Post Traumatic Amnesia, I've benefited from the help of 22 different specialists, therapists and other trained medical people.

I guess that number might seem a little overboard, but that's not something I'm at all concerned about! Instead, I think of it as one way of tipping the odds in my favour. Tipping them away from my brain injury and its effects and back towards me and my recovery.

In the post, Have Hope!, I wrote about how, early on after my accident, the odds were stacked against me. Instead of being daunted by that, I've always seen it as a reason for taking every advantage I can. Even now, over three years on since my accident, I'm continually looking for ways to do things better. I guess it's part of the determination to recover.

My being determined to recover means I never give up; I never stop believing there's one more thing I could do to help me recover. All I have to do is think of it. Think about what exactly my current problems are and what might help me with them. Think about different ways I might tackle them. You guessed, I'm thinking about how to recover!

Cheers,
Mike

Keeping My Eye On the Ball

2008-06-01T09:16:00.001+12:00

I've written about how, with care and attention, things can slowly come right after a TBI. I'm coming to see how the need for care and attention doesn't really change, though. I've been making good progress with my fatigue and have now managed a working week of 35 hours. Yet, I still need that care and attention. I still need to keep my eye on the ball!

I tried finishing my first week of working 35 hours with a bang! I hung around after work for Friday evening social drinks. And I did so without first neuro-resting. Bad mistake!

I got tired again ... very tired! My old nemesis, long term fatigue, started setting in. That's where where my fatigue builds up and up so that it takes days for my energy levels to recover. Fortunately, I retained enough sense to call it a night about 8pm. I went home and basically collapsed into bed, quickly aware of my mistake. That rapid retreat saved me from bad long term fatigue, but my energy levels were certainly not a 100% during the rest of the weekend.

Yes, my fatigue is a lot better than it was early on, but, no, that I still need to be careful. I still need to wonder if what I'm doing is much outside my new, post-TBI constraints. I still need to keep my eye on the ball!

Cheers,
Mike