Category: Treatment

Treatment of brain injury that aims to heal neurons and restore functionality, cognitive skills, emotions, heart and temperature regulation, etc.

Brain Health

BIST ABI Acceptance Series, Week Two, A Review

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This month, the Brain Injury Society Of Toronto is holding a series of four information sessions about acquired brain injury (ABI) acceptance, adjustment, strategies, and resources. I attended the second one on acceptance, presented by Dr. Bojana Budisin, Neuropsychologist and Dr. Liesel-Ann Meusel, Neuropsychologist, of Lad and Associates in Toronto.The topic was “Learning Strategies for Adjustment and Acceptance – addressing the topic of grief, acceptance and adjustment.” The turnout was much higher than expected, probably for the same reason my posts on grief receive more views than any other of my posts on Psychology Today: Grief is a topic rarely addressed in our rehab and most therapists don’t seem to know how to treat the extraordinary grief of brain injury.

Acceptance over and under grief. Text image.

They began by asking for definitions of acceptance and printing them in large easily-seen capital letters on a giant piece of paper stuck to the wall. There was no shortage of suggestions.

  • Reality as it is
  • No criticism
  • Satisfied with where you are
  • No self-judgement
  • Not judgemental
  • Work with me
  • Respect decisions
  • Respect
  • Loving and liking yourself as you are now
  • Life changes
  • Reduction of anger
  • Letting go
  • Tolerance
  • Not imposed
  • Working with what you have
  • Open to change

It’s interesting that, although the presenters were wanting to focus on our acceptance of ourselves and our brain injury, the word equally raises the traumatic experience of others not accepting nor respecting us.

Budisin and Meusel then showed their word cloud divided into positive definitions and ones associated with negative connotations (in square brackets below):

  • Letting go
  • Consenting to
  • Letting be
  • Opening up
  • [Capitulating]
  • Giving permission
  • Stopping the fight
  • [Acquiescing]
  • [Approval]
  • [Giving up]
  • Giving permission
  • Make space for
  • Allowing
  • Adjustment
  • Make peace with
  • Assent

Acceptance is not saying we give up and stay where we are. Let’s learn to be with those awful emotions as they are so that we can shift our energy to more productive activities.

They emphasized that this session was about dealing with what we can control: ourselves. There are two problems with that concept as it relates to people with brain injury. After ABI and because of the injury, more for some than others, depending on the areas injured, we can’t control ourselves. Can you control a short circuit through willpower or behavioural means? Same idea with misfiring or not firing neurons. When neurons fire randomly, it’s important to treat them neurophysiologically so that they begin to resync again, to regenerate, and in that way, we can regain control bit by bit. The other problem, as one participant noted, is that others impose their anxieties on us. We’re fine on our own pottering about at our own pace and within our lack of abilities, but when in the presence of people who don’t know how to treat ABI, or how to react to our injury-affected meins, they get all anxious. Then we do. It’s been a long time since I was badly affected by this imposition, and I wish back then I’d known others experienced being buffetted around by others anxieties and judgements, too.

Budisin and Meusel defined acceptance as, “. . . means allowing our thoughts and feelings to be as they are, regardless of whether they are pleasant and painful, opening up and making room for them, dropping the struggle with them and letting them come and go as they naturally do.”

They did an exercise demonstrating this principle. Imagine a ruminating thought and its accompanying feelings written on your palms. Now raise your palms to your eyes and hold them close. What can you see? Can you hear, attend, or see the people around you or talking to you? You’re probably more aware of your palms and what’s written on them. Your shoulders and neck are probably starting to hurt, too. This position mimics how dominant the ruminating thoughts and feelings are.

Now, lay your palms on your thighs, still imagining those thoughts and feelings are on them, and push down. And keep pushing. You’re probably starting to get tired. It’s like the exhaustion of pushing your thoughts and feelings away.

Now, rest your hands on your lap, palms up. This is letting the ruminating thoughts and feelings be. They exist. They’re there. But you’re not judging or pushing them away.

Some found this position anxiety provoking. It’s a position of vulnerability, of exposing your emotions to not just yourself but to others, too. And if there’s one thing people with ABI have learned is that we get judged and criticized and told our emotions are wrong — we’re not moving forward or getting over ourselves fast enough — or our emotions are lacking or inappropriate to the occasion. So exposing them is to invite judging. Who needs that‽

Holding one’s hands up is familiar and shielding, as well. Budisin and Meusel didn’t have much to say on this reaction. Their point was to show that letting be is more restful, and it should be. There’s that should word! I was told during rehab to not use the “should” word but perhaps “ought to” instead. Yet in dealing with emotions and grief after ABI, even though therapists are compassionate, we still get an awful lot of being told how to think and feel. Letting be should also apply to others so that we can let be safely.

