Brain Health

Cogmed to Train Working Memory — An Experiment to Help Post-Brain Injury Reading Rehab

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I’ve begun Cogmed to train my working memory, that brief moment you hold something in memory in order to accomplish a task or store a piece of knowledge before you forget then scratch your head as you futilely try to remember what you were doing or reading.

The folks at the ADD Centre had told me about Cogmed a few years ago, but between lack of funds, lack of social support at home, and lack of energy, I declined at the time.

But I’ve spent most of 2016 stuck at home, and despite floods and pests trying to suck up dollars, I’ve saved a lot in medical costs. (Unfortunately, Virginia, there is no such thing as universal health care in Canada. What we call universal covers only the basics and no treatment outside of hospitals, especially for brain injury. There is no Santa Claus of health care despite the Canadian myth.) Also, I hate this time of year, too many long-term traumatic memories, and needed something to consume my brain space.

Cogmed is an online course you do about 1 hour per day, 5 days per week for 5 weeks. It’s intensive, and part of the pre-admission interview is to ensure you have the time and are not planning on doing anything else beyond your usual routine. (You really don’t understand how intensive it is until after the first 5 days when you reach your optimal memory level.) Also, they tease out whether your issue is attention or memory. Since my attention has been well treated at the ADD Centre, and as long as I’m in a quiet environment, I’m not likely to be distracted, memory not attention is my issue now. They want you to do Cogmed in a quiet place anyway. They also ask you about your sleep — they have my sleep study results — and current level of working memory — they assessed me most recently just over a year ago. It helps being their client: I don’t have to gather up any test results to send to them!

They take you through a demo then send you all the login details. While they set you up, you work out your Cogmed schedule; weekly and maybe daily rewards and a final one to help motivate you to keep going; and a time for your weekly 15-minute coaching call. My coach sent me the best times for her, and I picked when good for me too.

I had trouble coming up with rewards. My coach was patient, gave me some suggestions, but was thrilled when I came up with pretty inks for my fountain pen and a new groovy fountain pen for my final reward. During our coaching call, which happened on Day 6 of my Cogmed training, she also suggested a small daily treat as I had reached my optimal level and would no longer see the big daily improvements I’d experienced during week one. The program is designed to make you feel good in week one; then it gets tough. Lots of tries and fails at the same level, no going down a level quickly so that you have a success.

Anyway, I’d intended to start on a Monday, going Monday to Friday, taking the weekend off. But then realized the first two days of the week are actually my toughest. I need energy for this! So I began on Saturday. I tweeted:

17 Dec: I’m going to start online CogMed training,see if we can get my working memory to, uh, work. Step 1: schedule it. W #braininjury not done yet.

Cogmed. Round 1. Oh. My. God. My forehead crushed then: got my highest score on the very last exercise. 8 on Reverse Numbers! 😯 #braininjury

Cogmed cool down: Zootopia (English voices; French text Netflix). Still hv concentration headache tho pumped completing day 1. #braininjury

Dec 19: Cogmed Day 3: improve on prev 5 working memory training exercise but the 1 I forgot the instructions for. Ha! 3 new exercises. #braininjury

Dec 21: So an astounding thing happened at brain biofeedback: my HRV went up to 4!!! My heart rate dipped into 70s briefly! Holy f—! #braininjury

Cogmed Day 4: I suck at Sort. Numbers are my friend. Um, number of Assembly levels barely fit on screen already. Yikes! #braininjury

Dec 22: Cogmed Day 5: 3D Doom doomed. That rewarding sound à la The Game silent too much. But then picked up w rest of exercises.Phew. #braininjury

Dec 23: Cogmed Day 6: crash breathe! Coffee! Eggnog! fight breaks out twixt eyes & brain Somehow I improve. 😳👏 #braininjury #eyesurgery

On Day 7, I hit a wall, a mental wall like the famed runners wall. I’d only taken Tuesday off my first week and launched right into week two. My coach said to take either Saturday or Sunday off since I’d done my 5 days in the week and could afford the time off. Plus I needed it.

I felt good after Christmas Eve family service. Loads more energy than some days! I didn’t want to do Cogmed on Christmas Day after all, now the idea of a day off had been presented to me, soooo…

I was good in the first 12 minutes or so. I positively zipped through the early exercises compared to Friday. I even did slightly better on 3D cube of Death, um, Doom. But in the third-last exercise, my best one — Hidden — with only 2 or 3 tries left in it, I hit the wall. Brain stopped working. Totally. Oh-oh.

It would take hours to recover, I knew. But I had two more exercises to do. OK, I’ll run on instinct, I decided. That worked for Rotating Wheel of Joy — unbelievable! But for Numbers: complete miss. I got a few “Close” ones, meaning I missed only one number on each try — apparently Close is good because it means I’m pushing — yeah, no kidding. But no hits at all, wow. So glad I have 3 days off! It’s going to be optimal training from now on: always training me at the upper level of my memory. If I get one or two hits for every miss, I’ll be lucky. But a pushed brain is a brain that improves!

