What we lose after TBI… and what we can get back

woman standing with a leaf in front of her faceI’m feeling really grateful, this morning. I’m tired, but I’m content. I’ll have my nap later, and everything will get even better.

I spent yesterday doing some of the things I love the most: cooking, eating, writing, reading, napping, and watching football while eating non-dairy ice cream… all with my partner, who has been really struggling with mobility issues, lately.

I bought us a collapsible massage table a couple of weeks ago, so we can both take turns stretching out and do horizontal exercises without having to get down on the floor. I set it up last night for my spouse to lie out flat (major plus) and do the exercises their physical therapist prescribed. The floor has gotten too cold to lie on, plus, it’s hard for them to get up and down without pulling something or hurting. So having the table is a huge benefit. Plus – bonus – I went to bed at a decent hour after a long day of lots of work

And by the end of the day, I realized just how good I have it. I realized that, after all the years of struggle, all the years of incredibly hard work, all the pain and frustrations and perseverance, all the dead-ends, all the plans to just give up, and battling all the despair… I have come through to another side, and I am in a place where I am good.

It’s taken years for me to get to this point. And it feels like this is the first time I’m really settled into this good-ness in a way that I actually believe. I’ve spent so much of my life confused and confounded, thwarted and hurting… without much of any clue about why that was, or what I could do about it… I had started to think that’s just how things were going to end up for me.

Permanent disablement. Permanent screwed-over-ness. And I just needed to get used to the experience and accept if for what it was.

But that feeling has completely changed, just in the last 24 hours. Things are not perfect, by any stretch of the imagination. There’s a lot of stuff that’s going really, really wrong in my life — and the world in general. And there are lot of unanswered questions in my mind. Still, I feel like I’m in a state of mind (and body — fitness is so important) that I can handle whatever comes my way.

No, my thought process is not perfect. I still get turned around and confused, and lately I’ve really been struggling with memory issues and misplacing things that I can’t afford to lose. I still have my intense lows, when I completely despair and lash out at the ones closest to me. I still have my moments of feeling useless and unlovable. I still struggle with crushing fatigue and not being able to do things that plenty of other people can.

And of course, I struggle with the fact that I can’t tell people about my issues, because it will work against me in the larger world. It’s not going to help me get a better job, if I tell the hiring manager that I function best if I have a 20-minute nap at the middle of each day. That’s not part of the deal in the 9-to-5 world I operate in.

But these are all things I’m convinced I can manage effectively on my own. I can handle it. Because I have a much better sense of who I am, and what I can expect from myself.

People have said that “you can’t recover from brain injury“, but that was decades ago, and we know a lot more about brain injury than we used to. Also, we know more about how concussion really is a brain injury… and so many people have them, yet continue to live their lives.

I myself notice that there are some things I just can’t do like I used to. It’s not as easy for me to push through marathon tasks. I need to stop and take a breath… do something completely different. And it’s harder for me to remember what I was doing before I took that break. I lose things. I get lost, too. I sometimes look around and have no idea where I am — but that’s more because I tend to be so focused on what’s in front of me, that I don’t notice my surroundings, so I don’t think it’s one of those “On Golden Pond” moments where I’m literally lost and have no idea where I am, period.

I’m more forgetful about things that really matter to me. My home office is pretty much of a wreck, but in a Thomas Edison “genius-y” kind of way, and my work area has spilled into the dining room that we rarely use. I have been misplacing important documents I just can’t afford to misplace… and then scrambling to replace them. I have a harder time initiating stuff I know I need to do (like go for a swim at the pool), because it feels way too complicated and involved. And try as I might, I really mess up things I’m positive I’m going to “nail”. I’ve been feeling really ambitious about making new meals while I’m on vacation this week, but my cooking skills have really degraded, thanks to the bone-crushing fatigue and difficulty sleeping. And coordination? Yah, forget it. Don’t leave anything near the edge of a surface. I’ll knock it onto the floor, for sure.

I know I’m not as sharp as I used to be. I know I’m not as sharp as I’d like — or intend — to be. I can be downright dull, and the bummer is, I’m aware. Oh, lord, how I’m aware. It’s not the most fun thing in the world.

And yet… I’m happier now, than I’ve probably ever been. And even with all my limitations and drawbacks, I’m definitely more functional, all across the board, than I’ve ever been. I’ve got “the whole package” together, at last. Even with the TBI after-effects, the slowness and slipping, the exhaustion and intermittent sense of defeat.

See, this regaining of competence and practical functionality is the real TBI recovery I wish people would talk about. Not getting your coordination and cognitive quickness back, watching your memory and endurance dwindle, having all kinds of intense emotional ups and downs… some experts might consider those blockers to TBI recovery. They might say it means that a person has lost too much and can never fully recover from a brain injury.

But everybody on the planet has something they struggle with, TBI or no.

And in any case, the real loss for me from TBI had far more to do with my Sense-Of-Self and my sense of “agency” in the world, than any objective physical or cognitive limitation.

TBI/concussion isn’t debilitating just because it knocks out your practical abilities. It’s most impactful because it takes a chunk out of your understanding of Who You Are and How You Handle Life.

It strips our self-confidence, and in doing so, it hits us hard with a self-doubt that’s a huge source of stress and ongoing trauma. What does stress and trauma do to the human system? It makes it harder to learn. And since TBI/concussion recovery is literally an exercise in re-learning to live, so your brain can rewire with reliable connections, that loss of self-confidence is in itself a source of ongoing injury.

TBI / concussion is an injury to the Self. And until people start accepting that and dealing with that piece of things — as well as finding practical, common-sense, science-based ways to address those issues — TBI and concussion survivors will continue to suffer from their injuries as well as the limitations of the people who intend to help them.

My road back from multiple mild TBIs has been a long one. It’s taken me 13 years to get to this point (and today is the 13th anniversary of my last concussion). It’s been a grueling and winding path. Fraught with perils. It nearly cost me everything I worked so hard to earn. But I can honestly say, I’m finally on the other side.