This is partly why teaching people with ABI acceptance without including community takes years and why I come across people who look like they have it but the moment I trigger their real emotions, they’re pouring their pain out all over me. Not a problem, just rather unexpected and disorienting at the amount of unheard pain I’m suddenly being drowned in. When we’re taught that the only way we’ll be accepted is if we demonstrate acceptance, is it any wonder we learn to mask our true feelings? And then when someone comes along who’s willing to listen and believe, we let all of it out in one tidal wave of despair, pain, relief at being heard.

Budisin and Meusel’s second part of their acceptance definition was, “. . . gives us the skills to stop getting tangled up in our thoughts and feelings, to start thinking clearly and productively, to move forward with what is important to us.“

My very first thought was how does one untangle emotions when they’re being generated, or not generated at all, by injured neurons in a chaotic and disharmonious manner? Behaviour therapy like this is going to take forever without neurophysiological interventions. Even for people with simple anxiety, learning the skills is not easy. When after neuroplastic treatments, the brain is producing the brainwaves of relaxed, focused attention, then we have half a chance of learning and retaining the necessary skills. In conjunction with brain biofeedback or low-intensity light therapy and with the aid of audiovisual entrainment at the start of a learning-acceptance session, this kind of work would be healing and empowering to do.

A key point: our own concept of acceptance will at the end of the day differ from person to person. Accepting the non-acceptance by others is part of acceptance. Budisin emphasized that acceptance takes years and is not linear. It’s progression and regression.

Acceptance work is like dealing with quicksand. To survive it, you lie flat slowly and don’t fight the quicksand. It goes against every instinct. But by giving up fighting, you have more energy.

Suffering = pain x resistance.
Pain is physical or emotional.
Acceptance = taking away resistance.

I assume that means that suffering reduces down to:

Suffering = pain.

There are nine basic emotions for all humans across all cultures:

  • Love
  • Anger
  • Sadness
  • Fear
  • Disgust
  • Curiosity
  • Joy
  • Shock (can be good or bad)
  • Guilt/Shame

These emotions can feed each other. A single emotion can be broken down further, depending upon one’s life. We live in a world that emphasizes happiness and positivity, but only three of the basic emotions are positive in normal human experience. We have to learn how to manage the six “negative” ones.

Budisin and Meusel asked: Why do we need them?

They answered: Each signals to us that this is something we care about.

Emotions are data or signal beacons to something we care about. Better to feel them and label them accurately so that we can better discern the precise cause of our feelings and more accurately take steps to move forward. I thought of how I needed my health care professionals to help relearn how to identify emotions when they began to return after well over a decade of being absent, and how difficult it was when they either didn’t or simply labelled them all as anger and frustration or my injured emotional centres as depression. Accurate identification is the only way one can (a) relearn how to identify emotions and (b) be heard. When psychiatrists take the easy route of labelling them all as solely depression or anger, we lose out.

Budisin and Meusel used an iceberg analogy for emotions.

Iceberg

Anger often is like an iceberg. Others see our anger, the part of the iceberg that’s above the ocean. But so much more is underneath it, and that’s the primary, raw emotions that’s driving the anger. Those are the emotions we, all of us, need to listen to, the part of the iceberg that’s below the ocean surface. Anger is more complex than just anger.

What is anger?

Anger: protective nature. One feels energized and stronger. A bit out of control. Flight and fight. With anger, you can defend yourself and others around you. Ready to protect the raw, vulnerable emotions that’s driving it. Those raw emotions are often sadness, being hurt, being tricked, helpless, embarrassed, annoyed. If you remove the anger, you expose the vulnerable emotions. Those are the signal emotions. And those are the ones you want to acknowledge and work with. That’s why open palms creates anxiety as it reveals the vulnerable under-the-ocean iceberg.

But when health care professionals — especially psychiatrists who are the only ones covered by medicare and thus affordable — would rather avoid us or not deal with our issues or farm us out to “experts” who know just as little, how do you state your need? How do you safely show the signal emotions? How can you get them to hear us?

Budisin and Meusel moved on to grief.

Grief

Recognizing grief is complex because of the overlap with ABI and PTSD. That’s when we get the feeling of dealing with so much. That’s why therapists start chipping away at something so that they can reduce the overall load we’re carrying. Having a good conceptualization and understanding of what’s going on is important, and hopefully health care professionals will recognize that and tease out what is what. To do that, they’ll work in stages, eg, to get rid of acute symptoms then after that they’ll start addressing grief.

