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Author: Trevor Powell
Submitted by: Craig Lock
Category (key words): head injury, brain injury, neuro-psychology
Web site: http://www.headway.org.uk
Other Articles by Craig Lock are available at: http://www.selfgrowth.com/articles.html
(Personal growth, self help, writing, internet marketing, words of encouragement and inspiration, money management)
Publishing Guidelines: I hope that the following piece may be informative
to others. This article
may be freely reproduced electronically or in print. If it helps
anyone "out there in the often very difficult, but always amazing 'journey of life' in any way, then we're very happy.
"We share what we know, so that we all may grow.
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THE COGNITIVE EFFECTS OF HEAD INJURY
by Trevor Powell
Submitter's Note:
Craig has been researching and studying in this field for nearly twenty years stemming from a long-standing head injury. He hopes that by sharing that it will make some difference in those lives affected by brain injury. Craig likes to share knowledge and insights from his life experiences to try and help others. He hopes that by sharing, it will make some difference in those lives affected by brain injury.
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Part of the text is reproduced by kind permission of Trevor Powell from his book 'Head Injury: A Practical Guide'.
The cognitive effects of a brain injury affect the way a person thinks, learns and remembers. Different mental abilities are located in different parts of the brain, so a head injury can damage some, but not necessarily all, skills such as speed of thought, memory, understanding, concentration, solving problems and using language.
The cognitive system can be divided up into six separate areas:
Memory
Memory is not one thing or one skill on its own. It is easily damaged by brain injury because there are several structures within the brain which are involved in processing information, storing it and retrieving it. Damage to those parts of the brain on which these abilities depend can lead to poor memory. Problems with memory is a complex subject and is covered in more depth in a separate section.
Headway has produced a publication Memory Problems After Brain Injury that provides further information.
Attention and Concentration
A reduced concentration span is very common after head injury, as is a reduced ability to pay attention to more than one task at the same time. These problems are usually caused by damage to the frontal lobe. Attentional problems tend to get worse when the person is tired, stressed or worried. When there are problems with concentration, other skill areas can be affected. It is difficult to follow instructions, plan ahead, be organised and so on, when there is a problem concentrating. Working in a place with as few distractions as possible can help and, as concentration improves, distractions can be increased. In this way, someone can slowly learn to concentrate better in a world which is crowded with distracting sights and sounds.
Speed of Information Processing
Slowing down the speed at which the brain performs the task of information processing is often due to 'diffuse axonal damage' caused by a shake up of all of the pathways the brain uses to transmit messages. This results in problems such as not understanding fast speech, being unable to absorb instructions first time around, and not being able to quickly formulate a reply to a question. To improve the speed of information processing, it is advisable to keep mentally stimulated at the right level to avoid overload.
Executive Functions - Planning, Organising, Problem Solving
Damage to the frontal lobe can affect these skills, resulting in a subtle set of deficits which have been called 'Dysexecutive Syndrome'. This covers problems in making long-term plans, goal setting and initiating steps to achieve objectives. The ability to stand back and take an objective view of a situation may be lacking, as may the ability to see anything from another person's point of view. If the person is aware that this is a problem, then encouragement and direct feedback can be given to help the person modify their behaviour. It is useful to try to create structure in otherwise unstructured situations, by breaking down any task into specific tasks, perhaps using checklists. Flexible thinking is made up of both divergent thinking (thinking outwards or generating ideas from a single point) and convergent thinking (thinking inwards, taking ideas and summarising them). Exercises which practice these skills not only improve ability but help to identify difficulties and improve awareness.
Visuo-Spatial and Perceptual Difficulties
Organs such as ears and eyes may be working perfectly well, but the part of the brain which makes sense of incoming information from these sources may not be working properly. This gives rise to several different types of difficulty. Problems in judging distances, spatial relationships and orientation can mean, for example, that a person may bump into furniture that they have seen, but have misjudged where it is in relation to themselves. Sometimes a person will have a problem where one side of whatever they are looking at is not seen (visual neglect). A person may only eat half the food on their plate, or read only halfway the across the page. The ability to recognise something viewed from a different or unusual angle can be lost. This can also apply to sounds as well as vision. Building objects or drawing them from component parts such as coloured block may be very hard.
