The Catch 22 of Acquired Brain Injury

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Catapult

I attended an ABI (Acquired Brain Injury) workshop, and support group recently. It was new experience. It left me musing about a number of things.

Even though no two brain injuries are the same there are some common elements. Memory loss and the loss of ability to problem solve seems to be most prevalent. Loss in the area of executive functioning is a close third. The challenges surrounding these three skills can be very frustrating. Frustrating because these are some of the key skills most needed in adjusting to a post injury life. The ability to figure out, implement and remember the changes that are needed is a key part of developing a quality of life post injury.

It’s the skills or abilities that are lost due to brain injury that are most in demand to regain a reasonable quality of life.

Memory challenges

With the loss of memory, learning to live with a post injury reality has numerous challenges. Making new procedures part of a daily or weekly routine are hard to adopt on a consistent basis. Additional demands are placed on ones memory, whether it’s dealing with additional appointments, remembering what activities to avoid or minimize, dealing with agencies such as insurance or other injury support agencies.

The need to problem solve is a skill that is in higher demand post injury. Learning how to accomplish tasks or daily activities with reduced mobility or much reduced level of energy. The reduced energy if often from loss of energy due to neural fatigue.

Strategies to the rescue

Learning new routines can be difficult. Learning new strategies to help remember new routines results in changing one’s life at two different levels of functioning.

Over the past 4 years I have gotten used to receiving two kinds of reminders. One type of reminder is getting a prompt that it’s the time of the day that I need to do a particular activity or head out to an event.

The second type of reminder is getting a prompt about the strategy that I should be using. For example, I recently had my family doctor complete a medical examination for renewing my driver’s license. Because of the residual effects of my injury my completed form does not go through the normal route that I have done for several decades. As I left the doctor’s office he reminded me to read the instructions to ensure the form was sent to the correct place. It hadn’t crossed my mind to check the instructions till he pointed that out. On top of that I was surprised that I hadn’t thought of it myself.

That is just one example of how the deficits I am dealing from my injury requires new strategies in order to compensate for my injuries. I have had to apply this to various areas for which I continue to take responsibility.

To make sure bills get paid on time I take the bill as soon as it arrives and open my online banking app.   I will then post date the payment so that I don’t have to remind myself and risk a late payment charge. However, applying this strategy on a consistent basis continues to be a challenge.

Executive Functioning challenges

Some tasks I find too complicated to take on myself. The most challenging one is getting reimbursement for expenses covered by more than one insurance company. Prior to my injury all my medical expenses were reimbursed through my work place insurance plan. Great. So simple.

With my injury I had the unfortunate challenge of having to deal with a two step process. I needed to first submit my expenses to my work place insurance and then to the auto insurance. It’s keeping track of the different steps along with the delay between submitting receipts to the first insurance company before I can submit to the second insurance company that things go awry. When I was at my lowest level of personal functioning that’s when I had too many of these. I finally resorted to having someone else take care of it for me.

Problem Solving challenges

Once I had recovered sufficiently from my injury to take on some projects I quickly realized that I had issues with problem solving. The problem solving issues appeared in two different formats.

  • Undoing mistakes

As I was building things I found myself forgetting some of the techniques I had learned over the years. This was frustrating as I was used to going ahead with projects knowing how to do it and expecting to be reasonably successful. The errors of cutting materials incorrectly and having to redo different steps in a project was disappointing and at times frustrating, not to mention wasting good material. Also, errors in the early stage of a project required some heavy duty problem solving to correct the situation. Needless to say, neural fatigue would set in rather quickly with that type of cognitive demand.

  • Planning

In order to successfully do the types of projects I had been familiar with, I realized that I needed to be intentional about the planning stage. It was no longer good enough to have a general overview of what I wanted to do. I now needed to plan each step and have a clear picture of how each stage of the project should unfold.

20190427_093247Recently while building props for a Medieval birthday party for my grandson I was very intentional about doing it right. I took on the challenge of building a functional catapult for attacking a castle. Every time I needed to think through a particular detail I would put the work aside and work on a different part of the party preparations. That gave me time to mull it over.

It might appear easier if I had downloaded an instruction booklet and buildt the catapult based on someone else drawings. I considered doing it that way, but that would have added a very different challenge, one of following someone else instructions. That would have contributed more quickly to neural fatigue. I chose to build my design and incorporate the materials I had on hand.