Phases of Grief
  • Denial
  • Anger
  • Bargaining
  • Disorganization
  • Despair
  • Depression
  • Acceptance

The aim of grief work is to process through the stages so as to reach acceptance but rarely is the process linear. It goes back and forth. Lasts for years.

Even at the end, acceptance can be partial and fluctuate.

Denial. Immediately after loss of self. I’m fine, and I can go back to normal life.

Anger. Frustration because of injustice and loss. Why me? What did I do wrong?

Bargain. What if I implement x then I can improve. Or if I just push through, things will resolve.

Disorganization. Trying to implement strategies leads to disorganization. Confusion. Who will I be? Exponential if also have injury-related confusion.

Despair. Loss of hope. Things will never get better. No change.

Depression. Like above.

Acceptance. Things are as they are. Accepting pieces of it.

A complication is a person goes through this process as a new self in order to become a new new self.

Acceptance involves developing skills that help you avoid getting all tangled up and carried away by painful thoughts. I notice I’m having the thought that x. This noticing creates a bit of distance. Also you can write it down to create distance. When you get tangled up, you get strong emotional reactions.

Thoughts are not always as true as they feel. We see things as we are not as they are.

Weather Report

One idea Budisin talked about is to learn to sit with painful feelings and notice them like we notice the weather. Do a personal weather report to validate them and then focus on the present. Am I sunny or is there a storm raging inside or is it in between? Rainy with sun? But don’t think too much about this report. Simply summon the report, notice it, and let it be. They wrote in their handout:

“By sitting with uncomfortable and unpleasant feelings and sensations and letting them be as they are, you’ll come to find that they will invariably pass on their own, in time.”

Palms in lap.

The only practical idea I heard on how to grieve was in a question they briefly posed: Have you commemorated aspects of yourself before ABI? They didn’t expand on it nor spoke about how they do that with clients.

I didn’t stay until the end because the session went over time and I had to leave at its scheduled end. I was also quite tired. There was a lot to take in plus I was taking notes. The part I missed was a 15-minute video TED talk they showed.

The next day I began to have flashbacks to my insurance battle and the many, many ways kind-meaning therapists didn’t hear me when I had no emotions. I survived those awful, awful years because my affect was off, as I wrote in my book Concussion Is Brain Injury: Treating the Neurons and Me. Suddenly, the week of the info session, all the emotions a normal person would have had when I was fighting on six fronts (my ex, my family, my insurance company, the tort claim, my friends, and my injury plus trying to find treatments that actually worked to heal) barrelled in to my consciousness, sucking all the oxygen out of my life. They’ve waned this week in the face of having to deal with my schedule being disrupted and having to adjust to another new routine. Just another week in the life of a person with brain injury when they have only the minimum or don’t have at all the medical, community care, social, and emotional support they need.

Brain Power

Last Reading Session with Lindamood-Bell

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It’s over! Hard to believe that it was only four months ago, I was starting to learn how to visualize and verbalize and on my way to regaining my reading comprehension. And now it’s over. I plunged in with Lindamood-Bell on the basis of their decades of experience, their thorough reading assessment, my brain Clinic Director’s endorsement. Even though they were fully confident they could give me back my reading, I was uncertain. After eighteen years of not much progress, how could I achieve reading books again in only two months?

Well, I did it. I ended the original 81 hours back in September and had five refresher sessions one week then two weeks apart. I’m still reading The Lions of Al-Rassan (on page 183 as of today, more than a third of the way through it), and I’m rereading the course material from the Philosophy of Mind course I took six years ago and did well in on the strength of my writing, my short-term memory, my intensive use of the iPad for notes and repeated calling up of word definitions (no vocabulary retention), audiovisual entrainment, and serious napping. Even so, I never acquired vocabulary. I never understood some concepts like Descartes’ extension. And I didn’t retain much of it. But now I’m reading it with comprehension. I’m acquiring vocabulary. The only thing I need to is read and work the visualizing and verbalizing process.

It was sad to say good-bye, but today, I was ready. I’ll still be checking in as checking in helps the student to retain and prevent drifting away from the process. I have to say that because I’ve been intensively writing a novel for NaNoWriMo, I have been drifting away. And some stressful events have seriously interfered with my memory of what I’d read. Having the last of the extra five free refresher sessions today gave them an opportunity to pull me back in and for me to ask for tips.

Read every day. And even if it’s only five minutes during this intensive writing period, read daily to keep the connection to creating imagery. Work the whole process if can read for 10 minutes.

Read daily.

Funny, before my brain injury, no one ever had to convince me to read daily. Not reading a book was a chore. After my brain injury, reading a book became a slog of quicksand-sucking proportion. Now reading daily is difficult yet returning me to the joy of books.

