Unless we understand #TBI / #Concussion, we can’t really treat it

I’ve been more absent from this blog, this month, than I’d intended. Life… you know? It’s been very busy at work, and things are shifting with my role. I’ve had some additional training and workshops, and I’m still trying to figure out where I fit in.

Fortunately, I have help. There are a lot of folks at work who are eager to step in and pull people up to the level they need to be at. I’m not the only one who’s having some challenges navigating the new organizational structure, but fortunately, the expectation is that each and every one of us is going to have challenges and struggle somewhat.

So, that’s helpful, overall.

Getting support at work frees me up to get back to my mission: To write about long-term recovery from concussion / mild traumatic brain injury, and show that it is possible to restore your life after you’ve sustained a brain injury. There is a real dearth of information about this out in the world, and I’m (still) on a mission to do something about that.

I realize that all my … “gyrations” at work have distracted me from this mission. It’s been siphoning off all my energy and distracting me, which is the opposite of what I want and need. So, I’m settling down in my job, chilling out, and looking to my long-term future… 10… 15… 20… 30 years in the future.

And that frees me up to concentrate on the here-and-now with greater focus. It lets me get back to my mission.

The other day, while researching a post, I came across this article:

New Advice to Move More After a Concussion

When young athletes sustain concussions, they are typically told to rest until all symptoms disappear. That means no physical activity, reading, screen time or friends, and little light exposure, for multiple days and, in severe cases, weeks.

Restricting all forms of activity after a concussion is known as “cocooning.” But now new guidelines, written by an international panel of concussion experts and published this month in The British Journal of Sports Medicine, question that practice. Instead of cocooning, the new guidelines suggest that most young athletes should be encouraged to start being physically active within a day or two after the injury.

“The brain benefits from movement and exercise, including after a concussion,” says Dr. John Leddy, a professor of orthopedics at the Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo, and one of the co-authors of the new guidelines.

And it makes sense to me. Because when you think about concussion / TBI in terms of what it is (an injury that disrupts connections and releases a bunch of “gunk” into the brain that shouldn’t be there), and you think about the brain in terms of what it does (processes information based on connections and makes new connections where none existed before), and you think about how the body works (moves all of that information through  – mentally and physically), then cocooning probably isn’t the thing to do for long periods of time.

TBI is a tricky thing. It’s different for everyone, of course, and something that works for one person might not work for another. But we’re all walking around in human bodies, and those human bodies function pretty much the same way.

So, if we use the principles of how the body and brain work, and we understand the nature of concussion, and we understand the dynamics of the whole scenario, new treatment approaches become clearer.

It surprises me a little bit that it took till May, 2017, to figure out how to better treat concussions. Then again, until the past 10-15 years or so, people didn’t really take “mild” traumatic brain injury that seriously. Everybody just laughed it off like it was no big deal.

Then we started to realize that onetime football players were ending up in a bad way — worse than the general public. And football players and their families started going public about their struggles. And people started talking — out loud — about stuff that used to be a source of terrible shame and embarrassment. The kinds of stuff that “you just didn’t talk about”, back in the day.

A lot has changed, thanks to research and increased awareness.

And we’re making progress in many areas.

But still, it surprises me, how much we don’t know… how much we still overlook… and how many people continue to struggle, months and years after a concussion or mTBI.

I have my own struggles, sure. A lot of the problems I had haven’t gone away completely. But after all these years of actively working on solutions, I’m doing a whole lot better at managing them, and that’s made all the difference. Maybe it’s true that brain injury can never be reversed, but then, life can never be reversed, and if we treat concussion issues as just another aspect of life that needs to be taken seriously and managed appropriately, it is very possible to have a “regular” life afterwards.

Sure, you’ll have to change some things. You’ll have to adjust. But life is full of those kinds of requirements. We don’t get a “pass” when we get injured, and the world jumps in to protect us. We just get a different set of challenges and difficulties and benefits to work with.

