Half a year

I have now been concussed for six months. It has been a long half-year. My brain has done a fair bit of recovering, and at least the constant headache is gone. It still hurts when I overexert my brain and I’m still easily overwhelmed by visual and auditory stimuli but overall I feel that I’m getting better.

Over the past week I went through three days of comprehensive neuropsychological testing. The goal of the testing is to determine objectively how well my brain functions in various ways: memory, reasoning, sensory perception. Some of the tests were easy, while others were designed to be difficult or impossible even for people who aren’t suffering from a traumatic brain injury.

First day of testing. The test itself began with a simple interview: What hand do I use to throw a ball? open a door? use scissors or a hammer? operate a computer mouse? The technician timed first how long it took to write my name with my dominant hand, and then with my non-dominant hand. The upshot of all this is that I’m mostly right-handed, with some tendencies towards ambidexterity. This didn’t tell me anything I didn’t already know.

There were several different memory tests, all of which I found extremely difficult. For the first test I was shown ~15 word pairs on a computer screen. The computer then showed a series of words and I had to record whether or not they were on the original list. Then I would be shown one of the words from the original 15 pairs and had to choose which word from a list was its pair. These word pairs returned to haunt me several times during the morning. As I worked through the other tests I was interrupted after a 20 minute interval to ask how many of the words I could remember; I was also given a second set of words and told to keep them separate from the first. Then I picked up where I had left off and worked for another 30 minutes before being quizzed on the word list. I was given a word and asked if it was on the first list, the second list, or neither. Yikes!

The tests all started easy and then got progressively more difficult. One of the first tests was shape recognition and matching. I was given a set of identical blocks, each with two solid white faces, two solid red faces, and two half-white and half-red faces divided along the diagonal. Then I had to look at red and white shapes in a notebook and recreate what I saw using the blocks. That was fun.

A slightly different test involved looking at patterns (say, a red triangle within a blue square within a red circle) with a chunk missing and choosing the piece that completes the image. The tricky thing about this test was that the options to choose from were all rotated out of position, so I had to be able to flip them around in my brain to see if they would fit. At first the missing chunks were easy to find, and then the images themselves and the missing pieces got more complicated. I had to guess on many of them.

One of the hardest parts of the day started out pretty innocuously. I was asked to repeat series of numbers (integers from 1-9) after having them read to me. Two numbers, three, four, five, it wasn’t too difficult even when the string was ten digits long. Then the test started over, only with me having to repeat the sequences in reverse order. That was easy until the string was about six digits long, then it got exponentially more difficult. I’d repeat the sequence in my head as I heard it (5, 8, 2, 5, 9, 7, 4, 4, 2, 6, for example) but when I had to start from the end and work backwards I’d have no idea what the first numbers (8 and 5) were. For the last part of this test I had to take strings of numbers and recite them back in numerical order. This also started easily but got increasingly more difficult. The really strange thing about all of this was the manner in which my brain failed. The missing numbers simply weren’t there. I’d remember the first several digits, then there would be nothing. I could have made up something but it would have been a random guess.

After 20 minutes of this I had to go back to the original memory test and list as many of the words as I could.

There was a section of verbal math problems. You know the type: “Jenny has 14 apples and gives two to each of her three younger brothers. How many apples does she have left?” And: “An item’s original price in October is $150.00. In November the store discounts the price on the item by 10%. In December the store adds another discount of 25%. How much does the item cost on December 31?” I had to solve these entirely in my head, without writing anything down. Sounds easy enough, doesn’t it? And it would have been, if my brain were working properly.

The other math problems were more fun. I got to dust off my old arithmetic and algebra skills and see if they still worked. How long has it been since you did long division by hand, or divided fractions, or solved problems such as: (x+2)(3x-14)=6? Or multiplied 6932.35 by 217.08? I mean, we can all do that, right? It just takes a little practice to remember how to do it. And I got to use pencil and paper, which helped a lot.

There was a standard vocabulary and spelling test. I think I nailed that part. There was also a list of common knowledge questions:

  • Who was the President of the U.S. during the Civil War?
  • On which continent would you find the Sahara Desert?
  • What is the capital of Italy?
  • Who was Catherine the Great?
  • At what temperature does water boil?
  • What is water made of?

and so on.

The most difficult part of the test was the last bit. This section evaluated my reasoning skills. I was given a keypad with the numbers 1 through 4 and told that I would be shown an image on the computer screen that would hint at one of the numbers. If I keyed in the right answer I’d hear a nice ‘ping’ and if I got it wrong I’d get a nasty ‘blat’. There were seven subtests, each consisting of a series of images. The same reasoning worked for an entire subtest but not necessarily for any subsequent subtests. In other words, once I worked out the reasoning for subset #2, I couldn’t automatically assume that it would work for subset #3. And there’s no going back, so I didn’t get to try multiple reasonings on any of the images I got wrong.

