Ready for action? This page will serve as your starting point
on the road to recovery from Traumatic Brain Injury. It will tell you how
to get there and what to expect along the way. It will show
you how to identify your needs and, have them met. It will
help you measure your progress as well as setbacks. It will
encourage you to stay the course in the face of disappointments.
It will help you to know when to cut your losses and chart another course.
Through out it all we will be here with telephone 206-621-8558,
How to get
there. Traumatic Brain Injury, TBI, undermines a lifetime
of learning and personal development. Often the effects of head injuries
are not immediately apparent. Many months may go by before such changes
become apparent. For many who sustain head injuries the effects last
for a few days or weeks. For many others the problems last a lifetime.
If you have sustained
a brain injury, or know someone who has sustained a brain injury, or simply
want to become more organized, deliberate, and goal oriented this site
is for you. Whether your injury was recent or many years ago the
information on this site will help enhance your quality of life. Our methods
will help you become more focused and effective in pursuite of your goals.
Even more important,
the tools you will gain will enable you to create and sustain feelings
of self-confidence, clarity, and vitality. If you have been diagnosed
with brain injury of one type or another the first thing, you want to do
is to become knowledgeable about your specific condition. You will
find links to information on many types if brain injury on the Support
Group link on our Library
page. You might also want to take a look at the TBI
Checklist page http://www.headinjury.com/checktbi.htm , to
get a sense of your symptoms or impairments. Remember that this is
a fluid measure, that is it is intended to be used repeatedly, over time
to gain a 3-D picture of the true nature of your impairments.
presence of such symptoms can indicate serious health problems. Anyone
experiencing such symptoms should be checked out by qualified medical professionals.
The next thing
that you will want to do is to get a sense of how such impairments impact
your performance, your productivity and your relationships with others,
see our Essentials
Skills Inventory , http://www.headinjury.com/selftest.htm
. Once you've completed this inventory you will be ready to make changes
to improve your daily functioning, and enhance your professional performance
The tools and
resources on this site will enable you to make quantum leaps forward in
your personal development. Your adoption and implementation of our methods
will help you revitalize relationships, see our As
Others See You page, as well as our As
You See It page. In Addition, our tools will help you transform
burn-out, and make health enhancing lifestyle changes, see our Wellness
Inventory. They will help you design a clear, specific vision
of what you really want in relationships, career, money, health and personal
happiness. See our Goals
Analysis page, http://www.headinjury.com/goalquest.htm , and our
I Grow Up page, http://www.headinjury.com/growup.htm . Most importantly,
they will empower you to develop practices and habits that will enhance
your quality of life and expand your capacity to enjoy life.
No one can predict
with any certainty how long TBI impairments will last. They might
last for a few weeks or they might linger for many years. No matter how
long they last, they are characterized by problems such as memory loss,
impaired concentration, attention disorders, mood swings, mental sluggishness,
impulsivity, heightened arousal, personality problems, fatigue, and diminished
IQ, etc. They are symptomatic a neuropsychological disorder caused
by brain injury due to head injury. It is known as Post
Concussion Syndrome, PCS.
Even mild TBI, also known as concussion, can cause sweeping changes in
the way the brain receives, processes, stores and retrieves information.
whether they last for a few months or linger for many years, the tools
on this site can help you minimize their impact on your life.
can interfere with the ability to manage multiple,
simultaneous stimuli. In other words, ordinary sights, sounds,
smells, light etc in the environment, known as, "sensory stimulation" bombard
and easily overwhelm the injured brain. The brain tries to process all
of this through sorting and filtering mechanisms that have been disrupted
by TBI. This susceptibility to "environmental noise" can diminish
an already sluggish capacity for thinking, focus and attention. Persons
without brain injuries are generally able to filter out distractions and
concentrate on the one thing they are focussing on. People with brain injuries
may have a substantially reduced capacity to filter stimuli, for them doing
so requires extraordinary effort and vigilance.
extra effort, vigilance, and concentration needed to compensate for such
deficits result in an enormous fatiguing effect. Such
an effort produces a continuous drain on energy levels and results
in chronic fatigue. Intellectual functions such as short-term memory tend
to deteriorate as fatigue
increases. Such deficits give rise to a vicious cycle that leads
to feelings of inadequacy, discouragement, irritability and depression.
