Another Approach to Therapy - Learning to Sing

I've always had a loud, deep voice, but it's become noticeably more raspy since my accident. I've also lost some control over my volume and pitch. Speech language therapy I had early on seemed to give me little relief. Part of that (perhaps a large part!) was that I found the exercises difficult to keep doing because I had trouble applying them in practice.

I'd been conscious my voice still needed work, though, and eventually I came across another way. I've started singing lessons. My singing instructor certainly doesn't have a speech therapy background. She was quite surprised when I explained my plans and hopes with my learning to sing, but we started lessons anyway.

I noticed an immediate improvement in the quality of my voice and I feel there is big potential for further progress. Singing allows me to practice using my full vocal range. As well as that, by it's very nature, singing well involves a much greater need for control over one's voice (compared to speaking). Perhaps because of the way our brains are wired, it's easier to hear when I'm not singing well compared to when I'm not speaking well. So it's easier to feel like I'm making progress.

I don't propose that learning to sing will work for everyone. Instead, I write about this here to discuss the value of thinking outside the box to help TBI recovery. Think about what it is you want to achieve. How have you been working on it so far and how has that been going? What other things, what completely new approaches, might help you out?

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

Tipping the Odds in My Favour

In my post, The Full Court Press, I talked about one approach I take to TBI recovery: if I'm having difficulty understanding a particular problem, I seek out the right specialist or therapist to help me with it. That approach means that, since my recovery from Post Traumatic Amnesia, I've benefited from the help of 22 different specialists, therapists and other trained medical people.

I guess that number might seem a little overboard, but that's not something I'm at all concerned about! Instead, I think of it as one way of tipping the odds in my favour. Tipping them away from my brain injury and its effects and back towards me and my recovery.

In the post, Have Hope!, I wrote about how, early on after my accident, the odds were stacked against me. Instead of being daunted by that, I've always seen it as a reason for taking every advantage I can. Even now, over three years on since my accident, I'm continually looking for ways to do things better. I guess it's part of the determination to recover.

My being determined to recover means I never give up; I never stop believing there's one more thing I could do to help me recover. All I have to do is think of it. Think about what exactly my current problems are and what might help me with them. Think about different ways I might tackle them. You guessed, I'm thinking about how to recover!

Cheers,
Mike

The Full Court Press

Basketball players will be familiar with this strategy: The Full Court Press! It's a variant of the double team strategy and involves man-on-man defence across the length of the court. And, just like the double team, it too can be successfully used in TBI recovery.

As I've repeatedly said, there's a massive variety of problems a TBI can cause. For TBI recovery, a Full Court Press means finding the right help from whoever is most able with any particular problem. Whenever I came across a problem, I think about how it might best be handled. Who should I talk to about it?

In the post, Stamina, I described the amount of help I'd received: I've seen eight different specialists, two general practitioners and twelve others (therapists, nurses or technicians and the like). When you include me as captain, that's almost enough for five basketball teams! And, of course, it's without any of the massive number of others who have helped me with support, ideas or even just by hearing me out.

A great way of recovering well from a TBI is to use a good team approach: The Full Court Press!

Cheers,
Mike

Talking to the Right People

In this post, I wrote about how difficult TBI recovery is. That concept implies one important thing: It's difficult to recovery well without professional, compassionate help. Medical staff might not understand everything, but they'll still understand a massive amount more than what the untrained will! Talking to them first can save endless frustration when coping with some difficult TBI recovery problem.

Since they can be of so much help, how best to use them? Simple, talk! Find the right person, talk to them and try to ask them the right questions! Have a think before you go to them: what would you like to know, what don't you understand, how best could they help?

Didn't get the answers you wanted or, just as importantly, didn't get them in the way you wanted? Remember to think, hang on, I'm the Boss! Remember how complicated TBI recovery is. That'll mean there's a massive amount of people that might be able to help you. Don't stop trying different people until you find answers you're happy with.

That's probably the most important thing to take from my process of relearning how to run. Someone as serious as a physician or even a neurologist was unlikely to help me with it. After all, I knew how to move the right muscles. The problem was moving them in the right order!

I tried two different exercise trainers who normally help healthy people with running, but neither were at all familiar with problems related to brain injury. In the end, after some encouragement from a friend, I tried talking to a physiotherapist who recommended another physiotherapist who specialised in the relevant area. Only with that, did I feel I was in competent hands that would help me with my running trouble.

Cheers,
Mike

Wanting to Leave Care

Related to acceptance of a TBI, many TBI recoverers want to leave care as soon as possible. Their desperation means that rehab centres have to keep the doors locked at all times. The desire to leave comes from the recoverer linking the effects of their TBI with their environment. They often believe that everything will be alright as soon as they get home. While that belief is understandable, it would be difficult to find anything less true for nearly all recoverers.

To help with the many and varied problems caused by a TBI, there is quite simply no substitute for thorough, professional care for a TBI recoverer. Leaving this care early will not make anything better; instead it will almost certainly make it more difficult to recover well. During my recovery, I remember the desperate desire to leave, but, in my case, it was somewhat limited by the fact that I couldn't walk! I needed the physiotherapists' help to relearn how to even get through the doors, first. I quickly saw that care was the best place for me to begin to come to grips with my various problems (only one of which was not being able to walk!).

Other recoverers have greater difficult dealing with the desire to leave. One recoverer at my rehab centre even went as far as to have conversations with his lawyer about his ability to leave. I only heard about this from him and so do not know how his conversations were received. I can only hope that the lawyer knew enough to attempt to discourage attempts to leave care.

