Mike suffered a severe traumatic injury to his brain. We say “injury” like it was a single injury but there were several injuries grouped under the “severe” umbrella, one of which was a severe diffuse axonal injury. Mike is trying to understand what happened to his head; what were the injuries and of those injuries how do they link to memory, and processing speed and well, you get the picture. So, he and I were doing some research this afternoon after his “new” speech therapy appointment and he thought it would be good to share something we read:
Diffuse Axonal Injury
Diffuse axonal injury occurs in about half of all severe head traumas, making it one of the most common traumatic brain injuries. It can also occur in moderate and mild brain injury. A diffuse axonal injury falls under the category of a diffuse brain injury. This means that instead of occurring in a specific area, like a focal brain injury, it occurs over a more widespread area. In addition to being one of the most common types of brain injuries, it’s also one of the most devastating. As a matter of fact, severe diffuse axonal injury is one of the leading causes of death in people with traumatic brain injury.
Causes of Diffuse Axonal Injury
Diffuse axonal injury isn’t the result of a blow to the head. Instead, it results from the brain moving back and forth in the skull as a result of acceleration or deceleration. Automobile accidents, sports-related accidents, violence, falls, and child abuse such as Shaken Baby Syndrome are common causes of diffuse axonal injury.
When acceleration or deceleration causes the brain to move within the skull, axons, the parts of the nerve cells that allow neurons to send messages between them, are disrupted. As tissue slides over tissue, a shearing injury occurs. This causes the lesions that are responsible for unconsciousness, as well as the vegetative state that occurs after a severe head injury.
A diffuse axonal injury also causes brain cells to die, which cause swelling in the brain. This increased pressure in the brain can cause decreased blood flow to the brain, as well as additional injury. The shearing can also release chemicals which can contribute to additional brain injury.
Prognosis of Diffuse Axonal Injury
It is thought that diffuse axonal injury can occur in just about every level of severity, with concussion thought to be one of the milder forms. In mild to moderate forms of diffuse axonal injury, recovery is possible, with the mildest forms of diffuse axonal injury often resulting in few if any long-term issues. About 90 percent of survivors with severe diffuse axonal injury remain unconscious. The 10 percent that regain consciousness are often severely impaired.
The more we research, the more Michael realizes that the severity of the injuries do not add up to the amount of recovery he has been able to achieve. “why me?” he asks not because he is feeling sorry for himself; “why me?” he asks as one would ask when they were afraid of the answer. The blog continues to be monitored by Mike’s watchful eye and he is still ”energized by your words”. Watching the video he is an observer to months of his life he cannot remember, those months we will never forget. He is unable to comprehend “was I sleeping when I was in a coma?” there is a quiet spiritual inspiration by what cannot be explained.
We lost the ability to link to the original video/slideshow that I put together last year and because it was tattooed in my memory, I was able to recreate it rather quickly over the last few weeks. On Tuesday, Jim kindly came over to help get the new ( hopefully improved) version linked back to the website. Thank you Jim! And to those that privately shared how the video and Mike’s journey is and has impacted your life, I say all glory be to God.
Therapy is free when you find it in a project that is close to your heart. I worked late nights for months putting pieces of the puzzle together to be able to share the tears, fears, the love of community and primarily the faith and hope of this journey with Mike. The slideshow chronicles life before and after October 21, 2007 when life as we knew it ended forever. Finding the music, searching through photos and while reading through each comment posted on the blog; an appreciation for the present evolved. The present, this day. The old saying “it is called the present for a reason” became very clear.
No matter what the day brings, it is a gift. I try to keep that little nuggett in the fore front of my thoughts but when I falter, all it takes is a 15 minute reminder of the blessings we have received. Fifteen minutes to remind us that in a blink of an eye everything can change. A reminder that we are not infinite. Fifteen minutes to remind us to thank God for this day, this gift of life; the present.
Having just watched the new video, I come to think. How far I have already come and to translate it (the progress) into a term or terms understandable for people NOT in my shoes. I just started a new therapy with an area renowned speech therapist. I think, I hope, that this will be yet another step leap in the right direction. For me, this time around, this life I’d been blessed enough to be granted a second chance at attempting to do the right things, to treat people right, and to treat myself right.
