Dancing Upside Down

The High IQ TBI

The thing about humans is that (at least prior to a brain injury) we all think everyone else thinks the same way we do. Therefore, if you are bright, dumb, or somewhere in between you think everyone is just like you and that you are nothing special.

Most people do not know they have a high IQ unless they have been told or, in my case, I figured it out by lots of research when I was trying to understand what was going on with me.  Later I found out about some old test scores and then, got scored again as part of the Neuropsych Evaluation when my brain injury was finally diagnosed.

Giftedness is a double-edge sword.  There are benefits that cut one way but difficulties that cut the other.  I wrote a post about the questionable and common overrating of the benefits while ignoring the drawbacks quite a while back entitled: High IQ is Overrated! Or is it?

We are different.  We are misunderstood; even by ourselves.  Maybe misunderstood especially by ourselves.  If we have not known we have a high IQ we have been beating ourselves up for not fitting in.

That their own perceptions and judgments are unusual may have been obvious since childhood, but they may have spent their lives assuming that this difference was a deficit, a fault, even a defect of character or a sign of mental illness (Lovecky, 1986; Alvarado, 1989). Thinking independently may seem foolhardy or antisocial.²

Gifted adults can misinterpret their complex and deep way of thinking as craziness. They can mistake their emotional intensity for emotional immaturity or see it as a character flaw. Because they have never been given information to explain what is "normal for gifted" they frequently experience frustration in the world, alienation, anger, self blame and emptiness. Without an adequate explanation of their gifted difference, they develop a facade with which they cover their authentic self; a face that they show to the world in order to fit in and so avoid disapproval or sanction.³

In fact, I still have a terribly difficult time admitting in here - announcing publicly - that I have a high IQ.  I feel like I am going to get stoned for saying it.  I envision a sea of onlookers heckling me; saying "Who in the hell do you think you are to claim you are gifted?!  You are just trying to make yourself seem special!"  The chorus of all of all my fears, failures, and the difficulties I've had fitting in are shouting in my head.  It is the music we, the "gifted" live with when we do not acknowledge or understand the way in which we are different and how to work with those differences.

We are a minority.  Think about it.  Even if we look at my IQ from the Neuropsych Evaluation that was given after my brain injury, for each person who has the same IQ or higher than me there are over 1000 people who have a lower IQ.  That means that I think differently than the majority of the people I come in contact with .  That can set a person up to be misunderstood at every turn of their life and especially when dealing with a TBI.

I think understanding our giftedness is very important for any person with a high IQ to heal from and live with a TBI.  The very things that make us different are the very things that make our TBIs different.  Having a TBI and a high IQ is a very mixed blessing. 

So, first off, what are some of the characteristics of being gifted?⁴ (No one probably has every single one.)

• perfectionistic and sets high standards for self and others
• is highly sensitive, perceptive or insightful
• fascinated by words or an avid reader
• feels out-of-sync with others
• feels a sense of alienation and loneliness
• is very curious
• has an unusual sense of humor
• a good problem solver
• has a vivid and rich imagination
• questions rules or authority
• has unusual ideas or connects seemingly unrelated ideas
• thrives on challenge
• learns new things rapidly
• has a good long-term memory
• feels overwhelmed by many interests and abilities
• is very compassionate
• feels outrage at moral breaches that the rest of the world seems to take for granted
• has passionate, intense feelings
• has a great deal of energy
• can't switch off thinking
• feels driven by creativity
• loves ideas and ardent discussion
• needs periods of contemplation
• searches for ???? in their life
• is very perceptive

Recently, I have been corresponding with two members on the TBI Survivors Network about the issues we face when we have a high IQ and have a brain injury. 

When a person has a high IQ to begin with, they still have one even though they have a brain injury. We actually don't lose it. Brain injuries are more like holes, big spots missing due to the injuries. But the part that is still intact still has the IQ which is the person's "normal".

