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Cognitive Problems After Traumatic Brain Injury Dawn Neumann, PhD and Anthony Lequerica, PhD, Model Systems of Knowledge Translation Center Page 1 of 2

What is cognition?

Cognition is the act of knowing or thinking. It includes the ability to choose, understand, remember and use information. Cognition includes:

• Attention and concentration.
• Processing and understanding information.
• Memory.
• Communication.
• Planning, organizing, and assembling.
• Reasoning, problem-solving, decision-making, and judgment.
• Controlling impulses and desires and being patient.

How does TBI affect cognition and what can be done about it?

After a TBI it is common for people to have problems with attention, concentration, speech and language, learning and memory, reasoning, planning and problem-solving.

Attention and concentration problems

A person with TBI may be unable to focus, pay attention, or attend to more than one thing at a time. This may result in:

• Restlessness and being easily distracted.
• Difficulty finishing a project or working on more than one task at a time.
• Problems carrying on long conversations or sitting still for long periods of time.

Since attention skills are considered a “building block” of higher level skills (such as memory and reasoning), people with attention or concentration problems often show signs of other cognitive problems as well.

What can be done to improve attention and concentration?

• Decrease the distractions. For example, work in a quiet room.
• Focus on one task at a time.
• Begin practicing attention skills on simple, yet practical activities (such as reading a paragraph or adding numbers) in a quiet room. Gradually make the tasks harder (read a short story or balance a checkbook) or work in a more noisy environment.
• Take breaks when you get tired.

Problems with processing and understanding information

After brain injury, a person’s ability to process and understand information often slows down, resulting in the following problems:

• Taking longer to grasp what others are saying.
• Taking more time to understand and follow directions.
• Having trouble following television shows, movies, etc.
• Taking longer to read and understand written information including books, newspapers or magazines.
• Being slower to react. This is especially important for driving, which may become unsafe if the person cannot react fast enough to stop signs, traffic lights or other warning signs. Individuals with TBI should not drive until their visual skills and reaction time have been tested by a specialist.
• Being slower to carry out physical tasks, including routine activities like getting dressed or cooking.

What can be done to improve the ability to process and understand information?

• Place your full attention on what you are trying to understand. Decrease distractions.
• Allow more time to think about the information before moving on.
• Re-read information as needed. Take notes and summarize in your own words.
• If needed, ask people to repeat themselves, to say something in a different way, or to speak slower. Repeat what you just heard to make sure you understood it correctly.

Language and communication problems

Communication problems can cause persons with TBI to have difficulty understanding and expressing information in some of the following ways:

• Difficulty thinking of the right word.
• Trouble starting or following conversations or understanding what others say.
• Rambling or getting off topic easily.
• Difficulty with more complex language skills, such as expressing thoughts in an organized manner.
• Trouble communicating thoughts and feelings using facial expressions, tone of voice and body language (non-verbal communication).
• Having problems reading others’ emotions and not responding appropriately to another person’s feelings or to the social situation.
• Misunderstanding jokes or sarcasm.

What can be done to improve language and communication?

Work with a speech therapist to identify areas that need work. Communication problems can keep improving for a long time after the injury.

How family members can help:

• Use kind words and a gentle tone of voice. Be careful not to “talk down” to the person.
• When talking with the injured person, ask every so often if he or she understands what you are saying, or ask the person a question to determine if he or she understood what you said.
• Do not speak too fast or say too much at once.
• Develop a signal (like raising a finger) that will let the injured person know when he or she has gotten off topic. Practice this ahead of time. If signals don’t work, try saying “We were talking about…”
• Limit conversations to one person at a time.

Problems learning and remembering new information

• Persons with TBI may have trouble learning and remembering new information and events.
• They may have difficulty remembering events that happened several weeks or months before the injury (although this often comes back over time). Persons with TBI are usually able to remember events that happened long ago.
• They may have problems remembering entire events or conversations. Therefore, the mind tries to “fill in the gaps” of missing information and recalls things that did not actually happen. Sometimes bits and pieces from several situ¬ations are remembered as one event. These false memories are not lies.

What can be done to improve memory problems?

• Put together a structured routine of daily tasks and activities.
• Be organized and have a set location for keeping things.
• Learn to use memory aids such as memory notebooks, calendars, daily schedules, daily task lists, computer reminder programs and cue cards.
• Devote time and attention to review and practice new information often.
• Be well rested and try to reduce anxiety as much as possible.
• Speak with your doctor about how medications may affect your memory.

Planning and Organization Problems

• Persons with TBI may have difficulty planning their day and scheduling appointments.

Cognitive Problems after TBI was developed by Dawn Neumann, PhD and Anthony Lequerica, PhD, in collaboration with the Model Systems Knowledge Translation Center. Portions of this document were adapted from materials developed by the Rocky Mountain Regional Brain Injury System, the UAB TBI Model System, the Mayo Clinic TBI Model System, the New York TBI Model System, and from Picking up the Pieces after TBI: A Guide for Family Members, by Angelle M. Sander, PhD, Baylor College of Medicine (2002). Copyright © 2010 by University of Washington/MSKTC. 

Please check the MSKTC site for any recent updates on this article.

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