What TBI recovery really means

Did these people stop driving because their car got flattened by a tree? I doubt it. They probably went out and got another car… and put this one up for sale.

Lately, I’ve been thinking a lot about the concept of TBI recovery. Some folks claim that there is no recovery from TBI, mild or otherwise, because the brain is unalterably changed and you can’t just go back to the way things were before.

The brain is not unlike a piece of metal, in that respect. Once you bend a piece of metal, you can never get it back to exactly the way it was before it was bent — you can get it back to the same shape, but there will always be a little wrinkle or dent or crook in it that shows you where it was damaged before. The object may be totally serviceable (like the door of my car that got side-swiped by someone who was texting while driving), but no matter how you try to pull out the dent, you’re always going to have some sort of tell-tale sign that something happened before. In my case, the car door is fine, it opens and shuts, but I’ll always have that reminder of the night that someone wasn’t paying attention as they were driving towards me.

Same thing holds true with the brain – once you’re “dinged” you’re dinged. The connections that were once in place aren’t ever going to go back to exactly like they were before. Tough nuts. What’s done is done. Your faculties may be 99% intact, but there will always be that little 1% (at least) that’s a regular reminder that things aren’t working as they once were, and you have to do things a little differently than before.

However — and this is where I differ from the experts who are riding the “no recovery after TBI” hayride to hell — just because certain connections no longer work, doesn’t mean you can’t create whole new connections that do the same thing, only a little differently. Sometimes whole areas of old abilities and ways of being are blown out, and they aren’t coming back to the state they once were. But that doesn’t mean you can’t create new connections in different ways that serve the same purpose, albeit not identical to the way things once were.

Think of TBI as a tornado that smashes the roof of your car and wrecks the roads going out of town. Combine that with a flash flood that washes out parts of the roads, too. Your car is toast. Totaled. An irretrievable loss. Everybody knows that sometimes you can’t repair a road to be exactly like it once was. So what? You take the check the insurance company sends you and you buy another car. You build a new road, you create something different. And sometimes the new road is even better than the old one. Sometimes it’s not, but it still does the trick. The new car might handle differently from your old one. The new road might take you down a longer route and it might be a little bumpier in places, but it will still get you where you’re going.

And you might get to see some different scenery, as well.

I have a theory that many (if not most) people go through some kind of major shift in the course of their lives, which causes them to rethink the routes they’ve been taking from the Point A’s and Point B’s in their lives. Whether it’s a mid-life crisis or a health crisis or an injury or a job loss or a failed marriage or a natural disaster, we all go through something like this at some point in our lives. Some of us have it happen more than once — which is not a sign that we’re total screw-ups, rather that we have even more opportunities to learn and grow and change. Even when the transitions are totally unexpected or seem to come at the “wrong” time of life — a concussion during a high school soccer game, or a car accident on the way to your vacation — they still present us with the chance to change and grow and find out what else we’re capable of doing/achieving.

Recovery from TBI, in my opinion, is no different in nature than recovering from the above “disasters”. And telling ourselves that just because we can’t get back to exactly how we were before, it means we cannot/will not recover…. that’s pretty counterproductive. And when an expert tells you that, well, it’s just ignorant and cruel and seems more like them covering their expert ass, than giving you something to work with.

Ultimately, expert advice aside, we all need to figure out how to live our own lives to the best of our abilities. If we put our whole trust in experts, who are human, we are setting ourselves up for disappointment. What matters most is what we believe about ourselves and what we believe is possible for our lives. Whether we move ourselves on through science or religion or psychology or exercise or will-power or tons of hard, hard work… or all of the above, the bottom line is, there are many ways to progress, to create positive change, and to become more and better than we were before.

It’s a process. It’s all a process. Never let anyone take hope from you, and never let anyone else define you with their own limitations. It’s bad enough that they want to do it, but you don’t have to let them.  So get up and get moving and see what you can do today. (Just make sure you eat right and get plenty of rest in the process.)

NEWS FLASH: Brain injury in high-def with fiber tracking

Amazing – this could be the break we’ve been looking for, in getting people to take TBI/concussion seriously.

U. PITTSBURGH (US) — New imaging technology will allow doctors to clearly see for the first time neural connections broken by traumatic brain injury.

High definition fiber tracking reveals loss of fibers, or connections, on the injured right side (yellow) and the intact, undamaged left side (green). The patient was injured in an ATV accident and lost function in his left leg, arm, and hand. (Credit: Walt Schneider Laboratory)

“Until now, we have had no objective way of identifying how the injury damaged the patient’s brain tissue, predicting how the patient would fare, or planning rehabilitation to maximize the recovery.”

HDFT might be able to provide those answers, says co-senior author Walter Schneider, professor of psychology, who led the team that developed the technology.

Data from sophisticated MRI scanners is processed through computer algorithms to reveal the wiring of the brain in vivid detail and to pinpoint breaks in the cables, called fiber tracts. Each tract contains millions of neuronal connections.

