I am 7 months post-TBI, having given myself a concussion and frontal lobe contusion getting into a car. In the last few months I have felt markedly better, but I have been noticing that I feel worse, often for days at a time, after bumps and jolts to my body/brain. Most recently, someone slapped me on the back very hard, and it seemed to have aggravated my symptoms.

I am questioning whether this increase in symptoms is real, or simply a product of my anxiety regarding future injuries to my brain. I would be interested to hear the experience of others in coping with what I view as inevitable shocks to the body as one returns to normal life.

AaronS,

Welcome to NeuroTalk.

There is no way to tell if this return of symptoms is due to physical trauma or anxiety. For many, from the way they comment about their symptoms, I believe it is anxiety.

How do you know you suffered a frontal lobe contusion ? Did you get an MRI or CT Scan that showed damage ?

What have you been doing to help your brain recover ?

Mark, thanks for the reply. I have had multiple MRIs showing damage to my left gyrus rectus. My original neurologist continued to call the lesion a contusion, even as it did not heal or change from multiple scans, but my new neurologist has told me she is certain it is all scar tissue/shrunken brain at this point.

As far as my recovery, the first month after my injury I was unsure what I was dealing with, and as a result I oscillated between work and rest. After getting my first MRI and seeing the damage, I immediately went on disability from my job and got as much rest as possible. About 5 months post injury, I still felt many cognitive deficits with little improvement above how I felt 1 month post injury. This led me to seek a new neurologist.

That neurologist, who I referenced above, referred me to a neuropsych and physiatrist specializing in brain injury who I now see regularly. Their approach is different from my first neurologist, who emphasized rest. They have had me pushing my boundaries and doing "work-like" activities to build up my mental stamina.

After about 2 months of that, I have had a lot of improvement in my cognitive function. I am now set to go back to work part time in June. I generally feel good, but these jolts throw off my mental state and confidence. I have a history of anxiety, so it's hard to know whether what I'm feeling is psychosomatic or not, but I try to return to the same tasks and take note of how well/poorly I perform as a way of reassuring myself that I haven't re-injured my brain.

Micromanaging ever little symptom is a losing game in my opinion. It only feeds anxiety. Anxiety can be two fold. There can be the psychosomatic anxiety but often there is a physiological response from that anxiety. So, learning to not be anxious can reduce triggering symptoms.

I and many others do not agree with the push the boundaries approach, especially if pushing the boundaries causes fatigue and symptoms. I also do not agree with the total rest approach. There is an in between approach.

First, you identify your symptoms, limitations and triggers as real and valid. Then, you use them as a starting point, not a point of deficit. No fighting against them or taking at attitude of "When am I going to be back to normal ?" This is your new normal. You start from here. Your learn to manage triggers, sound, light, work-load, etc so that symptoms are reduced to a manageable level.

This often requires learning work-arounds and other coping mechanisms. Then, within this framework, you attempt to move forward in small steps. Acknowledge each small step or accomplishment as a positive and celebrate it, even if that improvement does not last. Again, no negative "But I only accomplished X when I used to be able to accomplish XYZ."

Every gain, no matter how small is a positive. Every set back is a just an opportunity to start over and avoid pushing the limits. One of the goals is to overcome the anxiety of feeling like you have failed. Anxiety slows recovery. Rather than beat yourself up about causing a relapse, a simple "I'll need to try to avoid that" and "How can I learn from this and move forward ?"

For me, it was usually a "Woops, I'll probably pay for that." and then when and if I do, I expected it so it's no big deal. No anxiety. Just a lesson learned.

Another goal is to learn a new way of living. Chances are we will need these skills the rest of our life. Maybe not day to day but often when we have experienced stress or are taking on a stressful event.

Did you have a full NeuroPsych Assessment and what did the report say ?

Have you had a follow up NPA to chart your improvements ?

How did you hit your head so hard to cause such damage ?

Thanks for the advice, I'll try to keep that in mind. Perhaps I over-emphasized the "pushing" aspect of my doctors' advice -- basically I push myself to do the most that I can handle, without making myself feel so poorly that I have to refrain from activity the rest of the day/week.

I have had a full neuropsych assessment done, about 4 months post injury. It says a lot, but mostly identified problems with inhibition, attention, working memory and processing speed. It recommended stimulants, which my old neurologist was pushing me to take. This is party of why I switched neurologists -- I felt it was too early to be masking symptoms to try to get back to "normal." Even so, the new team treating me has recommended stimulants as I prepare to go back to work at the beginning of June.

I haven't had a follow up to that neuropsych evaluation yet, as my neurologist said she doesn't order them any sooner than a year after the initial test because anything intermediary would be too influenced by testing bias.

As far as my injury, people are always incredulous when I tell them. I hit my head on the door frame getting into a van -- the way one would when you move your full weight without realizing something is obstructing your path. My doctors tell me that the contusion, and my lengthy recovery is atypical for the kind of accident I had, and suggest it may be a result of prior, undiagnosed/asymptomatic brain injuries to the same area of the brain (left frontal lobe).

I am trying to adjust to a new way of living, but I have retained enough function that it is hard for me to let my old self disappear. Returning to work in June will be a sort of crucible, as I have a demanding, cognitively intense job. Still, I am hopeful that going back to work will give me confidence in my abilities.

Thanks for taking the time to consider my fears, dispense advice and learn about me. I appreciate it.

I disagree with the level of pushing. Instead, my suggestion is to learn to recognize those early signs that you are approaching your limit. Needing to reread a line of text, struggling to focus, and a myriad of other signs of fatigue are signals to take a short break. Just a few minutes break can make a big difference. Your brain does not heal/recover when it is needing to recover from pushing just a bit too hard. The goal is to maintain that level just shy of pushing too hard and as soon as you notice the tipping point, stop and take a break.

If your job is cognitively demanding, you will desperately need these skills when you return to work.

I have caffeine tablets in the cabinet. I occasionally need 1/2 of an 80 mg tablet to break through the slow processing. What stimulant did they suggest ? Are you taking it ? Many suggest limited use of stimulants, just to get started.

Your NPA show problems similar to mine. Did it say whether your memory issues are more visual or auditory or both ? How did those functions compare to your intellectual abilities ?

I am not surprised to hear the neuro thinks you may have had a pre-existing injury that got aggravated by your impact. I thought so too but was hesitant to make such a suggestion.

You might want to consider whether a cold hard return to work is best compared to a measured slower return to work. I take issue with those who set dates far in advance of evidence to support such dates. Goals are great but setting timelines without qualifying factors along the way tend to be problematic.

My original neurologist suggest Adderall and my current physiatrist prescribed Ritalin, which I have been reluctant to start taking. He prescribed a very low dose, 5mg, to start.

As far as my NPA, my auditory memory is better than visual, but both are considered poor for my education level and premorbid functioning, which was rated in the superior range. My divided attention is particularly bad.

I should have been more explicit regarding my return to work. I will be coming back part time (25 hours/week). My employer (consulting firm) has been understanding so far and I am hoping that they will be able to accommodate me with reduced hours if my output quality starts to suffer. Unfortunately, being client-based, we are always working around other peoples' schedules and don't often have the luxury of setting our own.

What do you think of Ritalin? I've been prescribed it for daily use.

Personally, I would not touch Ritalin. Forcing the brain to do something it is not ready to do is not good in my opinion. But, there are many doctors who claim to use Ritalin successfully.

Does you job require meeting with multiple people at the same time ? You may find you get easily overloaded when there are multiple voice in a conversation. You should look for opportunities of such conversations to see how you do.