As Good as It Gets

One recovery idea that I occasionally come across is the concern that, maybe, this is as good as it gets. This is a very understandable thing to worry about. Indeed, this is the very idea that a character with an obsessive-compulsive disorder played by Jack Nicohson battled against in a recent film of the same name. I find myself occasionally wondering about it, too.

A brain injury can cause all sorts of problems, problems that require such a different approach to things that used to be so easy, One can start to feel these problems are insurmountable; feel like there's no way "back to" the way you were before; there are no more improvements to be had. Basically, one can worry that this is as good as it gets!

I don't know about obsessive-compulsive disorder, but I do know a little of recovery from traumatic brain injury. While understandable, I think it a very dangerous thing to worry about. The brain is an immensely adaptable piece of equipment. Worrying that things won't get better almost flatly assumes the brain won't learn how to work around whatever problems it comes across. In my humble opinion, assuming that is almost as bad as ruling it out from ever happening. That is, if you want to learn to recover, start by believing that you are actually able to recover.

Yet, feeling this is as good as it gets is still very understandable; when I start thinking it, what do I do about it? Simple, I do my best to keep in mind specific areas of progress I have made, specific times when my brain has learnt about how to work around things. With that, I can convince myself that my brain can work around things. This is definitely not as good as it gets!

Cheers,
Mike

The Plateau and 'Bedding Down' Gains

I introduced the idea of a plateau in a previous post, Beware the Plateau! I have two reasons for not liking the concept of a plateau: the first I discuss in the post, The Plateau and Switching Activities, and the second here.

The discussion of the Concept of a Plateau under Myth 3 of Debunking Ten Myths of Brain Injury Recovery makes a further point. It's that TBI recovery can be made up of "fits, starts, and bursts, often interspersed with periods of apparently little change, or even falling back."

My sister has spoken to me before about a 'bedding down' period that happens as the brain properly absorbs new information and starts changing behaviour. Obviously, when the brain gets injured, bedding down can take longer. Accordingly, the times of "little change" can just be times of bedding down. Further gains will happen after the ones already made are bedded down.

In my balance example, the bedding down of gains came as I slowly realised that a lack of core strength in my trunk was contributing to my poor balance. What was required to help that was sticking with exercises that improved that strength. The 'bedding down' happened as I realised one cause of my problems and then set about working on specifically on that.

The bedding down of gains makes it dangerous to write off the possibility of more changes just because changes slow down. There is nearly always more scope to recovery, there is always reason to think about how to recover!

Cheers,

Mike

The Plateau and Switching Activities

I introduced the idea of the plateau in my previous post, Beware the Plateau! I have two reasons for not liking the concept of a plateau: the first is below and the second is in the post, The Plateau and 'Bedding Down' Gains.

So things had been working out well for me in my TBI recovery. When I write about it now, it seems obvious that eventually they wouldn't go quite so well. Somehow, I convinced myself that all that was required was more effort, all I had to do was "stay the course."

So I kept at what I'd been doing. Unfortunately for me, I was caught out by the old adage, you do the same thing, you get the same results. I was trying the same old things long after they'd stopped working, as if I expected them to magically start producing results.

Belatedly, I realised one thing that might help was a new approach, a new way to try and improve my skills at whatever the activity was. Back to my balance example, an alternative way to work on my balance more was to start relearning how to juggle a soccer ball. To juggle a soccer ball, you need to stand well on one leg while using the other to kick the ball in just the right place with just the right amount of force. Your balance must improve.

Ball sports have never been a natural thing for me and, even after heaps of practice, I'm nothing special at juggling. But I am better than I was and, more importantly, my balance is better than it was.

That's consistent with the discussion of Myth 3, the Concept of a Plateau in Debunking Ten Myths of Brain Injury Recovery. It talks about how "energizing environmental events" can lead to sudden leaps forward. Trying something different, getting the brain to think in a different way can cause it to 'wake up' a little bit more!

The discussion suggests, even years later, a new, committed counsellor or more social contact can bring about enough change to break from the plateau.

Cheers,

Mike

Beware the Plateau!

My TBI recovery went on well for a long time, but eventually I felt like it was reaching a plateau. Suddenly, I started noticing improvements came more and more slowly; I felt I had less and less to look forward to; I found myself wondering how I could keep going with the daily grind of recovering.

I'm trained as an economist and I wondered if the economic concept of diminishing marginal returns had set in. You put the same amount of effort in, but you start getting less and less out.

Worrying about plateaus can relate to many aspects of TBI recovery. The one particular problem that I think best sets out the concept is my balance. My balance wasn't good right from the start of my recovery. I was very lucky not to further injury myself in a fall I had in rehabilitation while relearning how to walk. Even well after properly doing that, my balance was very poor and didn't improve much.

My poor balance eventually resulted in a fall while hiking one day that badly broke my arm, which is one of my regrets. The question was, though, was that the limit of my recovery of balance? Was I always going to have to deal with poor balance? When you're the one doing the recovering, such thoughts are scary, to say the least.

In the majority of TBI cases, the concept of a plateau is not only misleading, it can be downright dangerous. A "plateau" can be used as an excuse by TBI recoverers, by families, even by therapists and specialists to stop making an effort; to slacken off; to "take it easy", when doing so can lead to the recoverer missing out on valuable care.

I discuss two reasons why I don't like the concept of plateau in the posts, The Plateau and Switching Activities and The Plateau and 'Bedding Down' Gains.

Cheers,

Mike