Brain Biofeedback

Return to Reading the Novel

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Reading. A. Novel. Except for the graphic wordless novel I read last Spring, I haven’t read a novel in 3 years. Yeah, that’s a shitload of time taken from me by changed and unknown identity; grief; loss; lack of consistent, continual professional help devoted to my reading; and lack of social support to encourage me through the concentration headaches, crushing tiredness after reading, needing to use study-type strategies for light reading, failing over and over to remember characters and plot and what I read after I’d finished it. Sigh.

Yeah, I know brain injury is a never-ending hoover of need, but unlike professionals and social circles, those of us living in it don’t get to walk away from our never-ending cognitive problems caused by the injury.

It was a fellow writer who right at the end of November catapulted me out of this place I seemed to have gotten stuck in, that place of no novels. She enticed me back into readers’ territory. She asked me to review a new novel not yet out. She said it was a light, easy read.

But I was nervous.

Reading a few paragraphs of newspaper articles so that I’d remember them and could discuss them cogently or a few paragraphs of my own book Concussion Is Brain Injury so that I could update it was one thing. But a novel I hadn’t read before? By an author unknown to me? Also, no one was testing and training my long-term recall despite my repeated comments and requests. And it had been a long time since my neurodoc had read poetry to me despite every now and then saying he should. My eye surgery had changed a few things in our reading routine. One of them was dropping poetry.

Recently I heard about a poetry podcast and subscribed to it on my iPad. Every so often I see the notification and so remember to listen to it. It helps my brain get used to the sound of language. And maybe understanding too. But I digress.

My neurodoc said this novel was a good opportunity. He said that with him and my mother reading to me 5 (later we went up to 8) paragraphs and then me reading to them the same number (except when I got noticeably tired, then I read fewer), and me recalling after they read to me and also after I read to them and then discussing it and lastly writing a summary in a journal, it should be doable and I should remember. Plus hopefully by reading my journal summary, I could remember the whole long enough to write a review. (Only fly in this theory is I keep forgetting to summarize in the journal and no one reminds me in a way that enables me to overcome my initiation deficit.) I bet the author didn’t think that when they asked me to review the book they’d get three readers for the asking of one!

Turns out that since they miss what the other has read to me, I’m sometimes having to summarize for them before we begin our reading session. I remember enough so that they’re not lost in the story, but I also forget entire sections.

I am however keeping track of the main character, where she is, what she’s doing, the way the plot is moving: the big stuff. I’m also remembering the characters, major and minor, and most of their names! Pretty impressive when I can usually recall only characters who recur in a series.

I’m stretching the limits of my brain, more often than not getting a concentration headache, at first bad ones but then lessening. And I’m tired. I haven’t had any brain space to think about or feel this experience of returning to written novels. But somewhere deep inside I feel the need for these reading phone sessions and the calm they bring. I know this is real calm, for I also read 5 minutes at a time, twice, during brain biofeedback, for a total of 6 paragraphs; my heart rate drops about 10 or more beats per minute by the end of 11 minutes of reading and recall. Proof this is doing my body, mind, soul good.

Brain Biofeedback

Easing Back into Brain Injury Health Care After Eye Surgery

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Well, it had to happen some time. I’ve restarted two-thirds of my brain-injury-care appointments. As of this past week, I have returned to using the TTC on my own – solely to get to brain biofeedback. So I’m not exactly using the entire TTC on my own, just one well-practiced route!

As expected, it took me a lot longer to get there by myself than with my CNIB orientation mobility trainer, even when he was shadowing me and out of sight. My slowness wasn’t just because it’s scarier going solo, it was also no one was around to push me to keep going: I’m dizzy? Sit! Brain feeling the effort? Sit! Had enough? Sit! Or lean against a wall since benches aren’t plentiful in this progressive city of ours.

One of the nice things about the boomers getting older is that benches are at long last popping up on some streets. Still too few though.

It took me double the time to walk to the ADD Centre from the TTC sans my mobility trainer; sooo about, uh, hoo boy, a bazillion times slower than prior to my eye surgery. Well, OK 5.4 times slower. On the plus side, last week I was only 1.2 times my normal speed in quiet, now-familiar areas where I’ve practiced my walking many, many times. And this weekend, in the same quiet areas, I’m pretty much at my old speed for about 15 minutes of walking sans any rests and except for crossing streets.

Anyway, my brain trainer told me when I asked that my CZ SMR brainwaves have dropped since June.

SMR: sensorimotor rhythm or 13–15Hz, the foundational brainwave in the area that loops from the outside of the brain to the critical thalamus deep inside. They are the brainwaves of relaxed, focused attention.