That being said, mental rigidity is probably one of the biggest hurdles to TBI recovery. The very black-and-white thinking that takes over when your brain gets injured can cause the injury to become even worse. Because you’re locked in a straitjacket of limited thinking. Getting your mindset out of the box and trying different things, living differently, getting on with your life, and being mindful about stuff… that can help hugely. I know it helped me more than I can say.

So, there are just a few more days left in Brain Injury Awareness Month. I’ve fallen far short of my stated plan to focus on brain injury recovery for the duration. I had such great plans… But of course… life. And my limits.

Turns out, what I’m taking away from Brain Injury Awareness Month is a reminder of how — yet again — I need to adjust my commitments and expectations and go a bit easier on myself. The thing to remember is that life goes on. And while I didn’t live up to my own expectations, the world keeps turning, the sun rises and sets, it snows and the snow melts, and the songbirds return to my bird feeder.

For today, that’s enough. It’s more than enough.

Mind the Bump – Mindfulness and how the brain works

The Amygdala Hijack

How Stress Affects Your Brain

Understanding Trauma: How Stress and Trauma Cause Chronic Condition Pain, Anxiety, Depression & PTSD:

When all the excitement calms down

Just keep going…

I’ve been in a kind of a funk, for the past few days. I just haven’t felt very energized.

I had a very busy weekend, with a lot going on, and I know I’m a bit behind on my sleep. But even when I do get some rest, I feel blah and slightly disconnected from my life.

I’m settling into my job, and that feels good. I’m settling into my routine, and that feels good, too. I’m working out or going for a swim, 3-4 times a week, and I feel pretty good, other than the aches and pains that come with the changing barometric pressure. My bank account is not at $0 anymore, and that feels great. I’m working through changing over my insurance, with a couple of different hoops to jump through, thanks to various insurance plans I’ve had over the years that I can now let go of. I’m fitting right in at the office, connecting with people and learning the lay of the land.

I just haven’t had the energy or felt the same engagement that I felt in the past.

Everything now is kind of “flat”. It’s solid and it’s stable, and it’s all wide open with a lot of possibilities. And it’s disorienting.  A little disconcerting. Like I’m walking across a prairie with long rolling hills,as far as the eye can see. Off in the distance, I can see proverbial mountains, but they never seem to get any closer. I just keep walking and walking and walking… hoping that eventually I’ll reach whatever destination I’m supposed to be at.

This is how it feels when I’m not going a million miles an hour in damage-control mode. When I’m not constantly reacting to problems and not on a perpetual hamster wheel of crisis, everything feels flat and featureless. I’m sure I’m not alone in this. Going from constant stress to having almost no stress at all, is a biochemical let-down, and the prompts that kept me alert, when everything was sh*ttier than sh*t, just aren’t there anymore to keep me charged up.

I know that life is good, the problems I thought would never disappear have faded into the background, and I am hugely grateful for it.

But I feel like I’ve got no gas in my tank, and everything just feels gray and bleary.

And that makes me feel even stranger. Like I’m a blank.

I know where this comes from. It’s a by-product of PTSD. I had a lot of trauma growing up, and I spent the first half of my childhood in a pretty dangerous environment, so my system has been wired for stress from the start. I was bullied as a kid on a number of occasions — all through 5th grade and 7th grade (I got a “year off” in between), bunches of kids ganged up on me and really punished me for being “weird”. And all the TBIs certainly didn’t help. That’s all the more trauma to add to the mix. Not much fun.

My adult life has been spent living pretty much on the edge. I have no idea what it’s like to be able to plan for retirement, because I’ve never had enough money in the bank for long enough to ever think that would be possible. The most I have hoped for, is not ending up crazy, on the streets, eating dog food.

It sounds a little nuts to me, as I sit here in my nice house (not palatial, but nice enough), with a good job, two cars in the driveway, and a respectable resume. But beneath the surface of this respectable life, there is no financial safety net, a declining spouse with encroaching cognitive impairment, parents who are also declining and expect me to care for them, and an uncertain job market that could take yet another hit from stock market fluctuations.

