After the Accident - Early Years

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After the Accident, Hospitals and Rehabilitation Homes, I went to living at Nursing Homes and I needed to move each month because that was the “Rule” of the then, Labor Government. My life was quite different. I was now seeing life from the other side of the fence and how normal people viewed people who had disabilities or who were in a wheelchair (the world would be quite different if they only knew what we were going through every day). Therefore, I had to re-acquaint myself with this new world and I knew this would be one of my biggest challenges. All I wanted to do was go home and get out of all that day to-day routine living. If I was in the Army I wouldn't have any problem fitting in to a specific way of life. I felt so regimented in the way my life had been controlled over the past several years since my accident and all I wanted to do was start another type of life, outside of institutional living, and try with as little help as possible to see how I would manage, but when that occurred I discovered the true meaning of the word 'disabled'.

I started living with my mother, who had supported me greatly through my time since the accident, with some help from my brothers and sisters. (I feel that family input really helps the person neurologically - just simple things like remembering things that they had been through eg: people they remembered, places they had been and things they had done are just a few). Anyway, I stayed with my Mum for a while and she helped me immensely. We had a nurse come in to help in the morning - just getting me up and dressed was a long involved task at the start of a day and I was still having trouble with doing that independently. Living in a unit has its limits especially trying to get a commode (shower chair on wheels) into the very tight space in a small bathroom. After quite a while I found I was spending too much time at home so I started going to my sisters or brothers places. The time had come where I had to decide what I was going to do besides look at four walls so I bought myself a Computer (Apple of course). Right from the word go, I virtually fell in love working with computers and up to this day I still regard the computer as a part of life - I mean, where would I be without it. 

As time went on, living with my mother became a bit difficult for both of us so I bought a one level house in another suburb of Sydney and I would have Home Care in the morning and most of the time in the evening but this became a bit expensive so I hired a person for both morning and evening shifts which worked out much better. I did enjoy this style of living, to a degree, although there were things I just couldn't do or handle. I had only been there a year or so and I realized that trying to live like this was not really working for me - so I sold the house and moved back home. I went back with my mother until my sister and her husband moved out of the second unit our family owned just down the hall from my Mum and I eventually moved into that which gave my mother peace of mind that I was close by and she could assist me whenever necessary and yet it still gave her the freedom she needed and deserved.

I had my unit partly fitted out with a few items that would help me get by. I already had an electric bed for raising me up into an eating or watching T.V. position, there was a bar on the right hand side and a larger bar on the left to help get out of bed, the only other bar was in the toilet/bathroom which was there to help with toilet duties. 

After becoming established in the Unit I had more freedom, as did my mother. I spent more time doing things at my computer (even did a Small Business Management TAFE course from home). I went out more with family and a few faithful friends and when I say 'friends' they were the friends that you could really call friends as a lot of the people that I THOUGHT were my friends had given me the flick after the accident & seeing me in a wheelchair. Seems like some people couldn’t deal with the changes that had happened to me – and I’ve since learned that this is very common. People want the ‘former friend’ back and they can’t adjust to the ‘changed friend’ so they disappear from your life.  Without my family this could have been a very lonely few years for me having lost so many close friends.  I also did three trips overseas to the U.S. in the chair and three to Port Douglas, Queensland. Every time I flew overseas the only problem was pointing out why and what all my tablets were for which I suppose the Customs people were just doing the correct thing in asking those questions as my luggage did resemble a mobile Chemist Store. At that time the medication I was on was Tegretol, Rivotril, Epilim four times a day but every now and then I would need to take some Valium just to settle the nerves. On only one of the flights overseas I was made to wear a catheter which I didn't enjoy. I didn't actually wear it but simply strapped it on my leg with the bag at the bottom just in case they checked and that was the luckiest thing that I did on that flight as when we asked for a drinking straw they didn't have any so I had to take the catheter off to use as a straw (the things we will do just to quench our thirst)!! All of the trips overseas came with small hurdles to cross especially getting into the American cars as the front door was smaller than what I was accustomed to but the majority of difficulties we were able to overcome simply by being resourceful and working through a situation.  I discovered that travel, while not easy, is a tremendous thing to aim for even when reliant on a wheelchair because you forget about yourself and focus on learning so many new things – travel is really educational as well as very enjoyable with so many interesting things to see and do in our world.