“In our experiments, HDFT has been able to identify disruptions in neural pathways with a clarity that no other method can see,” Schneider says. “With it, we can virtually dissect 40 major fiber tracts in the brain to find damaged areas and quantify the proportion of fibers lost relative to the uninjured side of the brain or to the brains of healthy individuals. Now, we can clearly see breaks and identify which parts of the brain have lost connections.”

http://www.futurity.org/top-stories/brain-injury-in-high-def-with-fiber-tracking/

After the Crash

RIP Sarah Burke (September 3, 1982 – January 19, 2012)

The Concussion Blog had a good post the other day – Action Sports an Issue Too — with a couple of videos that have really haunted me since I watched them.

I’ll show them again here:

There’s some mention at The Concussion Blog about high impact falls and the fencing response (which everyone who plays sports and is concerned about concussion should be aware of), which is good food for thought.

And it really did get me thinking. Because looking at Mr. Huston taking those falls, then lying there for a while and shaking himself off and jumping up to have another “go” at it is exactly the kind of behavior that gets so many of us into trouble.

I’m not sure if it’s the sudden release of glucose into the brain cells, or the whole rushing extended metabolic cascade of concussion that makes those neurons fire like crazy, but there’s something about getting hit on the head — and I hate to say it — that makes you want to go at things even harder. Perhaps it’s an evolutionary development from days of yore when warfare was largely hand-to-hand, and head trauma was just another part of the fight… and if you got hit, you couldn’t just lie there and wait for your opponent to make mincemeat of you. You had to jump back up and go at them even harder than before. Consider the eons of warfare humanity has been embroiled in, practically since the beginning of time. If darwinistic evolution has anything to do with how we’ve evolved as a species, and if the ones who could rebound after a blow to the head and keep fighting to the win, no matter about the dizziness, nausea, blurred vision, light sensitivity, cognitive deficits, poor risk assessment, etc…. and procreate along the way… and if the children inherited the qualities of their warfaring sires… then it makes sense that we would be in the situation we’re in.

‘Cause people have been running around, getting in fights, slugging each other over the head with sharp and blunt objects, and basically, wreaking havoc with the hidden grey matter since before recorded history. And if we as a species are conditioned to bounce back up and head back into the fray, well, then, it makes sense that Nyjah Huston is falling and hitting his head, apparently sustaining obvious concussions in the process (as indicated by the “unnatural position of [his] arms following a concussion. Immediately after moderate forces have been applied to the brainstem”), lying there for a moment or two to collect himself, then hopping up, grabbing his hat and board, and heading back up to the top of the stairs to try again, regardless of the “overt indicator of injury force magnitude and midbrain localization”.

Says Nyjah, “It normally takes that one fall in a trick like that to, thought, ride away and kinda like realize what you have to do to actually land it. And yeah then after that one that I rode away on, the next one was perfect, and it felt so good riding away from it after that battle.” (See the Berrics video at 2:19 to hear the roar of the crowd — which is really what so many of us want, right?) And all the while in the background, a band is playing “Well, you’re gone, you’re gone, you’re gone, you’re gone, you’re gone, you’re gone, you’re gone / But you went on and on and on and on and on and on and on and on…”

And so it goes. We fall, we get hurt — sometimes seriously (whether we know it or not) — but we get back up and run right back into the fray, regardless of possible consequences.

And the crowd cheers.

Because we value “resilient” athletes of all kinds, and we applaud them to no end when they actually succeed at the things they’ve practiced, over and over again. We value “resilient” employees and individuals who can “take a licking and keep on ticking”. We reward people who make sacrifice after sacrifice for the greater good, even when that “greater” isn’t so good. Even when it’s something as transitory and non-essential, like a Saturday afternoon ball game. Not that sports don’t matter – they certainly do. But is the temporary distraction of fans from the humdrum, sometimes uncomfortable facts of their lives as equally important as the long-term health and well-being of the athletes at play?

At what point does entertainment — and that’s what so much of it is for spectators — become more important than the health and safety of the entertainers.

Granted, entertainers and performers of all kinds have a long tradition of taking risks for the enjoyment of the crowds. Think high-wire acts, trapeze artists, bullfighters, bull riders, and people who play with fire to please an audience. In some ways, entertainment and distraction are as vital to human survival as food and air and water. We have to have them, or we wither amidst the constant rigors of the everyday. Something has to keep us going through it all. So, we have our sports and our games and our shows and YouTube and Twitter and so on.

And in watching those games and shows and performances, we learn lessons about what it means to be human, what it means to struggle to overcome adversity, be resilient, and keep on. We get reinforcement for our values, and we cheer on those people who support our values and demonstrate successful practice of the qualities we value most — the ability to take a hit, the ability to jump back up after a particularly hard fall, and get back in the game, not letting anything stop us.

