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Dig Deep: A rehabilitation neuropsychologist reflects on the strength and resilience of people reinventing their lives after a traumatic brain injury.

Dams-O'connor, Kristen Phd

doi: 10.1097/01.NNN.0000472917.13040.d3
Departments: Speak Up

A neuropsychologist reflects on how people with traumatic brain injury reinvent their lives.

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ILLUSTRATION B

I ran cross country in high school, and my teammates and I logged countless memories over the miles we ran. One of my most vivid is the sound of our coach yelling at us toward the end of the race, when our legs were leaden and our resolve was waning. His hoarse voice, straining to be heard over the crowd, would shout: “Dig deeeeeeeep! Diiiiiiig deeeeep!!!

We loosely translated this phrase as, “Run faster!” Hearing these two words usually did make us run faster, but we really had no idea what he was saying.

Now, almost 20 years later, I'm a rehabilitation neuropsychologist working with people who have sustained a traumatic brain injury (TBI). Cognitive rehabilitation is rarely linear or easy. Some people struggle with anger and loss that undermines their best efforts to get better. But I am often amazed by the creative and graceful ways people reinvent their lives.

I once worked with a young woman who sustained a severe TBI after driving into a tree while intoxicated. When she started our program, she told me she did not want to live unless she could finish her college education. At that time, she struggled with even the most basic daily tasks. Over the next several months she made tremendous progress, but she also began to appreciate the importance of being more flexible in setting goals.

Although I never told her she wouldn't go back to college, she became more aware of her new capabilities and decided to focus on other priorities. She told me recently that she appreciates the “examined life” she has learned to lead—one that requires the constant monitoring and correcting of words and behaviors and emotional reactions. In many ways, she says, she is more in control of her life now than ever before.

Another patient, a business executive who was hit by a car while crossing the street, can no longer make complex decisions or pay attention to details. His words are slow and jumbled. His deficits forced him to leave his career, and he became self-doubting and withdrawn. But he was never hopeless. Through intensive therapy, he learned strategies to minimize the impact of his impairments on his day-to-day life. He developed new interests, such as music and painting, and fostered fewer but stronger friendships.

I recently spent several weeks helping him prepare for a wedding he was attending with some former work colleagues. He identified several brief phrases he could use to make conversation, and he practiced saying them slowly and clearly. Just before the event, he confessed that he really wanted to dance with his wife. His balance and coordination were poor, so we decided he would ask his neighbor to help him practice a few simple moves before the wedding.

The following Monday, there was a message on my answering machine. I could hear the smile in his effortful, halting speech. “I want to tell you. I had a great time. I spoke slowly. People understood me. And I was able to dance.”

If only we could bottle the energy that allows some people to negotiate a new life that is truly satisfying. I cannot promise all my patients that things will turn out as they wish, but I can tell them that the human spirit is amazingly resilient. People can (and do) thrive in the face of devastating loss.

In thinking about how to foster hope, I find myself recalling my high school coach's earnest shouts. Now I think I understand the message he yelled when we were at our weariest: I know you think you have nothing left, but I believe you are capable of more. Switch gears. Be strong. Dig deep.

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Kristen Dams-O'Connor, PhD, is an associate professor in the department of rehabilitation medicine and co-director of the Brain Injury Research Center at the Icahn School of Medicine at Mount Sinai in New York.

© 2015 American Academy of Neurology