Social isolation takes a toll on the brain. It should be fucking obvious to every human being who looks beyond their navel, but apparently not in North America with its cult of busy-ness and every person should shut up about and look after their own disability. Isolation is either chosen (some people have been taught it’s safer emotionally-speaking to be alone) or imposed when family, friends, neighbours, health care workers take zero initiative to reach out to the person who’s lost their independence to ensure they don’t lose their biologically-critical social life too. Small towns and England are better at reaching out or as one community worker put it: reaching in. Reaching in to the hurting person, the suffering person, the ill and injured is how we prevent brain damage from social isolation. But not even churches in the big city of Toronto are good at it, preferring to wait for parishioners to call up, nag, beg before fellow congregants can look away from their look-how-compassionate-I-am-I-volunteer-for-the-homeless (or African communities) Pharisaic stance to spare a glance at the suffering in their midst and do something about it. The ones who are most invisible are the ones they should be reaching in to. But that takes not following the disciples to town but following tired, hungry Jesus to the woman at the well – compassion plus effort, don’t you think?

@ShireenJ: Guest on @CBCOntarioToday: “As a community, it’s OUR responsibility to be reaching in.”As person w #braininjury rarely exp’d that. WldB nice”

Anywho, my brain trainer and I have re-established the routine of 30-second assessment, 3 minutes of HRV (heart rate variability), and two screens of biofeedback: inhibit delta-theta (2–5Hz) and busy brain (24–28Hz) and enhance SMR (12–15Hz) and if possible gamma (39–42Hz), ie, gamma when we can use the computer that allows for two-display biofeedback screens. My muscle tension was above 2 this past week but came down nicely, as did my delta-theta.

I’m pushing my neurodoc and the ADD Centre to see about treating my reading difficulties better. To that end, we did a 3-minute assessment over Broca’s area at FP1-F3 and 3 minutes at the corresponding area over the right hemisphere at FP2-F4.

It’s been suggested to me that getting a diffusion tensor imaging scan would aid in finding out exactly where the injury broke my reading cognition. A DTI will show the health of my neural networks. The problem is that whereas out west they offer that MRI-variation scan clinically, in Ontario they do not. The Kathleen Wynne government doesn’t pay for it clinically, apparently preferring to spend health care bucks on things like more administration since 39% of community care going to admin is not high enough and managers are way more important than doctors, nurses, therapists, and scans, don’t you know.

So we may have to continue to guess the best we can and wing where to treat the brain while continuing to practice reading. Meanwhile, my neurodoc isn’t into facilitating communication since medicare in Ontario doesn’t pay for phone calls, emails, texts, and he doesn’t believe in answering questions left on voice mail or even acknowledging receipt of any communication. So tough shit if you keep forgetting to ask things when see him, can’t read notes to help you remember, and email (or in our security-conscious world, text) is only way you can express yourself and actually get it done. Gah. So fed up with it all.

Brain Health

Eye Surgery Post Brain Injury and the Vision is Amazing

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I had eye surgery to improve my reading and had rather . . . unexpected results.

  • Full left to right panoramic vision
  • Peripheral vision on both sides, not just one
  • Depth perception I thought I had but apparently not because suddenly objects had crannies and hills I hadn’t seen before
  • Details! So many more details I can see
  • Colours look richer, more intense, more nuanced — I can distinguish similar colours easier
  • Facial perception has changed — not only can I see more details and colour gradations, but I think I’m perceiving micro-expressions I used to miss. Um, everyone looks older though. No more photoshopped view!
  • I can stand like a stork on both right and left legs equally well sans wobbling or only a little bit.
  • I can swat a fly on the first try — this is so very satisfying.

The world looks familiar yet so brand new! Despite my eye feeling and looking like it had undergone a few rounds sans bruising — ice cold compresses with a take-home washcloth for the win! — I could see really, really well! Holy cow!!

ice it, squeeze it, lay it gently on the eye

In the first month or so after surgery, I’d stand and stare: stare at bricks on houses, at their fine texture, subtle shadings of reds and pinks; stare at trees, their leaves with their popping-out veins and layers upon layers of branches; stare along a main street, the streetlights marching down the street, the farthest one as sharply focused as the nearest one, the far-off people way down the street so clear and never quite disappearing into the vanishing point I’d never seen before; stare at text on my iPhone and marvel at how crisp it is.

I expected improvement but not to this scale. And I didn’t expect my hearing to shoot up! I awoke from the anesthesia to a plethora of sound –holy cow, the nurses and patients were loud in the recovery room. I could hear every conversation, including the whispers between nurses about some of the patients. Ahem. Or boss nurse telling underling nurse to ensure I swallowed the pain pill while the old-fashioned painkilling tablet burned the side of my tongue like sand paper and the oxygen saturation monitor beeped beeped beeped till they stuck an oxygen cannula up my nose while my fellow patient regaled us all . . . Oh wait, shhh.

