Hanging Out With Piaget

Here's the game-plan as outlined by the doctor and various therapists: 

For the time being, I will continue to work twenty hours a week, five hours a day, at a call center helping people apply for their passports, with accommodations such as longer and more frequent breaks, more time between calls, and being isolated in the most remote and quiet corner of the room (This all follows for my attentional problems, processing speed issues, and neural fatigue).
Although I am learning the job I think remarkably well, I'm told that I can't increase those hours as I'd like, because the accommodations haven't been implemented yet and they need to see how I improve once they're in place. 

Will I tire less easily? 

Will I be able to understand what is said to me without having to ask repeatedly for the same explanations? 

Can these changes improve my ability to focus? 

The doctor also keeps reminding me of "quality of life" issues as well, such as that a long day at work means a short evening typing for this blog and then going right to bed.
Another reason they advise against increasing my hours is that I am starting Occupational Therapy, and therapy for PTSD, and they don't want to overwhelm or exhaust me.

What is the goal behind Occupational therapy?

• The Occupational Therapist is going to help me transition back into independent living, which includes whatever kind of a job that I'm going to be able to do and any accommodations or resources I may need to regain/maintain a normal level of functioning.
• Initially I didn't think I needed occupational therapy because it predominantly addresses common sense, practical life applications such as driving, budgeting, and how to respond to an emergency situation. I didn't feel I needed that, although Thea was quite concerned over many of these types of things. 
• But I did hear this therapy would help me get more dexterity back into my right hand, and that was sufficiently worth my while to pursue. I have stories to write and more pictures to paint!
• Over the course of a year my sister and her husband have developed a list of things that they've been having to do for me. The driving back and forth for 2 1/2 hours one way to get my kids for me every other weekend alone takes a huge chunk of time, money, and energy out of their days on my behalf. 
• Regarding my difficulty with day-to-day household management, my sister has often complained that
  
  I've always had these problems, my neuralpsychologist disagrees. To his way of thinking, by all accounts it was my roll-over accident with the van in 2008 that set the ball rolling. After all, there was a loss of consciousness indicative of a concussion, some considerable confusion, and I never sought medical attention. In his mind, all my struggles over the past five or six years since my divorce relate back toward brain injury incurred from that first accident. He cites the fact that more than one person had noted drastic changes in my behavior following that accident, all of which also just happen to be symptoms of brain injury -- The organizational and time management problems, subsequent depression, drop in grades at college when I'd always before had all A's, money managing issues, less patience with my children, the personality change that my ex-husband complains of even now, etc. 
• In short, he said, I have been constantly confused and frustrated by my inability to do things that I felt shouldn't have been too hard for me, when all along it has been due to an undiagnosed brain injury. "You can absolve yourself of all guilt," he told me, "You can't blame yourself for behaviors -- symptoms, really -- that your brain was incapable of comprehending. Add this double concussion from last year and it's no wonder your brain couldn't take on the additional stress."
• This connection justifies the need for Occupational Therapy. Because frankly, I'd taken to grudgingly agreeing with my sister's assertion that this is just the way that I am. Seen from the Doctor's perspective, I feel more optimistic about my ability to get the help I need to get my life back on track, and I also feel less guilty for not being able to do better for myself before.
• I'm not terribly good with Gestalt anymore. I am constantly puzzling over what the connection is between my brain injury and my therapy. Every week I ask myself if all this fuss over the symptoms from my accident is actually justified, and then every week something happens to remind me that it is. In fact, my sister notes that I am asking her about what "The Plan" is every week, over and over again. 

1. How does all this therapy turn into working full time and being self-sufficient? 
2. What's going to happen with my life? 
3. Shouldn't I just get out of all this therapy, get a permanent job somewhere, and get my old life back? I always think so. 

