Brain Health

Neurodoc Chronicles: Reading Rehab and Unheard Brain Injury Grief

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I emailed my neurodoc a long time ago a tweet about what reading means to me. He’d repeatedly said my emails were important; he understood they were my way of communicating what I needed to talk about during our sessions. He printed, signed, filed it. And he wonders why he isn’t succeeding with me.


As far as my neurodoc seems concerned, drugs and the DSM are the only answers. Using newer communication methods is, well, he’s not going to do it. Learning about 21st-century discoveries of the brain and brain injury aren’t actually to be acted upon. Working in a Toronto teaching hospital, one can’t be too forward thinking, y’know. After all his ABI expert colleague didn’t want to burden his brain with 20+-year-old knowledge of thermoregulation. Better to tell the patient to get on with their life than help them. But I digress.

Let me help my neurodoc figure out what to do.

He could’ve printed out that poster. At our session immediately following me sending that email, he could’ve shown me the poster and read it out to me then asked: “Tell me how you feel or what you’re thinking as I read that out to you?” I probably would’ve bumbled around or resented being asked how I feel since half the time back then I had no clue. So then he could’ve brought up each pictogram, maybe mused about what he thought, and drawn me into a discussion. That at least would’ve started my thinking. It would’ve brought up memories. And memories would’ve dragged up emotions and the grief — over time. Doing that only for one session would’ve stopped the process of my broken brain remembering, reconnecting memories to emotions, processing the grief. Sticking to that topic over the next few sessions would’ve continued that process. But, y’know, email.

My futile attempt at communicating some deep, hidden-to-my-conscious mind emotion I could barely talk about all began with an email. And since the Ontario government won’t pay for emails and Canadian physicians think emails are the devil’s work or way too innovative or something like that, my grief over losing my reading went unheard. This was one of many attempts I made to get reading rehab going, to have my grief over losing the core of my identity being heard. Telling him that being a reader who inhaled books like opium — well, that went unheard, ignored, dismissed, shut down, year in and year out while I dragged him like a dead weight to help me rehab my reading, one agonizing step at a time, with rising hope as I glacially made progress only for him to “forget” the rehab, forcing me to remind, nag, beg to resume again. I’ve put my neurodoc on hiatus. The emotional cost of reading rehab is no longer worth it.

Brain Power

Reading Rehab: Big Picture Begins to Return

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River in Kluane National Park between mountainsLast Monday brought a surprise — in the neverending river of reading rehab, I connected the elements in a chart in the book I was reading with my mother to the succeeding paragraphs. I could see automatically how they connected. Maybe this uptick in reading cognition happened because this is my fifth time reading this book — the second time reading it out loud with another person — but it’s probably also the reason I felt so nauseated last week. Any time I feel nausea and/or dizzy all the time, it’s usually because my brain is making those final neuronal connections (as I see it) to give me back what injury took and produce a sudden leap forward. I never know what the improvement will be until about a week later.

I can’t believe it’s in my reading!

I can’t believe it’s in the stubborn-no-I-won’t-see-the-big-picture area! To see automatically how one chapter flowed out of the previous, how sections tied in together on Monday was . . .

Whoa.

Previously it was either a conscious effort to see it or I just saw sections and chapters as silos, knowing they were connected but unable to see it. This deficit didn’t affect my recall. Instead, it created anxiety over the effort of reading, of perceiving “how does this all tie together‽”, the big picture of it all.

The big picture has always eluded me. I may sound like I see it when I recall what we’ve just read or recall the chapters read so far, in my reading work with my neurodoc, but what I see in my mind, how I understand the book is not as a whole unit, but rather as a series of silos or silos co-existing.

Or to put it another way, imagine building a little lego village. You place a brick on the flat green pad. Then another brick next to it. And another. Pretty soon you have a wall, then a house, then another building. And a tree. As you click in each lego piece, you see all of what you’re building and you can see it growing into a little village. That’s the big picture. Now imagine you can’t see the whole. You can only see part of the first building. Then that fades away as you see the tree you clicked in last. How can you see the village you created if all you can see are the south wall of the first house or the top of the tree or the roof of another building, in succession but not altogether?

Monday, those silos of views connected to each other. Awesome.

