compensatory strategies

The Power of Reflection — revisited, at a deeper level

aforrest Leave a comment

I love it when I am in a reflective place where I am appreciating how my life has improved during the year.

I was thinking about that improvement this morning.   I was heading out for my walk and I was cued by seeing my sun block so that I could use it BEFORE I started my walk. I have consciously looked for, and found, a place to put my sun block so that I see it on my way out the door. When  I see it, I am reminded to put it on.  The “cue” — seeing my sun block on my way out the door — means that I can get the sequence right (put sun block on before walk). The cue frees me up so that I am more likely to get sun block on either because I remember to do so (sometimes) or because I am cued to remember it. Either way, my life is better with the sun block on for my walk, and because I am training my brain about the sequence.

As I was putting on the sunblock this morning, I remembered what the pattern was like on my almost-daily walk in Arlington, Virginia before we moved to Austin, Texas. I would often have already passed by several houses when I realized I did not have sun block on, if I realized it at all. So I noticed that and tried to improve upon that. And over the years, I have. In Texas, wearing sun block is much more important than in Virginia because the sun is so much more intense here.   And I have made alot of progress on getting it on.

Like I have said, small things make big differences in my world.

I realized the other day after I posted on reflecting about my “rehab” accomplishments, that I had a lot more to say about the improvements that I have had this year in the continued “re-training” my brain department.

Why do I need to re-train my brain still? Because I have persistent symptoms from my concussion/mild traumatic brain injury that I am still working a way on and, in working on them, I am improving my quality of life and functionality. The kinds of persistent symptoms that I am working on are mostly in the executive functioning category. What is executive functioning? My non-technical definition of executive functioning is the more advanced brain functions like getting a process in sequence, getting things done in a certain time, determining what activity has priority over the others and accomplishing it, getting more than one thing to happen by a certain time and taking in new information into the process.  I will have to look up the more technical definition in a future post, but that is the working definition that I remember from my formal rehabilitation.

What I have learned is that the more often I can combine rewiring activities with another activity that I am already doing during my day, the better.  That way, I don’t have to find separate, extra time in my day to do the rewiring work.   Since I have to do the activity anyway, if I can work on rewiring at the same time,  then the rewiring work will be done on a regular basis. And the more I practice, the more I train my brain with the new habit.

The trick is that I often have to be conscious that I am doing a training activity — and that means doing it more purposefully to imprint it on my brain.   Doing an activity more purposely, sometimes can mean doing it slower.    I remind myself that I am training my brain the way I want it to work in the future and that slower will make it better in the long run.  (No multi-tasking allowed!)

Raising my son is the best example of a daily life activity that has also pushed me along in my rewiring.    As a mom, I have to think ahead — so that exercises my planning skills.   I have to think ahead about how to direct him and focus him on what he needs to know about and learn.   And I have to look for effective ways to encourage behaviors in him that are good for him and away from behaviors that are unsafe or are not age appropriate or that I don’t want to encourage.

My doctors have been very encouraging that I am at the point in my recovery where taking care of a child is beneficial to me.    There definitely was a long period where I couldn’t even take care of myself, much less another.  I have had a lot of help on learning about child raising and have been taught how to build a support system around doing it.   But my point in this blog post is that raising my child is rewiring that is mostly fun to do and that I am able to take advantage of during my day.

My son is 5 years old and thriving in his preschool class.   He’s doing well, loves school and loves his friends and family.    His progress is amazing.   And when I reflect on my accomplishments this year in my rewiring, I can count the progress in his growth and development as rewiring work and progress for me also.

If you would like to read ahead about motherhood and my injury:

www.brainline.org/content/2011/10/bringing-up-baby_pageall.html

 

 

 

 

 

 

Read More - The Power of Reflection — revisited, at a deeper level

The Power of Reflection before welcoming in the New Year

aforrest Leave a comment

I usually end the year by exercising my reflection skills.  I find it very powerful to reflect about how my life has gotten better during the last year and to write these down.