Once upon a time, I was like that. I would get hurt, and I would jump right back into the fray. I wouldn’t take any time off, I would just push myself, no matter what. I would crash — and sometimes burn — but I’d be back eventually. Before anyone even really noticed I was down for the count. And I kept getting hurt. Like Nyjah Huston, I would lay low for a short while, then gather myself and plunge right back in. I kept recovering as best I could, then rush back into the action — in sports as well as in life. Knocked down and way woozy for a while? No problem. Just prop me up and turn me loose again. Smashed up in a car accident and unable to read with comprehension or understand what people were saying to me? No worries. Just give me a few days and a job change, and I’ll be right as rain before you know it. Went down a flight of stairs and smacked my head hard and can’t talk or think straight? Forget taking some time out. Let’s just get going — and move even faster than before.

That was pretty much the story of my life until 2007, when I started to notice that things were falling apart, and I didn’t understand why. Then it all caught up with me. And the rest is history. Here I am, working at rebuilding my life as best I can — and finding ways to do even better than rebuild — to actually build from the ground up, in so many ways.

In a way, what I’m doing now is a long, protracted rebound from the extended fall(s) I took over the course of my life. And this time I’m doing it a lot better than ever before.

Because I’m taking time off. Not 100% out-of-commission time off, but I’m stepping back from the crazy rush of everything, moving at a more sensible pace, and I’m not letting everyone else drive my action. It’s been an incredibly difficult change to make, but it totally makes sense for me. It’s a shift away from the reactive to the active, a move away from letting others define me and my life goals, and going with my gut — what I want and need, not what other people tell me I want and need. I’m not pushing to reach some brass ring that’s forever out of reach. I’m backing off… being more introspective about my approach… and giving myself time to come up with answers that make sense to me, not just the rest of the world.

It’s an entire life change, which hasn’t been easy. But it’s been necessary. And long overdue.

After the crash, when you take a hard hit, it can be a really good idea to step back, reassess, and only return to play after getting to a place where you’re truly good to go. If you got injured pretty badly, it may take some time to get back to that place, but you’ve got to resist the temptation to race right back into the fray without giving your body and mind some time to recover. If you take time off, you may actually figure out if you’re hurt, and how badly, and what you need to do to get back into decent working condition. But you’ve got to give yourself a chance to catch up with yourself. You’ve gotta be smart and self-defensive, not succumb to the pressure of the cheering crowds which can push you out into dangerous situations all over again.

Now, you can’t just sit out indefinitely, losing your conditioning and your abilities by being over-protective. And you can’t run away from the urgings of others, who may actually see things in you that you don’t see in yourself. That’s another danger that’s very real and present, and I’ve seen a lot of people pass up great opportunities in life because they were afraid they weren’t ready or up to it. At some point, you’ve got to find it in yourself to move on and act on opportunities as they arise, provided you’re up to it.

If you don’t, then brain injury has taken over your life, and you’re a hostage for as long as you let your fears dictate your future.

Now for the disclaimer: For brain injury survivors, self-assessment and accurately gauging the levels of your abilities can be extremely difficult, if not impossible. So, you may find yourself in “interesting times” as the Chinese phrase it, with all hell breaking loose, thanks to disconnects in your abilities vs. interests. It can be helpful to have the input of others who are realistic as well as supportive. Indeed, taking steps to get back in the game may in fact reveal that you’re better off not getting back in the particular game you want to rejoin. Self-reflection and objective observation of real feedback about your life and your abilities may show that you should find a different game — metaphorically choosing tennis or golf, instead of ice hockey or football. Whatever you find and whatever you choose, the important thing is to not get STUCK in one place, and to NOT GIVE UP trying to find a different way. The brain is a big place with tremendous plasticity. And history has shown that even significantly injured individuals have recovered and developed abilities that nobody expected or realized they had.

It’s a balance. And it’s a very hard balance to strike.  Especially after the crash, when your brain is telling you go-go-go… not necessarily for any particular reason, just to GO… and the rest of the world is cheering you on, urging you to get up, dust yourself off, and jump back in the action ASAP.

So, how DO I tell if I’m hurt?

I’ve been taking it easy, the past few days, trying to settle my nerves after that last fall. It was more like a slip-and-collapse than a fall, really. I think I did the right thing by just letting myself go down, instead of trying to break my fall. Still, I did hit my head, and I’ve been a little “off” ever since.

I really think it’s just nerves. Anxiety fiddling with my head. I’ve been a little uncoordinated, a bit edgy, and I haven’t felt quite like myself. But I’ve been working like a crazy person, lately, putting in super long hours, and that’s got to have an effect on me.

It couldn’t ALL be the fall.

Anyway, it’s been a challenge, figuring out whether the problems I’ve been having have been because I really got hurt, or I just got scared. The aches and pains and bruises on my arm are clearing up, but I still have this painful knot on the side of my head that bothers me when I touch it. I try not to touch it, but I also like to check in and see how it’s doing. I expected it to go down sooner, but it’s still bothering me, still feels tender.

I see my neuropsych tomorrow. They may be able to tell me something about that. Or not. They’re not a doctor, after all.

This is the big problem (for me, anyway) with head injuries — how do I tell which of my problems are neurological, and which are psychological, and which are physiological? I’ve definitely been “off” since the fall, and I think it may have plenty to do with anxiety, nerves, being worried about getting hurt. And also feeling stupid about falling in the first place.