Brain Power

Reading Re-Evaluation Results After 81 Hours Visualizing and Verbalizing Instruction with Lindamood-Bell

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Today was re-evaluation results day! It seems like another lifetime ago yet only yesterday that I received my initial reading assessment results from the Minnesota Lindamood-Bell centre. I’ve completed eighty-one hours of visualizing and verbalizing instruction with Lindamood-Bell’s Double Bay, Australia centre (which because of the time zone difference allowed me to do it two hours per night, five nights per week). I had my re-evaluation this past Sunday, Monday, and Tuesday nights. The time was broken up because of my fatigue — I don’t have a lot of stamina — and because they wanted to use new-to-me stories in addition to the same ones I had been tested on the first time around for the reading comprehension section.

Like before, all the results were normed to my age and gender. And those tests that haven’t been normed in awhile, were used for diagnostic purposes.

Re-Evaluation Results

What I wrote about my June results is in italics; my re-evaluation results underneath each point:

  1. “My reading rate is too slow. I’m in the 16th percentile. That means 84 percent of women my age read faster than me.”
    1. My reading rate has not increased. I remain in the 16th percentile.
  2. “My foundations are solid. These are the ability to hear phonemes, the sound parts that make up words. The ability to recognize and pronounce high-frequency words. The ability to figure out an unknown word within the context of known words.”
    1. My foundations remain solid. I can still sound out multi-syllabic words, as they’ve heard and seen during my sessions while reading complex material like philosophy of mind.
    2. Although a couple of my scores dropped in this category, they remained in the above grade 12 level. The word attack — decoding nonsense words, which is about sounding words out — also has only 26 possible points. So going from 26 out of 26 last time to missing 2 of the 26 this time equals a big drop in percentile; if there had been more points, the drop would not have been as large. The symbol to sound one (things like sound out “ou” or “oa”), I like to think dropped because Canadian accent versus Australian accent. Heh. But to be honest, I didn’t put a lot of effort into that one test because in the real world, I can pronounce words okay. It’s my reading comprehension, reading rate, and amount of text I can read that are the issue.
  3. “I rely on my vast knowledge bank and familiarity with language to prop up my comprehension. When I cannot see a word but only hear it and I have to pick out an illustration that best represents the word, I cannot rely on my ability to decode a word from its roots to figure out what it means. And so I don’t do so well. Based on results from standard vocabulary tests, I drop about ten percentile points, maybe a bit more, when given the same vocabulary test when heard, not seen, and using pictures instead of words to “define” the word spoken to me.”
    1. Well! I’m so chuffed. My Peabody Picture Vocabulary Test result shot up.
    2. There was actually a greater than 10-point discrepancy between a regular vocabulary test and my initial Picture Vocabulary test result.
    3. I went from 82nd percentile to 95th! That’s more like it!
    4. This test measures receptive vocabulary, that is, vocabulary that’s spoken to me. The improvement reflected my improved ability to image words.
  4. “My accuracy in reading words is very high.”
    1. This remained the same.
  5. “Fluency is rate plus accuracy. So my fluency is not at the level that my reading foundations indicate it should be. (Slow reader.)”
    1. This has not changed.
    2. My reading rate remains in the 16th percentile.
    3. My accuracy remains very high in the 95th percentile.
    4. Fluency remains in the 63rd percentile. The only way for me to increase it is to read faster.
  6. “When I can rely on my knowledge bank and ability to decode words, my comprehension is good. When I read new or lengthy material even text at grade six level, where I can’t rely on my knowledge of content and language, my comprehension drops a lot.“
  7. “Concept imagery is the ability to conceive a word, sentence, or idea as a whole in a kind of picture. I don’t have it. It’s sort of, uh, depressing . . . more than that . . . grievous and devastating to see one rated as having a mental age of 14.5 or 13.5 years in these tests after eighteen years of rehab, active treatments, and passive home treatments. On the other hand, they confirm I’m not imagining my reading problems. I have real difficulty despite the fact that I’m “articulate” and can read words no problem.“

In relation to points 6 and 7: big change! Happy Snoopy dance!!

Concept Imagery

Lindamood-Bell’s visualizing and verbalizing instruction is aimed at improving one’s ability to conceive a word, sentence, or idea as a whole in image form. Being able to conceive a word or sentence or paragraph or idea as an image both improves comprehension and recall. My re-evaluation objectively measured whether I’d learnt how to do this and improved in these two areas. In the words of the Double Bay Associate Director, I “knocked it out of the park.”

