Chapter 4 - The Claw, Hook, and Broca's Aphasia

 Traumatic brain injuries are like snowflakes, they’re all different but still the same. The way I understand TBI, and explain it, is as follows:  TBI patients don’t regain their lost abilities, as much as relearn them.  The section of my brain that told my right hemisphere what to do doesn't work anymore, because of the blow it took.  So the undamaged parts had to learn how to direct the body's right side limbs. It's a new job for that part of my brain, and although I can now use my right leg, arm, hand, fingers etc. they don't work like they once did.

I didn't look into, or research my disabilities, until several years after my TBI, when I began writing about my experience. The frontal lobe is important for voluntary and planned motor behaviors. I was drawn to a list that describes problems associated with injury to the frontal lobe because I had whacked mine pretty hard. The list told me damage there may result in any, or all, of the following
1.  Paralysis 
2.  Inability to sequence
3.  Loss of spontaneity in interacting with others
4.  Perseverance on a single thought
5.  Inability to focus and express language (Broca's Aphasia.

When I woke from my coma I was certainly paralyzed, on the right side.  But, I came away from the hospital able to walk with a loft strand cane; the tall cane with a strap around the upper arm, midway between the shoulder and elbow, and a horizontal handle to grasp, below the strap.   My right side motor skills function now, but not like they once did.  There is a delay somewhere in my circuits so I limp.  And the hitch in my get along is such that I can no longer run.

They also worked to get my right arm, hand and fingers moving again.  That was occupational therapy's (OT''s) primary goal. I started by manipulating large blocks, and moved to puzzles with large pieces, like my own kids had among their toys.  OT deals with being productive, and I was a housewife, so they must have assumed I baked.  One session of occupational therapy dealt with following a recipe, as well as cutting an apple with a sharp knife.  My family thought the whole activity was crazy because therapists had me holding an apple with one hand, and wielding a sharp knife in my compromised hand!  Today, I am apt to warn everyone in close proximity that I have a knife in my bad hand, and to stay clear!     

If they thought I could cut an apple with my affected hand, why didn't they think I would be able to write with it?  I know they didn't, because they tried to teach me to write left handed, just before my release. I never came close to proficient, and no one could read my chicken scratches, but I continued my left handed scrawl after leaving the hospital because that is what I was told to do. I am, at heart, a rule follower.

My legibility never did improve, and during my 1st year home, the young son of friends visiting, watched me struggle to write notes to myself.  Robert said to me, Why don’t you just try to write with your right hand?

Why didn’t I think of that?  I wondered.  And then I attempted to finish with my right hand. Bingo!   My left hand knew how to assist the other by holding/turning the paper, and my right hand knew how to form the letters.  It took much concentration, at first, but the letters were more legible, and the task was much easier than with my left hand. Over the years, I have gotten pretty good.

I can type now, too.  But, to use both hands and all ten fingers  is very slow and laborious. So, throughout the years, I have perfected unorthodox typing skills.  Mostly, I utilize my fully functional left hand.  My right pointer finger is relegated to hunt and peck, and usually hovers above the right shift key, for capitalization. 

Because my right hemisphere does not work like it did previously, I have come up with tricks to use the disability to my advantage. It is most comfortable for my right fist to be closed and that arm pulled up to my shoulder. My hand remains closed, without thought, so it’s easy to hold things that are easy to lose; like the pencil you need for quick notes, correct change for the snack machine, or the keys to… anything.  Nothing, and I mean nothing, will cause me to inadvertently release whatever I hold in the claw, and once there it will stay indefinitely.  

Also, because my elbow is naturally bent, I can slip the handles of many grocery bags onto the hook, and as long as I even out the weight by carrying something comparable on the left side, I am fairly balanced.  I guess I could say, One really does have to look for opportunities to best utilize what they have, rather than focus on what is missing, but I really was just trying to make my life easier.