I understand my situation. I also understand the nature of my injuries, and how they affected me. But most important of all, I understand what I can do about it. And while I do tend to whine a bit here at times, the most important thing is for me to focus on the positives and share the lessons I’ve learned, so others don’t have to suffer as terribly as I did.

TBI and concussion are “recoverable”. We might not get back every single ability, and we may be left with lasting challenges, but we can restore our Sense-Of-Self, so we can get on with living our lives to the best of our developing abilities.

We’re made to heal. We’re made to grow. Regardless.

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After #TBI – Give myself some extra time. Be generous to myself.

capacitors
I tend to run out of energy

It’s pretty easy for me to push myself past common-sense limits. I get my heart set on being able to do something or being able to do something a certain way, and then when it doesn’t work out, I spend way too much time being hard on myself about it.

That helps no one. It really doesn’t help at all.

So, I need to be generous with myself and give myself the extra time I need to do things.

I’ve figured out what to do about my work situation. It occurred to me, last week, that I’m 2.5 years away from being old enough to qualify for early retirement. It sounds bizarre to say it, but I am. I’ll be 55 in a few more years, and that means — in the high-tech industry — I’ll be “old”. And old enough to take a retirement package.

Does this make me happy? You better believe it. “Happy” is an understatement.

I mean, there are things I like about the job, but it’s just too demanding, and I’m not being properly compensated for what I give up, each and every day. I provide a sh*t-ton of value to my employer, and yet…

But in another couple of years, I can not only leave, but also potentially leave w/ a retirement package that’s a nice little golden parachute (emphasis on “little”) that can buy me some time and give me a buffer against any drop in income I might experience.

In the meantime, I’m working on a particular skillset that will allow me to either transition to a different kind of role, or allow me to consult. I’m downloading all my LinkedIn contacts, and I’m building a prospects list for people to reach out to in the future. There’s some danger that some of my contacts will “age out” of the industry (as some are older than I), and that I won’t have as many people familiar with my past work, who I can reach out to. But I have close to 1,000 contacts, most of whom are well familiar with my work. So, I’m pretty hopeful.

I just need to get everything set up ahead of time.

That means I need to:

  • Brush up on specific technical skills
  • Stay current with the part of the industry I’ll be working in
  • Figure out how much to charge for my services
  • Build up my portfolio of solutions I’ll be offering
  • Keep my image squeaky-clean and not do anything in public that will put me in a bad light
  • Update my wardrobe to be more professional and consultant-like
  • Build out my website in ways that put me in a really great light
  • And more…

I’m sure I’ll discover a lot more I need to do, as time goes on. But for now, this is a good starting list. I need to stay steady and systematic, and really pace myself.

I’ve tried to get my own thing going, many times in the past, but it never really worked. I think I just pushed too hard, too fast, and I wore myself out. I never factored in the effects of all those concussions. I had no idea they would even bother me. After all, in movies and cartoons, people were shown getting hit on the head all the time, and it never bothered them. So why should it bother me?

I just always pushed through — also, because I was using stress to numb my pain and confusion. The more confused I was, the more in pain I was, the harder I pushed. And it backfired on me, time and time again.

Well, this is my do-over. I get to do things differently this time, and I will. I have a healthy timeline ahead of me… enough time to get all my ducks in a row, set myself up to succeed, and get all the pieces in place for the future I want to have.

I’ve been helping to make a lot of other people rich for a long time, so why not at least give myself a fighting chance at independence?

It’s the least I can do for myself, after all these years.

Onward… at a common-sense, considerate pace.

Today’s a new day

railroad tracks leading into the distance with "start" painted on a tieIt’s Friday. For many, that means a few days off.

For me, it means I have a few days ahead of me to put in some more work. Some thought. Some intention.

It’s precious, precious time to step back, reconsider what I’ve been doing for the past week, re-set my direction, if necessary, and also rest, recuperate, re-adjust myself to a life that’s more like “me” and less like how the rest of the world expects me to be.

My TBI recovery has taken me in so many different directions, but at the core, it’s reminded me of who I really am, deep down inside, and what I want from my life. I was frankly on a wrong path, back when I fell down those stairs in 2004, and although it cost me dearly, I’m now on a much better path.

My path.

My life.

Today is my day.

Onward.

Brain injury comes in a number of different “flavors”, but it affects us in very similar ways

Brain injury is a brain injury, and as much as we may say “each brain is different, each injury is different,” we still need to look at the ways that each kind of injury is similar to others. And the experiences we have can be quite similar.

Loneliness, isolation, confusion, not feeling like yourself, getting angry quickly, mood swings, and let’s not forget the bone-crushing fatigue and the embarrassment that comes from not being the person you used to be… They are all things brain injury survivors have in common, and it’s helpful to actually treat people accordingly.

I honestly don’t understand why more emphasis isn’t placed on the experience of brain injury. That’s what trips us up, quite frankly. That’s the thing that makes our recoveries so much harder — the experiences we have and the effects those experiences have on our selves, our Sense-of-Self.

Well, that’s why I’m here. To speak up for those of us who tend to get stuck in our post-BI experiences, and need to see there’s actually a way out… Because there is. There is always hope — even in the most dire cases. Nobody can tell me different. That’s just how we’re built — to amaze… to heal… to grow… to learn. And learn some more.

Here’s a quick summary of the different types of brain injury:

Acquired Brain Injury (ABI)

includes things like stroke and anoxic (being without oxygen) brain injury. Some consider traumatic brain injury to be an acquired brain injury, because it “is damage to the brain that was not present at birth and is non-progressive” (See The ABI Manual for more). Personally, I wouldn’t call it “non-progressive”, but everyone’s experience is different.

ABI Resources:

Stroke

happens either when a clot blocks blood flow in the brain (called “Ischemic” stroke) or a blood vessel pops and there’s a brain bleed (called “Hemorrhagic” stroke)

Stroke Resources

Traumatic Brain Injury (TBI)

is related to trauma to the brain that comes from a fall, an attack, a sports injury, or an accident.