Your high IQ is a big part of the reason this is all so painful. You (and I) acutely feel how much has been lost. Or in the words of my doctor "The holes can go deeper you, than for us mere mortals." (Yes, he said that!)⁵

An IQ is actually made up of Verbal and Performance scores. With brain injury there is usually a big gap between the two. There is in mine. There was also a decrease in both of them from what I had tested at pre-TBI, but it is the Performance that really took a dive. It is classic sign of a TBI.  A big part of our frustration is that part of us still tests way up high (the Verbal/analysis part) but our Performance is shot to hell.

The loss of ability is only one of the many things that is amplified by giftedness.  Let's look at the above list with an eye on how a TBI intensifies the characteristics of being gifted.

• perfectionistic and sets high standards for self and others
  

We do not stop adhering to perfectionistic standards for ourselves.  We try.  But it is pretty ingrained in us.  We must learn patience and compassion toward ourselves.

• is highly sensitive, perceptive or insightful

Highly sensitive means highly sensitive in every sense of the words.  Normal (non TBI) gifted tend to be highly sensitive to noise, lights, smell, and touch - to the point of cutting labels out of all their  clothing. 

A TBI increases all of these sensitivities to way beyond bearable!  PTSD does too.  And TBI and PTSD often come together.

I firmly believe that gifted adults and children suffer far more acutely in the area of hyperarousal than someone with a more normal IQ that did not start out as highly sensitive to begin with.

• fascinated by words or an avid reader

Aphasia is caused by damage to the parts of the brain that control language. It can make it hard for a person to read, write or say what you mean to say.  When you have a deep love of words and language it feels like a part of your very essence is missing to not be able to find words.  (I am so very thankful for the power of computers and Thesaurus.com.)

• feels out-of-sync with others
• feels a sense of alienation and loneliness

Heck, that is something anyone with a TBI feels.  It is probably exaggerated in the gifted.

• is very curious
• has an unusual sense of humor
• a good problem solver
• has a vivid and rich imagination
• questions rules or authority
• has unusual ideas or connects seemingly unrelated ideas
• thrives on challenge
• learns new things rapidly
• has a good long-term memory

Most of these attributes change with a TBI.  It changes who we are, how we see ourselves, how we interact with the world and our life. 

One of the biggest difficulties for Gifted/Brain Injured adults is that all of our life we have been able to rely on our ability to pick things up quickly, make the thought connections between disparate ideas, multitask, multi-think . . .  We relied on it even if we were unaware that we were doing so. 

Suddenly those abilities have been stripped from us.  That is huge.  At first we are completely at a loss how to navigate life.  Even with a very mild TBI executive functions involving planning, multitasking, and sequencing are usually compromised.  Because the gifted tend to "coast" relying on the enhances abilities this fall from grace is into an especially deep pit.

• feels overwhelmed by many interests and abilities 
• can't switch off thinking

Again, what is normal to us is only amplified by a TBI.

The way I would describe this for myself is that, yes, I definitely had these characteristics.  But with the TBI, especially before I got help, it felt like all the thoughts, interests, head noise were going all over the place.  It was like pre-injury I had a lot of colored dots swirling around in my head but there was a pattern and rhythm to them. I could somewhat control their path, channel them into useful, productive actions or thoughts.  After the TBI it was like all those dots were still in my head but they were going every which way at a frenetic speed.  There was no rhythm or pattern.  I could not channel them because in the first place the channels were all missing and even if I could grab one ball and hold on to it for a second I would lose the one I thought I had hold of; heck usually I would lose them both!  But they wouldn't entirely go out of my head.  They would stay there bobbing and flying around just out of reach!

• is very compassionate

Here is a key blessing.  Once we really start to get a grasp on what has happened and start to explore who we are now, we can turn our ability to be compassionate inward to ourselves.  Additionally we can also turn our compassion outward to all the caregivers who are working to help us heal and help us to learn and accept this new person inhabiting our bodies.  I think our ability to extend compassion also helps us to be a good coach, friend, and support to others traveling on this bumpy TBI journey.

