vision therapy

’tis the season

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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!

 

 

 

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Why guidelines for treatment after concussion/mild traumatic brain injury are so important to me

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Back to guidelines for concussion/mild traumatic brain injury this morning.

I have been thinking about what is the most important thing to me personally as a survivor about the updated Guidelines for Concussion/Mild Traumatic Brain Injury and Persistent Symptoms developed by the Ontario Neurotrauma Foundation (ONF).   I introduced the guidelines in my blog a couple of weeks ago.    They are the first guidelines for the treatment of civilian adults with persistent symptoms in the world.

They have been updated recently to include the latest research and clinical knowledge.   I worked with a group of other experts on these, including several experts from the U.S. and Australia as well as experts from Canada.

I know that the ONF guidelines may be difficult to read and understand since they are written for Health Professionals.   So I want to talk about what they mean to me and explain them in a way that can be understood for people with concussion and mild traumatic brain injury and those who love them.   Here’s the link to the guidelines posted on the ONF website: www.onf.org/documents/guidelines-for-concussion-mtbi-persistent-symptoms-second-edition

Before I go further, I have to say alittle about my ability to prioritize what the most important thing about the guidelines is to me.   Prioritizing is definitely not my strong -suit post-injury.   In fact, what I have come to learn is that prioritization requires some higher level executive functioning skills that I am still consciously working on to improve.

I will say though that my ability to prioritize has gotten better with practice.   In fact, I remember that people would ask me what’s the most important thing  about this or that for you?   And it would stump me.   I couldn’t answer, especially in the time that they expected me to answer it.    I learned to compensate by learning to ask — “Could you give me a yes or no question?”

Later, I learned to try to say it with a little humor — “Could you give me an easier question for less money?”

Practice in awareness has also helped me recognize that even without my challenges in prioritizing, it might be difficult figuring out the most important thing about the concussion/mild traumatic brain injury guidelines.  I say that because there are many important parts of the ONF guidelines that affect me as a survivor very personally.    And,  I know that many of the parts are important to other survivors because I have had many conversations with survivors and their loved ones who have had big difficulties finding the help they need after concussion/mild traumatic brain injury.  And the guidelines address many of the questions that I and others have taken weeks, months or years trying to resolve  for ourselves.

As I sat down to write this blog this morning, I realize that  the first thing I really need to explain is why I think Guidelines for Doctors and Health Professionals for treating patients with concussion/mild traumatic brain injury are helpful to survivors and their families and why I would like to see them for every country.   Then I will talk about specifics in the ONF guidelines.   I think they could be used as a basis (or jumping off point) for the development of guidelines in other countries.

Guidelines are important because, quite simply, many people with concussion are (still) not getting the best advice on appropriate treatment after concussion/mild traumatic brain injury.   So, again quite simply, better information to Health Professionals will lead to better outcomes for people with concussions/mild traumatic brain injuries.

 

 

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The importance of cognitive rest

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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?

 

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