Brain Injury and Cognitive Function
March is Brain Injury Month and for many individuals with HH – the challenges of HH and those associated with a brain injury can be very similar. Fortunately, therapies designed to help individuals with a brain injury regain cognitive function can also be very beneficial to individuals with HH.
“Brain injury” refers to the occurrence of an insult to the brain which causes some sort of damage. Because each type of injury affects a different part of the brain, every injury is unique.
Although the causes of brain injury differ, the effects of these injuries on a person’s life are quite similar.
Whatever the cause, a brain injury can, according to the Brain Injury Association of America, result in “an impairment of cognitive abilities or physical functioning. It can also result in the disturbance of behavioral or emotional functioning.”
Cognitive consequences can include memory loss, slowed ability to process information, trouble concentrating, organizational problems, poor judgment and difficulty initiating activities. Physical consequences can include seizures, low muscle tone, fatigue, headaches and balance problems. Emotional/behavioral consequences can include depression, mood swings, anxiety, impulsivity and agitation.
For individuals with hypothalamic hamartomas, which is a congenital lesion (or present from birth), the impact of the lesion and the potential abnormal wiring of the brain presents symptoms very similar to a brain injury. To further complicate matters, the side effects of HH surgery can include memory loss, decreased energy, extreme fatigue, headaches, and a host of endocrine complications.
Most of the cognitive impairments that are common both for HH and brain injury are in the area of Executive Functioning. You can read more about Executive Function in our previous blog, "What is Executive Function?"
The effects of a brain injury are often invisible to an unknowing observer. An individual cannot “see” a brain injury and therefore may not understand why a person may act or say things that seem inappropriate or disrespectful. This can cause the individual with a brain injury or HH a great deal of frustration and anxiety as they feel they are being unfairly judged or treated.
The good news for individuals with HH is that treatments for brain injury have been well established and may be very helpful when it comes to supporting cognitive and Executive Function challenges. Some of the more common and also more difficult challenges include:
Problems learning and remembering new information
- Individuals may have trouble learning and remembering new information and events
- They may have problems remembering entire events or conversations. Therefore, the mind tries to “fill in the gaps” of missing information and recalls things that did not actually happen. Sometimes bits and pieces from several situations are remembered as one event. These false memories are not lies. It is called confabulation.
What can be done to improve memory challenges:
- Establish a structured routine of daily tasks and activities.
- Be organized and have a set location for keeping things.
- Learn to use memory aids such as memory notebooks, calendars, daily schedules, daily task lists, computer reminder programs and cue cards.
- Devote time and attention to review and practice new information often.
- Be well rested and try to reduce anxiety as much as possible.
- Speak with your doctor about how medications may affect memory.
- Use statements such as “If I remember correctly” or “I don’t recall at the moment, let me get back to you with that information” and check your facts before responding
Language and communication difficulties
Communication problems can cause difficulty understanding and expressing information in some of the following ways:
- Trouble starting or following conversations or understanding what others say.
- Rambling or getting off topic easily.
- Difficulty with more complex language skills, such as expressing thoughts in an organized manner.
- Trouble communicating and interpreting thoughts and feelings using facial expressions, tone of voice and body language (non-verbal communication).
- Problems reading others’ emotions and not responding appropriately to another person’s feelings or to the social situation.
- Misunderstanding jokes or sarcasm.
Speech therapists can often help in this area (communication pragmatics) and improvements are often quite significant with time and effort.
How family members can help with communication difficulties:
- Use kind words and a gentle tone of voice. Be careful not to “talk down” to the person.
- When talking with the injured person, ask every so often if he or she understands what you are saying, or ask the person a question to determine if he or she understood what you said.
- Do not speak too fast or say too much at once.
- Develop a signal (like raising a finger) that will let the injured person know when he or she has gotten off topic. Practice this ahead of time. If signals don’t work, try saying “We were talking about...”
- Limit conversations to one person at a time.
- Keep instructions simple.
There are many factors that can affect how or if someone will improve cognitively. It is likely that with practice, cognitive challenges can improve.
Cognitive rehabilitation is therapy to improve cognitive skills and has two main approaches, remediation and compensation:
- Remediation focuses on improving skills that have been lost or impaired.
- Compensation helps you learn to use different ways to achieve a goal.
While no outcome is ever guaranteed, the goal is to help individuals continue to build their cognitive, emotional and behavioral skills, reinforce learned strategies, and facilitate the achievement of educational and vocational goals.
Check with your neurologist or primary care provider to see if there is a program or facility near you.
Brain injury and cognitive challenges affect not only the individual, but also the family, close friends, coworkers and other social networks of the individual. Remember to focus on getting all the support you need as a caregiver or individual with HH.