Thinking and understanding after injury:

general

It is normal to feel a bit forgetful or have difficulty to concentrate while you are in hospital and once you get home. This is often due to some of the drugs that you may get in hospital and the shock that your body experienced due to the accident. These symptoms should resolve over time.

However, if you are experiencing persistent cognition problems (thinking and understanding) of any kind, it is important to seek guidance from your healthcare team, including an occupational therapist and psychologist who are specialists in neurology where possible, to discuss specific difficulties and treatment options. In addition, everyone's rehabilitation is affected by their personality, mood and social situation. Every person is different, so every recovery journey will be unique.

Thinking and understanding problems after injury: the Cognitive Treatment Model

The model below as a visual tool to break down different aspects of cognition.

Attention & Orientation

Before your brain can do anything, you need to be awake and taking information in. Sometimes after trauma, and particularly if you have a brain injury, people tend to be very sleepy and hard to rouse so need lots of rest. Problems with attention are common after a brain injury. It means people get distracted easily, lack concentration and are unable to divide their attention between tasks (e.g. walking and talking at the same time). They may be oversensitive to noise as their brains can’t select which things to filter out, so it’s good to have a quiet environment. Some people may be confused about where they are or what the date is - an orientation board with this information written on it can help remind them.

Tips on how to manage attention difficulties/overstimulation/distractibility

Be aware of the amount of distraction in a given environment e.g. busy café.
Use orientation boards/ diary/ calendar as appropriate for the person
Simplify tasks
Very clear and consistent daily routine
Minimize distractions
Planned rest periods
Avoid sensory overload
Allow plenty of time for even basic every day tasks e.g. personal care.

Information processing:

After serious injury, it can take a while for information to be processed so if you caring for a trauma survivor, particularly someone with a brain injury, it’s important to give the person time to respond. People may appear to not understand instructions when they just need extra time to process information. Don’t be afraid of silence/ thinking time. Also be mindful of potential language problems. If these exist a person may struggle to find the right words to communicate. Writing or drawing pictures may help.

Tips on how to manage problems with information processing

Always ask for the injured person to repeat/ summarise what you have said to them to check understanding.
Allow plenty of time for the person to respond
Simplify instructions
Use verbal and visual strategies e.g. writing down information
Use repetition and make a summary of the information given

Visual Processing/Perception

Messages from our eyes and sensory organs can be disrupted on the way to our brain. Perception is our ability to take information from the world around us and make sense of it. This can be through seeing, smelling, touching, hearing or tasting - in other words using all our senses.

The way we are able to understand or perceive what is around us can be damaged after a brain injury. Some perceptual problems can seem like a memory loss or a communication problem but they are not. Examples of difficulties with perception include inability to judge distances and space in relation to self and other objects. The also include problems recognizing and using objects correctly. People may have an altered understanding of their body parts e.g. where their arms and legs are in space which may cause many difficulties e.g. dressing self.

Tips on how to manage problems with visual processing/perception

People with these problems are likely to require one on one support in everyday tasks from a person who understands their difficulties and is able to encourage independence while maintaining safety at all times.
Repetition of everyday tasks in a structured environment will help with problems in this area.

Loss of Memory

Loss of memory could mean even simple tasks become more difficult and require lots of attention to complete. Learning new skills or information becomes very tricky, and tasks such as attending an appointment or taking medication could be forgotten. If you are caring for someone with these problems, they may need reminders.

Tips on how to manage memory problems:

Repetition of tasks in a structured environment
Use a diary
Use reminders/ alarms e.g. on phone
Some people find writing to do lists/ using white board helpful as they are clear visual reminders
Voice recordings can be helpful
Family and friend support/ awareness and education is essential

Executive skills

Executive skills include: planning, organisation, problem solving, adapting and decision-making. If these skills are affected, some things might become more difficult, for example: making decisions, adapting to changes and problem solving in every day activities.

Tips on how to manage executive problems:

As these skills need an advanced level of cognition to carry out, if you are having problems, it is likely that you will need professional support in this area.
Grading activities from more simple to complex is essential

Awareness & Regulation

For rehabilitation to be most effective, a person needs to have insight into their condition. However, if a person's injuries include a brain injury, quite often people don’t think there’s anything wrong with them. This impacts all the other levels of cognition.

Tips on how to manage awareness & regulation (including insight)

Education is essential to support people with insight difficulties because without insight into their specific problems they will make very limited progress
Feedback on difficulties within any given task and setting appropriate goals for people to work towards.