TBI Symptoms – Common Cognitive Dysfunction

I’m really enjoying reading Neuropsychological Rehabilitation by George Prigatano, which I recently got from the library. It may sound strange, but I’m into it.

On pp 4-5, under Common Cognitive Dysfunctions and Their Psychosocial Outcomes, the following issues/disorders are listed (in slightly paraphrased form, so I don’t provoke the gods of intellectual property):

Attention/Concentration Disorders:

  • Having trouble sustaining attention
  • Getting fatigued easily
  • Impairment of selective scanning and attention
  • Poor ability to shift attention back and forth — so you “get lost” a lot in group conversations

Problems with Initiation and Planning of Goal-Oriented Activities

  • Abstract attitude impairment: you frequently miss the point of what’s being considered and take information literally, instead of symbolically
  • Problems with taking action impulsively before it’s required, or keeping going after you should stop taking a certain action
  • Slow initiation time
  • Getting confused about where to start with problem-solving, and therefore ending up with problem-solving strategies that aren’t very realistic
  • Trouble ordering/sequencing info
  • Trouble knowing where, when, and/or how to ask for help
  • Difficulty learning from your mistakes — and your successes

Judgment and Perception Problems

  • Misinterpreting the intentions and/or actions of others
  • Getting confused when presented with a bunch of information at the same time
  • Having a tendency to be socially inappropriate when talking to people
  • Being unrealistic when appraising yourself and your strengths and weaknesses after head injury

Learning and Memory Disorders

  • Lousy rote learning
  • Trouble organizing/processing information that you really need to remember — especially when related to work or academic activities
  • Memory deficits that are material-specific (for example, having trouble with non-verbal vs. verbal information, and vice versa)
  • Having memory problems that are below your IQ level

Speed of Information Processing Disorders

  • Reeeeeaaaaallllllyyyyy   ssssslllloooooowwwww  rrrreeeeeeaaaaaccccttttttiiiiiioooooonnnnnnnnn   tttttttiiiiiimmmmmmeeeee (that is, really show reaction time)
  • Talking, writing, and doing mechanical tasks are slowed down

Communication Disorders

  • Trouble remembering words
  • Trouble finding the right words
  • Going off on tangents when talking and thinking
  • Being talkative
  • Using peculiar phrases and words
  • Uninhibited word choice (e.g. four-letter words) in conversation

According to Prigatano and Fordyce, “these disturbances exist in most, if not all, traumatically brain-injured young adults.”

I know they certainly exist with me. And while reading this list is a bit disconcerting, it’s also very comforting to know I’m not alone. And it explains a whole lot.

In the following pages after the list, Prigatano and Fordyce go into brief descriptions of the different types of disorders and talk about how they still have a long way to go before adequate rehab techniques are developed for them. This book is dated 1986, so I am hoping this has changed in the past 23 years, but you never know.

In any case, even if the book is older, it still has valuable information. And if I’m thinking about the timeframes correctly, it was written before the rush to create and market TBI rehab programs picked up steam. So it’s more likely (at least in my estimation) to have unbiased info.

Unsullied, as it were, by its own success.

Or somesuch.

Or maybe it’s my misinterpretation of the actions and/or intentions of others that’s getting me into trouble 😉

Anyway, I’m still reading…  It’s taken me several days to get through 7 pages. I read through them, then back up and re-read… then back up again and re-read… I think I’ve got more of it in my head, now. At least I have it written down 😉

My books have arrived from the library!

I’m really stoked. I finally managed to find a library copy of George Prigatano’s Neuropsychological Rehabilitation After Brain Injury and Prigatano & Schacter’s Awareness of Deficit After Brain Injury.

I’m sure it sounds odd for me to be so excited about getting them from the library, but these are books I’ve been wanting to read for some time. I first came across George Prigatano a little over a year ago, when I was researching brain injury and wondering why in heaven’s name I had never realized there was something “up” with me. I mean, I had a lot of problems when I was a kid and throughout my adulthood. Problems with memory, problems with mood issues, problems with keeping track of stuff, problems with temper, problems with freaking out over every little thing, problems with money management… I get tired just thinking about it all.

