Instructions for Concussion and Traumatic Brain Injury Patients
Steps to Follow Post-Concussion:
See your primary care physician first and if needed meet
with a doctor trained in treating concussions if you find that your symptoms do not resolve within
4-6 weeks (see symptoms list).
Limit visual input. Wear sunglasses outside and indoors
(Solar Shields or FL41 sunglasses to block sunlight, LED and fluorescent lights); Darkness is your
friend.
Avoid TV and limit cell phone screen time.
Rest! Limit all physical activity. Some head injury
patients need to sleep every few hours and this is okay.
Wear a baseball cap outside and in stores, at school, and
in offices. Fluorescent lighting taxes your nervous system.
Wear musician's earplugs (Earasers, found online or
at Guitar Center, work well for many people).
Avoid loud environments like auditoriums and sports
events. Know your limits to being exposed to noise.
Ask for accommodations at work or school.
Know that you can get your life back after a Mild Traumatic Brain Injury
By Cathy Grochowski, May 2019
Brain injury can lead to a real roller coaster of emotions. As one of
Dr. Markus' many clients who sought out her expertise following having read The Ghost in My Brain book
by Dr. Clark Elliott, I was asked to share my story, some thoughts, and potential steps that might come in
handy for you or your loved one moving forward.
My mild traumatic brain injury/concussion took the better part of two years to resolve. It was indeed a long
journey, and I commend you and your loved ones for seeking as much knowledge as you can to do your best to
beat TBI. TBI survivors are a strong bunch, and they need to be their own best advocates.
NEVER GIVE UP, you have the neuroplasticity of the brain on your side! According to medicinenet.com,
neuroplasticity is "the brain's ability to reorganize itself by forming new neural connections
throughout life. Neuroplasticity allows the neurons (nerve cells) in the brain to compensate for injury and
disease and to adjust their activities in response to new situations or to changes in their
environment." If one provider fails to encourage healing, whatever the techniques and tools used, move
on to other alternatives. During the first year of my journey, I learned it took a village to heal my
hurting brain.
A concussion, even a mild one, is a traumatic brain injury. I wince every time I hear someone state "Oh,
it's just a concussion, she'll be fine. I had many concussions and they are no big deal."
Argh! Here's a little-known stat to ponder. Approximately 80% of concussions will resolve within the
usual suggested timeframe of 4-8+ weeks. That's great news! However, that leaves 20% of us (a whopping
500,000 people annually in the U.S. alone) whose symptoms may not fully resolve so quickly or easily. For
these individuals, quite often things get worse in the weeks following the initial insult to the head.
The following is a list of head injury symptoms I endured either immediately or soon after sustaining my
injury. Yes, it's a lengthy list, and no, not every symptom was present from day one. That's a key
understanding that all should be aware of, symptoms come and go and quite often they arrive well beyond the
initial date of injury. I think in my own case, part of my not noticing certain symptoms immediately was
that I had other stronger symptoms that took my complete undivided attention. In hindsight, I'd say I
was "putting out fires" symptom by symptom as I sought relief.
While the symptom list below is lengthy, you won't necessarily experience all of the same symptoms. Use
the list as a starting point to enable you to identify some of your own concerns/struggles. Know that you
can get your life back. Be patient and kind to yourself. Thanks to doctors like Dr. Markus and others, I
experienced a full recovery and you can too!
Head Injury Symptoms:
Nausea
Vertigo or dizziness; loss of balance
Sound sensitivity (hyperacusis)
Light sensitivity, especially to fluorescent lighting
Feeling overloaded/overwhelmed
Difficulty with emergency vehicle lights and sound
Problems walking in wide open areas; on shiny floors; on
"busy" rugs/carpeting; in crowds
Blurred vision/Double vision
Constant fatigue, long naps, sleep difficulties at night
Failure to initiate movement
Depression; mood swings; low motivation
Anxiety, frustration, anger
Hypervigilance, exaggerated startle response
Limited attention or concentration
Inability to follow directions
Poor reading comprehension (rereading the same
paragraphs); memory loss; short attention span
Poor spatial judgement
Impaired depth perception
"super market syndrome" (difficulty walking down
the isles in a supermarket or other store)
"Unsteady-non-specific spatial disorientation"
Feeling of "walking in my own silent movie" (a
phrase often used to describe the disconnect between the individual and the environment)
Inability to watch TV – any fast movement leads to head
pain
Cannot watch commercials (scenes are switched quickly)
Word-finding difficulties
Inability to multi-task or work in transition
A feeling of "Electrical storms" in the brain
Poor adaptation to visually complex environments (patterns
on the floor, high ceilings)
Post-injury amnesia (no recollection of specific
events/activities not connected to original injury)
The Ghost in My Brain: How a Concussion Stole My Life and How the New Science of Brain Plasticity Helped
Me Get It Back
by Clark Elliott, Ph.D.