I find reflecting on how things have gotten better makes me be more appreciative of my accomplishments.

Many of my accomplishments happen at a very slow rate.   In fact, at a much, much slower than I would like.

By practicing things I want to accomplish over and over, I do see progress.  My brain does eventually reorganize around a habit after I have practiced it over and over.

I find that sometimes that forward progress is easy to miss or sometimes its easy for me to take the end result for granted when it finally happens because I can finally do it and its just suddenly there.

So remembering where I was at the beginning of the year and how my life and my functionality has gotten better provides useful perspective and good feelings about my persistence and my hard work.   I am still getting better.

Here are a few of the accomplishments in developing new brain patterns (or what I refer to as continued rehab) that I have had this year:

–I am driving my own car now which means more freedom for me.    I also no longer need to schedule sharing a car with my husband which has made my life as a mom to our son much easier.    I have the car when I need it and I know that what I put in the car for our activities will be there.

–Being comfortable on some of Austin’s  bridges and expanding my range are now two of the new challenges I am working on with my driving.

–I am finding time several days a week to work on my eye exercises.  I am seeing progress from that.    I am finding that there is a shift in my eye-brain connection on my right side.  This is the area where my headaches can originate (when I am not able to rest from a cognitively-intense activity before I get a headache).   I cannot quite translate the shift  into increased function yet, but I can feel that something is changing for the better.   My hope is that this shift will eventually lead to new pathways on that side and eventually no headaches.

–I am walking twenty minutes  a day and using my arms to exaggerate the motion of going from one side of my brain to the other.   I meditate for 20 minutes a day (4 or 5 times a week).    The meditation mat “draws me to it” when I am not able to make the time to meditate.     Both the exercise and the meditation help me get through the day and make my life better.

Those are some of my reflections on ways my life has improved this year.    I do this same reflection in all parts of my life.

What are the new brain patterns you have accomplished in 2013?

Where were you when the year started and where are you now?

How do you feel when you reflect on the changes that are improving?

 

 

 

Read More - The Power of Reflection before welcoming in the New Year

’tis the season

aforrest Leave a comment

A friend who is also a mom told me the other day that she realized that if she didn’t get on top of things Christmas was not going to happen at her house. She said she stayed up late that night and used Amazon Prime and other online shopping to help her become less behind.

Her comment focused for me why December is such a challenging month for me. Because I need to keep up my sleep and cognitive rest in order to be able to manage my persistent symptoms as best as possible,  I am not able to use her strategy of staying up late. If I stay up late to do all that I think I am behind on, it only sets me back further. I must take on less in December and simplify as much as I can, in order to take on the increased tasks of preparing for and being present for celebrating Christmas.

My very wise Visual Therapy Doctor taught me a lot about slowing down in December. He did not hold our vision therapy classes  in December at all. He said there’s enough stress with the season and to teach his patients to reduce stress, he gave them time by not holding class.

He also advised against taking on anything that could be done in January in order to clear out time to do increased holiday activities like get together with friends and family.

I have followed the strategies he suggested for years and I am grateful to him that he taught me this.

TisTheSeason

I also pick which events will make me happiest and then choose among those. I have to work very hard not to over do it. Once I have picked what I would like to do, I have to be flexible about whether its good for me to do it and cancel if its not. And I focus on enjoying the things that I am able to do.

Another “strategy” for managing my life that I was taught in my rehab was to write everything down. Doing this is especially important during December. I write everything down in my calendar  in order to free up as much room in my brain as possible so that I can use as much of my brain as possible for problem solving the things that come up during the day.

If my brain is too cluttered with things I want to remember, then that clutter impedes making all the decisions that I need to make on an everyday basis — decisions so simple as which key is my door key and what to eat for breakfast or how to get from my house to the grocery store and what to buy. In December, there are so many extra details to remember and kept track of that I find I really have to be as vigilant as possible about getting things down on paper and out of my head. Presents, extra grocery shopping, trying to keep structure when everyday routine changes with the holidays  and finding good conversation topics can take up a lot of room in one’s brain if its not written down.

