Martelli, M.F. (1998). Idiographic Study Mild Traumatic Brain Injury in a Neuropsychologist: When Patient is Also Doctor. Presented at the 17th annual national symposium, Brain Injury Association, New Orleans.

NEUROPSYCHOLOGIST WITH MILD BRAIN INJURY:

WHEN PATIENT IS ALSO DOCTOR

Michael F. Martelli, Ph.D

In this article, a neuropsychologist examines early and late post-concussive symptoms. The unique findings of a rehabilitation neuropsychologist who specializes in teaching compensatory cognitive, emotional and behavioral coping strategies who sustained a mild, complicated Acquired Brain Injury (ABI) are presented. Issues relating to identification of symptoms via skills inventory, the process of making attributions about many symptoms (e.g., age vs. stress vs. post-concussive vs. pain), the role of information/ preparation by profession, skills repertoire, expectancy and vulnerability/ resilience factors are explored. Finally, the conceptualization of ABI as disrupting essential habits and the application of a habit retraining restorative model is presented, along with a suggestive outline of some of the specific compensatory strategies that were employed to reestablish necessary habits to continue employment, without interruption.

Patient

Accident Details:

Emergency Medical Assessment and Treatment:

Litigation Status:

Initial subjective responses, recollections:

First Discharge Activities:

Early Symptom Course

Early Symptom Course and Late Symptoms (With Compensation)

Identification of symptoms via skills INVENTORY:

The process of making attributions about many symptoms, after an accident and life disruption causes an unexpected and unusual attention to current status, is complicated. When one looks in the mirror, one expects to see a 25 year old. Age versus stress versus post-concussive symptoms, versus pain, represent some of the attributional options.

The following require inferential reasoning with regard to attribution, and remains speculative.

Compensatory Coping

Resilience Factors: Positive Prognostic Indicators

Positive Effects

Outcome

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Martelli, M.F. (1998). Options for Improved Energy / Decreased Fatigue / Improved Sleep HeadsUp: RSS Newsletter, Vol. 1, No. 9 (Dec.).

OPTIONS FOR IMPROVED ENERGY/

DECREASED FATIGUE

M. F. Martelli, Ph.D.

STANDARD RECOMMENDATIONS FOR

IMPROVED SLEEP

M. F. Martelli, Ph.D.

OPTIONAL ADDITIONS (5-HT Loading)

OTHER POSSIBLE FACILITATORS

OR, try all of them in different combinations to try to find a helpful combination.

FINAL OPTION:

Addendum: Boredom is an age old remedy for sleep. Thoughts which alert us (e.g., things we forgot, desirous wishes, etc.) interfere with sleep. Try thinking only boring thoughts. Try to eliminate interesting or alerting or anxiety evoking thoughts. One way to do this if thoughts are especially difficult to stop (e.g., by thought chopping them) is to transform them by controlling your images & thoughts to make them boring. For example, if you are thinking about an upcoming day or events or person, make it or them boring experiences (e.g., the day is rainy and everyone is boring; the person is monotonous and says or does nothing worth paying attention to, etc.

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Martelli, M.F. (1998). Task Analyses: The Foundation of Rehabilitation Strategies. HeadsUp: RSS Newsletter, Vol. 1, No. 6 (Sept).

Task Analyses

By Mike Martelli, Ph.D.

Concussion Care Centre of Virginia (CubeV)

Task Analysis involves breaking any task or chore or complex procedure into single, logically sequenced steps & recording the steps in a Checklist. The checklist allows checking off each step as it is completed. Task analyses always make task initiation, completion & follow through much easier. Performing a Task Analysis and generating a checklist can greatly improve ability to perform tasks in persons with limitations in memory, attention, energy, initiative, ability to sustain performance, organization, or almost any other difficulty.

Task Analysis Checklists are also extremely useful in minimizing fatigue by reducing the demand for, and energy consumed by reasoning and problem solving associated with planning, organizing & having to recall, make decisions & prioritize appropriate steps and sequences for a task. Task analyses are useful for both basic and complex behaviors. Most importantly, Task Analyses allow re-establishing the efficient routines that make up normal everyday human behavior and activity. When the procedures assisted by Task Analyses are repeated consistently, they eventually become automatic [habits] and become as natural as tying a shoe.

The ingredients for rebuilding these automatic habits are the 3 P's: Plan, Practice, Promotional Attitude. The result is rehabilitation, or removing obstacles to independence.

Task Analysis Samples

Single Doctor

Chores CheatList

BATHROOM

Tub and Toilet Floor LIVING ROOM KITCHEN STUDY/OFFICE, DINING ROOM ...

BEDROOM

LAUNDRY

TA Samples: Single Tasks

Weekly Shopping Checklist

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Martelli, M.F. (1999). Fighting Fatigue in Chronic Progressive Disorders. HeadsUp: RSS Newsletter, Vol. 2, No. 7 (Oct.).

Fighting Fatigue in

Chronic Progressive Disorders

by Mike Martelli, Ph.D.

Developmental and Reactive Stresses

For persons with progressive diseases, including, for example, Parkinsons, Multiple Sclerosis, some forms of stroke, and cases of aging for many persons with brain injury, declines in health status represent a major and continuing stress that places major demands on an individual's coping resources. These stresses result from both the declines in functional abilities themselves, as well as the consequences of these declines.

Interventions For Decreased Initiation/Endurance/Energy (i.e., fatigue), Decreased Physical Capacity, Depression, Declines in Cognition & Problem Solving & Socialization

However, compensatory coping is a means of devising new strategies to get around the resulting obstacles

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Note: Strategies referred to in this article have appeared in previous versions of Heads Up and are also included as links on this website (Villa Martelli Iternet Disability Resources), under the "Useful Rehab Model and Methodology" heading links. Email the author ( mikefm@erols.com) if you did not easily find copies.

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