I am thinking a lot about losses, these days. Loss of friends, loss of doctors, loss of family, loss of jobs, loss of money, loss of hope.
I’ve been actively working on my brain injury recovery since 2007 — nearly 10 years. I got hurt at the end of 2004, so it’s been over 11 years since my last TBI. And my expectations and hopes have varied, during that time.
I always expected to be able to build back my abilities to at least some extent. I expected to be able to be able to retrain my brain to build back my memory, to address my distractability, to handle my fatigue, and basically all-round get myself back to where I wanted to be.
But that hasn’t happened. The one area where I have significantly improved, is in my gist reasoning, which is really the biggest “functional” deficit I had. Not being able to see what ideas are important in a sea of details is one of the most debilitating effects after mild TBI. It’s also a better predictor of how well people “deal” after mild TBI.
Even if we look great on other scores, even if we only have a few measurable deficits, if our gist reasoning is not great, we’re far more likely to suffer and stumble and have troubles. Nothing seems to make sense. Nothing seems to fit together. And we make one mistake after another, miscalculating and mis-reading cues in ways that really make our lives (and others’) very difficult.
And for no apparent reason.
It’s a hidden thing. And it’s a real problem. On top of that, it’s not recognized as “a thing” by a lot of folks. One refrain I’ve heard repeated, over and over from my neuropsych, is that I only have a few measurable deficits, and they aren’t even that terrible, so I should be able to get back to my life without too much struggle. It’s been kind of demoralizing, hearing that each week, as things just didn’t seem to fit together for me. Yes, my tests said that I was supposed to be in good shape — better than I felt I was. Yes, my tests said I have just a few deficits. But nothing made any sense.
It just didn’t make any sense at all. And it’s been constant work for me to get myself to a point where A) I don’t feel stupid and lazy and useless, and B) I actually understand the nature of my issues and can deal effectively with them. I’ve worked at it, I’ve really concentrated on it, and I’ve made some pretty amazing progress, actually. Even more than my neuropsych ever expected.
The thing of it is, if I’d listened to them and just and said to myself, “Well, my measurable deficits really aren’t that many, and relatively speaking, I haven’t been impacted nearly as badly as other people have,” I might have just sat back and not worried about it… and kept screwing up. I probably never would have made this much progress. I wouldn’t have had a need to. I could have just scaled back my discontent and kept my sights lowered, and eventually just settled in to working around the specific problems I had.
But a focus on the specific problems is a huge problem — especially with gist reasoning. It completely misses the point. Gist reasoning is about bringing everything together to sort through it and make sense of it, and if you just think about (and disregard) the smaller pieces, it’s not going to help you build overall strength in your gist reasoning.
So, just looking at my handful of small deficits wouldn’t have helped me at all. At the same time, sitting back and saying, “Well, I’m not nearly as bad-off a other people are, so I should just get on with my life and not worry about it,” would have put the kaibosh on my progress. Because in fact it’s the combination of taking those small things seriously and tweaking them — within the context of my overall functionality — that kept me going over the years.
And it still does.
Now I am changing neuropsychs, and it will be interesting to see how they approach things. I’m a lot less concerned than I was before, because I’ve been thinking about all the ways my old neuropsych was wrong, over the years. I’ve always felt that dealing with their wrong-ness was even more helpful than dealing with how they were right. It’s been an important process for me, to really think through what they’ve told me, and decide for myself if they were right or wrong. And the times when they were wrong – oh, so wrong – have been pretty educational for me.
So, yes, they can go, now. Sure, I’ll miss them. But it’s not the end of my world – it’s the end of one part of it, and the beginning of another.
A new study reveals that individuals with traumatic brain injury (TBI) have significantly more difficulty with gist reasoning than traditional cognitive tests. Using a unique cognitive assessment developed by researchers at the Center for BrainHealth at The University of Texas at Dallas, findings published Friday in the Journal of Clinical and Experimental Neuropsychology indicate that an individual’s ability to “get the gist or extract the essence of a message” after a TBI more strongly predicts his or her ability to effectively hold a job or maintain a household than previously revealed by traditional cognitive tests alone. The study also further validates the Center for BrainHealth’s gist reasoning assessment as an informative tool capable of estimating a broad range of daily life skills.