My friends are treating me the same way I hope to have the courage to treat the new people as they come into my life, with patience, understanding, and respect.
I just had another birthday, 27 years to find purpose?
I guess, ya know I’m not even sure about purpose so much anymore. I think it is more about direction.
In which direction am I headed? Well, right now I can say that at least it’s not destructive. So sure, I’ve traveled, I’ve been to the beach on both coasts, I’ve even been snorkeling in the Carribean. I’ve been to school and learned new things.
I feel like now it is time to do those same, similar things PBI (post brain injury). After all I’m going to (knock on wood) be a brain injury survivor for a long time coming.
Such a drastic change from October 2007, geez 2007? Seems like a lifetime ago, oh how things change. I feel like it’s up to us to try and continue to make changes as positive as possible.
Yes, it (this journey after trauma) is not over, but it is still moving forward and as of yet there is no way to stop time from continuing to progress. So,if you’re going to work on anything, try to make its impact as positive as possible.
From where I stand currently that is at least my perspective.
Michael Rosner was in a single car accident 10/21/07 because he made the decision to get behind the wheel and drive after spending the evening drinking with friends. He arrived CODE BLUE in the Trauma ICU – non-responsive, in danger of immediate death.
We are inspired by his strength and determination and believe it was through the love of this community, through prayer and by the grace of God that Michael is with us today. If you believe, you will recieve. We believe.
Host: Mike Rosner and Family
Location: Nokesville Park View Map
12560 Aden Road
Nokesville, VA 20181
When: Saturday, October 17, 11:00AM to 4:00PM
Join us for some fun in the country!
Volleyball, and food, horseshoes, apple snugglin’, water balloon toss, and food, some poopin’ in the basket, hoola hoop contest and food!
All of us will be faced with obstacles throughout our lives. We have to persevere and learn from them and some of us will have to work harder to reach our goals.
Who are we?
We are an ever growing community of friends, family acquaintances and strangers banded together with the purpose of supporting our friend, our brother, our grandson, our cousin, our nephew, our son in his time of need. We are moms and dads, teachers and students, therapists, worker bees, managers and administrators, we are well known and we are anonymous. We are you and me.
We feel it is important to Celebrate LIFE and the successes of ALL survivors who have each met overwhelming challenges with courage and hope.
There is life after brain injury and life is what we celebrate! Michael’s recovery continues to amaze us but he does not and cannot do this alone. So for the countless hours of hard work in therapy, we applaud Michael’s continued determination and success as a brain injury survivor and for having the courage to be just that-a survivor.
We also celebrate the incredible support of family and friends that help him walk this journey – we celebrate you. Through this second year you have continued to help us stand when many times we thought we could not go on.We are you and me. We are ONE. It is the LOVE of this community of friends and family that we celebrate.
Last year we asked that you bring your favorite side dish or dessert and it was such a great success. The salads, the cookies, the melt in your mouth BROWNIES – YUM-O – Please do it again!
We look forward to being able to Celebrate Life with each and every one of you because your life means so much to each and every one of us.
Below are comments from the last post. I wanted to bring a little more attention to them because as Mike deals with the nice pretty gifts that accompany self awareness; low self-esteem, depression, doubt, fear, regret, anger, frustration and it only gets prettier. I thought it was important to bring it to the surface. We will NEVER understand what this is like for him and for others who must live the rest of their lives with an injury to their brains. It not only changes who you are forever, it shakes the very foundation of your being. There is no escaping it. There is only learning to cope and compensate. It is still in the silence of knowing and then not being able to be the person you know. Still in the silence.
Nate
Sep 14, 2009 at 1:52 pm
sounds more like transitive – If a = b and b = c, then a = c( I had to look that up btw ).
But, Im sure there are plenty of other equations that you can apply to the situation.