So, it would be fair and accurate to say my life has its share of stress — especially if I dwell on all of the above, which I choose not to.

I’m coming out of a number of years of intense pressure and trauma and post-traumatic stress. Workplace changes, health changes, my spouse getting more marginal by the month, and watching people around me make genuinely unhelpful choices with their lives… it all takes a toll. Add to that a lack of job stability and the ongoing feeling that I’m hung out on a limb and being played for a fool by the overlords at work, and it adds to the challenge.

The intensity gave me energy for the fight. It kept me going. It felt like it kept me sharp. Over time, existential stress wears you down and wrecks your system, but when it’s at full-speed, it makes you feel like you’re really alive. Traumatic stress is tricky like that – it promises you one thing, but delivers another… and ultimately, that lie can kill. I had a level of intensity that put people off for as long as I can remember. Only my bosses, who knew how to harness it, didn’t have a problem with it — unless, of course, I directed it against them. Then they weren’t so pleased.

Now that things aren’t intense like that anymore, that source of “energy” is gone, and I’m feeling deflated and a little depressed. It’s taking my system time to get used to it, and all the while it is disorienting — and a little stressful in its own right.

So, what to do? I can’t go back to that old level of traumatic stress. Not only is it not good for me, but I’m hip to its lies — it’s not the source of energy my system thinks it is. It’s making me more stupid with each passing day, not smarter, like it tells me. I’m onto it. It can’t fool me, anymore.

What are my options?

What’s there in the details?

Mainly… Focus. Keep my focus trained on the little things around me, and keep myself engaged and active in some way or another.

My patience is short with people who fritter their time away on whatever-ness and get overly busy and overly riled about every little thing, so I need to keep from even thinking about them. There are so many of them, and I don’t share the love of drama. Not anymore.

This kind of focus and letting go of all the imaginary recreational drama can be lonely. Social media is full of people who are “in it for the fight”, while my chief objective is to back off the whole fight thing and give my system a chance to right itself. When you aren’t all caught up in the push-pull, what can you talk about with people? If you don’t want to fight, and you don’t want to constantly promote your “personal brand” and take a stand on this, that, or the other thing… what can you do in the everyday world?

There’s not much draw for me, frankly. And I feel myself pulling away from a lot of the discussions and interactions from before. I understand it, and I know it’s important to people, but I just can’t be bothered with it, any longer.

I have what I need. I am what I need. There’s no need to fight, because I understand how things work around me, and it’s no longer necessary to constantly push and pull and drive and strive, to get where I’m going.

And stepping away from that drama, that boiling cauldron… it takes practice. It can be lonely.

I’m sure I’m not the only one who feels this way. I’m sure there are others I can connect with who are experiencing the same thing. I’m getting away from the old milieu I’ve worked and lived in for so many, many years… just part of maturing and growing up and out, perhaps? And I’m sure I’m not the only one.

I guess it’s just going to take some time for me to find another “ecosystem” to blend in with. Because the old one isn’t doing it for me.

Time is something I have.  Time to start looking around — up, down, left, right, out, in — for what’s next…

Getting the Gunk Out – Again and Again

Here’s your memory training image for the day (sorry I have forgotten to include these in the past days)

Study this image for a few minutes, then read the post below… and then draw it afterwards.

Get that gunk out of the gears

So, I’m starting my new job tomorrow, taking it easy today, catching up on my rest, and not going too crazy with everything. I had some errands I intended to run, but I went to bed, instead.

Just as well. Those errands can wait.

I’m pretty excited about my new role, and I can’t wait to find out how it’s going to go.

I got myself some really nice, fresh food for dinner, and I’ll start cooking that up in a little bit. I need to get my things together — make sure I have clean socks, as well as a formal suit to wear. It’s my first day. I want to look my best. I’m sure it will prove to be a lot less formal than I’m dressing for, but I’ll just take off my jacket. Roll up my sleeves.

Problem solved.

