Shireen Jeejeebhoy

We’ve reached the application stage! The goal when I began the Visualizing and Verbalizing program with Lindamood-Bell was to get to the point where I could read novels, neuroscience, and Philosophy of Mind.

Novels because my entire life prior to my brain injury I’d read fiction, novels since I was a child. I carried a book with me everywhere I went. It’s been eighteen years sans a book in my hand, and I’m not sure if I’m that kind of reader anymore. I’d pursued getting back my books for so long, though, I’d put novels as one of my goals.

Neuroscience because to keep the web pages for Concussion Is Brain Injury up to date with research in the brain and treatments for brain injury, I need to be able to read it without a huge amount of brain-breaking effort. I need to be able to understand it and retain what I’ve learnt so that I can write on it and continue to integrate accumulating knowledge with what I’ve written before without having to reread and reread and reread . . .

Philosophy of Mind because I took a course in it back in 2012, and the reading just about killed me. (Luckily, my writing saved me.) I retained none of the new vocabulary from the course, and almost everything I read slipped out of my consciousness, not from lack of understanding but because that’s what words do in my brain. They slip out. I never was able to do any of the extra reading, though I really wanted to. My brain caved in from the fatigue and effort. I gave up on pursuing it.

Tonight, we read samples of each; then I discussed with the Associate Director how to proceed.

We began the first hour reading the Mind-Body intro notes from my Philosophy of Mind class. But before we could even begin reading it, we had to develop a picture for qualia. We perused the dictionary definition. Broke that definition down into pictures for each part. Only then was I able to create a picture for qualia. That whole process seemed to take forever. But it may have taken five minutes. My clinician read first — receptive language. I created hardly any pictures. A complete zero except for one part where there were a couple of concrete details. I also didn’t expect her to ask me for a word summary, but of course, that’s part of the Visualizing and Verbalizing process. After read a whole page or passage, give a word summary! In the effort and confusion of tackling such complex, abstract language, I’d forgotten. I had barely any summary as I’d created little imagery. But slowly, slowly as she asked me questions about one sentence and then another, starting from the concrete detail and expanding out to the more and more abstract parts, I built up strong, stable images. My picture for “qualia” also filled in more. Then I read a shorter section — expressive language. Uh . . . ?? But it was rather amazing that in six minutes I read a short passage, attempted a word summary, created images under the guidance of my clinician, and gave a better word summary than in my first try.

Next, she read the first page of the Prologue of The Lions of Al-Rassan, a novel by Guy Gavriel Kay I’d been given by a friend in the early years after my brain injury and had had to give up. My brain had simply been unable to read it. This was easier in that there were concrete details, but I was unable to absorb the first few words. My old nemesis of the first sentences being like a car not wanting to start then finally roaring to life. I created moving pictures, not just a series of still images. Sweet. But, again, my pictures had holes in them as my first attempt at a word summary revealed. She asked me questions; I figured out ways to remember his name, added in expressions, and by the time she’d finished guiding me in creating more stable, vivid imagery, I was able to give the main idea.

Fatigue dragged me down. A break was like sinking one’s face in cold water on a hot day. And, yeah, it is hot today, too.

Hour two of the application process began with me reading the second page of the Prologue. I had an easier time of creating imagery because I knew better how to engage with the novel’s language. I gave a word summary, we discussed my pictures, and we talked about perspective. Did I see the action through Ammar’s eyes, from inside him, or from outside him? For me, my perspective was all external as if I was seeing him from behind . . . or at least it seemed that way at the time I answered the question. I’ll have to consider that question more closely next time. I didn’t give a main idea. Instead, we moved on to my third material, the neuroscience.

My clinician divided up the abstract of an article on using tDCS for fibromyalgia into sections because it was so dense. I had less trouble with vocabulary because I was familiar with all the terms. The one or two I wasn’t quite sure of I googled. I was able to explain them to my clinician. She read most of the abstract — receptive language. We went through the Visualizing and Verbalizing process for each, except for the main idea. I suppose the last part that I read was the main idea for the whole abstract, and my word summary became, in effect, the main idea.

The Associate Director joined us, and we decided that we’ll begin with reading the novel as a kind of warm up. Also, spending half the time on the novel will allow me to learn about themes and other aspects of reading comprehension when reading a work of fiction. The other half of my session, we’ll read Philosophy of Mind.

I’d better find a good way to energize my brain because I’m fatigued fatigued fatigued in a way I haven’t been in a couple of weeks! It’s worth it!

The Director of the Double Bay Lindamood-Bell Centre in Australia popped in to test my reading level, first with me reading a Whole Paragraph on something science-y and then me reading a Whole Page on Fermat’s Last Theorem. Although I had a bit of trouble with words at one point turning into gibberish, somehow when he asked me about that part, “What was that all about?” I saw the answer and stated what I had been unable to absorb consciously. The Director noted the issue I had was because I was overwhelmed by not processing that passage quickly enough. When that happens, I’m to give myself a moment, let my brain process the words, perhaps ask myself, “What was that all about?” to trigger the emergence of imagery from my sub-conscious into my conscious mind. Then continue on reading and creating mental pictures.