When I found about this, earlier this year, it was like a light went on for me. I knew my neuropsych eval scores put me in an “intelligent” range, and by far, the majority of my test scores came back looking good — some above average, some far above average — and according to my neuropsychologist, there was really no reason I couldn’t have the quality of life I desired.
But I’d been having so many difficulties putting things together. And the story my test results told simply was not consistent with my difficulties. There was no way it was all emotional. Something else had to be “up”. Hell if I could communicate that to my neuropsychologist, however. Like being frozen in place, mute and motionless… unable to get the words out.
A telltale piece of the puzzle was the gist reasoning exercise I’d done at the start — it was a fairly detailed picture that could have been boiled down to a basic narrative of a few sentences, but when I was asked to describe everything I saw, I wrote two full pages in very small handwriting — and I could have written more, had I not decided that I was really going on far too long. My evaluator attempted to explain to me how my answer was wrong, but I fought them on it. As far as I was concerned, I’d done as I was told — write down everything I saw happening there. I’d completely missed the gist of it.
The next time I did the test, I was shown the same picture. If I’d done as I wished, I’d have written four pages of small-print description about what I saw there, but I knew the task was about communicating the gist of things in a few succinct sentences. So, that’s what I did. I summed it up briefly, and I passed the test as having excellent gist reasoning. (Note: I still have arguments with the way that part of the test was administered, and there are much better ways to elicit details about someone’s gist reasoning, but then, I’m not a testing expert, so I’ll save it for later, when I can deliver a well-formed proposal.)
In any case, my ability to sum up the contents of that picture correlated well with my increased ability to function. The degree to which I’d improved in understanding what was expected of me, as well as how to deliver the most meaning in the fewest words, was a good indicator of how much better I was functioning in my life, and how much it was improved over the years before.
I wonder, now, how I’d do. But of course, it wouldn’t be a fair comparison, because I understand the question, I know how to game the test, and nobody from here on out is going to get a genuinely usable result from my response to that test.
Benefits/Results/Outcomes After Discovering This Research
To say that I benefited from this research would be an understatement. I credit it with:
Confirming my pre-existing suspicions that my test results were not reflecting the reality of my situation and the degree of my difficulties. As a result, I felt far more confident of my self-assessments. That confidence led to a more settled sense of myself and more self-assurance — which ultimately contributed to me finding a better job at a 30% increase in pay (and a 30% increase in the taxes I now pay into the system). The IRS can thank UT Dallas for that 😉
Indicating that, if lacking gist reasoning was connected to poor functioning, then improving my gist reasoning might improve my overall functioning. I developed some gist reasoning exercises (click to see them) for myself and others to use. I focused my attention on doing gist reasoning exercises for some time, which I felt had a noticeable effect in how I thought about things. Knowing that my ability to piece things together effectively and derive meaning from them, was directly related to my ability to function re-oriented me in ways that have helped me perform well in my new job.
Improving my overall state of mind and quality of life. Again, the taxes have contributed to society… and also a more stable home life, for myself and my spouse. Having this piece of the puzzle, gives me a greater sense of agency and capability and self-determination. When I”m struggling with the logistics of my daily life, I can check in with how I’m understanding the world around me, and work a little harder at extracting the gist from my day-to-day. Granted, it’s not exactly a double-blind controlled study, but the arguments and depressive spells have become less frequent, so that’s a measurable result.
In any case, this research makes excellent reading for anyone who wants to better understand some of the complications of TBI — as well as get some insight into why people who appear to be perfectly intelligent and capable can screw things up so badly, and be so inconsistent in their performance.
I strongly recommend it as almost-required reading.
In three weeks, I will be at my new job. It seems surreal. I am finishing up with my current job, just trying to get all my “ducks in a row”… along with rolling with all the change that’s going on in the organization.