• Thea says that the fact that I do always think so, and keep forgetting that we already talked about it before, is the very reason that she believes unequivocally that my brain is not the same.
• Now that she's gone and pointed it out to me, I've made a list of steps, goals, and motivations that I check every morning. I also asked the doctor for copies of the write-up on my test scores so that I can make the connections I need to justify to myself such a silly thing as Occupational Therapy for a grown woman who is still smart enough to score in the 95th Percentile in Vocabulary testing. 

The Doctor handed the papers to me and said, "There's things in here that we sent out, and some additional things I thought you might find interesting. I mean, you should find these interesting. After all, they're about yourself." 

Now, according to the laws of conservation, as referenced by my neural psychologist's testing, three months after the accident, I was (and may still be somewhat) functioning at Piaget's PreOperational Stage. As an educator, I find this quite disturbing given the fact that this is a stage I've always reserved for describing elementary students. 

However, if according to extensive and meticulous testing and cross-testing I tend to test as egocentric, then I suppose I have to at least consider the possibility that this may be true. 

What I'm doing is writing to you about those original scores, basically just because it's easier for me to comprehend things when I organize them on paper for myself (or in this blog, as in this case)... And also because I am egocentric, after all, and I therefore think it's all about me, and I love to talk and write about -- you guessed it -- Myself! ;-)

(You can always ignore this entry if you like. It's not like I will ever know!)

If I want to make sense of something confusing me, I have to write it down and/or read/say it out loud. I was doing that tonight when I was on the phone for forty minutes with a man who pedantically read and re-read the qualifying questions for the online passport application verbatim because he didn't believe I understood his questions and he didn't know how to explain them or elaborate on them. He repeated, I parroted it back to him in question form to show that I understood, and then I would tell him the answer to his question. He only had three questions, but this performance was repeated several times for each question until he was fully satisfied -- and I was dangling over the side of my chair, bumping my head up against the side of my cubicle and pretending to shoot myself in the head with my finger because calls are only supposed to last four minutes and thirty seconds, and I didn't want to find a complaint slip on my desk tomorrow. Forty minutes,three questions.

This is a list of test results that I've been puzzling over:

1. In motor functions I'm moderately impaired to average. Finger dexterity, especially of the right hand, were moderately impaired. 
2. Attention/Concentration: I was severely impaired to average. In my Attention Capacity Test, I was only in the 1st percentile. My ADHD Score was -7.98. 
3. I was moderately impaired in Working Memory. 
4. Visual Organization: Mild to moderately impaired at a stinking bike-drawing test, and I missed two points drawing a clock. I'll bet I could do a lot better now than I did originally. At the very least I could do better on the clock drawing, I should think.
5. My Verbal Intelligence scores ranged from average to superior, with my vocabulary coming in at the 95th percentile. 
6. In Memory/Learning, 30% of the measures were impaired. I ranged from moderately impaired to high average. Mildly impaired for logical memory, short and long delayed recall, and even cued recall.
7. Executive Function: 14% of my tests were impaired. The scores ranged from severely impaired to very superior! I'm moderately impaired in categorizing things, average at many other tests under this domain, and I scored Superior on verbal fluency tests so long as I was well-rested.
8. I only scored at 50% for Achievement, which concerns acquired skills or knowledge through formal learning or job training, mastery level of age appropriate materials, proficiency of gained knowledge or a standard of academic job proficiency content. I scored from 16% to 63%. (But I'm a smarty, I say, because I am actually learning at this call center job despite predictions to the contrary). 
9. There's a Symptom Validity Test that checks to see if you are exaggerating your symptoms or being a hypochondriac, but I got zero (0) impairment in this domain. I am therefore not a "malingerer." ha hah! (I love that they used the word "malingerer." )
10. In the Personality Test,  I typified as a person with some evidence of a systematic approach to
    
