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We Are Imperfect Customers

by Linda W. Arms

This is a different kind of post but wanted to share with you.   I’m sharing this with many customer service providers and groups via LinkedIn and other sites.   Here it is:


Our Imperfect Customers

How do you view your customers?    Are they like you?     Are they at the top of their game as you might be?    Probably not.     We have many imperfect customers who need special attention or, at least, an awareness of their challenges.   I used to always see my customers as having similar cognitive abilities as I and my co-workers.     After suffering a brain injury 8 years ago, my views have changed.    There are millions of people in the United States who have cognitive impairments so you might take a second look at who is your customer.

Those of us with cognitive impairments travel, shop, visit web sites, visit business offices, talk on the phone, drive …. you name it.   For many of us, we do it with great difficulty.   When we’re done, we are often exhausted.    For example, just doing a simple thing like grocery shopping was a tremendously difficult task.    There were days I would decide not to go, or I’d walk into the store and right back out again because it was too overwhelming;  other times I’d fill my cart with an item or two and then just leave it and go home; or after shopping, I’d go home and nap for 2 hours.

I spent over 25 years in a customer service role providing a variety of financial and information technology services to a wide range of customers.     As a manager of a help desk and other I.T. services, I was always looking at “who is my customer” and “what do they need”, trying always to improve their experience with our services.      I looked at our Help Desk customers in terms of their role in the organization and their different needs (engineers, administrators, highway maintenance workers, etc.).    I saw other sets of customers based on how they accessed the organization’s network (hard-wired, dial-in, VPN, etc. ) to work with various applications.     There were other types of customers also but I never considered the cognitive health of those we served.

There are many people like me whose cognitive abilities have been affected by trauma, disease or other causes.     I look fine and have since my accident but in the early years of my recovery my cognitive abilities were greatly affected.      Impaired cognitive abilities cause problems with awareness, perception, reasoning, ability to focus, memory, judgment and many other things.    Since every injured or diseased brain is different, there are many symptoms.    Our brains control everything in our bodies including the ability to walk, see, talk, comprehend written and/or spoken communications, perform math calculations, make decisions, balance, move our hands, hear, and the list goes on and on.    Most of us have problems with the speed at which our brains process anything.    The world moves and speaks way too fast for many of us.   Many people with an injured or diseased brain have problems with our visual systems.   Some of us have problems with sounds where we become overwhelmed by too many sounds, too much volume, and sensitivity to certain types of sounds.

How Many of Us Are Out Here in the United States?

  • 1,700,000 people suffer a traumatic brain injury each year
  • 800,000 people suffer a stroke each year
  • 70,000 people are diagnosed with a brain tumor each year
  • 30,000 people suffer a brain aneurysm each year
  • 5,000,000 people live with Alzheimer’s
  • There are many others with diseases that can affect cognition including Parkinson’s disease and Multiple Sclerosis
  • There are many who live with an acquired brain injury due to anoxia, bad drug interactions and other things that damage the brain
  • One in 5 veterans returning from the recent wars has a brain injury

The Challenge of Phone Calls

Interacting on phones can be very difficult for those with cognitive problems.    There are many steps that our brain needs to process when we make a call and we can easily become overwhelmed.   First we have to find the phone number and dial it.   Next, we have to comprehend the automated message or what the person on the other end is saying.   Our brain has to process the accents or dialects of the person.   We have to try to adjust to the speed of their speech.   Our brain has to work harder when the person is not speaking clearly or there are distractions we hear in the background.   We may not be able to keep up with the speed at which the information is coming to us.   Unfamiliar terminology throws us off.   Complex sentence structures overwhelm us.   Sarcasm and innuendo may not be understood.

The Overwhelm of Stores and Offices

Walking into a store or office can be overwhelming with a cognitive impairment.    We may be having problems with balance so as we walk in, see and process our relatively unfamiliar surroundings, we are immediately thrown off.   Our brain is working overtime to address just the balance issue.

Then, there are so many things in the establishment that we see and our brain has to process.    Fluorescent lighting is more difficult for our brains to process adding more to the overwhelm we are feeling.    Next we have to find what we are looking for, we have to scan objects, make decisions.

We have to interact with the office worker or clerk who may be speaking way too fast for us, or mumbling, or speaking with an accent.     Constant interruptions throw us off.   Everything becomes more difficult.   When someone asks us a question, it may take us a few moments to respond.   Many times, because we have not yet responded, the person asking the question will not pause for very long before asking again and trying a different approach.   Not good – we need some quiet moments to gather our thoughts and get them out our mouth.   Constant talking interferes with our ability to think.

