September 2012 Inventory


Persistent Intellectual Impairments
Check Score Note
1.1 Memory problems Yes 3
1.2 Difficulty concentrating Yes 3
1.3 Attention Difficulties Yes 3
1.4 Easily Distracted Yes 3
1.5 Misplacing or difficulty tracking things Yes 3
1.6 Difficulty making decisions Yes 3
1.7 Difficulty solving problems Yes
1.8 Difficulty understanding spoken instructions 0
1.9 Difficulty understanding written instructions Yes 3
1.10 Difficulty finding words Yes 3
1.11 Difficulty communicating thoughts / feelings Yes 3
1.12 Unintentionally repeating the same remarks 0
1.13 Unintentionally repeating same activities Yes 2 Forgot I had done them the first time.
1.14 Stuttering or stammering 0 Not observed
1.15 Difficulties doing simple math 0 Problems with reimbursement organization not the math
1.16 Impaired abstraction or literalness literalness Tend toward doing small detail things and not seeing larger context
1.17 Mental rigidity Yes Follow fixed routine and travel patterns
1.18 Deficits in processing information Yes 3 Miss errors. Need multiple reviews. Misinterpret, misunderstand. Not sure of state
1.19 Deficits in sequencing information ?? Not sure what this means
1.20 Difficulty executing or doing things Yes 3 Will start and then leave and go on to something else. Lots of incomplete projects.
1.21 Difficulty starting or initiating things Yes 3 Real need to push to move outside “comfort zone.” Tend to revert to routine.
1.22 Difficulty handling work requirements ?? Have to push myself to complete Dr assignments, letters etc
1.23 Difficulty handling school requirements ?? N/A
1.24 Having to check and re-check what you do Yes 3 Yes, especially safety / security items stove, car keys, house keys, documents
1.25 Disoriented by slight changes in daily routine Yes 3 Yes. Become uncomfortable
1.26 Unsure about things that you know well Yes 3 Sense that I am not making adequate perceptions. Spend time mulling events over.
1.27 Difficulty learning new things Yes 3 HTML 5, css3, js
1.28 Doing things slowly to insure correctness Yes 3 Yes. Documents undergo endless revision. Paper management frustration.
1.29 Decreased capacity for reality testing ? Not sure what this means
1.30 Impaired ability to appreciate details Not sure what this means
1.31 Impaired ability to benefit from experience Not sure what this means
1.32 Inappropriate responses to people & things Yes 3 Pushy and impolite in crowded store
1.33 Difficulty taking care of your self Yes 3 Wounds, open sores
1.34 Difficulty taking care of children N/A
1.35 Sect 1 TOTALS 57
Psychological Consequences Check Score Note
2.1 Impaired sense of self Yes 2
2.1 Fear of loss of control Yes 2 Dementia, things no longer under my control or as expected
2.3 Easily agitated or irritated Yes 3 SAAQ
2.4 Easily startled 0 Not noted. Have startle response in absence of stimulus
2.5 Feelings of paranoia Yes 2 Yes. Afraid to mention this as thought it would be weird
2.6 Spells of terror or panic Yes 3 Have sense of this in exiting crowded or noisy spaces. But not panic as I know it
2.7 Feelings of depression Yes 3 Feeling of “down” rather than the heavy quality of what I call depression
2.8 Feelings of shame or guilt Yes 3 Feel all this is my fault. That I should have done something sooner. I am weakling.
2.9 Persistent anxiety No 0 No anxiety at all. This seems odd.
2.10 Anxiousness or feelings of fear and dread No 0 Have sense of wanting to be “safe”
2.11 Feelings of discouragement Yes 2 Not sure if improving or getting worse. Make same mistake over and over.
2.12 Withdrawal or social isolation Yes 2 Not by choice. Consequence of crazy work schedule and job loss
2.13 Feeling others not appreciating your difficulties Yes 3 Fear of others
2.14 Feeling everything is an effort Yes 3 Constant vigilance
2.15 Feeling inept or worthless Inept 2 Mostly inept but also both. Job rejection. Social rejection.
2.16 Laughing or crying without apparent cause Yes 0 Had this previously. Not seen recently. Did cry when starting walks.
2.17 Worrisome thoughts won’t leave your mind 0
2.18 Making up explanations for things 0
2.19 Insensitive to others and social context Yes 3 Crowded places
2.20 Diminished insight Yes 2 Have to work at understanding. In some cases very vibrant insight, recollection etc.
2.21 Sect 2 TOTAL 33
Persistent Mood Disorders Check Score Note
3.1 Mood swings Yes 3 Walking helps even this out. Feel down and go for walk.
3.2 Having urges to beat, injure or harm someone No 0
3.3 Shouting or throwing things No 0 I may have been shouting at SAAQ. Tempted to throw in frustration.