None of my brain health care team anticipated what would happen; my eye surgeon had given me some indication in that understated way doctors do. He said, you’ll have more efficiency and better proprioception and perception.

I eventually understood that more efficiency means that the data taken in by the eyeballs is increased and fed more efficiently to the brain. Less guessing, I guess, and more concrete info my brain can use to see.

But no one anticipated how much that such significant change would discombobulate my brain. The only one who could have, who had the neuroscience knowledge (or did, but you know how experts are: they get real specialized and forget their basic knowledge; they hear eyes and think that’s got nothing to do with my specialty, the brain) and who had all the information about my eyesight, the surgery, and my vision changes over the last 16 years and who knew the surgery would give me better vision and thus help me read easier, which is why he urged me on — the only one to have anticipated what could happen . . . if he had used his little grey cells, didn’t.

The problem with medicine today is that doctors have bought into medicine is only evidence-based, and if there’s no evidence, then there’s no need to pay attention to it. The practice of medicine today has forgotten why medicine is also an art; too many doctors don’t use their little grey cells when faced with the unexpected or to anticipate what may happen and for which no studies exist to explain — yet. The brilliant ones, especially when it’s obvious no one else is helping their patient, practice the art of medicine. That’s what my eye surgeon did. He found my vision changes remarkable, warned and reassured me at the same time that because of my unique cognitive situation (aka brain injury and a brain that developed with vision from one eye, pretty much), it would take some time to recover. He couldn’t anticipate how long until my eye had healed fully and the system had restabilized, about the end of June, early July. Until then, everything was in flux.

He added: all he did was the surgery, the rest is my doing. Brilliant doctors are also humble ones.

We had one big clue what may happen. Before the surgery, for the first time ever, I identified a letter during a prism test. It looked tiny and vague (it was in reality very big) but I saw it. Later, I could see vaguely and blurrily with my scarred eye the largest letter on the standard eye chart.

I almost cried.

We don’t use the eye chart to test acuity with that eye. Instead they ask me: how many fingers? But back in March, I had without warning graduated to the eye chart! O.M.G.

After the surgery, on the same day, I could see taped on the wall, the large E, rendered in pink and green pencil lines. I couldn’t believe it. Never before my brain injury had I thought it possible.

During the early-followup-to-reassure-me appointment, I not only saw the largest letter vaguely and blurrily, but I also saw the edge of the next one lit up white on a black background with the room’s lights off. I saw it as an I. My mother said it was a large O. To even see the edge is hard to compute. As my surgeon said: remarkable.

2 drops = ahhh. no presevatives to irritate eye that felt like it had a loose contact lens in it

My eye was physically healing well — artificial preservative-free tears eased the soreness and dryness and didn’t irritate the dissolving stitches  while painkillers only touched referred pain into my temple but not the pain in the eye itself (it took 7 weeks for stitches to dissolve, 8 weeks for all pain and intense ache when used to go). But my brain had trouble seeing with eyeballs that were sending it vastly more info. I couldn’t walk I discovered without every neuron feeling like it was under carbon-crushing pressure. Worse, I lurched around and had delayed dizziness and nausea to walking, reading, writing. Yikes! My surgeon referred me to the CNIB, and they sent me a mobility orientation trainer. Thank you God! More later.

Brain Health

Eye Surgery for Reading

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Having had a closed head injury type of brain injury aka concussion, I didn’t go through the in-hospital and surgical experiences those with skull breakage do. Although I’ve had scans, sat for hours in waiting rooms to see umpteen specialists, I haven’t had an invasive or surgical procedure since my brain injury.

I will soon.

I’m a tad nervous.

Because of my wonky heart and brain injury, I had a pre-op consult with the anesthetist. The take-a-number and wait forever part was familiar. And the are-you-related-to – yes, he’s my Dad – part was too. And the wait-and-wait-and-wait for a blood test was too. Even the ECG and inadequate blood lab staffing was familiar, only the surroundings were new: tired, old, cramped, in need of all that ego money that goes into shiny new buildings with rich men’s names on them instead of into services that serve patients, services like cleaning hospital bathrooms more than once a day or staffing ORs or blood labs or having enough specialists to serve the brain-injured population. But then who would know how generous you were with your millions if you can’t proclaim it in metres-high letters on the side of tall, glistening edifices? But I digress.

The surgery is on my eye with the scarred retina; it is to finish the job my brain injury weirdly began.

When I was tiny and living in Bombay, I had a bad case of the measles and had to be put in a dark room to protect my eyes. Yes, folks, the measles can blind you not just give you a bad case of the spots. I came out the other side with one eye having a scarred retina and a damaged or distorted macula. Whether it was the measles or coincidental, I don’t know. I saw eye doctors. My earliest memory of Canada is walking down a long hallway in the old Bell Wing, my hand in my Dad’s hand, to see the ophthamologist. The kind, talk doctor recommended eye patching to force me to use my scarred eye. The pain was intense; the vision like that of a darkened dream. I taught myself to use my hand and touch as a guide while I complained increasingly louder about the pain. The patch idea was discarded. Eventually, I got used to seeing only colours and shapes out of that eye, to not be able to count the fingers on one hand or maybe somewhat after cocking my head this way and that to get the fingers into the view of my functioning retina.