The next part of my life was the start of a new era. I had met a young lady, Diane, whom I admired a lot. Her family were quite nice, although a bit nutty at times - at least you might say that after you met the father in the gutter (he was actually weeding the lawn but it looked like he was just sitting in the gutter) or the mother (with curlers in her hair) or the hard working brother with ink all over himself (straight from his Printing Business) but they all were very good and kind people despite my initial impressions when I first met them and they were not expecting a visitor. As time went on I got to know them all much better. 

Diane invested a lot of time driving back and forth to Sydney to visit me almost every weekend (she was working in a regional area 4 hours from Sydney) and she got me out of the unit and we did many different activities and met new people all of which I really looked forward to. It felt like I regained some purpose to my life.  Since my accident and till that time, most of the time, I’d felt like I was simply existing but having someone like Diane to do things with gave me a sense of purpose to living.  

Diane decided to get a job in Sydney in order to be closer to me and she had the idea that I could possibly be employed a few hours a day a couple of times a week – at least to give it a go and see how I managed. I was a little uncertain – keen to try but unsure of my ability - but my mother was very eager because she saw the potential I had with computers and she knew that getting me out of the unit and socialising and mixing with work colleagues could help me greatly. Diane asked her Boss if I could attend 3 mornings a week to perform computer data entry with Diane acting as my Supervisor. So, there I was, 10 years since my accident, in my wheelchair and dressed in smart work clothes with my Mum beaming as she waved me off to my first day back in the workforce.  Mum was right – I absolutely needed this opportunity.  Prior to Diane’s involvement nobody had ever discussed with me the possibility of working again – to that point it had seemed as if everyone wanted me to stay inside my 4 walls but Diane saw it all so differently.  She saw potental, she saw the I needed some purpose in my days, she beliveed in my ability and she was committed to giving me the chance so, 3 mornings a week she left home early and drove right past her workplace and came all the way to the car park at my Unit waiting for Mum and I to appear with me in my tie and Waverley school jumper (Mum always thought I looked so smart in that school jumper) and she would then drive me to work.  In her lunch break she would drive me home as half days were about my limit at that time without becoming physically and mentally exhausted.  However, I really loved working – I was so eager to get to work that often I would insist that Mum get me up much too early and this was so different to the previous years when I would sleep in late every day because I had no reason to wake and get up. 

I was very well accepted and liked by all Diane’s workmates – they showed a lot of empathy for my situation but at the same time they still expected me to knuckle down and do my work and get it right – but they always had time for a chat and a laugh. I loved it.  One lady in particular had a wicked sense of humour and we got on like a house on fire. I did well at the work once Diane had taught me my tasks and Diane was always extending me by throwing in a new task whenever I thought I had mastered the others. It changed my whole outlook and attitude.  My story if proof that sometimes a person simply needs someone to believe in them and give them a chance and life can take a turn for the better.  I’m not sure that my family were convinced that someone like Diane could deal with all the challenges that life would throw at us and there was some hesitation on their part that we could make a life for ourselves as they felt it would be simply too hard and potentially doomed to fail and they were concerned that I might sink into a big depression if Diane didn’t continue in my life but, it seems that Diane is motivated by taking on challenges and her attitude is always to look for a solution and not to get fixated on the problems or difficulties that stand in the way of success.  Diane’s pleasure in life derives from helping others and she was convinced that as a team we could achieve a better and possibly even a great life for me, and that would give her lots of satisfaction.

Diane and I had known each other for 2 years when we took our vows and we lived in Sydney for a year until the unit was sold as we knew we could have a better quality of life if we got out of the bustling city and found somewhere that moved at a slower pace. We took a road trip north to Queensland to see if any towns along the way grabbed our eye but most places didn't appeal to us except 'Coffs Harbour' and 'Bundaberg'. We discussed it at length and finally came to the decision of 'Bundaberg' mainly because it was very flat and easily accessible for the wheelchair and housing was cheaper. The house we bought was built for the present owner who was in a wheelchair so it already suited my needs perfectly so everything from then on was simply up to us to make it a success.  We moved from Sydney in May 1993 and began our life as Queenslanders. 