changes can turn a person into a non person, effectively incapable of performing,
routine daily activities. The challenge
then becomes to put in place compensatory strategies to help
your adjustment to a new set of strengths and weaknesses, and a framework
for a redefinition of self and purpose. The question then becomes
“What remains of me?” and “What remains for me?” The
trick is to become more self-aware, more Zen. The goal is to live in the
moment, to be still in the midst of chaos. Our methods teach you, to restore
your mental filters. They teach you to clear your mind and your environment
of clutter and distractions. See the Loss
Self page, http://www.headinjury.com/losself.htm, and the
Self , http://www.headinjury.com/foundself.htm, page.
effects of PCS are such that the person becomes a mere shadow
of his or her former self. Barring physical changes, they look the same,
but distinctive details, and personality traits have been altered or lost.
In the blink of an eye, a lifetime of learning and personal growth are
laid to waste.
Changes in memory and organizational skills after
a brain injury make it difficult to function in complex environments. Frequent
changes in schedules and activities create a disorienting effect.
Damage to the frontal lobes interferes with the ability
to control impulses, causing outbursts and inappropriate actions. It also
interferes with the ability to appreciate consequences of behaviors. Additionally,
it interferes with the ability to empathize with others. For more details
refer to our Brain
Map - http://www.headinjury.com/brainmap.htm
PCS interferes with how or whether a person goes
about doing something (e.g., Will s/he do it and, if so how?) This aspect
of PCS deals with executive functioning. Another aspect of PCS has
to do with what s/he knows or how much (e.g., How much does s/he know?
What can s/he do?
So long as the executive functions are intact,
a person can sustain considerable cognitive loss and still continue to
be independent, constructively self-serving, and productive. When
executive functions are impaired. the individual may no longer be capable
of satisfactory self-care, of performing remunerative or useful work on
his own, or of maintaining normal social relationships regardless of how
well preserved are his cognitive capacities -- or how high his scores on
tests of skills, knowledge, and abilities. Moreover, cognitive deficits
usually involve specific functions or functional areas; impairment in executive
functions tend to show up globally,, affecting all aspects of behavior."
In essence the old self is dead, done
in by the destructive effects of PCS.
All that remains are the tattered fragments of the old self. The challenge
then becomes to create a new self from the the remnants of the former self.
Adjusting to the loss self is a difficult and painful process. It is one
that might benefit from consultation with a professional with special training
in grief and loss.
Once that hurdle
is crossed, we explore the possibilities for developing a goal-directed
purpose in life. See the When
I Grow up page, http://www.headinjury.com/growup.htm , and the
page, http://www.headinjury.com/selftest.htm . This focus may be quite
different from pre-injury goals, see the Goal
Analysis , http://www.headinjury.com/goalset.htm , page. With a
re-adjusted sense of self and clear rehabilitation goals the depressive
effects of such losses can be minimized. Depression is a common reaction
to the losses caused by TBI, and should be addressed with a doctor with
special training and experience in TBI, see the Doctor
Finder , http://www.headinjury.com/doctorfind.htm , page.
Process. You will learn: 1. to recognize, identify
and clarify your needs and goals. 2. To maintain your
own sense of personal power and confidence. 3. to be
sensitive to toward others without ignoring your needs and desires.
section provides a framework for the implementation of the compensatory
strategies presented on this web site. It is a model of self-change
that unlike the traditional "action" model does not blame unsuccessful
attempts at change on lack of willpower or motivation. Instead, it
outlines seven stages and contends that by identifying and understanding
where we are in the process, you can gain control over the cycle of change
and move through it more quickly, efficiently and with less pain.
The seven stages
1. pre-contemplation, 2. preparation, 3. contemplation,
anticipation, 5. action, 6. maintenance, and 7. termination.
They are based on a book by Prochaska, Norcross, and DiClemente, entitled
Changing for Good.
don't think there is a problem. They resist change in themselves
yet want those around them to change. They feel demoralized, and
that the situation is hopeless, and avoid news of their problem.