Then there’s the physical problems — being off balance because I wrenched my shoulder and neck, and my muscles are not balance the way they usually are.

Then there’s the psychological stuff, the anxiety and nerves. The sick sinking feeling of helplessness as that slow-motion action happens and I can’t stop myself — or things happen so fast, I don’t have time to stop myself. Sense of helplessness. Loss of control.

Well, I’m tired. I need to go to bed. I try not to think about it too much, but what if I’m actually hurt?

Ow

This gets worse at night – the knot on the side of my head, the ache in my neck, the tightness in my shoulders.

The one good thing is, I feel like sleeping.

Thank heaven for small favors.

dealing with behavioral health issues from closed head injury

A usually mild-mannered driver, suddenly not.

• tbi and road rage
• tbi and adrenalin
• dealing with behavioral health issues from closed head injury
• mental disordes from brain injury
• restoration of self after traumatic brain injury
• overcome concussion
• stress effecting performance
• can avoidance emotinal numbing ptsd symptoms end a relationship?
• self part of brain
• tbi anger

So far today, 17 people have searched on these combinations of words — 5 of them about road rage. And it’s early, yet.

I wish I could see the time of day people are searching – I suspect it’s late at night, after everyone has gone to bed. They are thinking back on their day and the close call(s) they had while they were driving, wondering if their freak-outs had anything to do with their head injuries/concussions. Maybe they were going to work. Maybe they were coming back from work. All they know is, they flipped out and almost lost it behind the wheel of the car.

While it was happening, it felt so normal, it felt so right, it felt so justified.

But after the dust has settled, and they look back on the incident from a distance (and after a good meal), they realize that their reaction was wildly out of proportion to what actually happened. Somebody cut them off once too often. Somebody else wasn’t paying attention and did something bone-headed. And they could have killed them. Literally.

Is a stupid-ass move on the interstate worth pulling hard jail time?

You be the judge.

Anyway, yeah… behavioral health issues from closed head injury… When I think about it, the real problem factor is the “closed” aspect — in part, because a closed head injury isn’t obvious, like a broken leg dangling limply, or a ragged gash across the face. It’s hidden — from everyone — and it’s damned hard to manage. Believe me. Closed head injury is no piece of cake, especially for the survivor. Our brains can be pretty convinced they’re right, when they are anything but. And no one can tell us anything, because we’re so convinced that this right feeling is a right being. It’s not, but we often don’t realize it till much later.

And after the damage is done.

There’s another “closed” part of the troubled TBI dynamic that’s problematic, too — the closed minds of people all around us. The people who either make up their minds that you’re deficient and damaged and you’re not going to get any better… or the people who are closed to the idea that you need to do things differently in your life, like get to bed at a decent hour or have a conversation about what needs to be done, that’s more in-depth than a handful of instructions/commands/demands… or the people who are afraid of their own human frailty and marginalize you because you’re different and you remind them that they are not omnipotent.

The more I read and the more I look around and the more I think about things, the more I’m convinced that social isolation is one of the worst things you can do to a closed head injury survivor. Or any injury survivor, really. But especially TBI survivors. Because we need to be “in the mix” with other people. We need to be involved. We need to be able to watch other people and remember/re-learn how to act. We need to be able to interact with other people and take cues and close from them. We need to remember what is “normal” and practice at it. We’re not lost causes — unless everyone (including us) gives up on us.

Practice, practice, practice. With other people. Build up the connections in our bodies and minds that help us conduct ourselves as regular folks. Re-knit the synapses of our brains and re-establish connections that restore our sense of selves. Our sense of self is a funny thing — it’s often best defined in relation to others. So that we can only be truly unique and original when we are surrounded by other people who are like us, but yet very different.

But when we’ve got these behavioral problems — which are so very often triggered by physical issues that nobody can see — it’s tough to hold your own in the company of others. We get tired, because we have to work so hard at simple things, and we may have to work harder to keep our balance, deal with hyper-sensitive senses, or adjust for changes in our speed of processing. And when we get tired, we get irritable. And/or our attention wanders. And/or we get agitated. And we start to act out. We speak out of turn. We strike out at perceived threats. We snap at the ones we love, we chew out our co-workers. We think we’re standing up for ourselves, but we’re launching offensives against people and events that may pose no real threat to us at all. We just think they do. We get scared. We get confused. We’re all amped up on adrenaline, and we fly into a rage like a fighter pilot taking off from an aircraft carrier. We ride the anger roller-coaster. We jump on the temper train and take off for the frontier, six guns shooting all the way.

And because the people around us very rarely appreciate our situation — or if they do, they just forget — we end up looking like friggin’ idiots and imbeciles. Which doesn’t help our case, even if we have a justifiable right to be angry and upset.

So much for social integration.

Especially if you’re surrounded by people who have a lot invested in playing it cool. Who insist on everyone being smooth and chill and controlled. They need this veneer, this packaging, this mythic strength about them and everyone around them that instills confidence, even if there’s no justifiable reason for that confidence. They pour all of their energy into coming across a certain way, and expecting everyone around them to do the same. If there are any cracks in the armor, it spells trouble. They lose confidence. Quickly. And then all seems lost.