Most of my head-injured patients don't have seizure disorders (studies suggest this happens in 5 percent of head-injured people). However, it happens with enough frequency that people should be aware of it. When most people think of someone having a seizure, they think of someone who may fall to the ground and shake all over. When we see that happen in a store or restaurant many people are frightened by it. In a head injury, a seizure tends to happen at two periods in time (but it can also happen at any time). It happens sometimes within hours or days of the accident itself. You may be in a hospital when this first occurs. A second point in time is nine months to one year following the accident.

What is a seizure? Let's think about the brain again. We know that the brain can get a scar or bruise on it because it's been jolted. With time, the bruise will go away and a scar will start to heal. Do you have any old scars on your body? If you feel them, you may notice that they're a little bit more solid or firm than the rest of the skin. The scar is always a little bit thicker and tougher than normal skin. In order to close a wound, the body sends resources to seal it. It's kind of like glue that holds your skin together. The same type of thing happens with the brain. When the brain gets a scar, the scar tends to harden over time. Some of the scars are actually rather soft at first, and with time they start to harden up a bit. The brain doesn't like that hardening and the scar starts to irritate the cells (neurons) around it Neurons are these tiny wires that make the brain work. These are like wires in a computer, except the wires in a computer are like giant pipes compared to these small neurons. Remember we have 100 billion of these neurons in our brain. It takes a microscope to see them. Imagine a room full of electrical wires. Although most wires are coated with insulation, imagine having a room full of uncoated wires. If I were to throw a wrench in a room with uncoated wires there'd be kind of a short in the wiring. Basically this scar tissue is like putting a metal rod across open wires. That scar tissue takes six to nine months to build.

We talked about a short in the wire, but it's a little bit more complicated than that. Visualize a room full of mouse traps. Instead of putting cheese in the mouse trap, we put a ping-pong ball on each trap, and there's not a bit of space in this entire floor where I haven't put a mouse trap and a ping-pong ball. What if I just throw one ping-pong ball into that room? What's going to happen? It's going to hit one, which will bounce, hit two, which will hit four, which will hit eight and before long, the entire room has got ping-pong balls flying in it. That's a little bit like what happens with a seizure. Irritation in the brain may start at one area of the brain and then spread until it eventually takes over the entire brain.

Let's talk about different kinds of seizures. Probably the one that we're most aware of is called a Grand Mal seizure. This is the one that affects the whole body. The person begins to shake all over and may fall to the ground. This can cause injuries including even a second head injury just from falling and hitting the head on a desk, table, or the hard ground. What if you're driving and you have a Grand Mal seizure? You're not going to be able to control your movements and your car will run into something. In Australia, you cannot drive a car unless you have been seizure-free for 6 months.

Seizures sometimes give off a warning sign before they start. Sometimes it'll feel like a tingling sensation in the stomach. Some people may begin to see bright lights or stars. Some people may smell something (like the smell of burning rubber). Suddenly, they just find themselves lying on the floor. The warning signs of a seizure are called "auras." Not everybody gets a warning sign. Sometimes, you're just walking along and bang! - the seizure hits you.

Some of my patients develop what are called simple or partial seizures. A simple seizure can be just a simple movement. A hand can begin to move uncontrollably for a few seconds to a minute. It's important to note that not all of these movements are seizures. For example, we've all had moments when we're tired or sick, when part of our face starts to twitch. That's not a seizure it is just a spasm of a muscle. That's not a bad thing - it happens to a lot of people. Following an accident, you may start to get abnormal twitching. You must tell your doctor who can figure out whether it's a muscle twitch or a seizure disorder.

There's also what's called complex partial seizures. They involve short but complicated activity. I'll give you an example. There was a college professor whose entire seizure involved him saying the words "class dismissed." He would walk into his lecture hall, and five minutes into his lecture, would suddenly say "class dismissed" - then he'd realize there was no one in his classroom. This is a seizure that involves a more complex activity.