The last step in building the catapult, getting the tension tight enough was a two person operation. In the end I was able to make the catapult work reasonably well. In addition to that I was able to complete the castle, eight feet high and twelve feet wide to add an element of realism.

On the day of the party each guest was given a wooden sword, which my grandson had painted, and a wooden shield to decorate, which my son had made. This was greater than any ‘loot bag’ they might have gotten at a birthday party.

Being Intentional

With building the medieval props I knew I had only one week. I was mindful to carefully pacing myself, having my grandson or son complete some of the things I had committed to but couldn’t manage to complete before the deadline.

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Memorable castle under attack

Had I not planned and paced myself I might not have completed the props I had agreed to make. I also might not have been in a condition to enjoy the party. It’s so easy to fall into pre-injury pattern of doing things in the excitement of getting things ready for a exciting event. That would have been to my detriment.

Midway through the party I stepped away and crashed. I was helping the kids with the catapult. Dealing with groups of four or five kids and their energy level quickly drained my energy. When my part of done I walked away and crashed. I slept for an hour and  a half. Success for me was contributing in a significant way to a memorable event for my grandson and the fond memories for myself of being part of the event.

Needing a day or two for recovery time following the event was not a hardship. It left me with a sense of wanting to take on something like that again… though not for a month or so.

P.S. If you live within traveling distance you are welcome to borrow the castle and catapult. You need a 16 X 16 foot (4.8 m X 4.8 m) area to set up the castle plus room to attack the castle.

 

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Stumbling onto a Living Assist

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The Shine of a New Vehicle

I have been learning to live with an ABI (acquired brain injury) as a result of a motor vehicle collision. The journey of recovery started a little over 4 years ago.

Initially, one of the key challenges was driving or simply being a passenger in a motor vehicle. I eventually was diagnosed with PTSD symptomology related the collision. Being in a car for a period of time would put me into sensory overload. It wasn’t that I was hesitant to get into a car. It was the toll the low level stress or anxiety that would build each time a vehicle would approach. The bigger the vehicle the greater the effect. Whether I’m the passenger or the driver the results would be similar. Being on a divided highway helped to mitigate some of the effects.

Initially I could not tolerate any trip  over 30 km. Gradually I could manage longer trips by taking a break every 100 km. It meant having to plan each trip carefully. Not to mention that taking trips took much longer than pre-accident.

Noting Progress

Gradually the out of town weekend trips to family became less demanding. In the first couple years I would spend two to four days to recover. I would be reasonably recovered in time for the trip home. Gradually I would not need as long a recovery time once I reached my destination. At times, if the weather cooperated I would complete the last part of a trip by biking the last part of the trip. The invigorating exercise of biking the last 40 or 50 km would reset my body by clearing enough of the stress build up to allow me to visit rather than taking a nap as soon as I arrived. (Needless to say the biking strategy doesn’t work too well in the winter months.)

I have also done some solo out of town trips by car. I would work out an alternate plan if I could not complete the trip. One time I under estimated my level of endurance without having set up an alternate plan. I had to arrange for someone to come and get me as I was unable to drive home.

Some More Progress

A little over a year ago I did a number of longer trips with very encouraging results. I was still taking a break every 100 km or so but was arriving at my destination with much less sensory loading. This was very encouraging. I did not notice the change at first. Then again  I’ve learned to expect the unexpected. Sometimes a challenging situation goes unexpectedly well. Other times it goes in the opposite direction.

A Noticeable Improvement

About a year ago I did a trip with a few brief stops, and then joined other family members for a restaurant meal. (Restaurants, even if they are not busy at the time, have their challenges for me, particularly the ordering process. Too many choices and then trying to focus while a waitress recites the specials for the day.)

Later that day it dawned on me that the combination of the drive and the restaurant experience had resulted in minimal neural fatigue. That prompted me to take a look at what had changed in my environment. I realized the biggest change had been in my driving environment. The trip to our family usually involves driving through a metropolitan area of over 6 million people, which had also been the case on this particular day.

Driving Assists

The more that is at stake the greater the fatigue. When it comes to driving one does not want to make an error. The consequences could be life altering. So the need to remain focused while driving is paramount.

With the new car we purchased about a year ago, it included a feature called pre-collision. When the cruise control is activated the pre-collision feature can also be engaged. With the pre-collision engaged the car automatically adjusts to the flow of traffic. Driving in stop and go traffic is very effectively handled by the car.