As usual the first subtests were pretty easy. I’d figure out the reasoning for one subtest and apply it for the first entry of the following subtest. If it didn’t work I’d have to figure out something else to try. By the last two subtests I was randomly guessing. I couldn’t for the life of me figure out what was going on with any of the images. Occasionally I’d get one right, but every time I tried to use the same reasoning on the next image it was wrong. It was extremely frustrating and made my head hurt. A lot. The psychologist told me he knew I was getting frustrated but reassured me that my failures were giving him useful information. I sure hope so.

Second day of testing. This was much easier and less taxing, although I don’t know how well I did. Once again we started with a memory test. This time I was shown a drawing and asked to copy it on a separate sheet of paper, about the same size as the original. Then the original was taken away and I had to draw the thing from memory. This was much harder than it sounds. As in the memory test on the first day I had to try to draw the diagram from memory at 20 and 30-minute intervals.

There were several sensory perception tests on the second day. I was tested for bilateral sensitivity to touch on the backs of my hands: With my eyes closed I had to say whether or not I felt a touch on my left hand, my right, or both. There was a similar hearing test.

The most fun was a test to see whether or not I could tell if two rhythms were the same or different. I thought this was very interesting, because I realized that if two rhythmic patterns have the same beginning it’s not easy to tell if they’re different at the end. For example:

| | | ||| | | |

sounds more similar to | | | ||| | ||

than it does to || | ||| | | |

I had to stick my hand into a curtained box, and the tester put a wooden block into it. I had to determine what shape the block was, then use my other hand to point to the correct shape on a card. I did this with both hands.

A related test for shape recognition ended up being a lot harder than I thought it would be. I was blindfolded and a vertical wall was placed in front of me. There were shapes carved into the wall (I couldn’t see them, of course) into which wooden blocks would fit. I was given a “tour” of the board with my right hand, and then told to find the blocks on the table in front of me and put each block into its correct shape using only that hand. The shapes I remember are square, circle, oval, star, triangle, large parallelogram, small parallelogram, half-moon, and trapezoid (I think, not sure about that one). I’d be interested to know how other people worked this puzzle. I did it by picking up a block and holding it in my hand, then using my fingers to find the shape on the board. I think some people might determine a shape on the board and then go hunting for the right block. I can’t say that my way was the best, but I did eventually get all the blocks matched up correctly. It went faster with my left hand because I already had some familiarity with how the board was laid out. But I thought it would be a cake-walk when I got to use both hands, and it totally wasn’t. Maybe it was too much sensory input at one time for my brain to make sense of.

After the board was put away I was allowed to remove the blindfold. Then I had to draw the board, including the shapes in their respective places. I don’t think I did very well on this part.

The last test of the day was one of those T/F personality tests. I was instructed to answer the questions as they applied in the last month or so. There were several questions about drugs: Have I ever lost track of time due to drug use? Has my personality changed since I started using drugs? Have I used illicit or illegal drugs in the last six months? Has my drug use affected my relationships with friends and family? It wasn’t hard to figure out what those questions were angling for.

Third day of testing. Today was the last day of the neuropsychological workup, and it was the easiest. It started with a casual interview, to provide a description of the accident and my early injuries. Then I took a long version of the T/F personality test. I had to answer only 360 of the 500+ questions, which was good because many of them were very unclear. I was finding it difficult to make sense of statements such as “I always regret never having done such-and-such when someone told me not to.” Uhhhh. . .

Then we got the What It All Means debrief. Since I don’t have the full written report yet I can’t give you the long version, but the take-home message is that: (1) my verbal skills are still really good; (2) my incidental and working memory functions are average, probably less good than they should be; (3) I don’t have any major deficits at this point but the ones I do have seem to result from injury to the left side of my brain.

One result I found interesting was this timed finger tapping test I did last week. I had to tap a digital counter with my index finger as many times as possible in 10 seconds. With my right hand I got 57 taps in 10 seconds, and with my left hand I did the same. Apparently right-handed people should be able to tap faster with their right hand. So either I’m sort of ambidextrous and my right hand isn’t as dominant as it is in other right-handed people, or my right hand is somewhat impaired and should have tapped more than 57 times in 10 seconds. On the other hand, 57 taps in 10 seconds is pretty high for anybody with either hand. Given other indications of minor injury to the left side of my brain, a minor impairment on the right side of my body makes sense.

In terms of how to assist my brain in its recovery, the psychologist suggested continuing to do what I can, as long as it doesn’t cause my head to hurt, then to respect my brain’s limits. At this point overdoing it could set me back. In a nutshell, I continue to rest and not overexert myself.

With the analytical part of my left brain not quite up to speed, this afternoon I decided to exercise the artistic right side and made a little drawing:

Persimmon

 

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