Category Archives: Assess

Death of the Self

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I have been doing spring cleaning. In the process I am encountering something I believe to be called death of the self.

A milestone was reached with post number 100. There was a minor sense of elation, the growing confidence that I might actually accomplish something. In place of a human vegetable there is now a human vegetable with 100 blog posts to his credit. Believe me. In the psychological places I have been, that is a genuine accomplishment, not simply a weak attempt at a joke.
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2010 TBI Inventory – Part 3

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The 2010 TBI inventory Part 3 contains four sections.

  • Section 1 provides a key to the scoring of the TBI Inventory
  • Section 2 contrasts 2010 scores with post accident scores
  • Section 3 considers the TBI Inventory scores in a work context
  • Section 4 provides links to all posts dealing with this topic

 

Section 1 –  TBI Inventory Scoring Key

The TBI Inventory is scored according to the following key:

On a scale of 0 to 4, rate the effect of the impairment on you during the past 24 hours. For example:

  • 0 = not present
  • 1 = minimal, present but does not interfere with activities
  • 2 = mild, some effect, interferes with activities but not disabling
  • 3 = moderate, greatly interferes with activities
  • 4 = extremely disabling, unable to function

 

Section 2  –  Summary of the 2010, 2012, and 2013 TBI Inventory Scores

Prior to Accident 18 months Post Accident 30 months Post Accident
2010 2012 2013
Section 1 1 59 73
Section 2 8 35 34
Section 3 0 6 6
Section 4 0 19 25
Section 5 0 18 26
Section 6 0 19 11
Total 9 155 175

Notes on the Table Data

The 2010 pre-accident events occurred in the 2007 to 2008 time period largely within the context of therapy sessions. These were acute events, not chronic, and did not persist through the years 2009 and 2010.  The 2012 data under counts actual events as inventory  items were scored with question marks, or missed entirely and left blank. The reason random items were omitted is unknown. The increase associated with 2013 reflects an assessment which incorporates all items, including all those missed in 2012. The higher 2013 total also reflects increased scores for items associated with depression and discouragement.

  Section 3 –  Review of the TBI Inventory data

There is a clear distinction between the TBI inventory scores from before and after the accident. A review of the notes associated with each 2010 TBI Inventory item clearly shows that if the subject had experienced these deficits prior to the accident he would not have been capable of performing to the mandated occupational requirements and likely would have had his employment terminated.

This was not the case. The subject was a valued employee and delivered excellent performance until the date of the MVA on March 06th 2011. It was his misfortune to suffer the loss of his work routine immediately after the accident. Combined with other circumstances, this made it extremely difficult for him to gain awareness of his injury, or its severity.

 

Section 4 – TBI Inventory Associated Posts

The following posts deal with the subject of the TBI Inventory

The initial post was made on August 27th 2013. This August post reproduces verbatim the entries made in a September 2012 spreadsheet listing of the TBI Inventory Items. This post may be found here:

September 2012 TBI Inventory

The following posts describe the provenance of the TBI Inventory and its diagnostic validity.

Thoughts on September 2012 Inventory
Provenance and Scoring Key for TBI Inventory
Validity of the TBI Inventory

The next set of links connect to each section of the 2013 TBI Inventory. Each section includes detailed notes on the changes between the 2012 and 2013 review dates. Note that this sequence of posts are not in chronological, or ordinal sequence. When viewing a specific section, clicking the NEXT button on the page will not take you to the next section of the analysis. You are better advised to click the browser BACK button, return to this page, and select the next section of the analysis that you wish to review.

2013 TBI Inventory Section 1 Analysis
2013 TBI Inventory Section 2 Analysis
2013 TBI Inventory Section 3 Analysis
2013 TBI Inventory Section 4 Analysis
2013 TBI Inventory Section 5 Analysis
2013 TBI Inventory Section 6 Analysis

The final set of links are associated with posts made subsequent to the discovery of the draft copy of section 1 of the 2013 TBI Inventory. These posts discuss the rationale for the 2010 TBI Inventory, describe the 2010 TBI Inventory and supplement it with notes which examine it within a work context. This series on the 2010 TBI Inventory concludes with a Part 3 summary post (this post).