What's a common sign of a seizure? For the majority of people who have seizures, there's one symptom that follows having a seizure - a very intense feeling of fatigue. They could be just waking up in the morning, have a little movement with their arm, and minutes later they are asleep. Some people who've had Grand Mal seizures or even partial seizures will literally lie down on the floor and be asleep within minutes.

A doctor who suspects that you have a seizure disorder will order a test called an EEG (electroencephalogram). They glue little wires over your head and connect them to a machine that measures electrical activity in your brain. Each of the wires measures little tiny bits of electricity generated by the brain. If you look at an EEG while it's recording there'll be a bunch of needles jumping up and down over a long piece of paper. Remember all those billions of neurons? They all generate a little bit of electricity. Put a few billion together and you start to get some voltage (estimated to equal a 60 watt light bulb).

Getting an EEG is not a lot of fun. It's not painful, but it's basically annoying. Why is it annoying? Many doctors want you to stay up the entire night before. They won't let you sleep or they let you sleep for just a few hours before you go in for the test. Why do they want you to do that? Ever bring your car into a mechanic when it's been making a really nasty noise, only to have it not make the noise when the mechanic is looking at it? The EEG has the same problem. The abnormal activity may not be going on when it is recording. So if you're really tired, you're more likely to have some abnormal electrical activity. One of the problems in detecting a seizure with an EEG is that the brain may be behaving itself while the recording is going on. An EEG is really a device that only tells us something if the brain is being abnormal during the test. A normal EEG does not eliminate the possibility of a seizure disorder. Another annoying part of the EEG is the glue used to attach wires to the head during the test. In order to get a good contact between the wire and your head they use a glue that holds the wire in place. Many complain that the EEG glue takes a couple of days to wash out of their hair.

What do you do if suspect you have a seizure disorder? Approximately one million people in America have some form of seizure disorder. That's a large number of people. Doctors may prescribe anti-seizure medications. How do they work? Let's try to use another image or picture of how these chemicals work. Have you ever seen an oil lamp work? It has a wick and a knob that controls the wick. If you turn the wick way up it burns more oil and the light gets brighter. What if I turn the wick down a little bit? I'm still getting light but I'm not getting as much light. To some degree, anti-seizure medications work on the same principle. They calm the brain down. Seizures tend to happen when there is a lot of activity in the brain. Calming the brain down a little bit, decreases the odds of having a seizure. That sounds great, so why isn't everyone with a head injury on anti-seizure medications? Remember when we turned down the flame in the lamp example? Other brain activities are also "turned down". Some seizure medications tend to produce fatigue in people. In general, all seizure medications have an influence on your thinking to one degree or another.

In the early days of head injury treatment, neurologists were typically giving nearly all head-injured people anti-seizure medications. We know that 5% of head-injured people have a seizure; if I give anti-seizure medications to everybody, I'm going to control those seizures, right? What's the problem? The majority of people don't need the medication and they have side effects. If you have a seizure in the hospital, you can pretty well bet you're going to be on anti-seizure medications for a while. But if you've never had a seizure while you were in the hospital following your head injury it's unlikely that you will start off with that medication.

Copyright ©1998 Dr. Glen Johnson. All Rights Reserved.

Impaired memory is one of the universal problems of people with Head Injury. All of my patients have complained about memory problems following their injury. Most people think of memory as being "good or bad." As we get older, we recognize that our memory isn't as good as it used to be. It's more complicated than that. There are several different types of memory. Let's take a look at them.

TYPES OF MEMORY

First, we'll look at the different types of memory. For example, we all have memory for music. We can be listening to a song on the radio and have a very distinct feeling associated with that music. The brain processes music and puts that information in one part of the brain. We also have memories for taste and smell. We know the taste of chocolate. We know the smell of burning rubber. We have memories for the things we feel (physical). We can remember the difference between the feel of silk and the feel of sand paper. Each type of memory has a different site in the brain. Two of the more important types of memory are vision and hearing (in this case, words). Visual things are the things we see, such as a familiar place or where we've left our car. We also have memory for language, including things that we've heard or read (things we've read we translate into language). Verbal information is stored in the left hemisphere with visual information stored in the right hemisphere of the brain.