My main ideas are definitely there. It shows imagery is happening automatically; I’m able to review my pictures and analyse them in order to give the main idea. During my two training sessions, I also recalled two stories from the previous day with no prompting whatsoever and quicker than I have before! When my second trainer asked me to recall a second story from yesterday, I drew the usual blank and expected nada. Suddenly, a picture emerged into my consciousness and slowly, slowly dragged the other pictures in until I saw the first picture of the story and recalled it from there. Sweet.

The upshot of all this is that I’m being pushed up a few levels to grade level 12. I will also be reading only Whole Pages from now on. We began at the new level in my second training hour. I’m excited, amazed, fatigued!

At the end of my third week with Lindamood-Bell Australia, the Associate Director took over the last half of the second hour to test run paragraph by paragraph reading. She gave me a story at grade level 5, and I did well enough that she decided that it was time to drop Multiple Sentence task, continue with Whole Paragraph, and introduce Paragraph by Paragraph. That’s how I began week four today. I also had another improvement: all my main ideas were succinct, to the point!

We alternate who reads because I need to improve both my receptive (they read) and expressive (I read) language processing and reading comprehension. The Whole Paragraph Imaging with Higher Order Thinking stories are at grade level 9/10, but the Paragraph by Paragraph Imaging with Higher Order Thinking is at level 5/6. Aside from the obvious difference in length — read one paragraph as opposed to two or more — they also follow different processes. I have to review in my head or out loud when really tired the process before I begin.

Whole Paragraph Imaging with Higher Order Thinking

As I or the clinician reads the paragraph-long story, I image the characters, the movement, the colours, the scenery, background, perspective, etc., like a series of pictures or a moving picture. What I can’t image, I skip. Sometimes I don’t know what an object or person would look like, and I’ll skip that too. Sometimes the clinician is reading quicker than my brain can process, so I’ll zone out for a nanosecond and pick it back up wherever they are in the paragraph-story.

At the end of the reading, I’ll summarize the story in my own words based on the images I created. Then the clinician will ask me questions about my mental pictures of the story; as they ask, I create more pictures, add to the ones I’d created, ask them how to image abstract concepts, until I have a complete set of pictures for the paragraph-story. Sometimes I’ll change them as a result of realizing I’d misunderstood something or being guided to think more about the why behind a part of the story.

After the clinician has checked my mental pictures, they’ll ask me for the main idea. And lastly, they’ll ask me Higher Order Thinking questions. The books they use provide such questions; but often with me, they think up harder questions. And if we’re not careful, I’ll lead them into a rabbit warren of ideas and conversation.

Paragraph by Paragraph Imaging with Higher Order Thinking

This starts the same as Whole Paragraph: read one paragraph, give a word summary of that paragraph, check my mental pictures. We repeat the process for the succeeding paragraph(s). As I improve, they will increase the number of paragraphs I’ll read, and this process will be repeated for each paragraph. Today I or the clinician read to me two-paragraph stories. Either I can read the whole story, paragraph by paragraph, or the clinician will. The Associate Director said that sometimes we alternate who reads the paragraphs within a story. The one difference from Whole Paragraph is that a coloured square of felt is put down for each paragraph, like for the Sentence by Sentence or Multiple Sentence stories. They put a felt down, which I can see through the document camera, and I put a felt down on my own desk. I believe I’m also supposed to touch it, so I have visual and touch senses both feeding me an anchor tied to the paragraph (or previously, the sentence) that I’m reading.

Once the entire story is read, the clinician will ask me for three key images for each paragraph — the strongest pictures I have in my head, basically — of the story, touching and looking at each felt as I go through all the paragraphs. Then we take the felts away, and they ask me to give a word summary for the entire story — the story in my own words based on my mental images. When I have strong pictures or images, they know I’ll be giving a good word summary.

In my second hour today, and for the second Paragraph by Paragraph story of the day, sound suddenly entered my mental imagery! The addition of another sense, and automatically too, heightens the vividness of the imagery both in my mind and in the clinician’s mind when I describe my pictures.

After my word summary, like with previous tasks, I give the main idea and answer Higher Order Thinking questions.

Then I inhale half an ice cream sandwich, guzzle some pop, and fall into bed.

I thought Visualizing and Verbalizing was tough before. Yesterday, my fatigue grew and grew during the first hour that answering two more questions in the last minute was impossible. I’d read a third Whole Paragraph — only ever done two max before — done a word summary on it, been guided to develop more images and solidify them, come up with the main idea, and answered one or two higher order thinking questions. Before that, I’d completed two Multiple Sentences that were longer than I’d done up to that point and were filled with abstract language and concepts. I’d also begun the hour with a short recall task. I’d been expecting this task would be added; still, being asked to recall one of the stories I’d read the previous day caught me by surprise. Total blank for a few moments. Then the pink armadillo story slowly surfaced into memory. First a vague image, then it solidified and lead to another image and another until I remembered the key details. (Today, being asked at the start of the second hour, not just the first, also took me by surprise. Much more difficult trying to pull out of the blankness of my memory a second story.)

