Stretching for more

April first. Surprise. I have a noontime appointment scheduled with my neuropsych today to follow up on some things we didn’t get a chance to talk about on Tuesday. I’ve got the time, so why not use it? Except that the weather is bad. And I’ve got things I’d like to do with the three hours it would take me to drive in, consult, and then drive home. Like sleep. Seems to me, sleep might actually help me more than driving through bad weather, sitting and talking, and then driving back.

It might shake me out of my funk. I have to admit, I’m not very good at vacations. I like my schedule, my routine. It has been good, getting out of the schedule-driven mainstream for a week, but I’m ready to get back into work. I’m ready go back to my job, my office, my roster of duties. I don’t quite feel like myself, when I’m off my schedule. I have more time, but I get less done.

Still and all, it’s been good to get out of the frantic go-go-go of the daily grind. Working in technology sets a grueling pace, which is promoted by people of a distinctly darwinian bent, who think that the better you are, the faster you’ll go. Hm. Not sure about that. Seems like speed is its own justification, at times. They just want to feel like they’re doing something. They just want to feel like they’re making progress.

Hm.

Anyway, the weather is letting up, but I think I’m going to cancel my appointment. I have a standing appointment on Tuesdays, and I’ll be closer to the neuropsych’s office on Tuesday than I am today. Time savings. Life savings. I just don’t want to wear myself out even more than I already am. Didn’t get my nap yesterday. Got busy running around in the evening. Also didn’t get things done that I need to get done.

At three years into my active recovery, I’m finding that I need to make some substantial changes to how I go about living my life. Discovering that mild traumatic brain injury was the cause of many of my difficulties throughout the course of my life was amazingly freeing and totally unexpected. It set me loose in the world, the way few other things have. It gave me a framework to understand myself and my own personal situation, and it gave me a route to follow to address specific issues I had in a systematic, common sense way, rather than the scatter-shot trials and errors of my life to that point.

Discovering the root cause of my issues gave me the means to address them. And address them, I have. Now that I’ve made all this progress, a different approach is called for. It’s about using the tools I have and the knowledge I’ve gained, to take things beyond the basic survival tactics I’ve employed for the past three years. The basics are pretty much in place — being, my understanding of my history and how it’s affected me — and I have the tools to address my issues, like fatigue, irritability, anger, aggression, and memory issues.

With these in place, it doesn’t make sense for me to keep subsisting at a fundamental level, “just happy to be alive”. Sure, I’m VERY happy to be alive. Don’t get me wrong. But I don’t want to fall into the rut that some acquaintances of mine are stuck in. They’re my “recovery friends” on the mend from histories of violence, abuse, addiction, and other things that strike at the core of who we are and what we think we’re all about. They literally tell me, “I’m lucky to just be functioning at a basic level,” and they mean it. But from where I’m sitting, it seems to me they’re capable of a whole lot more than that. They’re just not taking that chance. They’re not testing their own limits. They’re sitting in their stuff, feeling sorry for themselves or telling themselves they’re really badly off… when they’re really no worse positioned in the world than most of the other non-recovery-focused people I know and work with.

Don’t get me wrong. I don’t dismiss their troubles and their issues. Lord knows, I’ve got my fair share — we all do. But that’s the point — we all have our issues, and nobody goes through life without some measure of pain and suffering. Even the richest and most entitled people in the world experience excruciating pain — which must actually be worse than being in pain as a “normal” person. It must be awful to suffer, when you’re well aware that all of life is arranged around you to minimize, even prevent, any sort of pain at all.

But who can say why or how or for what we experience what we do? Lessons, I suppose. Just a lot of lessons.

Which is where I find myself now, on the last day of my official vacation. I’ve had a lot of time to think and ponder and examine my life, and while I’ve come away with a pretty good sense of being in a far better place than I was three years ago, something is missing. Something more. Maybe it’s in my nature, being the sort of person who is always looking for what’s next and what else is out there. Maybe I’m just naturally inclined to push the envelope. Bottom line is, I need more challenge. I need more living. I need more life. I need to get beyond this immediate situation of mine and look to the future, with my tools and strategies as a good foundation for moving forward.

More life. Different life. I’ve been spending more time stretching, the past few days, and I’m realizing that I probably need to shift my daily routine away from straight weight training and more to strength-building yoga. Lifting weights is great, but it also shortens the muscles (when you build bulk), and that may be contributing to my pain. Also the tightening causes me to tense up. I’ve been tense for a long, long time, and I need to find a different way of living in the world.