IMMEDIATE MEMORY
Information going into the brain is processed at several stages. I'm going to simplify at this point and discuss what I call immediate memory. Immediate memory really doesn't last very long - perhaps minutes. When do you use immediate memory? When you call information for a phone number, the operator will tell you a seven digit number. If you're pretty good, you can remember those seven digits long enough to dial the phone. That's immediate memory - information that is briefly saved. With people who have a head injury, immediate memory can be "good" or it can be "bad." The problem for most head-injured people, however, is with short-term memory.

SHORT-TERM MEMORY

There's some variation in how people define short-term memory. I define it as the ability to remember something after 30 minutes. In a Head Injury, someone's immediate memory may be good, yet they may still have problems with short-term memory. For example, a nurse in the hospital asked a head-injured patient to get up and take a shower and get breakfast. The patient said that he would, but the nurse came back 30 minutes later and the patient was still sitting in bed. When the nurse asked him why he didn't get up and take a shower, he said that the nurse never told him. So immediate memory is something you quickly "spit back", but the problem rests more with short-term memory. For example, someone may tell you to go to the store and get some milk, some eggs, a newspaper, and some dish soap. By the time you get to the store, all that you remember is the milk. In Head Injury, impaired short-term memory is a very significant problem.

LONG-TERM MEMORY

Long-term memory is information that we recall after a day, two weeks, or ten years. For most head-injured people, their long-term memory tends to be good. One patient told me "I can tell you what happened 10 years ago with great detail; I just can't tell you what happened 10 minutes ago." After you get a head injury, short-term memory isn't working, so information has a hard time getting to long-term memory. For example, head-injured people may double or triple their usual study time in preparing for a test the next day. By the time they get to the exam, they are completely blank on the material. People with Head Injuries have also told me "you know, time just seems to fly by." The little events of the day are sometimes forgotten, making life "fly by" when you look back at events that have happened since the injury.

LOST MEMORIES - TWO TYPES OF AMNESIA

Before we go on with memory, let's talk about two common things that happen with people with head injuries: retrograde and anterior grade amnesia. Amnesia means you lost a memory that you once had. It's as if someone has erased part of your past. Retrograde amnesia means you have lost memories for events PRIOR to the accident. For some people, retrograde amnesia can cover just a minute or even a few seconds. In other words, they'll recall the car coming right at them but are unable to recall the moment of impact. For other people, retrograde amnesia may affect longer periods of time. The last three or four hours prior to the accident are gone. I had one individual who had lost the last year of his life. As people get better from their head injuries, long-term memories tend to return. However, memories tend to return like pieces of a jigsaw puzzle; these bits and pieces return in random order. In general the smaller the degree of retrograde amnesia the less significant the head injury.

Another form of memory loss is called anterior grade amnesia. In this case, events FOLLOWING the accident have been erased. A good part of that is due to the brain injury itself. Complex systems in the brain are injured. The chemical balance in the brain is upset. As brain chemistry normalizes and brain systems begin working, memory also starts to work. I've had patients who have spent several months in the hospital but are only able to recall the last to two to three weeks of their stay.

WHY IS MEMORY IMPAIRED?

Why doesn't my short-term memory work? Well, let's quickly review how the brain works. We know the information flows in through the middle of our brain and branches out like a tree. Before that information goes to different areas, it goes through a channelling/filtering system. It's almost like a mail room - this information goes into this box, and that letter goes into that box. When the brain is injured, these middle areas get pressed upon because of swelling (pressure pushes down on the brain). The middle sections of the brain are also resting on the bone of the skull. Because of forward and backward movement of the brain in an accident, they get sheered or torn. A problem develops when there is a large flow of information coming in which the brain can't process, or when information is not being sent to the right place. So the mail room of the brain is not doing its job.