Unfortunately, being overwhelmed by events interferes with all my cognitions, especially new improvements like this one. So bit of a setback this week, but that should be temporary.

In a related area and in the weirdness department, that same Monday, I gained energy as I read out loud the last two paragraphs of the two pages we were reading. Gained? Gained‽ Reading makes me feel better but always fatigues me. How did I gain energy‽!!! Was that just a weird blip or a real improvement 18 years, two months, and five days after the crash that obliterated my novel reading like it was so much sand in the wind. I can’t recall how I felt after reading a book in my pre-injury life, it was so long ago now. I only recall disappearing into and becoming one with the world of a mystery novel and surfacing a couple of hours later, wondering where I was. Did I have more energy? Did I feel rested and re-energized afterward to go back to work? My mother tells me I was always full of energy. Hard to believe after almost two decades of unrelenting fatigue and eighteen years of having that reading in flow, reading to escape, reading to re-energize, taken from me. If this is the first spark that it might actually be returning, I know from past experience that it’s just a spark at this moment. Things like this work like a short circuit: old skill/ability sparks on, hope rises, improvement vanishes, hold on to hope, wait and wait, another spark, hold breath that it’ll stay, release as it doesn’t, another spark and one that lasts longer, and so it goes until at last the short circuit is a whole circuit once again.

But this weird 180 of my reading from injured ability to maybe my old normal is so tied in to the grief of my loss, I dare not hope. Yet there it beats like soft feathery wings deep inside me.

Brain Power

Screwtape Teaches Us a Lesson about Reading Rehab

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Tunnel to the light.

Reading rehab continues. Because people were asleep at the switch when I hit the emotional wall with my impaired reading so that I could no longer read books on my own and because things went rather south with my neurodoc, he’s pulled out the stops and is reading with me most days. Brains really do support brains. When you have a brain injury, you can feel the alleviation of effort when doing a cognitive task with another as opposed to on your own. They not only support you emotionally when they’re encouraging and keeping you on task, but also their neurons are like scaffolds that hold up and activate your own.

This extends to the concept of conversation. Reading rehab can simply be reading and immediate recall, or it can include the give and flow of discussion. Discussion is the human way to express what’s in your mind, hear what’s in the other’s. It leads to clarity and understanding of the text, which straight reading and recall cannot do.

I noticed when reading Don’t Forgive Too Soon that the sections we didn’t discuss were much harder for me to remember later during weekly testing of my long-term recall. I also noticed that it was easier for me to remember those chapters I’d reread with my mother, again especially if we’d discussed them a bit. (I’m reading then rereading text to see if double reading within a relatively short period of time leads to better cognitive processing, remembering, learning. So far, I would say it does.)

But adding discussion was sort of ad hoc.

Just before the holidays, we began reading The Screwtape Letters by C.S. Lewis, which I’d read in my injured way many years ago. I remembered only the basics: Screwtape writes to his young relative about getting a human into Satan’s house. Something about the war. And something about the church. That was the sum total of my memory. Oh, and I enjoy Lewis’s writing.

So my neurodoc and I launched into it in the same way as we’d read Don’t Forgive Too Soon. I had no trouble with immediate recall. He also noted my abstract comprehension was improving. But he forgot to get me to do weekly long-term recall until I reminded him. That’s when I fell flat on my face. Although we’d been reading a couple of paragraphs daily, I couldn’t remember much of the concepts or the story, and we’d read only four short chapters! Not exactly a huge memory task. I also saw in my mind each chapter as a silo. I had no idea while we were reading how each chapter connected to the next, except that Uncle Screwtape was advising Wormwood on his latest issue and the human was a man converting to Christianity and was called “the patient.”

How to get me to see the big picture? How to help me build up the narrative in my mind and retain it so that not only could I see the progression of the story but also what Lewis was teaching?

We started over again at chapter one. We read a paragraph or two. I did a bit of immediate recall as usual. But my neurodoc quickly broke in to launch us into discussion. What was Lewis saying? What did I see? What was the theme that was developing? Sometimes I knew the biblical text being referred to and briefly recollected that. Then we discussed how that tied in.

Before we began reading chapter two, my neurodoc restated the theme of chapter one. When we examined the theme or issue in the first two paragraphs of chapter two, we discussed how they related to chapter one’s theme.