I have to say, I feel much better when I stretch. I steered clear of yoga for many years, because it was painful for me to do the stretches and hold the poses. But I’m at a point now where I’ve done enough stretching on my own to get past that excruciating pain. Stretching on my own, taking it easy, and being focused on my own movement (rather than a roomful of people) has been good. And I really need to do more of it — in a different way… in my own way.

{Pause to stretch}

Stretching… yes… in more ways than one. Physical stretching, as well as mental and professional stretching. I’ve had a lot of time this week to contemplate my work, why I do it, what it means to me. And I realize that the “career path” I’m on is less about climbing the ladder and more about having a quality experience… and sharing that experience with others It’s all very well and good for others to chase after the brass ring and climb over each other to reach the top, but that tends to be pretty debilitating for me. All that adrenaline pumping all the time — the constant go-go-go is all very well and good, but where does it eventually take you to? And once you get there, is that really where you want to be?

In the years before my last TBI, I was living that life. Fast and furious. Fiercely driven. I was a force to be reckoned with, and I was alternately feared and respected by my peers and highly valued by my employer. Then I fell, and it all fell apart. Then someone close to me died, and I sat and held their hand as they slowly slipped away from a life they had dearly loved and hated to leave. Then someone else close to me became seriously ill, and I was their caretaker for about a year. Three big hits in about three years. Even one of those would have been plenty to handle. But no, there had to be three.

Anyway… Coming out on the other side of it, now with three years of active rehab under my belt, I see how those experiences changed me, and how they have shaped my attitude towards life and my work. I know, having watched the young children and loving spouse of my loved-one who died all too young, that none of us has any guarantees in life. Even when the doctor gives you a clean bill of health and tells you to expect to see your kids graduate from college… they could be wrong. Even when you think you’ve got it all together, something as simple as a fall down the stairs can wipe out some of your most prized, cherished coping mechanisms. Even when you’re locked on target and think you’ve got your path figured out, serious illness can manifest and leave you feeling and acting like a six-year-old child, with all certainty erased.

And I realize — with the last week’s perspective — that no matter how hard I work, no matter how hard I push myself, it will never be enough. Not for me, anyway. And it will never be enough for the world. There will always be other things that need to be done, other endeavors to perfect. I also know for certain that the most important thing to me in my work is not the work itself, but the experiences I have in that work. That’s something that can’t be taken away. I need depth of experience. I need the kind of engagement and connection that makes memories for years to come. In the past, I have been so focused on getting things done, that I never stopped to fully experience what it is I was doing. I was so driven by results, that the process got lost along the way.

And that’s a shame. Because my memory is already iffy — why make it even worse?

Indeed.

The ironic thing is, when I take my focus off the delivery dates and bottom lines and pure results, and I focus on the core essentials — doing good work for the sake of doing it, and sharing the success with others to really create a working environment that, well, works — the results turn out even better, the bottom line is fed, and the actual results are longer-lived and more sustainable than ever. Getting the focus off the short-term, and putting it on the long-term, creates success not only in the present, but in the future as well. In the process of transcending the bottom line and delivery dates, those very things are fed. And it turns out better in the long run. For everyone. And I have real memories of live to look back on, later, not just a handful of deliveries and goals achieved.

Well, despite the weather, it is a beautiful day. I think I’ll step away from the computer now and have a good stretch.

Aggression and TBI and gender – does the mix matter?

This is another segment about Then And Now – Managing TBI Issues Over the Long Term – in particular, about Aggression.

Thinking about aggression and TBI, I got to wondering about whether the impact of aggression might make a difference, depending whether a survivor is man or a woman, a boy or a girl. I did some googling, but I ran out of steam trying to sort through all the different pieces of information.

Apparently, research points to women having worse long-term outcomes than men. Interesting. And unfortunate. There are a number of different possible explanations, which I found  at http://www.dawncanada.net/ppt/Women%20and%20Brain%20Injury.ppt (Good presentation! Very informative. I’ll have to examine it more closely when I have more time…) Some of them are that perhaps the medication prescribed interacts differently with women’s chemistry than men’s. Or women report more issues, and therefore appear “sicker” than men. Or perhaps it’s because of psychosocial factors. That is to say, women tend to be more verbally “fluent” than men, so they present as being much better off than they are cognitively. They seem fine, but they may be struggling in ways that only an objective test can pick up — but nobody thinks to administer a test, because “she seems fine”.

