Stories of Attention, Concentration and Distractibility after Brain Injury
The following are stories of real life survivors of brain injury. Clicking on the titles will take you to their actual story.
When I went back to work, the difficulty in deciding (what to do when)
Angela states that she had to go to the office on the weekends so that she had no distractions with phone calls,etc. so she could focus on her loans and write notes to herself so she knew where she was and what she was doing.
The phone would ring while I was trying to figure out what to do that was very upsetting to me and so then I would cry.
But each additional distraction, interruption will create additional demands on memory and the ability to attend. Add stress to that equation and the cognitive failure is predictable.
Well an environment, like a restaurant, where you have the table you are at. Even the table you are at, if you have a table of six, you may have three conversations going on. On top of that, you may have a kitchen, music overhead, you have a table behind you, having a totally different conversation, you have a baby over in the corner screaming, and you are trying, I am trying in those moments pay attention to the conversations that are going on at my table and contribute to the conversation in some way that is positive.
Let’s say I had gotten almost all the way through even though there was all these distractions with this file. Somebody then comes in and interrupts me right at the time when I’m almost done before I’m actually able to make the note about what I had done, I had to start over because of that interruption.
I’d be concerned about the people in the line, like from the standpoint of humanity, like I would be concerned that I was keeping them from something that was important and because there’s multiple things going on I would be distracted from what I was needing to do.
A store is a distraction filled world, with countless decisions to make, which most of us give little thought to.
Brain injury, brain damage is thought of as a thinking disorder, a problem which effects memory, concentration.
Fatigue is not as big of a problem for Betty as for some survivors, but she does find that lack of energy does make it more difficult to complete her household duties and to stay on task. Betty also describes her concentration issues with conversations, “Sometimes if I walk into a conversation and somebody would start talking to me immediately and I’d have no idea what they’re talking about I would feel not very smart asking well what was it that you were talking about? And if it’s a subject they’ve been discussing for 15 minutes and my brain walks away and I come back and then oh what was that you were talking about? Then they think that I’m not paying attention.”
I’m always late for everything. I get distracted really bad, really bad. I can’t just stop and get ready. I have to play with the cat or pick something up or just little things like that they add up and make me late. Like to be ready to go somewhere, I always just keep putting stuff off and putting stuff off, thinking I’ll have time but I don’t.
Many of Chris’s ongoing deficits are the classical cognitive issues one would expect to find after a TBI memory, language, speed of information processing. Others are classic frontal lobe problems, such as the executive functioning problems that made it so hard to get to work on time. Emotions and mood are big ongoing problems.
Chris worked for a shoe company before her accident. After her accident, she returned and worked there part-time for 4 years typing in ordering information, Chris was eventually fired due to problems with attendance. As is typical with many who sustain a brain injury, Chris had difficulty with time management and distractibility. She was not able to realistically plan how much time was required for various tasks and had difficulty keeping her attention focused on the task at hand (i.e., getting ready to go to work).
I asked DJ what seems to contribute to his short-term memory problems: “Distraction is right up there with the top two or three. The other day I was boiling potatoes, I was making Shepherd’s pie and all of the sudden I smelled something. All I did was go in and answer a couple of quick instant messages or something on Facebook and my stove is around the corner from my computer nitch at the condo, and I started to smell something. I knew immediately. I ran and got a cup of water and I had to get water back in there because all the water boiled down.” Let’s focus on a particular part of that. Do you have difficulty having a sense of time? If you’re going to cook something and do something else, you should sort of have a little alarm clock going in your head that regardless of how distracted you get, you know that that’s happening. Do you have a hard time focusing in on time when you’re doing anything else?: “I black out. I don’t want to say black out like a drinking black out, but it’s a dementia blackout. I mean I can literally be on that computer and smell the smoke, of course then I’m going to remember I got food on the stove or in the broiler.” But you completely lose track of time?: “I don’t even remember when I when I put them in there.