TBI Resources:

Concussion

is what people often call a “mild” TBI. Concussions are sometimes considered less serious than traumatic brain injuries, and a lot of people consider a TBI that clears up after a while, to be a Concussion.

Concussion Resources:

 

My last decent vacation in a good long time…

open book with a landscape scene in the pages
The way life goes, you never know how things will shape up. I’ve had so many hopes and dreams over the years, and so many times, I’ve been on the verge of really breaking through… then something happened. And that “something” was often a TBI.

I was just getting my act together in elementary school, finding my footing with my peers and getting involved in a special program for “gifted” kids and discovering what worked for me, when I got hit on the head and things changed. I became combative. Difficult. A behavior problem. So much for the gifted program. They showed me to the door on that one.

My family relocated, and I was finally figuring out how to interact with the people around me (who all talked with thick accents I could barely understand). Then I fell out of a tree and wrenched my neck. And I kept hitting my head while playing sports. Football. Soccer. Just playing outside. Hitting my head was routine. I can remember a number of really significant blows to my skull that disrupted my consciousness, but they happened against a backdrop of regular clunks on the head. It seemed like every time I got on my feet and started feeling like I had a grip on my life, I’d get hurt (again), and I’d be back at square one.

I eventually got out of my parents’ house and got on with my life. When I drank a lot, I fell down — a lot. I may have (probably) hit my head a bunch of times, but I don’t remember much from the 4-5 years after I left my parents’ home.  Those years that could have been some of my best (and in some ways, they were). They could have been years of exploration and learning and experience like no other, but instead they were mired in the muck of hangovers and all the confusion that comes from not knowing what happened the night before. A few scrapes with the law… being ostracized by my peers… some violent confrontations… making money by borderline means, just to get by… it was definitely an experience — that’s for sure. But it took me years to recover from the damage I did to myself.

After I was in the working world, driving to work each day, I got in a bunch of car accidents. They weren’t huge deals, mostly just fender-benders, but whiplash and getting clunked on the head didn’t help matters any. During years when most of my peers were getting on their feet, finding their way in the world, I was scrambling. Trying to catch up, after being set back. I got a job, then got hit by a speeding door-to-door salesman. I left that job without saying why. Just left one day and never went back. I relocated to a really great city, but just before moving, I got rear-ended and spent the next several months in a manic haze.

Years later, I had a pretty decent job with a lot of responsibility, then got tangled up in a 7-car pileup, and everything fell to pieces there, too. That worked out okay in the end, because I found a much better job and a completely different career track, but it did a number on my self-confidence, and it caused me to pass up a golden opportunity that my new manager laid at my feet (and begged me to take). I can only imagine how much more stable my life would be now, had I actually taken them up on it.

The last and most debilitating TBI was when I fell down a flight of stairs at the end of 2004. I was just 18 months away from having some investments mature, and if I’d been able to hang in there and keep up with my life, I could have repaired and paid off my house, gotten rid of my debt, and really solved a lot of logistical problems that are the kinds of things that only money will solve. None of that got solved. It all fell apart. And it’s taken me 12+ years go piece it all back together to just a semblance of how things once were.

So, what does this have to do with my current vacation (which is now drawing to a close)?

In the course of my life, I’ve never known just when everything would fall to sh*t. It’s partly me being oblivious, partly me not having a reliable crystal ball that lets me peer into the future. So, all those times when I just assumed I’d have time to do this, that, or the other thing… all those times when I thought I was set… all those times when I didn’t pay attention to what was Right In Front Of Me… in so many cases, they were the last hurrah for that part of my life. The last shred of self-confidence. The last vestiges of feeling competent. The last months of feeling like I could actually plan my future with certainty. The last weeks of being able to take certain things (like how my brain worked or how I’d react to experiences) for granted.

I didn’t savor those things when they happened, because I was too damn’ optimistic. Too oblivious to just how sh*tty life could get for me. Not experienced enough to realize that things could get That Much Harder for me in a moment’s time. I took them for granted. I didn’t wring every last bit of goodness out of them, while the goodness lasted. And now I just look back on a lot of wasted opportunities and chances I totally missed enjoying… all because I thought there would be another time that would be somehow better.

I don’t believe that anymore.

Especially not this morning.

From here on out, my vacations will probably be a lot more work than relaxation, a lot more frustrating than renewing, and a lot less worth it to me. But they’ll continue. Life goes on. Sh*t gets complicated. So it goes.

For today, I’m just going to enjoy myself. Because this might just be as good as it ever gets.

I have the next week OFF

beach with ocean and "relax" drawn in the sand
Soon…

I’m leaving for a week’s vacation today. I have a handful of errands to run before we can get on the road, and then we are heading out to a waterfront town that’s full of art galleries and novelties shops and all sorts of great restaurants. We have a few restaurants that we really like, but mostly we avoid the crowds and excitement, buy Mexican or Chinese takeout and head for the beach for our own waterfront dining. It’s the best way — sitting in the car right at the edge of the water, having a nice filling meal that doesn’t cost a million bucks.

It’s going to be nice to get away. It’ll give me time to think, time to relax. I realize that I’ve been stuck in limbo with my life for some time. There’s been all kinds of drama in my immediate and extended family for the past 15 years — actually, longer than that. More like 40 years. And it’s really dragged me down, watching everyone go through their problems — me included.

But now, here I am, at a place in my life where I just don’t feel like I have the time to fritter away on feeling terrible about things that I can just take care of. I’ve learned a whole lot about how to deal with my TBI issues, and I’ve made an amazing recovery. So why not enjoy it?

Why not, indeed? I feel like I’m at a point in my life where I’ve learned more than enough hard lessons, I’ve been through my make-or-break circumstances, and I’ve made it through. I’ve paid my dues. Now it’s time to just enjoy my membership.

It’s funny… I don’t tend to think of myself as that old. I’m really not. But I have been knockin’ around on this planet for over half a century, and I’m kind of over the whole newbie experience. I’m not a newbie. I’ve been around the block plenty of times. And it’s about time I just settled into living my life and enjoying it, instead of constantly pushing myself to “take it to the next level”.

