Cognitive Changes

Brain injury can affect the way a person thinks, learns and remembers. Different abilities are located in different parts of the brain, so some may be affected, while others are not.

Some of these issues are more significant at the early stages of recovery when the person is distracted with medical issues and the high level of activity in the hospital. However, in some cases the changes can be permanent.

The following are some common challenges:

Attention

Difficulties with attention can include:

• Directing attention
  The person may have difficulty focusing on a specific task or the important parts of the task. He or she may appear uninterested in or unaware of what they are being asked to do.

• Sustaining attention
  The person may not be able to concentrate on a task for very long. He or she may be easily distracted. 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 can’t switch from one activity to another. They may get stuck on a task and may not be able to stop doing it.

• 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.Problems with attention 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. However, they may be able to respond if they are given time to process the information.

Memory and learning

Memory is easily damaged by brain injury because there are several parts of the brain that are involved in processing, storing and retrieving information.

Although the degree and nature of memory impairments vary 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. 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 make up for the memory loss (e.g., written reminders, logbooks, 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.

A person sometimes has difficulty breaking down a task into the individual steps that are needed. As a result, the task can be overwhelming. For example, the person might want to phone a friend to arrange a visit, but the steps of finding a phone book, looking up the number, and deciding on the time and place to visit may be too much for them.

Strategies can help. For example, breaking the task into individual steps and providing cues to the person on how to complete each part of the task.

Communication

Brain injuries can affect a person’s ability to communicate. Communication is not just speaking. It is also communicating through gestures, body language and written language.

Language problems following a brain injury vary and may include:

• Dysarthria
  Speech is slow, slurred or difficult to understand because the areas of the brain that control speech muscles are damaged.

• Apraxia
  The person has difficulty saying words correctly.

• Aphasia
  Some people with aphasia have problems with expressive language (what is said). Others have problems with receptive language (what is understood). Often a person may have more problems with reading and writing than with speaking and understanding.  Additional information about aphasia is available here.

Sometimes people experience difficulties with the social aspects of conversation such as taking turns, generating ideas, reading social cues, and recognizing facial expressions in themselves or others.