So you can imagine my shock when one day during acupuncture after my brain injury, I was lying face down, staring through the head support, and suddenly realizing I could see the tiles on the floor with my bad eye.

Um, say what? I blinked.

I eagerly anticipated my next acupuncture appointment to see if that was an hallucination. Nope. Fairly quickly over the months, I began to recognize the shapes as identifiable objects. Within a year, I had peripheral vision on that side. It made walking a jumpy affair. For years I had walked blithely unaware of things on one side of me; suddenly people, cars, squirrels began jumping into view. A bit unnerving. It took me years to get used to it.

After a long while, the light levels in that eye rose to match the normal light level of the other eye. Brighter vision makes seeing easier. I have no idea why everything was darker in that eye or why suddenly it was like a darkened lens had been removed, but it was … interesting.

And then one day, for a moment, my two eyes worked together, giving me true binocular vision and one heck of a surprise.

I had always assumed that through the magic of my brain, I could see 3D. I suck at estimating distance and size, I can’t perceive optical illusions, but I can tell when things are farther or closer or wider or smaller. And then that day when my eyes said, hey, lets work together, suddenly what I was looking at got fatter, showed more of itself, and popped out at me.

Whoa! This must be what it’s like for people when they watch a 3D movie. Neat!

I began manually able to do it myself. What I saw was clearer yet kind of vaguer. I guess that’s what happens when the brain overlays the sight from a cobwebby retina over an intact one; but as it happened spontaneously more and more and for longer periods, my brain, I think, filled in the holes, so it’s not quite as vague looking but more solid.

In the way of these things, the doctors couldn’t care less. Oh yeah, that’s interesting, they said, but beyond that – yawn. The biggest response I got was from my mother and neurodoc. And the eye docs’ Twitter account.


My neurodoc felt that the clearer, sharper, truer binocular vision I had when both eyes saw together would help me with my reading. Would surgery to get my scarred eye to track with my good eye in such a way to have permanent binocular vision and not rely on the sporadic-when-I’m-not-fatigued timings, help me read easier, physically speaking? Maybe it would cut down on my headaches during reading.

With heroic efforts on his part and my eye doc’s, I finally saw a surgeon, who said he could test it out with a prism. If it worked, he could do the surgery, but the benefit to reading was entirely my bailiwick.

It worked. And so I will go in for day surgery. The anesthetist will take a couple of extra precautions because of my brain injury, etc. It will be like Star Trek – I’ll have a process EEG! The electrodes will monitor my brainwaves so that they can precisely titrate the general anesthetic. It will also tell them if I’m aware (so will if I move as they won’t be giving me a muscle relaxant). That’s reassuring!

Recovery for a normal person is no big deal, they intimated. Nausea will be the worst part because of working on the eyeball. But I haz a brain injury. My brain doesn’t have normal resources; fatigue is going to be a big problem. I’m resting up for several days before and will after too. And I’ve stocked my freezer, but I wish I had homecare. Oh well. If I have no energy to even nuke something, I can always chew on chocolate!

Brain Health

Graphic Wordless Novel Reading Rehab After Brain Injury: An Update

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I’ve settled into a pattern of reading the wordless graphic novel Cinema Panopticum. Once a week, I read 8 pages and get a concentration headache during it. Afterward I do something mindless until I recover my energy. It’s good!

Each page has from one to four pencil sketch panels. I take in a panel as a whole and then study the drawn details carefully before moving on to the next panel. I may talk to myself silently when deciphering the facial expressions or what I think is happening. When I reach the end of a page, I recall what I saw out loud. Then I turn the page.

If I forget something, which I usually don’t, I will re-study the relevant panel(s). On the odd occasion when I realize further along in the story that I misinterpreted an earlier panel or facial expression, I’ll go back and take another look.

It’s hard work, but I enjoy it cuz … it’s a book!

Last weekend, I tested my long-term recall of what I had read up until where I’d last left off. I had good recall of the book’s intro scenes and the first novelette, The Hotel. I took longer to recall the second novelette, The Champion, and I remembered its events out of order (I did know what order they were in, but memory often has more trouble recalling the middle of something than the beginning and end, and that’s what happened).

But to my horror, I had zero recall of the third novelette – what I’d read only 7 days earlier. I thought I recalled the title at least. But nope. “The Enterprise” is not the same as “The Experiment”!

It’s kind of weird I had more trouble remembering the recent reading than the first part of the book I’d read way back on March 19th. You’d think it would be the other way around. But thinking it over … I talked about the novel and first novelette a bit. I talked about the second one less so and the third one not at all.

