Question re stress and TBI
 

I have a question regarding how stress effects your TBI. I had been diagnosed with PTSD but had been doing much better. Unfortunately this year I received
3 concussions which resulted in many neuro problems, such as weakness in one hand, word finding problems, fatigue, balance problems. memory...you know the list goes on and on. I have a psychologist that insists that I have had no concussions (yes they have been diagnosed by others) but since my symptoms get worse under stress, my problems are ALL due to PTSD. So the question is, doesn't your TBI symptoms get worse under stress when the environment demands fast paced and multi tasking work with times of high sensory demand? Thanks, lynn

lyndianne,

Yes, Yes, and Yes.

Stress is very detrimental to PCS. The stress hormones and neurotransmitters get all out of balance in a super sensitive brain that is common to a post concussion brain.

There are also strong links between PTSD and PCS. They tend to magnify each others symptoms. This has been soundly observed in vets returning from Iraq.

Many psychologists ignore or have not read the research that suggests that PTSD causes physiological changes (damage) to the brain not unsimilar to the damages caused by a concussion. They can see changes in function during a fMRI study.

You asked, <doesn't your TBI symptoms get worse under stress when the environment demands fast paced and multi tasking work with times of high sensory demand? >

The multi-tasking alone can overwhelm a PCS brain. The fast pace alone can overwhelm a PCS brain. The high sensory demand alone can overwhelm a PCS brain.

You are hitting the trifecta with these challenges.

I would highly recommend that you try to find a psychologist who has a stronger understanding of and belief in concussion, especially subconcussive PCS, who can then tailor your therapy for the PTSD/PCS combination.

Many psychologist have a very high criteria for a concussion based on old school concussion ideas. They may consider anything that did not cause Loss Of Consciousness (LOC) or sustained concussion symptoms beyond the first few minutes to be a non-concussion. Recent research is showing that there are sustained 'post concussion like' symptoms resulting from sub-concussive impacts that need to be considered.

You can also do a bit of research on PCS and PTSD, especially regarding vets. Dr Robert Thatcher and others did extensive research at the Bay Pines V A Hospital on Florida. Here is a link with some info on him: http://www.scientificartsfoundation....ge/3529693.htm
Maybe one of his listed published articles will have some better info for you.

I know I have read articles by Dr Thatcher and others about this but do not remember if I have a reference filed somewhere.

My best to you as you struggle with this denial syndrome so common in the professional caregivers to the PCS community. Most of us have been in your shoes.

YES! Stress makes my daughter's PCS symptoms considerably worse. In some cases, she totally shuts down and just sits there in a ball. When it's really bad, her arm will start to temor.

I agree with Mark - find a pychologist that understands PCS and PTSD.

Your psychologist is an idiot. Get a better one ASAP.

I got my PCS in a terrible accident, so of course I've got PTSD, too. PTSD aggravates PCS, it doesn't cause it. The other thing bad/lazy clinicians will tell you is that you've got PCS symptoms because you're "just" depressed. No, I'm depressed because I have PCS. Anyway, you get the picture. Finding clinicians who understand our condition has been a struggle for pretty much all of us here. But I digress...

Yes, stress makes it worse. At bad times, I have found myself in the fetal position on the floor unable to function. I also find I stress far more easily than I did premorbid. Making even small decisions is difficult. Before my injury, I was cool as a cucumber. Now I get anxiety and panic attacks.

Cheers

psychologist
 

hi and welcome

stress yes my wife says my night fits get worse with stress and thats a physical response HUH

psychologist and people in general when it comes to brain injury, seem to be limited by there experience PTSD many of us have on top of our TBI and or PCS and of course the GP,s or PC doctors favorite Depression a nuro psychologist is probably the one ,who best understands what has happened to us, but may not be best placed to help with the living with it, but better able to diagnose the area of damage, some maybe gifted in this area too, I think all of us have been through or are still going through these hoops

I have 3 titanium plates in my head and look ok but know exactly were your coming from , with the you should be ok syndrome

as you can tell from the reply,s to your post ,we understand !