See the Denial
, http://www.headinjury.com/denial.htm , page, and the
involves gathering information about yourself, the nature and scope of
the problem, possible obstacles to the desired changes and strategies for
overcoming obstacles and implementing changes.
See the TBI
Types , http://www.headinjury.com/tbitypes.htm ,page,
http://www.headinjury.com/problemdef.htm page, the Problem
Solving page, http://www.headinjury.com/problem.html , and the
links in the previous section.
also known as procrastinators, know their destination and how to get there,
but aren't ready to go yet. They substitute thinking for action.
plan to change in the near future but haven't necessarily resolved some
ambivalence Their awareness of news on the subject is high,
they make public their intended change, and plan carefully to learn the
processes to carry them through to maintenance and termination.
In the action stage people are busy and changes are visible --see
our Daily Activity Inventory
-- but action is not the same as change, then see our Action
In maintenance, changers consolidate gains and work to prevent lapses.
In cases of TBI, it is a long, ongoing, lifelong process.
comes when the obstacle is no longer a temptation or threat, although some
problems can't be terminated.
It is possible
to progress linearly from one stage to the next, but that's rare -- very
few people have no setbacks, most people go through the various stages
three or four times before they complete the cycle. Conventional
wisdom has it that stages can't be skipped, people who try to accomplish
changes they aren't ready for set themselves up for failure.
As a rule, doctors do not educate
thing that doctors routinely fail to tell PCS patients and
their families is that recovery is a slow, lifelong process of struggle
and adjustment. Although recovery is agonizingly
slow, it has its rewards.
My mild TBI was in 1982, and yet, I continue struggle with the many cognitive
impairments that resulted from it. Believe you me, no one wants this
thing to be over more than me, but in reality,
for many individuals, there is no end to it. Rather, you
learn to live with it and accommodate it in your life. See Patient's
case history. A family had been advised by their daughter's
neurosurgeon to expect a "full recovery" within 2 years. Three years later,
the family was disappointed with her progress and felt that it might be
due her personal failings. Despite her hard work and remarkable accomplishments,
they seemed to have the impression that there must be some secret cure,
or something that they could do to restore their daughter to her former
were puzzled by her new behaviors that more closely resembled those of
a toddler rather than the mature responsible college age young lady they
Their question to was:
she continue to grow up and mature?" The short simple
answer is yes, it is very likely that she will continue to grow up and
mature, but she will never be the same. Her old life is over.
She will have to create a new life for her self, and she will have to reinvent
herself out of the ashes of her destruction.
It is likely that she will remain dependent on you
for many years to come. She probably longs to be free of parental
controls. Every healthy, young person longs for the day when
they can be free of such constraints. Unfortunately, her TBI impairments
have gotten in the way of her ability to fulfill that very basis instinct.
Their questions concerning her "maturity
and 'apparent' irresponsibility" did not provide sufficient
details for me to gain a clear understanding of what they meant. What
appears to be immaturity and irresponsibility might be the effects of her
TBI. This is not to say that she will not continue to progress, but it
means that any progress will be much slower than you would expect from
a fully intact, bright, capable young adult. Consider
are diagnosed with PCS it means that you have been saddled
with an unreliable memory,
http://www.headinjury.com/surveymem.htm , chronic fatigue, and unpredictable
mood swings. Some persons become emotionally
volatile due to their injuries. Such problems might be due to frontal lobe
injuries and become “rigid” in their thinking. (this means unable to be
flexible in their ideas or behaviors) and unable to wait.
Individuals with frontal lobe
injuries may be confused by metaphors. While others with injuries to different
regions of the brain may rely on the use of symbols or analogies to make
points more concrete for them. Some persons experience severe visual
problems and can not tolerate certain clothing patterns, or fluorescent
lighting that trigger seizure-like
activity. TBI can cause you to become hypersensitive to light, sound,
and stimulus of all types. It can interfere with your biological
cycles, such a sleep, appetite, respiration, digestion, etc. See our TBI
diagnosis of TBI means that:
problem solving , http://www.headinjury.com/problem.html , and
making , http://www.headinjury.com/problemdef.htm , become more difficult.