It’s a hard time for most people there. And it’s hard to not get pulled down into their frame of mind.
So, to counter-act that, I am expanding my skillset and gearing up for the next stage in my career. I’m taking some courses that will get me prepared for my new job — and my new career. I’ve always been out on the “front lines” of my industry, and this is giving me the chance to get out ahead of it again.
It’s pretty amazing. Exciting. And the beauty part is, the line of work I’m getting into is so new, there are no real college degrees in it, so the fact that I don’t have a Bachelor’s or Master’s doesn’t work against me. Nobody has that, yet. It’s all about practical results. Being able to do the job. Produce the numbers. Meet the need that my employer has.
I’ve got them covered, in that respect.
Anyway, I’m feeling like I have a new lease on life, with this new job. I’m finallygetting out of the rut I fell into, when I crashed my head down those stairs in 2004. It’s taken me 10 years (and a few months) to get myself functional again the way I want to be… the way I need to be. And I still have a ways to go.
I can get there. I’m not going to be held back. I can use the same sorts of skills I developed in my TBI recovery to recover my career, as well.
Now, this isn’t all happening overnight, and it’s not happening in a vacuum. Nor is it some situation where my fairy godmother or a genie from a bottle is showing up to shower pixie dust on me. I have put in a lot of hard work, over the past years, to get to this point. I have been studying and studying, working and working. Back when I was injured in 2004 until around 2010, I was unable to read books the way I had before. I had always been an avid reader, but I lost the ability to keep information in mind long enough to go from page to page. I would literally lose the train of thought if it went on past several paragraphs.
So, I quit reading, period. I read websites, in bits and pieces… news… etc. Whatever I could, without wiping myself out. I studied TBI and the brain, because that was the only thing that held my attention. It was the only motivated reading I could do, and even that was in fits and starts. One of the books that changed my life — The Brain That Changes Itself — I had to read in bits and pieces. In fact, I’m not sure I ever completely finished it (I should do that now).
I surfed the web and researched brain injury. I struggled to find really good sources of information — partly because there weren’t as many out there as there are today, and partly because it was hard for me to sort through all the search results and decide what was helpful and what wasn’t.
I also studied trauma and its effects. I managed to read a few books about trauma, but it was slow going. I had to find summaries online to really make sense of things.
Over time, my ability to read improved — ironically it came back after I had given up on it completely and decided, “Well, I’ll never read again…” It was slow going — fits and starts. But eventually it came back, and I worked my way back slowly.
One of the books I read (Aging With Grace – a study of nuns who outlived the surrounding population by 10-20 years and stayed sharper and functional longer than was typical for their geographical area) showed how “idea density” can contribute to holding off Alzheimers and other kinds of cognitive decline. Basically, with “idea density”, the more ideas that are packed into a sentence / paragraph, the more “dense” are the ideas. And I found out that scientific research papers had a lot of idea density. Not the most, but a pretty decent amount.
So, I started actively looking for scientific papers about TBI that related to me. Long-term outcomes. Childhood head trauma. Behavior issues. Mood disorders. Mental health issues. Sports injuries. Recovery approaches. Rehab. Frontal lobe and executive function. Mindfulness. I specifically searched for information that related to me, that would be useful and meaningful… and I could put to good use.
All together, over the course of several years, I found and downloaded over 300 research papers about TBI and TBI recovery. There were a lot more that I found and did not download. I did not read all of them from beginning to end, but I did read the summaries and abstracts, and sometimes I read the discussions recapping all their findings.
That was the best rehabilitation I could have asked for, because it was intimately related to me, it was self-directed, and I believe it even helped with my gist reasoning. When I did read the whole papers, and then I read the abstracts again, I could piece together the central theme of the data that was collected, and learn to screen out the things that did not matter. So, many, many researchers have indirectly contributed to my recovery.
Slowly but surely, I’ve felt my abilities improve. It took time, and it took a lot of diligent effort. Each and every day, just about. Each and every weekend. On my free time. During my not-so-free time. I have had a total life orientation towards TBI recovery that has paid off.