Talking about what you’ve read aids recall. Gotta remember that.

Anyway, after testing my long-term recall, I began my weekly reading session with re-reading page one of the third novelette, The Experiment. Got the usual headache but much quicker. On the bright side, by the sixth page, I was being drawn into the story.

It’s hard to engage with anything with a broken brain so it’s exciting it happened at all!

Brain Biofeedback

Another Piece to Reading Puzzle After Brain Injury

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I met again with the psychology prof who has helped me discover more pieces to my reading puzzle as I work to unravel why I have so much trouble reading after brain injury.

To recap: I have a diffuse injury, and so many areas involved in reading were damaged. But some areas were not. My health care team and I have worked on improving concentration, healing Wernicke’s Area, enhancing alpha brainwaves in the left frontal cortex. I’ve improved a bit. I can read more than one paragraph; I can skim and read Twitter; I can sort of see the edge of the big picture of an article. But I still cannot read a book in order to follow a plot, remember characters, acquire and retain new knowledge — and so I write what I’ve read about to try and help me retain it but mostly because a hard copy is my memory. The question is: which area or damaged areas are the sticking point? What precisely do I need to heal?

Clues came from the EEG assessments the ADD Centre conducted, other clues come from my meetings with the psychology prof. And always after one of our amazing discussions about cognitive theory, neuroscience, and my experience, I come away with a practical suggestion or two.

We began by discussing how the brain integrates information over space and time. (For some reason, I kept thinking about my book Time and Space!) Apparently, much has been studied about how the brain integrates information in space. For example, you look at a cup, your visual cortex sees the bottom of the cup, sees the lid of the cup as related to the bottom in space, and puts them together to create the information that you are looking at a cup.

The brain also integrates information over time. That’s reading! I thought. Yup. True, you see words in space, for they are next to each other or above and below each other on a page. But when you read, you take them in one after the other over time — if you’re a slow reader. If you’re a fast reader, well, it’s a bit more complicated. So let’s forget about fast reading; let’s just look at reading as if we’re a slow reader: one word at a time, sequentially in time.

The brain has a corresponding map of things in space. For example, the upper part of our visual field maps to an area below a sulcus (groove) near the bottom back of our brain. The bottom part of our visual field maps to the area above that sulcus. Yeah, the brain likes to reverse reality. It’s funny that way. That’s why we know a paralyzed right arm means damage in the left side of the brain. Anywho, bits of information in our visual field –- bits of what we see – get mapped into corresponding areas in the back of the brain. But then there’s another area, a little deeper in and towards the cortex or outside of the brain. This area also processes bits of information, except in combination not individually. So two points in the first area become one point in the second area. This is handy. I wasn’t clear if the processing happens over time; it seemed like it happens almost simultaneously. The brain sees both the bits and the combination of bits at the same time.

However, the brain has no corresponding map of things in time. We exist in a point of time. Our brains exist in a point of time. Our brains don’t exist in the past, present, and future all at once. So how does it map bits of information in time?

How does it map reading in time?

And how does it combine words, one after the other, in the way it combines bits of information in space?

We don’t know.

What we do know . . .

From my discussions with the ADD Centre, I understood that reading begins with the back of the brain processing the visual information – the words – then Wernicke’s Area receiving that information and translating the language of it into understandable meaning before sending it on to the frontal cortex where meaning is processed, old knowledge is accessed, new information and old are all synthesized together, and the whole thing stuck into long-term memory. I’m sure that’s a simplistic explanation. The sticking point to my reading problems could be anywhere or everywhere along that network.

After the ADD Centre used tDCS to stimulate healing of Wernicke’s Area, my ability to speak and listen improved markedly. Even though I must still prop up my ability to understand spoken words by watching people’s lips move when they talk, I don’t have to expend so much energy in simply understanding. That means I have more energy to compose and say my reply. Conversation with me is more fun.

But it did SFA for my reading.

And so there must be another sticking point. Early in 2016, the ADD Centre targetted my left frontal-prefrontal cortex (FP1-F3), and my headaches while doing my reading homework disappeared. My ability to organize also began to re-emerge from the dead. Unfortunately, having experienced extreme stress, my brain regressed. I had lost the foundation of relaxed, focused attention in the middle top part of my brain that they had trained in me back in 2005/2006, and we had to switch from training FP1-F3 back to enhancing 12-15Hz in the middle top part of my brain. Since gamma brainwave enhancement de-stresses me so well, we’re simultaneously enhancing it too. Although my resiliency and calmness are returning, unfortunately, my headaches from reading also have. I try not to think about that setback. Anyway, back to my conversation with the prof.

I talked about the effort of reading. This fascinated the prof, for there was no sign of the effort on my face while I was talking. How can I talk seemingly effortlessly yet have so much trouble reading? Well, listening is difficult too. Just because you can’t see the effort on my face doesn’t mean there isn’t a whole lot of conscious hanging on to words as my ears pick them up so that I can follow the conversation. If I want to ensure full comprehension, I have to make a very concerted effort to hear and understand, especially if the conversation is complex like ours was. But if it’s just social chit chat, then I can sort of coast.