What’s amazing to me, is how un-real so many people in the world are… How they build their entire lives around playing roles of the cool folks, the most popular kids in high school, and even when they mess up, they never admit it — they either cover it up or deny it completely. They just won’t let their guard down for a moment. Because then the jig would be up, and they’d be found out for who they are — people just like everyone else. Pretty lonely, actually. And closed. Closed to the full range of human experience and emotion and evolution.

This is the “closed” part that hurts us the most — the smallness of the minds of so many. We may have had closed head injuries, but so many people willingly close their perfectly functional minds to the vast possibilities out there. And not only do they distance themselves from people around them and make it harder for all of us to just be who we are, but they also cheat themselves of the full range of life, imprisoned in their own definitions of what is and is not acceptable.

But when I think about it, it seems to me that these folks — the closed ones — are probably as hungry for acceptance and freedom as anyone else. They are that way for a reason. Perhaps because others have ridiculed them or made life difficult for them. Maybe they’re short. Maybe they’re not beautiful. Maybe their parents were cruel to them. Maybe they’re sensitive and have been hurt too many times by bullies. Maybe the only way they can really survive in the world, is to be that way — closed. Who am I to judge?

All I know is, being closed doesn’t help any of us. We have all been hurt. We’ve all been injured in some way or another. And we can all use some generosity of spirit and help, as we go about our lives.

dealing with behavioral health issues from closed head injury… it’s always a challenge. But it can get better. The main thing to remember is that anxiety and stress and pressure don’t help the situation. The first thing to do, with TBI, is reduce the stress, take the pressure off, ease off the adrenalin accelerator, and quit being so hard on yourself. Learn to laugh at the things you do, and they will no longer rule your life. We tend to take things so seriously, we TBI survivors, and we see such gravity in everything. Every event can seem momentous and earth-shaking, but it ain’t always so, and the sooner we learn to lighten up, the quicker we’ll find our wings.

If nothing else, remember – you are not alone. Plenty of other people feel the way you do, and they manage to make it through somehow. TBI isn’t the end of the world, and neither is a temporary overdose of gravity. Behavioral problems come and go, and our health is often relative. If we can just be grateful for the good we have in our lives and focus on that, it can help a great deal. And if we can get some extra rest to take the edge off our sleep-deprived agitation and ease our exhaustion-related behavioral issues, all the better.

I recently read a statement that the human condition with its ups and downs is a lot like the weather — seasons come and go, passions rise and fall like floods during summer storms. Weather comes and goes. That’s just what it does.

And yet we survive. Look around. We’re still here — and that’s pretty amazing.

“Pain is weakness leaving the body”

Arlington National Cemetery

See also – New for 2012: The wars we wage – of sport, concussion, and our warrior style – Part I – Part II

I’ve been thinking a lot about this statement as it’s used in contact/collision sports, especially after reading this post over at The Concussion Blog. Something about hearing high school athletes saying, “Pain is weakness leaving the body” has always gone against my grain, so I’m doing some digging in search of what’s behind that for me. What I’m discovering is a vein of frustration that runs deep.

I seem to remember having heard this statement used in a military context, so I Googled the quote and found this over at Urban Dictionary:

“Pain is weakness leaving the body”

The above is a piece of propaganda used by the US Marine Recruiting office to get more people to join the marines. Its also figuratively true, and very effective in their commercials.

Pain is weakness leaving the body

If you punch a tree over and over again every day for a few years your hand won’t be broken (unless you punched TOO hard). Instead, it will be toughed, and calloused, and you will be able to take far more pain.

When a problem in life is emotionally painful you are emotionally scarred. But if you learn from it, the emotional scars will scab over and you will be a strong, more experienced and mature person because of it. When this occurs, as long as your emotional pain does not destroy you, it will eventually make you strong if you allow it too.

If you run 15 miles daily for a year, your body will be in a lot of pain, especially the first month or two. By the end of the year, your muscles would be so broken down and rebuilt you would be very strong, provided you had enough nutrients, water, and rest during the year. If you tried to do the same with 50 miles a day, you would end up dead.

Pain truly is weakness leaving the body, provided that the pain inflicted is small enough that you can handle it and grow from it, emotionally or physically.

The complete statement and the information behind it is important. For a number of reasons.

First, the statement is classic propaganda — a partial truth used in a way that triggers emotions that motivate you to take action that is not necessarily something you would do if you thought about things logically. It uses emotion and a promise of fulfilling a wish (to become tougher, less susceptible to pain) to induce someone to sign up for duty which may in fact result in their death.

Second, the grandly succinct  statement is followed by an explanation that tempers and explains the statement, but which is left out and forgotten in the repetition of the simple statement “Pain is weakness leaving the body.”

• your hand won’t be broken (unless you punched TOO hard)
• as long as your emotional pain does not destroy you
• provided you had enough nutrients, water, and rest during the year.
  
