Conclusion Do not underestimate the knowledge and observations of family members and caregivers who live with or care for the survivor. This tip card just scratches the surface. Use your experience to identify additional strategies, Cognition evaluate what works best for the survivor in your family, make changes over time, and continue on the journey of Compensatory strategies cognitive recovery. after brain injury Reference: Hammond, F & Guerrier, T. Eds. (2010). Brain Injury It is a Journey: A practical guide for families. Wake Forest, NC: Lash & Associates Publishing/Training, Inc. This tip card helps survivors, families This tip card is not intended as a substitute for the medical advice of and caregivers ... your physician. Consult your doctor regularly about matters concerning your health, particularly regarding symptoms that require diagnosis or immediate medical attention. ./ recognize cognitive challenges ./ use compensatory strategies

Written by Flora Hammond, M.D. Tam i Guerrier, B.S. Marilyn Lash , M.s.w.

Alaska Brain Injury Network, Inc. 3745 Community Park Loop, Suite 140 Anchorage, AK 99508 Office: (907) 274-2824 [email protected]

Item: ABIN-CCST Copyright© 2011 by Lash & Associates Publishing!Training Inc. This material is copyrighted by Lash & Associates and cannot be reproduced in any form without permission. Published by IASH &AsSOCIATES PUBLISHING/TRAINING INC 100 Boardwalk Drive, Suite 150, Youngsville, NC 27596-7761 Changes in How You Think Memory Many survivors have cognitive (thinking) difficulties The ability to remember can affect every aspect of a after a brain injury. Thinking is simply harder and takes person's life. Difficulty with memory can be frustrating, longer. It is the cognitive changes that often concern increase confusion, create safety risks, and affect survivors and families the most. Physical healing is much relationships. more predictable - and faster - than cognitive recovery. Do you have ... Survivors have said: D Difficulty remembering people, conversations, '1 didn't understand what had happened to me. I thought I was losing my mind on top ofeverything else. " places, events, instructions, appointments, telephone numbers, and dates? "Even the simplest things seemed impossible to me. I couldn't balance my checkbook and Tm an accountant. " D Inability to recall tasks from day to day? Or hour to hour? Families have said: '1 was terrified How would he ever be able to work again? D A tendency to fill in memory gaps with events, What would happen to us?" conversation, etc. that did not happen? '1t broke my heart to see her struggle so. It was just so hard " DA hard time remembering new information? Children have said: D A tendency to lose or misplace personal items? "My Dad couldn't help me with my homework any more." D Trouble remembering when to take medications? '1 had to learn how to get myself ready for school I couldn't Tips on compensatory strategies ... count on my Mom to help me anymore. " ./ Record names of visitors in a journal. Cognitive challenges are a major factor in determining whether a survivor can live independently, must rely on ./ Use memory aids such as calendars, daily planners, family for support, or needs a residential program. and checklists. Some cognitive changes are so subtle that only the ./ Write down information in a consistent place. survivor or close family members are aware of them. Other ./ Post visual reminders in key places. changes are obvious and affect the survivor's daily life, relationships, ability to work or go to school. ./ Repeat new information. Instructions ./ Give cues to help with memory recall. ./ Structure a routine for daily, weekly, and monthly This tip card lists common cognitive changes after a tasks and events. brain injury. In each of the following sections, check the boxes in areas that affect you or your family member. ./ Use alarms on watches or timers to cue when to do Each list is followed with suggestions for compensatory a task or take medications. strategies. Not every strategy will work for everyone. Each ./ Use tape recorders. person is different and each brain injury is different. By ,/ Keep personal and household items in the same trying these strategies, you can explore what works best place. for you and your family. These checklists can be used in discussions with your doctor, therapists or caregivers. ./ Use medication organizers. Attention I Concentration Mental Fatigue The ability to pay attention and concentrate can affect Cognitive fatigue is one of the most common everything from managing a household to succeeding in consequences ofbrain injury. The survivor's brain is simply school or performing a job. Attention