I should have realized a long time ago, that all those problems couldn’t possibly have been due to everyone/everything else. Something had to be “up” with me. But no… my broken brain was convinced it was everybody else, not me, that had the problem(s).

Anyway, now I’ve got the books on loan for three weeks — and the past-due fees are high, so I’d better get reading. I’m sure it’s considered a little “blasphemous” and presumptuous for me to be reading up on cognitive rehabilitation and advanced topics that are supposed to be beyond this layman’s brain, but I don’t really care what other people have to say about it. I have access to the information, and even if I don’t understand everything, at least I’m going to check it out.

My wrists are doing a little better. I’ve worked almost 30 hours in the last 2 days, much of that time spent typing, so I still have more resting I need to do. But that will come. Right now, I want to celebrate.

Celebrate life. Celebrate recovery. Celebrate cognitive rehabilitation. I saw my “neuroshrink” today, and we actually had a really good session. I was talking about different events of my past, and I actually got a laugh out of them. A good, hearty, spontaneous laugh, too. In the past, they’ve been kind of reserved and distant, like they were checking me out… not sure if they were going to keep working with me. But today was a good session.

They told me, in the course of our 50 minutes, that considering everything that’s happened to me, my life is a great triumph, not a tragedy. And yes, it’s true! My life is a tremendous triumph, and I’m feeling really grateful tonight that I’ve been able to do as well as I have.

How I’ve been able to do this well — bounce back from multiple mild tbi’s, including sports concussions and falls and assaults and car accidents, and build a life that’s full of activity and love and productivity and, well, happiness… I’m still trying to figure it out.

But if I had to chalk it up to anything, I’d say it’s just stick-to-it-ive-ness. Never giving up. Being tenacious. Stubborn. Hard-headed in the right ways. Trying and trying and trying some more. And never settling for less than I want — and deserve.

Just keeping going… in some ways, that’s the best rehabilitation of all. None of the other approaches actually work that well over the long term, if you don’t have this as the foundation.

But still, tenacity aside, it’ll be good to check out these books. It’ll be good to have some input that comes from outside my own head and immediate experience.

I’m also looking forward to reading more writing from George Prigatano. I have been a huge fan of his for quite some time, and what I’ve read from him I’ve really enjoyed. It might sound odd to talk that way about a neurologist, but everybody’s partial to something. Some folks are into Japanese art, some are into road bikes, some are into Turkish ceramics, some are into Dice-K, some are into the Cavs. I’m into neuroscience. Particularly cognitive rehabilitation after brain injury, and all the fascinating aspects of life that go with it.

And I do mean “fascinating”. The brain really is the final frontier, and despite the fact that everyone has one and we all love to talk about ourselves, precious few of us — scientists and doctors, included — seem inclined to talk about our brains and the way they impact our lives. It’s as though there’s this huge curtain drawn between our white/gray matter and the rest of us… a kind of holy-of-holies veil that keeps us from approaching the Ineffable Massiveness of what sits atop our shoulders and between our ears. I can’t account for the reticence, in general. It’s like everyone is running around talking about everything except their brains… like we’re trying to keep our minds off it.

Or maybe it’s just so close to home that it makes people waaaaay too nervous to approach, and anyway, we’re taught that unless we have degrees and qualifications, who are we to discuss such weighty matters? It puzzles me. We all have brains. We all love to obsess about ourselves and our human conditions. Yet we’ll invest countless hours in dissecting the life choices of Octomom, while remaining oblivious to the Real Drama that takes place inside our skulls, each moment of every day.

I can’t account for it. But it’s getting late, I need to rest, and there will be more time tomorrow to ponder these imponderables. And read the words of  George Prigatano.