2010 TBI Inventory Part 1 – Discussion of a 2010 TBI Inventory
2010 TBI Inventory Part 2 – The 2010 TBI Inventory Document

 

 

 

 

2010 TBI Inventory – Part 2

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Persistent Intellectual Impairments		 Check Score Note
Memory problems No 0 Excellent memory. Recall critical to work
Difficulty concentrating No 0 No such difficulty
Attention Difficulties No 0 No such difficulty
Easily Distracted No 0 No such difficulty
Misplacing or difficulty tracking things No 0 Able to act without memory aids
Difficulty making decisions No 0 Rational decision making. Self directed investor
Difficulty solving problems No 0 Work centred on constant problem solving
Difficulty understanding spoken instructions No 0 Work was verbal. Excellent performance
Difficulty understanding written instructions No 0 Many written policies. Followed 100%
Difficulty finding words No 0 Not experienced
Difficulty communicating thoughts / feelings Yes 1 Discussions with Dr D. See End Note.
Unintentionally repeating the same remarks No 0 Not noted
Unintentionally repeating same activities No 0 Not noted
Stuttering or stammering No 0 Not observed
Difficulties doing simple math No 0 Managed own investments
Impaired abstraction or literalness No 0 Not Observed
Mental rigidity No 0 Job required flexibility
Deficits in processing information No 0 Work mandated handling large volumes of information
Deficits in sequencing information ?? Still not sure what this means
Difficulty executing or doing things No 0 Projects completed on time and budget
Difficulty starting or initiating things No 0 Many household and work projects
Difficulty handling work requirements No 0 Excellent work performance
Difficulty handling school requirements No 0 Job required continual learning
Having to check and re-check what you do No 0 Job required high accuracy, performance highly monitored
Disoriented by slight changes in daily routine No 0 Accommodated all change including major shift changes at short notice
Unsure about things that you know well No 0 Confident in my abilities and performance
Difficulty learning new things No 0 Continual learning a key aspect of job
Doing things slowly to insure correctness No 0 Job required immediate delivery of correct results
Decreased capacity for reality testing ?? 0 Still not sure what this means
Impaired ability to appreciate details No 0 Attention to detail critical to job
Impaired ability to benefit from experience No 0 Continual learning from experience
Inappropriate responses to people & things No 0 Was grounds for immediate termination
Difficulty taking care of your self No 0 Not observed
Difficulty taking care of children No 0 Assisted Colin
Section 1 Totals: 1
Psychological Consequences Check Score Note
Impaired sense of self No 0
Fear of loss of control Yes 1 Associated with 2007 panic attacks
Easily agitated or irritated No 0 Had to control to perform job
Easily startled No 0 Not noted.
Feelings of paranoia No 0 Not observed
Spells of terror or panic Yes 3 Sought therapy with Dr D. See End Note.
Feelings of depression No 0 Not observed
Feelings of shame or guilt No 0 Not observed
Persistent anxiety Yes 2 Associated with 2007 panic attacks.
Anxiousness or feelings of fear and dread No 0 Not observed
Feelings of discouragement No 0 Nothing beyond routine.
Withdrawal or social isolation Yes 2 Consequence of crazy work schedule and employer demands
Feeling others not appreciating your difficulties No 0 Not observed
Feeling everything is an effort No 0 Sense of job mastery
Feeling inept or worthless No 0 Extremely positive performance feedback.
Laughing or crying without apparent cause No 0 Not experienced
Worrisome thoughts won’t leave your mind No 0 Not experienced
Making up explanations for things No 0 Not experienced
Insensitive to others and social context No 0 Would have resulted in poor job performance
Diminished insight No 0 Coached other agents job performance. Required insight.
Section 2 Totals: 8
Persistent Mood Disorders Check Score Note
Mood swings No 0 Extremely stable and consistent.
Having urges to beat, injure or harm someone No 0 Never
Shouting or throwing things No 0 Never. Would not have been tolerated in work place.
Temper outbursts that you could not control No 0 No temper and no outbursts. Would not have been tolerated in work place.
Section 3 Totals: 0
Persistent Physiological Impairments Check Score Note
Heart pounding or racing No 0 Never. Undertook regular excercise to compensate for sedentary occupation.
Rapid pulse No 0 Very slow and stable pulse.
Headaches or head pains No 0 Never