Alex
Sep 20, 2009 at 12:35 pm
Hi Mike, just dropping by, and had a thought. Your progress = brain fitness. In three weeks I will be running a half marathon in London. I ran one at the end of July, so I know I can run a half marathon, because I’ve done it before, right? Trouble is, what with the children’s summer holidays/limited childcare/getting overtaken by life….I haven’t done any training since I ran my last race. I think that much of what you get frustrated by with your mother is stuff you know that you can do – because you’ve done it before. (I remember you telling me when I asked about your empty journal pages – I can fill them in, I just haven’t) But I think you will know as well as I do that if I’m going to put in a half decent performance in October’s race I can’t sit back admiring my last race medal, I need to get out there and put the miles in to build fitness. Even if I know I’ve done it before.
Mike (it’s him)
Sep 23, 2009 at 12:59 pm
No Alex (lieutenant), of course you’re right again. I don’t think so. I know that the fat unemployed loser who lives at home again, the person I’ve become. Just because I can talk a good game in no way means that I can necessarily walk that same game. I just feel I have to somehow keep my spirits up and sometimes I do so by making myself sound maybe a little better than I actually am currently.
rae
Sep 23, 2009 at 7:08 pm
Welcome to the world of it doesn’t have to make sense. Mike, you and I have weekly discussions about perception. Perception isn’t always reality but perception can become your reality if you’re not careful.
Perception – a person’s knowledge creates his reality as much as the truth, because the human mind can only contemplate what it has been exposed to. When you see things without understanding, the mind tries to reach for something that it already recognizes, in order to process what it is viewing. So what most closely relates to the unfamiliar from our past experiences, makes up what we see when we look at things that we don’t comprehend
With that in mind, let’s take the accident out. If this were your life as you described above, of course you would not be happy. No accident, no injury living at home, not working hitting 200 lbs…yeah, you would call/think of yourself a loser. But it was real. As much as we all wish it didn’t happen to you, it did.
Do you understand that you live at home because you were in a horrible accident and what you lost on Oct, 21, 2007 on I66 is not an easy recover? Yes. Do you understand that you may not be an employee but the job you have now holds more responsibility and more commitment than any other job you have or will ever hold? Yes. Do you understand that every function, yes, EVERY function is controlled by your brain, including your metabolism and that extreme fatigue comes absolutely free with an injury to your brain? Yes, you know that. Do you understand that a loser would not have the strength, the will, the courage to not be JUST a survivor and would not have the determination to overcome this “f’d” up thing that happened? Yes, you know this. But does the reality of it all become too much to look in the face some days? Yes and because of that, it is totally ok to make yourself sound and feel like a fricking superhero if that’s what it takes to get through the day.
Take Alex’s advise. You know it’s true…you have to put in the miles and you do. But here’s the error…if your perception is that you’re unemployed and live at home again = loser, your perception is wrong. You have not been here before. You haven’t done this before. Yes, you’ve walked, read a book, played games, learned to play a musical instrument before, but you’ve never done it with an injury to your brain so severe, that doctors said you would probably be a vegetable. Sorry Mike. You’re not a loser. You’re a survivor. A survivor of something so devastating that most would not have the inner strength to persevere. You’re a soldier and this is the mother of all marathons.
The battle – progress vs memory
Understanding the effects of TBI in your life requires that you make honest appraisals of who you are and what you hope to achieve within the context of your situation. Extremely difficult when the injury itself has affected self awareness, short term memory loss, problem solving and decision making. It means that doing things and understanding things takes more time and effort than before TBI. It means that your reaction time will be slower, you will become more excitable, and your sense of knowing will be different. It means that organizing and expressing your thoughts will be more difficult so measuring your own success seems an almost impossible feat. It means that self regulation and self appreciation will be diminished.
progress vs memory
Swimming in a streaming exercise pool…you swim for an hour and you’re still in the same place. In the moment, there’s no visual measure of progress. BUT – if you could remember how long you were able to swim when you began the exercise; if you could visually see where you started and could compare then and now, maybe it would help. For Michael, although it feels to you like you are swimming upstream without progress, you are achieving nothing less than miraculous measurable improvement.