Please. What next level? No matter how hard I work, no matter how hard I push, there will always be another level ahead of me. So, why not just settle in and get the most out of the levels I reach? I haven’t done nearly enough of that over the years. And while it does keep me sharp and invested in my life, it’s also depleting and drags me down.

Eh, whatever. I’m going on vacation. I’ll probably blog a bit while I’m there. Just relax into it, do some writing, have a good time, while I’m at it.

And now… it’s time for more errands, as I prep for my 7-day escape.

Onward.!

Seeing my skills for what they are – and aren’t

moon shining on tree in fieldI’ve been “back and forth” about my job, for the past few months. One week, I love it. The next, I hate it and can’t wait to get away. I supposedly got a sort of “promotion” a few weeks ago — more responsibility and more influence, but no more money. Doesn’t seem to be much of a promotion, right? My boss is making bad decisions and is pushing me to put their ideas into action. It’s pretty much of a train wreck, with all the people at the top fighting over their territory, making their minions represent them.

Ridiculous. I don’t agree with any of it. But somehow I’m supposed to make it happen?

The only benefit: it makes the situation crystal clear — I really need to get the heck out of that situation, brush up my technical skills, put my resume out there, and get ready to move after the new year. I actually have some old projects I’ve been wanting to revive, and now seems like a great time to do it.

I tend to have a pretty low opinion of myself, mainly because I know what else is possible, and I’m very clear about how far I fall short. Plus, always being tired, my self-esteem really suffers. Like today. I’m just not feeling that capable or worthwhile…

Except for something that happened last night.

I was on my way home from a meetup in a nearby city, and as I was rolling through the dark countryside, I saw a bunch of cars stopped ahead of me. I was coming up to a tricky intersection, where a hidden road crosses at the bottom of a long, gradual hill. The tail lights of the cars ahead of me weren’t moving, there seemed to be smoke in the air, and I could see people standing in the road farther up the hill, so I slowed down and pulled over, just to figure out what was going on.

When I took a closer look (I was pretty tired), I saw there was a car sitting in the middle of the road with its wheels splayed and its front-end crushed in. The interior was full of smoke, and the whole thing was shrouded in a gray cloud. I was worried at first about there being a fire and the vehicle blowing up — I’ve seen too many movies, I guess. But I couldn’t just sit there. It didn’t look like anyone was helping, yet.

I walked closer to the wreck – carefully. There was glass everywhere. Pieces of car. Rear view mirrors. Chrome and plastic. Halfway up the hill, I could see another car lying on its roof in the darkness. It wasn’t smoking. It was just sitting there, eerily motionless, as people gathered quietly around it.

The vehicle nearest me at the bottom of the hill was a tangled wreck. Once upon a time, it looked like it had been a pretty sweet Mustang. No more. The airbags were shredded. Drawing closer, I could hear voices. I could hear a woman’s voice and a man’s, so I knew someone was alive. I lifted up the “curtain” of limp airbag that was hanging over the driver side window, and behind it there was a driver with is face smashed in and blood all over him, talking to a woman on the remote assistance intercom — like those Northstar systems that come with cars to help you unlock your doors or call for help. The woman was talking to him like he was coherent, but he was really messed up. He clearly had a head injury, his movements were jerky and automatic — like I’ve been a number of times after getting clocked on the head. She kept asking him questions, and he was responding like he knew what he was talking about. He didn’t. He was in bad shape.

Beside him, there was a passenger whose left leg was bent weirdly. No wonder. The car’s engine had been pushed back practically into his lap. I didn’t get a close look at the other guy — who was talking a bit, too — because I was focused on just talking to the lady. And others had come over to help and were checking him out. I talked to the lady on the intercom, told her what I was seeing, and reported what others were seeing about the other guy.

I also “talked down” the guys in the car, who were trying to get out. The driver kept reaching down beside his seat for something, but I told him to stay putDon’t move. Help was on the way. The interior of the car reeked of alcohol, and one of the other bystanders who was helping said she’d seen drugs beside the seat.

The local first responders were there within minutes. The accident was just a few miles from the local fire station, and when the fire truck pulled up, I told the firemen what I knew. They were on it, and I got out of their way. Then I got back in my car and moved on.

When everyone else stood at a distance, I stepped up.

When everyone else couldn’t communicate and keep things in order, I could.

When a couple of seriously injured people were on the verge of potentially hurting themselves more, I kept them safe and kept things steady.

I’ve been in these kinds of situations a number of times. A co-worked who collapsed and was unresponsive… someone who’d fallen and hit their head… an elderly person who had a bad reaction to a medical trial they were participating in… a person pinned between their car and a fence, when they didn’t put it properly in park… I’ve come across those people who were badly injured or hurt enough that they couldn’t help themselves, and I’ve been there for them, till help came. Several times I’ve run for help, myself.

It’s what I do. It’s one of the things I do best.

And for all the foolishness that’s taking place at work, at least I know this is something I do. Handling reality. Dealing with a true emergencies.

And I need to remember that, as I navigate this scene at work… finding a path out… figuring out what’s next. There are some things I do better than just about anybody else. They’re just not part of my job description, right now.

FYI – Stress and cell phone addiction

child with smartphone sitting on a benchSmartphone addiction is real.

And it can also make TBI recovery more difficult by affecting your sleep and getting you cranked up into a constant fight-flight state. Not having a lot of “screen time” after a concussion is a good idea for a lot of reasons. This is one of them.