There is also a second type of memory problem. Once information is stored in the brain, the brain has a hard time finding it. For example, you saw a movie but you can't recall the name of the actor in the movie. You can visualize who the actor is, but can't come up with his name. People typically describe a "tip of the tongue" type of thing--"I know what I want to say but I just can't get it out". It’s almost as if the brain is saying, "searching, searching" and not finding. Several minutes later, it just comes to you. So think of it as a library in some sense. If I take a book on history and I just put it anywhere in the library, I'm going to have to search that whole library to get that one book. So there are basically two kinds of memory problems: storage problems and retrieval problems.

WHAT CAN I DO TO IMPROVE MY MEMORY?

Work with a Specialist in Memory- One of the most important things is to get help from people who specialize in head injury. Every head injury program has a specialist who teaches memory strategies. In most cases, this is a Speech Therapist (they don't just help people who have slurred speech). In the Neuro-Recovery program, our Speech Therapist teaches 15 different memory strategies and helps you to pick the 2 or 3 that work best for you. There is often a fair amount of testing in order to figure out the best memory strategy for each head-injured person. For some people, one type of memory may be impaired (verbal recall) but another type maybe intact (remembering visual information). If I know that my verbal memory is not very good, I write things down and encourage visual memory systems to work. Specialists can help you pick out the best memory strategies to help you. Once you find an effective strategy, keep working on it. Think of memory like a muscle. The more you use it, the stronger it gets.

Get Organized- We learn better if we are organized. Many people have told me that, prior to their head injury they had incredibly messy desks with papers all over. But if someone came in and said, "I need this particular paper", they could pull it out of a big pile and say "here it is." After a head injury the ability to organize gets really messed up. One symptom of not being organized is when someone says, "I've started 50 projects and haven't finished one of them." If you organize information, it tends to help you recall it. For example, if you are constantly losing your car keys or constantly forgetting where you put your wallet, there's one simple technique to use. Put things in the same place. Always put your car keys in one spot on the dresser. Always put your purse in one spot in the house and nowhere else. Being organized helps your memory and you will be less likely to lose things.

Break It Down- Another thing that we can do to help memory is to break it into small bits. If you have something really tough to learn, try to break it down into small bits and then learn each one little bit at a time. Some people call this "chunking" - you are memorizing little "chunks" of information. For example, your brand new VCR has a remote control with 50 buttons on it. Reading the entire manual in one sitting to learn what all of the 50 buttons do is very hard. So, learn one function and then play with that feature for awhile.  Once you've learned that, go on to the next button. We've been using this technique for years to learn simple information like a phone number. The wonderful folks at Bell Labs (they invented the phone) figured out that people can memorise a 7 digit phone number if you group 3 digits together and then group 4 digits together (a "chunk" of 3 numbers and a "chunk" of 4 numbers).  

Using Association- Association is really important for retrieving important information. For example, you are taking a literature course and you need to remember a famous essayist - Francis Bacon. You might associate the image of a piece of bacon with the name of this person. So if you're trying to think of this explorer, an image of a piece of bacon will come to you. This approach is particularly helpful with learning names. Remembering names is a difficult task for most people in the world; it is especially hard for most people with a head injury.

Get a Daily Planner- Probably one of the best things you can do to help your memory is to use a daily planner. This brings up two important points:

• The First Rule of Memory - write everything down in one spot (your daily planner).
• The Second Rule of Memory - write it down when it's fresh in your mind.

For example, you go to your doctor's office and you are asked to return for another appointment.  Many people have a calendar stuck on their refrigerator or on a wall at home. By the time you get back home, you've forgotten the date or lost the appointment card. Next time, bring a planner to the doctor's office and write your appointment in it just after the doctor tells you the date. Get a medium size planner or something called an organizer. Don't get something that's too small - you're going to be doing a lot of writing. Write complete notes! Some people make notes so short that they later can't figure out what the note means.

Make A "To Do" List- In addition to a planner, make a "to do" list. For example, you may have a number of chores to do around the house but none of them in any particular order. What you can do is get a small pad of paper and write down the things that they have to do. Once you have this list, decide which task to do first, second, third, and so on. This will work if your list doesn't get too long. If the list gets too long, you're going to run into problems. 

