Memory impairment is a common cognitive disability in persons with brain injury. It is helpful for the individual who has sustained a brain injury to be reminded of memories or certain experiences through pictures or conversations. Writing down the memory may help stimulate thinking for the person.
Short-term memory loss is one example that makes it difficult for persons with brain injury to learn new things. It often takes twice as long for survivors to grasp new ideas as it did before the brain injury. Short-term memory loss makes it difficult for the person to recall what he or she did throughout the day, so the person with brain injury may ask the same questions over and over.
Repetition of saying things five times is helpful for cognition and memory, especially with short-term memory loss.
Associations are another memory technique. Examples of association are remembering a name such as Fred who has red hair by rhyming “Fred” and “red”.
Attention and Concentration
Sometimes a person with brain injury may appear to not be paying attention or is lacking initiation. It may just take the person longer to organize his/her thoughts or the person’s physical movement is slower to complete the task.
If someone is having difficulty paying attention, it may be a challenge for him/her to follow directions or do two things at once, such as answering questions while completing paperwork.
Reduce distractions to help the person concentrate on the task at hand. Schedule appointments when the person is at their “peak” attention time, such as early in the morning or after a nap.
Sensory overload is another example of a cognitive impairment that can make it very difficult for the person with brain injury to learn and focus.
Examples include at the mall being distracted by all of the people, noises, and lights and not being able to focus. Or at work and not being able to filter or block-out the distractions of voices and movement around you and closing a door is not an option
Add a desk partition around the desk to block visual distractions or try soothing music using ear plugs to block-out voices, as long as the music is not a distraction.
Disorganized surroundings can lead to lost and misplaced items, and difficulty keeping track of things in general. For someone who has sustained a brain injury, this may be frustrating and lead to confusion and agitation.
Label drawers and cabinets frequently accessed by the person. The labeling can be with words and/or pictures.
Establish and maintain a routine for the person with brain injury. For example, get out of bed around the same time each day and do the morning routine of showering, dressing, then breakfast. Discuss changes to the routine prior to the change.
A written or picture timeline may be helpful for the person to follow tasks as well as may help encourage safety and productivity. Posting the steps of the morning routine on the bathroom mirror such as wash face, brush teeth, comb hair may be helpful too.
Use medicine organizing “boxes” to ensure proper medication dosing and timing.
Daily calendar and cell phone apps may help persons keep track of all appointments or activities. Using a notebook, journal, or phone app may help the person recall important activities such as birthdays or what to bring to social gatherings.
We all struggle with problem solving at times, especially since there is more than one correct way to do something. An example is folding a towel. There is no right or wrong way, just different preferences.
Understanding the person’s strengths and limitations is important to advance problem solving skills.
Encourage initiation of a task by the person with brain injury. Suggest tasks in small increments or steps to help the person achieve goals. It may help him/her gain confidence for problem solving and do things on their own.
Allow for error, and failure, which can help the person increase awareness of their deficits.
Communication and Language
When communication impairments are present for a person with brain injury, speech may be impaired due to damage to nerves and the inability for the person to move muscles in his/her mouth. A communication impairment may be due to the inability of the person to understand and interpret written or spoken words.
Language abilities may be altered due to brain injury, depending on which lobe or lobes of the brain are damaged. The person may be able to understand everything that is being said, but is unable to verbalize thoughts. Or the person is able to verbalize thoughts and speak clearly, but he/she is unable to comprehend what is being said.
Communication can either be verbal, gestural or written. If someone is having trouble understanding words, try using gestures or simple words and phrases to communicate with the person.
Speak in short direct sentences and along with gestures. For example, “time for dinner” and gesture eating by bringing your hand to your mouth.
Use directions one at a time such as “Write your first name” (wait for the person to complete the task, then…) next “Write your last name” (wait again), “Write the date.”
Allow time for reduced processing speed by the person.
Face the person and make eye contact when talking with him/her.
Slow your rate of speech or encourage the person to slow his/her rate of speech. You may need to increase the volume of your speaking and clearly pronounce each word.
Make sure that when you are communicating with a person who has sustained a brain injury that you use the best form of communication for that person.
Use assistive technology and communication devices such as writing and/or a picture-communication board. Use of an iPad and phone apps are helpful too.
When brain injury affects motor skills, the person may not be able to raise his/her hand, drive a car or conduct daily care such as dressing, showering or holding a toothbrush. Physical limitations may include muscle or movement dysfunction in any part of the body that limits mobility or self-care. A person with a brain injury may feel tired, even after a good night sleep.
Speech may be impaired due to damage to nerves and it may affect the person’s ability to move muscles in his/her mouth.
Seizures may occur. Some people have seizures the first few months post brain injury, some never have seizures, and others have them for the rest of their life. Continued seizures often require medication, and the person is restricted from driving.
Some persons with brain injury may have persistent headaches and be sensitive to light.
Place commonly used items within reach in the bedroom, bathroom, kitchen, or other frequented rooms of the home.
Remove obstacles that could hinder mobility such as rugs, carpets or poorly placed furniture.
Make walkways well lit, and ensure the light is easy to access.
Encourage the person and his/her family to make sure a cane, walker or wheelchair is being used if recommended by a healthcare professional.
Encourage safe independence by suggesting the person try new tasks in your or a family member’s presence. Be supportive that failure may occur, but keep trying when it is safe to do so.
Perception or Sensory Changes/Disabilities
Perceptual impairments include a person’s senses and perceptions, such as hearing, vision, touch and balance. It also involves changes in time and space orientation.
Perception is the ability to perceive size, shape and color of objects and to differentiate things that might be somewhat similar such as a rectangle and a square.
For example, an individual with brain injury may be unable to determine where his/her hand ends and where the table is in front of them. Time disorientation is when minutes feel like hours and vice-versa. This happens to most people at some time, but due to brain injury the person may feel like this all the time.
A person with perceptual impairments may have trouble judging distances. Depth perception impairment may make a person appear clumsy as he/she reaches over or under an object due to the inability to judge depth and space. Have the person with brain injury reach for an object to help identify if the person may have a perceptual deficit.
Perceptual impairments put the person at risk of secondary injuries. They may fall when depth is not recognized. They may be burnt when they cannot sense hot temperatures.
Use alarm clocks or timers, phone or computer apps to stay on schedule.
Pictures and labels of caution may help reduce risks of secondary injuries.
Mental Health or Emotional Changes/Disabilities
Brain injury can include impairments in emotional control, mental health, social interactions and changes in personality or behavior for the person injured.
Psychological issues are common after a brain injury. They can include anxiety, depression, lack of emotional control, and awkward or inappropriate social interactions.
Psychological and emotional effects are usually caused by a combination of the physical injury to the brain and the lasting effects of the traumatic incident that led to the injury. Stress of being in the hospital, having to put their life on hold, learning how to walk or talk again can be contributing factors to emotional control and behavior issues.
The road to recovery of psychological effects from a brain injury begin with the individual seeking or being provided help from a trained mental health professional.