Conundrum.

Anyway, in thinking about TBI-related aggression, I got to thinking about different scenarios where a man exhibiting aggression would fare better than a woman exhibiting the same behavior. Aggression in men is often tolerated much better than aggression in women. With men, aggression is often expected, where with women, there’s a completely different standard that they’re expected to follow.

Say you’re standing in line at the post office during the holidays. Everyone has been standing in line for 45 minutes, holding heavy packages and wishing they were somewhere else… when in comes a guy who’s frazzled and obviously in a big hurry. He goes to the back of the line for a little bit, but after a few minutes he starts to fidget and curse under his breath. He then proceeds to jump the line and push his way into second place. The guy standing behind him gets bent out of shape and pushes him out of line, the two of them trade words, then start pounding on each other. The police are called, and the two men are hauled out of the post office and given a talking to by a couple of officers. They won’t let it go, though, and they still keep trying to punch each other in the face, so they’re separated in two separate police cruisers and driven off to jail.

Now imagine the scenario with an aggressive woman:

Say you’re standing in line at the post office during the holidays. Everyone has been standing in line for 45 minutes, holding heavy packages and wishing they were somewhere else… when in comes a woman who’s frazzled and obviously in a big hurry. She goes to the back of the line for a little bit, but after a few minutes she starts to fidget and curse under her breath. She then proceeds to jump the line and push her way into second place. The guy standing behind her gets bent out of shape and pushes her out of line, the two of them trade words, then start pounding on each other. The police are called, and the two of them are hauled out of the post office and given a talking to by a couple of officers. They won’t let it go, though, and they still keep trying to punch each other in the face, so they’re separated in two separate police cruisers and driven off to jail.

Doesn’t sound quite right, does it? How about a woman who’s just defending her own turf:

Say you’re standing in line at the post office during the holidays. Everyone has been standing in line for 45 minutes, holding heavy packages and wishing they were somewhere else… when in comes a guy who’s frazzled and obviously in a big hurry. He goes to the back of the line for a little bit, but after a few minutes he starts to fidget and curse under his breath. He then proceeds to jump the line and push his way into second place. The woman standing behind him gets bent out of shape and pushes him out of line, the two of them trade words, then start pounding on each other. The police are called, and the two of them are hauled out of the post office and given a talking to by a couple of officers. The man and woman won’t let it go, though, and they still keep trying to punch each other in the face, so they’re separated in two separate police cruisers and driven off to jail.

And then there’s the situation with two women:

Say you’re standing in line at the post office during the holidays. Everyone has been standing in line for 45 minutes, holding heavy packages and wishing they were somewhere else… when in comes a woman who’s frazzled and obviously in a big hurry. She goes to the back of the line for a little bit, but after a few minutes she starts to fidget and curse under her breath. She then proceeds to jump the line and push her way into second place. The woman standing behind her gets bent out of shape and pushes her out of line, the two of them trade words, then start pounding on each other. The police are called, and the two of them are hauled out of the post office and given a talking to by a couple of officers. They won’t let it go, though, and they still keep trying to punch each other in the face, so they’re separated in two separate police cruisers and driven off to jail.

It has a totally different feel from the scenario with two men. The situation with two men sounds like “boys being boys”, you might say. But two women behaving really badly and then coming to blows? Maybe in a toy store in LA, but in “polite society” this would stand out as an exception.

The point I’m trying to make here, is that there are different standards for acceptable behavior with men and women. And the fallout afterwards also tends to be different. With men, things can get “heated”, but with women, they get “out of hand” and the consequences are as different as the consequences for adultery in secular America versus church-centric America. In one case, it may elicit little more than a shrug, while in other cases it may result in being shunned and isolated.

Our society has a very different set of expectations for different genders, so when a woman with a TBI starts to act out, it really stands out. And it can be isolating. Unexpected, unacceptable behavior, along with social censure, can add to the cognitive load of a TBI survivor, which cuts into the available resources for just living their life, and also cuts them off from valuable social connections that can support recovery. Ultimately, if you have enough censure and isolation, without the proper feedback mechanisms for determining and modifying appropriate behavior, I would imagine things could degenerate over time and ultimately fan the flames of TBI complications, long after the initial injury has faded from memory.

If this is true in the case of women, then what about girls? I’m specifically thinking about girls who are concussed and don’t get proper care and have their concussions eventually become lasting traumatic brain injuries. What about girls who get hurt, don’t get the help they need, and end up exhibiting behaviors that alienate their friends, their families, their support groups that are necessary for healthy growth and maturation? What about them?