It means that doing things and understanding things
more time and effort than before TBI. It means that reaction
time will be slower, you will become more excitable, and your sense of
knowing will be different, alien even. It means that organizing and
expressing your thoughts will be more difficult, see our Essential
Skills page, http://www.headinjury.com/selftest.htm .
It means that understanding and interpreting subtle
clues, body language, and facial expressions will be more difficult. It
means that self regulation and self appreciation will be diminished.
It means that judgment and discrimination will be impaired.
the end of the day
A diagnosis of TBI means that maintaining
an appearance of reasonable normalcy requires extra effort and vigilance
which creates a chronic fatiguing effect which means that you will need
frequent rest breaks and more quiet time. To ignore this requirement
means that you will be continually bouncing off walls, offending, and alienating
everyone in the immediate vicinity. See
our Wellness Journal
Headaches and other physical symptoms could be signs
of the need for more rest. They could also indicate the presence of a TBI
related vision disorder. To distinguish between headaches and head pains,
see our FAQ
page for help with such distinctions. Additionally, check out the
resources on our headache
page, http://www.headinjury.com/linksha.htm. Also visit the sites
on our vision disorders
page, http://www.headinjury.com/vision.htm as vision changes are
common after TBI. Also consider dehydration and fatigue, and seizure
as possible causes of headaches. Be sure to report these and any
other symptoms of illness or diminished functioning to a qualified medical
Living with TBI means that a lifetime of learning
and personal growth goes out the window. It means that you must learn
everything all over again. You should know that your learning style might
have changed too. It also means that you have to grow up all over
again. The second time around isn't any easier, but you can get through
it in a lot less time. The best part about it is that you have a
lot more say in it. See our When
I Grow Up page, http://www.headinjury.com/growup.htm .
TBI means that you are no longer
the person that you used to be. This means that the old self is lost,
a victim of the destruction of TBI, see the Lost
Self page, http://www.headinjury.com/losself.htm
Surviving TBI means that, like the mythological
Phoenix, you must reinvent your self from the ashes of your own destruction,
see our Found Self
page, http://www.headinjury.com/foundself.htm. It means that you
must embrace and love this new self, warts and all. It means that
you must continually reform and refine the new self as you progress through
life's many phases, and challenges, see Essential
Restoring quality of life after TBI means that you
must learn to work smart, http://www.headinjury.com/actionplan.htm
conserve energy, become highly focused and deliberate in all things.
Doing so means that you must learn to live in the moment, as distinguished
from living for the moment. One is very self conscious and thoughtful,
the other is self centered and reckless.
Living well in spite of TBI requires that you become
intimate with it as it affects you and your family. And, then you must
create a plan , see our Goal
Setting page, http://www.headinjury.com/goalset.htm , that addresses
your needs and those of your family. It means that you must face and deal
with the deeply painful emotions on all sides, see our
Inventory, http://www.headinjury.com/anger.htm . Don't overlook
feelings of guilt, resentment and denial,
http://www.headinjury.com/denial.htm , that afflict family and loved ones.
See links to Well Spouse Association, and the Family Caregiver Alliance
on our , Support
Group page, http://www.headinjury.com/linktbisup.htm.
Living well despite TBI requires you to reaffirm
your values and priorities It means that you must become more skillful,
Quiz, http://www.headinjury.com/assertquiz.htm , and tactful.,
see As Others See
It also means that you must become your own advocate see Advocacy
Skills, http://www.headinjury.com/advocacy.htm , It also
means that you must make a special effort to become sensitive to the needs
of your family and loved ones, see our Pop
Quiz , http://www.headinjury.com/popquiz.htm .
A diagnosis of TBI means that learning new information
becomes very difficult. It also means that relearning old information
is easier than learning new information. Bottom line, learning becomes
more difficult after TBI. It also means that you become more distractible,
and your ability to attend and concentrate have been diminished.
TBI also means that you will have greater difficulty filtering stimulus
in your environment.
This along with all of the above school
becomes more of a torture chamber for students with TBI than
it is for those without such injuries. Changes in memory and organizational
skills after a brain injury make it difficult to function in complex environments.
Frequent changes in teachers, classes, schedules and activities create
new challenges for the student. Special accommodations such as readers,
tutors, note takers, extra time on test, and open book tests ease the transition.
