Changements Cognitifs

PROBLEM & SIGNS

WHAT TO DO

Problem: Confusion

Signs:

• Confuses times/ tasks in schedule of activities
• Confuses past and present events
• Confabulates (makes up convincing stories
• to fill memory gaps; this is not intentional lying)

What to do:

• Encourage the use of a notebook to log events and encourage the person to refer to it for details of daily events.

• Gently remind the person of correct details of past and present events.

• Confirm accurate information with other people.

• Arrange for consistency in routine tasks (use calendar and notebook).

• Limit changes in daily routine.

• Provide clear, concise explanations of even the most basic changes in daily routines.

Problem: Difficulty remembering

Signs:

• Unable to remember tasks from day to day
• Unable to remember new information

What to do:

• Establish a structured routine of daily tasks.

• Encourage the consistent use of memory aids such as calendars and notebooks to plan, record and check off tasks as completed.

• Encourage the person to write new information in the memory notebook.

• Encourage other family members also to write any information they need to communicate to the person.

• Encourage review and rehearsal of this information frequently throughout the day.

• Provide opportunities for repeated practice of new information.

• Try to pair new information with facts the person can recall.

• Provide spoken cues as needed for recall and, if necessary, help fill in memory gaps.

Problem: Attention problems

Signs:

• Limited ability to focus
• Distractible
• Difficulty in attending to one or more things at a time

What to do:

• Focus on one task at a time.

• Be sure you have the person’s attention before beginning a discussion or task.

• Decrease distractions when working or talking with the person. (Eliminate or reduce noises.)

• Praise any improvement in length of attention to activity.

• Gently refocus the person’s attention to specific details of the activity as needed.

• Keep abrupt changes to a minimum.

• Ask the person to repeat information that was communicated to be sure the person understood the conversation.

• Schedule brief rest periods between short periods of work or activity (for example, 20 to 30 minutes of work, a five-minute break; 20 to 30 minutes of work, etc.).

Problem: Difficulty with decision making

Signs:

• Hesitation with decisions
• Inappropriate or potentially harmful decisions
• Difficulty reasoning
• Ineffective problem solving

What to do:

• Encourage the person to “stop and think.” Many people with brain injury benefit from a note or a stop sign on the front of their notebook reminding them to “stop and think.”

• Help the person explore various options to solving problems.

• Have the person write possible options in the notebook.

• Discuss advantages and disadvantages of each option.

• Role-play to prepare the person for various situations.

Problem: Difficulty with initiation

Signs:

• Has trouble getting started
• Appears disinterested or unmotivated (this is typically not intentional)

What to do:

• Help the person develop and follow a structured daily routine.

• Provide specific choices for daily tasks.  For example, ask, “Would you like to do A or B?”

• Simplify tasks. Break down tasks into simple steps

and complete one step at a time.

• Encourage use of the notebook or calendar to set specific deadlines for tasks to be completed.

• Praise the individual for starting without assistance.

• Establish a time frame for accomplishing tasks.

Problem: Difficulty carrying out a plan of action

Signs:

• Lack of follow-through to completion with a task
• Difficulty planning a sequence of tasks
• Appears disorganized

What to do:

• Begin with small, realistic projects.

• Include the person in planning the activity.

• Provide a clear explanation of an activity before starting.

• Break down new or complex tasks into several easier steps.

• Have the person write the a step-by-step list as a plan.

• Ask the person to tell you these steps to ensure understanding.

• Encourage the person to refer to the plan, and check off each task that is completed.