Thursday, June 7, 2012

The unexpected effects of short-term (working) memory loss

(Please forgive my laziness in posting an article before it is properly documented.) 

One might reasonably think that anyone capable of writing blog entries surely cannot be severely disabled. In fact, I question myself a lot of the time. I started seeing a counselor a couple of months ago primarily because I had difficulty believing my own limitations. I thought surely there must be something else going on. How is it that I can write a meaningful essay or research paper, but I struggle to create an outline? Why did I have no trouble doing my own taxes, but a simple cancelation form for an online service was impossible?

One answer is, much of the work I do derives from long-term memory, and my long-term memory appears unaffected. Topics I have previously considered are already outlined in my long-term memory, and essays seem to write themselves as I sit at the keyboard. It takes longer for me to document references than it takes me to write a paper. On the other hand, outlining a paper has proven nearly impossible for me, because outlining involves working with ideas in short-term memory.

Another issue with short-term memory is the affect of interruptions. When an unfamiliar form requires information I am not accustomed to reporting, lack of short-term memory can make the task impossible. Especially if other interruptions present themselves, the time it takes to find an answer can cause me to forget why I needed that answer. Since my accident, it has become common for me to locate an object such as a book or a file, only to have no clue why I needed it. Worse, if there are secondary interruptions, I may lay the file aside, and not recall that I had it. When I eventually come back to the task, needed items are not where they go, and the task has become more difficult to complete.

Solutions
             One Thing! 
I have a couple of solutions for problems like these. My counselor suggested that I only create work lists with ONE THING on them. I use 3x5 cards for my one thing “list.” Additional notes have to do with those tangents that imposed themselves on me as I was completing my ONE THING. Another work-around is to encode audible memory into visual memory. Once encoded, visual memory is faster, and it can hold more information at a time than audible memory, but often the mental overhead of encoding will cause details to be lost.

Find ways to use existing symbols to reduce the overheard. Visualize fractions as slices of pie rather than keeping numbers in mind. Use the first random image that comes to mind to visually record names. The other day, during a neurological test, I was asked to keep three words in mind, “Chicago, power, and table.” I pictured a table saw with a “Chicago” album in place of a blade. Several days later, I still remember the words I was asked to recall.

Regarding outlines, I have found mind-maps to be a helpful way to pre-organize information for an outline. Mind-maps are like a brainstorm on paper. Write a main idea, then write connected ideas around those ideas, and draw lines to connect those ideas. Use pictures with your words. Mind-maps rely on visual memory along with audible memory. My short-term memory deficit is in audible memory, but my visual short-term memory seems to be fine. Your situation may be different than mine, but your individual strengths are also different than mine. Combining different kinds of memory will help you.

Simplify and declutter
I have been simplifying the way I file information. I used to maintain complex and redundant folders of information so I could have multiple ways to access information, but even with a healthy brain, the indexing of information became a nearly full-time job. Consequently, NOTHING got indexed much of the time, and my secondary method of filing everything together based on the date tended to override more meaningful methods of filing. Now I try to limit folders to three categories based on the book “The art of getting things done.” (cite)

Toss, Archive, Hold
My three categories, which I got from Life Hacker (citation) are 1) toss, 2) keep forever, and 3) hold for a while. The “hold” category has two sub-categories: the things I want to work with soon, and the things that are waiting for action by someone else (and may need follow-up).

Use Tags, not Indexes
Instead of indexing items by topic, I borrow Google’s concept of tags to categorize items for searches. Tags should broadly answer the familiar “who, what, when, why, how much” questions. They may include project names. They may include the context where the work will be done. It is good to create a few tags and use them often. It is good to limit total numbers of tags. Ideally, everything should have at least three tags, and nothing should have more than five tags. When you file documents, look for a “tags” property. Most modern software includes tags. Every photo needs a date, a place, and names of people. Every letter has a reason it was written, a recipient, and a sender, and possibly a company name. Files stored with tags can be searched in most modern operating systems. You can also use a cloud-based system such as Evernote(citation) to keep all files organized and available across multiple platforms(cite life-hacker).

Kinds of Memory
Most people have strong audible and visual memory (cite kinds of memory), and to varying degrees, use both kinds of memory all the time. Other people may find that textures and smells may be better ways of storing short-term information. Recognize your own learning style, and incorporate what you know about yourself to actively make what you learn a part of yourself. I believe there is another “learning style” that is so basic and so universal that it is often overlooked: social learning.

“Social Synapses”
I believe that our social connections are primary to thinking and memory. Discussing ideas, whether in a serious academic discussion, or in a wise-cracking informal context, can make connections between you and other people that are like having additional synapses in your own brain. Students who routinely study with a group, discussing ideas with each other, make “living” connections, and associations with the material they are learning. Our brains are wired to value other people. Social learning motivates the brain, and information is stored with a social dimension that cannot be duplicated with solitary “dead” learning (cite a social learning source). When you are struggling with memory issues, make use of other people as a resource, like a “back-up” of your own memory, but don’t ask others to remember for you. Do your own work. Instead of asking for facts, discuss shared ideas and experiences that will awaken your own mind, and your own memory.