Make a "Modified To Do" List- I commonly hear the same problem, "I've got 50 projects going but I haven't finished any of them." This is a combined problem of memory deficits and organizational deficits. One solution is to buy a small dry-erase board and put it up in the home (or office). On the board, you are only allowed to list five items on the "To Do" list. You cannot add another item to the board until you have completed one of the items already on the board. Make a "Modified To Do List" and put it somewhere in your house where the whole family can see it. Family can also offer suggestions to help you to get projects organized. This will in turn help family members get a better understanding of what the head-injured person has to deal with. When you get organized and use the Planner/To Do List, you'll feel better about yourself because you will be getting things accomplished.

THINGS THAT CAN AFFECT MEMORY

Fatigue and Sleep- Memory can be affected by a number of things. Some of these influences can affect even people without a head injury. If you do have a head injury, these effects are multiplied. For example, if you're tired, your memory tends to be poor. If you have to learn something really important, it's best to learn it when you're fresh. Generally, most people with head injuries learn better in the morning than in the late afternoon. So if you've got something really important (a test for school), studying the night before the exam may not be very useful. The best time to study is in the morning. In addition, people with head injuries commonly have sleep disorders. It’s very important that you talk with your doctor about getting your sleep pattern back to normal. If you wake up tired, you're going to make memory problems worse. 

Strong Emotions- Very emotional situations will distort your memory. If someone comes into a bank and waves a gun at you, this will create a very emotional situation (intense fear). Even though there are five people looking at the same person, you will get five different descriptions of the robber (that's one reason why they have cameras in banks). Being afraid, mad, or anxious will alter your memories. What should you do in emotional situations? You can't always control your emotions, but there are situations where you will need to recall important information. For example, going to a doctor's office can be a very emotional experience (many people are afraid or anxious).  Most head-injured people find this a very stressful situation.  One approach is to bring a family member or friend along. Another approach is to tell your doctor of your memory problems and ask the doctor if you can write down important information.

I have included a Memory Sheet for Doctors' Appointments. When you get to the doctor's office, you may be so nervous that you forget to tell your doctor ALL of your problems. The next time you see your doctor, you may recall some of the old problems that you forgot on the first visit. A common complaint of doctors who work with head-injured patients is, "Every time I see this person, I hear a new problem." Using the sheet of paper at the back of this book can help you organize your thoughts. Doctors deal better with information when it is presented in a quick and organized form. For each problem, I left a little space for you to write down what the doctor recommends. In this way, you can bring your memory sheet to future appointments and keep track of your progress. For example, maybe you're not sleeping and one medication approach is being tried. If that approach doesn't work or it has a limited effectiveness, you will want to keep track of that and bring it up the next time you see your doctor. If you don't write these problems down and monitor them, you'll be less likely to make progress with them.

Certain types of medications (pain killers, for example) can affect memory. In the hospital, people can be on fairly significant amounts of pain killers because they have broken bones or other injuries. Some medications can make you tired, which in turn makes your memory worse. It is important to have an ongoing dialogue with your doctor about your medications. People have told me, "I'd rather be in a little bit pain so I can be more alert." Sometimes the goal of pain medication is not to get rid of all the pain, but to control it. Talk with your doctor about your medications and the possible effect of medications on memory.

Copyright ©1998 Dr. Glen Johnson. All Rights Reserved

People will accept that Head Injury can change your thoughts and memories, but have difficulty understanding that it also changes your emotions. Your emotions don't exist in some cloud that follows behind your head. They're in your head just like everything else. Two of the more common changes in emotion are anger and depression. Someone may have been a "hot-head" or an angry individual before their accident. Since the head injury, this person's anger is multiplied 2 or 3 times. For example, a dog may pee on the carpet. This might be an angering situation for most people. But following a head injury, the anger is so extreme that the person may want to harm the dog. Anger after a head injury is quite different from normal anger. Anger following a head injury tends to have a "quick on" and a "quick off." Basically you can be in a good mood until some small thing irritates you and you suddenly get very angry. But this anger doesn't seem to last; you're angry for a few minutes, someone changes the topic of conversation, and you quickly stop being angry. In another variation of anger problems, some little thing sets you off and then the "whole day is ruined" (you're not mad but seem to be in a bad mood).