If Thanksgiving is my the Olympics of cognition, than Christmas is Mega-Olympics. It’s beyond what we have a term for.

Tis the season.  Enjoy!

 

 

 

Read More - ’tis the season

Thankful for Thanksgiving and the cognitive challenges it requires

aforrest Leave a comment

I am torn between blogging about what’s going on in the moment with the Thanksgiving Day holiday and saying more about the Guidelines for concussion/mild traumatic brain injury from the Ontario Neurotrauma Foundation that I started introducing last week.

This week, Thanksgiving wins.

Its my favorite holiday from way back because I love food and its a time to share good company and appreciate what’s good and what I am thankful for.   I am thankful for my family, for good food and for a roof over my head.   And I am thankful for continuing down my path to finding my voice through my blog and the self-expression that its giving me.

Thanksgiving can be a very challenging holiday for anyone.   I find I have to work much harder to manage my persistent symptoms during the holiday, so its more challenging than it was before my injury.

There are many reasons why the holiday is so challenging for me and why I have to work harder.

Here are a few examples:

— Routine helps me manage my daily life and so any holiday takes me out of routine.    When I am out of my routine, I forget to do things that I would be more likely to naturally remember or have cues to remind me, if I were more in routine.   This means that going into holidays I have to increase my planning in order to compensate.  And when I forget to increase my planning, my life can be very chaotic.

–I have to manage my energy on a daily basis so that I don’t get too tired and overwhelmed.   Thanksgiving can be a tiring holiday for anyone.   When I don’t manage my energy well, I get irritated and snappy and that makes things harder for me and for my family.   So I need to get cognitive rest to build up my short term energy reserves going into Thanksgiving and take more rest and downtime afterwards.   I also need to limit my activities that take energy and make sure I engage in activities that are uplifting and give me energy.

–In my rehab, I am practicing hard to get things lined up in sequence so that I can do them easier and better.   I work on this on a daily basis.   Getting things in sequence is pretty natural to many adults and certainly was for me before my injury.    But post-injury, I have to learn to consciously think about sequence until it becomes automatic again.    Getting things in sequence is a component of what’s called “executive functioning” skills.   Preparing for and living through Thanksgiving is the Olympics of sequencing in my mind.

What do I mean by the Olympics of sequencing?   Well, first, I only practice at Thanksgiving once a year, so its hard for me to access what I learned from last year to do this year better.   And typically its easier for me to learn tasks that require doing things in sequence when I can practice the task over and over.   If I am practicing the task often then I am more successful at using  information about where or how I misstep in order get closer to getting the sequence right.

Here’s a very small and practical example.  Pumpkin pie is the dish that is always mine to make and I love trying to make it.   I have been taught many steps to simplify making it — one is by using a store bought pie crust.  Another is to re-write the recipe instructions so that I can follow it as best I can and to make parts ahead of time.    Several years ago, my husband found an easier recipe that has a crushed ginger snap crust and that made it even easier.    But this year I forgot about the new recipe and it was not until I was trying to cook the store bought pie crust that I realized that I did not have the new easier recipe (and the ingredients for it).    This may seem like a very small thing.  But what I have learned is that a small thing can make a huge difference with managing  my persistent symptoms.   And this example, of forgetting what I did to improve things in a previous year will happen in about ten or maybe 20 times during the holiday week.   Rather than letting it get to me, I have to practice letting it go and being okay with it so that I can continue on.