The Get-Me-Out-of-Here Web Sites

Busy, busy web sites are everywhere.    People with injured and diseased brains have loads of issues with these web sites.    Remember many of us having problems processing visual input.   Our brains have to process the words we see and comprehend their meanings.   Our brains have to process the moving components on the page.    We have to process the choices we need to make from the menus.    We have to process every bit of it just like a computer processes every step of a routine.

Flashy sites with many graphics and moving components are everywhere.    It seems that the flashier, the better, but not for many for us.   We have problems with many types, sizes and colors of fonts covering the pages.   There are actually fonts that are easier for our brains to process but it is usually not a consideration when a web site is built.    Sites with dark or brightly colored backgrounds can be very difficult to look at and visually process.

My brain injury caused problems with visual processing.   I could not look at some sites without getting dizzy, almost nauseous.   I could not look for more than a few moments.   When I did stick with it, trying to find or understand the content was painful.   I could not think because of the visual effects of the web page.    There was one site I did visit fairly often but it had a moving graphic which I covered by taping paper to my screen.

As you can see, I am now a different kind of customer.    I look fine.   I’m much better than a few years ago but I still have problems, like with that young man yesterday who spoke too, too fast and actually made me feel dizzy and not see straight.   I had to ask him several times to repeat himself.    My brain just does not take in the information that quickly.

I now see that there is a whole different set of customers that I never considered that deserve some acknowledgement.   I am one of them.   We use your services.   We buy your products.  We visit your web sites.    We use your help desks.   We pay you money.    Perhaps you can learn more about those of us with cognitive impairments so you have more awareness of our needs.    There are so many of us, the imperfect customer.







Don’t Talk About “Killing Time”

by Linda W. Arms

Since my brain injury I have become rather sensitive to healthy people complaining about being bored, not knowing what to do and are just “killing time”.      There are so many of us who have had an illness or injury where our options of doing anything are severely limited.   We struggle to get better.   We struggle to do the things we did before.   We struggle to do things like other people.     We are happy when we can do a simple thing without too many problems, even stirring a bowl of instant mashed potatoes!        There are people living with SEVERE handicaps and illnesses who appreciate the moments they are given and find joy in little things.    Killing time cannot be in your vocabulary whether you are healthy or struggling with an illness or injury.

I am fortunate in that my brain injury was not as devastating as those of some other people I have met.   It has also been over 7 years since my accident during which I worked hard to get better.  I tried doing things I did before and continued to do many of them even though it was very difficult.   I keep looking for new goals to increase my level of improvement.    I want to live life.   I want colorful, rich experiences.   In my journey back from the despairing first years after my injury, I feel I have reached the mainland of living where I can participate more fully.   I don’t want to kill time and I absolutely hate it when I hear other people who say that.   How sad!   Just think of the poor victims of the recent bombing in Boston or the shooting at the Aurora movie theater.   They lost their lives.   Their time is “killed”.    I’m sure they would like to have had the opportunity to trade places with some of the living that are “just killing time”.

A couple of summers ago I participated in a week-long camp for people with brain injuries.   I was a volunteer acting as a buddy to a camper who had a much worse brain injury than I did.   My buddy was injured decades ago at around the age of 19.   He was in a serious car accident that occurred because something in the car malfunctioned.   He was in a coma for several months.   Today he lives with a caretaker but he participates in life by going to camps and has other activities to stimulate him.   He has terrible memory problems and many other cognitive problems.   BUT HE LIVES LIFE with a smile.    He is not bored.   He does everything he can do with the cognitive capacity that he has.

Another camper I met who was truly an inspiration was another young man who received his brain injury when he was a toddler.   He was in a coma for 2 years.   Thirty-some years later, he is in a wheel chair, he cannot speak, his motor skills are very, very poor.   He has to be fed or food cut up for him.  He is always dependent on someone for everything.   When I first heard about him coming to the camp and then actually met him, I thought, oh my God!   How do you interact with someone who is so severely handicapped.   I felt so bad for him.   But you know what; he had so much joy in his beautiful eyes and in his face when he participated in all the camp activities.   He and I connected in the last couple days of the camp and I thought he was truly an inspiration to living a full life given whatever limitation life has given you.

So my point is – no matter where you are at with your brain injury – keep going.   Live life, enjoy life, try new things and don’t just sit around “killing time”.   Be happy you’re alive.   Be happy you have options in living a fulfilling life and finding joy even if you have limitations.