• If you tried to do the same with 50 miles a day, you would end up dead. 
• provided that the pain inflicted is small enough that you can handle it and grow from it, emotionally or physically

All of these qualifiers are absent — absolutely absent — from the implied bad-ass-ness of the statement

And that serves only to cloud the issue and completely gloss over the qualifiers which are about as easily remembered as the fine print on a contract you sign for crappy cell phone service, only to discover that you’re locked in for 2 years without any hope of escape, unless you pay boocoo bucks.

Seriously, how many people qualify this pronouncement with the bullet points above? See how this sounds…

“Pain is weakness leaving the body — so long as you just take it in little bits and pieces and eat right and rest up enough to recover from the damage you’ve done to yourself. You really need to heal, you know…”

“Pain is weakness leaving the body — so long as you don’t do such a job on yourself that you’re impaired for life. Just be careful!”

“Pain is weakness leaving the body — so long as it’s meted out and supervised by a trained professional who has a full medical staff to back them up and get you the proper care, if you overdo it.”

You don’t hear anyone saying that, do you? It sounds silly — and a lot less tough than the 6-word announcement that implies that once you have expelled all weakness, you will feel no more pain.

Third, this is a military statement intended for legal adults… who are going off to situations where they are to be trained to kill and to die. This is not a small thing. For someone facing imminent death – as is always the chance, when you go into battle – ignoring pain is not an option, it’s a requirement. It’s life and death, and perhaps the most important quality a soldier can cultivate is the willingness to sacrifice ALL for their cause. There is no tomorrow. There is only today — This moment alone. And whatever sacrifices you make are (ostensibly) for the greater good. If you’re crippled or maimed or brain-injured, it’s for a greater cause — something much larger and far more vast than anything most of us can imagine.  Plus, it’s your job. Granted, it doesn’t make survival any easier, especially if you come home to a country that’s ill-prepared (or willing) to help you back into civilian life, but the bottom line is, serving in that capacity is about putting everything on the line, and it could very well mean your destruction.

Is this the kind of mentality and approach we want for high school football games, which are by their very nature transitory introductions into the larger “field of play” of adult life? Is this the ethos we want 16-years-olds to espouse? Lay it all – everything – on the line, with no regard for the rest of their lives past that game, never mind that it can maim them permanently… and for what? And do we want our student athletes to treat others on the field like enemy combatants — like Al-Quaeda or domestic terrorists who deserve to be obliterated? Do we want to blur the lines about who’s the enemy and who is not, on the playing field and off? Do we want to teach our next generation to use their bodies as weapons against perceived threats, with no thought to the consequences? Life-altering concussions and brain injuries in high school sports are the most cruel of injuries — you may end up sacrificing everything for something that ultimately doesn’t really matter (aside from fond memories later on down the line). Or you could end up doing the same to someone else.

And for what?

Let’s put this in perspective, shall we? Serving your country is a high honor that demands more from those who serve than many people would be willing to do for anyone or anything. It is life and death. It is the stuff that turns the world. It is what makes and breaks countless lives and nations and cultures. It happens on a scale that utterly dwarfs a high school football game — a season — the whole Friday night lights culture.

Hearing high school athletes using that kind of language runs so roughly against every fiber of my being — my great-uncle was killed on D-Day on the beaches of Normandy in WWII and was posthumously awarded a Bronze Star for single-handedly holding his machine gun position on the beach and pinning down the German gunners, so that “his section could maneuver into strategic positions”… and we could prevail. Pain was — for him — weakness leaving the body.

How does this compare to a Friday night lights contest? I don’t want to take away from the importance of the game for anyone, but members of my extended family have paid the ultimate price on the field of battle. Even the ones who survived, returned to suffer for decades with the wounds of their war. To them, the honor of that statement belongs.

Fourth — and I think this is perhaps the most important — the belief by high school students that they should shrug off pain and play through it, is utterly erroneous. Because we’re talking about students — young people still growing and maturing, whose bodies and brains have a ways to go till maturity. I’m not taking away from anyone, I’m just trying to put this in perspective. When you are 14, 15, 16, 17 years old, you have years to go before you are fully mature. It’s not a slight, not an insult. It’s the truth. The human brain doesn’t get out of its youthful development phase till you’re 24 years old. I repeat, 24 years old. If you are 14, 15, 16… and you sustain a brain injury (as I did — several times), you have at least 8 years left before your brain can be said to have stopped that early maturation phase. What effect early concussions have on the developing brain, we have yet to find out.

Now, I was in as much of a hurry to grow up when I was in high school as the next person. I was even in a hurry when I was in junior high. But when I was growing up, being an adult — proving you were a real man or a real woman — was not about playing games and battling pain — it was about going out, getting a job, being a responsible individual who could hold their own in adult company, both intellectually and logistically. The most mature peers of mine were the ones who had jobs at night or after school and all weekend, who had real-world responsibilities in the workplace and who cared more about paying their taxes and keeping their cars running, than scoring touchdowns on the field. Football players were popular, sure. But everybody knew, the real men were the guys who were the night supervisors at the local department store or supermarket, who had their own cars and saved their money for a house or education.