Thanks to Ken Collins for sending along this great research paper:

Exercise rehabilitation for smartphone addiction

Hyunna Kim*

Abstract

Internet addiction after launching smartphone is becoming serious. Therefore this paper has attempted to sketch out the diverse addiction treatment and then check the feasibility of exercise rehabilitation. The reason to addict the internet or smartphone is personalized individual characters related personal psychological and emotional factors and social environmental factors around them. We have shown that 2 discernible approaches due to 2 different addiction causes: that is behavioral treatment and complementary treatment. In the behavioral treatment, cognitive behavioral approach (CBT) is representative methods for changing additive thoughts and behaviors. Motivational interviewing (MI) is also the brief approach for persons not ready to change their behavior. Mindfulness behavioral cognitive treatment (MBCT) also the adapted treatment based on CBT. There are different types following the emphatic point, mindfulness-based relapse prevention (MBRP) or mindfulness oriented recovery enhancement (MORE). It is apparent that therapeutic recreation, music therapy using drumming activity, and art therapy are useful complementary treatment. Exercise rehabilitation contained the systematic procedures and comprehensive activities compared to previous addiction treatments by contents and techniques. Exercise rehabilitation can treat both physical symptoms at first and mental problems in the next step. So more evidence-based exercise rehabilitation researches need to do, but it is highly probable that exercise rehab can apply for smartphone addiction.

Keywords: Smartphone addiction, Exercise rehabilitation, Cognitive behavioral therapy, Complementary treatment

INTRODUCTION

The penetration rate of smart phones in Korea was recorded 67.6% as the world’s #1 in June, 2013. This is 4.6 times of the world average penetration rate, 14.8% and 10% higher than Norway ranked to second higher penetration rate (55.0%). In the case of 2012, the “Anypang game” craze was exploding in Korea. The daily number of that game was 10milion. It means almost every people using smart phone played the Anypang (Jung, 2012).

According to the “2011 Internet Addiction Survey” by Korea Internet Development Agency and Communications Commission, 8.4% of Korean people were heavily addicted to the smartphone. Smartphone addiction ratio is higher than the entire internet addiction. Problem is that 11.4% of 10 generation 10.4% of 20 generation was addicted to the smartphone.

The cause of addiction is enormous convenient mobile computing function of smartphone such as portable media player, high speed Wi-Fi mobile system. Smartphone carrying in the hand can access the internet more easily and conveniently than PC. Great variety of apps and games for smartphone are being made.

The general form of internet addiction can be divided into a game, chat, pornography, but the smartphone addiction can create a new addition category such as SNS or app addition. In addition to, in comparison with other media, smartphone require more intervention and activity by subject, immediate connectivity and social interaction as a game affect to the game immersion and addiction.

Seoul Metropolitan Office of Education surveyed the habit of using internet of middle school and high school students in March, 2013. As the results, 6.51% of the total number of smartphone users used the phone excessively. Among them, 4,585 students (1.81%) were risky users; they cannot done properly school work, interpersonal relationship and feel psychological anxiety and loneliness without using smartphone (Online news, 2013).

Smartphone addiction is not a personal problem. Addiction to smartphone has induced serious abuses problems more and more, especially to young students. This is the time to find the way to rehabilitate from the smartphone addiction at the national level. As reviewing the previous study about internet addiction, the addition research for rehab is relatively young is still establishing its basic treatment. In the case of addiction, except the pharmacotherapy, the behavioral approach to stimulate cognition and behavior has been applied typically. One of outstanding features employed in this device is that various treatments have been approved to help addicted individuals.

The commission on youth protection in Korea developed internet addiction treatment and addiction model in 2004. After 2005 they accomplished youth family camp for internet addiction and natural cure programs with Korea green culture foundation in 2007 (the Commission on youth protection, 2008). Analyzed the camp and other addiction program, there is growing body of attempts to cure the addiction not just focusing on the classical treatment.

Therefore this paper attempts to review the addiction treatments concerning general addiction and smartphone addiction from previous researches and offer the possibility of exercise rehabilitation for smartphone addiction.

INTERNET AND SMARTPHONE ADDICTION

What is smartphone addiction?

There are 2 types of addiction, one is drug addiction such as drug, alcohol and the other is action behaviors such as game, internet, even smartphone. Unfortunately, internet addiction is resistant to treatment, entails significant risks and has high relapse rates (Block, 2008). In case of smartphone, there are little research has been conducted. Smartphone addiction has many aspects that are similar to those of internet addiction and as such the internet addiction criteria must be considered when developing smartphone addiction criteria. So this study searched internet addiction treatment program for curing the smartphone addiction.

The terms Internet addiction were identified based on the Diagnostic and Statistical Manual, VI-TR definition of substance abuse and pathological gambling (America Psychiatric Association, 2000), but currently it described under the category of impulse control disorder, not otherwise specified.

Dr. Ivan Goldberg first coined the term internet addiction disorder (IAD) for pathological, compulsive internet use (Brenner, 1997). Internet addiction is an overarching term characterizing five problematic Internet-related issues: cyber sexual addiction, cyber relationship addiction, net compulsions, information overload, and addiction to interactive computer games (Young et al., 1999). Symptoms of internet addiction include social isolation, family discord, divorce, academic failure, job loss and debt (Young et al., 1999).

Causes and symptoms

Approached form the early previous studies, the research has offered the reason why people are addicted to the internet. Internet addiction have relevance to 3 factors, that is specific characteristics of the internet, personal psychological and emotional characteristics and social-environmental characteristics (Choi and Han, 2006; Kim et al., 2006).

Generally people who have psychological and emotional characteristics such as depression, loneliness, social anxiety, impulsivity, distraction (Kim, 2001) easily to addict the internet. The place where internet access, the degree of time to use internet, peer relationships parenting types are also associated the addiction.

Internet addition shakes physical and psychological problems. It provokes physical symptoms such as dry eves, carpal tunnel syndrome, repetitive motion injuries, wrists, neck, back and shoulders, migraine headaches and numbness and pain in the thumb and the index and middle fingers. As Young’s research (1999), fifty-four percent of Internet addicts report a prior history of depression; 34% with anxiety disorder; and 52% with a history of alcohol and drug abuse.