I’m trying to drink a lot of water, so I’m clear for tomorrow. The last few weeks were pretty action-packed, and I need to settle my system. Yesterday I ended up being pretty busy and active, which wasn’t my ideal. I really wanted to have yesterday off, but that’s not what happened. Oh, well. That’s what Sunday’s for, right?

I spent a lot of time, this afternoon, relaxing and stretching and breathing. I did that after my nap, while I was lying in my warm bed, feeling comfortable and easy. I am having more trouble with my upper back, shoulders, neck, and trapezius muscle. I’m really stiff and sore, and not feeling great. All that lifting and moving yesterday didn’t help. Oh, well. I stretched, rolled on a tennis ball to work out the knots, and I “breathed into it ” as my chiropractor tells me to do. In the end, I felt better than when I started, but it’s still tight and painful to move at times.

The main thing for me is to work on clearing out the stress sludge from my last job. Let by-gones be by-gones, and also help my body clear out the biochemical leftovers from all the ridiculous dramas and conflicts that people seemed to dream up to keep themselves entertained. It’s not a small thing, clearing out the sludge. We have to do it, in today’s world, because nobody else will do it for us. We live in very stressful times (especially as the new political season picks up), and our systems are deluged with all kinds of conflict and strife and perceived threats.

If we allow it to build up and stay there, it takes a toll. It puts additional stress on our systems, and it drags us down. I dunno about you, but I don’t need anything else dragging me down. Especially if I know how to clear it out.

So, I’m breathing – steady as she goes – count of 5 in… count of 5 out… nice and even, relaxing all the while. It balances my autonomic nervous system and gets me out of fight-flight mode. It backs down the stress response and makes it possible for me to clear my head, so I can think properly.

This is important. This is critical. I know how to do this, and I must do it. It’s no longer optional for me. Not just some interesting thing to try out, here and there, but a discipline I need to regularly do.

Like the image memory exercises.

Both help. In different ways. They really help.

 

…

 

And now, get your pencil and paper and draw the image you just looked at above. No peeking. It’s important to see where you come up short. If you succeed each and every time, you’ve learned nothing. Good luck.

Real Warriors – Real Strength – Support # for combat #stress to call / chat

Thinking about asking for help for combat #stress? Call or chat @DCoEPage Outreach Center 24/7: 866-966-1020 or http://j.mp/RWlivechat

The Grand Canyon of post-TBI traumatic stress

You can end up like this – with a big old gash cut into the foundation of your life

Trauma from traumatic brain injury is about more than what caused the injury.

Life after TBI (or other brain injuries) is traumatic all around. And the stress of living with yourself after TBI, can be like a river cutting a canyon into the earth, one bad experience at a time.

If you really want to help, you have to factor in the stresses that come with TBI.

You need to understand how traumatic it is to deal with the changes of a brain injury — the changes to how you process information, how you react to that information, how you interact with others, and how that compares with who you knew yourself to be, before.

You also need to understand how traumatic those changes are — what a threat they pose to your identity, your sense of self.

You need to “get” that the trauma builds up and can overwhelm an already taxed system. And if it is not cleared by things like exercise, good nutrition, some sort of self-help routine like meditation or mindfulness, and regular interaction with strong social supports, it can — and will — erode a person’s ability to function over time.

The other thing it’s important to realize is that while the Grand Canyon may always be there, you don’t have to stay in the bottom. The effect of the damage is fixable — it’s even reversible. No matter how far down a person has gone, it is always possible to help them rise back up. They don’t have to stay at the bottom of that gulch. They can climb out of that canyon and find firm footing again.

The human system is built to rise from the ashes, to re-wire its circuits, and find ways to become fully human… even if your sense of human-ness seemed to be long gone.

I have been caught in my own canyons many times. And I have climbed out of them, repeatedly. I have rebuilt my system, seemingly from the ground up, many times over in the course of my 50 years on earth, and I know from personal experience how impossible it can feel.

I also know from personal experience, how possible it really is to get up and out of The Pit.

But before you can do that, you need to understand that what’s pulling you down is very, very real, and it needs to be accepted as “a thing” and addressed directly.

