Your injury was described by someone (in a post I can no longer find) who said it fractured your skull and cheekbone on the right side. With the location, with that description, it could have hit anywhere from more in your face to the side nearly back by your ear. Almost all of the area likely to have been directly hit would be the frontal lobe, but different parts of the frontal lobe do different things.
If more to the side of your head, it might have hit the motor strip which would disrupt movement on the left (opposite) side [that would explain your typing 'around' the letter 'd' as mentioned above, but also could affect walking and other movements, where I do not know if that is the case]. Just to the rear of that (at the back-most part of the frontal lobe) is the sensory strip, which could also impair movement because it would limit the reception of feedback from the nerves which tell one what their body is feeling.
While damage to the motor area might cause difficulty walking and other movements that would be more obvious to onlookers, if the injury was closer to the front it may be far
more disruptive to behavior than awkwardness in movement. It would make others' seeing someone's head-injury-related problems MUCH more difficult, because there is no obvious problem like a limp or 'dead' arm to cue someone to the fact there had been an injury. [My injuries were pretty much all like that: not obvious to onlookers.]The Frontal Lobes
The frontal lobes are nearly universally damaged in any impact. But they would be likely to have been more injured than usual with your impact where it was, particularly if it was more towards the front (nearer your face).
The frontal lobes control many things, a few of which I'll mention here. They play a great role in the ability to pay attention to things (many, if not most, head injured people have difficulty with distractability). They play a large role in sequential thinking and being able to put memories in proper order for which happened first. They also govern impulse control and self-monitoring; being able to tell what condition you are in and what is happening with yourself. (That can result in difficulty assessing personal safety. That is likely why the program had you retested for driving, as they could not be sure your assessment of your remaining abilities were accurate.) The frontal lobes control some of the ability to process and express emotion. And they regulate the initiation and cessation of action [inability to stop an action is called 'perseveration']. The inability to start particular actions can be misinterpreted by uninformed doctors after head injuries as depression about an injury and inability to get things done from that, rather than the organic problem that it actually is. Depression and head-injury-caused inability to initiate actions have VERY different treatments. [Antidepressants usually have a sedating effect. If they are given when not needed, they can make initiating actions that much more difficult.]
The frontal lobes are believed to be central in decision-making. Following a head injury, what used to be a simple choice can become overwhelming. [For an example here's something from just after my first head injury, while I was still working. At the end of a day's work I had three things to do before I could go home. They were: write the progress note for the last person I saw, prepare the billing for that person, and to prepare the next day's materials. They all had to be done before I left. None of them was 'urgent'. But I sat for a minute or more, near tears, because I could not figure out which to do first.] Personality
Head injuries most often include a change in overall personality. This can be subtle, or it can be dramatic. That personality change includes the way a person feels and expresses their emotions, but also the things I mentioned before (difficulties with social situations often occur as social cues, and subtlety, and hints, may be missed). But the person may overreact (or underreact) to emotional events in their environment. They may 'hyper-respond' to emotional cues, such as crying easier than previously or getting angry easier (e.g. if one runs into difficulties putting dishes away, one may start crying about it, or one may get angry and break things [I've done both at one point or another since my head injuries; a few years back I actually stomped a VCR into rubble because it was messing up]).Those With Head Injuries Functioning in Crowds
Until you know that you can handle them without stress, crowds are generally to be avoided, particularly right after a significant head injury (especially during that first 6 mos), as overwhelm is likely. That is because the head injured usually can't filter out things like other conversations, stray noises, lights, movement, so it is often very difficult for them to focus on a person they are talking to. [One of the ways I developed for myself is to ALWAYS wear an iPod and headphones when I was out, and play familiar music. The muffling of surrounding sounds helped reduce the demands on my brain when grocery shopping, for instance. Another thing I worked out was that I also wear sunglasses whenever I am out during the day, or in stores at night, as the dimming of the light reduces the amount of processing my brain has to do.]