is the ability to focus working harder to think and learn. Cognitive rest is just on something. It may be a conversation, a movie, a sound as important - maybe even more important - as physical or an activity. How long the person holds this attention is rest after the brain has been injured. Cognitive fatigue called concentration. Something might get your attention, can have a ripple effect. You may have a shorter temper, but may not keep your concentration if it doesn't interest find it harder to concentrate, make more errors, misplace you or is too hard to follow. things or forget appointments. You may feel like you can't Do you ... think straight no matter how hard you try. Many survivors describe cognitive fatigue as "hitting the wall". D Find it hard to stay focused on a task? Do you ... D Have trouble focusing on more than one task? D Feel tired after mental exertion? D Become easily distracted? D Have a harder time thinking after working on longer D Leave tasks unfinished? or more complex tasks? D Find it hard to follow conversations? D Need more sleep than usual? D Have problems following instructions or D Find it hard to get through the day without directions? napping? Tips on compensatory strategies ... Tips on compensatory strategies ... ./ Focus on one task at a time. ./ Take breaks . ./ Break tasks down into steps. Allot a short period ./ Schedule rest periods. of time for each step. ./ Stay organized . ./ Clear home and work areas of unnecessary distractions. ./ Use a daily planner. ./ Perform tasks in a quiet area. ./ Use time management strategies . ./Use timers, alarms and checklists to mark ./ Eat nutritious meals on a regular schedule . completion of tasks. ./ Go to bed at a consistent time. ./ Remind the survivor when the conversation goes ./ Create a weekly exercise routine . off the topic. ./ Request a medical evaluation . ./ Ask for instructions or directions to be repeated. ./ Discuss medications that may help with a physician ./ Eat a balanced diet and get proper rest. specializing in brain injury rehabilitation . ./ Discuss medications that help with attention with a physician specializing in brain injury rehabilitation. Slowed Responses Tips on compensatory strategies ... It may take longer to process information that is ./ Cue the survivor on "the next step". coming into your brain as well as more time to respond and ,/ Write down instructions or reminders with send information out from your brain. Too often, slower checklists, "to do" lists, daily planners or electronic processing is misunderstood as lower intelligence. devices. Do you ... ./ Review plans and schedules at the beginning of each day and at regular times during the day. D Need more time to complete a simple task? ./ Create organizational systems at home. D Respond more slowly to a question or conversation? ./ Have everyone in the family use the same reminders, cues, and strategies. D Have a slower reaction time in general? ./ Help the individual set goals and identify steps to Tips on compensatory strategies ... reach the goals . ./ Allow more time to respond or complete a task. Judgment and Safety Awareness ./ Do not speak or do the task for the survivor. Many survivors and family members worry about ./ Be patient. another injury. Impaired judgment increases this risk . ./ Do not put the survivor in dangerous situations. Do you ... ./ Follow recommendations of physicians and D Get a thrill from speed or dangerous activities? therapists for supervision at home, going back to D Make poor choices or use poor judgment? work and returning to driving. D Use alcohol or drugs to feel high? Planning and Organizing D Ignore the risks and dangers of actions? These are often called "executive skills" because they D Follow warning labels on prescription and over the are higher level thinking abilities that require multiple counter medications? cognitive functions. Tips on compensatory strategies ... Do you ... ./ Consider safety risks of all situations. D Have a hard time doing necessary steps in order to ./ Limit choices. accomplish something? ./ Anticipate unsafe choices. D Have a hard time learning new information? ./ Offer safe alternatives. D Have difficulty thinking ahead or anticipating ./ Do not allow the survivor to be in dangerous consequences of your actions? situations. D Become disorganized more easily? ./ Provide close or constant supervision if D Find it hard to problem solve and come up with recommended by a physician or therapist. strategies and alternatives? ./ Remove or lock all potentially dangerous D Avoid developing plans to accomplish your goals? possessions from the home, including alcohol, firearms, car keys, medications, etc.