Mike says to me “I think I’m done. I feel like I have plateaued”, rebuking the notion I give him examples of the progress I continue to see on a regular basis. Improvements in initiation – noticing that meds need to be refilled and gathering every prescription and vitamin from the cabinet and refrigerator. Sorting, filling, and then letting me know that a ‘script needs to be called into Costco for a refill. Improvements in planning – without assistance, remembering to check the monthly view on his planner to see when he would have time to schedule a massage. Improvements in processing speed – M-F watching Wheel of Fortune and then Jeopardy, Mike is attentive and spitting out answers with the best of contestants. Last weekend I think he impressed quite a few of us. Spending a couple of hours on a Fantasy Football Draft conference call with Matt and Karl, which at any other time during this recovery phase just maintaining the stamina and focus would have been a huge accomplishment in it’s own right, but he also kept up with who’s turn it was, which players he needed for his team AND through all of that kept up and initiated some ”smack” talk which could have been a huge distraction . Accomplishments are notable and measurable, but my references to those improvements were not what the doctor ordered. I’m his mom – he thinks I might be a little biased and perhaps the same little cheerleader I’ve always been. He isn’t affected.
That Friday’s visit with the neuropsychologist – he doesn’t waiver. He says to her ” I think I have plateaued.” she looks at him with almost disbelief, looks at me then back to him and says ” not only would our visits be fewer or further between, but if I didn’t think you were continuing to make progress, I would most likely discontinue treatment. Mike, in just the last month, I have seen many cognitive and behavioral improvements…”. She continued giving anticdotal details and examples that confirmed her professional opinion. But that coaching session did not pick away at the concrete where the thought was planted - he knew this “was it” for him. We still hadn’t gotten through.
Already in place was a plan for me to meet with his Cognitive Rehab specialist after their session on Wednesday to discuss a day and time change for the upcoming few months. During the meeting, Anthony took the time to show Michael and I reports that were generated by the cognitive computer programs that Michael uses during their appointments. It was there that Michael was able to see not an opinion but something tangible; something on paper, in black and white (actually it was in color) that he was progressing! Michael could clearly see that from day 1 to present the marker of each exercise went up. Not down, not straight across; UP. In the beginning of one exercise for a particular cognitive area, Mike was at a level 2. At the end of this day’s session the report showed that each and every week from day 1 Mike had increased a level or two and was now scoring above the measurable scale. Not an opinion, measured and marked by this computer program and is just as concrete as that thought planted in Michael’s head making him think that he had plateaued. There are many areas…there is much more ahead… but for this phase, this wall – how do you spell relief? A-N-T-H-O-N-Y.
Progress vs. memory – I read something once that stuck in my head; a little abstract but here goes: our memories are what keep life in color and without them the “now” is in black and white; like Dorothy in The Wizard of Oz. Being able to remember where you were and how far you’ve come = measurable progress = color/the land of oz. Measurable progress without being able to remember = thinking you’ve plateaued = black and white/ Auntie Em…Kansas. …I don’t know. It made sense to me at the time
Michael – it’s going to be ok. I know we are at a pretty challenging stage right now, you are often frustrated with me because I am the constant reminder that our work is not done. Many thoughts these days get planted in concrete and running into the wall time after time has become routine. BUT we will find a way to work through this. We will because it is the most important journey of your life.
I almost forgot to mention what took my breath away when we were walking the other day – Mike says “mom, I don’t know if it’s a transitive property or an associative property (I’m thinking I don’t know what either of those are but go ahead), I respond “uh, huh”, he continues “but I was thinking about the mathmatical properties of what has happened because everything can be connected mathmatically” Again I’m thinking, “really?” but say ” ok”, he then says ” if (life+drive) =work and work = dreams acheived then (life +drive) = dreams acheived”. We walk a few more yards and I’m still trying to figure out the answer to the whole transitive/associative thing and he says “so I’ve been thinking about that if (alcohol+driving)=life and life = dreams deferred then (alcohol+life)=dreams deferred. I have no idea where any of this came from but can I just tell you that I am absolutely blown away by the way his mind thinks. BLOWN AWAY! OBTW – he looked it up, it’s transitive he thinks.
If I can get the video to link, it is a video of putting potatoes and peppers in the basket that I took with my phone I apologize in advance for the poor video quality. But it might be a good reminder of your progress when memory fails to be the measure.
reference – basket of peppers Blog Post december 4, 2007 titled “Never Ending Faith”
Never Ending Faith? Still have it. Won’t lose it. You with me?