Dr. Donalee Markus’ cognitive restructuring treatment is detailed in this unforgettable chronicle of
recovery, one that provides a window into the tremendous power of the human brain and offers new hope to
those suffering from concussion and other brain traumas.
The Ghost in My Brain: How a Concussion Stole My Life and How the New Science of Brain Plasticity Helped
Me Get It Back
by Clark Elliott, Ph.D.
Dr. Donalee Markus’ cognitive restructuring treatment is detailed in this unforgettable chronicle of
recovery, one that provides a window into the tremendous power of the human brain and offers new hope to
those suffering from concussion and other brain traumas.
Traumatic Brain Injury Rehabilitation
Responses to the Designs For Strong Minds (DSM)
treatment ranged from participants who could document personal behavior change to others who perceived
change in their thinking styles. (memory, concentration, focus) Participants exhibited improvements in their
communication and decision making skills.
DSM puzzles and the DSM mediation technique are vital tools to rehabilitate adolescent and adults with mild
or moderate post-traumatic head injuries
School systems are willing to provide accommodations to students with brain injury, but often parents are
unaware of what to ask for. According to the Brain Injury Association of America, there are two important
objectives when determining accommodations a student might need. “First, the parents should meet with the
school’s or district’s administration to discuss the situation. Second, a thorough evaluation of the
student’s academic and cognitive abilities is essential to determine what accommodations are necessary.
These evaluations can be performed by neuropsychologists, psychologists, and trained school psychologists.
It is important to consult with an experienced brain injury professional (such as the child’s doctor or
therapist) who can thoroughly document academic strengths, limitations, and recommended accommodations.”
Teachers and other adults at school naturally want to help struggling students. That being said, most
adults are not familiar with concussion/TBI symptoms and will not automatically make adjustments to
classroom activities and requirements once a child returns to school following head injury. In order to
avoid quick overwhelm upon return, parents absolutely should request special accommodations on behalf of
their child. They should consider scheduling a conference with teachers prior to return to discuss their
child’s needs.
School accommodations to consider may include:
Additional time to complete classwork, homework, quizzes
and tests
Completion of tests and quizzes in a quiet environment
with limited distractions or allowing tests and quizzes to be given orally
Extra time for reading, writing, and responding to
questions/prompts
Reduced workload to include only necessary assignments
Seating in a location away from busy and/or loud areas
and/or seating close to the teacher in order to minimize learning distractions
Seating in a location away from fluorescent lighting (or
requesting overhead lighting be lowered or completely off)
Teacher notes in advance or after lessons are delivered
(if available)
Use of a recording device to capture lectures and/or
teacher instructions
Travel to lunch or classes early in an effort to avoid
crowded hallways
Lunch/snacks in a quiet room instead of a busy cafeteria
Being excused from gym (while not all children will
exhibit nervousness or anxiety in gym, excessive movement in busy environments such as this can
greatly exacerbate concussion/TBI symptoms and cognitive overwhelm)
Breaks in a quiet area a few times daily to calm the
central nervous system
Pairing the student with another student in order to
lessen potential anxiety related to missed verbal instructions
A written Individualized Education Plan (IEP) that
explicitly outlines needed accommodations. Avoid placing a limit on how long the accommodations
might be needed as there is no way to predict how long TBI symptoms may persist.
Tools we recommend you use for supporting concussion and post-stroke rehabilitation!
Dr. Donalee Markus created custom mobile apps that target specific parts of the brain to strengthen
weaknesses and create new brain pathways – think of it as cross–training so that you use more of your
brain power.
Your brain is constantly exercising, but how much exercise and what type is key. Your brain trains
through experience and builds its own “muscle memory” – habituates new patterns of behavior. When you don’t
work it, you forget things you once knew, and when you really exercise it, you strengthen what you already
know and develop and create new capabilities. We use puzzles because they are not threatening – they allow
you to play and explore without pressure. And we use visual puzzles because unlike verbal puzzles, they let
you rehearse concrete systems to build critical thinking skills.
