Energy, Tolerance, Capacity: Self-Assessment Post-Injury

In 1999, Dr. Clark Elliott suffered a concussion when his car was rear-ended. Overnight his life changed from that of a rising professor with a research career in artificial intelligence to a humbled man struggling to get through a single day. In his book, The Ghost in My Brain: How a Concussion Stole My Life and How the New Science of Brain Plasticity Helped Me Get It Back, which you can listen to here as part of a free trial, he describe how it feels to live as a person who has experienced a concussion, who he calls “concussives."

Everyone's capacity for plans changing, learning, increased stress, absorbing new information, workaday projects, and socializing is constantly in flux, especially for TBI survivors. Dr. Elliott, a TBI survivor, used a cognitive battery analogy to capture the structure of recurring setbacks he experienced which left him drained and unable to function, period. He describes 3 batteries that power the brain: Battery A, Battery B, and Battery C.

The only way to recharge is to pause usage of the battery. Sometimes the most productive action is inaction.

Battery A works immediately and recharges easily. B is the first level backup for Battery A, and takes longer to recharge. C is the last level of backup charge, only used after Battery B is diminished. This battery takes less time to be drained and much longer to recharge, sometimes weeks. A healthy brain under normal conditions uses Battery A for all processes.

For a TBI survivor or "concussive," their brain can only use Battery A for a short period before it begins to become depleted. If heavy demands are made on A, its power becomes completely drained and needs downtime before it can continue normal processing, otherwise it Battery B is used. When B becomes drained and has insufficient time to recharge, Battery C is only available for a short period of time. If all Batteries are in recharge mode, it can lead to setbacks requiring extensive time for cognitive rest.

"Self-care is how you take your power back." - Lalah Delia

• headaches become more frequent and intense

• fatigue and body aches set in: this can feel like a fever without actual fever

• diminished speech skills: becomes hard to find words

• eyes become dry/watery and/or vision becomes blurry

• difficulty in making decisions: loss of innate ability to move past information and trigger what should be done

When these indicators are present, capacity is reduced. Another way of thinking about your capacity post-injury is the Window of Tolerance, a concept originally developed by Dr. Dan Siegel to describe the optimal zone of “arousal” for a person to function in everyday life. Arousal is a fancy way of saying that we are awake and our senses are perceiving the world.

How we engage with the world around us opens and closes, like a window, based on what else we are dealing with.

When we are operating within our Window of Tolerance, we are in the zone of arousal in which we function most effectively: able to readily receive, process, and integrate information and otherwise respond to the demands of everyday life without much difficulty. Above the window we are in Fight or Flight mode. Below the window we are in Freeze mode. Experiencing trauma and living with impairments like head injuries narrows our window of tolerance, meaning it is easier to become dysregulated.

Self-assessment is the basis of all self care

In order to go anywhere, you first need to know where you are. Self-assessment is a reflective self-monitoring technique which teaches you about your symptoms in real time as you are experiencing them. And it brings integrity to any self care you do because it gives you language for your symptoms and ways to explain your experience to others.

But what does it look like practically? You can test out either option below to see what feels productive in your body. The most important components of self-assessment are to check in before and after you conduct the middle part of your self-assessment so you can note differences in how your skull, eyes, neck, and mind are feeling.

1. active/engaged

Identify how you feel with key words that come to mind: awake, tired, taxed, refreshed, balanced, thrown off, content, worried. Find the most comfortable seated posture you can on the floor. Support your legs with pillows and blankets. Sit in quiet meditation, watching your breath and letting go of thoughts as they arise. As you ease your way out of meditation, scan your skull, eyes, neck, and mind and see if the words changed.

2. passive/receptive

Take a few moments to note how you feel. This could mean tuning into sensations in your body, and/or your emotions or state of mind. Lie on your belly or side with one leg straight and the other bent and the inner thigh and shin resting on the floor. If you lie on your belly, you will be in half frog pose. If you lie on your side, you will be in the Recovery Position used in First Aid. Bring your awareness into your sides and belly and observe the rhythm of your breathing in those areas for anywhere from 2 - 15 minutes. Then return your awareness to your mind and body as a whole and note any shifts.

That's great Alissa... Now what??

To begin with, set humble goals that you know you can attain and build time for rest into your schedule.

Self-assess before you start working on your goal. Think Challenging but Doable: keep going when you notice the activity becomes hard, but stop to rest before you drain Battery B or dipping into Battery C. This takes practice and trial of different activities to see how they affect your energy.

Self-assess again after you finish working on your goal. Which symptoms worsened? This might help you to know which Battery you are using. Everyone is unique. When I am working in Battery A, I experience headaches, visual disturbances, and tinnitus. Draining Battery B causes cognitive impairment, deep fatigue, and emotional dysregulation. And when I deplete Battery C, I quickly go downhill and experience dark thoughts, chills and muscle aches, and my sense of self-identity starts to slip away. Others have referred to this as “the bottom falls out.” Ideally, we don’t use Battery C except for emergencies. So if you are able to notice your symptoms as they are happening, you might be able to stop when you feel yourself using Battery B.