Maybe it’s just the time I was raised in, as well as the area where I grew up — which was rural and of old-school hard-working northern European extraction.  But it seems to me, as I look around, there is far less emphasis now on students going out and getting jobs and learning to work, than there is on participation in sports. Maybe it’s a class thing. Nouveau riche parents don’t want their kids to have to work. They want to show the world that they’re wealthy enough to educate their kids and give them every advantage.  But the area where I grew up was a rural, working class farming environment, and the most valuable inheritance from your parents and community was learning how to be a productive member of society. If you wanted to be a grown-up, you worked, you didn’t just “work out”.

I’m probably being harsh, but this is serious stuff that just drives me NUTS… not least of all because this is the next generation of Americans who are being harmed by this inappropriately applied philosophy. If I rant, it is out of love for my country and concern for perfectly healthy young people with so much potential for making a difference in the world… our true Homeland Security… who are harmed by the foolishness and narrow-mindedness and short-sightedness of adults who themselves may have been brain injured in their own high school careers, and whose judgment may be blurred because of it.

Who’s going to let their kids’ future be impacted by someone whose own capacity for risk assessment is impaired, whose own head injuries were undiagnosed, and who may in fact be suffering from an invisibly spreading assault on the brain that can only be detected by specific chemicals dropped onto thin slices of their frozen brains after they have died?

Seriously folks, let’s get real about the impact that CTE and repeated concussions has had on the whole discussion about football, to begin with. Dave Duerson was in charge of determining if his former teammates were in need of medical assistance, and while he denied many of their claims, he himself was impaired by his own undetected and unacknowledged neurological medical issues. It seems to me that the strongest opponents of amending football’s deliberately harmful violence probably need to undergo neuropsychological testing, themselves, to see if they are even competent to discuss this. It’s not a slight. It’s just objective consideration.

I’m ranting, I know. But seriously, lives are at stake. When I think of all the pain and suffering I’ve been through because of my own multiple sports-related concussions, and I think of all the student athletes out there who may be experiencing the same thing — even worse — because people are too busy denying there’s a problem or downplaying it, all the while telling student athletes that they should ignore (or even welcome) pain, because it’s “weakness leaving the body” — it makes my blood boil. Yes, I have come a long way since my last injury. Yes, I have overcome a great deal, and I’m living proof that concussion and repeated mTBI doesn’t need to destroy your life. But the price I have paid… I wouldn’t wish it on anyone. My brain injuries started before I was old enough to protect myself and make conscious choices, and in years before anyone knew enough to take my injuries seriously. A number of my mTBIs were also accidents. The thought that adults are putting students in harm’s way out of arrogance and ignorance, incurring completely needless and avoidable injuries, and not giving them proper treatment… all the while reinforcing the “don’t be a pussy” mindset by saying “Pain is weakness leaving the body,” and increasing the risks… it’s almost unfathomable. In this day and age? With all that we know? How is this possible? (Unless it’s directly related to prior head injuries among the people who are debating the issues — I’m just sayin’…)

If you take nothing else away from this (given my rant), I hope you at least take this:

Pain for a student athlete is NOT weakness leaving the body.

It is the body telling the mind that it needs to STOP doing what it is doing, because IT IS DOING DAMAGE TO ITSELF. The reason we feel pain in the first place, is because our bodies are detecting a threat that we are either not aware of, or we are ignoring. It’s the body’s way of saying, “Knock it off – you are harming me.” And the more pain there is, the higher the stakes. Pain is not a frivolous distraction, the domain of pussies and pansies. It is a real thing, the one  (and sometimes only) way the body has to communicate to us when we are being idiots about protecting our own safety. Pain should be respected and listened to, not dismissed as the price you pay for character development.

If you’re in anything but a life-and-death situation where the risk of losing everything outweighs the damage you’re doing to your body, well, that false-bravado attitude is just plain stupid.

For my great uncle on the beachhead near Colleville-sur-Mer in France on June 6, 1944, it made sense to ignore whatever pain he experienced, because it was for a higher purpose — the protection of his section’s mission, and the overthrow of the Nazi regime. He also was a 24-year-old man who left school when he was younger and his father became ill, and he supported his family with two jobs. On D-Day, that man made the ultimate sacrifice, “realizing that he was facing certain death… ” His was a “heroic, self-imposed mission” and he made a conscious choice in an honest-to-God real life battle that would have lasting consequences. His sacrifice served someone else, not just his own ego.

But the sacrifice of young brains — young lives — for the sake of staying in a school-age game… whom does this serve? The game is passing, but injury and struggle and difficulty are lasting. And who bears the brunt of the pain? The former player, not the coaches and other players who pushed them to stay in.

Concussion and brain injury (even “mild” traumatic brain injury) is no laughing matter, and it’s not something to be shrugged off. It has consequences. It often comes at an extremely steep price.

Pain is not always weakness leaving the body. Sometimes it’s weak-mindedness betraying the body.