You guys rock! I actually was given a neuropsych eval at lovely Kaiser by a intern and a student. She said my cognitive scores were too low because I wasn't trying. She said I wasn't trying because I didn't draw my lines quicker even after she told me to. DUH, I can't draw them faster!!!!
You all are so right. I will definitely look for a different psychiatrist.
The people who REALLY understand have been chiropractic neurologists. They have been AMAZING and without the care I have received from mine I would be lost. Thanks again!

lyndianne,

I had a neuro-psych assessment by Kaiser in Sacramento a few years ago. The NP was doing his neuro-psych internship/residency. He was an idiot. He chose to not include the scores that went against his diagnosis. He said I was faking it. He blamed my symptoms on depression. But when I got a copy of my scores, I scored 48 and 49 on the validity/malingering tests. 50 is a perfect score and means that I was absolutely not faking anything. The scores that show malingering or faking are in the 30's or lower.

He attempted to do a PASAT, Paced Audio Serial Addition Test verbally with a 'close enough ' stop watch technique. Dr Gronwall developed the PASAT back in the 1970's as one of the first tests for diagnosing Post Concussion Syndrome and her protocol calls for using a tape recording of the audio.

Even the MMPI-II (Minnesota Multiphasic Personality Inventory II) is misused when administered to the probable Post Concussion subject. I have had that used to mis-diagnose me.

One of the problems with neuro-psych assessments is very simple. If you score well on the WAIS (Wechsler Adult Intelligence Scales) scales but do poorly on the other tests, they blame your low scores on faking or malingering. I have had two different NP's disregard the validity scores that conflicted with their diagnoses.

On the Trail making test, it is common for the NP to improperly score them. If the A test is in the lower normal times but the B test is in the higher normal times, this discrepancy points to a cognitive problem with switching. I had to look back to determine what number or letter I was looking for. My tester tried to hurry me up too. The test protocols call for the tester to prompt the subject about errors or such but not to discount the effort. If they could just see what our eyes are doing as we search back and forth for the next target....

It is amazing that some NP's have the boldness to state in their report, "Contrary to the scores in the ..... test that show low indicators of depression... the subject's primary problem is depression. This is due to the subject's purposeful lack of effort, despite his strong showing on the scales for effort. " My first NP assessment in 2002 was supposed to last two days. It was finished by 2:30 the first day. The NP still charged the employer for the full two day battery claiming he spend two days testing me. He billed the employer almost $4600 including an approved extra fee for extra pages in his report. He mistakenly included his letter that mentioned being authorized for his extra fees beyond those authorized by Work Comp fee schedules. Do these NP's think we are dummies?

The non-neuro-psych psychologist who assessed me for Social Security Disability in two hours did a better job. He actually understood concussions. But he could not write a decent report.

So, be very careful about who you let assess you. It is difficult to overcome a biased or poorly presented assessment.

Glad to hear you found a Chiro who understood concussion. A friend with a moderate concussion had a mental melt down in her chiro's office. Her vital signs went haywire. He did not have a clue what to do. Unfortunately, he was her primary physician in a Work Comp case. He controlled who could examine her. He refused to let her see an MD.

intelligence
 

just a point to add

intelligence vs lost of executive function, slow processing, memory white outs . ect ect ect

lost of executive function is a kind of apathy its not depression it just an,t there

slow processing, is exactly what it says on the tin

memory white outs brain stops thinking

oh and instant memory , what was that ????

intelligence can remain unaffected by loss of function they are not one and the same

I was lucky to have one of the best neuro-psychologists in the country do my testing. This one had enough smarts to realize that I wasn't malingering on the intelligence test where you have to replicate a pattern with blocks. I just have such poor visual memory that I couldn't keep the image I'd just seen in my mind when I looked back at the blocks to move them.

This is not a test that should be administered by interns or idiots.

Hockey,

Isn't it amazing how few people can even begin to understand how a person can have no visual memory?

To those of us with visual memory deficiencies, "Out of sight, out of mind" is a entirely true statement.

I am working on some Posit Science brain training programs In one, I need to pick the target from among a number of distractions. I have a hard time remembering what the target looks like as compared to the distractions. They are both birds with the same silhouette but the colors are different. I struggle to remember what colors I am looking for.

My first NP did not understand what was happening when I became overwhelmed by the noise of a leaf blower outside the office window. He also thought my comment about struggling to stay focused on him because of all of the plaques on the wall behind him was odd.

We need to remember that some professionals are the best that the insurance company's money can buy.