I do not know what I am doing.

Went for afternoon nap. Woke from nap and realized it was early, before 0500 and therefore went back to sleep. Slept until 0700. Which I now realize is not 0700 but is actually 1900. Have this horrible sense of “How did I manage to do that?” It is a very negative feeling, as if I am adrift in space and unable to become anchored.

My anchor, my bedrock, is to fight to understand the nature of the injury and return to the land of the well and the unafflicted. I am attempting a new method of generating notes to myself. These are some of the findings from my walk of today.

Flow State

The first period of the walk, roughly the first two reps or 1.2 miles (2.3 miles if the distance from the house is factored in), is the most perky period and exhibits the greatest degree of thought activity. Subsequent to this I enter into what I believe is a Flow state. I am on effortless autopilot, floating through the forest. I am conscious of my surroundings but my body is operating without me as the driver. There is a oneness to this experience. My thoughts remain confined to the immediate experiential present: the drizzle of rain, wet leaves strewn across the damp earth, the glistening rock. There is not the same sense of new, fresh, insights popping into mind as occurred in the immediately prior walk segment. Mind has quieted down and become one with the environment.

Kaizen

With regard to the application of Kaizen techniques to brain injury. There exists a small difficulty in that the fundamental basis for Kaizen, and all other TQM methods, is that the process being monitored must be under full operator control – there must be no independent exogenous variables.

When this condition is present the operator is able to establish baseline process performance. Once this baseline is established, it is then possible to alter a single variable and determine if the outcome results in a positive or negative change in the target metric. If positive, the change may be incorporated and normalized as an element of the ongoing process. If negative, the variable may be returned to its prior state, the process returns to its unmodified baseline condition, and there exists an opportunity to test another process variable to determine its impact.

The mTBI victim typically lacks process control. The victim is subject to a large number of unexpected and unfamiliar exogenous variables. It is the presence of these new exogenous variables that result in the lifestyle and performance disruptions experienced by the mTBI victim.

While mTBI fails to meet the attributes required for true Kaizen, the methods of data collection and review may still have application. It will also be possible to establish crude process parameters and then gather data within that framework. This is the approach taken by the recent Work Experiment. It delivered useful insights.

In a circumstance in which the victim does not fully comprehend the nature or degree of compromise, where the medical intervention may only be loosely guided by prior knowledge due to the unique nature of the individual injury, then it is possible even crude data collection methods may have significant value.