Tuesday, June 5, 2012

Distinguishing normal anxiety and symptoms of an anxiety disorder

Immediately after a brain injury it is normal and understandable to feel embarrassed about mistakes that would not have been made prior to the injury. Under such circumstances, It is normal to avoid situations that would expose weaknesses that did not exist prior to the injury. However, if those new behaviors persist and become habitual avoidance of routine aspects of life, the avoidance can become worse than the situations that trigger the avoidance. The following was clipped from the website of the International Association of Anxiety Disorders:

(“Understanding anxiety,” 2010)
Reference:




Monday, May 28, 2012

Sleep As An Droid Android App Review


I'm always looking for ways to objectify the information I report about my recovery, since symptoms of brain injury can affect perception of those symptoms. I recently found an android application that interprets sounds I make as I sleep and graphs sleep cycles. I have learned two things from these graphs:

1) I'm not getting as much night-time sleep each as I imagined.
2) Only when I am very well rested, do "standard" 2½ hour sleep cycles emerge.





The review gets a couple of details wrong. The software does provide comparisons of sleep data. It can optionally record when you snore or talk in your sleep. The description I read says the app uses a combination of motion and sound to produce its data, since not all android phones have identical capabilities, the method employed by the app to gather its data will vary from phone to phone.


Thursday, May 17, 2012

Brainstorming About Ideas I'm Considering

As I recover from a moderate traumatic brain injury, working through understanding new limitations, and looking for ways to cultivate positive outcomes from a negative event, I plan to post resources for recovery as I discover them.

Soon, I intend to link a set of static pages with the kinds of resources the title of this blog suggests. I also intend to post a description of the accident (to the best of my ability) that caused my brain injury. That description may take the form of a "first" blog entry. I have written about the accident on a number of occasions, so I have notes I can use to put together something rather quickly. One issue that concerns me about describing the accident is my continuing amnesia surrounding the event, and the discrepancies between what I think I remember and what others reported at the time. I still haven't resolved what I really think about the accident in my own mind. It is safer to say I don't remember, and to report what others have said, than it is to report my own disconnected set of mental images that are inconsistent with each other, and don't fit the observations of others.

I started writing this morning with the intention of discussing the value of brainstorming to overcome limitations with short-term memory, but as I prepared, I found my thoughts are too disorganized to write coherently about a single topic today. Instead, I'll do some brainstorming here, and mention some of the ideas I'm considering.

As I have considered my own situation I have become fascinated by the relationship between problems with the inner ear and a range of cognitive difficulties that are traditionally associated with the cerebellum. Specifically, I am intrigued with the suggestion that inner-ear difficulties that cause vertigo can overwhelm the cerebellum with conflicting data, slowing down its function, and causing a variety of difficulties which fit the general pattern of symptoms I have experienced.


mindmap created using http://www.mindmeister.com

The idea that vertigo and cognitive and sleep issues could be related is exciting to me because it would imply that exercises and meds that are effective in treating vertigo may also be effective in helping my recovery.

References:

Schmahmann, J.D. (2004). Disorders of the cerebellum: Ataxia, dysmetria of thought, and the
          cerebellar cognitive affective syndrome. The Journal of Neuropsychiatry and Clinical
          Neurosciences, 16, 367-378.
 






Monday, May 14, 2012

As I recover... (first entry)

While this May 14th entry was my first blog entry, I intend to create additional prior entries from other notes I created on those days to provide a sequential perspective to my thoughts.

As I recover from a moderate traumatic brain injury, working through understanding new limitations, and looking for ways to cultivate positive outcomes from a negative event, I plan to post resources for recovery and accommodation as I discover them.

One of my new limitations is a tendency to think ahead of my speech, making comments that are out-of-context for those who cannot read my thoughts as I think them. Sometimes entire sentences and words that I believe I have spoken, were not spoken. More often, I speak parts of words, dropping prefixes or suffixes 
as I speak, or even single letters of the alphabet as I write. I have discovered I make word substitutions such as "necrology" instead of "neurology." Since my accident, dropped words are now common in my speech and writing.


Social resources 

One of the most humbling aspects of a long-term recovery is the need to accept the help of others, and to show appreciation for "help" when it goes beyond what was wanted or needed. As I work on this website, expect to see changes as people make comments to help me improve the site and make it more useful.

I depend on others to help me overcome these difficulties with my speech. If others do not make me aware I have said something that makes no sense, then I assume they have understood me. Depending on others to help me recognize errors requires me to contribute to the process by accepting others' misguided attempts to help with a sincerely appreciative attitude. 



Software resources

Just as I depend on others to tell me when my spoken words have not made sense, I depend on software to help me express myself clearly and consisely in writing.

MS Word's document review feature can identify misspelled words and grammatical errors. However, MS Word can be tedious for checking single paragraphs that are common in online posts. SpellCheckPlus.com is free to use, and does a great job of identifying grammatical errors. In a recent email to the company, I wrote:

... I tried using the grammar checker in Word, but word seemed more concerned about use of passive voice than it was in nonsensical word choices. Your software catches my errors, and it enables me to write intelligibly....