• has a great deal of energy
• feels driven by creativity

Can you say "Brain Fatigue"?  The lack of brain stamina is horrific.  You think 3 thoughts and feel like you need to go to sleep for an hour; in fact, you do!  It is like taking a car going 120 miles an hour and having it suddenly slam into a solid cliff wall.  Who is this person who can't function and can't even stay awake?

• feels outrage at moral breaches that the rest of the world seems to take for granted
• has passionate, intense feelings
• loves ideas and ardent discussion
• needs periods of contemplation
• searches for ???? in their life
• is very perceptive

Again, I am going to cover this group of characteristics with a broad brush by saying "After a TBI; only more so!"  Because things are out of whack in our brain and our life we can exaggerate any and all of these characteristics.

Giftedness giveth.  Though our giftedness heightens or amplifies the changes due to a TBI, our gift also gives us many advantages in healing and dealing with the daily reality of the TBI. 

I will close with another quote from an email I wrote to a friend on the TBI Survivors Network:

Though the holes can go deeper, for us there is also a great deal on the positive side to having high IQs. We are tremendously  capable of developing good compensatory skills.  We are tremendously capable of using the attributes of our high IQ to help us heal, and develop a life that works. 

It is why I want you to get to a good TBI center. You will be able to take the help they give you and really use it! You'll see. It is not going to make the TBI go away. It is not going to give you (or me) our old self back. But it can give us a life worth living; a life we can enjoy.⁶

Footnotes:

1. The wonderful cartoon "Tis better to have loved and lost your mind" at the start of this entry is by Jeff Gregory of Jagged Smileand is used with permission.  I love his blog and his cartoons! 
2. Stephanie S. Tolan, Discovering the Gifted Ex-Child, Originally appeared in Roeper Review, August 1994.
3. Lesley Sword & David Harrison, Gifted Adults, from the website of Gifted & Creative Austrailia  This site is chock full of information for anyone wanted to learn more about Giftedness in Adults & Children.  I especially want to recommend their Articles page.
4. Lesley Sword & David Harrison, Gifted Adults
5. Emerson J. Browne, private email on the TBI Survivors Network. 
6. Emerson J. Browne, private email on the TBI Survivors Network.

Cliche' to Creativity

What does it take to heal from a TBI? 

What does it take to rebuild a life or to build a new life as the new person one has become? 

   

In an article entitled Deciding to Show Up Barbara Winter writes:

I am reminded almost daily that entrepreneurs think differently than people who are stuck in a job. ... For instance, someone who has a fixed income mentality might dream of traveling and decide to scrimp and save for some faraway trip.  Given the same dream, the entrepreneurs among us will start generating creative ideas that will fund such an adventure – and maybe even bring a profit.  It's the enormous difference that only comes from living your life as cause, rather than effect.¹ 

Most TBI survivors become entrepreneurs of life, if not in business, just out of necessity.  We have to become advocates for our own care.  We have to become educators because TBIs are so misunderstood and, most important, we have to think like entrepreneurs to creatively overcome the hurdles our disabilities have put before us.

In groups like the TBI Survivors Network there are many heartbreaking posts because it is a place where we can be honest about the down days and the tough times, but there are also many stories of success and adjustment.  There are many who, in hindsight, even think they have become better people from the challenges they had to address due to the head injury.  (My jury is still out on that score.  I am still adjusting.)

A friend recently sent me a great article that was, in part, about developing persistence in kids.  

A firm belief that the way to bounce back from failure is to work harder—sounds awfully cliche: Try, try again.

But it turns out that the ability to repeatedly respond to failure by exerting more effort—instead of simply giving up—is a trait well studied in psychology.

People with this trait, persistence, rebound well and can sustain their motivation through long periods of delayed gratification. Delving into this research, I learned that persistence turns out to be more than a conscious act of will; it’s also an unconscious response, governed by a circuit in the brain.