Suddenly I saw how chapter one flowed into chapter two. And I began to see the plot progression and the beginnings of the big picture. Phew!

So now at the end of each chapter, I say what I saw as its theme or issue. Then at the next reading session, before we begin reading the next chapter, I relate the themes and how each chapter flows one into the next starting with chapter one and ending with the chapter we’ve just finished. Needless to say, I have to remind my neurodoc that’s what we agreed on and to stick with the program. Sigh.

As we progress through the book, it’s getting harder and harder; yet this method is letting me see the characters, be aware of the plot not just vaguely the concepts, understand more and better what Lewis is saying.

I could not do this on my own. It takes too much effort to initiate; it’s a tremendous amount of cognitive work to do on one’s own; you need another to prompt you or encourage when memory or abstract processing fails; and the discussion part is key. You can’t really discuss something with yourself. I mean, you can, but it’s kind of limited and devoid of the benefits being a social animal gives us.

I need to add this book to my Goodreads so I can track my progress. Oops. (Having another human remind me would be awesome. Oh well.)

Philosophy

Mind Notes: The Blind Spot

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Photo of eyeWhen you have a lot of trouble reading books, that is, seeing the big picture, absorbing details, able to build up the narrative in your memory, learn and retain the learning, etc., etc., studying philosophy of mind gets a little discouraging. Unbelievably exhausting too. Enter videos. When you can’t read, watch!

Video courses may have been set up for normal, busy people who want to learn in their spare time, but they’re a boon for people with disabilities who would like to go to class but cannot due to various limitations. Financial is a big one, too, because the unemployment rate and medical expenses for people with disabilities, especially brain injury, are rather high. Not much left to pay for courses or ways to compensate for one’s limitations.

One of the perks of winning NaNoWriMo was a discount on Great Courses Plus. When I found out they had a series on Philosophy of Mind, I signed up! I began watching the series right away. Brain injury makes everything slow going. I just finished watching lecture 7 of 24 of Mind-Body Philosophy. It’s the second time I’ve watched it. I couldn’t recall this morning the last lecture I’d viewed before Christmas, this one didn’t seem familiar, loaded it, went, oh yeah, I have seen this, but kept watching because I hadn’t understood what the eye had to do with consciousness. This go round I got it . . . I think.

If consciousness is like a picture, then I guess the point of this lecture is that what the eye sees should be the same as what our conscious mind is aware of. It isn’t. Prof. Grim (no, no typo) showed two card tricks you can do with your vision. One is without seeing what it is first, you hold up a playing card way out to the side while looking straight ahead. Now see if you can tell what colour it is. You won’t be able to tell if it’s black or red until you move your arm closer to the front of your visual field. For whatever reason, with both eyes, I can tell much earlier than he could. The right side was more of a blank white with one playing card until I held the card at a particular angle. Perhaps I have more cones in the periphery than normal . . . ???

But it was the other card trick that made me realize something. On a white card draw an ‘x’ and a black dot, about 2 cm apart. Cover the right eye, hold the card up straight ahead with the ‘x’ on the right side of the card, and bring the card slowly toward you keeping your left eye focused on the ‘x.’ At one point the dot will disappear; as you keep bringing it closer the dot will reappear. If you draw lines around and over the dot, the dot will still disappear but the hatching will not.

The current view of philosophy of mind philosophers is that the brain is the mind. If that is so, then why does the dot disappear? It disappears because of the physiology of the eyeball. But the brain can “see” the hatching that is over the dot. In other words, the brain is very, very good at filling in our blind spot. I have personally experienced how good the brain is at approximating depth perception (which I realized only last year when I acquired true depth perception and what the difference is). But if consciousness is the brain, then when I am conscious that there is a dot on the card, my brain should still be able to see the dot. If brain is consciousness and consciousness knows the dot is there and the brain is really good at “filling in” missing info, then the dot should not disappear.

When I took Philosophy of Mind Oxford short course online, I became convinced of the dualist argument. The mind is not the body. The brain is not the mind. This dot test, is one confirmation of that.

Book Reviews

Fish — A Graphic Novel Review

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Fish! With legs!!