K.I.S.S. – Part III of “Keep It Simple Sweetie”

by Linda W. Arms

For many of us with an injured brain, communicating requires some extra care and attention.    We want to easily understand what is said to us without it requiring a lot more brain energy and frustration.   When we were like everyone else, comprehending what is said was so much easier and we often didn’t give it a second thought.

As my previous two posts on this topic mentioned, there is SO MUCH happening that you don’t think about.   The brain that is receiving the words/sentences is very busy as it processes all the pieces that make up the spoken communication.    At the same time, there are many things happening around us that our just part of the environment we happen to be in such as a restaurant or in an office.

Many things add to the complexity of the communication which results in more work for the injured brain to sort through and get to what is actually being communicated.    Here are a few more things that get in our way to easily comprehend what is being said to us:

  1. Distractions – there are always other things happening that distract us from comprehending the words coming at us.   Things like TV’s or radios in the background, and other people having conversations requires those of us with an injured brain to work extra hard in filtering out those other things.    It is also extra work to understand someone who is busy doing something else while they are speaking to us. Our brain is trying to focus on the words coming at us but at the same time we have to filter out the other activities the person is involved in.    I’ve had a hard time focusing on a person’s words when they use a lot of hand motions as they speak.   Even excessive facial expressions will interfere in my abilities to focus on what is said.
  2. Sarcasm, innuendo, and those other added complexities of communication – these are those things that require the listener to “read between the lines” of what is said.   We have to analyze the implications of what is said not just understand the words.    If we have an injured brain, we often just don’t get it.   We tend to take things very literally.   I’ve often felt left out when others laughed or reacted a certain way to something that was said because I couldn’t understand the innuendo or other twist on words.
  3. Words that sound like other words – an injured brain does not go down too many different paths in figuring out which word was really intended.    When my brain was far less nimble, someone said something to me about “lox on the window”.   Actually what they said was “locks on the window”.   For some reason, I initially comprehended lox (the fish) – on the window.   You can imagine my confusion which resulted in me losing the rest of what was said until I could figure out that they really didn’t mean having fish on the window.

Although comprehending what others are saying to us is more challenging for many of us after a brain injury, we have to remember that those “normal” people are just speaking like they always did and like we always did.   They can help by paying more attention to how they are speaking to us and what is going on around you.   We, with the injured brain, need to keep challenging ourselves to help improve our ability to comprehend.    We can’t isolate ourselves.   We can’t expect our loved ones, friends or caregivers to turn into robotic style speakers.    It does get easier.    Now after 7 years I actually understand things much more easily and I actually get most of the sarcasm, innuendo and other things.    Now I can look back and actually laugh at how I reacted (or didn’t react) to things that were said to me.

See my earlier posts with tips on communicating with those of us with a brain injury:

Part I of K.I.S.S. – “Keep It Simple Sweetie”

Part II of K.I.S.S. – “Keep It Simple Sweetie”




Taking Back Control After a Brain Injury

by Linda W. Arms – March 2013

A brain injury often results in us losing control of our lives. Often, because we need the help and oversight, we have to depend on others. We need help with simple, daily living activities such as getting to an appointment because we can’t drive. We need help with simple decision-making. We need help understanding what we are reading or hearing. We need the help of someone else’s brain for so much!

Our loved ones or caretakers start taking over our lives through no fault of their own. We have to lean on them for so much. They make many or all of our decisions, sometimes even for very simple matters. They answer someone’s question for us. They tell us we have to eat or have to rest or stop doing whatever it is we’re doing because they see it’s too much for us or it’s not safe to continue. We want them to do these things for us because it’s too much work or impossible to do by ourselves.

After my brain injury I felt like I instantly turned into an 85-year-old woman and a young child at the same time. I could not move fast and was unsteady. I had little strength. I needed someone to hold my hand to walk across the street, to tell me to stop what I was doing, to take a nap… I wanted someone to comprehend what was being said to me and help me respond.

As I improved, I slowly took over many things people were doing for me. I was not always successful, so I needed their help again. My capabilities were also inconsistent depending on my level of fatigue. My helpers were often standing by, watching and ready to step in. They let me try on my own. It was like being a young child who is learning new things in life. I was VERY grateful for all the help!!! Often I thought, “please, make this decision for me, it’s just too hard for me”.

In recent years, however, as I improved, I needed less and less help. It is sometimes a little difficult taking back that control over your life. Those you counted on became too used to taking over for you when you could not do something. As you improve it is often a bit challenging and even confrontational when you start taking charge of your life again. After all, you’re a big girl (or boy) now and you can do it by yourself.