Resources:

Nadasdi, T. & Sinclair, S. (2012). Spell check plus. Nadaclair Language Technologies.
          Retrieved from http://Spellcheckplus.com.


Neurology. (2012). Dictionary.com unabridged. Retrieved from
          http://dictionary.reference.com/browse/neurology

.








Friday, May 11, 2012

Something strange just happened.


(Posted 5-23-2012, this note was taken from my journal entry for 5-11-2012 as-written, including some dropped (missing) words which I left to illustrate my on-going difficulty. I did see the error, and I chose not to correct it.

Please be warned the post is about a nose bleed. I delayed going to bed to write a description in the hope that the released pressure would trigger an improvement that I would want to document. Sadly, the day-to-day variance in my symptoms over-shadows any small improvement that the released pressure might have brought about.

I removed the ''
things to discuss with my doctors" link to my medical information that was in the original post. I also re-ordered words in the next sentence for aesthetic reasons.)
Blood in the bathroom sink
(there is no actual blood in this photo)


Ever since my accident, I've been bothered with more sinus pressure than usual, and difficulty with sinus-related headaches. I have suggested to my neurologist repeatedly that I think sinus pressure could be related to the neurological symptoms, but he has repeatedly assured me nothing serious is going on up there. As I taking drinking my bedtime water and thinking about taking some Nyquil for cough and sinus pressure, suddenly one of my sinuses on the left side of my head behind and under my eye released pressure, dumping a large (1/8 cup) quantity of bright red fluid. The fluid had enough blood in it to look very disturbing. I wonder whether this is something serious?



Written Saturday Morning, 5-12-2012
Last night just before bed, my sinuses behind and under my left eye suddenly released a large quantity of bright red fluid too thin to have been all blood. I estimated the quantity to have been more than two tablespoons. I had not been doing anything that could have caused the bleeding. I had been doing some loud forced guttural sounds trying to loosen heavy mucus high in my throat (at least that's were I perceive the location of the pressure that makes me gag if I don't continually work at getting it to clear). Normally several times of doing that will loosen chucks of mucus I can spit. This effect of causing a large quantity of liquid that also contains bright red blood is entirely new.

I debated about whether the incident was serious enough to require an immediate call to a doctor. I decided since there was not actual bleeding, just a single gush of bloody fluid, that I was OK. I should probably maintain a list of things to discuss with my doctors, though.

Thursday, March 15, 2012

Symptoms


(This journal entry was written 3-15-2012 but posted to this blog on 5-28-2012. In spite of the glaring errors, I attempted to catch errors at the time. Hopefully my ability to see those errors now is evidence of improvement. There is a strong temptation to fix the missing or substituted words and the resulting improper grammar, but I think allowing the reader to see the kinds of mistakes I was making may be helpful to understanding this condition. For writing comparison, look at my other blogs such as Big Bad Ideas where I allowed myself to get a little crazy with miscellaneous posts, or Recharge Point which was used to post my thoughts as I worked toward my master's degree in Instructional Design and Technology--specifically designing online courses.)
Sometimes I report symptoms very differently than at other times, because these symptoms bother me to varying degrees from time to time. Some of these symptoms may not be specifically related to TBI, but are associated with my experience after the bicycle accident and head injury. Also, some symptoms are difficult to track, because the symptoms affect my perception of the symptoms. 

Amnesia is a good example of a symptom that hides itself. To be aware of the problem, I have to be confronted with external evidence that I don't recall something I once knew. Examples of evidence I have encountered involve tasks I started only to discover I had already completed the task, such as the work involved in concluding my last week of class after the accident, and two weeks later suddenly panicking because I could not recall completing the previous course. Fortunately, it was a simple matter to look up the work I did, because one of the assignments was posted online. In the first several weeks after the accident, evidence of amnesia was one of my most troubling symptoms. 

Some of my symptoms are difficult to name. Since the accident, I have been confronted with evidence that I never did a task I believe I remember doing. It is my impression that I'm recalling an incomplete thought process in which I started a task with the intention of finishing, but was momentarily distracted. Later, when I review my task list, I mark the item done, believing it was done. I have learned that when facts don't agree with my recollection, that I usually recall a specific image of working on that task, which is the basis of my belief it was completed, but if I try to recall the entire scene, I cannot recall it, because it was interrupted and left unfinished. While this problem may sound potentially serious, I'm not terribly concerned because I can test my own memory and know instantly whether I have a complete recollection of the entire task. If I can't recall every step of finishing, and someone else says I did not finish, then I did not finish. If I do have a complete recollection, then I treat the issue the same way anyone else would, by presenting evidence that supports what I am saying.

Fortunately, most people are flexible enough that an occastional moment of personal reality adjustment is not terribly upsetting to them, and if they aren't upset, then neither am I (to a point).  

Prior to the accident of 6/23/2011, I never experienced episodes in which I discovered I had done work I did not remember doing. amnesia. 

Vertigo is an example of a symptom that comes and goes, and can be disabling at times, but usually is not noticeable. Vertigo can be dangerous because it can cause accidents, especially if it comes on while driving a car. Prior