These digital brain games can help those with concussion, traumatic brain injury, stroke, and other
neurological challenges gain essential cognitive skills. Everyone can benefit from these braingames!
Strong Mind Puzzles
Strong Mind Puzzles provides progressively difficult variations and requires the participant to
correct their mistakes. This encourages deliberate rehearsal and enhances learning. The rules,
graphics, number of icons, and abstract images become more complex as the participant advances to
higher game levels. Individuals must use the voice in their head to match the goal and complete the
game. The voice in our head (internal dialogue) builds executive skills because it:
Reduces impulsivity
Contributes to planning behavior
Encourages introspection and reflection
Provides a system to generate alternatives
Build working memory
Enhance short-term memory and concentration
Strong Mind Treasure Hunt
Strong Mind Treasure Hunt exercises the ability to view information from multiple perspectives.
The participant:
Compares and contrasts relevant information
Recognizes spatial details in negative and positive space
Gives attention to accuracy and detail
Maintains concentration and focus
Build the foundation for mathematics and abstract thinking skills
BYOPuzzles
BYOPuzzles strengthen the right hemisphere of the brain, which is primarily responsible for visual
perception. The visual perception skills needed to solve the puzzles include: shape perception,
spatial relations, part/whole relationships, detail discrimination, figure ground differentiation,
and pattern recognition. Playing BYOPuzzles:
Strengthens concentration
Increases memory
Catalyzes creativity
Strong Mind Mazes
Begin Strong Mind Mazes after you complete Strong Mind Puzzles. Strong Mind Mazes includes 4,000,000+
variations. This demands the participant process 7 variables to solve the maze. SMM provides ample
rehearsal to strengthen memory, concentration and problem solving. There are 125 levels with a wide
palette of colors, patterns and graphics which promote learning and mental agility.
NASA Engineers favorite exercise to strengthen mental agility!
Strong Mind Estimator
Strong Mind Estimator presents mathematical puzzles that force the individual to guess based on the
relationship between the whole and it’s parts. Estimating is a high level mathematical skill. It
involves mental manipulation of mathematical concepts.
Estimating saves time and helps individuals make faster, smarter decisions.
Concussion Testimonials
A Brazilian attorney’s journey to healing from a concussion
I am an attorney from Brazil and this was a long journey until I found a cure for my concussion. My life
played out like a movie-- The kind of movie that once it is finished you thank god it was just a movie
and you are safe and sound on your couch. I saw many doctors and most of them just didn't
understand my symptoms. My family thought my symptoms were psychological and I needed therapy. So I did
it for years. Of course, doing therapy never tackled my real issues. But after seeing Donalee my life
started to change in the blink of an eye. One week after seeing Donalee and the other professionals she
recommended, I flew back to Brazil. And my mom said: "You are so much better, you are more like the
son I know, you don't need psychotherapy, you just need to keep doing this treatment!" Of
course I was better, I was more present, attentive, more balanced. I used to drift to the left when
walking and had to consciously correct my self. Well, that went away. It's been 5 weeks since I
first saw Donalee. I am not 100% back to what I used to be but I am getting there, and fast!
Unfortunately, the concussion and the symptoms I had to live with were not in a movie but in my life.
But the good news is that I've found a way to solve something that apparently looked unsolvable.
A computer scientist describes how DSM Exercises
changed his brain after he was hit by a car
For reference, you may remember when I was playing the paper version of Mind Mazes I wasn't
satisfied because of how much of a logical conversation I had to have with myself. I had to very
consciously think through what the options were for matching each time. I had to think very methodically
about each shape in an order to see if I could connect with a line. I felt like I often got into a
repetitive and on-constructive pattern. I'd continue to ask myself the same questions for two
patterns, not quite remembering the other options I had already gone through, which ones I already
determined matched, if it for sure wasn't a match. I generally would force myself to give up after
a while, just look at another set of patterns for matches, but not really certain I'd ruled out the
option of the two I'd been focused on.
Great news is that at least for this game I've broken that behavior. I played the app periodically
while in Chicago on Saturday after our Friday appointment and got to level 50 before getting home
Saturday night. I continued to play for 10-15 minutes a few times a day and had gotten to level 125 by
by about the end of the week, so playing the app in total for about a week or less. I continue to play
level 125 once a few times a day and am averaging about 1 minute or less to finish. It just feels right
now.
