“One of the things a head injury does is to break some of the long, slender communication lines from the bottom of the brain to the top and from the top to the bottom. This makes thinking sluggish, dull, and easily overcome by fatigue. It requires the survivor to focus extra hard to get pumped up before doing something, so that there will be enough energy and chemicals to power the action. It requires doing things with extra effort so that the actions don’t become too weak.”
Section 1 The Brain-stem
The above quote is from Section 1 of How the Brain Works (HBW. See the prior post for details of this publication). I am now on my fifth or sixth reading of this document. When I first discovered it I had the belief that it might serve to explain my injuries. I am now less confident of this explanatory power. I suspect this is more my own fault rather than that of the publication. I suspect my expectations were set too high.
I do wish to complete this set of posts. I have therefore collected excerpts from the HBW document which appear to describe my own experience. The lead in quote describes my experience precisely. When I encounter something that requires intellectual effort (writing the TBI proposal, attempting to write the outreach letters) I experience fatigue after performing the activity for three to four hours. I have experienced fatigue in trying to assess and understand the HBW publication. I also encounter fatigue when I encounter new situations (when I met Dr N, on visits to the x-ray clinic and to the hospital). When I perform a low level set of daily routines I do not encounter the same level of fatigue. I did encounter such fatigue in the past. In the first period after the accident I also experienced “foggy thinking,” or a difficulty in thinking. I attributed this to the fact that I was attempting to make the transition from a 2030 to 0700 night shift after spending almost 2.5 years working nights. When I first started seeing Dr H I found myself experiencing heavy fatigue and headaches on each visit. After meeting her I had to return home and nap. I no longer have this level of fatigue when I see her.
“Brain-stem injuries are often physically disabling or obvious to others because they can produce a kind of spasticity in these muscles that makes the face look strange.”
I am experiencing what I call “flutter” events in which muscle groups exhibit tremours or twitches. I also have atrophy on the left side of my body. When I went to ride a bicycle for the first time after the accident I was unable to support my weight on my left side and had difficulty operating the left side brake. When I examine my left upper arm in the mirror it appears there has been a significant loss of muscle mass compared to my right arm.
“Minor damage produces a problem called sleep apnea, where you stop breathing in the middle of the night, and then start again so suddenly that it wakes you up. Severe apnea can leave you exhausted after a night of sleep, or even damage the brain further.”
I may have experienced something like this. There was a period where I would wake in the night without explanation. This post describes one such event. I also had an extended period where I would go to sleep feeling positive about my situation and then wake in the morning very down such that getting out of bed was a struggle. I do not wish to create more problems than I have and this is one case where I do not feel confident making inferences based on the HBW description.
Section 2 Systems to Process Input and Output
This was a short section. It did not trigger any reflections on my own experience.
Section 3 The Levels of Perception
“The stations that process sound are found directly beneath the ears, on the sides of the brain.”
In my case I appear to have suffered a loss of hearing in my left ear.
“Many survivors have trouble from focal damage to this part of the brain, usually in the form of being oversensitive to noises, but also sometimes in the form of having difficulty understanding what people are saying”
I have noted a difficulty in understanding what people are saying. This is most prevalent when I encounter someone with whom I have had no prior interaction (Dr N, members of the non-profit, sales and clerical staff)
Section 4 Centre for Controlling Learning and Memory
“They are filled with a brain chemical (glutamate) that is very toxic, so that if one brain cell gets torn open it tends to kill those around it. So most head injuries produce problems with learning new memories.”
I have had a great deal of difficulty with learning. I did not experience this prior to the accident. In fact, one of the reasons I enjoyed working in IT was the constant exposure to new technologies and the associated learning requirements. I have attempted to upgrade my skills using on-line training media and this does not appear to “take.” I have constant problems in this area and find it very frustrating. Even when I force myself it appears to make little difference.
“The practical effect of damage to these centres is to create special problems when large amounts of material must be learned in one siting, as when reading, taking classes, . . .”
I have encountered this effect. I still encounter problems with long form text although I can absorb short text. See this post for an example.
“. . . damage to these centres also leaves a person very vulnerable to head-injured moments that involve forgetting or mis-remembering important information at crucial times.”
I was unable to remember my own phone number when registering at the x-ray clinic. Felt very stupid.
“. . . you learn more if you study smaller amounts of information, . . .”
See the example at the URL above. Even in working with the HBW document I have had to chunk it and work with smaller segments.
“. . . develop the habit of committing all important information to written notes. A well-developed system of note writing and note filing can almost completely take the place of the defective memory systems.”
This certainly describes my behaviour after the accident. I have become heavily reliant on using my home computer as a form of external memory. I take notes on all of my activities, maintain detailed lists for food shopping, and pending tasks, and create dedicated lists each time I must venture from the house. If I do not do this, then I run into problems. I also run into difficulties if I misplace my written task, or shopping lists, once I am out of the house. I really need a means to move lists and data seamlessly to my mobile and back again.