Think of a tape recorder as an assistive device - record lectures, some
schools provide this service.
Fortunately, the law understands such special
needs and requires schools to provide reasonable and necessary accommodations
for students with special needs, see our Little
Red Schoolhouse page, http://www.headinjury.com/school.htm .
Such a multitude of impairments might cause a person
to be perceived as "immature and irresponsible,"
but it might be an unfair characterization. TBI impairs the ability
to to respond to the demands of daily living, yet in spite of such an enormous
burden living well with TBI required you to demonstrate leadership in ways
that would tax those without TBI.
Understanding the effects of TBI in your life requires
that you make honest appraisals of who you are and what you hope to achieve
within the context of your situation. It also
means that you must possess enormous patience and forgiveness.
well in spite of TBI means that you must learn be smart and to work
smart. My best advice would be to encourage you daughter to continue
along the lines she is going, taking courses and rebuilding her skills.
This whole process must be very grim for her. At the time of her
accident she was poised on the brink of independence when it was snatched
away from her. She had completed a very grueling rite of passage,
when she graduated from high school. She was looking forward to a
normal, college career, another important rite of passage. Then along
comes a head injury which strips her of the ability to compete with her
friends, and diminishes her capacity to enjoy life. End
of case history.
1. Standard MRI, PET-scans, CT-scans
and the like are historically insensitive to the microscopic lesions that
result from Traumatic Brain Injury, TBI.. These lesions (wounds)
cause a condition known as Post Concussion Syndrome, PCS.
The definitive test of PCS is a battery of
test known as a neuropsychological assessment. Typically, a "neuropsych"
will contain, among other things, a standard IQ test as well as measurements
of high level mental functioning such as memory, concentration, attention,
mood, execution, and initiation. Assessments of test scores are compared
to those of individuals with similar backgrounds (demographics) who do
not have a history of head injury. Test performance is judged against past
accomplishments as well as other influences in your personal history.
2. Many doctors do not believe
that long term impairments result from mild TBI.
Neuropsychological rehabilitation programs are designed
to treat such conditions. Often, psychological counseling is needed to
deal with the many, chronic impairments that follow head injury.
3. Many doctors believe that a loss
of consciousness is essential to a diagnosis of TBI.
4. In my experience, "pseudo seizures"
can be controlled by careful lifestyle management.
This, of course, has
to be accompanied by balanced life-styles of good nutrition, sleeping habits,
exercise routines. It is advisable staying away from drugs and alcohol
which accentuate depression and increase dis-inhibition.
5. Memory mood and fatigue are
the top 3 complaints of TBI patients.
6. Persons with a history of sexual
abuse, child abuse, depression, as well as individuals with a history of
unresolved emotional disorders, face special difficulties following head
Note: While the appearance of Post Concussion Syndrome
impairments can be worrisome, rest assured that they will get better over
time. You should notice progressive improvements especially if you
actively work at getting better. While the rate of progress might be much
slower than usual, its better than the alternative. For many individuals
the rate of progress can be excruciatingly slow. Often years of hard
work are required to achieve a level reached in weeks pre-injury.
The information and resources in this section will help you increase your
self awareness, and help you monitor your progress as well as set backs.
Remember, sometimes you have to go backward to go forward.
The success of rehabilitation
usually depends on three main factors: (1) The age of the patient.
Younger patients typically make better recoveries than older patients.
The amount of brain tissue damage and where in the brain the damage occured.
Some functions are less specific than others and the brain can compensate
by making new connections. Other functions, like speech and language, seem
to more "hard-wired," and if the basic neural "circuitboard" is damaged,
less recovery is expected.
(3) Persistence. The three rules of successful
rehabilitation are practice! practice! and practice! Even in the face of
seemingly overwhelming odds, near-miraculous "recovery" is possible when
patients, their families, and knowledgeable clinicians all work together
diligently and persistently over time.
However, the down-side of such expectations
is that it can put undue pressure on the patient to keep "getting better"
when he/she is already doing everything neurologically possible.
The key is to use a combination of clinical wisdom, common sense, and compassion
to make all the gains he/she can, and then both accepting the limits that
remain and - just as important - finding new ways to express his/her remaining