It all seemed to "click" around levels 30-50 the Saturday after our appointment. At that point
I started to better understand what I expected of myself, why I was frustrated by what I described
above, even though you felt like I was doing fine, having a conversation with myself, going through
logical steps, etc. When it "clicked" it’s almost like my subconscious took over the
processing. I didn't really need to go through a conscious logical process. I would just look at
two shapes and "know" if they shared two characteristics. If I stopped to think I could
quickly describe (to myself in my head) what two characteristics matched.
Sometimes I'd get caught up with one or two of them and spend a minute fixated, but for the most
part just move from pattern to pattern. Also great is that I can count on one hand the number of times I
made a mistake caught during submission.
This is the first time doing your puzzles I've gone at the speed I expect of myself. Where I
don't feel like l need to logically think through what process to follow to get the right answer. I
don't know if t'm saying this right but it sounds like my subconscious almost just takes care
of it. It's kind of crazy that my brain still expects this level of processing, that I get
frustrated not having it, after 8 years of being level-set backwards after the accident. I guess
that's just how the brain works though.
A college student refuses to accept her
“new normal” diagnosis post concussion
Dear Donalee & Margit,
There is a beautiful Japanese phrase “otsukaresama” which is used to express gratitude. I love this word
because it directly translates to “you are tired”, acknowledging the effort that kindness and good deeds
take.
I want to say otsukaresama to you both. I can see how hard and passionately you work and the effects your
work has on people is revolutionary. I have already mades so much progress since my week in Chicago and
could not be more grateful for that. Thank you also for being so welcoming, kind, and fun - and for all
the tea.
You both work in a field that isn’t widely understood but that is so important. I will work hard to
spread the word of neuroplasticity and how it has helped me and so many others. I hope you never get
discourage from opening up your “yes you can” clinic no matter how challenging it may seem, because it
is so necessary and will make big changes to the work. I’m looking forward to see you in August!
Sincerely, your fan, S.R.
An artist’s interpretation of her
cognitive recovery from a car accident
Janette Gerber - Textile Artist / Designer
"Open to Brain Plasticity"
Brain Plasticity refers to the ability of the brain to change itself, to rewire.
This work is an expression of my gratitude for the professionals of the many healing paths I have taken
to get my “Self” back, post injury and concussion. The umbrella, made of constructed cloth, is a loose
representation of the synapses made by our magnificent brains. From the head spring many of the symptoms
which occur simultaneously. Think of the inside of a telephone cable, with multiple colored wires, bare
in spot and shorting out as they touch.
Each of the eight sections of the umbrella is devoted to a phase of healing with dangling visual
representations of some of the healing steps, a process that is ongoing.
This is a very brief summary of a long and difficult internal invisible injury and journey. Integrating
Traditional Medicine and Alternative Therapies, I build a dancelike interweaving of complimentary
approaches, each working toward the common goal of brain plasticity.
Dr. Deborah Zelinsky O.D. referred me to Cognitive Therapist Donalee Markus Ph. D. who said that her
exercises would result in the return of the “pictures in my head.” It is a frightful loss for an artist
to the pictures. Mine had gone, along with my creativity, in the moment of the crash nearly three years
ago. Cognitive exercises brought the pictures back.
Janette Gerber
DSM heals father of eight when traditional medicine offered no treatment for his Traumatic Brain Injury
Don K. I was on the job for SBC one Saturday morning four years ago, parked in my truck, when
I was hit head-on by a reckless driver. I recovered quickly from a concussion, but was subsequently
plagued with post-concussion syndrome: I was hypersensitive to noise, my field of vision was broken down
to pixels rather than a whole integrated picture – in fact, all my systems were hyperactive.
Doctors wrongly told me I'd be good as new in a year; what did make all the difference was working
with Donalee, who said, "Life's going to be different from now on, so let's make good use
of it." It took me less than four years to retrain my brain with Donalee Markus, and I'm back
with SBC, splicing cable – thanks to Donalee, I'm able to lead a normal life.
A parents nightmare: their 16 year old is
in a catastrophic car accident
Kathy A. - Parent A catastrophic car accident at age 16 left my daughter Krysty with a
traumatic frontal-lobe brain injury and a broken neck. Her physical wounds healed, but her brain did not
– until we took her to Donalee Markus. Krysty arrived at Donalee's office with her higher
functions, including executive function and critical thinking, gone – along with 20 points from her IQ.
She was almost emotionless and operating at an 11 year old's social level.