I've written this post mainly to help family and friends decide what is best for their recoverer. Please keep in mind that, almost by definition, a TBI will mean a recoverer is initially confused and not thinking properly about what's best for them. In time, thinking will most likely improve, but, early on, friends and families may need to offer firm ideas about how best to help recoverers.

Cheers,
Mike

Stamina

In the post, Recovery from Any TBI, I wrote about how a severe brain injury wasn't that disruptive because of the severity of any one problem it caused, rather because of the number of problems it caused. Indeed, my accident caused a bit for me to deal with. I can remember (and there was a good portion of time early on in my recovery where I don't remember) seeking help for eight separate problems related to my accident - things like relearning how to run and learning more about problems with my vocal chords and speaking. All but one of these problems were caused by my brain injury. For those eight problems, I've seen eight different specialists (four of which I saw about this problem with my eyes), two general practitioners and twelve others (therapists, nurses or technicians and the like).

Those eight don't include all the problems I've had, but haven't sought medical help for (normally because I don't think it useful). Chief among them is fatigue, but the nature of those problems extend to things like needing to relearn how to eat without spilling stuff down my front. :-)

I wrote about the very involved approach I take to medical help in the post, I'm the Boss! That approach is difficult to maintain for every problem I've sought help with and so I've called this post, Stamina, not because I think I have it, but because I wish I had more of it.

One idea I've used to maintain my involved approach is to stagger my appointments. For instance, I decided not to seek help with my excessive sweating (probably caused by an injury to my brain stem) until after I'd had my eye problems resolved. Remember this is three years after my accident now. So, yeah, stamina is what I wish I had more of.

Cheers,
Mike

I'm the Boss!

All the way from hardcore medical specialities like neurology through the different therapies such as speech therapy, physiotherapy and occupational therapy to off-the-wall suggestions like learning tango dancing for balance, I've had it suggested as a way to help my recovery. There's one approach I take to it all, though, and that's, I'm the boss!

I am the one who goes through the hassle of operations, attends the appointments and has the sessions of therapy. And I am the one who has to live with the results of the care, be they positive or negative. It's very much in my interest to know exactly what's happening. When I first see a specialist or therapist, I want to know two things and I'm going to say this in bold because I'm very serious about it. I want to know A) that the person knows what they're doing and B) what they're doing is worth my while. Neither scalpels nor swiss balls should they bring to me without convincing me of both of those things first.

Like any good boss should be, I am acutely aware of the amount I don't know. I've never had any serious medical training at all. So there has been and still is much that's completely new to me. But I pride myself on being very curious and having an inquiring mind. I really like stuff being explained in a way that I can understand. If I ask my specialist or therapist a question, an answer I don't understand is almost as bad as no answer at all. The only thing making it better is that an answer that I don't understand allows me to ask further clarifying questions.

To find out about A) and B) for any particular specialist or therapist, I've found three questions particularly helpful. The answers given in response tell me a lot about how confidant they are and what they're feeling. The questions are:

• What are the benefits of us doing this?
• What are the risks?
• What are the other ways we might do it?

Of course, those questions won't always be appropriate. For instance, I have sometimes found out answers to them before I've even had time to sit down. But I want to be roughly clear on them before I start investing time or effort in pretty much anything to do with help for my recovery.

Cheers,
Mike

My Brain Trainer

I've had help from a number of important technologies during my recovery. All are easily available and ready for action, but I want to tell you first about what I thought the most important, the website, My Brain Trainer.⁽¹⁾ It is marketed as an online mental gymnasium - a "brain-gym" - for healthy people. Healthy people are those not fortunate enough to have had a TBI. :-) Yet, just like physiotherapy and physical gyms, this brain-gym is also very useful for TBI recoverers.

The website currently contains ten different series of exercises designed to test different activities of the brain. Those activities range from reaction speed through short term memory to executive function. The tests gradually get harder within each series and the website is very clear on results. It gives you your score and what underpins it. It also gives you the average of the scores of other people.

Those comparisons don't make me despair when I perform below average, though. And I do perform well below average for some activities - I consistently get a score over 25% lower than the average (for my age group) for reaction speed to audio stimulus (although not, interestingly, to visual stimulus). Still, because those averages are mainly for healthy people, they don't represent a good comparison for someone with a TBI.

Despite my continued slow audio reactions, I think the website has helped my brain function in a range of areas. The first area I noticed was short-term memory, but I can also add executive function and an ability to respond fast to a changing environment to that list. The latter was a particularly big thing for me and, right now, I still hope to improve it greatly! I don't like to think, however, what I'd be like without the website.

For the full gymnasium you need to pay about US$10 for three months' access. You can still have a small go for free, though. Click on 'Take the Challenge!' to access one of the exercises. And enjoy!

Cheers,
Mike

(1) My Brain Trainer is but one of a number of online brain-gyms. Although I haven't tried the others, three websites (including it) are discussed in this article.

A Nod to OTs

The turf of the Occupational Therapist. By talking about things like managing TBI fatigue and returning to work, I'm going to be treading on it sometimes. But, during my recovery, I've developed a great amount of respect for OTs.

These guys are the masters of problem solving and strategy creating! No everyday life problem brought on by my accident was too much for them. While I still had trouble walking, they made sure I was safe using a wheel chair. They came to my work and chatted to my boss about my return there. They even helped me figure out ways to remember what I'd said to people to save me embarrassing myself by saying the same thing twice.

So I hope this site contributes to, rather than detracts from, the noble profession of the OT.

Cheers,
Mike