Without the pre-collision there are just too many things to stay focused on.  Watching for  the vehicle ahead of me. Responding with the right amount of braking and acceleration to maintain a safe gap. In stop and go traffic this can quickly become too demanding. (There is a reason why a high percentage of collisions happen each day during the morning and evening  commute.) With the pre-collision I still need to keep a close eye on things, particularly watching out for vehicles that suddenly cut in front of me. The pre-collision system doesn’t respond quick enough when someone cuts too close in front of me.

The pre-collision removes one of the biggest components that causes me neural fatigue while driving, the constant need to remain focused. At the same time it reduces the risk of an accident. This reduced risk was borne out by the car insurance quotes I received when I took delivery of the new car.

A Safer Car

The car we took off the road was a 15 year old Elantra without collision coverage. We insured a brand new car with the same coverage plus collision. The cost was a couple of dollars cheaper to insure the new car. (All other factors such as geographic area, claims record, number of demerit points etc were unchanged.) I was pleasantly surprised because I had definitely expected to pay a slightly higher premium.

If the question was put to me, “Are you a proponent of ‘self driving’ cars?” my answer would be a clear “no”. I think there are issues when choices are taken away from the driver due to automation. (Think of the Boeing 737 Max 8.)

The driving assist that was a standard part of our new car purchase has improved my quality of life. A benefit that I had never considered but have warmly welcomed.

Invitation or Inclusivity

 

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Alderville First Nations War Monument Restored in 2011

As citizens of Canada, where do we stand when it comes to acknowledging the indigenous peoples of Canada? As a nation we have gone through the healing process with the Truth and Reconcilliation Commission of Canada, having completed stage one of it’s work and having put forth 94 Calls to Action.

How will the Calls to Action change the general mindset of the average Canadian towards the indigenous peoples of Canada. The actions of government leaders often fall short of taking the 94 Calls to Action seriously.

Recalling a personal discussion

I spoke with an electrician who was transplanted to Fort MacMurray every two weeks. I asked him whether any aboriginal workers were part of the labour force with the Tar Sands project in northern Alberta. He told me that part of the contract is to have aboriginal workers make up ten percent of the work force. When I asked him if that was a reality he confirmed it.

He then went on to explain that while ten percent of the labour force is aboriginal, in his experience they were on the payroll but weren’t expected to work. In other words they were hired, got their pay cheque but they weren’t expected to be integrated into the work force.

The letter of the  contract had been met, but in reality it was a sham. I guess with the high profits it was not considered a hardship for the company to have ten percent of the workforce add zero percent to the productivity.

Moving to a public discussion

I was reminded of the above discussion during an interview on CBC January 21, 2019, The Next Chapter, with David Johnston former Governor General of Canada. Johnston made a distinction between inviting someone to the dance or dancing with someone at the party. The one is an invitation while the other is inclusivity.

It is only through inclusivity that we begin to understand another person. Given the enormous challenges that Canada’s indigenous people have faced due to colonialism, it is not enough for indigenous people to be invited to join the work force when contracts are set up. They need to be engaged, they need to enjoy a sense of inclusivity.

Taking personal steps

I realize I am looking at this from a distance, living three provinces away from Alberta. Though I live within 20 km of the Alderville First Nations, a local indigenous community where I occasionally buy cheaper gasoline. That hardly counts for interacting with my indigenous neighbours.

How do we develop and sense of inclusivity with our indigenous neighbours? What colonial attitudes are biasing our view of indigenous people? What colonial residue underlies our comments and attitudes?

The Truth and Reconciliation Commission issued a clear statement. Without a willingness to developing inclusivity we will simply perpetuate the colonial mindset and issue apologies as needed.

The promise of reconciliation, which seemed so imminent back in 2008 when the prime minister, on behalf of all Canadians, apologized to Survivors, has faded. (Truth and Reconciliation Commission Volume 6 pg 11)

Every new law or  policy that the federal and provincial governments of Canada introduce should move one step closer to a working relationship grounded in reconciliation. As Reverend Stan McCay of the United Church of Canada, himself a ‘survivor’ has stated, both perpetrators and survivors need healing. That healing can only happen in a posturing of humility and search for understanding.

Aboriginal and non-Aboriginal people of Canada each carry their own responsibility to work towards reconciliation. How do we most effectively do that? What does that mean for me?