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Brain Injury Cognitive Deficits

Changes and problems in cognition can occur as a result of a brain injury.

Cognitive deficits may have a permanent impact on everything the patient does. It can be common for the patient to have limited or no awareness of these impairments. As a result, it's helpful for the family to be able to recognize these deficits and understand what the patient is going through as well as what the purpose is of the rehabilitation program. The rate at which a patient progresses varies by each individual.

Awareness and Orientation

A person with a brain injury may be unsure of information about self, family members, location, and time. As a patient's condition improves, the patient will become more adept in the following areas:

  • Awareness 
  • Orientation to Person
  • Orientation to Place
  • Orientation to Time
  • Deficit Awareness


Attention Deficits

Attention deficits are common and can affect a person's ability to function in all areas of daily living. Deficits vary with each individual.

Types of attention that may be affected include:

  • Sustained Attention
  • Divided Attention
  • Selective Attention
  • Alternating Attention

These, and other attention challenges, as well as how they impact a patient's ability to do everyday things, are addressed in therapy.

Memory Deficits

Most people who sustain a brain injury suffer some form of memory impairment. There are many different kinds of memory and these different types affect a variety of areas. The extent to which amnesia exists provides information about the severity of the injury and problems that may occur as a result.

There are different types of amnesia:

  • Retrograde Amnesia
  • Anterograde Amnesia 
  • Post-Traumatic Amnesia (PTA)

There are different kinds of memory, each described with a specific term. Problems can appear in any number of these areas:

  • Remote Memory
  • Prospective Memory
  • Episodic Memory
  • Procedural/Working Memory
  • Topographical Memory
  • Semantic Memory
  • Visual Memory

A patient's awareness of memory problems following a brain injury is important. Some patients are better than others when it comes to realizing their memory deficits. Some patients may try to cover up their memory problems or by using confabulation. If awareness does improve, the patient is able to relearn how to use memory strategies.This ability enables patients to better function on a daily basis and perform self-care activities.

There are several techniques for improving memory:

  • Association
  • Elaboration
  • Mnemonics
  • Visualization
  • Rehearsal

In addition, the use of daily memory journals, calendars, notebooks, and digital recorders may help patients compensate for memory problems.


Higher Level Deficits

Higher-level cognitive deficits may include difficulties with problem solving, reasoning, judgment, analyzing information, integrating old and new information, and organization. In addition, patients are slower at processing, or making sense of information, particularly more than one piece of information.

Problem solving is the ability to think through a problem and come up with an appropriate solution or solutions. Difficulties with problem solving can be seen when a patient in a wheelchair keeps bumping into walls and cannot figure out how to get out of the situation. This represents perseveration.

Patients often are unable to "see the big picture"; resulting from problems with reasoning and judgment. Patients are unable to identify or consider alternatives in a given situation. That is, patients think one thing, or act in a particular way, without first thinking through the situation. This impulsivity can compromise the safety of completing daily routines.

Frequently, when improvements in cognition occur, patients are able to see alternatives when they are presented. This is one step in the process toward improving skills in reasoning, judgment, and problem solving.

As higher level cognitive skills improve, there is an increased awareness of strengths and weaknesses. As a result, patients are more able to look at themselves as others might, evaluate their own behavior, and judge their effect on others. They have an increased awareness and ability to know what they know and what they don't know, as well as what they can do and what they can't do. When metacognition is present, patients are able to continue the rehabilitation process with a greater level of independence.


The Healing Process

The extent to which your family member has problems with cognition can be described using a system called Levels of Cognitive Functioning. It was developed in the 1970's at Rancho Los Amigos Medical Center in Downey, California. This 10-part progression describes changes in behavior and awareness from the time of injury to higher levels of independence. It outlines, in general terms, expected behavioral recovery from a brain injury.

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