I never felt like there was a choice for me. I have been given a lot of gifts in life, and I believe it’s on me to ensure that I return the favor to the universe — or whoever else has helped me. I really feel that sense of responsibility. Even when I’ve been at my worst, I never lost sight of that. I knew I had to get back… I was on a mission.
Now I can read books again. And I can remember what I read, pages and chapters later. Miraculous. And I’m gearing up for my new job by reading some more. And thinking. And taking some classes. One class I started, but I’ve realized it’s best that I do another class first, so that I have a better foundation. I also need to strengthen some of my skills, including math. Geometry has always made perfect sense to me, and I was doing advanced fractions when I was in elementary school, years before most kids even had a concept of fractions.
It all just made perfect sense.
But over the years, that sense got kind of trained out of me, because nobody was really qualified to help me excel. They were so busy trying to get kids “normalized”, and I was so un-normal in some ways, that they focused on my weaknesses, rather than my strengths. And in the process, any latent ability I had for advanced materials got lost in the shuffle because of my attention/distraction difficulties, behavior issues, and trouble understanding what people were saying to me. I kept getting punished because I simply did not understand.
Now things are different. I’m all grown up. At least that’s what they tell me 😉 And I have to let go of that earlier conditioning. I’m not stupid. I’m just out of synch with a lot of the world. And now I have a new chance to start fresh in a line of work that suits me so well, it’s scary. I’m going to my dream job in less than three weeks, and I want to be ready for it.
So, I’m studying. I’m finding more papers to read, that have to do with my new field, rather than only TBI. I’m also pacing myself, taking my time, not getting ahead of myself and being very systematic about my approach. Because it matters to me so deeply, and I am so grateful for this opportunity to learn and grow.
On top of it, I have an appointment tomorrow with a trainer who focuses on strengthening specific neurological features. I’ve been reading about this method over the past couple of weeks, and I’m very excited to see what comes of our meeting tomorrow.
I had a very taxing day, yesterday. In the midst of telling my manager that I was leaving (and having them freak out, albeit in a professionally muted way), and also trying to get work done, so that I can wrap everything up for folks before I go, I had the constant interruption of people stopping by or sending me messages or emails or whatever, so that they could find out what was up… process… congratulate me… etc.
Everyone has been really great about it. Of course, we’re only in the early stages of grief.
We’ve only gotten to the first stage (though I know everyone handles loss differently, so the order can be mixed up), and I’m expecting anger, bargaining, and depression to ensue before long.
As long as I’m prepared, that’s the main thing.
The issue is, all the interruptions, all day long, the emotion, the storytelling — getting the sequence of things correct, so that I’m telling a consistent story and don’t sound like I’m lying to people — it’s exhausting. Trying to focus, while people are all worked up and want to talk… good grief, it’s tiring. And by the end of the day, I was wiped.
Which is part of the reason I burned supper… then had a minor meltdown when my spouse started yelling at me… then got all bent out of shape about that signalling the permanent end of my marriage, because I just couldn’t take being yelled at when I’d had such a demanding day…
I felt a nasty migraine coming on, and retreated to my bedroom with the lights off and focused on my breathing and slowing my heart rate, to head the migraine off at the pass. It worked. And my spouse came to find me to talk things through because it made no sense for me to go to bed angry. And then I went downstairs and watched “Happy-ish” which is my new favorite show, because there are so many parallels between the main character and myself.
In the end, we finished the evening on a much more normal, loving note. I got a good night’s sleep and woke up to a glorious day. Glorious! as my elderly aunts used to exclaim, when I was a kid.
I miss those venerable elders. I miss them a lot.
Anyway, while reading The Ghost In My Brain, I found a lot of similarities to the author’s experience and my own — the nausea that sets in when people are talking to you… the balance problems… the fact that driving is actually okay, when you’re not cognitively drained (it’s actually a relief)… preferring blurry eyesight to glasses that make objects sharper, but don’t address the full spectrum of vision issues… and having everything be in slow motion when talking, because there are all sorts of additional processes that need to take place in the background, while you’re working through what someone is saying to you… and then there’s the trouble planning.
