Friday went well. Corey’s neuro psych eval was 3 1/2 hours long. It’s hard to say it was good or bad. In case you’ve never heard of this type of testing, it is a series of tests that reveal a multitude of cognitive strengths, abilities and weaknesses.
Test 1: the doctor read 20 random words aloud. Corey was asked to repeat as many as she could remember. What’s interesting, the doctor used the same list from our 9/11 visit. On that day Corey recalled 3 words from the initial list. Since that time, we’ve altered her medication. Friday she remembered 8 words on the first round. The test is repeated 3 consecutive times and then is introduced at the end of the session (3hrs post initiation). The subsequent rounds yielded an additional 3 words, some from the bottom of the list. On 9/11 the Dr. asked Corey to recall the words and Corey’s response was ‘what words’? Friday her response was ‘I don’t remember them all’. The Dr. asked Corey to say Yes or No when they were each read aloud at the end of the session. On 9/11 every word was NO or I don’t know; Friday she recalled 13 of the 20.
Test 2: On the lower half of an 8×11 sheet of paper there were a cluster of numbered circles 1 through 8. Corey was asked to connect the dots. This test studies number recognition, sequencing, fine motor control, visual scanning, spacial ratio, following directions and organizational thinking just to name a few executive functions. Major stumbling block…the circled numbers were black ink on white paper. Corey has extreme difficulty processing black on white. She has no difficulty white on black. The world…and every test she had to take on friday…prints black on white. She worked her way through it and completed it without error but very slowly…it was a timed test.
Flip the paper over and there were 25 numbers sporadically scattered across the full sheet of paper also black on white. Corey found number 1 on the lower right corner and started to connect to number 3 just below it. The Dr. stopped her to remind her it needed to be sequencial. Number 2 was on the lower left…Corey has a field cut and can’t see the left side of the paper. We reminded her to scan for the numbers. (another obstacle) Number 4 was at the top left of the paper….She can’t see above midline and didn’t notice the top half of the paper at all. The Dr. decided to forego this test and move on so Corey wouldn’t feel overwhelmed.
Test 3: word recognition. Two columns of vocabulary words from 4th grade level to college level. Corey was handed the paper and asked to read all the words she could. I interjected on her behalf. “Corey needs each word isolated. The list as is, is too overwhelming. When we read, we place a paper above and below the sentence or word to help her focus”. (I’m not supposed to ‘cheat’ or interject but there was no way I was going to let her appear to fail when I knew she would nail the test given the proper modifications). The Dr. blocked each word appropriately and out of 50 words, she missed 6.
Structurally, Corey’s eyes are perfect. Her visual field cuts and limitations for font size and color blocking are neurological. The connections haven’t reconnected yet. Looking back, Corey could type or write any word but couldn’t read the word she physically penned. If we showed her the alphabet, she could identify the letters if they were in alphabetical order but out of sequence she couldn’t identify any of the letters yet could still type and write words. Then one day she could read what she was texting, typing and writing. How did it happen? We have no idea…one day it clicked…that’s brain injury.
Overall, Corey handled the testing with a few meltdowns but nothing close to what Corinne usually displays. That in and of itself is improvement. The Dr. would like to repeat some of her testing but plans on adapting the sheets to white on black. She will be writing up her preliminary report and we will move to the next round of consultation/testing to begin a cognitive therapy plan of care.
Dr. K met us at the end of the day to review Corey’s medication changes and discuss the physical, cognitive and behavioral changes we’ve noted during each week. My primary concern has been the loss of physical function causing a regression in PT. We will be tweaking her levels over the next 3 weeks hoping she regains her strength, stamina and she becomes less sedated during the day. We were also referred to a headache specialist. Corey doesn’t go one day without a headache that ranks a 4-5 up to a 7 on a scale of 10 every single day. No wonder Corinne rears her ugly head…who wouldn’t be fed up living with pain 24/7.
We learned a great deal from this visit. From a behavioral position, Corey is easier to ‘talk off the ledge’ and overall, calmer. From a cognitive position, she seems more engaged and I am noticing Corey displaying a greater sense of self awareness. She recently started to ask, “how do I look, is my hair ok? Do I need lip gloss”? “Does my shirt look nice”? “Do people know why I’m in a wheelchair”? Corey’s injury was global. Every part of her brain was damaged. Each part controls different intellectual and physical functions. Damage to the frontal lobe often causes loss of Executive Function, such as planning and organizing, flexible thinking, monitoring performance, multi-tasking, solving unusual problems, self-awareness, learning rules, social behavior, making decisions, motivation, initiating appropriate behavior, inhibiting inappropriate behavior, controlling emotions, concentrating and taking in information.
Looking at this list, Corey is recently reconnecting several of these functions. Is it medication or the natural course of ‘healing’? This is why professionals say, “if you have seen one person with a brain injury…you’ve seen one person with a brain injury”! There are no two alike and no two will recover the same way. We will forever be comparing lemons to oranges.
What they all don’t understand is Corey will take those lemons and throw them right back at the person that handed them to her! xoxo