Cognitive Challenges: Sequencing, Staying on Task, Topic

Cognitive Challenges: Betty Part Seven

Those who don’t know much about brain injury are often surprised at how “normal” someone with a brain injury may be and are not aware of the cognitive challenges of the brain injured.  Only the truly profoundly injured will show the kind of overt dementia that we have been programmed to expect.  Most cognitive challenges are far more subtle than what an Alzheimers or severely learning impaired individual might have.  Much of the brain may be unaffected by even a severe injury, including long term memory and communication ability as some of the cognitive challenges. Both Angela our first case study and Betty are perfect examples of that.  That Betty communicates so well is both proof of that tendency but also a credit to the extensive and multi-year rehabilitation that she received post injury.

Betty describes a number of classic cognitive challenges.  Sequencing (putting things in order)  and memory are ongoing cognitive challenges.  Like most survivors, she has learned to write everything down.

If there’s something I need to do or something I need to get from the store the night before I’ll write it on a list and I’ll place it on top of my purse so that when I come downstairs and see it then I know I’ve got to go to the store to get those items.

Driving is one of the most troubling aspects of disability for a wide range of brain injured individuals.  It is one of the  unique cognitive challenges , requiring intense attention, visual perception, multi-tasking, capacity to deal with stress and coordinated sensory, reflexive and muscular control.  It took Betty about three years to get her drivers license again after her TBI.  Even now more than 25 years post injury, she must be careful where and when she drivers.

I don’t like to drive distances too much.  I have a friend who also sustained a head injury who lives in south Milwaukee and I’ve gotten lost trying to get over to that house at least a dozen times.  That’s a problem I have is somebody gives me directions, I’ll look at the directions and I think that I’m following them and all of a sudden I’m in, practically in Illinois.  I use a lot of gas when I’m driving, it’s a sad situation.

Fatigue as One of the Cognitive Challenges:

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.

I get very tired, and with me not working now there have been times that my husband would get up, he gets up at 5:00 three mornings a week and goes to the YMCA to work out and then he goes to work and I get, well I get up with him but then I go right back to bed and I would set the alarm for maybe 7:30, 8:00 and it goes off and I, oh, I want to sleep another hour and that doesn’t do me any good because I know I’ve got things that I have to do with the house and shopping or laundry or going to see my mom, helping her out.  It’s just a difficult, it’s a difficulty I have putting that all together and knowing what I’m supposed to be – keeping my mind on one task, my mind on, keeping my mind on task for the one particular action that I’m doing.

Other Cognitive Challenges:

She also has significant anxiety problems in keeping up in 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.

She also has a hard time staying on topic in conversation.  She explains:

I seem to jump from topic to topic.  I’m sitting with a couple people and they’re talking about how one time that they had gone on a trip and they lost their luggage all of a sudden I’ll click in and I’ll say oh well I went to college in New Orleans and I flew down there a couple times I just – I mean, it has nothing to do with what they started talking about and then they look at each other as if to say okay why did she just do that.  Because they had been talking about one thing and I inappropriately at times also change subjects and say things that are not appropriate.

For Part Eight, click here.