ADDICTION TREATMENTS

Behavioral treatments

Following the previous studies, personal factors may play a key role in internet use and the development of internet addiction. Adolescent personality traits that correlated positively with internet addiction included high harm-avoidance, reward dependence, low self-esteem, and low cooperation (Weinstein and Lejoyeau, 2010). Poor academic achievement might be associated with low self-esteem and with behavioral problems such as sleep disorders, aggressive or depressive symptoms, dropping out of school, antisocial personality disorder and alcohol abuse (Valdez et al., 2011). Adolescents with poor academic achievements usually received less respect from surrounding people, and poor academic achievement might be associated with low self-esteem and with behavioral problems such as sleep disorders, aggressive or depressive symptoms, dropping out of school, antisocial personality disorder and alcohol abuse. Those kinds of feelings and isolation would make these adolescents to go online in a search for sense of belonging and self-satisfaction.

Most studies have focused on the relationships between psychological characteristics and internet addiction (Choi et al., 2006). Classical treatment had focused on individual factors such as low self-esteem and aggressive and depressive symptoms. The main issue of classic treatment is how to change personal feeling and thoughts.

Cognitive behavioral approach (CBT)

CBT is the typical mental health care for develop psychological symptoms such as obsessive-compulsive disorder. CBT can assist the individual with internet addiction disorder to recognize thoughts and feelings causing person to inappropriately use the computer to meet personal needs (Orzack, 1999).

Generally, CBT is an efficacious method of treating substance abuse, depression and anxiety to substance abuse issues and drug addiction. .Further to this, there is evidence to suggest that the use of integrated approaches in dealing with depression and alcohol abuse have a higher rate of success (Baker et al., 2010; Magil and Ray, 2009).

The term of CBT first appeared in scientific literature in the 1970s based on Beck’s theory and has since become the treatment of choice for a broad spectrum of behavioral, emotional and psychiatric problems. To date it has been empirically tested for a range of issues including anxiety disorders, depression, obsessive-compulsive disorders, eating disorders and addiction (Frank, 2004).

CBT is a fusion of 2 distinct traditions in psychology. CBT addresses the interaction of thoughts, emotions, physical sensations and behaviors. It uses cognitive processing helps clients to recognize negative thoughts and behavioral strategies help them identify helpful and unhelpful behavior.

The role of CBT is to carefully identify the biased cognitive processes that influence behavior and decision making and to shed light on both the process of relapse and the states of mind and reaction that leave a person vulnerable to old solutions. There are 5 stages to change behavior overtime. That is pre-contemplation, contemplation, preparation, maintenance and termination. In the pre-contemplation stage, therapist focus to break the denial that a serious problem with computer uses exists. In the contemplation stage, individual recognize the need for change, but the desire to change may not be substantial and feeling or being overwhelmed may exist. In the preparation stage, the individual is ready to establish a plan to address the problem. The maintenance sate begins when the individual feels he or she has control over computer use and is putting less energy into the behavioral change. The final stage, termination has the goal to prevent relapse.

CBT is not only about making specific and identified changes to thoughts and behaviors but also making clients their own therapists. This will enable them to apply the learning developed in and between sessions to life in general.

Motivational interviewing (MI)

MI is a brief, patient-centered, directive approach that emphasized personal choice and responsibility. Generally, MI is the greatest challenges facing substance use disorders treatment agencies. Mostly person who are addicted to something, they deny the problem and do not seek rehabilitate. So for persons who not ready to change their behavior on their own, MI may help (Merlo and Gold, 2008).

Mindfulness behavioral cognitive treatment (MBCT)

Zindel Segal and colleagues found a possible solution in practice of ‘mindfulness’– a type of meditation that helps people decenter from negative thoughts and associated sad moods (Segal, Williams and Teasdale, 2011). MBCT appeared to prevent relapse in patients who had experienced three and more episodes of depression. Addiction is in essence a habit. The addicted person is believed to act automatically or ‘mindlessly’ with little real awareness of the cues and that trigger substance misuse. The idea of promoting mindfulness could thus prove to importance in tackling addictions (Frank, 2004).

Mindfulness-based relapse prevention (MBRP) is another name of MBCT. MBRP is psych educational intervention that combines tradition cognitive-behavioral relapse prevention strategies with meditation training and mindful movement. The primary of goal of MBRP is to help patients tolerate uncomfortable states, like craving and to experience difficult emotions. Mindful movement includes light stretching and other basic gentle movement.

Mindfulness oriented recovery enhancement (MORE) is adapted from MBCT for depression treatment manual. MBRP and MORE is also the program focusing on meditative approaches to coping with cravings, as well as education and training about how to identify and skillfully change or mindfully let be, mental processes like thought suppression, aversion, and attachment (Garlandet al., 2011).

Complementary treatment

Previous studies have documented that an adolescent’s family environment is highly predictive for adolescent internet addiction (Nam, 2008). Moreover, a number of studies in South Korea have found family factors that influence internet addiction among adolescents. There are many researches about the relationships between protective factors such as parenting attitude, communication, and cohesion within families and internet addiction among adolescents (Hwang, 2000; Kim, 2001; Nam, 2008).

Complementary treatments have more focused on the environmental factors and use diverse activity for cure the internet addiction. There are many studies for finding the specific effective activities like music, art and even exercise for decreasing the rate of smartphone addition.

Therapeutic recreation

Therapeutic recreation is the professional intervention for leisure life. Therapeutic recreation is the purposeful and careful facilitation of quality leisure experiences and the development of personal and environmental strengths, which lead to greater well-being for people who, due to challenges they may experience in relation to illness, disability, or other life circumstances, need individualized assistance to achieve their goals and dreams (Anderson and Heyne, 2012). There are many facilitation techniques for gaining the goal.

Few studies have examined the effect that a resource such as leisure activities might have on the relationship between stress and health among elderly men. Data from the Normative Aging Study (NAS) were used to examine whether specific groups of leisure activities (social, solitary, and mixed activities; activities performed either alone or with others) moderated the effect of stress on the health of elderly men and whether there were differences in this effect between bereaved and non-bereaved men. The sample of 799 men was divided into two groups: a group bereaved of family and friends and a group of non-bereaved. Hierarchical regression analyses compared an initial model, a direct effect model, and a moderating model. The results indicate that for both groups of men, mixed leisure activities moderated the effect of stress on physical but not mental health. Additionally, for the bereaved group, social activities moderated the effects of stress on physical health. The negative effects of life stressors (other than bereavement) can be moderated by engaging in leisure activities for both bereaved and non-bereaved elderly men. Implications of the findings for future practice and research are discussed (Fitzpatrick et al., 2001).