 

Second, Thanksgiving is the Olympics of sequencing because in order to buy groceries (that I am not used to buying on a routine basis) I need to plan out what groceries we need to buy or that we are taking to someone else’s house.   Then I have to work backwards and get it all on the shopping list.   And I need to remember to adjust the list for how many people our family is cooking for.  So those are three or four discrete steps that I need to be conscious of and try to keep straight:  plan what we need to make or take, make a list, adjust list for how many people will be eating what we make or take, then update list at least once when people are added or subtracted.    Keeping the steps separate and keeping them in order takes me alot of time and energy. And I have to set low expectations for the results.   All these steps may be unconsciously done by most adults, but I have to remind myself to do them as they aren’t automatic for me.

And those are examples of only a few of the reasons why Thanksgiving is the Olympics of sequencing.   Thank goodness, I love the holiday so much that its worth taking on the challenges!

 

 

 

 

 

Read More - Thankful for Thanksgiving and the cognitive challenges it requires

My “Ah Ha!” moment — What I wanted to know about how to recover and rewire after my injury

aforrest Leave a comment

I had an “Ah Ha!”  moment about my posts this past week.    With my brain the way it is now, I have to learn more by doing as opposed to thinking things out ahead of time.   Often,  I just have to get going on trying something new, like writing this blog.   Once I have have practiced at it abit, it comes to me where I am trying to go.

My “Ah Ha!” moment was that all my posts have been about trying to describe my “new normal” from the perspective of many years out after my injury.    You can go back and look at them.   Some are about some of the gains that I have made long after my injury–like driving and speaking to the media and how practice has helped me.

Others have been about some of the work I still have to do to stay on balance.

These have been descriptions of different aspects of my “new normal” !

So far, I have talked about how I have hope because I know how to rewire my brain and recover more functioning.  This is called neuroplasticity (and I will come back to it).    Overall, I know that neuroplasticity is working for me —  I am still getting better and the evidence that I am still getting better gives me hope that I will continue to do so.

I also know that I have persistent symptoms following concussion/mild TBI and that I am not “well” and that I need to work hard using my self-awareness, using the compensatory strategies I have learned from doctors and professionals  (in and out of outpatient rehabilitation (which it took years to get receive)).   I have also learned from self-care, from managing and respecting my limitations, and all my strategies to cope with my injury long after the initial “acute” injury–the actual swinging of my head from back to forward and from side to side (referred to as the coup-contre-coup).

And when I am on top of my game, I have to work at it very hard, but my life goes okay and is meaningful.  And my life is getting better at a slow, but overall, sure rate.  I have had long-term recovery and rewiring and it continues (although at a slower rate than I would like, but better than no rewiring at all)

And when external things come up (like they do in life) or I get sick  or I get out of balance for whatever reason, then I need to step up my work to get myself back in balance.    Sometimes I am unaware that there’s too much on my plate or I need “to be cued” to compensate for them and sometimes, it takes me awhile to recognize that I am off balance and I fall “off my game”.    This is part of life.

When I am off my game, my life can become intolerable and I am irritable and cranky and I can get down and depressed and at some times, when it gets really bad, I simply don’t want to go on.  So I know I want to do everything I can to avoid getting in to that “trough” or valley or even getting near it.    At this point in my recovery, I have learned alot about how to manage this downward cycle that I would describe like an airplane in a tailspin.   I know I need to use all my strategies to keep me from getting in a tailspin and if I am unable to avoid getting in a tailspin or do not recognize the tailspin until fairly late, then I must use them to get out of tail spin as soon as I can.    I have a list of things to do to pull me out of a tail spin and reminders to be patient because it takes time.

I think everyone’s life has its ups and downs that may need to be managed abit.   With persistent symptoms following my concussion/mTBI,  I have learned that my issues may just be more extreme.  Some of the strategies that I use might have been helpful for me prior to my injury.  Now they are critical.

And that is a rough description of some of the things that come to mind in describing what my “new normal” is like.