Number 2 on the list is inability to sequence, and it continues to be difficult. I had cognitive therapy to deal with this. Those sessions included playing Where in the World is Carmon San Diego on the computer.  I don’t forget the steps involved, as much as I misjudge how long each step will take me. It can take me an inordinately long time to do something I think should be done in a jiffy.  So planning a meal where the food is ready to eat all at once, is not one of my stronger skills.  I’m sure that my head injury plays into that, but I also realize that the desire is not really there.  Hunger is something I rarely feel, but I do eat, and cleaning up, after the meal, is what I am best at.  It’s routine. 

The 3rd thing listed is loss of spontaneity when reacting with others.  This was never a problem, that's how strange TBI's are.  My difficulty is that I am impulsive; I vocalize what is going through my mind, at any given time.  During a physical therapy session with Kyle, I looked across the room at Jim, a therapist who often assisted when more than two hands were needed.  I simply stated, Jim needs a haircut, as his hair was floppy long. You could say my comment was inappropriate, as well as arbitrary, but it brought a smile to Kyle’s face, nonetheless.  He even laughed aloud!  Kyle told me later that my comment showed him I was finally coming around.

Next on the list is perseverance on a single thought.  Although I was always driven to complete what I started, I don't find that to be true anymore. But, I think the perseverance indicated here has more to do with  focusing  on only one unimportant issue, and has a slightly negative connotation.  All I can say about this is that I probably do it, more often than I think, and I know I still struggle with letting things things go.

The list concludes with the inability to focus and express language.  Aphasia is defined by Webster’s Dictionary as …a loss or impairment of the power to use or comprehend words usually resulting from brain damage. Broca's area is in the lower part of the left frontal lobe (exactly where my head was hit) therefore it is called Broca’s Aphasia.  It feels good to know their is a name for what has plagued me since 1991.

The frontal lobe controls the motor aspects of speech so that’s why, especially early on, my speech was halting, and mono tone.  Speech therapy, then, was also part of my daily regimen.  Once home, the daily conversations with my family provided the practice I would need to sound more normal.  I spoke easily to my two young children, and later, I was comfortable talking to my fifth grade students.  Even though my speech definitely improved over the years, I still hate to hear my recorded voice.

My inflection may be right, and I'm not as mono tone as I once was but I’m still a step behind verbally, struggling sometimes to find the words I want.  I know the word is very familiar but I can’t locate it. I pause, as if thinking deeply on the subject when all I’m really doing is rifling through the files in my head for the simple, much-used word I need.  It can feel like I’m wading through sludge trying to reach it.

Close friends, who know my history and feel comfortable with me, often fill-in-the-blank with the word I am searching for.  They are not surprised when I say Can you flip that thing on the wall so that… poof?  They know that I am referring to the light switch, and that I’d like the lights turned on.  Or I give the a brief definition of the word just out of reach and they provide the word.

Not only was my brain's left frontal lobe damaged, the brain stem also took a shot. That's why I see double.  But since my TBI, I've had two eye surgeries.  When I started to drive again, I  wore an eye patch. I didn't want to be caught trying to determine whether the car coming straight towards me, was the real image or not.  I don't  wear the patch, anymore, because now I only see double if I'm very tired or just want to. 

Sometimes I like to show people my weird eyes.  I cover one eye, focus with the other, then uncover the covered eye because then my pupils jump around.   Both of my eyes work, but they don't work together, is how I explain it.  My right eyeball does most of the work, and focuses on what I'm looking at.  My left eyeball looks off to left, but it still can visualize things that are to the right.  It doesn't appear to be looking at what it should be focused on until the right eye is closed.  It's as if my eyes have a brain of their own, that I'm not in control of.