In any case, listening is still not as difficult as reading.

Also, talking, like writing is output: both are easier than the input skills of listening and reading. He came back at me with the fact that talking includes assessing facial expressions, body language, monitoring what you’re saying, etc. Only later did I think about the fact that after brain injury, little of that happens, which is probably why we make for sucky conversationalists. But my ability to read faces and body language, to stay on point and not hop around like some crazed bunny, has improved markedly. So just because talking is multi-faceted doesn’t mean it’s still equivalent to reading. I can talk sans caring about conversation. I can’t look at words sans reading without caring about the fact nothing is happening if I do that unless I make myself OK with that (I did for awhile).

I think feeling the effort of reading is like feeling the effort for any ability or skill that’s damaged after brain injury. The brain learns, and while it’s learning skill X, it’s effortful. Watch a child learn to read: their brow is furrowed, their tongue is tucked into the side of their mouth, they mouth words with effort. Then watch an older child read: their brow is relaxed, their mouths may silently sound out words, but they read easier than the early reader because their brain has automatized reading. Only when they come across a new word will you see their brows come together, their lips move in exaggerated caricature and their tongues in wide gestures, several times, maybe even asking a parent or teacher to sound out the word a few times, before they master it. Even then, it may require several exposures to this new word before it becomes part of their effortless reading. Now watch an adult reader: they’re relaxed, nose deep in book, they’re absent from the real world, they’re deep inside the imaginary world, feeling the feelings of the characters. almost physically experiencing the fictional world they’re reading about, relating themselves to the characters, having revelations, learning sans knowing it. Time means nothing. That adult reader exists outside of real time and lives inside imaginary time. They can do that because reading, learning new vocabulary, putting the story into memory and adding to it, drawing out old knowledge and using it to understand the story – all of that the brain has become so good at it, it’s automatic. Anything that’s automatic takes less energy and frees up resources for the brain to do other things, in this case, engage emotions and get into the state of flow. And learn.

Brain injury has taken me from that adult reader to the youngest child, except that I retained my vocabulary. At first, I lost access to much of it; as I heal, my access is returning. At this point, it seems like it’s 100 percent. I know it isn’t, but it’s returned enough to have that façade.

As I talked to the prof and listened to his theories and explanations, I would repeat the concepts or spring ahead with my concepts. This puzzled him: how could I create concepts and understand complex concepts yet have so much difficulty reading? I told him the psychologist who saw me way at the beginning of my injury said that I had not lost my logic or reason, they were only stuck inside and I could still use them, albeit at glacial speed. My speed has increased markedly since 2000, and I have retained my old knowledge. I can access that, especially when conversation stirs old facts back up into the recognition memory zone. Logic and reason and my foundation of old knowledge acquired during decades of voracious reading pre-injury are the reasons I can create concepts and understand complex ones.

I explained the effort of reading and listening is in the hanging onto each word or idea as I move onto the next word. I have to effortfully keep them present in my mind as I add to them. It’s hard work, and it’s all conscious work.

We went on to discuss working memory. Way, way back in my university studies, I had learnt about short term and long term memory. Simplistically put, information goes into your short-term memory; whatever your attention decides needs to be remembered is shoved into long term, the rest forgotten. Working memory is a newish construct to me. I asked him to explain. There launched a rather interesting discussion, the upshot of which is that there may be no such thing as working memory in the brain. It may simply be a psychological construct with no physical reality. What I had learnt remains true.

He concluded that my sticking point must be at the basic elemental level, that is, the level of taking in bits of information and combining them. What if we took that block out? What if we combined those words for me? Pictures do that. It takes many words to describe a picture; but one glance to understand a simple picture or a prolonged glance to understand a detailed picture. In either case, the words are combined for the viewer.

There’s a new genre in town: the wordless graphic novel. The reading is in the looking at each image panel in sequence. He loaned me Cinema Panopticum to see if it would make a difference to my reading, to see how my brain would react.

The other issue I have is speed. I can follow people much easier than I used to, but if they talk too quickly, or when my speech speeds up all of a sudden – ack! – I get lost. I can compensate by either not caring I’m not following them and faking it or by asking them to repeat themselves. I’ve grown clever at being able to ask people questions so that they repeat what they said without it being obviously asked.

He suggested that I could use a podcast app that speeds up or slows down the rate of speech to assess how quickly I can comprehend the spoken word. I can take a passage and note down the speed. Then listen to it for x minutes and record at what speed I could comfortably comprehend it. Repeat that assessment regularly, say, once a month to track my progress.

When I first began my reading rehab in 2015, I had timed my speed in seconds per word. But now I time it in terms of paragraphs per number of minutes. Less work. However, it would be a good idea to time my reading per word every so often. Being able to see if I’m changing or not will give me an idea of my progress.