Many people say, following a head injury, "I cry real easily, sometimes over the dumbest things." This is especially tough for men in our society because men have been taught not to cry. I've had many male patients say to me, "I've never cried as an adult; now I'll watch some silly movie on television and have tears running down my face." Many people begin to feel that they're losing their mind because of this emotional roller coaster.

Why is this happening? We know that the middle sections of the brain are pretty primitive. Rage, fear, and sexual feelings all come from very primitive emotional areas of the brain. If you have animals at home, you'll see the same primitive emotions in them. Humans also have primitive systems in the brain that says "yes" or "DO IT". If you're mad, hit something. If you get hungry, let's eat. Don't wait, do it right now. In contrast, the front part of the brain helps plan and control behaviour. The front part of our brain is involved in saying "NO". For example, your boss says something to you that gets you really mad. Your first impulse is to hit him. The "NO" part of your brain says "Don't do that--you’re going to be fired--you're going to go to jail." So the frontal lobes and the primitive parts of the brain act like a thermostat and a furnace. If the "NO" part of the system isn't working so well, the primitive functions tend to be more prominent.

This change in emotion may cause your family members and friends to start avoiding you. With family members, they're going to learn to walk around you as if on "eggshells". If it's your friends, your yelling at them will result in a lot fewer friends. They may be afraid of the changes that they see in you.

What can you do to deal with the anger problem? One very helpful approach is the Time-Out procedure. Before you get to the point where you are going to explode (throw something, break something, or punch a hole in the wall), you MUST walk away. You have to get away from the thing that's really irritating you. I ask people to walk away for a minimum of 15 minutes. Get out of the house; go for a long walk. But don't stay in the situation that's making you angry. Why 15 minutes? People will say, "I'm pretty calm after 5 minutes." But they go right back into the situation and they're instantly angry again. It takes quite a while for your emotional system to calm down. Time-Out must be at least 15 minutes. The more you do Time-Out, the more you learn to control your feelings, or hold back the flood of emotion. It's basically practice, practice, and more practice; just like learning to hit a ball with a bat. The more you try, the more likely you are to get better at it the next time. You can't just say, "Okay, I've got the principle on swinging a bat; now I'll go out and play major league baseball." You have to keep at it - so practicing "Time Out" is a good thing.

One of the problems with Time-Out is that people don't realize that they are angry until it's too late. For example, I had one patient who was waiting in a check-out lane in the store and there was a little child being a brat; picking things up, throwing them on the ground, yelling, screaming, and basically driving everybody in line crazy. The family member who was with the patient could see the anger starting to build. The jaw was tightening; the fists were clenching; the feet were tapping. The head-injured person didn't recognize the anger. This person finally "exploded" at the parent and said, "Shut your kid up!" There are cues that anger is building in us, and we've got to learn to pick them up. It may be tightening in the jaw; it may be clenching in the hands; it may be sweating more or breathing heavily. It depends on the person. I often request that family members help with Time-Out. (In fact, the family member is most often the target of the anger.)

I also have a rule for the time-out procedure: No matter who calls time-out (whether you feel it's fair or not), you've got to do it. If you're the head-injured person and someone calls time-out on you, you have to do the 15 minute Time-Out, even if you don't think you need it. You may get mad because someone's called a Time-Out procedure. You still need to do it. Family members, however, have to "play fair" with the time-out procedure--they can't chase after you with an ongoing argument (the No-Nagging rule). If you're trying to get out of the situation, family members must not run after you and say "Oh yeah and here's another rotten thing you do." They've got to do their part by "shutting up" during Time-Out.

It helps if you have a signal for time-out. It might be like the referees in a football game, where they make a "T" with their hands. If it's in a crowd and you don't want to be obvious, you might pull on your earlobe or touch your nose. Whatever the cue that you and your family use, you've got to do it. The more you practice this technique, the more it works. The first few weeks, it may not seem as if it’s working. But keep at it; it will work over time.

Copyright ©1998 Dr. Glen Johnson. All Rights Reserved.