After working with Donalee, Krysty regained her higher brain functions, emotions and IQ, got back on the
honor roll, and is now on the honor roll in college and an officer in her sorority. I simply cannot
thank Donalee enough for what she's done.
After a cerebral hemorrhage, high-level function
is recovered through neuro-cognitive restructuring
Moira M. In October 2006, I was interviewing a new client of the publicist who employed me as a
writer of press materials, when I suddenly experienced what felt like a sledgehammer blow to the back of
my head. I lost consciousness, and upon awakening – on the floor – found I was hallucinating. Day-glo
colors of pink, green and yellow were swirling all over the faces of the people clustered around me
trying to help. I knew something was direly wrong with me, and I was right: a giant brain aneurysm (that
I didn’t know I had) had ruptured, causing a cerebral hemorrhage and the first of three hemorrhagic
micro-strokes.
I remember the paramedics arriving and lifting me onto a stretcher – and my next coherent memory was
fully three weeks later. I was in Northwestern Memorial Hospital’s neuro intensive care unit, and just
beginning to discover – to my horror -- the extent of the brain damage.
While my verbal skills seemed intact, I found I could no longer read an analog clock (the kind with
hands.) I couldn’t identify black-and-white line drawings of familiar objects: a hammer, a bed, a horse.
I had trouble sequencing. I couldn’t do simple math problems like long division – even subtraction, as
long as it involved borrowing. My head felt like a Cuisinart, with disjointed thoughts whirling around
so fast I couldn’t get a fix on them. As for multitasking, I figured those days were gone forever.
In addition to the publicity job, I’d been a longtime freelance journalist, and my main outlet was at
that time (and still is) the Chicago Tribune, Once the full import of my brain injury registered with
me, I was terrified I wouldn’t be able to write an article again. I had all the words, but did not know
if I could sequence them, or link them with the ideas that would make them into a feature article.
Leaving intensive care a week or so later, I entered in-patient rehabilitation. After two weeks, I could
identify line drawings once again, and seemed to have improved in other cognitive areas as well. But I
was far from being recovered – and it was at that point I began to see Dr. Donalee Markus.
With Donalee, my high-level recovery began. After a few weeks, I was able to hold more than one idea in
my head simultaneously. I began to regain my ability to multitask. And two months after the ruptured
aneurysm had felled me, I had my first post-trauma article published in the Tribune. As part of the
writing process I used an invaluable organizational tool I’d learned from Donalee: mind mapping. I’ve
continued to use mind mapping with each subsequent Tribune article I’ve written – a general process that
has gotten less and less difficult, thanks to Donalee.
One very important skill that Donalee’s neurocognitive therapy restored was my ability to navigate. My
visuospatial center had been hard-hit by one or more of the strokes – and I’d found, to my considerable
distress, that I could no longer visualize the street grid of Chicago in my head, in order to get from
one place (or set of coordinates) to another. I couldn’t picture north, south, east, and west in
relation to where I was at a given time, which made getting around the city where I live much more
challenging than it had ever been – if not, in fact, utterly daunting.
But the visual puzzles Donalee had me do – ramping up their complexity bit by bit – brought back my
ability to see the grid in my mind. Once again I could stay oriented, figure out where I was going, know
which major Chicago street would be coming up next in the direction I was walking.
I even began trekking to New York City in the fall of ’07 to visit my daughter (a freshman in college
there), and my work with Donalee had so improved my visuospatial skills that I was able to navigate
around Manhattan and even Brooklyn with few mistakes.
I loved doing those puzzles – especially the wonderful dots that are Donalee’s trademark. I swear I could
feel the damaged connections in my brain knitting back together, or rerouting themselves. I found the
puzzles simultaneously relaxing and stimulating, and I looked forward to doing them daily the same way
you might anticipate getting a massage. Donalee’s visual puzzles – as well as Sudoku, which she taught
me and which I still do almost daily -- also helped me with my scanning, which had been severely
impacted.
Another issue that had given me much grief, even half a year after the rupture – was that I had focusing
problems. I would forget to retrieve my ATM card from cash machines; I’d forget to close the lid of the
coffee maker when setting up my husband’s morning coffee the night before. After working several months
with Donalee, my attention to those details (and others) noticeably improved. I continued to feel more
and more like myself as time went on, thanks to Donalee Markus and her remarkable, cutting-edge
neurocognitive therapy. I am so fortunate to have been able to work with her: it’s no exaggeration to
say she gave me my life back.