DJ states; “And, I know for a fact I could not wait tables and be in that environment any more. The noise, the distraction, the stimulation, I just think it would be a – plus the dizziness. I think I would drop a tray. I would trip.” You are talking about too much stimuli. Is concentration a major issue for you?; “As long as I’m concentrating on one thing, like what we’re doing right now. One question at a time. Give me a second, boom. I think I can get you an answer. Maybe not every time but I can get you an answer. Coming at me with two and three and four things, you know, or directions, three and four directions. Go down the hall, turn left and I left something at the front desk. That might work but probably not.”The brain functions the same as a computer. It has a certain capacity to do multiple things at once, a capacity similar to the RAM on a computer. After a brain injury, one of the biggest losses is that attentional capacity of the brain, its RAM, is compromised. As long as the attentional demands are below the diminished RAM capacity, the brain may work without overt signs of disability. But once the attentional load approaches capacity, the injured brain’s functioning will show significant evidence of impairment. As opposed to the quiet of the neuropsychological test environment, the real world is full of piercing distractions, RAM hungry demands upon the brain. Each one of those – traffic, background noise, stress – will directly impact the ease and the accuracy of post brain injury function and attention problems.
When asked if he went to watch the fireworks on the 4th of July it reminded him of his distractibility. Did you do fireworks?: “I did. I went downtown. I watched fireworks and then, I’m glad you said that because this happens, too. Is I’ll leave and if I’m, my heads not together and I’m not paying attention, I will walk around and just suddenly realize I’m very lost. I just, I get on the phone and talk or I answer Facebook. I’ve done it going to the store to get bread. I’ve done it, you know, a lot of different facets and forms. Believe me. And, I get a little bit lost. I called a cab and I came home. So, I went to bed about 12:00. I think I woke up around 6:00 or 7:00, which is as much sleep as I’ll ever get but I probably walked somewhere around 8 miles.”
He seems to have relatively few problems with change in routine, distractions noise.
When discussing Gina’s absentmindedness with her husband he responds;”Yes. A lot of times, yes. Even like tonight. We’re invited to a birthday party for a friend of mine and when I asked her about it today, you know, she said oh, yeah. I forgot all about that. She forgets where she needs to be. This morning coming here to meet you we were talking about our son’s continuing education. Finally I said Gina, we got to get going. And she’s like oh, for what? I was like remember where we have to be? Oh, yeah. It’s already 10 after 8:00.” When asked “Does she start and get distracted and then not finish?” he responded; “She does. She, she gets distracted I think with a lot of issues that she’ll put something down and just leave it sit. Example is our auto insurance cards came in the mail a few weeks ago and there’s a card for each of the three vehicles. Our son has a vehicle on our policy and everybody needs to put these in their vehicle and the vehicle she normally drives I just noticed this morning her card is still sitting on the kitchen counter.”
When asked “When do you have problems with concentration?” Ian resonds; “Where I have a tendency, you know, if certain people talk to me and I just kind of like go into another room so to speak. And, and they could still be talking to me and they ask what I, what they just said and I’ll look at them like, I have no idea.”
“Now one difficult thing I just experienced at this instant, is I was thinking of something I was going to explain to you of thoughts, and as I get off on tangent, then I can’t remember what I was going to tell you, which I never would do before. So…
What about getting distracted?: “Yeah, I mean distracted sometimes like just playing sort of getting, getting like sort of in the moment of playing a song and, or wanting to play a song, to share a song and continue on and, and but not really stay on task with like trying to learn this other song or something but.”
Attention and concentration problems get most of the attention in mild brain injury cases. In contrast, other more overt symptoms often get the focus after severe brain injury. However, recovery from the more overt symptoms of brain injury does not mean that a survivor may not be plagued long term with the more subtle attentional issues that plague many survivors of mild TBI. Kelly can’t do noise. The reason is likely because screening out what she intends to listen to from all of the background sounds requires a level of over-attending that it quickly tires and exasperates her.
When asked what bothered her about being in a restaurant “What is about children and noise that bothers you?” , Kelly replied: “The crying, the demanding, just the, the noise.” When you go to a restaurant at a busy time, there’s always almost an overwhelming amount of background noise. Does that cause you trouble, too, or is that almost white noise for you?: “It’s pretty much white noise.” What issues do you have with, multitasking, staying up, keeping your attention, jumping from thing to thing?: “As long as I’m able to define what my task is and I can set a goal for each task, then I’m able to work that task. And they come drop another one on me, I’ll have to work it in to how I’m going to work it with this task. And if they don’t coincide, I will tell somebody, they don’t coincide with my abilities.”
Is it difficult for you to read if there’s any distraction or noise around you?: “Yes. I like to read when it’s quiet, you can concentrate better. And so noise, your mind gets distracted and you can’t concentrate when you’re reading, what the book is saying to you.”