Computerized concussion testing – not such a good idea after all?

The Concussion Blog pointed the way to this excellent post by Matt Chaney, discussing the issues around computerized concussion testing, especially the ImPACT test that’s publicized by the NFL

His post discusses:

glaring faults in “baseline” testing of hot-selling ImPACT software employed by youth leagues, schools, colleges and pro sports. “The use of baseline neuropsychological testing in the management of sport-related concussion has gained widespread acceptance, largely in the absence of any evidence suggesting that it modifies risk for athletes,” Randolph observes.

Since 2005, Randolph is among reviewers for several journals who find unacceptable rates of false-positive and false-negative results for ImPACT, among popular brain assessments developed and marketed by academics and doctors associated with the NFL and benefiting from the league’s pervasive publicity machine.

“It is a major conflict of interest, scientifically irresponsible,” Randolph told ESPN The Magazine in 2007. “We are trying to get to what the real risks are of sports-related concussion, and you have to wonder why they (NFL experts) are promoting testing. Do they have an agenda to sell more ImPACTS?”

The marketing succeeds, with sales to a thousand schools and hundreds of colleges thus far, and media only increase exposure of ImPACT in the furor over concussions, especially in football.

Read the rest here (http://blog.4wallspublishing.com/2011/04/23/critics-evidence-debunk-concussion-testing-in-football.aspx) – it’s well worth the read.

What really worries me about computerized testing is what worries me about most computerized “solutions” to problems in life — they relieve you of the burden of having to really understand and think about what’s going on. A computer will give you a certain amount of information, which can be a good starting place. But it’s really up to you to figure out what — if anything — to do with the information. Most people forget (or never figure out) this important fact, and they think they can let the computer do everything for them.

On the playing field, “testing” (potentially) concussed athletes without paying very close attention — over the long term as well as the immediate short term — can have catastrophic consequences, if the test is not accurate (or fudged), and real issues go undetected and unaddressed. Again, the damage can happen over the long term, not only the immediate short term, as issues arise and become problematic beyond the playing season, even beyond school, and well into adult life — beyond any window of opportunity for ImPACT testing.

Lost income, underachievement, broken dreams, and shattered lives due to health issues, attentional issues, cognitive-behavioral problems (and more) arising from undiagnosed and untreated traumatic brain injury are something no computerized test will ever be able to measure.

Watch Chara at :46-:50 and 1:38-1:41

Unintentional? Really?

Calling Concussion Brain Injury Changes A Lot

Here’s a shout out to readers of the Concussion Blog who have found their way here. And if you haven’t checked out the Concussion Blog yet, please do. It’s great.

I’ve been giving a fair amount of thought to concussions over the past couple of years. In the course of my tbi rehab, my neuropsych has referred to my mild tbi’s as “concussions” and oddly, I never really thought of them that way. I’m not sure why I didn’t make the connection. I guess I thought, like so many others, that concussions are not that big of a deal — just a bump on the head. Getting your bell rung. Getting dinged. Big deal, right? Then, when my neuropsych talked about all the concussions I’ve had, the light went on.

My mild traumatic brain injuries were concussions. Concussion sounds a lot less dramatic than TBI, but essentially, it’s the same thing (I won’t go into the distinctions that SUNY-Buffalo Concussion Clinic people make).

Anyway, about a year ago, I started getting into reading about concussions more seriously and thinking about them in terms of not only my own experience, but also that of many other student athletes who have experienced concussion. I got Chris Nowinski’s book Head Games,  and I read that (and got very concerned about the idea of getting knocked around again), and did some more thinking.

Basically, I’ve seen two trains of thought around concussion — one treating it as concussion, the other treating it as brain/head injury. Which highlights one of the core issues for me — concussion can be more easily dismissed (as I once did) if it’s not viewed in terms of being a traumatic brain injury. It may also be more easily studied, however — googling “long-term sequelae of head  injury” returns 857 results, while googling “long-term sequelae of concussion” returns 279,000 results. Interesting disparity there.

So, there’s more talk about concussion… perhaps because it’s a “safer” word. But is that safety costing us, in terms of seriousness? Calling something a nicer word may make everyone feel better, but is that we should really be doing? Granted, upping the volume on concussion concern and awareness can introduce a certain paranoia to the discussion, and without the proper context and a level-headed approach, it can degenerate to knee-jerk “Stop all play now!” kinds of frantic reactions. But we also need to be adults about this and accept that concussion isn’t just about being “violently shaken” — it’s about the brain. And that’s not the sort of thing it pays to dismiss.

Prediction:

It will take about three years for the reactionary tone around the concussion crisis to give way to level-headed, medically and scientifically sound and experience-based discussions and responses. It will happen, but it’s not going to happen overnight. First, we need to get our heads around the potential severity of the situation, learn as much as we can about what can be done to prevent and respond and adjust, and create a culture that can protect its active members both during and after play. I give us all five years to come up with an actual plan of action that’s been shown to work. But let’s not wait five years. Let’s start now.

Because concussion is a brain injury. And our brains matter.