Because of that difficulty with crowds, I was rather concerned when I read your comment that you were "missing meetings", as I believe it was referring to your job. Such things may be overwhelming and extremely hard to process. DO NOT be afraid to accept and mention that to the people working with you in the rehabilitation program. They may help you interact with your employer about it.Desire for Life to 'Return to Normal'
Unfortunately, the freshly head injured just want 'things to get back to normal' so they most often push themselves to do everything they were doing before the injury. The difficulties freshly head injured people run into with that often cause both functional problems and emotional problems. And very often, because of the memory problems which occur regularly with head injuries, it is possible for them to not remember how much difficulty it causes them from one day to the next (or one minute to the next). So they just continue doing whatever, and they cannot remember enough to report it to the cognitive therapist who could potentially help them learn strategies to help them process it. Often the freshly head injured end up doing nothing about a problem they've noticed, or worse, devising their own ways of coping with whatever it is, which, because of their injuries, can often be maladaptive.Recovery
What you may be wondering is, "will I recover, and if so, how much?"
The truth is, there's no guaranteed way to gauge that. But there are some things that may be helpful to know.
1. It used to be believed that length of coma related to the degree that previous functioning might return [the longer the coma = the less recovered functioning]. But if your coma was induced to reduce damage from swelling, then that doesn't apply. And, there are exceptions to most any health-related rule: some people have been in comas for long periods of time and recovered most of their functioning.
2. The largest amount of functional recovery takes place in the first six months. During that period it is because of the hyperactive axonal formation, and while the injured, but not dead, superficial neurons heal. This is the same time period as the delayed functional problems from a head injury occur (and for the same 'healing' reason). But - particularly when receiving appropriate cognitive rehabilitation - the good connections far outweigh the bad, so there's a net increase in function, even though some new problems may still occur.
But especially during this six month period with the rapid brain repair going on, it is ESSENTIAL that things like alcohol and tobacco be avoided, as they put stress on the neurons. If the neurons are injured, alcohol and the anoxia (lack of oxygen) caused by cigarettes can very well kill them (one of the main outputs of cigarettes is carbon monoxide: the same thing people die of from concentrated car exhaust). That results in lost functioning that could have been retained. Unfortunately, many, many freshly head injured people self medicate with alcohol (or drink to forget the functioning they can tell that they've lost). [Even I, who learned all this about the brain and injury, self-medicated for a time after the first one; every day that I worked I was so far past capacity that I'd come home and need to shut my brain off, and I drank hard liquor to 'shut down'. I had help stopping that. I have now had very little alcohol in the last 16 years, and since getting on the proper anti-seizure meds, and reducing what I try to do during the day, I have not wanted any more. That is because the anti-seizure medication keeps me functioning at a relatively normal pace (well, 'post-head-injury' normal, at least), and because, with the alterations in my functioning from the head injuries, I treasure every bit of consciousness I can get.]
It is also important to eat properly, and according to research [http://www.amenclinics.com/
], make sure to take a multivitamin (the B complex is especially important), and get a lot of Omega-3 fatty acids (about three grams a day). Taking the Omega-3s as both fish oil and flax-seed oil allows the body to take them in in slightly different ways, as the body may process them from one source easier than another.
3. Additional fairly easily noticeable increases in functioning continue for the next roughly two years. During that time it is possible to see functional improvement with some speed. Although it can be helpful for resolving functional difficulties at any time post-head injury, this first two years is when most focal neuropsychological/cognitive rehab has the best effects.
4. Some functional increases can continue for a decade or longer after a head injury, but during this time span (2yrs-10+yrs) it is VERY slow, and can only be seen when comparing one's functioning to how one functioned, say, 6 months-1 year before. [I still have little improvement 'bumps' that occur. They are never major things, but every bit of functional improvement helps.]
One uses the functioning and brain areas that are retained to work around those that were damaged. But the unfortunate fact is, despite what some may say, there is NEVER a full return to previous functioning after a head injury, particularly a moderate to severe one (one causing a coma, or requiring an induced coma). People may get 'close' and appear
'back to normal' in the way they act. But, because there is no part of the brain that is not used in everyday life, there is no part of it that is expendable. So any damage will have some permanent results.
