Cognitive Syndromes
Impact of Thinking Problems on Daily Functioning
Last Updated:
Difficulties with thinking skills (also termed cognitive skills), such as the ability to remember new information, concentrate on activities, and solve problems, can be disrupted by a significant head injury. These cognitive difficulties often affecting memory, concentration and processing, can have an impact on the person’s ability to engage in daily activities, including caring for themselves.
For instance, when someone is experiencing problems with memory functioning, it will be difficult for that person to remember what he or she wanted to do on a particular day and, as a result, chores are not completed and appointments are missed. It is common for people with memory difficulties to recall conversations incompletely or not at all, to forget to take medications, and forget phone messages. But there are memory strategies that can be woven into the person’s routine at home that may help with these problems. For some people, making lists of activities and a schedule of daily events that can be posted in a central place works best. It establishes a consistent place he or she can to for reminders. Others like having an external memory aid such as a notepad or day planner they can take with them.
Poor concentration skills can cause problems in completing even simple tasks. The person is unable to stay focused on a task and attention is easily distracted to something else. As a result, it may be difficult for the person to complete activities of daily living such as bathing, grooming, and dressing without someone to remind them to stay on task. Being easily distracted also affects reading, cooking, doing laundry, and handling finances. To overcome this problem it may be helpful to limit distractions when the person needs to concentrate—for instance, turn off the television and radio during the morning routine of bathing, dressing, and eating. Also discourage the person from carrying on a conversation when in the midst of a task.
Persons with brain injury often have difficulty processing, a skill needed to solve problems. An inability to think through a problem can have significant impact on daily functioning. In order to solve a problem we must be able to recognize that a problem exists, develop a strategy to solve the problem, apply the strategy, check to see if the strategy works, and shift to another strategy if needed. This represents a complex series of thoughts that can be disrupted by head injury. Sometimes a person with head injury cannot recognize that there is a problem, while at other times the person may have difficulty developing a strategy or shifting to a new strategy.
Because of these difficulties, even simple problems may prove challenging. For instance, if a towel is not readily available after showering, the person with head injury may not stop to consider where a towel might be located. Selecting proper clothing for the weather conditions may be a problem.
Sometimes, difficulties with memory, concentration, or problem solving are made worse by a lack of awareness of the problems by the injured person. This can make it very difficult to assist them with the activities. However, organizing the environment can help. If a task must be done in a particular order, such as shaving, create a list of the steps and post that list where the activity takes place (such as on the bathroom mirror for shaving). Assist the person with self-awareness by calmly pointing out the problem and asking how things could be done differently. They may need suggestions for solutions but with repeated cueing, the person’s ability to problem solve may improve.
Dr. Novack is a Professor of Physical Medicine & Rehabilitation at the University of Alabama at Birmingham. He has practiced neuropsychology at the Spain Rehabilitation Center since 1985. Dr. Novack is Board Certified in the area of Clinical Neuropsychology. Most of his clinical practice involves the assessment and treatment of people with traumatic brain injury. He has published extensively on the topic of traumatic brain injury in professional journals and serves as the Project Director for the TBI Model System at UAB. He is a Board Member of the Alabama Head Injury Foundation and participates with the Alabama Head Injury Task Force sponsored through the Alabama Department of Rehabilitation Services.