Sketch of visualizing and verbalizing instructionAs I’ve detailed in previous posts, Lindamood-Bell Australia began teaching me how to visualize with a single word. We moved on pretty quickly to a single sentence. Once I learnt what is meant by picturing a word then picturing a sentence, I had to learn how to verbalize it. I didn’t really understand “visualizing and verbalizing” until about August even though I was doing it.

It isn’t enough to create a mental image in your mind, that is visualize an entire sentence then a whole paragraph then an entire page; you need to be able to describe that image and also summarize the sentence or paragraph or page in words  clearly — that is, verbalize it to your clinician.

I didn’t get to the chapters/articles level as shown in this diagram by the Minnesota Director. But I did reach the Page level and soon after during the Application stage, the Page by Page level.

So what did that mean?

The Big Result: Reading Comprehension and Recall

In the Gray Oral Reading Test, Form A, which is one of the tests used for diagnostic purposes, I improved hugely. This test measures straight recall. You read a paragraph. They take the text away, and you have to answer four open-ended questions posed to you by the assessor. I had inconsistent and kind of depressing results the first time. This time — 100% all around, well, except for one pesky grade level. But I improved there too! At the grade 6 level, I improved from 75% to 100. Eighth grade I remained at 100%. Tenth grade, I improved from 88% to 100%. Grade 12 I went from 50% to 88%. College level, I went from 75% to 100%. And adult level I remained at 100%.

Gray Oral Reading Test, Form A Pre and Re-evaluation results

I’d noticed my recall had shot up. I was able to not only remember but have confidence in what I was remembering because it felt solid in my memory banks. I remembered what I read — whether pages from the novel The Lions of Al-Rassan or sections in Philosophy of Mind text — because I could see the images in my head. For the first time since my brain injury, I was also able to build up the big picture of what I was reading — this requires recall. If you can’t recall what you read previously, you can’t build up the big picture. But you also need comprehension.

The Gray Oral Reading Tests 4, Forms A/B comprise stories you read out loud then they take the story away and put in front of you five multiple-choice questions. You read along with them as they read out loud the first question and its four possible answers. After you choose A, B, C, or D, they read the next question, and so on. This time I recognized within those questions, concepts such as main idea, higher-order thinking questions, questions about feeling and expression, things I still struggle with but are way, way, WAY, better than back in June. They saw I was stressing over reading stories I recognized from my original assessment, wanting to do better, still not happy at how back in June I’d struggled over answering some of the multiple-choice questions. I was definitely not struggling as much. But was that a practice effect or comprehension? It felt like comprehension to me. They decided to test me again using new-to-me stories without telling me why they were giving me additional stories to read; they scored me on those stories. I was less stressed as I read the new stories, the questions, the multiple choices, and answered the questions. I actually scored better on the new ones than on the ones I knew from the June assessment! That’s what stress does to you!!

As I mentioned earlier, my reading Rate results from this test remained abysmally slow: 16th percentile. Accuracy remained at 95th percentile. Fluency remained at 63rd percentile. But — drum roll –my Comprehension score went from 63rd percentile to 84th! This is actually the top percentile for adults. The best part: I scored 70 out of 70. *Pumping fists*

Gray Oral Reading Tests 4, Forms A/B

They don’t test for volume of language, that is, how much text I can read in a sitting. But we know experientially that I’ve been increasing week after week the volume I’m reading. We began with a sentence. I’m now up to four pages, reading them Page by Page. My next goal is a chapter. I don’t know how I’ll get there, though. I’ll be working on goals next week.

Main Idea

Reading rate is the same. Volume and Comprehension are up. My reading rate hasn’t changed, but I’m understanding much better what I read and I’m reading much more text with comprehension and good recall.

It is possible to restore reading comprehension after brain injury! No strategies needed anymore!! (Well, except for covering off the text . . . for now.)

I haven’t tested my long-term recall in the real world. But every time I summarize what I’ve read so far in the novel, starting from the Prologue, I remember it. The Philosophy of Mind is not as solid with just me reading it, probably because it takes more mental energy and effort. I fatigue quicker with it; fatigue plus huge effort equals not being as disciplined in creating images. I also am not good at creating higher-order thinking questions (HOTs). I’m going to go back to my course modules and use those questions as my HOTs. But I think this day calls for cake!!

Brain Power

And Just Like That My Lindamood-Bell Reading Rehab Is Over

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Final Lindamood-Bell Progress Report for Visualizing and VerbalizingIt’s surreal. It seemed like the whole summer stretched ahead of me, five nights a week spent in intensively retraining my brain to read with comprehension, two nights recovering my energy before once again being immersed in Visualizing and Verbalizing the Lindamood-Bell way. I met and worked with six, seven different clinicians. Suddenly, tonight, it’s over. After not seeing her for awhile, the clinician I began my training with, I ended with. It was a full circle moment! At the end of my last hour, I received my final progress report from my Lindamood-Bell Australia consultant (also the Associate Director of the Double Bay resource centre) and a lovely send-off, complete with a signed certificate that they’ll mail me.