Although I didn’t feel myself being drained as I recalled the story, I’m sure I used up some of the brain energy I would normally have had to read and create images.

I had also met with the Associate Director and Director about an hour before my instruction for a half hour videoconference. Maybe I didn’t recover my energy fully before I began my training . . .

My neurodoc was supposed to have been there. He got the address wrong. But I had a productive meeting, regardless. And I’m so used to doing rehab on my own that having had a successful collaboration would’ve seemed weird, anyway.

Today, the Director of Instruction, who was in California, joined in on my first half-hour of instruction. Between her and yesterday’s meeting, I learnt a few things.

What is effort on my part to the point I begin to develop a concentration headache and can feel the energy leaving me, looks effortless to Lindamood-Bell staff. No wonder brain injury is so invisible! Interestingly, my term “concentration headache” gave both the clinician directing my instruction and the Director of Instruction vivid images of what was going on in my brain. I hadn’t developed any images from my own term!

I’m only twenty-six hours in and already at level J (new term for me!), which is grade level 9/10. They’re very happy with that, though expected me to be on this pace. I was told there isn’t any difference in terms of content between grade levels 9 and 10, and 11 and 12. The difference between 10 and 11 is subtle and usually about increasing vocabulary and building on prior knowledge. It mayn’t be much difference between grade levels once reached high school level, but I feel like I’ve been flung into a swift moving river and am stroking hard to keep my head up. I’m doing it, but the ice cream refuelling is becoming essential! It doesn’t help my fatigue when it’s muggier than a swamp after a thunderstorm.

Another thing I learnt: when concept imagery becomes automatic and language processing advances (becomes easier, I think), that’s when I may start to achieve flow — the state when so immersed in a book or work or cooking that the real world falls away from your consciousness. But my fatigue will limit how long my brain can sustain that. No guarantees!

Imagery in day-to-day conversation happens when automaticity has been attained in creating images. However, you can kickstart it in another person by uttering a negative command: “Don’t picture a pink elephant.” You just saw a pink elephant, didn’t you? Apparently, your brain does that automatically so as to be able to carry out the negative command.

The Associate Director noted I had changed, now adding gestures and using language that was consciously painting a picture in her mind. So even if I cannot perceive much change in myself, someone who sees me only every few days or once a week, can. That’s why the Director of Instruction wants to see me again next week, to see for herself if there are any changes. Meanwhile, she’s adding in a new task for tomorrow: Paragraph by Paragraph. Yikes! She assured me we would go down to a lower level, 5/6, for that. Phew.

These longer Multiple Sentence stories that require “5 felts” or have much more abstract language in them, are making my neurons pulse hard and continuously in areas not used to working in this way. This work is making me more aware of my imagery during instruction and is starting in a tiny way to make me conscious that maybe I should try creating images when reading articles outside of instruction. Maybe.

As they get me closer to automaticity, then it will bleed more into my normal reading life like tweets and articles. When I get to a place where it becomes automatic, then they’ll introduce more and more language.

Various people at Lindamood-Bell have commented on my focus and how I’m really working the process. I was a bit puzzled by that. I understand kids may not be diligent. They won’t be aware of the monetary outlay and maybe don’t care or want to work that hard. But any adult who plunks down a chunk of change and then doesn’t work at it is either swimming in dough or is . . . (scratches head) . . . I got nothing. This is the way I was raised. Work hard whether the job is school, volunteer, or paid. And besides, I’ve been trying to regain my reading for 18 years. I’m having all sorts of blinking grief issues over that, that disappear during these two hours of intense instruction. Escape from the crap is rather motivating, too.

The Associate Director of the Lindamood-Bell Double Bay, Australia centre popped in for my first hour to read a few whole paragraphs with me. We began with a Multiple Sentence with me imaging pictures for each set of sentences. Nice pictures was the verdict. We moved on to reading a Whole Paragraph from the level 7/8 book. Doing well was the verdict. She pulled out another book from the stack she’d brought in and chose a non-science story since I seem to find science-y stories easier. It was one I was well familiar with; I think I’d learnt it from either a chemistry teacher or an English lit teacher who liked those sort of details of how authors come up with characters, in this case, the Mad Hatter. Still, I wasn’t completely able to form images or moving pictures of the story as she read it at a normal rate.

The final verdict: I’m moving up to level 9/10. She explained that I wouldn’t see much difference between the higher levels, for example, between 10 and 11. But I would see more abstract language and more difficult vocabulary. Since I have a rather extensive vocabulary, the latter shouldn’t be much of a factor for me. It’s imaging abstract and complex concepts that’s the challenge. Also, if I understand right, once I’m proficient at level 9/10, they’ll be introducing longer stories. Then it’ll be super tough! I’m so very glad I stocked up on Soma hot chocolate to rev up my brain in the morning after a hard night using it!!

I feel like I’m on a silent train speeding up unexpectedly every time I become comfortable . . . or even before I do! The AD told me that they had anticipated I would move up through the levels rapidly, that the first two weeks were to solidify the process and now we’re at the level where we use the process to really retrain my brain to read lengthy, complex material. And books.