Sep 222009

Last time, I wrote about how I found the ADD Centre and what it did for me in treating my brain injury. But I didn’t get into the nitty gritty details of how the assessment and treatment goes. So here’s a rundown of the first step: assessment.

Dr. Lynda Thompson, the Director of the ADD Centre, and her husband Dr. Michael Thompson conduct their parts of the assessment separately. Neither watches what the other is doing nor sees the results until they’re completed. That way, they don’t inadvertently influence the others’ tests, leading to a more solid diagnosis.

I met first with Lynda. She began with an intake interview. I had spoken about what had happened to me so many times because of the endless round of quacks my insurance company had sent me to under accident benefits, that I could have answered the questions in my sleep. Unfortunately. But the big difference for me was that she was genuinely interested in helping me. She wasn’t looking to twist my story round, and she was paying attention. It’s amazing what it does to your confidence when a therapist or doctor pays attention to you and takes your concerns seriously.

After the interview came the “boring” test, as she put it. I expected to ace the test, for so many had told me to “get over it”, “move on”, “you don’t have brain injury”, “your problem is you’re talking about it too much; if you stopped talking, you’d get better”, “you look fine to me”, “you look the same as before the accident” (that last one when I looked like the Michelin Man still puzzles me). And these were said by my closest friends and family; the insurance hacks’ put downs were on top of that. I can count on one finger the number who didn’t doubt the diagnosis at some point, who didn’t pretend I was better than I was, who didn’t say rehab was a crutch, who didn’t…well, you get my drift.

But back to the test. Lynda sits you down in front of an old CRT monitor, the kind that’s black and monotone green (or was it orange?). Once she sets you up, she leaves you alone in the quiet room to do the test. You put on a pair of headphones and place your hand on the mouse. You then see good-old DOS graphics pop up on the screen. (It was comforting in some way, and since the test works well, why update it to the latest incarnation of Windows?) And then it begins.

The computer instructs you on how the test will run for the next 15 minutes and you practice. I don’t remember the specifics of the test, but it has to do with responding to seeing “1”s and “2”s appearing on the screen or being said in your ears. The computer measures how quickly — or not — you respond and when you respond to the stimulus of seeing a “1” or a “2”. It was boring. It felt like forever, but was only 15 minutes. I thought I had missed a couple, maybe, but I figured it would show my concentration was hunky dorey, after all I’d heard that often enough. Was I mistaken!

The next test was closest of all of them to what the treatments would be like. You sit in front of another computer in another room. Lynda places an electrode on each of your ear lobes and then one on top of your head. The key to good connections is cleaning. They use an abrasive scrub to clean your skin where they’ll be placing the electrodes. Lynda goes at it vigorously. A little painful, but it gets the job done every time in one go. I was soon to learn I much preferred that method over the tentative gentleness of others that meant repeating the cleaning and placing the electrodes all over again as it never connected the first time. After she cleans, she puts electroconducting goo on the electrodes and puts them on you. The electrodes are plugged into the computer, and again you sit and face the screen. I don’t remember anything more about that test, which is kind of odd as I’ve done it about 4 times.

The last test is the best, as in, for me a former psychology student, fascinating. Too bad I was too zombified to appeciate it the first time. Michael does this one, with one of the trainers assisting. You go into another room, where the trainer hauls on a cotton-bathing-cap looking thing with 19 holes in it. It fits snugly over your whole head. She then plugs it into the computer and up pops a graphic of a head with electrode points on it. Each point starts off red on the screen, red for the fact it isn’t connected. She squirts the electroconducting jelly into each hole and plays around with it. Since there is no mirror, I cannot see what she’s doing, only feel, but I also can’t see what a dork I look like either. A bonus, if you ask me. As each of those “holes” connects with my scalp and picks up the electricity generating from within, it turns first yellow then green on the screen. For me, this became a painful process. Not painful physically, but painful in the tension of wondering if it will-connect-oh-no-it-just-disconnected-oh-now-it’s-green-again. Once all 19 points are connected, then the rest of you gets hooked up to the computer: breathing, pulse, skin temperature, muscle tension, all are monitored and noted.

Michael has you sit back, relax your jaw. He has you open your eyes, close your eyes, read, do math in your head (I did better than most accountants! It was the one and only area where I relaxed and my issues clearly were not math ability but focus inability.) He also conducts other tests on the computer. Sometimes, you can see all 19 points of your EEG scrolling across the screen, and you have to not worry about some of those low-active areas. It may not be because that part of your brain is off in snoozy land, but because whatever it is you’re doing doesn’t need it. Well, in my case, Ha!

The EEG readings are then fed into two computer programs that I know of. One generates a bunch of results about the kind of waves your brain is producing under each of those 19 points; how awake those areas are; how much delta-wave activity each is producing; how coherent or not the different sections of your brain are. That last is crucial. A brain whose sections work as one is going to be slow, but a brain whose sections are wildly discoherent is not going to function well either. At the time of my first assessment, they didn’t do coherence training to fix those coherence problems, it was so new from what I understand. During the second half of the second year of my brain biofeedback treatments, they did with amazing results. Anyway, the second program maps the brain and shows it in 3D. You can take out sections and see deep inside the brain, just like an MRI scan, except this one is based on electrical activity, the primary means of communication within the brain. Only at the neuron ends do chemicals come into play, and that’s in response to an electrical charge from the neuron. As you can tell, I think EEGs should be a de facto means all doctors should use to assess brain function. This program pinpointed clearly the areas of my brain that were not functioning normally; it told Michael, along with the first program, why I was having so much trouble reading when I don’t have trouble interpreting the squiggles on a page as letters or words.

Based on the results of all the tests and what my main concerns were, they devised a treatment program for me. They told me that without a doubt they could improve my concentration, that they could work on my acquired learning disability. But they weren’t sure about helping me with my reading; still they would give it a try. They were excited about the possibilities and booked me in for brain biofeedback treatments beginning in September 2005. While I waited for the first available spot, Lynda suggested I purchase an audiovisual entrainment unit to use at home. I bought that from Edmonton-based Mind Alive immediately. I still use it.

The assessment told me I wasn’t crazy; instead all those people who denied my difficulties were the crazy ones. The assessment gave me hope that this dark cloud would lift, that I would not be a zombie for the rest of my life. The assessment gave me back my dignity as a suffering human being. And that was only the beginning.