Tuesday, October 09, 2007


The wonderful folks at Medscape bring an article detailing a questionnaire which NCNeuropsychiatry P.A. has made available on-line to medical personnel which their patients and/or family members can take. It has 207 questions which are correlated to groups of symptoms and specific conditions indicated by them.

The questionnaire is notable for traumatic brain injury patients because it includes a short test for problems related to concussion. Results below for a fictitious patient who presents with moderate disability from a traumatic brain injury have been directed pasted from the test site:


[end of cut and paste from site]


It is noted that report of symptoms does not indicate that the patient has or doesn't have any of the conditions associated with them. Some patients may over-report symptoms and some others may under-report. The test results of the fictitious patient above may indicate perception of mild problems with attention, mood stability, fatigue, and sleep. The symptom clusters aggregate into a possible clinical picture of the presence of post-concussion difficulties as well as mild autism and Asperger's. An experienced qualified clinician can utilize the testing results in fact gathering and diagnostic interviewing. Because the patient can re-take the test throughout treatment as well as at termination, there is a direct way to measure any progress in reduction of symptomology.

NC Neuropsychiatry P.A. offers evaluation, treatment, and medication management for those people who have symptoms of a variety of disorders including but not limited to serious psychiatric conditions, learning disabilities, cognitive impairments, A.D.D. ad A.D.H.D., and broad autism spectrum disorders as well as traumatic brain injuries. Clinicians are researchers as well as qualified specialists and the practice also offers clinical trials.

The website itself is easy to read and easy to navigate. From the well-written section on traumatic brain injury, I found that traumatic brain injury is one subset of acquired brain injuries. The practice also offers for purchase a series of tests which measure things like working memory, ability to shift tasks, and flexibility in cognitive tasks. The tests may also be accessed from a computer [the clinician can download a complete battery] and norms are included. The series of tests together is referred to as the CNS Vital Signs Assessment Battery. The things that the tests propose to measure have implications for traumatic brain injury patients and for those with mild cognitive impairments, A.D.H.D., and stroke.

The subject of words, definitions, and labels has recently come up in two e-lists I belong to which deal with brain injuries. One of the ideas that was expressed was that researchers are only in it to "make a name" for themselves thus they have a vested interest in the nomenclature associated with brain injury.

From my own perspective, it is vitally important to recognize the medical terminology associated with brain injuries. Common civilian words that are used to describe brain injuries and the effects of are not adequate when reading peer-review research studies. The N.C. Neuropsychiatry P.A. website illustrates the commitment of the researchers associated with that practice. Doctor Johnson has a long list of publication credits and Doctor Gaultieri's is even longer.

Researchers do not work in ivory towers. With the increasing religiosity inherent in the U.S.A. government decisions of who gets what funding as well as competition for research dollars, researchers by and large do have to possess a commitment to the subject of their research as well as to displaying verifiable results.

I encourage anyone reading this who is a medical consumer with a specific chronic condition or disorder to familiarize yourselve with medical terms and research protocols. Medicine continues to advance at a rapid pace. We can become our own best advocates if we are willing and able to gather information in order to communicate intelligently with the professional helpers on our medical teams.

Financial Disclosure: sapphoq has never been a patient at N.C. Neuropsychiatry P.A. located somewhere or other in North Carolina. Neither they nor Medscape paid sapphoq for the nice things she said about them. Thank-you.

Saturday, October 06, 2007


That excitement of finding new places or re-finding old ones.
Pieces of me scattered in places I had never been.
I set off in April alone to find those pieces and indeed
they have been found. I knew. Never any doubt or question.

In my brain, I have snapshots of the many places I've been.
Places I have loved and places of tragedy or apathy.
Sacred places and places that have lost their holiness to me.
I have lived and loved and died many times over.

I have always been able to navigate through fairly well even those cities which I've visited after lapses of decades.
I remember how to get around neighborhoods and I can still see houses, apartments, stores, trees.
There are very few maps in my world; and very little need to ask strangers for directions.
An acute sense of direction combined with almost no sense of distance and a marked indifference to time.
Time leaks onto the fabric of the pages of my life,
muddying the words therein. I can still sing the words and I do.
I can read upsidedown with no problem.
I can write with two hands in various combinations of left, right, forward, backwards, rightsideup, upsidedown.
These things I have always taken for granted.
A long list of "Can't everyone?"

Just like the phone numbers from childhood and the addresses I can still recall.
First memory-- learning how to walk. And the revelation of a secret tryst inherent.
I was on the second floor of a house being encouraged by an old Italian man with missing fingers
to walk around the coffee table with no hands to steady me.
That old Italian man turned out to be the father of my step-father.
That is how old the affair of my mother and step-father was.
She was still married to my dad at the time.
From that memory, I understood how the two of them had met.
My mother had happened to hire an old Italian woman as a babysitter.

Odd. Almost everyone with a traumatic brain injury winds up with deficits in memory.
I am not one of those. I tested in the 99th percentile in both working and long-term.
My t.b.i.-er friends all tell me that they can't remember. I can't forget.

I did forget for a time who I was before my brain injury.
I could not describe my self pre-bonk.
And then random memories of my life began to return at random times.
Not anything I'd been counting on or even expected to happen.
More memories to add to an already bulging mental scrapbook.

Oh, I did forget how to cook.
The burnt pot of wilted herbs in a smoky kitchen told me so.
Cooking, like so many other things now, not automatic pilot.

I cannot take much for granted.
No. Having walked with death, I've been catapulted into life.
Vision like a permanent acid trip took some getting used to.
The world was too fast. I got used to my own pace, my own music.
I've "adjusted." Those who say otherwise know not of what they speak.
Yes, today I can describe my character traits before the accident.
Today, that doesn't feel important.

My mother told me when I was moving out, "You can never go home again."
I thought that meant she would not take me back in. I was too traumatized to care.
She had lost me through her abuse years before I was able to leave her house.

I understood a different meaning to not going home again many years later.
That people and places change, that my memories of those people and places
were expected to dull to inaccuracy, that returning does not render magical healing of heartbreak.
She was wrong.
So fundamentally wrong
in ways that I cannot explain and don't want to.

I have gone home again.
To places where I had never been before.