Lungimsam, early on after my 8th+ concussion, I was told I needed cognitive 
therapy at least three times a week. I also did vestibular therapy. 
Essentially these therapies all tried to recreate the circumstances of life 
in an artificial environment and try and get me to do what I couldn't do. I 
saw multiple problems with this approach. First, the cost to get me to, 
through, and home from each therapy session was significant. My wife had to 
drive me, taking her away from her work at home for at least three hours 
(90 minutes of driving plus an hour there), my cost in brain energy (I 
didn't have enough for the rest of the day, and needed time to recover for 
a week plus, but was being seen every other day during the week), and the 
cost of repeatedly focusing all that brain energy on what I couldn't do. If 
it helps, the main issues I experience with my brain injury are various 
cognitive deficits, including little short term memory, variable brain 
fatigue due to inability to filter out sensory input, and constant 
neurological vertigo on two axes (like being in a twirling, twisting seat 
in a roller coaster that goes any direction at any time).

I realized I had the perfect "therapy" environment at home: young kids 
often creating chaos. I created a "sanctuary" so I had a place to go and 
recover as needed (it also became the place I learned to go before my TBI 
rage hit, when I was getting over stimulated). I also focused on things I 
could do rather than things I couldn't. a minute or two with my kids (this 
has expanded over the years to being up to an hour at times with the wee 
ones, we have four now, and doing multi-day bikepacking trips with the 
older ones), hiking, running trails, and biking remote roads and trails, 
writing, reading, etc. What I discovered is that by focusing on what I can 
do and what I love doing, I engage my brain, accomplish something real, and 
also push the periphery of my capacity, developing new pathways. Also, my 
vestibular therapist early on said he'd done all he could for me and the 
best thing I could do was continue to hike my mountain trails.

I've come to call this approach chronic brain injury recovery (though it 
seems to apply to any chronic health issue), and now understand that the 
medical world is completely geared for acute care of trauma, including 
their therapy, which is why it is geared and focused wrong for chronic 
recovery. At some point early on (3-24 months) in an injury like this, 
there is a shift from acute recovery to chronic recovery, and the approach 
also needs to shift. Instead, the system keeps people in "acute therapy" 
too long, everyone gets frustrated by their lack of progress, and they get 
told their healing has stopped, they're as good as they'll get, or that 
they're regressing. Nonsense!

The end result of this approach after 13 years is a cumulative effect from 
a multitude of baby-step miracles that individually may not seem like much 
(though they each have made an enormous impact of our family's quality of 
life), but looking back at where I was 13 years ago the difference is 
stunning. A lot of the improvement is due to coping strategies (I can run 
and bike despite the vertigo not because it has improved any, but because 
of deeply developing my proprioceptive system by going barefoot.), but a 
lot of these improvements are organic to my neural structure either healing 
or developing around the damaged areas. I look forward to seeing where the 
next 13, 26, 41 years take me! Grin.

With abandon,
Patrick

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