 

 

 

 

Read More - My “Ah Ha!” moment — What I wanted to know about how to recover and rewire after my injury

The importance of cognitive rest

aforrest Leave a comment

I have learned alot about cognitive rest and its importance in re-finding balance, and re-building after my injury.    I was reminded of it last week when I noticed that I was getting more and more out of balance in my life.  I realized I needed to change direction and get my life going towards re-finding balance.

There are many names for good rest — brain rest, cognitive rest, power naps, downtime, REM sleep.  My friend has coined the terms “aggressive rest therapy” and “emergency nap”.

The role of cognitive rest is so critical.

Several years after my accident, I benefited from the guidance of a neuropsychologist who taught me my compensatory strategies so I wouldn’t get too tired–or what my friend and I call, “too tired to sleep”.    The neuropsychologist  taught me to do daily life activities then rest, then do daily life activities then rest, and she thought I needed 3 rests a day.   She called this ” pulsing”.  I learned that I could actually get much more done in my day if I rested my brain frequently.

My vision therapy Doctor  taught me to stop doing or limit the things that were fatiguing to my eye-brain connection.   I had to learn what these activities that caused the fatigue were.  They were often things that I could have easily done before my injury like walking more than 20 minutes.   So, it took me years to learn when I was (unintentionally) over-tiring myself and to stop doing them.

Later, a speech therapist gave me rules like “no computer after 7 pm at night”.  ( This was helpful when I was finally able to be back on the computer with the help of assistive technology).   She also taught me to limit my time on the computer for only 20 minutes a time.

And my speech therapist taught me to stop all activities BEFORE my symptoms (irritability, intense fatigue, feeling overwhelmed and increased confusion) began.   It was more efficient to stop ahead of time then to wait til the onset or overdoing it came.  Because the onset was often delayed, this self-awareness about when to stop was really hard to  to master and took me years.

But I have gotten ahead of myself.

Last week, when I realized I was out of balance, I was able to use the cue to begin the process of putting into place my compensatory strategies to help me.   Thursday afternoon, I thought I would take one last look at my blog before I published it.    Turns out our cable service went down.    So I couldn’t publish the blog post from my computer.   Rather than being frustrated, I realized the best thing for me was to seize the moment and let myself take a “cognitive rest”  for the entire time that my sitter was here.

Boy, did that help me!   Sometimes, it feels like too much luxury to stop to get brain rest.  Or, like Thursday, that I don’t have time to get cognitive rest.

What I have learned through practice  is that when my internal voices are telling me that I don’t have time, is usually when I need downtime the most!    As an overachiever, learning to “hold back my inner over-achiever” has been one of the hardest things about my recovery.   I have learned for my own recovery, I  need to err on the side of more rest rather than erring on the side of less rest.

And, as it turned out, getting downtime Thursday was indeed the best thing I could have done for myself.   It  helped me to be alittle more calm and it helped me regain more balance.  I find cognitive rest helps me make my life tolerable and allows me to keep going.   My cognition is always better afterwards.

Do you use cognitive rest to help you regain balance and help in your recovery and rewiring?   How does it work for you?

 

Read More - The importance of cognitive rest

I feel hopeful when I practice, practice, practice

aforrest Leave a comment

I feel hopeful when I practice, practice, practice.

I do.

I wanted to repeat that I feel hopeful when I practice, practice, practice because it is so important to my life.

I didn’t want you to read it so quickly that you missed it.

Just doing this habit makes me hopeful.

I feel hopeful because I know that practice, practice, practice will bring me results.

I do not know when it will bring me results.

What I have learned is that following a habit that will eventually give me results is better than not doing so.

I would rather head down the path of practice, practice, practice to change how my brain works eventually,  than to do nothing differently.

And what I have learned in life is that those are my choices.   Of those two alternatives, I would rather choose the the one that may make tomorrow better than today than the one that won’t.

 

I suppose my habit of practice, practice, practice is a little like planting seeds and being hopeful that they will take root and grow for the future.

 

 

 

 

Read More - I feel hopeful when I practice, practice, practice