FishFish by Peter Kielland
My rating: 3 of 5 stars

I was given Fish as the next step up in my using graphic novels as part of my reading rehab. A traumatic brain injury — a concussion type — had stolen my ability to read books. I remained literate, just couldn’t read. It’s a too-common problem unaddressed by health care professionals who think the band-aid solution is just fine. It’s not. In discussions with a psychology professor, we thought graphic novels may help my ability to see, conceptualize, and follow a plot. Take the text out and maybe my brain can process ideas. The first one worked well, so on to this one!

Uh, well . . .

Fish was bizarre!

I began each weekly reading session, recalling out loud what I’d read so far. I read four, five, or six pages, recalling each page out loud at the end of it. I tried to motivate myself to handwrite a summary at some point during the week. And I struggled to understand what the heck was happening; then as I began to understand the what, I continued to flail at understanding why and what it all meant. It revealed to me (because health care people taking care of my brain aren’t working with me on this, so it’s just me myself and I figuring this whole thing out) that I have trouble building up the picture of a story not because it’s presented in text but because my brain can’t do it, period. This also means I can’t understand concepts that have depth to them. And Fish ain’t a superficial, silly story about a fish with legs that ends up in a city! Each scene means something. The sequence of the scenes is probably important. Being able to not only recall but also to tie the scenes and dream sequences together, to be able to remember a scene from early on and tie it to something much further on in the book, is necessary to “see” the big picture and understand a concept being built up.

But as I worked at reading four pages at a time, then eventually six pages — always reading to the edge of my fatigue — little bits of what the author meant by the dream sequence of Calvary and other scenes began to populate the big blank in my mind, like filling in a jigsaw puzzle. Mid-October, it was still difficult for me to see the point of the story, the story arc, and the plot. But after a break during most of November while I wrote a novel, I returned to it in November’s last weekend and surprised myself by how much I recalled and how I suddenly understood concepts I hadn’t before. Boggled!

Being able to understand the theme somewhat abruptly changed the book in my mind from being a chore I had to slog through to being slightly curious to see what would happen to Fish next.

The following weekend, as I reread the previous four pages I’d read then read the last five pages of the book, much more of that jigsaw puzzle filled in. I still don’t have a solid feeling of the book. It’s like seeing the author’s ideas through blackened glass with pieces cleared here and there, but it’s enough for me to feel pretty good about my reading progress and to sense the author was making some rather pointed comments.

As for the book . . . it’s strange and disturbing. I’m not a fan of that kind of drawing style. I admit that I could have benefitted from discussing it with someone, in the way that using a new word in conversation three times helps one understand and remember the word. Those kinds of discussions as I progressed through the book may have made me appreciate Fish’s story more. But, again, to be honest, the drawing style kind of repelled me. Only as I’ve digested the book, gotten away from seeing the pictures so that the character of Fish emerges stronger, do I feel sorry for Fish while admiring how he reveals the people around him.

View all my reviews

Brain Power

Don’t Read, Watch to Learn!

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Although I did well in the Oxford online short courses on philosophy of mind and metaphysics, the reading just about broke me because my neurons in the reading-related networks were injured, and so little is known about how the brain reads that treatment had been a series of guesses and so not hugely effective. Plus no one in the health professions grasped that a writer needs to be able to read for hours, not a few minutes.

In my book Concussion Is Brain Injury: Treating the Neurons and Me, I write about my ongoing reading rehab adventures and draw up a theoretical program to recover reading.

Since I took the Oxford courses, I no longer need a two-hour nap after reading a newspaper article or couple pages of a book; my abstract processing has improved; my cognitive skills have improved; and my emotions are beginning to connect. But I still cannot read philosophy.

Thank God for the YouTube revolution and NaNoWriMo winner goodie of a discount to The Great Courses Plus. The GCP site has a course on mind-body or philosophy of mind. After getting help to sign up, I’ve happily begun watching Prof. Patrick Grim’s series of half hour video lectures with graphics. OK, I needed a nap after the first one, and I can feel my brain straining to grasp the concepts in the second one even though I’ve studied the Greeks back in high school and studied much of the first two videos in the Oxford Short Course. But it’s still a lot easier than reading!