... It monitors the reward center of the brain, and like a switch, it intervenes when there’s a lack of immediate reward. When it switches on, it’s telling the rest of the brain, “Don’t stop trying. There’s dopamine [the brain’s chemical reward for success] on the horizon.” While putting people through MRI scans, Cloninger could see this switch lighting up regularly in some. In others, barely at all.

What makes some people wired to have an active circuit?

... “The key is intermittent reinforcement,” says Cloninger. The brain has to learn that frustrating spells can be worked through. “A person who grows up getting too frequent rewards will not have persistence, because they’ll quit when the rewards disappear.”²

Now, that is an interesting thing to think about on lots of levels when applying it to TBI survivors.  First off, the "switch" is located in an area of the brain that is commonly damaged in TBIs: the orbital and medial prefrontal cortex.  But the key thing is the sentence "The brain has to learn that frustrating spells can be worked through."  Even though we may have damage there, most of us have a brand new, huge, "opportunity" (read: necessity) to work through "frustrating spells" and therefore build new brain cells in that area.  We have no choice but to persist.  Well, I guess we have a choice of sitting around and moping instead of working to create a new life, but most of us do not choose that.

Most of us also have impaired dopamine production.  Since dopamine is the "brain's chemical reward for success" it stands to reason that lack thereof is an additional reason why staying positive about recovery is so very hard in the first couple of years and does seem to improve for most of us over time.  I wonder if part of the reason is that we have to rebuild our dopamine production as well as rewired our powers of perseverance. 

Footnotes:

1. Barbara Winter, "Deciding to Show Up",  Winning Ways, September/October 2009.
   
2. Po Bronson, How Not to Talk to Your Kids; the Inverse Power of Praise, New York Magazine, February 11. 2007
3. Photo Neurons is by ktsdesign purchased from 123rf.com.

Major Depression is Common after a TBI

I have been struck by the number of people posting on the TBI Survivors Network who appear to be depressed.  This concerns me.  It appears they are either not being treated for depression at all or are being undertreated. 

A multidisciplinary team of researchers at the University of Washington just completed a study of 559 adults who have had a traumatic brain injury showing that over half (53 percent) of the participants developed major depression in the year following their injury.  The study was published in the May 19 Journal of the American Medical Association (JAMA).  The quoted text below is from an article discussing the study in University Week.

"We found a very high prevalence of depression in the months after the head injury," said Bombardier, "yet only 44 percent of the depressed patients received antidepressant medications or counseling." This is especially surprising, he said, because patients with brain injury are seen regularly by health care providers in the months after their injury. Attention is directed to physical and cognitive impairments, he noted. Depression is sometimes overlooked.

Psychological impairments represent significant causes of disability in these patients. Major depressive disorder may be the most common and debilitating of these conditions.

... About half of the patients who became depressed were identified by three months. A window of opportunity might be available for early identification and prevention or treatment. They note that the risk of major depression persists throughout the first year regardless of pre-injury depression history, and that risk of post-brain injury depression probably persists beyond 1 year.^1,2

There has also been an ongoing discussion on the TBI Survivors Network about Anxiety. Many of us report a far higher level of anxiety compared to pre-injury. The study goes on to say:

Patients who had major depression reported a lower quality of life, difficulty managing their daily routine, and less mobility, compared to similarly injured patients who were not depressed. The depressed patients also had a nine times higher rate of anxiety disorders, compared to the non-depressed patients.^1,2

I think there can be increased anxiety without having major depression.  I am only surmising that from conversations with other TBI survivors. 

One thing that keeps bugging me is this blurry gray line between "Psychological Impairment" and "Neurological Impairment".  We are talking Brain Injury here folks . . . doesn't it seem logical that the depression, anxiety, and whatever else could be caused solely by microscopic tears in the neural pathways? 

Elsewhere in the article they mention counseling as one of the treatments for depression.  I think counseling is very helpful in helping a TBI survivor deal with the changes that the brain injury caused.  But I am not so sure it is an answer for treating depression.  In fact I see the treatment for depression as separate, very separate, from the counseling.  If the depression is being caused by neurochemical pathway disconnects or poor production of neurochemicals due to the brain injury itself it seems that neurochemical intervention in the form of medication is the route to go.