What makes things even more complicated, is that some of these symptoms — the aggression, the mood issues, and more — may take months to show up, so during a time when so much is in flux and changing around them, they’re all of a sudden hit with this weird new character trait of a short fuse and an explosive temper. And seemingly out of nowhere. What do they do then? If a girl is expected, pressured, trained to be a little lady, and then all of a sudden she becomes more like a wild animal, what then? If her popularity and self-image is dependent upon her behaving in a certain way, and then TBI suddenly makes it impossible for her to behave that way, what’s the impact to her development overall as a girl, then a woman?

Now I’m not saying that girls have it harder than boys, but there are differences in gender expectations, differences in behavior expectations, and if there’s one way TBI can really throw a wrench in things, it’s in the behavior area. So, if most of the studies of the impact of TBI are concerned with boys/men, what does that mean for our overall understanding of the impact — not only to the individuals, but to society as a whole?

My grandfather used to say, “Women have to be better than men. They are the ones who create our culture.” He was fine with that idea, while my mother always pursed her lips a little bit when he said that. He was an old school kind of gentleman, but there was a nugget of truth to it — although the truth was more about expectations, than actual fact.

Ultimately, I think that gender and TBI should probably be studied more closely. There’s so much to it — it’s quite mind-boggling overall. But we really need to factor it in. And when we talk about managing long-term issues, I think it can be helpful to consider to social and cultural contexts. As different as each brain injury is, as individual as each recovery is, we can’t overlook factors like gender, as well as class and ethnicity and age. It’s all a huge ball of string that begs to be unraveled, but that’s a bit beyond me right now. I’m on vacation(!) and it’s a beautiful day outside.

But first, I could really use a nap…

Help for a teen-age girl who had a brain injury

I recently received this comment from someone looking to help the daughter of someone they work with.

I was wondering if you could give me some advise a woman I work with has a 13 year old daughter who was shot in the head at the age of 7. She has more or less fully “recovered” physically and mentally as according to her physicians.

Recently she has been getting in trouble at school when she gets stressed out about tests and friends and one of her problems at school is that when she gets stressed she involuntarily scratching her forearms which is alarming school officials . But when the officials approach her she becomes more stressed and scratches her self more.

So I gather you see the problem — the school has ordered my friend (who I will call Stacy) to take her daughter to a psychiatrist and to her PCP. The PCP says that there is nothing physically wrong with her so he can’t do any thing. The psychiatrist wants to medicate but is unsure what the side affects will be as seeing that she has had severe brain trauma and suggested Stacy to contact her neurologist; which she is doing but it takes awhile to get an appointment.

While they are waiting for the neurologist appointment I suggested getting her daughter involved in a support group with others who are going thru the same kind of emotional and psychological healing that she is going thru so she doesn’t feel alone and this is where I’m drawing a blank can you or can any one else get me in contact with a support group that may meet this girls needs if you can

Bless you

Thanks

I’m worried for Stacy also, I think she needs some one to talk to who is going thru what she is.

And here is my (slightly modified) response:

Hi Mel –

Thanks so much for writing and thanks for helping Stacy!

It sounds like Stacy’s daughter is using (negative) sensation as a way to calm herself down. This is not uncommon — some folks with seizure disorders will do it to stop/interrupt their meltdowns — they hit their heads or they hurt themselves in some way. Other folks who are overwhelmed will use pain to focus their thinking. They will scratch or hit themselves, bang their heads, or do something else to “get themselves back into the present”.

It could also be that she’s using it as a way to get people to back off of her — I have been known to do some kind of bizarre things — unconsciously and consciously — that caused people to back off of me. Things like twitching and behaving strangely, that made people look at me strangely, but got them to stop coming at me so hard. I didn’t WANT to act like a freak, but I found that my involuntary reflexes had the (negative) benefit of putting some distance between myself and the person who was yelling at me, so it actually helped in a way. Additional Note: I’m not saying Stacy’s daughter is intentionally doing bizarre things — I’m just saying I can relate, and the negative reactions I myself have displayed, have contributed to my own behavior and social issues, over the years.