The author talks about how he had regular appointments with a Dr. Miller to work through daily logistics with TBI, and he was often not 100% sure he was supposed to be there. I used to do that all the time with my neuropsych, for a number of years. I was pretty sure I was supposed to be there, but I wasn’t 100% confident, so I just went — and if I was supposed to be there, then that was cool. If I turned out to be there on the wrong day, I was prepared to turn around and go home.
Fortunately, we always had appointments on Tuesday afternoons, so it was consistent. If it was Tuesday, then I’d go to their office and wait in the waiting room. Sometimes I would sit in the waiting room for quite some time, if I got there a little late. I wasn’t sure if I should go knock on the door, or if they would come out to find me. Eventually, I got in the habit of knocking on the door — the thing is, I now realize, I would avoid it, because it hurt my ears when I knocked. Driving an hour through evening rush hour traffic really took it out of me, so my hearing was on HIGH. I’d just suck it up, though, and knock. The discomfort of the knocking, though, was actually preferable to the auditory shock of hearing their door open suddenly. It always startled me, because they have one of those noise-dampening brushes across the bottom of their door, and it makes a really loud noise when it opens.
At least, it’s loud for me.
Anyway, all the discomfort aside, I’m considering following up with a neuro-rehabilitative optometrist to see if I actually have vision issues that are making my symptoms worse. After I was hit in the head with the rock when I was 8 (a year earlier I’d fallen down a flight of stairs and temporarily lost the ability to speak), I developed double-vision (diplopia, I think it’s called). I was taken to an eye doctor who prescribed reading glasses, and I’ve worn them ever since.
In recent years, I’ve actually opted for not wearing my glasses whenever I can. It’s more comfortable for me. My glasses help me see things in the distance just fine, but I prefer to do without them. Sometimes I will even drive for short distances without my glasses (if no one is around and the road is empty and runs straight ahead). I have been thinking it’s because I just can’t stand having them on my face… but now I’m wondering if maybe they are actually making it harder for me to see, because they are not allowing my eyes to get the kind of light I need to get.
Reading The Ghost In My Brain, I am finding so many similarities — especially with how vision and balance are so closely connected — that I think it makes sense to follow up with my vision. Just get my eyes checked out for that other aspect. Apparently, there are three ways our eyes help us — regular straight-ahead vision, peripheral vision, and then connections with sleep-wake cycles, balance, hormones, neurotransmitters, posture, etc.
And I wonder if maybe so many of my logistical problems — which I have never been able to articulate well to anyone, because they make no sense to me or anyone else — might have to do with vision issues. From the time I was 8. So, for over 40 years. If this is true, and my visual systems have been impacted, then it makes a lot of sense why I perform so high on visual-spatial tests. I’ve had to develop more abilities to offset the deficits I got from those TBIs. Add to that even more blows to the head, and you’ve got yourself quite a recipe for a very interesting life.
Additionally, I’m looking into the Feuerstein Method, which is a way of “learning to learn” — finding your strengths to offset your weaknesses, and restoring functionality that I really need to have, but which has eluded me.
My neuropsych has been incredibly helpful to me, in terms of helping me sort through all the psychological clutter, helping me retrain my executive function and beefing up my gist reasoning. The thing is, they take that approach, which is psychological, and the physiological aspects fall by the wayside. At least, that’s how it seems to me. And anyway, I do a really poor job of communicating everything that’s going on with me, at times, because I have a long drive to get to them, at the end of usually challenging days, and I’ve been so stressed out over the years with all my old sh*tty jobs, that I haven’t had as much bandwidth as I’d have liked to.
I do a danged good impression of someone who’s got their act together. Because I have to. If I don’t, I can lose my job. I can lose my house. I can lose everything, and my spouse will lose it all, too. So, keeping up the appearance of being on top of everything is my top priority.
