How to decide???

A client of mine is about to tackle a big de-cluttering project. We reviewed the binary choice system (that's the one where you make only one choice at a time: keep/don't keep, taxes/not taxes - ugh, my favorite). She posed a good question: How do I decide to keep or not? This is one example of the brain's going through a number of factors generally at a subconscious level. And, if you're good at it, it happens very quickly. But, naturally, it's more complicated.

So, here are some guidelines:

(1) Is the stuff outdated? A good example of this is travel information. No point in keeping 10 year old recommendations about restaurants or even hotels.

(2) Will you use the item or article: the ratty old dog-gate, the pieces of old furniture that you could fashion into something else, the uncommonly ugly Broncos bird feeder your daughter's first college roommate gave her...you get the idea.

Organization books suggest that if you haven't used something in a year you should get rid of it. This assumes you remember you have it! If you have memory issues, this "rule" may not apply.

(3) You won't miss it. During one of our moves, we filled two identical boxes, one with stuff to keep; the other with stuff to pitch. We didn't mark them (yeah, I know, pretty stupid). Then, one of us (and I'm not naming names here) put the "keep" box out on the curb where it was taken away with the trash. I have no idea what was in it but I don't miss it. The next week, the other box went out to the curb. I don't recommend this technique but I do think you can ask yourself whether or not you'd notice if something were gone.

(4) Can you access the information another way? See #1. Up-to-date travel info is available on-line. Ditto with recipes. I'll bet you can find a clone for just about any recipe you have in that fat file folder upstairs in your attic by typing a description into that google box.

(5) Sentimental value is always an ok reason to keep something.

OK. So I hope this is helpful. Have fun!

Thoughts on recovery

As I recover, I've been thinking about some of the things I talk about with my clients. They make a lot of sense but, as I try to apply them myself, I realize what a challenge this whole process is.

I tell people to focus on what they can do rather than what they can't. The positive rather than the negative. Why is this so hard? I think it's because of our programming. Research has found that we store negative and positive information separately and that negative data is stronger. If you think about it, this is adaptive. We need to pay attention to the bad stuff, avoid it if possible because it can hurt us. The positive we just take for granted. So it really does take an effort to shift our focus to the good stuff even if we're not injured.

Another thing, we have a certain amount of energy dedicated to worrying (differs from person - I'm a champion worrier). When there are a lot of problems, this worry energy is distributed over a lot of territory. I always noticed that people initially didn't seem worried about certain things, until they started getting a lot better. Then, the same amount of worry energy became focused on fewer things and they became intensely concerned about those residual problems.

Years ago, when my son was two and an only child, I was having a conversation with a friend about how much I worried about him. My friend, incidentally, had 10 kids. I remember her saying to me, "You need to have a few more. You'll worry about all of them less." Same principle, I guess.

Finally, a lot of times your therapists and doctors will ask you to give a percentage to describe your improvement. I don't think this helpful for a couple of reasons: first, whether you're 30% or 2% away from "normal", it's still too far. Second, if you're 2% away from normal, and that 2% is what made you "special", it can be pretty frustrating.

I think, speaking from personal experience, the best thing is to be patient with the frustration. It's OK and even normal. And then to set small goals so you really can measure your progress.

"Automatic" Processing

I don't read my professional journals. I'm not proud of this. I understand that the object of the academic articles is to validate clinical practice and I admire the statistical methods used to do this even if I don't entirely trust or understand them. I also admit to reading a lot of popular science. There are some great science writers who gather information from researchers and summarize the findings. Often, I come across an article that puts things together in an amazing way.

One such discovery had to do with how we grow new nerve fibers. We've known for awhile that the brain grows new fibers and establishes new connections pretty much forever. It is the mechanism of new learning. There was a study a while ago indicating that we have the maximum profusion of nerve fibers in the brain as teenagers/young adults. Then, what happens is that our brains gradually shed some of the connections even as we get more proficient at tasks.

I got to thinking about this and, of course, it makes perfect sense. As we're learning, the neurons send out fibers to reinforce information. Each step in a process might be represented by neural fibers (individual steps, multiple parts). As we get better, the process consolidates - maybe it gets "summarized", channeled into one central connection. The auxiliary fibers could then atrophy because they are no longer needed. The process is now automatic.

But, what happens if there's a problem with the main connection? Oops. There aren't any backup fibers ready to take over. When the process became automatic, they were no longer relevant. The good news is that, with effort, those steps can be accessed, reinforced and eventually reconsolidated.