Also, with me, my tbi’s have slowed down my reaction time, so when I have gotten into trouble with authorities in the past, and I haven’t reacted as quickly as they wanted, they acted like I was intentionally defying them, and they came at me all the harder. I wasn’t deliberately being bad, I was just “slower on the uptake” and they mis-interpreted my response as defiance. That may be happening with Stacy’s daughter, and if she’s like me, the increased attention feeds my confusion and I get even more overloaded — A Real Problem, which Stacy’s daughter may be having.

It also could be that — like me, when I was a kid — Stacy’s daughter is (mis)interpreting the school officials’ attention and concern as being in trouble and she thinks she’s being punished or disciplined, which — if she’s like me — just adds to the overwhelm. When they approach her, the school officials need to say explicitly that she is NOT in trouble. They are trying to help her. They may think she knows, but with tbi, it’s never safe to assume anything. Now, if the school officials ARE treating her like she’s in trouble, that’s another issue — a problem with the officials, themselves.

For dealing with sensory overload… Other people with sensory integration issues will do things like rub a coarse surface, tap a rhythm, hum, or do some other action which brings a single point of focus to their attention. It’s called “stimming” or “self-stimulation” and there are many different kinds that people do in different ways. If you Google “stimming” you may find something useful.

Additional Note: Stimming is often used by folks who are autistic or have some other developmental delay — I AM NOT saying Stacy’s daughter has become autistic as a result of her head injury, only that understanding stimming behaviors (as they are used by folks on the autistic spectrum), may help Stacy understand her daughter’s need to scratch her forearms.

I have been known to hurt myself (slightly) to “get out of” a downward slide into a meltdown or when I feel like I just can’t handle all the outside stimuli coming in. Before I knew about how even a mild TBI can affect the brain, I used to bang my head when I was too overwhelmed to function. (Note: since I learned more about tbi, I’ve stopped that behavior — I’ve got all the head injury I can handle, thank you very much.) I have also hit myself, grabbed my forearms really hard and squeezed long and hard enough to bruise myself, I have punched myself, and I have done other things to get a little pain into my system to clear my head. I have never severely injured myself — like cut myself or banged my hand in a drawer or something extreme like that. I just needed a little bit of pain to chill myself out and stop the chaos in my head. I have used sports in the past to create “managed pain” in a positive way — I would push myself really, really hard in practices and competitions, to the point where I was in real physical distress. But then I was able to chill, and life went on.

I’m not an expert in this, but I believe it’s because the pain triggers endorphines (and other stress hormones/adrenaline) which can help clear the mind and help someone get a single point of focus back, when they’re being bombarded with stimuli that they cannot sort out. (Interestingly, this ties in with the research I’m presently doing about how people (unconsciously) create stress and really difficult situations to help themselves function better, when they’re totally overwhelmed.) From personal experience, I can say that there’s nothing like a little pain, sometimes, to help me focus. NOTE: I am NOT advocating self-injury as a coping mechanism, I’m just observing that — on a very limited scale — self-administered pain/stress has helped me cope throughout my life. And in fact, I still use it, now and then.

Anyway, to avoid real injury and help myself focus, I use other techniques that are less stigmatized — more like stimming than self-injury. I usually have a rolled-up paper napkin or towel in one of my pockets that I carry around with me to rub and clench in my fist, when I’m feeling overwhelmed. A rolled-up napkin really works, because it’s coarse, and it fits in my hand, so I can carry it around without people noticing it. I find it very soothing. Also, I do things like rub the seam of my jeans, tap out rhythms (working on a computer keyboard is very soothing for me), and press my thumbnail into the sides of my fingers or palm. I do these things secretly, so no one will see, because if/when they do notice, they become worried and agitated, and it makes the situation worse for me.

For Stacy’s daughter, I would strongly recommend regular exercise, like getting involved in sports. I had real sensory issues and I was a total wreck, when I was a kid. Bit when I got to high school, I started getting involved in organized sports, and that made all the difference. But I couldn’t do every sport — team sports like basketball and softball and field hockey were too chaotic for me, so I ran cross country and track. I did individual sports as part of a team. If I hadn’t been so afraid of water, I would have gone out for the swim team, but I had a lot of trouble coordinating my breathing with motion when I swam, and I was (rightfully so) afraid of drowning.

If Stacy’s daughter is not athletic, I would really encourage her to do some sort of rigorous physical activity that she can do alone or with a small group. But find something physical to do, that lets her really work out her anxiety and channel all that energy. With each successive head injury I’ve had (8+), I’ve often noticed a sudden surge in my physical energy — and I felt more blocked, like I didn’t know what to do with it. That’s been a real problem over the years. But if I can find something really physically demanding to do, I’m usually able to get myself back on track.