Language Skills
Problems with language loss can be either receptive such that no sense can be made of what is heard or read, or expressive which means it is not easy to find the right words to say or write. Difficulties with these areas are known as aphasia. When both problems are present the condition is known as 'global aphasia'. There is a special area on the left side of the brain concerned with producing speech (Broca's area which is located between the frontal and temporal lobes) and another area for understanding the speech of others (Wernickes's area which is located further back between the temporal and parietal lobes). These two are connected by numerous pathways but are quite distinct. It is useful to remember that the brain skills which produce and understand speech are different to the ability to make the sounds of language. The latter can be due to problems with the muscles in the throat and mouth, and more detailed information is given in the section on physical effects after head injury.
A publication titled Communication Problems after Brain Injury is available which describes the common problems and gives hints and tips on dealing with them.
Other organisations can help, such as Speakability.
EMOTIONAL EFFECTS:
Everyone who has had a head injury can be left with some changes in emotional reaction and behaviour. These are more difficult to see than the more obvious problems such as those which affect movement (a physical effect) and speech (a cognitive effect), for example, but can be the most difficult for the individual concerned and their family to deal with.
Headway has produced publications to help and advise on many of the problems outlined below. There are more than twenty titles covering subjects such as Psychological Effects of Brain Injury and Personal and Sexual Relationships Following Brain Injury
Headway's network of local Groups and Branches are an excellent source of advice and support for the head injured person and members of the family by people who have experienced these difficulties at first hand, and can advise on coping strategies and treatment methods.
This subject is very large, and not everybody will experience all of the problems below. The severity of the problems will also vary.
Agitation
Explosive Anger and Irritability
For example, exaggerated angry reaction to apparently minor annoyances.
Direct damage to the frontal lobes, which is the part of the brain which controls emotional behaviour and tolerance of frustration, can create emotional lability. This means emotions can swing to extremes. The stress of coping with even minor crises, such as misplaced shoes or a noisy vacuum cleaner, can be too much and trigger an angry outburst. If these stresses can be identified, they may be able to be reduced.
Lack of Awareness and Insight
The mental ability to monitor personal behaviour and adjust it accordingly is a sophisticated skill contained in the frontal lobes of the brain. Damage to this area affects the ability to be self-aware, have insight into the effects of personal actions, show sensitivity or feel empathy. It also means that a person may not fully appreciate or understand the effect that the accident is having on their life, health or family. Involvement in a head injury support group can be very useful for meeting people at various stages of recovery, who can help a person recognise difficulties they may also be experiencing.
Impulsivity and Disinhibition
For example, speaking your mind no matter what the circumstances, touching people inappropriately, and not considering the consequences of any action.
This is the lack of ability to control either actions or speech, and is due to neurological damage to the frontal lobes. This problem often goes hand in hand with lack of awareness, and the person may not be aware of breaching any social rules or etiquette. A behavioural management system devised with the help of a neuro-psychologist can help improve the situation, and prevent a person developing unacceptable behaviour through habit.
Emotional Lability
This describes a person's tendency to laugh and cry very easily and to move from one emotional state to another very quickly.
Loss of control over emotions means the person has lost the ability to discriminate about when and how to express their feelings. This can be very tiring and embarrassing for family members to deal with, but in time a person can begin to re-learn emotional control.
Self-Centredness
For example, not showing any interest in family matters, and only being concerned with personal needs.
This can be partly due to direct brain injury affecting a person's ability to judge how another person is feeling, and may be partly due to a person becoming accustomed to the huge amount of attention focused on a head injury survivor while they were in hospital. The result can be very hard to cope with. It needs to be handled firmly to avoid a family feeling their effort and love are not appreciated.
Apathy and Poor Motivation
For example, no interest in hobbies enjoyed previously, or not being bothered to get out of a chair all day.
Lack of motivation or spontaneity, or apathy, is a direct result of brain injury to frontal lobe structures that concern emotion, motivation or forward planning. Over time, lack of motivation can lead to social isolation and lack of pleasure. To help, activities can be broken down into small steps to avoid overwhelming the person.
Depression
For example, feeling there is no point in having survived the accident, or thinking that everything has changed for the worse.
Depression is a very common emotional reaction which comes on in the later stages of rehabilitation, often when a person realises the full extent of the problems caused by the accident. This can be seen as a good sign, that a person is aware of the reality of the situation, and is coming to term with the emotional consequences. 'Healthy' depression can be worked through in time, as adjustments are made. If a person feels emotionally blocked and unable to move on, professional counselling from someone who understands head injury may be helpful.
