COGNITIVE CHANGES
The cognitive changes after brain injury can affect the way a person thinks, learns and remembers. Different abilities are located in different parts of the brain, so a brain injury can damage some but not necessarily all.
Some common issues include difficulties with the following:
Some of these issues are more pronounced at the early stages of the recovery when the person is distracted with medical issues and the high level of activity in the hospital.
For some people however, changes in the way the person thinks can be permanent.
Attention:
Difficulties with attention can present themselves in different ways.
- Directing attention
The person may have difficulty attending to a given task or focusing on the important or relevant components of the task. They may appear uninterested in or unaware of what they are being asked to do.
- Sustained attention
The person may be able to direct their attention to a task for a few moments but may not be able to concentrate for very long. He or she may become distracted easily. The complexity of the task and the person's fatigue level can affect how long they can focus on a given task. Internal stimuli (e.g. thoughts about lunchtime) or external stimuli (e.g. outside construction noise) may interfere.
- Shifting attention
The person may be able to concentrate on one task but cannot switch from one activity to another. They may get stuck on a task and may not be able to stop doing it. This is sometimes called perserveration.
- Divided attention
Some people have difficulty coping with multiple tasks. For example, a student may not be able to listen to a teacher and take notes. Or the person may not be able to concentrate on cooking dinner while the radio is on.
Attentional problems tend to get worse when the person is tired, stressed or worried. Working in a place with as few distractions as possible can help.
Speed of processing:
After a brain injury some people process information or think at a slower rate. Sometimes it looks as if the person does not understand or is not going to respond to what is said to them - but given time to process the information, they may be able to respond accordingly.
Memory and learning:
Memory is easily damaged by brain injury because there are several structures within the brain which are involved in processing information, storing it or retrieving it. Although the degree and nature of memory impairments varies in each situation, there are common patterns.
Often the person with a brain injury has a good memory for past events or previously-learned material (e.g. family members, where they worked, the family pet's name).
Short-term memory loss is the most common and troublesome type of memory problem. This can manifest itself in a variety of ways. Examples of this are forgetting what has just been said, having difficulty in learning a new skill, repeating the same question over and over, forgetting people's names, getting details mixed up, forgetting a change in routine and forgetting where things have been placed.
There is no magic answer to improve this type of memory problem, but rehabilitation can help a person cope by teaching strategies to compensate for the memory loss (e.g. written reminders, log books, established routines).
Planning, Organizing and Sequencing:
People with brain injuries can experience difficulties with planning, organizing information or sequencing things to get a task done.
People sometimes experience difficulty breaking down a task into the individual steps that are needed and therefore the task can be overwhelming. For example, they may wish to phone a friend to arrange a visit but the steps of finding a phone book, looking up the number, deciding on an appropriate time and place to visit may be too much for them.
Strategies can be used to help in these areas, for example breaking the task into individual steps and providing cues to the person on how to complete each component of the task.
Communication Concerns:
Brain injuries can affect a person's ability to communicate. Communication is not just speaking. It is also getting ideas across through signs, symbols, gestures, body language and written language.
Language problems following a brain injury vary. The speech produced by a person who has traumatic brain injury may be slow, slurred and difficult or impossible to understand if the areas of the brain that control the muscles of the speech mechanism are damaged. This type of speech problem is called dysarthria.
Others may have what is called apraxia of speech, a condition in which strength and coordination of the speech muscles are unimpaired but the individual experiences difficulty saying words correctly.
Another communication problem sometimes experienced by people after brain injury is aphasia. Some people with aphasia have problems primarily with expressive language (what is said) while others have major problems with receptive language (what is understood). Language is affected not only in its oral form of talking and understanding, but also in its written form of reading and writing. Typically, reading and writing are more impaired than oral communication. The nature of the problems varies from person to person, depending on many factors but most importantly on the amount and location of the damage to the brain.
Source and additional information about aphasia: www.asha.org/public/speech/disorders/Aphasia_info.htm
Sometimes people experience difficulties with the more social aspects of communication and conversation such as problems with turn-taking, trouble generating ideas, trouble reading social cues in a conversation, difficulty recognizing facial expressions in self or others.
Where to get help:
Professionals called speech-language pathologists are able to help people with communication problems. They can also give suggestions to family members on how to communicate more effectively with someone with aphasia.
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