Appearing 'back to normal' is just that: appearance. How the person thinks, and how they manage to do particular tasks mentally, will never be the same. [I am just over 17 years post-my first head injury, and 13 years post-my third/final one, and I STILL miss my premorbid (i.e. "pre-injured") personality and functioning, though I have learned to accept and work around most of my limitations. In face-to-face and phone conversations with people, they've told me, "you sound perfectly fine!" (as if that is meant to be reassuring). The thing is, they don't get that it may take me up to two weeks to recover from a one-hour in-person discussion (or a 20 minute phone call), and it has taken over a month to recover from interactive evenings lasting a few hours. During that recovery time, I may not be able to follow a TV show plot (even as predictable as they usually are), hearing words may give a spike of pain in my head with every syllable, reading is out of the question, and so forth. (So, "you sound perfectly fine," is - at best - an irritant, but often angering because it ignores the devastating consequences of an interaction for me.)]Other Things to Look Out For
Memory is very frequently, if not universally, affected by head injury.
'Lost time' is possible. That is where you become aware that you were not aware of your surroundings for a time (and is about as difficult to recognize as seeing an invisible man; one can only tell this from things like noticing that the last thing one remembered, they were in the middle of a TV show and now they are in the middle of a commercial, with no memory of anything in between). This needs to be followed up on, as it can be a sign of 'low grade' seizure activity.
The drug Neurontin has been found to be helpful to those with head injuries for a number of problems (attention, memory, lost time, and more). Sometimes it can be routinely prescribed. But, since the brain can be much more responsive to most all medications following a head injury (particularly those with brain effects, such as making one tired), the dosage may require significant adjustment to be truly helpful.
Sleep disruption, or appetite disruption (the ability to tell when you are either hungry or full), or what seems like a balance issue (walking on an angle such that one may hit walls or people), or double-vision can occur with brain-stem damage. This can happen since the brain-stem is at the base of the skull. So not only abrasions from scraping the skull, but 'tugging' on the brainstem can also damage it, as the brain moves during impact, but the attached spinal cord at the other end tries to hold the brain in place. The brainstem, being between the two, takes the brunt of that tug-of-war. The walking on an angle and double vision can be from a specific type of brain damage that results in Vertical Heterophoria Syndrome. That is a misalignment of the images produced by the two eyes. It occurs with some frequency with head injury, and can often be fixed very simply by getting glasses with prisms in them, to take the strain of trying to realign the images off of the brain. [I have a pair of these each for reading, computer, and distance viewing.] One of the foremost researchers in that area is at this site, with an online test that helps decide if that may be a problem for you: Vision Specialists of BirminghamTreatment [and Overwhelm] and Recovery
Proper medication (if needed), and proper cognitive rehab can help tremendously, especially in the earliest stages: right after injury to two years-post. But that rehab can ONLY be helpful if it truly takes into account the current functioning of the injured person, and is tailored to not overwhelm them. That generally is not the case with standard outpatient cognitive rehab, as the 'simple' act of just GETTING to the facility may be more than enough to wipe out the functional capacity of the person for that day. [That was the case with me, but, knowing I 'should' do it all, I did it, and it - instead of helping - made some things worse and likely slowed my recovery. Overextending myself past my capacity may have also amplified my 'abnormal electrical activity in the left temporal lobe' [the quote from my EEG report... 'abnormal electrical activity in the left temporal lobe' = seizure activity].]
When you mentioned that the program you are in was testing your ability to make burgers, or your ability to drive, it was clear that one of the things it sounds like the program is doing is testing 'daily living skills'. This is a very good thing. When someone has had a head injury, particularly one as severe as this one must have been [a coma and a metal plate replacing broken skull], testing to make sure that someone can still do tasks that are required to function on a daily basis is necessary (things such as making themselves food to eat, or driving safely so as not to endanger themselves or others).Important Point to Remember
Rest when you are tired. Accept that your brain - which, when NOT injured, consumes about 25% of all the calories your body takes in - is going to need extra rest. It is just like someone who was a runner prior to a knee injury: if they start back by doing a marathon, they will, inevitably, stay injured and take longer to heal. One needs to start recovering slowly, and build up again, going just a tiny bit beyond current functioning. Only then can recovered functioning be retained. [The thing that was hardest for me to accept is that repeatedly pushing myself well past what my capacity was actually slowing
If someone ends up with a bruise or a bump that one can see on their head from an impact, most likely their brain was damaged to some degree as well. One can work around that damage, or create alternative pathways in the brain to bipass it, but that doesn't mean that it 'goes away'. A dead neuron is a dead neuron: it isn't resuscitated. A broken axon is a broken axon: it MIGHT be regenerated if JUST the right combination of effort is exerted, but most likely that pathway is gone for good and a more roundabout path is generated.