Now it turns out that the authors of this study are currently conducting another study to examine whether a specific type of counseling called cognitive behavioral therapy is effective in treating major depression after traumatic brain injury.  The study is entitled Life Improvement Following Traumatic Brain Injury but more often called the LIFT study.  I have read the protocol on the LIFT study and my memory is that the cognitive behavioral therapy is being offered in addition to medications.

The article closes with the following:

What is the take-home message for people who have had a brain injury? Fann said that if you can't seem to get out of a sad mood, if you have trouble enjoying things, low energy, difficulty sleeping, or thoughts of dying or suicide, you shouldn't simply attribute those difficulties to your brain injury.

"These are not part and parcel of brain injury," he said. "It's important not to ignore these symptoms, or to assume they will get better soon on their own. If you have had a depressive episode in the past, you might be at risk for a recurrence. Talk to your health care provider and ask about screening and treatment options for depression. Treatment can be effective in relieving your symptoms."

Depression can be tricky to identify in oneself.  And we can fool others because we try to put on a "good face" for people.  . . . But that is a post for another day.  

Footnotes:

1. Leila Gray, "Major depression is common and disabling after traumatic brain injury"University Week (University of Washington) May 20, 2010   http://uwnews.org/uweek/article.aspx?visitsource=uwkmail&id=57994
2. The study team was led by Dr. Charles H. Bombardier, UW professor of rehabilitation medicine, and Dr. Jesse Fann, UW associate professor of psychiatry and behavioral sciences; others on the "Rates of Major Depressive Disorder and Clinical Outcomes Following Traumatic Brain Injury" research team were Nancy R. Temkin, professor of neurological surgery and biostatistics; Peter C. Essleman, professor and chair of the UW Department of Rehabilitation Medicine; Jason Barber, UW research consultant in neurological surgery; and Sureyya S. Dikmen, UW professor of rehabilitation medicine, who also holds appointments in neurological surgery and psychiatry and behavioral sciences.

Dendrite Trails

This blog is almost a year old!  I have personally traveled a great distance during that time.  I started blogging soon after I had been told that I had Traumatic Brain Injury and long before I finally got concrete help.  The earlier posts especially chronicle my journey as I was finally diagnosed correctly and the early struggles I had to understand it and start healing.  I think any person dealing with a TBI will identify with many of the feelings and thoughts I had. 

I encourage anyone new to this blog to skim through the category on Brain Injury and Recovery.  Those posts are the foundation for many of the posts I will soon be writing.  I couldn't be where I am now were it not for the where I was back then! (And yes, I meant to write the sentence that way!!)

10,000 Hours

What does 10,000 hours get you?  It is an enormous amount of time.  It divides down to a little over 19 hours per week if you divide it evenly over 10 years. 

10,000 hours is the "magic number" of practice time to achieve mastery; mastery of anything. 

"The emerging picture from such studies is that ten thousand of hours of practice is required to achieve the level of mastery associated with being a world-class expert - in anything" writes the neurologist, Daniel Levitin.  "In study after study, of  composers, basketball players, fiction writers, ice skaters, concert pianists, chess players, master criminals, and what have you, this number comes up again and again.  Of course, this doesn't address why some people get more out of their practice sessions than others do.  But no one has yet found a case in which true world-class expertise was accomplished in less time.  It seems that it takes the brain this long to assimilate all that it needs to know to achieve true mastery."¹

The above excerpt is from Outliers² by Malcom Gladwell, however the part I quoted is actually Gladwell quoting Daniel Levitin from This is your Brain on Music: The Science of a Human Obsession³.

Gladwell goes on to discuss "prodigies" such as Mozart, Bobby Fisher (chess), Bill Joy (Java, etc.), Bill Gates, and others - all 10,000 hours!  And usually the minimum time to accrue the 10,000 hours is 10 years.  Bobby Fisher is the exception.  It took him only 9 years.