So, when clients tell me, "I used to do that without thinking", I explain this little neurological hypothesis. It helps them understand how they got to the point of automatic processing and why it's now important to go through the intermediate steps. Of course, we never do anything without thinking: some things happen so quickly and efficiently that it seems that way. Doesn't make it less frustrating but people are generally interested if not reassured by this information. And, if they do the work, they can shake that rust off!

Good News: My Book is OUT!!

At long last, my book, Mild Traumatic Brain Injury: The Guidebook, is published and available at Lulu.com. (You can also find it on Amazon.) Here's the blurb:

Mild Traumatic Brain Injury: The Guidebook is an indispensable resource for people living with the consequences of Mild Traumatic Brain Injury (MTBI). In this concise, comprehensive manual, Cognitive Rehabilitation Specialist Mary Lou Acimovic draws from over thirty years of clinical experience to validate and demystify the symptoms of MTBI, offering a unique approach to treatment designed to educate, empower, and inspire. The mission: Help the millions of people struggling with this potentially devastating condition understand their injuries and regain control their lives. It is a guide to recovery.

Pretty cool, huh?! Get it HERE

The "Ultimate Empathy Experience"

Why the radio silence on this blog? Well, I'll tell you: In August 2010, I was felled by a virus that went into my spine, causing swelling in the c5/c6 vertebrae. The culprit: West Nile. That's right, a tiny little mosquito got the best of me, and now I'm going through what my family and I are calling "The Ultimate Empathy Experience" as I embark on my own journey of neurological recovery.

As a result of the nerve damage, I have limited use of my arms (my left is totally gimpy; my right is a little bit better), and I am, as my husband says, "weak as a kitten." Now that I'm out of the hospital, I have physical therapy and occupational therapy five days a week, and I'm dabbling in alternative therapies like acupuncture and hyperbaric oxygen. I feel totally helpless. (My daughter is typing this post for me.)

On an intellectual level, I know from working with Mild Traumatic Brain Injury clients that the Road to Recovery is long, progress is subtle, and patience is critical. But man, are these things hard to accept. Like so many of my clients over the years, I want a miracle. I want to wake up one morning and have everything be back to the way it was "Before." The advice I've given so many clients over the last thirty-five years—"Don't push yourself too hard!" "Adjust your expectations!" "A good attitude goes a long way!"—seems extra hard to swallow, and yet, I'm choking it down. All in all, the experience has validated a lot of the things I understood as a clinician about this type of recovery.

I wrote about many of these things in my NEW book, Mild Traumatic Brain Injury: The Guidebook. In a brilliant stroke of irony, I received the first published copy while I was an in-patient at Boulder Community Hospital's Mapleton Rehabilitation Center, where I worked as a cognitive rehabilitation specialist for thirteen years. Life is strange, isn't it?

BUY THE BOOK HERE!!!

I do that all the time…

Have you heard this one? You complain about a mistake you made or something you forgot to do, and your friend laughs it off, saying, "oh, I do that all the time!" Infuriating, right?

Here's the deal: people can relate to the problem because these faux pas do happen occasionally to most people. But, I can promise you, if it was indeed happening all the time people would be concerned. They'd be coming in to my office or going to see their psychologist. They would recognize that something was wrong. Because, with MTBI, it's a matter of degree and impact on functioning. Sure, it used to happen from time to time but now it occurs several times a day. Most of my clients were pretty darned efficient and really didn't make too many mistakes of this sort. Now, they just plain have trouble getting anything done. Of course they're upset!

I think people who respond by saying "that happens to me all the time" may be well-intentioned, trying to reassure you, or maybe in some sort of weird denial. And if really pressed, they'd admit that they're not really messing up "all the time." But, when you're asking for support, it's not helpful.

A psychologist (I think) by the name of Lees-Haley did some studies in the mid-nineties in which he gave questionnaires to non-brain injured people, asking them if they experienced things like anxiety, fatigue, sleep problems, etc. A lot of them said "yes". Unfortunately, these studies have been used a lot to show that people with MTBI are just complainers or making up symptoms because they are involved in lawsuits. But, again, although we can all relate to occasional problems with forgetfulness (and, yes, it does increase with age), the cognitive problems people have with MTBI are much worse and represent a huge change compared with pre-accident functioning.

So when someone says, "that's normal" just smile and say, "not for me!"

Contact me!

If you have a question or would like to hear about a specific topic related to mild traumatic brain injury, you can shoot me an e-mail and my new dedicated gmail address!! mtbitheguidebook@gmail.com

I look forward to hearing from you!