Family and outdoor activities along with participative and supportive parental monitoring reduce the tendencies. Parental monitoring is inhibitors of adolescents Internet addiction. Thus adolescent should be supervised and monitored in their daily routines and encouraged to participate in family and outdoor activities. Further, adolescents should develop a positive attitude toward leisure and the skills to deter overdependence on online relationship (Chien et al., 2009)

Internet addicts can be a form of wrong leisure pattern. Internet addicts often encounter time-management problems. This means unbalanced time allocation and leisure boredom and unsatisfaction from unpleasant leisure activities may be motivated to seek another alternative – The Internet.

The high risk game addicted people not much leisure activity with families compared to low risk game addicted people. The more they addicted to the game, the more they want to get recreation activities or hobbies. They answered to participating leisure activity with friends (46.4%) or families (27.6%). 65.3% of young juvenile addicted the game want to participate family leisure activity. Unusual thing is students who are rich or have highly educated parents also were addicted to the game.

Music therapy: Drumming activities

Recent publications reveal the substance abuse rehab. Program has incorporated drumming and related community and shamanic activities into substance abuse treatment (Michel, 2003).

Drumming circles have important role as complementary addition therapy, particularly for repeated relapse and when other counseling modalities have failed.

Drumming enhances hypnotic susceptibility, increase relaxation and induces shamanic experiences (Mandell, 1980). Drumming and other rhythmic auditory stimulation impose a driving pattern on the brain, particularly in theta and alpha rages. Physiological changes associated with ASC facilitate healing and psychological relaxation: facilitating self-regulation of physiological processes: reducing tension, anxiety, and phobic reactions: manipulating psychosomatic effects; accessing unconscious information in visual symbolism and analogical representations; including interhemispheric fusion, synchronization and facilitating cognitive-emotional integration and social bonding affiliation (Mandell, 1980).

Art therapy

Park et al. (2009) applied the art therapy to game addiction juvenile for improving the self-control techniques. As a result, hostile attitude was decreased and social interaction with peer group and family members was increased.

THE APPLICABILITY OF EXERCISE REHABILITATION

Exercise rehabilitation has the evidence-based exercise science knowledge to address a wide range of physical and psychological problems. It use exercise programs for patient rehabilitation based on exercise science. It follows the scientific process. In the clinical subfield, baseline such as physical capacity, health information, medical history, work status, previous exercise experience need to be set. After assessment, supervised rehabilitation sessions conducted for achieving the stated goals. Exercise rehabilitation aims to recover not only musculo-articular rehabilitation after surgery, chronic pain or fatigue, neurological or metabolic conditions but also even psychological conditions such as depression and anxiety.

Smartphone addiction is psychological disorder appearing physical and psychological signs and symptoms. The person who addict the internet or smartphone not do much physical activities, they generally disregard their health, and also negative physical signs like carpal tunnel syndrome, poor posture, backaches, migraine headaches, poor personal hygiene, irregular eating, sleep deprivation, eye strain, dry eyes, lack of sleep can affect immune functioning and hormone secretion patterns, cardiovascular and digestive pattern (Diane, 2005).

Exercise rehabilitation can employ the first goal for recuperating their physical health on the surface. Moreover if they indulge in specific exercise program such as horseback riding or exercise gymnastics, treatment can be going on to the second stage. Mindfulness program is also based on yoga or physical activity for meditation. Exercise rehabilitation could seek mental changes through feeling of confidence, satisfaction, and new feeling of happiness.

DISCUSSION

There are many reasons to addiction, internet accessibility is also one of the most decisive factors for overuse by college students (Anderson, 2012; Lin and Tsai, 2002). When access is free and easy, college students tend to be vulnerable to becoming addicted to the internet (Kandell, 1998). In South Korea, anyone have easy internet access due to the nationwide internet infrastructure and may be vulnerable to pathological internet use. So fair is not fair internet and smartphone addiction. We need to regulate the internet and smartphone access.

To date, the Youth Internet Addiction rehab program was composed of classical treatment represented the behavioral and cognitive-behavioral approaches focusing on aware of the risk and severity about internet addiction, and learning the way to regulate their emotions then adjust their behaviors. In response to the increasing risk of internet addiction and its negative consequences, there is a need to explore intervention models. Unfortunately, a survey of the literature shows that there are settled only a few treatment programs for internet addiction, such as CBT and MI interventions, group therapy with a combination of Readiness to Change (RtC), (Orzack et al., 2006), as well as Reality therapy group counseling programs.

We examined by references about complementary treatment using many activities for curing the internet addiction rehabilitation based on the environmental addiction factor. Therapeutic recreation is much interested on the family leisure types, music therapy using drumming activity are hypnotic susceptibility, increase relaxation and induces shamanic experiences.

Exercise rehabilitation is not much utilize the internet addiction until now, but if given that young student were most addicted to the internet, exercise rehabilitation can be the efficient activity they want to participate and also help to grow their health and mental status.

CONCLUSIONS

This paper has attempted to sketch out the diverse addiction treatment and the feasibility of exercise rehabilitation. To capitulate briefly, we have shown that 2 discernible approaches: behavioral treatment and complementary treatment. The standard to divide the treatment for addiction have drown from the addiction path and causes. There are 2 factors to causing the addition; that is personalized individual characters and environmental factors around them. CBT is representative of classical methods for changing additive thoughts and behaviors. MI is also the brief approach for persona not ready to change their behavior. MCBT also the adapted treatment based on CBT. There are different types following the stressful point, MBRP or MORE. It is apparent that therapeutic recreation, music approach using drumming activity and art therapy are useful complementary treatment. In general terms, it is highly probable that exercise rehab can apply for smartphone addiction.

