Corey’s first day at the Carrick Brain Center was filled with intense testing.
She began at 11am with a VNG test (Videonystagmography (VNG) evaluates the movements of the eyes as they follow a moving target or as the head is positioned in different directions in order to locate functional or cognitive brain impairments in the vestibular system and the associated vestibulo-ocular reflex.).
Corey sat in front of a large screen monitor wearing goggles that had a camera attached to view/record each eye. A “cross target” was centered on her pupil. The cameras were wired to a computer. Corey was instructed to look for a yellow dot on a black screen. There were going to be several different tests moving the target up/down and left/right with varied speeds. There were two rules; 1-don’t move her head only her eyes to follow the dots motion and 2-try not to fall asleep (the young technician was actually quite funny. He set the expectation and explained each direction clearly. Corey was at ease with him).
A second series of tests consisted of a BRIGHT blue screen with yellow lines that moved rapidly both horizontally and vertically. (this test caused a bit of anxiety for fear of initiating a seizure but Corey handled it well)
The results were immediate and not surprising. The impact of the initial injury was to her right. The force of the impact caused her brain to move left, right, front, back and spun within the frame of the skull. This is called DAI; diffused axonal injury with a global sheering. The axons were severed from the force of the hit. Here’s where it can get confusing…the right side of the brain controls the left side of the body. Corey’s injury was worse on the right side which is why her left side is still weak and slower to strengthen. What we learned today was the force of the impact also affected the center core of the brain as well. This information is not new but it was thoroughly explained to us for the first time.
Corey’s vision test showed her eyes move in a smooth direction from left to right, but the motion from right to left caused several breaks. The eye actually moves in short spurts as it tries to move left. It pings or ratchets back and forth rather than smoothly transitioning. The muscle is trying to move left but the brain is sending the signal to go back to the right.
This will be the first critical hurdle to overcome. Why? It was explained to us that this information leads the team to the vestibular center of the brain at Nerve 8. The vestibular is typically known for balance. You can’t walk before you can stand and you can’t stand if your eyes can’t focus and your inner ear fluid is compromised! We also learned that this nerve is one of the primal nerves developed in the womb. In addition, this area also regulates blood pressure and oxygenation to the brain as well as balance.
Corey’s next session was cognition tests. This part was very unsettling for both Corey and me. Corey had a series of exercises on a computer to track long and short term memory and timed responses. Good news Bad news.
Corey remembered how to use the desktop mouse and could independently read and answer some of the questions when the font was large enough.
When I read the instructions for each sample exercise, she scored perfectly.
If I did not read the instructions, read the list of flashing words, random sketch drawings and color sequences, she failed each independent exercise.
It was very, very upsetting to sit and silently watch her struggle. Her memory loss, extremely slow processing and response time, plus her mental fatigue caused her to become frustrated and feel defeated. She was unable to complete the tests. At one point she leaned across to place her head on my shoulder and verbalized her struggle. It nearly broke my heart to hear the words she used to describe how she felt about her inability to perform the exercise. The tests were aborted but fortunately, the team quickly adapted. The tests could be completed with a one-on-one approach using auditory questioning as well as the use of manipulative’s.
Corey’s day closed with an evaluation with Dr. Ross and Tram, his technical assistant. Dr. Ross’s evaluation lasted almost 2 hours. We reviewed Corey’s history, the intake forms, the test results, physical and neurological exam, and the initial plan for the upcoming week based on today’s results. There will be a 4 component plan to begin her program. Each component will work towards the initial list of goals from our first Carrick post. We will write about each component as she uses them in each upcoming session.
Side Note; when Dr. Ross reviewed Corey’s history and rehab to date discussing all her accomplishments, he turned to her and commented, “Girl…you are bad ass!” Corey looked at him surprised at first but then smiled and owned it! It was one of those rare moments I will never forget.
Tomorrow Corey starts at 9am for Session#1. At 11am she will be meeting with a metabolic specialist. At 2pm she will close the day with Session #2.
Day 1 complete, xoxo