Brain Power

Returning to the Graphic Novel for Reading Rehab

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It took about a month to recover after the insane CCAC-bureaucratic-rules-of-can-only-get-help-in-4-weeks-tough-shit-if-can't-keep-it-up mandate. Now that I'm feeling more my usual self, I'm sitting up and looking around at life outside of writing and am getting back to reading a graphic novel weekly as part of reading rehab. I set myself a ten-minute goal and multiple alarms so that I will keep it up. I hope! With brain injury, with no human resource help, sustaining a draining cognitive activity is more about failure than success. Alarms and apps help!

I was given Fish by Peter Kielland to read quite awhile ago. Unlike the first graphic novel I read last year, this one has a bit of text, but so far not much, so it is like it's a graphic wordless novel. Strange, primordial tale so far. Four pages, and I was all done in. Almost got to 10 minutes, but if not for that goal, would've happily quit at 8 minutes and three pages as fatigue hit and a concentration headache began. That's reading after brain injury for you, though.

Brain Health

Cogmed Rehab of Brain Injury Working Memory Over!

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Cogmed is over. I’m both really glad and kind of sad, for it’s been five weeks of something different that also makes me feel like I’m regenerating my brain in real time, not the usual let’s wait a couple or more months or years (or decades with traditional rest and strategies) and see if this will work. The usual takes patience and faith!

Leaping into Cogmed took faith too. But not as much patience. And interestingly, it gave me the ability to be patient with my fatigue.

Cogmed is like taking the toughest school test you’ve ever had when you’re at your most tired and trying to stay fully focused while being wise in timing your breaks the entire hour to one and a half hours it takes. First two or three weeks, fatigue got to me. The deep, deep desire to nap would overwhelm any sense and sensibility, and I’d rush through the rest of the exercise then lay my head down till my eyes would open and go on to the next exercise, repeat, until with a heaving sigh of relief, I’d be done. And could go watch an animation movie on Netflix.

But in the last ten or so sessions, I began to notice a change. I no longer absolutely had to sit and watch blankly an animation movie while inhaling chocolate right after my Cogmed session was over. I could maybe put laundry on then go watch any kind of movie. Even better, I began to be able to stick with my method of deep breathing, adjusting my vision to peripheral or eye tracking, focusing right to the very last try in the very last exercise. No more rushing just to get it over with and go watch a movie so I wouldn’t have to think any more. After about session 18, I became more methodical in my rest breaks, having noticed that too-short breaks resulted in not great performance but too long also didn’t work well. My coach mentioned in a couple of our early calls about staying in the rhythm of the exercise and not taking long breaks between tries. That’s difficult when fatigue is pulling down on your eyelids, making your hand jerk the mouse spastically leading to errant clicks, and your brain on an unconscious level is trying to reassert my old vision and narrow my new wider peripheral vision back to my old narrow focus.

So I focused hard on the task, put all my effort in to keeping my eyes open, and tried a quicker method of just taking a sip of water in between tries during the Rotating Wheel of Joy exercise. That worked. Then from Day 17 or 18 to Day 22, I expanded that method gradually to the grid exercises and then the number exercises. I had felt that methodical with breaks worked better for the latter; also the patterns of numbers bled from one try into the next if the break was too short.

But on Day 22, I went for it: I stayed in the rhythm of every exercise, at most sipped some ice water, only stretched my neck and shoulders to wake me up and stick my face in the feeble sunlight in between exercises and only rested for 10 minutes between the first set of four exercises and second set.

Unbelievably it worked! My daily index and Max Index both shot up.

It definitely wouldn’t have worked in weeks one and two, even in weeks three and four because I didn’t have the mental stamina.

Fatigue makes one hit the proverbial runner’s wall: you can’t see or think never mind remember anymore or remember so slowly it’s like watching molasses ooze down a glacier’s side as your memory finally comes into view so that you know what to click. You need confidence the memory will come into consciousness eventually and the patience to wait.

Somehow this intensive memory training has improved my stamina so that by the middle of the last eight sessions, I could stick to my method to the end, work quicker, and improve my performance — and all without my head hitting the desk in a dreadfully needed mini-nap time.