Of course, that can backfire, because then you can’t always reveal the areas where you need help, when someone is there to help you.
But anyway, that’s another blog post for another day.
Right now, I’ve got some new lines of inquiry to follow, and that’s super cool. I also have some exercises I can do to help me — Designs for Strong Minds (the site of the rehab person who helped Clark Elliott retrain his brain) has a bunch of exercises at http://www.dsmexercises.com/, and I went ahead and paid the $13.99 for the full suite of exercises. It’s easier and quicker than trying to piece things together for myself. Plus, it’s a deal, because individually, the collections of challenges are $9.99 each.
Even the most basic ones pose some issues for me, although I’ve been scoring 87% or better. A number of my choices have been lucky guesses. I won’t be happy until I can score 100% without doubts. Then I can move on to the next batch. There are exercises for NASA rocket scientists, and other pattern matching things.
And that reminds me about my Dual N-Back training I used to do regularly. I need to try that again. I was doing Dual N-Back training when I was learning to juggle. Now I know how to juggle, and I wonder if my Dual N-Back training is “sticking” as well.
New tests for a new day.
Interspersed with lots of rest.
I’m pretty happy about the progress I’ve made in my life, relative to where I was 10 years ago. Relative to where I believe I could be — and should be — I’m not happy. I know I can do more and I know I can do better. Getting there is the challenge.
And it finding out if I have vision issues that can be fixed, could be an important next step.
Gist reasoning is all about picking which pieces of information matter, and which don’t.
Gist reasoning strength is a better indicator of how badly someone has been impacted by TBI, than just about any other measure. Intelligence tests and memory tests don’t do it. It’s how we put it all together, that shows how well — or poorly — we do.
Like I’ve said, posting materials online for people to use and improve is NOT rocket science. You just have to put something out there. But this kind of instruction seems to be tied up with folks who have certain professional credentials or special training.* For me, as a person who has been profoundly impacted by multiple undiagnosed and unaddressed TBIs, it makes my heart ache to think of how many others like me are out there not getting the help they (and their families) desperately need, and I cannot just stand by without doing something about it.
So, I’m building tools, based on gist reasoning information I am finding online. Below are links to some scenarios and collections of terms — some of the items matter to the Scenario, some of them don’t. Follow the instructions for each Scenario.
You can either print out the pages, or you can just write it all down — writing it out by hand is good, because it exercises your brain in helpful ways. You may want to show it to someone who has better daily functioning skills than you, to see if you’re on track.*
Check back again in the top menu and also on the Scenarios page for added tools and exercises. Some of them may seem quite rudimentary, but it is what you make of it. You can really “play” with some of them! So, have fun with it.
Just so we’re clear, I have to say the following, so I don’t get in trouble for claiming to fix brain-type things without proper credentials… I don’t have the money to defend against a lawsuit.
*Please note: These exercises are for “entertainment” purposes only, and no guarantee is made about their ability to improve your gist reasoning abilities. I am not a formally trained educational instruction designer. I have conducted trainings for many people in professional settings, as well as taught individuals how to use software. But I’m not formally trained or certified in this kind of work. Like many things in my life, this is an experiment intended to help people like me who have been left behind or overlooked by the established rehab industry.
Okay, so “we” now know that gist reasoning is a more accurate indicator of how well folks with TBI / concussion can live their lives, than other sorts of testing, like memory and IQ.
Those of us who have been working through TBI issues, lo these many years, have known it a lot longer… A hearty Welcome to those of you in the scientific / academic community who are just now catching up.
However, there seems to be a dearth of actual exercises you can do online. That’s odd. Because:
A) Folks with long-term TBI issues can be profoundly marginalized from the mainstream, and the Internet is their one reliable connection to the rest of the world.
B) Online training is incredibly easy to put on the web. It may be difficult to design, but once you’ve got it designed, publishing it is a relative breeze. There are many, many people who do far more complicated things on a regular basis. Finding decent developers is not rocket science.