10,000 hours.  Even though that is a lot of time, it gives me hope. 

In the long run what we, the people with Mild Traumatic Brain Injuries, are hopefully doing is developing new pathways around damaged areas of the brain.  In the short run, we are developing compensatory strategies to manage our lives.  But if we work and work at something, for instance making detailed written plans to compensate for the lack of executive functions which include planning and sequencing, will we in time, in ten thousand hours, have developed mastery again?

I don't have the answer yet.  I recently sent an email to the nurse practitioner at the Harborview CORP-TBI clinic asking about about this very question.

... At my appointment on Wednesday with Dr. Zumsteg I asked about prognosis.  She told me that I have probably seen about as much improvement as I will see.  But on thinking about it later, that was not what I was asking.  I don’t think I clearly verbalized what my actual question was.  Therefore, I think my question still remains.  (At least when I do unclear things like this I know you people at CORP understand.) 

I think Dr. Zumsteg thought I was asking about actual healing of the brain tissue, but that is not what I meant.   I know and understand that the brain tissue that was injured is permanently damaged and that those specific areas that are still problematic will not heal. 

What I am trying to understand is what I can do to improve or grow other areas to compensate for or work around the damaged areas.  Or is there no way to do that?  For instance will my executive functions always be this handicapped or over time with working on them will they improve?  Will I forever be struggling this much with depression or over time can the brain chemistry become more normalized? 

I went on to explain how stubborn I am.  I gave an example of how, in my twenties, I had regained the use of my right hand after being told I would lose 75% of the use of it due to a major injury.  In the email I went on to say,

So that is where I am coming from in regards to these questions.  I am older this time around and I can feel that my body regenerates more slowly.  BUT I am still just as stubborn as I ever was!  I want to get more of me back.  I want to get my life to a more normal balance.  I desperately want to be able to work and earn a good wage so I can rebuild my retirement.

The idea of 10,000 hours to gain mastery is fascinating to me on many levels. This is the first of possibly a few posts on the topic.

Footnotes:

1. Daniel Levitin, as quoted by Malcolm Gladwell in Outliers, from This is your Brain on Music: The Science of a Human Obsession.
2. Outliers is Malcom Gladwell's third book.  In my opinion it his best book yet.  It is a quick "listen to" on CDs and a joy since Gladwell does the reading himself.  However, it is best to read the book in addition since Gladwell adds in a lot of side notes that are not in the audio version.
   
3. Daniel Levitin, This is your Brain on Music: The Science of a Human Obsession (Plume/Penguin,2007) This book sounds fascinating but I have not yet read it.

High IQ is overrated! Or is it?

Think about it.  

There are no negative or even neutral words to describe an IQ that is more than two standard deviations from the mean.  People have a High IQ, they are Gifted, Exceptional, Above Average, etc. 

The CIVIQ Society, which accepts people with an IQ of over 145, explains: 

"That high intelligence is a gift with only positive implications is a common misconception: it brings up facilities (talents, strengths and interests) on one hand, but often also specific difficulties and needs on the other."¹

IQ falls in a bell shaped curve with long tails on either end.

Two standard deviations below the mean is considered to be low IQ or mentally handicapped. We accept that people with low IQ fall outside the norm and may need additional assistance to adapt and be successful in society. 

Sadly, the same compassion and understanding does not often exist for people more than two standard deviations above the mean.  The existence of only "positive" words to describe IQ on the higher side is an example of that.

A big difficulty for people with high IQs is that they are sorely in the minority.  Though there is a long tale to the bell curve it is a narrow one.  96% of all people fall within 30 points of the mean IQ of 100.  For someone with an IQ of 146 they are 1 out of a 1000 or in other words for each person with an IQ of 146 there are about 999 people that have a lower IQ. Therefore "gifted" people are very much a minority. The world is not set up for them!  By the term "world" I mean school, the workplace, and even many social situations.  

