In January 2021, at his neurologist’s recommendation, Matt underwent a grueling three-hour neuropsychiatric evaluation. The battery assessed everything: IQ, academic achievement, executive function, and emotional health. The final report gave precise names to the invisible wall we had been hitting—specifically anosognosia (a neurological deficit that masked his own verbal slip-ups). In addition, both orthographic and phonological dyslexia explained his struggle to recognize whole words by sight, recall visual spelling patterns, or connect letters to their corresponding sounds.

In lay terms, it amounted to a profound linguistic impairment, severe difficulty retaining and retrieving verbal and written information, and a persistent brain glitch during the planning, organizing, and execution of multi-step tasks. It was far more than a simple learning obstacle to hurdle—asking his damaged cognitive center to interpret words was like asking a one-year-old to take up pole vaulting before mastering how to walk. The trauma had fundamentally dismantled how Matt’s mind integrated the world.

We asked for practical techniques to help Matt navigate word-finding blocks and foster a more realistic self-assessment of his speech, since he frequently overrated his verbal abilities. Dr. Broege explained that this missing internal mirror is common after a brain injury and doesn't always return naturally. Hmmm. A polite clinical phrase for a terrifying possibility.

One key approach was having Matt critique video recordings of himself, including past college lectures. Dr. Broege emphasized that self-appraisal was a far more effective therapeutic intervention than external feedback. Although Matt occasionally dismissed the exercise as unhelpful, when actively engaged, he could objectively identify his need to enunciate, slow down, or speak more clearly.

A deeper challenge was his inability to catch himself if he mispronounced a word or substituted the wrong term during oral reading. Dr. Broege gently delivered a hard truth: each time Mike and I stepped in, we inadvertently enabled him to take the easy road out. We had to stop finishing his thoughts, resist offering hints, and refrain from letting mistakes slide—allowing him to experience incremental failure as a vital instrument for growth.

We rallied our support network—Jessica, Dave, and our extended family—to implement these boundaries. Dave pressed Matt for specificity in technical discussions, and Jessica required immediate do-overs whenever his message lacked clarity. It was a comforting relief to share the responsibility with others rather than carry it alone; we had a unified team.

Upon reexamination a year later, in February 2022, the RBANS evaluation revealed a puzzling disconnect. His raw scores had improved across every domain. Yet, except for visuospatial construction—a domain in which he soared to the 79th percentile—his overall percentile rank remained stubbornly below the 1st percentile. This highlighted a major flaw in traditional clinical metrics: standardized tests are engineered to categorize deficits relative to a typical population, not to capture incremental, functional growth. For TBI survivors, forcing a comparison against the general population can be utterly deflating.

A far better way to preserve hope and morale would be to measure lower-level baseline functions—tracking micro-gains against a survivor's own past performance instead of a bell curve that refuses to budge. While the medical world could see only a permanent deficit, we were witnessing a marvel unfold in real time: Matt was actively reading, coding, and communicating, defying the very metrics meant to quantify his limits. Assessments capture a single snapshot, but instinct, persistence, and everyday effort can rewrite the outcome.

© 2026, Sarah Watkins