    problems, but lacking the ability to form a general rule from the problem. In other words, I was functioning at Piaget's preoperational stage, wherein an individual begins to see the relationship between the past and the future (who, me?). "The Preoperational Stage is marked by ego-centrism, inability to reverse logical concepts, and generally non-logical thinking. For example, individuals are unable to reverse mathematical concepts, unable to understand the property of conservation, and unable to take the viewpoints of others into consideration." And also I lack the cognitive skills to place objects into a hierarchy. (Okay, so no categorizing and no hierarchies. I wonder if this plays into my inability to prioritize, make decisions, or keep my space clean. I'm not so sure about parts of this description. For example, I make a great effort to consider the viewpoints of others, don't I? Or is this related to my complete inability to agree with people who don't feel as I do about political subjects? Because if it's politics, not understanding is a conscious choice on my part sometimes. LOL)
11. In something called the House-Tree-Person Projective Drawing Test, my work was judged as indicative of regression or erosion of one's personality, which apparently is not uncommon after TBI. Erosion of personality? I'm going to have to ask what that means. It brings to mind Borderline Personality Disorder.
12. My inability to make decisions is identified as a serious clinical issue related to TBI. And here I thought I was a just wishy-washy person who likes to poll several people's opinions before making a choice. That's only half bad, isn't it?

At the end of all the paperwork there's a sum-up of sorts that states that 80% of the domains I was measured in resulted in findings of actual deficits, these areas being...

• sensory perceptual
• motor functions
• attention and concentration
• information processing
• visual organization
• learning and memory
• to some extent speech and language, with verbal fluency being the two scores that were not above average
• 50% of the brain injury impairment measures were in the impaired range
• Arithmetic (I have stopped even trying to add without using my fingers in front of people anymore)
• executive functions
• depression, anxiety and PTSD

"Also noteworthy, the patient had sixty-three scores that averaged the 75th percentile. These were in multiple domains, such as the IQs (all above average). On the other hand, there were fifty-two scores that averaged the 28th percentile, with those low average and deficit range scores being largely in speed of information processing, motor speeds, and visual and/or motor performances. For instance, in a combination of visual and a motor skill, the scores was 7.98 standard deviations below average, a very severely impaired score. There were also, in this same vein, a high number of visual or speed or memory scores that were well below average, despite the patient's high IQ scores, as follows:

• Motor speed and dexterity for the four scores averaged at the 9th Percentile
• The working memory scales averaged in the 5th percentile
• Regular memory scales averaged at the 7th percentile
• The TOVA's six scores (on attention) averaged at the 6th percentile
• The Halstead Impairment Index (acceptable as evidence in court) featured a finding of 50% of those very sensitive scores (to brain injury) were impaired.

SUMMARY AND RECOMMENDATIONS:

"The patient has TBI from the motor vehicle accident of 3/19/14, as documented and described above. The patient will have a series of and continuing treatment needs that will persist until treated. This recommendation would be for the patient to receive that treatment, especially at the Brain Rehabilitation Center, where the specialty there is in visual perceptual processing, and motor and sensory functions. The patient would benefit from evaluation and treatment with the treatment services:

• Occupational Therapy (Finally!)
• Physical Therapy for balance and vestibular function (Check!)
• Speech Pathology for memory, information processing speed, and accuracy (Ongoing)
• Vocational Services, for return to work and return to school (Ongoing)
• Rehabilitation Psychology, for awareness, education, adjustment, and PTSD treatment."

WHEW! 

I found it all quite repetitive, but maybe the insurance claims adjuster needs things spelled out to him thoroughly and often (I still can't get over how he sounds like a stuffy-nosed high-schooler). 

The Doctor said that brain injury survivors don't have to be retested because their improvements are marked by their behaviors. I can tell you right now I'm a heck of a lot better than I was a year ago, but still there's so much room for improvement. I hope.

Kathie Martin, Vocational Therapist, says that I've pretty much done the bulk of any potential improvement already, so I need to start thinking in terms of only part time work with disability payments to pick up the slack. I listen to her and I know that she is someone who considers herself to be a realist. 

But I still stand by this Wayne Dyer quote...