Plus there is the additional burden of that it is not alright to talk about having a high IQ.  If you mention it you are thought to be boasting.  It cannot be discussed on any sort of equal, unemotional, and realistic footing. In fact, it is considered more politically correct to discuss hemorrhoids than IQ!  So a "gifted" person often struggles in silence; not understanding why they don't fit in and why their experience doesn't match what everyone else is telling them.

"After a particularly tough day of feeling "different", a 9-year-old, who is thinking of going underground with her abilities, says "I don't want to be a purple leaf, when the rest of the tree is green." ¹

And a child describes herself as a cube, "in a world of flat squares." ²

Things are slowly improving in the "Gifted" arena.  There is much more awareness in schools.  Children are tested at an early age for giftedness and there are many gifted programs even in public schools.  There are also many resources on the web for parents, educators, and kids to access.  (See the footnotes below for some links.)

So, back to the title of this post "High IQ is overrated! Or is it?"  I don't know if overrated is the right word.  "Koyaanisqatsi" is a Hopi word. It means "life out of balance".  (It is also the name of an avant-garde 1982 film about the frenetic speed of modern life.)  It is how I feel about the overrating of having a high IQ.  The rating is out of balance.  It exaggerates the positive aspects of the IQ without respecting the difficulties.

Footnotes:

1. The Civiq Society
2. The quotes come from the "You know you're the parent of a gifted child when . . ." page of Hoagies' Gifted Education Page.  Hoagie's is probably the very best site for parents of gifted kids and for the kids themselves.  It is a labor of love done by one couple.
3. The cartoon is by Jeff Gregory of Jagged Smile and is used with permission.  I love his blog and his cartoons!

Heads Up: A Tool Kit for Physicians

Well, this is cool in multiple ways!  First I just found out there is no copyright on Federal stuff.  The reasoning by the courts is that we already paid for it.  (I am not sure why the same reasoning does not apply to states, but it doesn't.)  Therefore I can put this CDC (Center for Dis-ease Control) notice in here verbatim!

The second way that it is "cool" is that this is so very needed.  The article explains it well, but I will add that I am one of the many people who got "missed".  You had better believe that I am sending this on to the Vashon Health Clinic and asking them to order this kit!!

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

An estimated 75%-90% of the 1.4 million traumatic brain injury-related deaths, hospitalizations, and emergency department visits that occur each year are concussions or mild traumatic brain injuries (MTBI).

Many individuals who sustain an MTBI are not hospitalized or receive no medical care at all. An unknown proportion of those who are not hospitalized may experience long-term problems such as persistent headache, pain, fatigue, vision or hearing problems, memory problems, confusion, sleep disturbances, or mood changes. Symptoms of MTBI or concussion may appear mild, but can lead to significant, life-long impairment affecting an individual's ability to function physically, cognitively, and psychologically.

Physicians can play a key role in helping to prevent MTBI or concussion and improve a patient's health outcomes through early diagnosis, management, and appropriate referral.

In response, CDC, in collaboration with an expert work group, has recently updated and revised the "Heads Up: Brain Injury in Your Practice" tool kit. This tool kit is available free-of-charge and contains practical, easy-to-use clinical information and tools, including:

• a booklet with information on diagnosis and management of MTBI;

• a patient assessment tool (Acute Concussion Evaluation or ACE);

• a care plan to help guide a patient's recovery;

• fact sheets in English and Spanish on preventing concussion;

• a palm card for the on-field management of sports-related concussion; and

• a CD-ROM with downloadable kit materials and additional MTBI resources.