Increased blood pressure No 0 Never
Increased sensitivity to touch No 0 Not experienced
Ringing in ears No 0 Never
Easily fatigued No 0 Not experienced
Numbness or tingling in parts of your body No 0 Not experienced
Weakness or loss of strength No 0 Not noted. Did home renovations, shovelled snow with no problems.
Feeling tense or keyed up No 0 High stress job but managed it well.
Restlessness, unable to sit still No 0 Sitting mandatory for job performance
Lessened ability to perform physically No 0 No noted problems
Decreased tolerance for alcohol and drugs No 0 Do not use
Appetite disturbances No 0 Strong, consistent appetite
Trouble falling asleep No 0 Excellent sleep hygiene
Awakening during the night No 0 Worked nights. Rarely woke during the day apart from noise disturbance.
Sleep that is restless or disturbed No 0 Slept well, woke refreshed
Section 4 Totals: 0
Persistent Personality Alterations Check Score Note
Passivity, or submissiveness No 0 Not experienced
Aggressiveness No 0 Would not be tolerated in the workplace.
Apathy, lack of interest or emotion No 0 Grounds for dismissal.
Overly sensitive No 0 Agents had to accommodate all kinds of customers.
Discouragement or demoralization No 0 Not experienced
Increased emotional distress No 0 Not in workplace
Chronic frustration No 0 Experienced satisfaction at performing in a difficult environment.
Grandiosity or boastfulness No 0 Not experienced
Excessively talkative No 0 Not experienced
Compulsive writing No 0 Not experienced
Egocentricity No 0 Not experienced
Childishness No 0 Not tolerated in the workplace
Silliness No 0 Not tolerated in the workplace
Overly responsible No 0 Adhered to my area of responsibility.
Irresponsibility No 0 Not tolerated in the workplace.
Impulsively No 0 Not tolerated in the workplace.
Self-indulgent No 0 Not experienced
Indiscreet comments and acts No 0 Not tolerated in the workplace.
Obscene comments or acts No 0 Not tolerated in the workplace.
Increased sexual activity No 0 Not experienced
Decreased sexual activity No 0 Not experienced
Increased shame or guilt No 0 Not experienced
Religiosity No 0 Not experienced
Section 5 Totals: 0
Persistent Neurological Problems Check Score Note
Sense of observing your self from afar No 0 Not experienced
Altered consciousness No 0 Not tolerated in the workplace.
Slowed reaction time No 0 Reaction time measured in the workplace and was key retention metric.
Smelling odors that others do not smell No 0 Not experienced
Hearing music that others do not hear No 0 Not experienced
Making up explanations for things No 0 Not tolerated in the workplace.
Sensitivity to temperature shifts No 0 Not experienced
Seeing dark spots before your eyes No 0 Not experienced
Blurred vision, especially when fatigued No 0 Not experienced
Double vision especially when fatigued No 0 Not experienced
Diminished night vision No 0 Not experienced
Difficulty relaxing No 0 Not experienced
Twitching No 0 Not experienced
Sensitivity to sound or noise No 0 Not experienced
Sensitivity to light No 0 Not experienced
Section 6 Totals: 0

End Notes

The issues identified were acute in nature, were primarily evident during therapy sessions, and did not extend over the complete period prior to the accident of March 06th 2011. They were absent during the 2009, 2010, January to March 2011 period.

In the fall of 2007 I experienced crippling anxiety attacks while at work. These were precipitated by a fear of loss of employment arising from a work place rumour. I did not know anything of anxiety attacks and did not identify them as such.  I thought these events were signs of some pending mental illness and I sought therapy with Dr. D.

In the course of our therapy sessions, I experienced considerable difficulty addressing specific events from my past. Discussion of these events would trigger a high level of anxiety.  At some time in 2010 my employer altered my shift schedule to place me on an overnight shift. This made it very difficult to continue seeing Dr. D. I was secretly glad of this change as I wished to avoid encountering all of the problems experienced in therapy sessions.

Subsequent to the accident, I find I experience no anxiety despite having failed to locate employment and living on dwindling retirement savings. I find this to be very strange given that my initial reason for consulting Dr. D was due to anxiety attacks provoked by a work place rumour of job loss. This job loss is no longer rumour but is now fact; I am unable to explain my lack of anxiety in response to my current situation. This lack of anxiety was one of three key triggers that caused me to seek medical attention.