Since the cycling accident 16 years ago that left Claudia Osborn, D.O., with a serious brain injury, she has continued to lead an active life through a combination of memory-aiding strategies, a two-day-a-week assistant, and the helping hands of family and friends. But although helping hands are welcome, caretakers are not. “In brain injury, the most important thing is for people not to do things for you,” she explains. “We are, as far as our disabilities are concerned, more likely to stay dependent than other people. We need people who foster our independence by allowing us to fall down, fail at something, and being there to pick us up and support us and encourage us to move toward greater independence.”

One pair of helping hands takes the form of the helpful paws of Micah Matisse, an 8-pound Maltese. Micah is a service dog, trained to help Claudia to function independently despite impairments in memory, orientation, alertness, and judgment. Micah can’t pack Claudia’s suitcase for her before her many out-of-town speaking engagements; however, he does make sure she is alert and ready to board her flights on time, reminds her to take her medications, and unfailingly returns her to her hotel room after her daily walk. Micah is copilot rather than codependent—sometimes quite literally. When rollerblading through Metro Detroit parks, Claudia’s tendency to become inattentive would sometimes result in collisions with other people. Now Micah rides shotgun in her backpack, gently nudging her when someone else approaches on the path.

Executive function
Until Claudia was struck by a car during a bike ride near her home in Grosse Point, Michigan, she was a hard-driving physician working in the trenches of an urban hospital. In her 1998 autobiographical account of her injury and its aftermath, Over My Head, Claudia paints a vivid portrait of a busy professional, confidently marching from patient to patient, from task to task, dragging doctors-in-training along in her slipstream. These are the gifts of the brain’s frontal lobes, a key area for “executive functions” and an area damaged when Claudia’s head hit the pavement. Executive functions include complex, goal-directed behaviors such as decision-making, abstract thinking, planning, and carrying out pre-planned sequences of steps to complete a task. The frontal lobes are also involved in self-control, such as deciding which behaviors are appropriate under various circumstances.

Carrying out executive tasks also requires an ability to stay on track toward a goal. Due to her injury, Claudia suffers from a condition known as adynamia: a tendency to shut down and slip into a state of flatness, apathy, or low mental energy and alertness. But if so, Micah is there to nudge her along. “Because of the adynamia, I have a tendency to turn off,” she explains. “The dog turns me back on.” That includes waking her up at the gate when her flight is called. He’s a great guard dog, too. “People at airports used to steal my stuff. They don’t do that anymore.”

Memory matters
As is common after brain injuries, Claudia experiences difficulty forming new memories. This condition, known as anterograde amnesia, makes it harder to recall specific or “explicit” memories. “If you asked me what I had for dinner last night, I probably wouldn’t be able to tell you,” Claudia explains. “But if you said, ‘Wasn’t that a great lasagna we had last night?,’ then maybe I would remember.” To compensate, she uses various strategies such as working from lists and technical devices such as a timer and digital voice recorder.

She also works with a coach to design new strategies. Packing a suitcase, for example, may not seem like a particularly complex task, but stop and think for a moment: You have to pack items based on a clear mental picture of where you are going, for how long, what the weather will be like, and other details. You have to step through the trip and match the contents of the suitcase to the plan. Five years ago, it was not possible for Claudia to successfully complete this task. “It seemed like one of those things that I was never going to master,” she recalls. “Then slowly but surely I began to get a handle on more and more pieces, and I was able to do it more independently.”

Moving on
Although Claudia was not able to return to clinical medicine, she maintains a busy schedule. For part of the year, she is out of town on overnight trips every week. Her engagements include talks to brain-injury advocacy groups, other physicians, and legislators to lobby for greater support for people like herself. On a national level, she says, there is an urgent need for more support for people with brain injuries to allow them to remain active and contributing to society. “Every year I improve,” Claudia says. “That doesn’t mean I don’t have permanent deficits I have to work around, but every year my life is definitely better and I do grow and change and learn new skills.”

Micah plays a key role. As she wrote recently in the August 2003 issue of the publication Healing Garden, “I cannot throw out all my strategies now that I have Micah, but his skills augment my tools and working with him has provided an enriching change in my life. Along with my greater independence, he makes it possible for me to consistently function with more ease and smoothness.”

Further Reading:

“Over My Head: A Doctor’s Own Story Of Head Injury From The Inside Looking Out,” by Claudia L. Osborn. (Andrews McMeel Publishing: 2000. 256 pages, paperback).

www.claudiaosborn.com - Includes web links to information about service dogs for disabled people.