Exercising the muscle of attention

Exercise is good

Use it or lose it. We’ve all heard it said, and it’s often true. I’d like to add another thought to that, specifically with regard to mTBI and attention difficulties — which often go together.

I’d like to also say — Even if you lose it, use it… and you may get it back.

I’ve been reading this article: Mild traumatic brain injury in persons with multiple trauma: the problem of delayed diagnosis and the author cites some scientific findings, namely

“Memory, attention deficits, and speed of processing information have been identified as some of the longer lasting and more pervasive neuropsychological symptoms seen in head injured adults (Kay et al., 1994; Telzrow, 1990),” and ” Deficits in higher cognitive functions can occur in the face of relatively normal performance on other more basic tasks (Cullum et al., 1990), explaining the improvement in intelligence tests scores without a comparable improvement in function. Wood (1987) showed that attention, which is often impaired by MTBI, is more important than intelligence (measured by IQ) during the learning of a simple discrimination task, and suggests that attention permeates all aspects of behavior. This helps to clarify why functional deficits continue in the face of intellectual recovery. Deficits in attention are particularly serious because there is little evidence for success of attention training procedures (Bigler, 1990).”

That last sentence caught my eye: Deficits in attention are particularly serious because there is little evidence for success of attention training procedures. Really… That’s a downer.  Especially because my attentional issues became abundantly clear during my neuropsych testing… and thinking back over my life, attention (or lack thereof) has been a major contributing factor to the difficulties I’ve had.

If there is little evidence for success of attention training procedures, what does that mean?

Well, personally, I have to wonder about

A) the type of evidence they’re talking about and when/where did they look for it?

B) what their measure of success is?

C) what attention training procedures they were using?

It seems to me that the lack of evidence is more about the lack of attention they’re paying to… attention. The attention deficits seem to be on the clinical side, as well as the TBI side. And the possibility that people aren’t measuring this on a regular basis under special scientific conditions that give the results scientific credibility, means that this sentence is instantly suspect.

What’s more, who can say what attention training procedures were being used? Seems to me, there’s more than one way to train your attention, and the best ways may be 100% incompatible with a clinical setting or an environment set up to gather data.

So, I really can’t worry too much about this statement, which dates back to 1990, as well. A lot can change in 21 years. So, this may just be old information.

But anyway, back to the idea of exercising your attention and making it stronger — practicing attention exercises after mTBI, with the intention of improving your ability to sustain focus and attend to what’s in front of you. I truly believe — and we have found more and more evidence in the past years — that the brain can and does rewire itself, and neurons that fire together wire together. What it takes is intention and determination and consistency. Truly, consistency may be the biggest element in all of this. For no matter how good your intentions and no matter how determined you are, if you’re not consistent in what you do, you’re going to have a harder time making progress, than if you stay on track and on target throughout the weeks and months, even years.

It’s worth it, however. Well worth it. I have to say that in the past three years, my ability to attend to things has dramatically improved. That improvement started with first learning that I had deficits and I needed to take action. It really commenced in earnest when I decided that no matter where I was at the moment or how I felt, I was going to change this for the better. I wasn’t going to settle for “what is” and “what isn’t” — I was going to dwell in the land of “what isn’t — yet”…and  “what will be”. I can’t say that I achieved every one of my goals I had in mind. I’m still not quite where I’d like to be with my short-term memory, and I may not ever get exactly back where I used to be. But then again, I might be able to find ways to be even better at the short-term remembering thing, using other tools than I had before, when I was wholly dependent on my memory alone.

I’ve known a number of people over the years who have informed me that they had attentional problems, and that’s just how they were. They resigned themselves to being less than they could have been — and I am quite certain they could have improved their performance, had they simply applied themselves. But they decided, years ago, that they were how they were, and that was that. No room for growth. No room for expansion. No room for change. Sad. 😦

The thing is, they basically disabled themselves. They spent a whole lot of time feeling bad about themselves and telling themselves that they sucked at what they did, etc. etc. And they just didn’t try harder. They didn’t change how they did things. They didn’t extend themselves. They didn’t suspend judgment about themselves. They just decided that they were how they were, and that was the hand they’d been dealt in life.

And they lived these half lives filled with anger and frustration and defeat.

What a waste.

I tried encouraging them to try different things, to do things in different ways, but they just wouldn’t. They’d made up their minds. Perhaps because the people they turned to for guidance had not seen enough clinical data that demonstrated that attentional issues can be resolved through practice and deliberate action.