Way back in June, the Lindamood-Bell Minnesota centre, who had assessed me initially, told me: “We can restore your book reading.” It felt untrue. I asked:

“When you say I’ll be able to read a book like I used to (before my brain injury), do you mean a book at the level of an Agatha Christie? A PD James? Neuroscience article? And/or philosophy of mind textbook?”

They answered:

“In creating your recommendations for instruction, the goal I had in mind was your ability to read and process literature at the level of your potential, and at the level that would support research and continued learning for your writing. Especially with the full recommendation of 120 hours, I picture your ability to access all of the examples you provided in your original question. Our instruction may start at a lower level, but over the daily and weekly sessions, you’ll see an increase in the amount of language (text) you are processing as well as the complexity.”

That’s exactly what they did, except the Associate Director of the Double Bay, Australia resource centre knew I could afford only 80 hours of instruction; she set goals for me to achieve what I asked within that ambitious timeframe. I remained skeptical even while meeting all the goals on time as I progressed through the summer. But I didn’t just cross my fingers and wait for them to prove their assertion. I worked with the ADD Centre to ensure my brain biofeedback training would complement my reading comprehension retraining. My brain trainer told me what was most important was for my weekly brain biofeedback to ground me. I also used my Mind Alive audiovisual entrainment device a couple of hours before each nightly session to entrain my brainwaves into SMR and Beta frequencies, the ones that show a relaxing effect in people with brain injury and enhance the thinking brainwaves (beta frequencies of around 18Hz). I replenished my brain with glucose aka ice cream during the five-minute break between hour one and hour two of the reading retraining, as well as afterwards. Brain cells use glucose for energy; this past summer was steamingly hot, so ice cream was a must. I parked my brain more and more during my two days off. Other things got a little behind. My priority was reading. My energy needed to go all to reading. This was a last-ditch shot at getting my reading comprehension back; it was a rather expensive debt-exploding shot, too.

Lindamood-Bell Minnesota also said: “Since our vision for instruction will include increasing the volume of information you are processing, our goal is to decrease your fatigue, by systematically and consistently reinforcing independence with visualization for increasing lengths of language. Just like any foundational skill (ex: learning a new language, learning a new instrument) practice and continuous exercising of the skill, makes it more automatic. Instruction will stimulate and strengthen this process for you, but practice outside of sessions and beyond instruction, will also be key. You may still need to take breaks, but I anticipate the length of breaks and the frequency of breaks will diminish as you, on a daily basis, start reteaching your brain this visualization process.”

That is exactly what happened. When I began back in July, a sentence seemed super long to visualize and reading a whole paragraph all at once seemed impossible. As of tonight, I can read — that is, visualize and verbalize, denote and comprehend — four pages of a book, one page at a time in sequence, with less fatigue than when I was visualizing and verbalizing a sentence way back in July.

Even as I experienced progress, I remained concerned about being able to practice daily on my own. I worried about all this effort and money I really didn’t have wasted if I was unable to practice and lost any gains I made. People with brain injury have both motivation and initiation deficits. If someone tells me to read a page, and I’m able to do it, I will. But that kind of responsiveness is not the same as me being able to motivate myself to read a page and to initiate the action of reading a page. Too many health care professionals equate the two as being the same. They’re not. Responsiveness is not motivation. Responsiveness is not self-initiation.

I use a variety of technologies to initiate me. But nothing beats a fellow human being. When we speak, my neurodoc is now asking me to give me the main idea and a couple of pictures from my novel reading and my philosophy reading. My mother has bought the novel I’m reading, The Lions of Al-Rassan, and we discuss the plot, the characters, the action every so often. Accountability is so important.

But so is reward.

I was out and about with my CNIB orientation and mobility trainer and found myself near Soma Chocolate. I needed more of their kick-the-brain-awake hot chocolate; as I picked some up, I spied their chocolate covered dried cherries. Ooohhh. The perfect reward. One chocolate-covered cherry per page of novel read or per two paragraphs of philosophy read. That’s how I managed to read four paragraphs of philosophy this past weekend, not sweat through only two paragraphs and call it a day. I rewarded myself with two chocolate-covered cherries — soooo good — but the better reward was unexpected.

https://twitter.com/ShireenJ/status/1038471243559837698

I connected what I read with what came before. I saw the big picture unfolding. I comprehended how each of the writer’s points connected. I saw his philosophical argument beginning to unfold.