In the occupational therapy world, writing down goals and ticking them off is how they get those of us with brain injury to see that we are accomplishing things, because things take so frigging long to do. The same with timing podcast passages and words read. It would give me an objective number — those two methods would show me and my health care team exactly what kind of progress I’m making.


Reading Wordless Graphic Novels a Two-Fer for Brain Injury Rehab

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Another day, another six minutes doing my reading homework. I’m now doing two stints (well, one, most days in these last hellish crowdfunding days) of reading homework daily: one, reading paragraphs from an article assigned by my neurodoc and one “reading” the wordless graphic novel the psychology prof loaned me.

I just had a revelation about the latter. A new, unexpected benefit revealed itself.

One of the problems in holding conversations after brain injury is reading facial expressions. My ability has improved markedly, but I still have trouble.

From Cinema Panopticum by Thomas Ott
 Today, I began reading my ascribed 8 pages of the wordless graphic novel and immediately hit a bump: I had to spend some time studying the girl’s facial expression in reaction to The Hotel to figure out what she was showing and thinking. I had to study each eye and her mouth to feel like I’d “got it”: fear, surprise, laughter (nervous or fear laughter??). In another panel further on with the masked man, El Macho, I had to do the same again, although his expression was less complicated.

I’m thinking reading wordless graphic novels is a two-fer. I don’t know how rehab formally teaches people to relearn facial expressions because I was not considered to need it (yeah, OK), other than showing us photos of different expressions and having to identify them in the social group at CHIRS …

But I just realized: a wordless graphic novel helps us relearn to read a book and to read facial expressions in a natural way. Not in a you-need-rehab-your-brain-is-fucked way. The rehab way is socially isolating and reminds us of the slog of relearning we have to do. The natural way is more fun, lifts the ego, and makes us feel part of (trendy, youthful) society because other “normal” people read graphic novels too.

Update, 4:25pm: Another bonus of the wordless graphic novel is no associations with the past, no mourning, for I’ve never seen one before. No memories of what it used to be like; no grief because there’s no mourning a lost skill I never experienced. It doesn’t look like a comic book, so no reminding me of that loss too and thus again no grief. I suspect that would be true for most people with brain injury because the wordless graphic novel isn’t a commonly known genre. Yet.

Brain Power

Reading Rehab Experiment: Reading a Wordless Graphic Novel

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The psychology prof I meet with occasionally to discuss reading suggested an experiment: read a wordless graphic novel. He loaned me Cinema Panopticum by Thomas Ott. We had been discussing how the brain takes in information one word at a time and then processes the same bits of information but combined in another area. The prof noted I don’t have trouble creating or understanding concepts; instead I have a lot of trouble ensuring my brain absorbs each bit of information — each word — and putting them together, depending on the complexity and length of the material.

What if we gave me something where the words were already put together, so to speak? What if we bypassed the basic problem of getting my brain to absorb each word and to combine the words? They say one picture equals a thousand words. Well, maybe in a wordless graphic novel, one picture isn’t equal to a thousand, but it sure is equal to many, maybe even one paragraph. Would that make it easier for me to read?

Today, I am sitting down with Cinema Panopticum to find out.

It’s a large-sized book I can lean on a cushion while I read it. Each page has a black background, and each panel is drawn in grey scale, like a pencil sketch. Fairly easy on my eyes, and fairly easy for me to perceive. Some panels are on the outer limits of how much detail I can comfortably perceive.

I used the same routine as for my regular reading homework: begin with three minutes of deep breathing to relax me and prepare my brain. Wear my reading glasses. Set the timer for 10 minutes. Begin.

I wasn’t sure how one “reads” a wordless novel. I have a tendency to look at images or photos quickly, and that’s what I did with the first panels. The first part of the story is also fairly familiar to readers: a girl wants to go to the fair, she only has five coins, all the rides cost more than five. But I suddenly realized a headache was coming on. I checked my timer.

Two minutes.

I remembered I’m supposed to take three deep breaths between each paragraph to ease any burgeoning headache or prevent one. But what is a paragraph in a wordless graphic novel? A page of panels? Two pages? Or is it better to go by time?

I took the three deep breaths but didn’t recall out loud. I read for another minute and a half. This time I looked at each panel longer, and a few of the panels I studied carefully, like I was the girl trying to figure out what she was looking at as she explored the fair. The headache began to encroach again, and I was at the end of the first section. I remembered this time I’m supposed to recall out loud. I spent another minute and a half recalling out loud section one — or is it chapter one? (no, the description of the novel says it’s the intro to four novelettes) — while I took three deep breaths.

I considered continuing on because I had been reading for only five minutes, but I had a small headache, and I was tired. Better to quit while ahead than try to push it. I’m looking forward to reading novelette one tomorrow.