” . . . even survivors who have a great deal of difficulty remembering new information generally have no problem remembering all of their skills.”
This is an example of procedural memory. This explains why I have no problem with cooking as cooking is an example of a procedural skill. For the 12 years I worked for HPQ I would go in to work, sit down, and start writing text on a computer. This too is a procedural skill. So I have a well established prior routine that involves computer note taking skills, plus I have developed the habit of depending on computer notes as a form of external memory.
“Accessing stored knowledge also involves a robust network that is rarely destroyed by TBI. For this reason survivors who cannot remember what they did yesterday have no difficulty remembering what they did on their first date, or their first prom night, or their first job, even if it was many years ago.”
I have been struck by the degree to which I have been able to recall long forgotten events from my childhood or youth. During recall these events are as vivid as if they had occurred yesterday. See Bias Toward the Past in this post for an example.
Section 5 Creating and Controlling Emotions
“So when it’s working properly, your emotional system helps you to think, forces you to make better decisions, and energizes actions that need it.”
My emotions appear flat or less present than they once were. I do not get the same emotional charge from image creation that I once did.
Problems with following the rules of social life. I have encountered this after the fact. I try and fit in and only later realize that I was somewhat off the wall. I am not sure how to describe this accurately.
Section 6 Organizing Familiar Actions
“The most common problem in using old skills is slow execution. which is caused by minor damage to the transmission lines that connect the input to the output control centres and the output control centres to the spinal cord.”
I have noted this. Dr H has recommended I pay attention to my daily tasks. As I have done this I realize that much of my time is taken up by relatively few tasks. The result is that there are other activities I should perform which are left undone as I never get round to them. This is one of the reasons that I want to complete this HBW post sequence. I want to shift my focus to a review of my task activity.
Section 7 Wilful Control of Special Situations
Section 8 Command Centre
Section 9 Output Control Station
Brain Networks
Section 1 The Emergency Network
Section 2 The Automatic Pilot
Section 3 Language Information Processing System
Section 4 The Nonverbal Information Processing System
Section 5 The Emotional and Memory Influence Networks
Section 6 The Control Network
“There are five work stations that help to control thoughts and actions, the basal ganglia for automatic actions, the anterior cingulate for willful switching, the dorsolateral prefrontal area (on the sides) for planning, the orbitofrontal area (over the eyes) for stopping thoughts and actions and for processing internal needs, and an area we have not discussed called the supplementary motor area, behind the dorsolateral prefrontal area. These five work stations are all linked, and they form a network that gives people the power to make themselves do anything they decide to do.”
“The control network is usually damaged by TBI. Consequently, enforcing decisions and carrying out plans takes extra mental effort.”
“As patients with head injury get better, they teach themselves to amp up this network, so that it puts out enough control to pilot the damaged central nervous system.”
“It seems to take a lot of practice to learn how to turn on this network by simply deciding that it is needed. That is some of the most important work of self-therapy.”
I believe this explains how it was possible for me to submit the appeal document to the insurer. I had this sense at the time that my life depended on completing this submission and that I had to get it done no matter what. The result was a 24×7 effort that required total task dedication and effort. It was a huge undertaking and I still recoil at the memory of the effort required. What is interesting is that after exerting all of this effort and getting the appeal submitted I then felt a vacuum, a sudden let down and absence. I now found myself stuck without a project around which to centre my activity. I then began searching for a project in which I could again “amp up this network.” I did not realize it at the time but what I was doing was learning how to control and apply this brain network. I also recognize that I have now learned to apply it in a variety of other circumstances, most of them involving text creation.
What I need to do now is learn to apply this network to other situations and to task clusters that involve more than text creation.
Section 7 The Problem Solving Network
“This is also the system that notices when things don’t work out the way they are supposed to, and realizes that you can’t do all of the things you thought you could do. This is the system that keeps your self-concept realistic.”
“Unfortunately, this network is damaged very easily by head trauma.”
“This is why survivors feel so sure that they are not making mistakes, so sure that they are making good decisions, so sure that they are thinking well, and so disinterested in doing things to repair their deteriorating lifestyles.”
These statements also describe my experience. I learned to “amp up” the control network to complete the insurance claim appeal. Having done that I went in search of other activity to which I might apply the same network and began working on a newsletter project. This commenced as a local initiative and then expanded into a trans-Canada initiative (it takes as much time to put together a local newsletter as it does to create one that goes around the world).
My problem was that I was completely unrealistic in being able to assess my own performance capabilities in any realistic way. In many respects I was operating from a self image formed prior to the accident and was not taking into account the limitations imposed by the injury. As a result of this I created something of a mess. The after effects of these events are described in this post.