Holy s—!!!

I have not been able to do that before, seeing the big picture like a carpet unrolling, showing me its beautiful, intricate pattern. It wasn’t just that I comprehended it, I saw it. This is what visualizing means. Create imagery, and you’ll remember and understand.

For the first time this weekend, I felt confident that I will continue to progress on my own.

https://twitter.com/ShireenJ/status/1038504783852781569

Lindamood-Bell Australia told me I have partial proficiency in the application part of instruction because I need prompting with my higher-order thinking questions — yeah, I find it tough to ask myself these kinds of questions, a definite side effect of my brain injury — and to be more precise in my main idea. I’d achieved succinctness in my main ideas with Lindamood-Bell texts, but it’s not so easy with The Lions of Al-Rassan or Philosophy of Mind texts! They also noted that with the novel and philosophy, it takes some discussion between me and the clinician to make my images clear. I find creating imagery for concrete details far, far easier than for thoughts, flashbacks, concepts, abstract ideas, which are abundant in my application text. They did note that even neurotypicals need to pause when reading philosophy, reflect, go back, review vocabulary. It is not light reading for anybody.

I am absolutely amazed and stoked that I can finally — FINALLY — acquire and retain new vocabulary using Visualizing and Verbalizing!!!

They said that they don’t know what my reading will look like in the future. Will I be able to read a chapter and not be exhausted? They do know that, given how I have responded, I will continue to respond (as long as I practice). But is there a ceiling? They don’t know what the ceiling is or if my brain injury means there’s a limit to how much I can respond. The challenge for me will be how much language I can process as well as my reading speed. It takes longer to read when I have to break up a page into paragraphs and need hours to recover afterwards, like with my philosophy text. This limits me, there’s no doubt, because I still cannot keep up with others who can consume pages and/or chapters of a textbook or novel at one sitting, something I need to do if I take a course again. Maybe if I’d been able to afford 120 hours, I could have progressed to reading a whole chapter under their guidance before being out on my own . . .

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I will be re-evaluated in a week. But whatever the results, I know experientially, and my health care professionals have observed, I have improved dramatically. I have regained in eight weeks what I was unable to in 18 years using standard medical care or electrophysiological care for brain injury.

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Eliminativism, Visualizing and Verbalizing, and The Right Decision

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Blue brain illustration Eliminativism is one of those Philosophy of Mind pseudo-intellectual theories that makes no sense and was part of the Oxford short course I took back in 2012 when experimental gamma-brainwave enhancement had lead to a sudden intellectual uptick in me. The reading for the course slayed me, demanding naps after 20-minute sessions with the material. I used the reading session of my audiovisual entrainment device to concentrate my mind and so help me learn and remember better. I used reading rehab strategies like covering off the text I wasn’t reading and writing notes in my iPad. Yet the concepts I could discuss well enough in the short term with continual rereading vamoosed quickly and new vocabulary eluded me, demanding I keep on pressing Select/Look Up on my iPad to refresh my memory every few seconds while reading or writing for the course.

Philosophy of Mind floated my boat but reading and learning it drowned my neurons. I had to give it up.

Until now.

I spent about half of the last 20 hours of Visualizing and Verbalizing instruction with Lindamood-Bell Australia on reading a novel I gave up reading over 15 years ago or so and the other half on some of that Philosophy of Mind course material. I did so well in learning, understanding, and remembering the word and concept “qualia” in the mind-body intro we began with that I forged into the unit on Eliminativism with its convoluted concepts and brain-breaking vocabulary. I spent a lot of the session time developing imagery — not easy for abstract ideas nor ideas that make no sense. Being able to discuss imagery ideas helped enormously. As we read, I improved on or outright changed the imagery for concepts like “folk psychology” that had simply pinged off my brain in 2012.

That was about one week ago although it felt like two weeks!

Yesterday my neurodoc tested my recall of Eliminativism. (I mistakenly told him it had been two weeks since I’d read it. Better correct that!)

I got nothing. No picture. No ideas. No memory.

Great, all that work and zero recall. My heart beat faster. I landed in a funk for about a second.

Then the edge of an image crept in: Thoughts are language. Another fuller image: A thought is a statement. A third: Churchland, the philosopher who espoused the theory of Eliminativism. More and more pictures stumbled into my consciousness. Suddenly my picture for “folk psychology” was front and centre. That phrase that my 2012 brain could not grasp, that I had at last truly understood last week, was still solid once the picture for it returned to my mind. I described the picture, explained Churchland’s idea of folk psychology.

Holy cow, I remembered Eliminativism! I remembered a good chunk of this ridiculous theory because I remembered the imagery I’d created using Lindamood-Bell’s Visualizing and Verbalizing process!!

