Inertia: An Obstacle in Goal Setting

By Attorney Gordon Johnson
Call me at 800-992-9447

As big of an obstacle as lack of insight can be in setting appropriate goals, inertia can interfere with setting goals at all. Doug is someone who seems to have fewer goals than his retained intellectual capacity might suggest. While bright, his life is inert. But whether his lack of inertia to change his life is result of an organic deficit from injury to his brain or functional response to the facts of his disability, is difficult to determine.

Doug survived a very severe injury that left him with significant physical limitations, including spasticity and left sided paresis. He can walk only with the use of a cane to and has limited use of one hand. Doug was comatose for more than a month, had several months of amnesia (including a full month of retrograde amnesia) and was in inpatient post-acute rehab until 13 months after his accident. Still, in our interview with him, his cognitive functions appeared intact. For the beginning of the Doug story, click here.

Part of the problem in assessing a severe TBI survivor’s on goal setting, is that to have goals requires an innate sense of optimism that anything can be achieved. Not only does the brain injury change thought and mood, but the circumstances of a life of disability, may rob a survivor of optimism. While I am not sure the degree to which Doug lost either frontal function or hope, it is clear that he see his future as mundane. On his day to day routine:

My alarm usually goes off at 7:30 because that's when I take my pills. They have me taking Depakote every 12 hours, so I got to take it at 7:30 in the morning and 7:30 at night. If I feel a little bit tired I'll lay back down and sleep a little bit. Otherwise I'll get up and, and have a meal that comes during the week from the healthcare center at about 11:00.

Then in the afternoon I'll watch TV and then I'll wait for my aide to come in the evening, you make supper and wait for my aide to come. He comes at 7:00.

I cook my own dinner. I usually cook whatever I feel like cooking. I'm trying to think what the most complicated thing I've cooked. I know I'm pretty well known for making my pizza hot dish and that's a pretty complicated recipe to make.

On his favorite recipe:

You got to ground the hamburger and then you got to boil the egg noodles, and then you got to put the egg, yeah, then you got to put the egg, drain the egg noodles. After you put the hamburger, and you either got to put the hamburger or the noodles on the bottom, I think it's the noodles on the bottom and then the hamburger and then there's two cups of tomato sauce.

Once in a while I'll forget something but, I just feel like that's something normal, that other people always forget. You know, people forget to do something on a certain day. You know, I just think well that's just something, people forget on a certain day.

As one can tell from his explanation of this recipe, his memory functioning is better than one might anticipate in light of his physical limitations and the length of his inpatient rehabilitation. He doesn’t have to write everything down. He made the choice to participate in this project on his own, after meeting me at a support group. He learned about the time for our interview from the facilitator of his local TBI support group and told his aide, who wrote it on his day planner. Doug was on time for his interview.

Doug was wearing a Packer jersey for our interview, which took place during the middle of the Packers’ 2010 playoff drive to the Super Bowl. I asked about the Packers.

It's pretty exciting that they're going to the Super Bowl. I would not have thought they were going to the Super Bowl with 14 players being on injured reserve earlier in the year. It's pretty amazing that they've come this far.

He could adequately explain why Brett Favre (former great Packer quarterback traded before this Super Bowl) might not have been happy about the Packers’ success that year.

Doug says he is on his computer a couple of times a day, even though he can only type with three fingers on his right hand.

I'm checking my emails, I'm checking sports stuff, my scores information, my sports stuff. I'm now on Facebook.

Doug reports few problems with change in routine, distractions. He looked forward to watching the Super Bowl (as he did the NFC championship) in a crowded environment “out in the lobby of my building, because there are a lot of other people that are handicapped.“

The frontal lobes are not just our “executive” they are also are “social” being. Key to continuing recovery after TBI is ongoing cognitive challenges. We believe such challenges can help to rewire damaged circuitry and create a renewed self actualization. Major opportunities to promote re-circuitry of the brain exist in vocational rehab and community reintegration.

Doug might greatly benefit from both, even though he is getting very little of that currently. He had vocational rehabilitation, but it has been years since he has gotten even a whiff at those services. I believe his intellectual functioning is currently at a level that he might be a good candidate for retraining. That wasn’t the assessment years ago he explains:

They didn't think I'd be able to, they couldn't find me a job or wouldn't think I'd be able to work, be able to work a job where I could stand full time.

What about a job sitting at a computer?

Yeah I never thought about that.

Do you have any problems with speech?

Not really.

(The only thing I noticed in terms of speech was that he would often pause mid-sentence, to gather a little momentum, then finish a thought.)

And you can communicate effectively on a computer?

I think so, yeah.

Would you like to work?

Yeah I've always thought about it.

What would you like to do?

I'm not sure.

This is one of the things that vocational counseling should provide, counseling to assist capable people in finding paths to increase capacities. But in the shrinking rehab world, if the brain injured survivor is not a strong self advocate, they will be far down the list of those receiving the services. As one of the most predictable problems facing a survivor is deficits in goal identification and setting, if we don’t provide assistant with that function, the survivor will languish.

One of the lessons of the TBI Voices project is that a lifetime of recovery from brain injury is possible. But the more we understand the disability, the more we must realize that our system must provide guidance for those who have executive challenges.

 

Contact Attorney Gordon Johnson: 1-800-992-9447

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