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Coping with Cognitive and Behaviour Change following Brain Injury

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Dr Simon Collinson, NeuroPsychologist

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Coping with Cognitive and Behaviour Change following Brain Injury

  1. 1. Dr Simon Collinson Coping with cognitive and behaviour change following brain injury
  2. 2. 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”.
  3. 3. 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.
  4. 4. PART I: How do brain injuries affect thinking and behaviour?
  5. 5. 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?
  6. 6. • 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 Part I: How do brain injuries affect thinking and behaviour?
  7. 7. Functional compartments
  8. 8. Part I: How do brain injuries affect thinking and behaviour?
  9. 9. 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 I: How do brain injuries affect thinking and behaviour?
  10. 10. PART II: Possible changes in thinking and behaviour caused by brain injury
  11. 11. Sensation/Perception Language Attention/Concentration Memory Executive skills Changes in personality and behaviour Changes that can occur: Part II: Changes in thinking and behaviour
  12. 12. Working memory Environmental stimuli Short term memory Long term memory Attention
  13. 13. Executive functions Planning & organising Problem solving Abstract thinking Thinking flexibly
  14. 14. 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:
  15. 15. PART III: Strategies for dealing with changes in thinking and behaviour.
  16. 16. 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
  17. 17. 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. Part III: Strategies for dealing with changes
  18. 18. 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 Part III: Strategies for dealing with changes
  19. 19. 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 Part III: Strategies for dealing with changes
  20. 20. 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 Part III: Strategies for dealing with changes
  21. 21. 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) Part III: Strategies for dealing with changes
  22. 22. 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 Part III: Strategies for dealing with changes
  23. 23. 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! Part III: Strategies for dealing with changes
  24. 24. 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? Part III: Strategies for dealing with changes

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