A response to Michael’s last post that I thought deserved better placement than just a comment. This is to Mike from his beautiful brother, my son Nathan.
Mike,
I cannot agree more with the everyone who has responded to this post. You just left my house after a late night bowling, and I am thinking that walking away from that accident was a gift. That the brain injury is a miracle. I dont quite know how to say it, but it appears to me that you have a new brain. Which means that you have new eyes, and new hands, and a new voice, and new ears, and a new perspective on life.
I remember seeing you become concious for the first time after being in the coma, and you could not talk.
But you looked at me.
And, that was the beginning.
Everyday is a celebration of so many things, but you are now openly celebrated everyday. And not because you own a yacht, or you studied astrophysics, but a much more humble and simple celebration. One we can all understand. Just waking up and being alive, and climbing everyday. Higher and higher, and I’m coming with you.
Tommorow we swim and start with 400 yards again. Climbing. Tommorow we go to Dito and I imagine I will see you again, buzzing with positive energy and creative thinking. Climbing. And I know you will push yourself in all the physical and cognitive therapy you do every day.
Climbing. Climbing. How about we go hiking one day?
Look, I’m coming to realize that maybe I’m setting my goals too high. I mean I have always been a huge dreamer, dreams of a fortune 500 company, a 100ft+ yacht, an astrophysicist!!!!
I live at home and I just turned 27, granted I did suffer severe head trauma and I do realize its live at home again……still, no excuse in my mind.
I feel like it is all collapsing on me again….I feel like this has happened to me before. Throughout my life I have had serious ebbs and flows like I just can’t get it right.
Maybe its that HE hasn’t figured out my plan, all-knowing……I don’t want to be blasphomous but….all-knowing should mean, ahhhh scratch that……I don’t even know what I’m talking about posting on the world-wide web this gutter trash. Who am I kidding?
Am I giving you hope? Does it help you to read about another man’s struggle?
I feel like I’m crazy or at least soon-to-be. Have I lost my mind?
On the 21st of this month, Michael will have been working toward recovery for 21 months. Twenty two months since the accident, one month spent in a coma. I don’t know where I thought we would be. How do you plan for the unknown? There’s no “based on historical data” with a brain injury because not one of them is the same. The medical world can tell you what was injured and what those areas control or contribute to when they analyze an MRI or CT Scan but they will also be the first to admit that they cannot predict the outcome after an injury to the brain. The medical professionals are an essential part of recovery and I am so thankful that Michael has had some of the field’s “best” on his team. Without their guidance, this brain injury thing would be more than a long road; it would be an insurmountable journey. Although Northern Virginia has it’s downfalls, we were and are very blessed to be where resources for brain injury survivors are within an hour’s drive. Blessings…we have many.
I was looking for a notebook this morning and stumbled upon “For One More Day”. Beneath it was the book that replaced the large blue posters that hung in Michael’s room in Fairfax Hospital. Jordan brought in the first of three posters and within days they were full of pictures and well wishes, pleas for recovery, tic marks for how many days Shannon had been able to get away with illegal parking, notes about the good looking nurses and a few “so and so was here” but every one a message of hope that Michael would open his eyes to realize just how much he was loved and needed. (Fast forward – the posters remain in Mike’s room today). My brother Ron and his wife Kirsten replaced the posters with a small notebook when Micahel was moved to Mt. Vernon Rehab and although not quite as noticable as something hanging on the wall, the sentiments were the same. Danny wrote “Mike, I stopped by today with Catherine and Liz. We went to Five Guys and brought you back a burger…” Karl wrote “…I stopped by before going to church and we talked about the Tech game…” In the book Michael reads the log of reminders that he was not alone on this journey; he was loved and needed.
Twenty one months…how’s Mike doing? It’s complicated.
I’ll begin with his schedule. Monday is two hours of Cognitive Rehab through Brain Injury Services in Springfield. I went the first couple of sessions and one day I needed logistical assistance and asked Nate if he could take Mike. Since then, Monday is group for both Mike and Nate. The group not only offers Michael an opportunity to improve cognition but offers a safe environment to share his ideas and circumstances with others who’s lives are so different from their independent lives before brain injury. From my perspective, the window into the world of other TBI survivors has granted Nathan insight to the significance and value of his contribution. Interacting with intention is what we do as parents but it also happens to be what we can and should do to assist after TBI. HERO alert – Nate volunteered to assist with the rehab group program at BIS on his day off. Pay it forward. Brain Injury Services INC Springfield VA – I can’t say enough about them or their services – DONATE please. http://www.braininjurysvcs.org It is such a worthy cause.