Avoiding the trauma aspects of traumatic brain injury is a mistake. But it’s also reversible. And you have to do it in the right way, in the right sequence, with much sensitivity and intuition, not to mention common sense.

More on this later. Must get to work. But this is important. For all of us.

TBI Alert: Rehab Program Improves Memory and Mood, Even Years After Injury

Work it!

From Neurology Now

Tuesday, June 09, 2015

TBI Alert: Rehab Program Improves Memory and Mood, Even Years after Injury

BY REBECCA HISCOTT

Depression and difficulty concentrating are some of the potential long-term symptoms of a traumatic brain injury (TBI), but a specially designed cognitive training program may help improve these and other symptoms—even 10 years after the injury. That’s the finding from a new study from the University of Texas at Dallas’s Center for BrainHealth, published in the journal Neuropsychological Rehabilitation.

The researchers developed and tested an eight-week, 18-hour cognitive training program called SMART (for “Strategic Memory Advanced Reasoning Training”) in a group of TBI patients, many of whom had sustained the initial injury more than 10 years earlier.

The SMART Approach to Rehab

For the study, 31 TBI patients between the ages of 19 and 65 participated in the SMART program; 13 were veterans. All had experienced TBI more than six months earlier, with two-thirds experiencing the injury more than 10 years earlier. They all had chronic cognitive or psychological symptoms, including difficulty carrying out daily tasks, grasping complex concepts, or problem-solving, which affected their ability to work full-time or find employment.

During the program, the patients learned strategies for improving their attention, reasoning, and innovative thinking skills. For example, the researchers explained, patients with TBI have trouble multitasking, which can tax the injured brain. In order to improve concentration, investigators taught the patients to identify and block out distractions in order to better focus on a single task. In turn, honing these attention skills helped the patients read complex articles and tease out the core ideas and messages. The participants were also asked to apply these strategies in their daily lives, for instance by reading the newspaper and identifying the most important parts of a news story.

The researchers compared the effects of the SMART program to those of a brain health workshop, in which 29 people with TBI learned basic facts about brain health and brain injury, but did not learn any specific strategies for dealing with the symptoms of TBI.

SMART Improves Memory, Thinking, and Mood

After eight weeks, people in the SMART program had improved their ability to grasp abstract concepts, as measured by a reading test, by 20 percent and improved their scores on memory tests by more than 30 percent, the researchers reported. The patients also reported a 60 percent decline in symptoms of depression and stress, and a 40 percent reduction in symptoms of post-traumatic stress disorder (PTSD).

These cognitive and psychological improvements could also “have a positive impact on one’s confidence, cognitive control, sense of well-being, and self-worth,” the researchers wrote.

Brain Imaging Shows Signs of Improvement

As part of the study, the researchers also administered magnetic resonance imaging (MRI) scans to all of the participants, looking at blood flow in areas of the brain linked with stress and depressive symptoms, such as the frontal lobe, the anterior cingulate, and the precuneus. In people with TBI, blood flow to these regions is decreased, which is considered a marker of injury severity and is linked to worse performance on cognitive tests and symptoms of PTSD, the researchers explained.

Patients who participated in the SMART program had a more than 25 percent increase in blood flow to these brain regions, suggesting a healthier and less-stressed brain, which could also explain the improvements on psychological health, the researchers said.

Effects Last for Several Months

The benefits of the SMART training program persisted when the researchers administered another set of cognitive tests and MRI scans three to four months after the program ended, noted lead investigator Sandra Bond Chapman, PhD, founder and chief director of the Center for BrainHealth, in a news release.

Need for Further Study

The results are promising but preliminary, and will need to be verified in rigorous future studies, said Dr. Chapman and her colleagues. If future research confirms the results, SMART could be added to the growing arsenal of cognitive training programs that have shown promise for treating the long-term effects of TBI, the researchers said, with the ultimate goal of helping people with TBI lessen their symptoms, rejoin the workforce, and lead happier, healthier, and more productive lives.

To learn more about traumatic brain injury and how it’s treated, see and browse our archives here.