This article and podcast looks at the cognitive effects after a brain injury and is part of a brain injury series. Cognitive areas that may be impaired by a brain injury include memory, attention and concentration, logic and reasoning, language skills, information processing speed and insight into your abilities.
One of the most common problems that people have after a brain injury is impaired memory. At the time of the accident itself, someone with a serious brain injury may have amnesia for the events in the hours, or even the days and weeks, preceding the brain injury. They may have amnesia for the events after the brain injury and their first memory after the accident may not be for a number of weeks after the event. After that, there may be ongoing problems with memory, particularly short-term memory and people might have difficulties, for example remembering something they were told earlier the same day or an activity they did on the previous day.
Problems with attention and concentration
Another very common problem faced by people with brain injury is difficulty with attention and concentration. If you are at a medical appointment being given information, you might find that your mind wanders after just a few minutes. You may find yourself getting distracted more easily in situations. There can often be an overlap between memory issues and problems with attention. After all, if you haven’t been able to pay attention to what someone was telling you in the first place, you won’t have taken in the information and will have trouble remembering it later.
It is common after a brain injury for people to lack ‘mental flexibility’. They may find it difficult to switch their attention from one task to another. They may have concrete, rigid thinking, one consequence of which is that they may not be able to understand other people’s points of view.
A person may demonstrate perseveration, which is a tendency to get stuck in certain behaviours or thought patterns, and to continue repeating words or behaviours long after they have ceased to be appropriate or relevant.
Many people with brain injury have problems with their “information processing speed”. This may mean that they find it harder to take in information than they did before the accident, and may need to ask people to repeat themselves or need to re-read things that they have just read. Again, this can be made worse by attention problems. At other times, people might find themselves for example having difficulties following a conversation where a number of different people are talking
A brain injury survivor may have difficulties with language, including making themselves understood clearly or understanding others. It is not uncommon after a brain injury for people to have problems understanding non-verbal communication, such as facial expressions. They may find it harder to understand nuances of tone or sarcasm.
Another difficulty that is often faced is difficulty with reasoning and planning. The effects of this may include having problems following directions or planning a journey. They may have difficulties carrying out a task that has different stages that need to be carried out in a certain order, such as preparing a meal.
People with brain injury often have difficulties with motivation and initiation. This may mean that they have little motivation to begin a task or may lose interest soon after. This is often wrongly confused with laziness.
To cap it all off, people often lack insight into their abilities after a brain injury. They may not understand why they need help or why other people might be restricting their activities.
One potential difficulty with diagnosing these problems, and in particular their cause, is that it is not uncommon for someone with brain injury to have anxiety and depression and this can cause or contribute to some of the above impairments, such as attention and memory difficulties.
Rehabilitation for brain injury
Arranging rehabilitation for people is a really important part of what we do and some of these problems can at least be alleviated by coping strategies and by treatment from neuropsychologists, occupational therapists and speech and language therapists. Speech and language therapists can help with language difficulties. Neuropsychologists can provide cognitive rehabilitation. Occupational therapists can help come up with adaptive strategies to try to find a way round some of these cognitive issues. For example, there are numerous apps that can be used on your mobile phone to help remind you of appointments and other events. Some people use a whiteboard in their kitchen to help them plan their week. Problems with attention and fatigue can be alleviated by trying to decrease distractions, breaking up complex tasks into smaller ones and taking breaks in between tasks.
Making a brain injury claim
When making a claim on behalf of a brain injury survivor, we will arrange for them to be seen by a number of different independent medical experts. All of the appointments are arranged by us to minimise any inconvenience to the client. One of the most important experts that we use for brain injury cases are neuropsychologists. As part of their assessment, they would carry out what are known as “neuro-psychometric tests” to assess the level of cognitive impairment caused by the injury. Other experts we may use would include a neurologist, as well as a neuropsychiatrist to look at any psychiatric effects caused by the brain injury such as depression and anxiety.
How Moore Barlow can help
Matt Tuff is a senior associate in the major trauma service at Moore Barlow. As well as recovering compensation for our clients, I place particular emphasis on securing rehabilitation for them at an early stage. I have extensive experience of working closely with expert case managers and rehabilitation companies to secure this goal.