Coping with Cognitive and Behaviour Change following Brain Injury

Dr Simon Collinson
Coping with cognitive
and behaviour change
following brain injury

What is Neuropsychologist?
“A psychologist who specialises in evaluating
brain/behaviour relationships, planning training
programs to help the survivor of brain
illness/injury return to normal functioning and
recommending alternative cognitive and
behavioural strategies to minimise the effects of
brain illness/injury”.

Summary
PART I: How do brain injuries affect thinking and
behaviour?
PART II: What are the possible changes in thinking and
behaviour?
PART III: Strategies for dealing with changes in thinking
and behaviour.

PART I: How do brain injuries affect
thinking and behaviour?

We only use 10% of our brain
Alcohol kills 100 million brain cells
The bigger your brain, the smarter you are
Scientists have no idea what the brain does
The brain cannot recover after an accident
Brain Myths
Part I: How do brain injuries affect thinking and behaviour?

• We use 100% of brain’s capacity (but not all at the
same time)
• The brain is functionally compartmented
• Compartments are different on left and right side (but they
talk to each other!)
• Compartments differ in men and women
• Compartments differ in left and right handers
Brain Facts

1) Destroying brain tissue through invasion/displacement
2) By increasing pressure within the brain
3) By causing seizures
4) Secreting hormones that influence brain or other body organs
4 ways brain injuries can compromise
function:

PART II: Possible changes in
thinking and behaviour caused by
brain injury

Sensation/Perception
Language
Attention/Concentration
Memory
Executive skills
Changes in personality and behaviour
Changes that can occur:
Part II: Changes in thinking and behaviour

Working
memory
Environmental stimuli
Short term
memory
Long term
memory
Attention

Executive functions
Planning & organising
Problem solving
Abstract thinking
Thinking flexibly

Creativity and drive
Impulsive/risk taking
Irritable or easily frustrated
Problems with managing anger
Trouble seeing own behaviour as changed/different
denial of problems
Seeing from other person’s perspective
Restlessness /impatience/agitation
Inappropriate in social situations
Difficulty with emotional control
Excessive laughing or crying
Changes in personality & behaviour that
can occur with brain injury:

PART III: Strategies for dealing with
changes in thinking and behaviour.

Strategies
Remedial: Strategies which seek to remedy the
problems in thinking in behaviour through challenging
the brain to change
Compensatory: Strategies which seek to get around the
problem so that it lessens their impact
Part III: Strategies for dealing with changes

Sensation and perception
Adapt rather than compensate
Repetition
Self prompts
Checking
Restructure the environment
Remove dangerous items
Maintain constancy
Reduce complexity of environment
Seek OT involvement
Prism glasses, blinding.

Language
Expressive;
Talk slowly, take frequent pauses
Keep messages short
Write statements on a pad
Receptive;
Ask people to repeat or rephrase
Tell people that you have a language problem and ask
them to slow down
Accept feedback from others

Attention/Concentration
Keep distractions to a minimum
Try to reduce demands on attention, reduce time pressures
Change tasks frequently (e.g. turn off radio/TV when reading)
Break down activities into short steps with regular breaks
Read magazines/paper rather than books
Focus on other activities that don’t require so much concentration
e.g. gardening, walking
Avoid situations which require dividing attention between multiple
tasks

Memory
Use a notebook or diary – keep it with you at all times!
Use calendars, whiteboards, lists and alarms as reminders
Keep important items like keys, glasses in the same place.
Repeat information and check diary frequently
Remember stress, tiredness and anxiety reduce memory capacity

Executive skills
Abstract reasoning
Ask people if you are ‘getting it’
Ask for information to be rephrased.
Planning & organising
What am I trying to achieve?
Break down into small steps (and tick off as completed)
Reduce time pressures
Get into a daily routine (e.g. walk at 9am, breakfast 9.30)

Behaviour
Frustration
Try to notice the ‘triggers’ which lead to frustration and avoid them
If you feel like you are getting frustrated re-direct your attention
and/or do something else
Accept advice from family members
Impulsive behaviour
Try to slow down before you act or speak
Accept feedback from others about your own behaviour
Avoid situations where impulsivity could be a problem (e.g. driving)
Drive
Structure your day so that you have things to do.
Have a schedule
Accept prompts from others

General strategies to reduce fatigue
Go to sleep and wake up at regular times
Go for a walk as soon as you wake up
Eat at regular times
Take regular rest breaks BEFORE you get tired
Avoid stimulants (caffeine) or depressants (alcohol)
Avoid risky activities when fatigued e.g. driving, working with
machinery
Do less!

General strategies to help adjust to change
Life is unpredictable and people cope better with unpredictable
events when they adapt (or try to adapt) to change.
Accept that permanent (and even temporary) changes to cognition
and behaviour require adaptation
Accept that life changes after a brain injury. Pace yourself, rushing
back to work or former activities should be managed in a graduated
way.
Be kind to yourself, having an illness can be hard work and it is OK
to seek support from others.
Look for meaning. What meaning do the events have in your life?
How are things better? What has it taught you?

Coping with Cognitive and Behaviour Change following Brain Injury

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