Chapter 3 ... coached, coach·ing, coach·es: to train or tutor or to act as a trainer or tutor

          The pneumonia lengthened my stay in Palmdale, and I spent a week recovering. I needed the extra time though, to gain the skills that would get me transferred to an appropriate facility.  The head injury recovery process  begins in the intensive care unit and moves to a neurosurgical ward.  The patient might then be transferred to a sub-acute unit and then either a long-term acute care facility or a treatment unit.  To Gary, the long-term acute care facility looked like what we used to refer to as an Old Folks Home, and he decided against warehousing me.  He was my strong advocate. Many may not have pushed me towards the recovery I was capable of making.

He educated himself about head trauma, and knew that I needed inpatient treatment in a unit that specialized in that field, and he found Northridge hospital. It had an Acute Brain Injury Rehabilitation Program.  For my doctor to agree to the transfer, though, I was going to need to be able to perform cognitively.

While I ran track at the University of Oregon, my husband played football.  Coaches had been part of our lives since we were young.  I was, basically, an impassive lump of flesh, but I was his wife, and he had seen me train in college and then again while working full-time so he knew I was up to the task.

The cognitive assessment would require me to respond to a verbal command. So that’s what Gary would train me to do.  He prepared me to take a ball from his hand upon his command.  In essence he coached me to that end. During the doc’s formal assessment I was able to respond to his direction so I was sent to Northridge. 

I had hit my head in the left frontal lobe region and as a result lost all motor skills in my right hemisphere.  I also suffered from constant double vision, but that would not be known for some time.  I was not in good shape at all, but I was alive.  The admittance history describes me as a 30 year old, previously healthy female, suffering from an underlying brain injury caused by a closed cranial trauma resulting from an automobile accident.

          For some reason, it feels good to read the residual post traumatic encephalopathy, or brain injury, I was suffering from was of a severe degree.  My athletic soul often thinks I’ve been a wimp, and part of me thinks I should have come further, in terms of recovery.  Sometimes, I still think if I had worked a little harder or put more effort into my recovery, I would be more like I once was.  But, then I recall it was severe and I give myself permission to go easier on myself. 

Upon admittance to the second hospital, he pushed my wheel chair through the hall, and turning into my room I passed by a mirror, or a glass window, and saw my reflection.  A look of surprise registered on my face.  An area of my scalp was shaved to allow for insertion of the pressure relieving shunt, and although the device itself had been removed, my hair line was still uneven.  I have a vague recollection of this, and I remember just wanting to be put in bed so I could sleep

The report also states that I fractured my mandible, and my jaw was surgically wired shut to allow for healing.  When I did begin to rejoin the living, the wiring, as well as the inability to eat, didn't even register as out of the ordinary.  I had a hearty appetite, and loved to eat so the fact food was not a part of my daily life should have been quite upsetting. 

I was in a hospital, unable to speak or move, with no recollection of what brought me there in the first place, and on top of that, I was seeing two of everything.  The two images were not side by side either. Things were really out of sync but I quickly figured out how to deal with the problem.  I simply closed one eye.  Medical professionals equated the one closed eye with double vision but the same experts chose to address other, more pressing problems first.

The more urgent issue I faced was the paralysis of my right hemisphere, so I began with two sessions of physical therapy daily.  My therapist was new to the hospital, but Kyle quickly endeared himself to my family.  He laughed easily, but definitely made me work.  We formed an immediate bond but it was my father’s efforts that brought us there.  

My father was proud of all his children.  We nicknamed him friendly because of he entertained complete strangers with stories of his kids' accomplishments.  Less than 10 years prior to my crash I had been a record setting, track and field athlete at the University of Oregon, and my successes gave him plenty of story material.  He regaled anybody within earshot with my achievements. 

          My father let Kyle know, probably immediately, about my sports accomplishments, as if to say Yeah, she’ll get this taken care of.  We started work on a low, matted physical therapy table, where he began by teaching me to move from lying down to sitting up.  This can be tricky, especially if only half your body works. 

          After transitioning to sitting, we worked on getting on my hands and knees.  That too was challenging as my right hand was closed in a tight fist, as if ready to clobber someone.  Kyle would have to pry my digits open and so that my fist was not clenched.  He would splay my fingers so my palm would rest flat on the surface of the mat.  This hand position is still difficult, many years post TBI.