Why is Eating So Much Work?

by Linda W. Arms

After a brain injury, everything seems to take so much energy out of you.   One of our most basic needs, nourishing ourselves, can be a lot of work.   Obviously cooking involves a lot of cognitive activities but even eating can be challenging.    After my TBI, it was difficult to sit at a table and eat.   I would often eat part of my meal and be so exhausted that I would have to lie down.

Think about everything that is going on at the table while you’re eating, especially if others are with you.   Another person is moving their hands to pick up the fork, cutting with a knife, moving food to their mouth, reaching for a dish of food…   They are picking up glasses to drink.   They talk.   Maybe a radio or TV is on in the background.   There are plates, glasses, napkins, and other things on the table and all around you.   All of this is being processing by your injured brain.    On top of all this, you have to feed yourself.   All those little actions that have to be handled by your brain.   Can you see why it’s exhausting?

I had visual problems after my brain injury that took a few years to be resolved.   It was very uncomfortable for me to sit at the table and eat. I wasn’t particularly hungry and then adding the stimulation of being at the table was too much for me. Even my own hand movements of eating and cutting the food were too much visual stimulation.   I would sometimes feel nauseous from the hand movements.    For some reason, clear glassware on the table caused a problem for me also.   I think my brain couldn’t quite figure it out, looking through it or whatever but the more there was on the table the more difficult it was for me to look at it.

I also had a sensitivity to sound and light.   Think of the sounds at the table that your brain has to process.   Bright lights around you add to the level of stimulation.   I used custom fitted musician earplugs to muffle the sounds around me but, unfortunately, having them in my ears while eating did not work very well.   The sound of me chewing was very loud which was disturbing.   The chewing sounds would also drown out anything someone was saying to me.     I knew I had to eat but the experience was not comfortable or enjoyable.   I’d eat a bit and then take a rest.     This is a lot for an injured brain to deal with just being at home where your surroundings are familiar, imagine the additional burden when you are out at a restaurant!   Just remember it gets better as your brain heals.   Know your limitations, and try to control your environment to keep things that trigger your symptoms from taking over.




It’s About Brain Injury, Not Politics

by Linda W. Arms

Let me start by saying this is about brain injury,  not politics.   My TBI occurred in early 2006 when you didn’t find much in the news about brain injury.   My husband and I looked for answers to my brain injury problems from medical providers and from the Internet.   During the first couple years I was appalled by what I was reading regarding our military coming back from our wars with brain injuries and just not getting the attention and care they needed.    Obviously many people just didn’t “get it” when it came to brain injuries, including our government.   One person stood out at that time and I thought “yeah!!!” somebody is doing something to try to help.   That person was Hillary Clinton, who recently suffered a brain concussion and complications as a result.   So I would like to say that we should put politics aside and kindly remember that Ms. Clinton did try to help those with TBI.

To know more, here is an excerpt from that speaks to the action that Ms. Clinton took back in 2009:

“The Fiscal 2009 budget released February 5 eliminates the Traumatic Brain Injury (TBI) Program, administered by the Health Resources and Services Administration; provides only modest reductions in claims processing wait times, from 177 days to 145 to process disability claims for separating service members or veterans; and fails to guarantee funding of the VA, leaving professionals at the Department unsure of next year’s budget….

Hillary Clinton joined Senator Barbara Mikulski in writing to President Bush, calling on him to reverse his plan to eliminate the Traumatic Brain Injury Program, which has a been a crucial component of the federal government’s system of care for the million of Americans dealing with TBI, including many veterans returning from the wars in Iraq and Afghanistan. The program that was eliminated by President Bush’s budget provides grants to states to help them develop systems of care for those impacted by such injuries; these grants are essential components of our national system of care for all Americans impacted by TBI.”

Furthermore, Ms. Clinton “included a provision in the recently enacted Fiscal Year 2008 National Defense Authorization Act to mandate that the Department of Defense implement a screening protocol for Traumatic Brain Injury within 180 days. The nearly 1,000 young West Virginia citizens that join the armed forces each year, along with members of the National Guard and Airmen from the state, now receive regular health screenings to detect Traumatic Brain Injury, thanks to legislation Hillary introduced. In addition, in 2006, Senator Clinton authored provisions in the John Warner National Defense Authorization Act for Fiscal Year 2007 that increased research into ways to improve TBI care for veterans injured in Iraq and Afghanistan.”

No, this did not fix it all but at least someone was paying attention to the needs of the TBI community.   So much more needs to be done to increase awareness and treatment.   So I say thank you to Ms. Clinton for her efforts and I truly hope she  has no long lasting effects from her concussion.   I say this as a person with TBI to another person who has been affected by brain injury.   It is not about politics.