For the first couple of months after I suffered the concussion on April 9, I spoke very slowly and with a flattened tone of voice. In order to understand what others said to me, I needed them to speak as slowly as I did AND in simple sentences. However, I wasn’t aware enough to advocate for myself until June, when I started language therapy. Even when I was able to speak a little faster, I was like an old phone battery - I slowed way down when I got tired. By July, when I spoke more like my “old” self, I still wasn’t able to comprehend as fast as I spoke.

What have I learned that I’m using with my students? 1. Advocate and ask people (teachers/parents/tutors) to speak more slowly. 2. Use technology to read slowly for you - ex: Google Read/Write, Speak Selection on Mac, Audible. 3. I knew to slow my rate of speech before I fell, but now I am more consistent in using a slower rate of speech with all students. I hope this will help you as therapists and as parents when speaking with children: Think about speaking like Mr. Rogers to students through third grade. Adults tend to speak about 160 words per minute but even high schoolers best comprehend at about 145 words per minute.

I think of working memory as the notepad in your mind. For example, you use working memory to remember directions and then follow them. With slow processing, often by the time I had a thought, I just blurted it out, interrupting people for fear I’d forget if I waited. I knew I was interrupting - I just couldn’t help it. For at least a month, I don’t think I even apologized for interrupting because it was more to say and I would get distracted and forget. I then learned to write down people’s names and topics I know about them so I wouldn’t forget in the moment of a short conversation, all thanks to my team of SLPs at Rush.

What have I learned that I’m using with my students? 1. Use Siri (or other voice technology) to make Notes or Reminders of things to remember. 2. I cannot think of any strategy to help with interrupting - especially with the combination of slow processing and a deficit in working memory. Try gently reminding your student/child to apologize when they interrupt, and help them notice why they might be doing it. Chances are they are not doing it on purpose. Referring back to Part 1: The brain will be ready when it is ready. But therapy helps.

I think of this to mean that one’s vocabulary is not well organized in their brain and/or the information connected to each word is not rich/deep. Imagine a filing cabinet in which the papers are just stuffed inside and/or each file only has one paper in it. The result is that the person ends up saying “thing” or “stuff” or talking around the word but not getting to it. I used the word “thing” a lot in the first two months, maybe three. In the moment of talking with someone, I felt time pressure and could not use any of the strategies (ex: describing the word I couldn’t think of; thinking in a specific category to help me think of a word) I teach to students! Older students have chuckled at this; other students have been excited that I actually “get it” now. This still happens to me occasionally. My body feels that old reaction of anxiety and is unable to recall strategies. However, my brain is now able to use those strategies thanks to both time and practice (therapy).

What have I learned that I’m using with my students? 1. I refer you, yet again, back to Part 1 - The brain will be ready when it is ready, AND therapy (practice) helps. 2. I continue to use the visual strategy I’ve always used with students to help with category/salient attributes/function. Connected to working memory, the more you practice a skill (ex: using strategies), the more likely it is to become automatic. The more automatic a skill is, the less you have to rely on working memory, which frees up cognitive resources.

October 9 marked six months since I fell and incurred post-concussion syndrome. I’d say I’m about 95% to full-functioning now.

In language therapy at Rush University, I worked on problem solving. Initially, this meant the clinicians gave me a one sentence scenario and asked me to provide 2-3 ways to solve the problem. Three months after I fell, I responded many times with, “I’ve got one idea and that’s it. Let’s move on.” It was very frustrating. Once I started coming up with 2-3 possible solutions, typically the first option was the worst one. For example, one day Pat, my husband, was not home, and I wanted to make tuna salad. Even making something to eat at this point required me to make a list of all the steps. Anyhow, three cans were stuck together. My first solution was to wait for Pat. About an hour later, after snacking on several things, I was hungry. I recalled my therapy sessions to come up with other options. This time, my first solution was to use a knife to pry them apart. I realized that was not a good one; Thanks to the practice in language therapy, I thought about possible obstacles to my plan. I ended up banging the stack on the floor to get them apart.

What have I learned that I’m using with my students? 1. I used to focus on four steps for problem solving including considering the good and bad points of each option. Now, I ask students to think of at least two possible solutions, and point out that first one is often the worst one. 2. Not to sound like a broken record, but reminding students and parents that practice helps and the brain will be ready when it is ready. The tie of therapy to real life really matters. As an adult, I was able to connect therapy to my life at home, but children and teens may not naturally think to ask, “Have I don’t something in therapy that can help me in this situation?” They need the help and practice to apply what we do in therapy to school and home.

This will be my last post about my concussion experience. I hope the information I have shared has helped you in some way. Many thanks to all of you who have been following along.

I think of sensory regulation as being when the sensory systems (think of your five senses) are in sync, alert, and ready to engage. When out of sync, this causes us to dysregulate. For example, if you hear something that is too loud, it can be off-putting, not just hurting your ears. Emotional regulation is similar. If you are in balance, you might feel sad but not sob. I have collaborated with Occupational Therapists for years, and have learned to have sensory options so that students feel regulated, attentive, and ready to work. Sensory options in my office include a chair that rocks back and forth, and thinking putty for fidgeting. When a person's sensory processing is not regulated, this can manifest itself in outbursts, and I have been on the receiving end of such outbursts. Students may holler, push, or act out in other physical ways. However, I did not completely understand why it was so hard to help the students use strategies in the moment. While brain research tells us that the primitive brain (ex: amygdala) can disrupt the thinking brain (ex: cerebrum), I now know firsthand that when your body is dysregulated, you cannot access strategies.

With my concussion, sensory dysregulation surprised me. I recall one day, when I was washing my hands, I realized I must have been standing there for many minutes. The water felt so calming. In another example, the TV in our house was not turned on for months because it was too loud and visually stimulating. Watching it made me feel overwhelmed, not just worsening my headache. Emotional dysregulation was more disruptive for me. I found myself going from zero to sixty emotionally. One night, my husband made some food for me, but he wasn’t hungry. I swore and hollered at him for not eating with me. This is not how we typically communicate. In addition, I cried whenever I felt even a little bit overwhelmed - pushing myself on my walks for PT, seeing a loved one for the first time since I had fallen - and I’m not typically a person who cries. Given my experience with yoga for many years and reminders from therapists, breathing eventually became my “go-to” strategy. However, I was not able to think about that strategy until after I was completely dysregulated (and apologized for my behavior).

What have I learned that I’m using with my students? 1. I work to help students find one “go-to” strategy to become regulated. I used to have them review all their strategies, thinking that one will come to mind when they need it. However, when you are dysregulated, your brain cannot do that work. 2. You’ve read this over and over in my posts…practice, which can be at home and in therapy sessions, helps…and…the brain will be ready when it is ready.