What about noises? For example, the backup alarm on a truck, does that bother you?: “It can. Actually the biggest noise problem I have is when, it’s pretty quiet, like if you’re in for a test and you’re supposed to be doing the test, people coughing, dropping their pencils, that would drive me nuts. Actually what drives me nutty kind of nuts right now is when I have all four of my kids and they can’t give me just one second because I’m very slow at understanding what they’re asking, comprehending.” Your problems keeping up in conversation has a lot to do with how many different sensory inputs are going on at once?: “That’s true. Actually from my accident, let’s see if I can remember which year because my dad didn’t tell me this when I talked to him last night, I believe it was this year I did something to my eardrum so I had very bad hearing out of this ear, so I used my right ear to, I rely on my right ear a lot.”
Another one of the criteria is the ability to maintain concentration and attended, concentration and attention for extended periods. Did you have problems with that?: “Oh, yes.” In what ways?: “When I was working for the government, too much attention on the computer to anything really started to bother me. Before I quit there, they took me off the computers and just put me on paperwork. But for me and my seizure disorder at the time and from what Dr. Nash had told me about people that are being dyslec, the people that are being dyslexic, you can’t do that to them. Because they get jumpy and I was supposed to put out like 200 pieces of paper an hour. If you got two from me that was lucky.”
You were saying she had some problems at the talent show. : “Yeah, she was in the talent show and, and everybody likes her to be there. She won the talent show last year on one of her songs. But she had a song to sing this year and it was more of an upbeat song and the kids were clapping in the audience with the beat and she kind of forgot, she got into the whole mood so much she forgot her place. And it was really kind of, it was really cool because then the kids were singing the song along with her and then when she got lost they kind of brought her back to the spot where she was supposed to be and then she finished. It was really cool.”
Did that come about because your daughter was being tested?: “Well there was so many factors that were becoming aware that I thought it was necessary to get checked and it was a cognitive test and I didn’t do very well on it, and they had said that, uh, the, it was ADHD kind of brain injury. They said it was caused by â€“” Attention processing problems? : “Yes.” Distractibility?: “Yes.”
Is there a level of distraction that starts to make it hard for you? : “Sometimes, you know, like when you were talking to her I got thinking; I was listening to you guys talk but then I got thinking about other issues, so I missed half of what you were talking about. That’ll happen when I’m having a conversation with you, you’ll ask a question and, it says Dynex on the stand, and that’s distracting me. I’m wondering what, never heard of Dynex, and then I forget what your question was.”
Conversation, as soon as you add one more person, make it a three-way conversation, and you have to listen more, it becomes more of a difficult? “Yeah. It, to me it’s like trying to multitask, doing, it, let’s do two things at once, if there are more than one person to communicate with. I mean in a group of people yeah, there’s conversations going on, separate conversations going on, it’s like do I pay attention to that one, do I pay attention to that, you know, and it does, it is strange.” The longer my questions the harder it is for you to follow them?: “Yeah, because I, so now you asked. You just asked three questions in your conversation with me. I was focused. Now I’m totally focused on the first question, and I’m like oh shit. He’s saying, asking another question; now I forgot the first question. Now I’m trying to think, well what was the first question, well crap now he just added a third. So that’s why at the end I just said look it, you know, there’s, you just said way too much.
Do you have difficulty completing a task? : “Sometimes yes.” Can you give me an example? : “Cleaning the house. If it’s, let’s say it’s taking care of the cat litter and vacuuming and doing the windows. When I first came home, doing three of those things would never have happened. Doing one partially might have, you know, whereas now I can at least do those functions, but I’ll sometimes, you know, I’ll do, start one of those tasks, get distracted and then remember oh yeah, I got to finish what I started. Is the distraction where you run into the most difficulties?: “I don’t know. I’m not sure, but like let’s say I’m in the middle of doing the cat litter; I may get a phone call, you know, and, and then get off the phone and be hungry and remember, oh yeah, I haven’t had breakfast. It’s 2:00, I’ve got to eat, and then oh yeah, I’ve got to finish the litter, and then well I need to eat breakfast before 2:00 in the afternoon.”
Do you also have problems in terms of the sequencing of how to fix a car ” that you have to plan it, you have to diagnose it and then you have to plan the process of fixing it.: “Organizational and multi-tasking skills are so non-existent for something like that. It kind of messes me up.”
I So even when he watches something that it seems like he might be interested in, he’s really not paying attention to it?: “No. There’ a lot of blankness on his face.”