3.4 Temper outbursts that you could not control Yes 3 SAAQ. Also work conflict, conflict with Val, outbursts.
3.5 Sect 3 TOTAL 6
Persistent Physiological Impairments Check Score Note
4.1 Heart pounding or racing No 0 Have noted this but not recently
4.2 Rapid pulse No 0 Very slow and stable pulse.
4.3 Headaches or head pains Yes 2 Have headaches and “discomfort” which is less than what I would call a headache
4.4 Increased blood pressure ? 0
4.5 Increased sensitivity to touch ?? 0 Do not think so
4.6 Ringing in ears Yes 2 Started again after starting walks. Present all the time.
4.7 Easily fatigued Yes 3 After Dr sessions, after walks, after paperwork
4.8 Numbness or tingling in parts of your body No 0 Noticed in months right after the accident. Feet appeared numb
4.9 Weakness or loss of strength Yes 0 Hitting the wall with no caffeine. Dropped things after accident.
4.10 Feeling tense or keyed up No 0
4.11 Restlessness, unable to sit still No 0 Opposite. Would sit still all day. Did pace a lot during job search.
4.12 Lessened ability to perform physically Yes 3 Blame this on caffeine
4.13 Decreased tolerance for alcohol and drugs N/A 0 Do not use
4.14 Appetite disturbances 0 very routine meal, menu
4.15 Trouble falling asleep Yes 3 Working on this at 2 am as unable to sleep
4.16 Awakening during the night Yes 3 Get up at 3 or 4 have tea. Used to start job hunt during this time
4.17 Sleep that is restless or disturbed Yes 3 Wake up thinking I have missed appointment, very vibrant dream, think I am in dream
4.18 Sect 4 TOTAL 19
Persistent Personality Alterations Check Score Note
5.1 Passivity, or submissiveness No 0 Don’t think so
5.2 Aggressiveness No 0 Don’t think so
5.3 Apathy, lack of interest or emotion Yes 4 Changed in Past year. Less apathetic
5.4 Overly sensitive ?? 0 Don’t think so
5.5 Discouragement or demoralization Yes 3 Changed in Past year. More discouraged
5.6 Increased emotional distress No 0 Changed in Past year. More emotional distress
5.7 Chronic frustration Yes 3 Very easily frustrated when faced with relatively simple tasks
5.8 Grandiosity or boastfulness No 0 Don’t think so
5.9 Excessively talkative Yes 2 Dr D mentioned this. Excessive detail
5.10 Compulsive writing Yes 2 Yes. Taking notes on all weirdness. Notes for projects etc
5.11 Egocentricity No 0 Don’t think so
5.12 Childishness No 0 Don’t think so
5.13 Silliness No 0 Don’t think so
5.14 Overly responsible No 0
5.15 Irresponsibility No 0
5.16 Impulsively No 0
5.17 Self-indulgent No 0 Maybe. Video phone affair.
5.18 Indiscreet comments and acts No 0
5.19 Obscene comments or acts No 0
5.20 Increased sexual activity No 0
5.21 Decreased sexual activity Yes 4
5.22 Increased shame or guilt No 0
5.23 Religiosity No 0
5.24 Sect 5 TOTAL 14
Persistent Neurological Problems Check Score Note
6.1 Sense of observing your self from afar ?? 0 I am trying to be more self-observant// Also disassociation issue
6.2 Altered consciousness ?? 0 Not sure what this means
6.3 Slowed reaction time Yes 3
6.4 Smelling odors that others do not smell Yes 2 No others to check but I suspect the smells are phantoms – kitchen cupboard, hall
6.5 Hearing music that others do not hear Yes 2 Complained to condo association
6.6 Making up explanations for things No 0
6.7 Sensitivity to temperature shifts Yes 2 Have noted this but did not see it as due to TBI
6.8 Seeing dark spots before your eyes No 0
6.9 Blurred vision, especially when fatigued Yes 3 Happens regularly but at short distances
6.10 Double vision especially when fatigued No 0 Not recent but yes in months after accident
6.11 Diminished night vision Yes 2 Have had a sense of this but did not see it as due to TBI
6.12 Difficulty relaxing
6.13 Twitching Yes 2 Did have this on months after accident. Much reduced now. Nipped tongue. Startle.
6.14 Sensitivity to sound or noise Yes 3 Problems in crowded, noisy spaces
6.15 Sensitivity to light No 0
6.16 Sect 6 TOTAL 20


Note

This table seeks to accurately reflect the data contained in the original, paper based, TBI inventory document completed in September 2012. A copy of this TBI Inventory was forwarded to SAAQ in August of 2013 as an element in the initial appeal submission. If there are blanks in this web document that is because those items were left blank, or were not scored, in the submitted version. The section totals were tabulated by hand and contain tabulation errors. This version preserves those errors, and seeks to provide an exact duplicate of the submitted paper version.