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Working Out What Is Broken

Working Out What Is Broken

Introduction

If you are overwrought with managing the symptoms of your brain injury you may find that that it feels impossible to work out which aspects of your functionality are no longer working. A loss of or changes in self-awareness can also make it impossibly tough to work out why so many things are so hard to do anymore.

Because every brain injury is unique, and because we are all individual and different in so many ways, no one set rule works for all. A lot of what you will need to do to ‘fix’ your brain will depend on what you work out and determine for yourself.

Neurological experts can help with this process, but not everyone has access to this kind of specialist guidance, and, even when they do, it can be hard for them to understand why they are being helped and what this involves.

Even those who retain full self-awareness can cognitively struggle with understanding why some aspects of daily living are really difficult to manage, but others aren’t. Great intellect, common sense, and personal capacity for insight aren’t always the allies they once were after a brain injury.

The haystack

Sequencing thoughts after a brain injury can be as random as the placement of each piece of dried grass in a haystack. We may think that the shape of the haystack looks fine, and yet not know for a long time that it is in complete disarray.

For those who are walking and talking, it can be especially hard to recognise problems with cognitive and executive functionality. Just as people on the ‘outside’ can misjudge us – so we too can misjudge ourselves. It is all about the illusion of perception, which our auto-pilot can readily interfere with following a brain injury.

Many people believe that they are fine and think all they need to do is deal with the symptoms, such as depression, lethargy, headaches and brain fog. Getting a grip with these can clear up a lot of the confusion and clear the path for understanding the difficulties caused by the physical neuronal damage. For many of us, it is natural to keep doing the ‘keeping going’, and yet few people pause to consider what we may be doing to ourselves by slogging from one moment to the next. The stress of doing this can perpetuate the vicious circle.

The main things that drive us are our biological survival instincts and our innate personalities. Every human being has core aspects of ‘innate personality’ – and one of these is tenacity. As babes, we build and balance square blocks, and when they fall over, we have another go. We take one step and fall over; we pick ourselves up and try and make it two steps. None of us could advance or learn anything without this inbuilt trait.

Psychological learning can impact the strength of these innate traits – but they never go away because nature gifts us with all we need to survive.

Getting to grips with what is broken, even with professional input, isn’t ever as easy as it seems for some, and is likely to be as challenging as imagined for others.

The wood and the trees

If you have sustained a brain injury, you also have some degree of biomechanical and neurological damage. Where and how hard you hit your head, or which areas of the brain were affected by injury, stroke, disease or neurosurgery, can all have a bearing on the physiological extent of the injury.

If you haven’t recovered from an injury diagnosed as a minor head injury or concussion after a couple of weeks or months at most, then you are most probably struggling with persistent post-concussive symptoms associated with complex pathophysiological processes – the disordered physiological processes related to disease or injury.

There is a rising tide of scientific data that is driving changes in clinical practices and management of concussed and other brain-injured patients and this greater understanding is changing the way people are understood.

A functional MRI (fMRI) and neuropsychological assessment can help to determine the extent of your injury. When it comes into clinical practice MEG (Magnetoencephalography) imaging will be even better. Getting help is an essential step as your diagnosis may be changed to post-concussion syndrome (PCS) or mild traumatic brain injury (mTBI) following testing. There is a range of new diagnostic tools being developed and applied in clinical settings.

Even with all these new advancements, none of this necessarily makes it any easier for a person to understand the changes in their thinking, skills and behaviour. You may still ‘feel like you’ but at the same time be aware that lots of things trouble you and go wrong. Alternatively, you may not feel very much like yourself at all. While there are similarities, everyone experiences brain injury differently.

Seeing the wood for the trees can become enormously complex and understanding what everyone else is telling you can feel akin to trying to communicate with an alien but with a brick wall between you. Very often, we are unable to see what others can.

Working it out

Working this all out can take time. Depending on how severe your injury was, it can take a lot of time. It can be a dark and stormy road and every time you think you have grasped something vital about you – you forget it again.

Living with a brain injury can feel worse than perpetually taking three steps forward and two steps back. It can feel as though those steps ahead were an illusion and never really happened.

Hanging on, even to the thinnest periphery, can be all-consuming and people don’t get that this is what you are doing when you interrupt or shut yourself away. They don’t understand why you keep talking about the same thing when the topic has changed. To you, perseveration helps your brain to make links, forge fundamental understanding, create better memories and process incoming data. To those in the outside world, this persistence or repetition of a thought or action after the causative stimulus has ceased can seem inappropriate. You can’t stop this from happening without risking falling into a bottomless, dark pit of no return where you are likely to forget whatever it was that seemed necessary for your brain to know. The significance of understanding becomes, and is critical to us because instinctively we know this is helping us to get better,

Thinking out loud in this way, taking our time, pausing, and conscious reflection can help us to notice and understand what is going on. It is a slow and exhausting process, but one that is necessary for rewiring.

If we can learn to self-observe again and to look back on events in the day in a reflective way, we can begin to notice those things that keep cropping up; we can begin to start seeing what is broken.

As we gradually get this figured, we can also slowly start to try and teach ourselves when we need to pause, when we need to step back, when we need to stop and try to listen, and when we are failing to make ourselves understood.

All of these things help us to understand what is broken, what is persistently going wrong, and, when we get this, we start turning the longest corner we ever turned.

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