Mark Fox

In a life divided by "before" and "after," the contrasts are striking.

Before, she would sit at her computer and type the assignment for law school, then read through it a couple of times, making small changes, before printing it out to turn in. After, she labors and labors, each revision making it worse, unless she makes the effort — and it's hard! — to outline everything.

Before, getting ready to go somewhere was automatic. After, she uses a checklist so she remembers to shower before she brushes her hair.

She looks the same as before, and she's just as smart, but after a car crash, she has subtle, nonetheless life-altering, brain trauma that has destroyed some of her short-term memory, wreaked havoc on her organizational skills and annihilated the ability to organize and automatically break tasks into logical, doable parts.

She needs help moving on, and that's the topic of Saturday's Deseret Morning News/Intermountain Health Hotline — rehabilitation after a brain injury. From 10 a.m. to noon, speech-language pathologist Mark Fox and Barbara M. Bills, certified employment specialist, both of Intermountain Outpatient Neuro Rehabilitation, will take phoned-in questions on recovering from brain injuries.

It can happen to anyone, and people wrestle daily with the aftermath of stroke, traumatic brain injury and related conditions. Some had auto or pedestrian crashes. There are folks with football and soccer injuries, concussions, falls. Alcohol and drug abuse can create significant cognitive disorders, as can carbon monoxide poisoning, near drownings and other assaults on the brain.

Increasingly, experts also are learning to deal with the result of injuries from shockwaves, such as blasts suffered by soldiers and civilians in war zones. And for some, there was nothing dramatic, just a long line of little knocks that were cumulative in their damage to the brain, says Fox.

People who talk casually about concussions, he adds, miss that cumulative component. "It's only a concussion" actually means "it's only a brain injury, because that's what a concussion is. It may be temporary or permanent, but it's a brain injury."

What's hurt is usually not intelligence, but rather the processes that allow one to efficiently use that intelligence: how to do things logically, pay attention, multitask, screen out distractions, access recent memory. Organization and sequencing take a big hit, as can putting information together in a usable format. Some lose their inhibitions and ability to read social cues, so they have trouble with relationships and say and do inappropriate things. Judgment is impaired, and communication may be difficult. Social isolation is not uncommon.

It's a frustrating, sometimes intermittent set of problems that can leave very intelligent people feeling stupid, Fox says. And while lots of resources are available for physical damage, most people not only don't have ready access to professionals who deal with the brain-injury aftermath, but also face a world that says they just need to pull it together. And it's exhausting.

The good news, Fox and Bills agree, is that many skills can be relearned. And experts can help brain-injured people develop strategies to compensate for what's lost, from checklists to planners, project worksheets and assignment tracking sheets.

"It has to be individualized to different people," Fox says, taking into account what they need to do and what skills have been sabotaged by injury. Sometimes he helps patients break tasks into components.

By far the biggest challenge is making peace with the fact that an individual is not the same as before. "It's not just an attack on how you do things, but an attack on who you are," he notes.

The other major challenge is external. Because people look the same, they are judged by people who do not understand what has happened to their brains. "They get beat up over and over again emotionally. 'You need to try harder.' 'You can do this; the doctor said you're fine."'

It can be slow going. Bills and Fox both have clients they've worked with for months, or even years, sometimes intermittently. But things do get better, once someone is willing to face the challenges and the changes, Fox says.

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