C) You’d think that everyone in the country would be falling over themselves, getting gist reasoning training online, because helping people with TBI better handle their lives can translate to improved daily functioning, which can translate to higher employment rates, which can translate to more tax revenue and lower needs for social services.
That’s what comes to my mind, anyway.
And yet, looking around online (granted, I only spent a few hours between yesterday and today, but I’m a skilled searcher, and if I can’t find it… well, it’s reallyhard to find), I’m not seeing any gist reasoning training readily available, other than some that are intended to teach kids how to read, think, and understand.
There doesn’t seem to be much developed for adults, especially those recovering from brain injury.
Sidebar: You know, I realize now that a lot of what I’ve been doing with my neuropsych over the past 7 years, is working on my gist reasoning. We spend a lot of time with me talking about my days, my experiences, my future plans, and then summarizing them at the end. At times, it seems so tiresome, to have them repeating back to me what I think I just said, but now I understand the method to that madness.
And I’m glad I did not just get up and walk out on them, like I wanted to do, so many times.
I’m glad I just went with it. Because it works. My deficits that were found, 7 years ago, are still pretty much there without change. However, my ability to live my life fully as well as engage with things around me and also have a higher quality of life than ever before, has dramatically increased. Phenomenally, in fact.
So, being all incensed about the lack of online tools for TBI recovery, I’ve started adding gist reasoning tools to this site. I’ve found some really intriguing ideas, that I think can be replicated… and possibly improved. And there appears to be a massive gap in online gist reasoning training, specifically for TBI survivors. Plus, a lot of this is not rocket science and it can be replicated — even improved upon — quite easily.
Of course, in the coming months and years, I’m sure there will be a flurry of products to help people with this stuff… In fact, there already are tools out there, like Lumosity and BrainHQ. But what about those of us who don’t have all sorts of money to drop… or who have difficulties navigating online payments… or who don’t have (or want to have) Flash on our browsers? Or who just want a “quick hit” of a test to help us sharpen up a bit?
A lot of us are getting left behind – and for no good reason, other than that people either aren’t aware, or they haven’t bothered to try and fix the situation.
But never mind that. I’m going to do something about it, rather than just bitch and moan.
So, in summary (here’s where I work on my own gist reasoning):
I’m really encouraged by the recent research that shows that the degree of TBI recovery is demonstrated by a person’s “gist reasoning” ability — the ability to “get” the point of a mish-mash of details from situations. I’m also very excited by the fact that gist training can — and will — help us to recover.
I’m frustrated by the lack of online information about gist reasoning, along with exercises to strengthen it. I’ve searched… and I have not found much.
I don’t understand why there aren’t more tools online — especially for TBI survivors, whose main contact with the world may be their computer and Internet connection. Online publishing is actually quite simple, and it could be a great way to alleviate a lot of suffering.
Never mind what others are doing/not doing. I’m going to put together my own tools and post them here.
People with traumatic brain injury may have more difficulty with gist reasoning compared to traditional cognitive tests. This cognitive assessment may in turn be a clearer indicator of a person’s ability to succeed at a job or at home after injury.
A cognitive assessment developed by the Center for BrainHealth at the University of Texas, Dallas evaluates the number of gist-based ideas participants are able to extract from several complex texts. The test provides a more clear assessment of cognitive abilities for patients that are considered “normal” following traditional cognitive testing.
The study, published in the Journal of Clinical and Experimental Neuropsychology, included 70 adults aged 25 through 55, 30 of which had traumatic brain injury one year or longer prior to the study. The subjects went through a series of standard cognitive tests to assess memory, inhibition, and switching.
The group had similar IQ, reading comprehension, and speed of processing scores, however nearly 70% of the TBI subjects scored lower on gist reasoning than controls. These decreased gist-reasoning scores correlated with self-reported difficulties at work and home. Additionally, cognitive tests alone predicted daily function with 45% accuracy, while the addition of gist-reasoning scores boosted accuracy to 58%.
The impairment of gist reasoning could reflect a loss of flexible and innovative thinking in patients with traumatic brain injury.