The argument which is the best program between behavioral treatment and complementary treatment is waste of time. What remains to be determined by the future research is the evidence-based certain addiction study revealing the significant factors. Exercise rehabilitation program can also one of main program for smartphone addiction but considerable work needs to be done.

Footnotes

CONFLICT OF INTEREST

No potential conflict of interest relevant to this article was reported.

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Articles from Journal of Exercise Rehabilitation are provided here courtesy of Korean Society of Exercise Rehabilitation

From J Exerc Rehabil. 2013 Dec; 9(6): 500–505.
Published online 2013 Dec 31. doi: 10.12965/jer.130080
PMCID: PMC3884868

After #TBI – Don’t depend on your brain’s weak systems

hand holding pen, checking off lists on a checklist
Getting stuff done… one thing at a time.

From the Give Back summary of how to fix your brain… This is something I have to constantly remind myself. It’s a hard one, because I hate to think of my system as being weak — or weakened. But that’s exactly what’s happened. And the thinking systems that have been weakened have been permanently altered. So, I need to always keep this in mind. When I forget it, I suffer. And so does my work and my relationships. My whole life starts to go downhill.

3. Don’t depend on your brain’s weak systems for organizing and memory to manage your time and your activities.

  • Get your brain to use your full intelligence to plan your day thoughtfully, a day ahead of time, when you can think everything through well.

It’s practically impossible for me to do this a day ahead of time, because things can change so rapidly with me. From day to day, I don’t always know what’s “coming down the pike”. Stuff changes rapidly — plans change, weather changes, people change their minds about what they’re going to do.

But that doesn’t mean I can’t plan in other ways. The best way for me to do this is break it up — look at my next day plan on the afternoon / evening before… and then check in with myself first thing in the morning. And keep track of things throughout the course of each day. Track it.

  • Write that plan down on a schedule form so that you take no chances of forgetting what you need to do.

Scheduling things has become a lost cause, in general, because things are so unpredictable at work and at home. So, I have a standard list format that I use.

[ ] Thing I need to do

[ ] Really important thing I need to do (I use a yellow highligher)

[/] Thing I am in the process of doing or have started

[x] Thing I have done (I have a green marker to track the things I’ve completed)

–> [ ] Thing I needed to do today, but didn’t get to, so I need to do it tomorrow. (I use an orange marker to make it stand out)

I try to keep a running list of things that I “carry over” from one day to the next. I’ll copy my –>[ ] items onto lists for later days. That way, I can keep track of everything I need to complete.

  • Develop the habit of writing plans and following them, and soon you will be in total control of your time and your productivity.

I agree. The habit of writing out plans and following them (as best I can) has done wonders for my ability to get things done, as well as my self-confidence. I have a support system that works for me. And when I use it (which I admit is not consistent enough), it really helps offload a lot of the mental grunt work, to save my brain for more interesting and important (and challenging) things.

If there had to be one thing I’ve done that’s helped me get back to the level of functioning I’m at now, it’s developing lists and systems around lists, that let me do what needs to be done without having to think too much about how to do it all. Coming up with a ‘standard operating procedure’ for just about everything — from getting up in the morning and going to work, to taking down the Christmas decorations — has made me a whole lot more functional than I ever was, when I was just going with the flow or winging it.

Lists are my friend. They can be yours, too.

Onward.

1. Know that you have a new brain, one that can work well once it is reprogrammed.

hand holding magnifying glass over brain, which is made up of gearsOne of the things I really appreciate about the  Give Back Orlando materials is that they don’t sugar-coat TBI recovery, but they also don’t make it into a “accept your new normal” approach, where you have to resign yourself to everything being so much worse than before. The core message is that you can improve… provided you make some specific changes in how you live your life.

The first change is:

  1. Know that you have a new brain, one that can work well once it is reprogrammed.
    • It needs to be reprogrammed because your old programs don’t run quite right on your new brain.
    • Help yourself to keep this fact in mind as you go through your day.

When we’re very young, we come into the world with the capacity to create a whole lot of synapses — connections in the brain that carry information. Over time, our synapses are “pruned”, as our brain refines its ways of doing and understanding things. By the time we get past adolescence, a lot more connections have been pruned than we had, just 10 years earlier.

It’s been said that one of the things that “gets you” after TBI, is that you may have lost a bunch of the connections you really depended on… and that’s a loss.

But here’s the thing, see? If we have “neuroplasticity”, we can create new connections to take the place of the ones we’ve lost. That, to me, is the essence of TBI recovery.

Granted, there may be parts of the brain that are so damaged that there’s no repairing them by present means. Maybe sometime on down the line, but not right now. But the brain is an amazing thing, and we can create a lot more connections than people used to think we could. In fact, the old ways of understanding the brain — that you can’t repair it, if it’s injured… that only certain parts are used for specific activities… that damage is permanent — those old ways have been disproved.

It’s not true.

What IS true, is that with regular practice and the right approach, the brain can be “reconditioned” to perform at, near, or even better than levels you had before.

But you have to realize that change has to happen. You have to deliberately create those new synapses, those new connections, those new ways of your brain functioning. You can’t keep doing things the same way as before, over and over.

You have to realize you have a new brain.

And you have to keep reminding yourself of that, through the course of each day.

It’s like trying to run a Windows 10 program on Windows 3.1 (remember that? I do). It’s just not going to work. Not because Windows 3.1 was so much worse. It was good for what it did. It’s just that the “gears” work differently now.

And you have to accept that fact.

I’m not talking about accepting it because it’s a sad fact that life is going to be so much worse.

I AM talking about accepting it, so that your life can get so much better.

Big difference.

So, that first step is the best kind of acceptance of all.

Again:

  1. Know that you have a new brain, one that can work well once it is reprogrammed.
    • It needs to be reprogrammed because your old programs don’t run quite right on your new brain.
    • Help yourself to keep this fact in mind as you go through your day.