To order a free tool kit, click here

View and download kit materials
(PDFs require Adobe Acrobat Reader)

Information for Physicians

• Introductory Letter [PDF 123 KB]
• Facts for Physicians booklet [PDF 4.58 MB]
• Acute Concussion Evaluation (ACE) form [PDF 79 KB]
• ACE Care Plan Work version [PDF 76 KB]
  School version [PDF 78 KB]
• Concussion in Sports palm card [PDF 38 KB]

Information for Patients

• Heads Up: Preventing Concussion fact sheetEnglish [PDF 239 KB]
  Spanish [PDF 219 KB]

MTBI Clinical Diagnosis Guidelines developed by CDC and the American College of Emergency Physicians

View the newly revised MTBI clinical diagnosis guidelines that can help improve diagnosis, treatment, and patient outcomes for the more than one million people who visit the emergency department every year for mild TBI or concussion.

The revised guidelines address the following four key questions and offers recommended courses of action:

• Which patients with MTBI should have a head CT scan in the ER?
• Is an MRI more useful than a CT scan when assessing a patient with acute MTBI?
• In MTBI patients, are brain specific blood serum biomarkers predictive of an acute traumatic intracranial injury?
• Should an MTBI patient with a normal neurologic evaluation and a negative CT scan be discharged from the ER?

CDC's National Center for Injury Prevention and Control-the Injury Center-invites your comments about the "Heads Up: Brain Injury in Your Practice" tool kit. We are especially interested in knowing which materials you found most useful and your recommendations for ways to improve the tool kit. To provide comments, please
e-mail us at ncipcdirinfo@cdc.gov.

Research shows Internet Searching is Good for the Brain

One of the fun (though time consuming) things about writing this blog is all the places it leads me to due to Internet searching. 

For instance in looking for a picture that made a visual statement for my metaphor I learned a lot about Sinkholes and saw some amazing photos of some huge ones. 

I also search to make sure I have facts straight, to check my use and spelling of words, get a quote, look up footnote formatting, etc. I therefore was happy to see that Internet searching may be good for us!

In the News from the Frontier section of the November-December 2008 issue of BrainWork there was a short article entitled "Being Internet savvy may have cognitive benefits". 

"Regularly searching the Internet activates regions of the brain that are known to be involved in decision making and complex reasoning, according to a new study led by UCLA neuroscientist Gary Small.

The study, currently in press at the American Journal of Geriatric Psychiatry, involved 24 participants between the ages of 55 and 76. Twelve had previous experience searching the Internet; 12 were self-described as “Net naïve.” The groups were matched for age, education, and gender. 

... Small and colleagues found that there was a significant difference in brain activity between the two groups during the Internet searching task. The “Net Savvy” subjects showed greater brain activation, particularly in the frontal lobe, which is known to be involved in decision making and complex reasoning. When the Net Naïve group searched the Internet, their brain activity resembled the activity during the reading task.¹

Of course, there is no real conclusion that can be drawn from this one small study but it does lead towards some interesting ideas and hypotheses.  However, I got a kick out of the only one that Small was willing to profess “Probably what you’re going to find from people who work out their brain searching the Internet is that they’re going to be better at searching the Internet.”

Footnotes:

1. "Being Internet savvy may have cognitive benefits" News from the Frontier BrainWork Vol.18, No.5  November 01, 2008  

Journey to the Center of the Brain

This is an excellent talk by brain expert, Vilayanur Ramachandran.  He gets a standing ovation at the end for good reason!  He is a great speaker. 

In this talk he discusses the research being done using specific brain injuries to map the brain but also goes into some fascinating rehabilitation techniques that he has developed.  Especially amazing is the use of the mirror box for the treatment of phantom pain and also for use in stroke rehabilitation.

Vilayanur Ramachandran is the director of the Center for Brain and Cognition at the University of California, San Diego, and an adjunct professor at the Salk Institute. He is the author of Phantoms in the Brain, the basis for a Nova special, and A Brief Tour of Human Consciousness; his next book, due out in January 2008, is called The Man with the Phantom Twin: Adventures in the Neuroscience of the Human Brain.  Newsweek magazine named him one of the "hundred most prominent people to watch in the next century".

I am curious to hear about work using the mirror boxes for stroke patients.  If readers know about stroke rehab being done using mirror boxes, please post a comment.