If Stacy’s daughter can find something to do that is safe, as well as physically challenging, and not terribly expensive (running cross country and track are about the cheapest sports you can participate in), I really think it could help. And being in organized sports in school was great for me, because it gave me structure and guidance from coaches, as well as well-defined rules to play by — very important for me, after those injuries and concussions.

Now, if she cannot under any circumstances participate in sports, she may benefit from developing other (hidden) stimming techniques — like carrying a “worry stone” with her — a rough stone or some other texture that will keep her attention focused on something other than her confrontation and/or overwhelm. Or like me, carrying a rolled-up napkin to squeeze and rub, when things get a little ‘tight’. If she can be shown other ways she can dissipate the stress that don’t attract a lot of attention, that could help.

Above all, I would recommend that someone work with her in a non-judgmental way so she can develop other coping techniques. Like an occupational therapist. Since she was obviously head-injured by a gunshot wound, she must have medical records which show she is a tbi survivor, so she may be able to get help that insurance will pay for. Rather than sending her to a shrink or medicating her or treating her like she’s mentally ill, if someone can just explain to her that her brain is not processing information the same way that other people’s do, and it’s getting turned around (no fault of hers — it’s a result of the injury), and then work with her to constructively and positively deal with her unique situation, I think that could really help. Again, I’m not a trained professional in this, but as a multiple tbi survivor with sensory issues, I know it would have really helped me, when I was a kid.

As for Stacy, I would recommend that she spend some time reading about tbi online — check some of the links on my blog and learn about it. Even though her daughter has appeared to recover physically and mentally, she will likely have a bunch of issues that she needs to work through — many of which may look like “bad behavior” but are really neurological. Also, the young lady’s age tells me that because she’s going though puberty, her hormones are changing, and that can alter your neurological experience. Women with seizure disorders are known to experience changes in seizure activity which are directly related to their hormonal condition. Stacy may wish to keep a log about her daughter’s monthly cycles so she can track any kinds of behavior changes around the time of her ovulation/menstruation. That way, she can discuss it with a neurologist, and/or help her daughter prepare for times that may be tougher, due to hormonal fluctuations, and use that information to really be pro-active and common-sense about these seeming inexplicable behaviors.

I would recommend, also, that you give Stacy a copy of the self-assessment form(s) I have available on my blog, so she can see what kinds of symptoms can come with TBI. It could be that her daughter is having more problems than anyone realizes – but because of cultural bias, people think that her daughter is just being badly behaved. Or that Stacy is being a “bad mom”. I can’t tell you how many people were really hard on my parents — especially my mom — because they thought their bad parenting was responsible for my behavior. It wasn’t my parents — it was my tbi’s that caused me do do the things I did!

The more Stacy knows about tbi, the better. And her daughter’s school officials should be educated on it, as well. If nothing else, Stacy should make sure they know about her daughter’s brain injury, so they can respond appropriately and work constructively to develop positive approaches that don’t stress out the young lady. Stacy should NOT be afraid to tell them her daughter was brain injured. If she educates herself, she can advocate more effectively for her daughter.

Oh, AND — THIS IS REALLY IMPORTANT!!! if Stacy goes to a neurologist, she should make sure they know about traumatic brain injury. Not all neurologists do. I went to one who specialized in carpal tunnel and multiple sclerosis — not really helpful with tbi, I can tell you! Her local Brain Injury Association should be able to point her in the direction of a neuro with tbi experience.

Stacy may also find support through her local Brain Injury Association. Please tell her not to be afraid of the “brain injury” stigma — there are plenty of people who have had one. The association will probably have support groups she can attend, for survivors’ family members. Her daughter may be able to find support, also. On the surface, it may look like her daughter is all better, but the brain is mysterious thing. And especially since she’s going into full-blown puberty, she may find her “neurological landscape” changing, because her body and her hormones are changing, too. So, she’s going to need new and different help for her tbi, which will affect her in new ways as she matures.

Anyway, I hope that Stacy’s daughter can find other ways to relieve her stress, other than publicly injuring herself. I hope that Stacy can learn more about her daughter’s condition in a constructive and positive way. I hope that her daughter’s school can find ways to deal effectively with this young lady. And I hope you find more ways to help Stacy. It’s wonderful that you’re reaching out like this, and Stacy is lucky to have you as a friend!

Peace
BB