Monday – Cognitive Rehab Group session at BIS in Springfield 10:30 -12:30 / Bowling with friends 9pm – midnight
Friday – 10 -11:30 Yoga in Manassas 1pm Neuropsychologist in Springfield
Mike is working on an outline for his future speaking ventures and in those notes is the word “average”. Average = normal. Michael says he is working his way to average. Who would have ever thought Mike Rosner would ever strive to be “average”? Who would have ever thought that night that getting behind the wheel after drinking would eradicate the normalization of independent living, social re-adaptation, family life, and education or vocational endeavors? Mike obviously didn’t think about that did he? Now cognitivly impaired, including frontal executive functions (problem solving, impulse control, self-monitoring) attention, short-term memory and learning, speed of information processing and speech and language functions. One decision changed everything forever. Oh, but that’s just me talking.
The changes in personality and behavior are complicated by the lack of awareness of the changes. I don’t like to post things that might have an adverse effect so I post with hopes that my words have a positive effect. A TBI survivor may be unable to appreciate that his behavior is different, which is in stark contrast to the fact that family and friends are painfully aware that the person has changed in fundamental ways. The TBI survivor might have a vague sense that he is different or “not who I used to be” and yet struggle to define the ways in which his behavior or personality is different. After TBI, they’re not aware of changes in their behavior and especially not executive functions. But, they may be able to see changes in more concrete things like physical changes or motor function. It’s not purposeful, it’s just a symptom of the cognitive deficits and the dreaded frontal lobe executive dysfunction . Even in the moment and able to admit to some difficulties, he won’t be able to remember, or connect the implications of these deficits for future situations. Like I said, it’s complicated.
So, how is Mike doing?
He is amazing and still pushes himself beyond what most with his injuries would or could. Is he like before? No. Is he healed? No. But he is still improving. He mentioned to his doctor the other day that he thought maybe he had plateaued. she basically said “no way”. Nate told me the other day that he was so happy that each week he saw something new and improved. Yesterday morning for the VERY FIRST time, Mike refilled his meds on his own with no prompting, no hints, no ques….there is an alarm set to take meds on his watch at 9AM. The alarm went off, the case for the week was empty and so the “normal” thing to do would be to get the arsenal of medications from the cabinet and refrigerator and refill the meds and vitamins for a seven day period dividing to the appropriate AM or PM per the prescription. He “normally” did what needed to be done. I came in to the room to see Michael making another “first” in initiation and 21 months in to this recovery, it was just like the day I watched him walk up the stairs to get his socks because his feet were cold. I wanted to cry out, to jump up and down with joy because he continues to defy the odds. As much as he fights me, as much as the deficits in motivated behavior from the hippocampus circuitry of reward (oh, yeah I’ve had to learn a lot – it’s the apathy thing) as much as I feel like some days he pushes away every thing I try to accomplish with him… it (the brain injury) is not winning!
We are STILL winning…Michael is STILL improving. It is worth it all.
Keep Hope Alive. Just Do It.
LIVESTRONG Michael.
xxoo
Learn to become still … take your attention away from what you don’t want, and place your attention on what you wish to experience.
consider the following:
enter stage left – one man with an appetite for destruction, who drinks away his sorrows. Add the alcohol, make sure it is an obscene amount, mix in a muscle relaxer/pain killer to increase the effect of that alcohol.
There also once was this jeep wrangler that the “fellow” would use to cruise around. It wasn’t a very nice vehicle, but it got him around.
Then consider that this person was living in Arlington, VA at the time and would on occasion visit his parents who live in Manassas, VA. Succomb to maybe a type of self-inflicting peer pressure, he drinks to excess.
