Attention Problems and Concentration after Brain Injury

Attention Problems and Concentration: DJ Part Eleven

DJ explains the attention problems along with his trouble with concentration.   He describes situations where he has difficulty.

“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.”

Another problem with cognitive functioning with attention problems is with multi-tasking, which can also impact short-term memory.  I asked DJ to give me some examples of his attention problems with multi-tasking:

I would say simply getting a phone call while grocery shopping.  I mean, I check off my list.  Multitasking, riding the bike and maybe getting a call and maybe a mom I know has called me on occasion to say they’re coming in town or, you know, a package is being sent, expected on a certain day and I don’t stop to put on my calendar.  Um, being out in the community and somebody gives me two and three and four thoughts.

I need one at a time.  I have to stop them and say, “Hold on.  One thing at a time.  I can’t figure out your answers.”  And before I got hurt, I could do four tables with a kid over there that needs a bottle heated up, a guy over there that needs another beer or somebody over there, the steaks not cooked right and all that stuff got filed and it just flowed.  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.  Are concentration and attention problems 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.

What about restaurants and crowds?

For the first year and a half to two years, I’d say no.  That was not an option for me.  I didn’t like it. I don’t like cars, either.  There’s too much going on there and I always feel like we’re going to crash.  I still do.  I don’t like cars still.  But, as far as restaurants and stimuli and things like that, it, it has gotten better.  It can’t be too loud or too crazy.  I can go down to Applebee’s and sit there and eat and that’s okay.  But, I can’t have like a baby screaming over there, a waitress talking to me and then maybe a guest, you know, a friend trying to rap with me, too.

Applebee’s, because of your attention problems, is better if you go by yourself than if you try to hold a conversation with someone else?

I can go with somebody but then, they got to stop talking while the waitress talks and when the waitress delivers food, they need to stop talking.  I mean, everything’s got to be, you know: USF psych said it, “very succinctly.”  It’s one of the few things that I agree with them.  It has to be military like.  A, then B, not A, D, C, B, like life used to be.  You know: go over here to get a little list done and then we’ll come around the corner and cover that.  It’s not like that anymore.

How do you control those sequencings with your attention problems, those stimuli, that input – so that your brain is just taking one task at a time?

Do one task at a time.  I train it.  I teach it.  I tell people A.  You have to do A.  If you’re going grocery shopping, don’t take your bills with you.  You know, don’t go get a hair –well, you, I can get a haircut because I’m, I’m out and the grocery store is in that shopping center but, like payday.  I go to the bank.  I do what I got to do.  I go around the corner.  I get my haircut.  I stop.  I get something to eat.  Beautiful Italian guy from New Jersey makes a great pizza.  And then I go to Publix and from Publix, it’s home.  It’s not stop at CVS and add another group of stuff to my grocery bags or anything.  It’s from there you go home.

With your attention problems, do you have to map that out ahead of time, almost give yourself a to-do list to make sure that you hit all those five stops?

Not anymore because I been here a year and a half now it’s all in one shopping complex.  The bank is within a half mile of the shopping complex so it, it’s kind of a done deal now.

Concentration and Attention Problems Explained Like a Computer

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.

How DJ has Conquered Some of His Attention Problems

DJ has over learned his environment, has established a routine, which minimize the distracting world around him to cope with his attention problems.  When he does that, his functioning approaches pre-brain injury levels.  Yet, one culprit that can still derail him is noise becomes an attention problem, not just because of its attentional demands, but because of injury to the way his brain hears.

Next in Part Twelve  – Brain Injury Impacts What the Brain Hears

By Attorney Gordon Johnson

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