Gist reasoning is the ability to “get the point” of something. It’s being able to extract the unimportant details from a narrative and figure out the salient / important / significant details… and the “get the gist” of the story. It’s being able to look at a picture and tell what’s really going on — or what other people think is going on, so you can discuss with them.
Gist reasoning is turning out to be a better indicator of impairment after TBI / concussion, which is encouraging to me, because showing up for neuropsychological testing and being told, “Hey, you’re really smart in a lot of ways!” is hugely deflating when you’re struggling with day-to-day issues. Knowing you’re smart just rubs it in, and it makes you feel even more lame and damaged. But being able to measure gist reasoning and see that there’s significant impairment in that… now that’ssomething to sit up and pay attention to.
My own test results, with two passes divided by 4-5 years of active rehab work, show that I’m way smart in some areas, but I struggle in a few respects. And in 5 of 6 areas of deficit, my deficits have not changed significantly. I guess that’s where Muriel Lezak would say I have not recovered.
On the other hand, the area where I havechanged, is how well I’m living my life. And that’s what really matters to me. That, to me, is what recovery is all about, not reversing deficits which would probably change over the course of my life, anyway(!)
I can still tell I’m slower than before. I can still tell I struggle with many things, including fatigue and irritability and fogginess. But these things aren’t wrecking me, the way they used to.
I still need to work at things on a daily basis. And I need help, here and there — although I’ve learned how to behave in a way that doesn’t look like I’m disabled and in need of assistance. I still struggle with things that “should” be easy for me, but haven’t gotten that way — if anything, some of them have gotten harder. Getting going on things can be a huge challenge, when I’m not motivated. And stopping things that I need to stop, to do other things I need to do (like stopping surfing the web in the morning so I can get to work on time), is as hard as ever — maybe harder. My memory is still Swiss-cheesey — especially when I’m tired. And although my temper has calmed down immenselyin the past 7 years, I still have my moments, when I just Go Off the rails. Likewise with emotions like sadness and despair. I generally keep those in check, because I can go down a rabbit hole that is terribly difficult to pull out of.
I think those times when I am less effective, are when I am overwhelmed by everything that seems important. And I think — from just a cursory reading of literature — that has to do with my “gist reasoning”, or my ability to pick out the salient / important / significant details from a situation and focus on them.
I’ve been doing a bunch of online research about the SMART training that the Center for Brain Health does, and I found that they’ve actually patented it (thank you Google patent search). If this is indeed intellectual property, and it’s controlled by them, then it’s more valuable to them in terms of money and quality control, than it is to the general populace.
And telling everyone Woo Hoo! You Can Recover From TBI With Our System! … only to say, “Oh yeah, it’s proprietary… but you can visit us and get training here — or at another one of our approved affiliates”… well, now I’m less elated.
Not that this is going to stop me trying to employ their techniques, however. I’m crafty that way, and because I’ve always been on the fringes of the medical/rehab establishment (first because of lack of information in the world I grew up in, and later due to lack of money and resources and my diminished ability to communicate with healthcare providers, thanks to a slew of unaddressed issues)… I’ve had to take a lot of my recovery into my own hands.
Of course, it helps to have access to a competent neuropsychologist to consult with on a weekly basis, but even they are a bit flabbergasted at my recovery. They say they’ve “never seen anything like it.” Woot.
So, yeah. I think I’ve got an approach that works for me – and it may work for others.
I’m going to be doing more research over the coming week and see if I can’t come up with some practice exercises for myself and others to use to improve gist reasoning. I mean, how hard can it be? It seems really fundamental to me — it’s just been hidden behind all the Wizard Of Oz machinery of the medical establishment. Hidden in plain view, all this time.
How can I improve my gist reasoning? How can I strengthen my ability to screen out what doesn’t matter, in favor of what does — and move forward?
Figuring this out — I believe — will help me prioritize my activities better, help me determine the things that matter and the things that don’t, and help me stop wasting so much time on chasing distractions for the sake of distraction. I have a handful of projects I need to finish, and I’m hoping this will help me do just that.