My neurodoc said my retention was very good. Yes, it had been hard pulling those pictures up, but he continued to be amazed at how well I’m reading and remembering what I’ve read and learnt, the novel and philosophy both. This is validation I made the right decision. Phew.

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Last Week Visualizing and Verbalizing with Lindamood-Bell

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Visualizing and verbalizing progress report for 24 August 2018My final week. Hard to believe the Lindamood-Bell Visualizing and Verbalizing program is almost over; in three weeks or so, it’ll be re-evaluation time. We’ll see, objectively, how much my reading comprehension has improved . . . if it has. Hopefully the tests will show I’ve improved and it’s not all a feeling!

Today, I read one page of a novel on my own for the first time in eons, using Lindamood-Bell’s Visualizing and Verbalizing method. It’s a bit strange asking yourself to give yourself a word summary of the novel page you just read, then tell yourself, “Now give the main idea and a couple of your strongest pictures, too, please.” But the latter especially helped me develop my mental imagery, for I was not as disciplined in creating imagery as I am during my sessions.

The pages of the trade paperback I’m reading are fairly long, so it astounds me that reading a page out loud while trying to create imagery took me only two minutes. And another six to do the word summary, main idea, and pictures. It’s difficult to ascertain if I captured the main idea OK; in session I usually can tell if I’m being a bit wordy, not so much if I miss key points.

Unlike previous Sundays, there wasn’t a huge jump in my abilities. Instead, subtle changes like remembering the plethora of foreign-sounding names in The Lions of Al-Rassan easier; creating imagery for philosophical concepts in real time instead of through extensive discussion; being able to recap the novel to date more succinctly. It’s amazing to me that in my recap all the confusing flashbacks and internal observations and memories that Jehane peppers her narration with turned into an easily articulated picture of the society she lives in and the lessons she learned.

Since my brain injury over eighteen years ago, I’ve been unable to read books. Building up the big picture, remembering character names, keeping track of plot points, predicting what will come next in a novel, all eluded me. When Lindamood-Bell told me that they can restore my book reading, I was hopeful yet skeptical as to how that was possible in only 80 hours of instruction. After reading twenty-five pages of The Lions of Al-Rassan, I am doing all of that. I am beginning to engage with the story. I can hardly grasp this change!

Six years ago, I exerted great effort to comprehend the Philosophy of Mind course notes as I read them. I was unable to acquire new vocabulary. Last week and today, using Lindamood-Bell’s Visualizing and Verbalizing techniques, I am acquiring new vocabulary with effort but retaining the new words and phrases. I am not struggling to understand the concepts; I’m grasping them fairly quickly.

Reading comprehension matters. It matters to enjoyment of books. It matters to understanding new concepts and ideas. No “cognitive therapy” strategy improves reading comprehension after brain injury, no matter what the medical experts claim. In seven weeks, Visualizing and Verbalizing has done more to improve my reading comprehension than anything and everything else I’ve done. The question is: will I retain this new skill? Only time will tell.

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Application of Visualizing and Verbalizing Begins to Improve Reading Comprehension After Brain Injury

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Visualizing and Verbalizing progress report for 17 August 2018We’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!

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Leaping Levels in Visualizing and Verbalizing with Lindamood-Bell

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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!

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Paragraph by Paragraph vs Whole Page when Visualizing and Verbalizing

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Interesting note here about the formatting of the reading materials Lindamood-Bell uses in its Visualizing and Verbalizing program. When I’ve read Paragraph by Paragraph stories up to tonight, they’ve looked like paragraphs online — no tab indents and line spaces in between. The Whole Page the Associate Director had me read out last night to test how I would do with reading a whole page at once looked like paragraphs you’d see in books — tab indents and no line spaces. Tonight we read Paragraph by Paragraph stories, but they were formatted like the Whole Page story I read last night. That’s because these grade level 9 stories we can read one paragraph at a time or the whole story all at once (their choice? my choice? not sure yet).

The other thing is that we can also read them similarly to the way I read Multiple Sentences a few weeks back. When the paragraphs are short, we can combine two of them as if they are one: I put down one coloured felt square onto my desk and read two short paragraphs, then the story is taken out of my sight, and I give a word summary based on the pictures I formed. Repeat for the next paragraph if it’s a longer one or next two paragraphs if short. I suppose this is a way of easing me into reading a Whole Page. Start with reading a paragraph or two using material formatted the same way as a Whole Page story, then when I go on to reading a Whole Page, my eyes and perception are used to seeing book-like formatting so that my brain can forget about processing the formatting and focus solely on the language (written text) and creating imagery.