In the hospital I wore a molded plastic brace, created specifically for me to force my hand to remain open while I slept.  Also, the created a cast for that arm to open it in varying degrees.  My brain would be reminded that the arm was not suppose to be pulled up, and rigid all the time.  They divided my final cast in half so that it could be removed during the day, but I wore it, along with the hand brace, at night. While awake, I had to consciously focus on keeping my hand and fingers as well as my elbow joint, relaxed.

My right side was not just weak, it did not function at all, initially, and when I could actually bear weight and stand upright, I was not able to rely on a walker.  Therefore, Kyle and two other therapists parked me upright, in front of an ordinary shopping cart.  I gripped the handle, as if it were a lifeline and one of the therapists was assigned to my bad leg, one was assigned to the cart, and Kyle was, somehow, in charge of the whole escapade.  To those watching, I am sure, we moved agonizingly slow, but it was a milestone.  Kyle had taken me from doing nothing, to doing something.  To me it was just another day in therapy, doing what I was told to do, with as little back talk, or complaint as possible. 

Along with physical therapy, I also received occupational and speech therapies at Northridge Hospital. Occupational therapy dealt with being physically productive, and the speech work I had also involved working on my cognition; my actual thought process.  That was an area needing help, too. 

KGEZ Radio

I was interviewed this morning on KGEZ here in Kalispell.  Last month I was inducted into the University of Oregon Hall of Fame and it was a bigger deal than I thought and I was hoping the hullabaloo was over after I gave an interview to the city newspaper but then I got the call to come talk to Mike Hodges.  It wasn't that difficult since I've told the same stories for years now, but hearing my voice, pregnant pauses and all, was pretty excruciating.  Yes, I do sound like I've sustained brain trauma, but I appreciate everyone saying I sounded fine.

After hearing myself I realized that I speak similar to the way I walk; slow, and deliberate.  On foot I'm always extra careful to pick the shortest distance between here, and there, and talking live on the radio I had to choose my words carefully too.  I tend to ramble, and it can be hard for me to reach the point I had started towards, and I didn't want to do that to a station kind enough to talk to a mature track athlete who just happens to still hold a record after many years.

The record I still hold is the 400 meter hurdles and for a while I thought I held it for so long because Oregon, in my mind, was always a distance school; think Prefontaine, Salazar or Warren. When I left I held records in the long jump, 100 meter hurdles, and the 400 meter hurdles.  My long jump record was the 1st to be broken, and I don't think I had been gone very long. It was understandable, a Pac 10 (that's what it was when I ran) long jumper really should jump at least 20 feet, and I never broke that barrier.

The 2nd record to go was the 100 meter hurdle mark, and it was broken by the winning NCAA pentathlete  (or maybe she only placed in the top three.)  I thought was justifiable too, as I was never a national champion, or even close, for that matter.

That leaves the 400 meter hurdle mark of 57.0 something.  It still stands, after many years.  I'm not sure how many because I forgot the last time I set it, and I don't feel like looking it up again.  It's a strange event, for sure.  And I was fast in that race because I could hurdle well.  I was an OK 100 meter hurdler, and I never quit running them, and continued focusing on my hurdle technique.  I ran an OK open 400 meters too, but only ran it consistently in the mile relay.  My best was 54 something, The difference in times, between my open 400 time, and 400 hurdles was closer than most.

So that's why I got inducted.  I hold a record I've held for longer than most are held.

The radio show focuses on local athletics; coaches talk about game play and they choose a high school athlete of the week. My interview mimicked my HOF acceptance speech, as I talked about how I got to Oregon, and I now coach at Kalispell Middle School.  I was able to say a lot of my hurdlers are distance runners because I also coach cross country. That makes me laugh.

You should giggle as much as possible, it makes life easier.