The number exercises are my absolute best ones. Grid ones and most movement ones are in between. My absolute worst are Twist and 3D Grid of Doom. My vision and eye tracking are the reason I do poorly. And too late I realized my depth perception being so new and my brain trying to shut it back down again is why I haven’t improved at all in the 3D Grid, the only one I haven’t improved even a little bit. Even Twist has improved a tiny bit — that’s with most of the time the patterns I’m holding in visual memory disappearing the moment the 4×4 grid twists back 90 degrees before I have to click the sequence I saw lit up.

Having tried Cogmed on both the iPad and the computer, I’d say that the computer with its bigger and thus more challenging display is better to work my peripheral field and eye tracking. I think working on the iPad helped me understand the exercise and train the eyes to know what to do. But after that, though much harder, the computer display is better at training peripheral vision and eye tracking and thus improving and retaining the improvements, like my head staying straight and my weak eye continuing to work with my stronger eye.

One of the best parts of Cogmed is that I had absolute control. The problem with brain injury rehab is that you depend on others to make it work. The person you depend on has all the control, even when they claim you’re trying to hold onto control (ie, when you demand, beg, ask for, fight for more help) and they claim being controlling is your issue. You’re screwed if they don’t feel like it, it’s not within their regular practice, it’s not how they operate, they only have time for some of what you need, they prefer to refer you to someone else — which entails waiting months or years never mind more hours in the waiting room because hey you don’t work anyway so your time ain’t worth much — they cut you off as you’re improving but before you’re stable. There’s nothing you can do but accept the inadequate help and hope you can live within brain injury hell under the cover of gratitude and a positive vibe without going insane.

But with Cogmed you have all the control. You do as well or as poorly as you want within the limits of your own neuroplasticity.

No one can let you down.

So rare, so empowering, so uplifting when you begin each session reminding yourself that this rehab is yours, all yours, and no one can let you down or undermine your efforts.

Improvements I’ve seen so far:

Reading speed quicker.

Reading length longer.

Short-term ie immediate recall of what I just read or someone read to me increased, richer depth of detail, quicker and for longer to speak it out.

Perhaps better long-term recall — this has been tested only once in a clinical setting. It was good.

Intonation of reading is up: I don’t read in a monotone anymore. I even put in a character’s tone in dialogue after Day 22 of Cogmed.

Walking is quicker; after 20 sessions, it’s normal in all areas I’m familiar with unless people suddenly rush past me or a group is wandering (how my brain perceives others walking) towards me. My eye surgeon advised me that the last part of my visual system to adapt will be motion:
Me moving while others and objects are also moving. Sometimes it feels like I’m on some psychotic tilting sidewalk trying to navigate people. Anywho . . .

Better stamina for cognitive work.

Starting to be confident of my cognitive skills because my memory of what I read is much more reliable.

My coach was sick so I have yet to have a final call with her. But the program told me that:

My working memory is up 57%.

My ability to follow instructions is up 24%.

And my math performance is up 1%.

Why is math barely improved when my affinity for numbers means those exercises just keep on going from one level to the next? Processing speed, peripheral vision, and fatigue. I can feel my neurons slowing down, the answers being held behind a viscous wall through which I’m pulling and pulling until they finally pop out while my peripheral vision narrows and narrows so I have to eye track every number in the equation and in the answers next to the arrow keys so that I know which key to press. And fatigue drags down my ability to keep at it. It’s the same issue I have when trying to calculate the tip on a restaurant bill for my mother. What I once could do in my head and rapidly too, now is arduous. After a year or so being completely unable to do it after my brain injury, I lost all confidence so that I wanted to avoid it. My mother’s math ability is worse than my injured one, so she won’t let me avoid it. Still, I usually throw out a guess instead of methodically doing it even in the last week of Cogmed. I guess patience through fatigue and slow processing hasn’t translated to math in the real world yet.

Cogmed and the ADD Centre say that improvements continue for the next six months. That’s why there’ll be a final assessment around June. Also, I will be taking the option of 100 maintenance mini sessions. I also have three regular sessions as make up ones for where I encountered technical snafus because of my hand jerking or finger double tapping on the iPad (the software should recognize and ignore tic-like double taps). They do warn tics can increase. And they did, but then in the last week, they decreased!

Whatever happens in my life, this accomplishment can’t be taken from me.

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!