Anxiety
For example, panic attacks, nightmares, and feelings of insecurity.
It is natural for people involved in a traumatic experience to feel anxious afterwards. Loss of confidence when faced with situations and tasks which are difficult to cope with is also a pretty normal reaction. However, long standing problems can occur if difficult situations are continually avoided, or if carers encourage dependence rather than independence. Talking about fears and worries is very helpful, and adopting methods of staying calm under stress can reduce the effect of anxiety on everyday life.
Inflexibility and Obsessionality
For example, unreasonable stubbornness, obsessive pattern of behaviour such as washing or checking things, or fear of possessions being stolen.
The ability to reason must not be taken for granted. The roots of this type of rigid behaviour are in cognitive difficulties resulting from damage to the frontal lobes. The person can lose the ability to jump from one idea to another, and becomes 'stuck' on one particular thought. This type of behaviour is often made worse by anxiety or insecurity, so reassurance is helpful, as is trying to redirect attention to more constructive ideas and behaviour. This type of behaviour can be very irritating to family and friends, and often leads to social isolation.
Physical Effects
Part of the text is reproduced by kind permission of Trevor Powell from his book Head Injury: A Practical Guide
Tiredness
Fatigue after head injury can be one of the most limiting symptoms because it affects everything a person does. Energy stores are easily depleted, and it can take a long time to build up the reserves again. By pushing themselves too hard a head injured person can exhaust the supply of energy, so it is better to recognise the early signs of fatigue and to rest.
Movement, Balance and Co-ordination
Damage to the brain which causes movement difficulties usually happens to the motor cortex, the brain stem and the cerebellum. As one side of the brain affects the motor co-ordination on the opposite side of the body, a person often experiences a weakness or paralysis of one side. Damage to the cerebellum affects fine co-ordination of the muscles, and can mean continuing problems with dexterity even after a period of improvement. Difficulties with balance can be caused by damage to the vestibular system, which is a small mechanism at the back of the skull. Even a minor brain injury can upset this delicate organ, so that the person often feels dizzy. Learning to walk again after a head injury involves re-learning the basic developmental stages so that they learn to balance before a stable posture can be achieved. Contractures, that is, abnormal shortening of muscles which make it very hard to stretch limbs, can seriously affect posture. Exercises provided by the physiotherapist are essential in helping to overcome this in the early stages. More severe contractures may require the muscle to be encased in plaster and gradually stretched.
Dyspraxia
Dyspraxia is a disorder of deliberate voluntary actions, or sequences of actions. That means it is different from problems with motor co-ordination or movement. The person may not have a problem with actual movement, rather the problem lies with being unable to put movements together deliberately and intentionally. This kind of problem can often be perceived as a lack of co-operation on the person's part. A good example of the kind of problem would be a person who cannot bend his elbow when instructed to, but a few minutes later could tell the time by looking at his watch which involves bending his elbow quite automatically. Rehabilitation aims to break actions down into a sequence of activities, with cues and prompts, which is then practised until the cues and prompts can be gradually dispensed with.
Loss of Sensation
Different parts of the sensory cortex deal with sensations in different parts of the body. After a head injury, people may experience a loss of sight, hearing, taste, smell (anosmia) and so on without actually damaging any of the sense organs. If the sensory cortex has been bruised, a gradual recovery of sensation may be possible. If the area has been torn, it is unlikely to return to normal functioning. Processing what the eyes see is carried out in the occipital lobes at the back of the brain. Damage here can result in either full or partial blindness, or gaps in the visual field. Visual neglect is covered in the section on cognitive problems. Temperature control can also be affected, particularly by damage to the brain stem.
Trevor Powell
Reproduced from the Headway web site: http://www.headway.org.uk
Headway - the brain injury association Reg Charity No 1025852
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"Success to others may be apparent in what you DO; but
significance, meaning and purpose lies, then reveals itself
in what you ARE and BECOME down the 'river of life' - how
and the spirit with which you face, then overcome the daily
obstacles, the frequent trials and tribulations along the
often rocky path-way of life's magical and mysterious
journey.
Light your path brightly."'
"The task ahead of you can always be overcome by the power within you...and the seemingly difficult path ahead of you is never as steep with the great spirit that lies within you."
"When the world is filled with love, people's hearts are overflowing
with hope."
- craig
http://www.craiglockbooks.com