So we have an obviously intoxicated person who then may make the descision to drive home as he then decides to take the pain pill. Is it any wonder there was an accident to follow? Maybe the surprising part is the extent of his injuries and how he has lived to tell the tale, perhaps being able to pay it forward in communicating his story. Severe Traumatic Brain injury, coma for about 30 days, and then a lifetime of rehab.
Hey, at least he’s no longer drinking.
I read a quote that said “Unless a man undertakes more than he possibly can do, he will never
do all that he can”.
When acceleration or deceleration causes the brain to move within the skull, axons, the parts of the nerve cells that allow neurons to send messages between them, are disrupted. As tissue slides over tissue, a shearing injury occurs. This causes the lesions that are responsible for unconsciousness, as well as the vegetative state that occurs after a severe head injury.
I was looking for a notebook this morning and stumbled upon “For One More Day”. Beneath it was the book that replaced the large blue posters that hung in Michael’s room in Fairfax Hospital. Jordan brought in the first of three posters and within days they were full of pictures and well wishes, pleas for recovery, tic marks for how many days Shannon had been able to get away with illegal parking, notes about the good looking nurses and a few “so and so was here” but every one a message of hope that Michael would open his eyes to realize just how much he was loved and needed. (Fast forward – the posters remain in Mike’s room today). My brother Ron and his wife Kirsten replaced the posters with a small notebook when Micahel was moved to Mt. Vernon Rehab and although not quite as noticable as something hanging on the wall, the sentiments were the same. Danny wrote “Mike, I stopped by today with Catherine and Liz. We went to Five Guys and brought you back a burger…” Karl wrote “…I stopped by before going to church and we talked about the Tech game…” In the book Michael reads the log of reminders that he was not alone on this journey; he was loved and needed.
I’ll begin with his schedule. Monday is two hours of Cognitive Rehab through Brain Injury Services in Springfield. I went the first couple of sessions and one day I needed logistical assistance and asked Nate if he could take Mike. Since then, Monday is group for both Mike and Nate. The group not only offers Michael an opportunity to improve cognition but offers a safe environment to share his ideas and circumstances with others who’s lives are so different from their independent lives before brain injury. From my perspective, the window into the world of other TBI survivors has granted Nathan insight to the significance and value of his contribution. Interacting with intention is what we do as parents but it also happens to be what we can and should do to assist after TBI. HERO alert – Nate volunteered to assist with the rehab group program at BIS on his day off. Pay it forward. Brain Injury Services INC Springfield VA – I can’t say enough about them or their services – DONATE please. 
Mike is working on an outline for his future speaking ventures and in those notes is the word “average”. Average = normal. Michael says he is working his way to average. Who would have ever thought Mike Rosner would ever strive to be “average”? Who would have ever thought that night that getting behind the wheel after drinking would eradicate the normalization of independent living, social re-adaptation, family life, and education or vocational endeavors? Mike obviously didn’t think about that did he? Now cognitivly impaired, including frontal executive functions (problem solving, impulse control, self-monitoring) attention, short-term memory and learning, speed of information processing and speech and language functions. One decision changed everything forever. Oh, but that’s just me talking. 
He is amazing and still pushes himself beyond what most with his injuries would or could. Is he like before? No. Is he healed? No. But he is still improving. He mentioned to his doctor the other day that he thought maybe he had plateaued. she basically said “no way”. Nate told me the other day that he was so happy that each week he saw something new and improved. Yesterday morning for the VERY FIRST time, Mike refilled his meds on his own with no prompting, no hints, no ques….there is an alarm set to take meds on his watch at 9AM. The alarm went off, the case for the week was empty and so the “normal” thing to do would be to get the arsenal of medications from the cabinet and refrigerator and refill the meds and vitamins for a seven day period dividing to the appropriate AM or PM per the prescription. He “normally” did what needed to be done. I came in to the room to see Michael making another “first” in initiation and 21 months in to this recovery, it was just like the day I watched him walk up the stairs to get his socks because his feet were cold. I wanted to cry out, to jump up and down with joy because he continues to defy the odds. As much as he fights me, as much as the deficits in motivated behavior from the hippocampus circuitry of reward (oh, yeah I’ve had to learn a lot – it’s the apathy thing) as much as I feel like some days he pushes away every thing I try to accomplish with him… it (the brain injury) is not winning!