See, this is one of the things that gets me about all this scientific information — it’s subject to change.  And it’s open to interpretation. And so many times, there is no follow up over the years that shows that their original assumptions did not pan out over time. And people like me, who have a thirst for knowledge and a trust in experts, see them saying things like, “There’s no recovery for people with mTBI — they may improve, but they can never recover,” and they give up. Because some expert somewhere decided something, based on their own limited information and experience.

Let me say this — TBI cannot and should not define you. You may have been hurt, you may have gotten injured. You may have a rough time for a while, and it may be rocky going, finding your footing again. You may end up with “souvenirs” of your injury that follow you the rest of  your life. But that doesn’t mean the story is over for you. It doesn’t mean that’s all there is, and the proverbial fat lady has sang.

Oh, no. See, experiencing a brain injury is like moving to a different locale. There are some things you have to leave behind, because they no longer serve you. If you move from Sweden to Miami, chances are, you’re not going to need your heavy winter clothing, and you won’t have to concern yourself with limited sunlight during the winter. But that doesn’t make Miami any less good than Sweden. It also doesn’t make it any better. It just makes it different. For me, my series of injuries have chipped away at my working memory, until I sometimes can’t remember stuff that gets said to me, 15 minutes after someone says it. I can’t remember unfamiliar number sequences longer than 4 digits. But I can sure as hell write stuff down, and I have ways of making a note of the information I know I’ll need to use later. I may not have as much of certain abilities as I did before, but I have plenty of others to fill in those gaps – and in some cases, the new ways of doing things may be even better than the old ones were.

This is not to make light of TBI. It’s disruptive. It destroys lives. It seriously messes with your sense of who you are. But what if recovery from TBI were about recovering a quality of life – the sense of it, the experience of it – rather than the specifics? And what if we actually were able to restore what we’d once lost, through hard work, effort, determination, and consistency? What if that were the case?

Well, I’ve gotta run. I’m at the public library, and I’m parked four blocks away from my car, which has another 20 minutes on the parking meter, by my calculations. I’d like to have a leisurely walk back, then get on with my day.

Life awaits.

Write it down, or risk forgetting

I read something really useful the other day over at Give Back LA — the reminder that I absolutely need to write things down, or I run the very real risk of forgetting them.

I must admit, I have gotten away from doing this, over the past months. For some reason, I seem to think I can use other compensatory techniques to keep in mind what is important. And to some extent it works. But that’s a load of crap.

If I don’t write it down, I might as well wave good-bye, because there’s no guarantee that it’s coming back.

My memory, to be truthful, tends to be highly unreliable. As an example — which keeps happening to me — I have two sets of three digits of a conference call code that I need to key in, to join the conference call. I think I can remember both sets of three, but after punching in the first set of three digits, I’ll be danged if I can remember the second three. Sometimes I can remember 1 of the 3 digits. Sometimes 2 of the 3. But remembering all 3? It often doesn’t happen.

I think it will. I hope it will. I expect it to. But it doesn’t happen.

Anytime I start to think that all my issues are over and done with, I need only try to recall short sequences of numbers and/or letters (like library book numbers) for more than 15 seconds, and I’m reminded all over again that I have to keep up the effort to not have things fall apart. I need to keep up the effort to keep things in order in my life, from the bills that come in that need to get paid — but don’t, when I put them in a pile with all my junk mail and the disappear from sight, and I forget all about them, till the late notices (and fees) start rolling in.  I  need to stay honest about what I can and cannot retain, and not over-estimate my capacity for stuff that stays in my head.

It’s all too easy for me to think, “Oh, that’s not a very large piece of information – I’ll surely remember it!” Then I find out that it might be small, but it’s all but disappeared from my memory. I’m lucky if I even remember that I’ve forgotten about it.

Fortunately, this problem is relatively easy to fix — just write stuff down.

The problems start happening when I start writing EVERYTHING down, in such exquisite and exhaustive detail that I become overwhelmed by the amount of info that’s there. The more nervous I am, the more caught up I tend to get in details, so writing things down and being worried that I won’t remember them just makes things worse.

The best thing I can do is just trust the fact that I’m writing things down, and leave it at that.

If I forget a piece of it, oh well. It’s not like I don’t know how to do damage control on things I’ve completely forgotten.

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