Thinking About Thinking (part 1 of 2) June 9, 2010

 The most common residual deficits that challenge survivors of brain injury in the long term are in the area of thinking (also known as cognition).  Thinking skills are often further divided into attention-related skills, memory-related skills, and high-level executive functioning skills.   It is these high-level cognitive skills that I would like to focus on during this month’s cognitive corner.

 If you are a survivor, how do you know whether you have executive functioning challenges?  If you, or your family / caregivers answer “yes” to any of these questions, then you may have some ongoing deficits in these areas:

• Do you often miss important details in tasks?
• Do you have difficulty maintaining mental energy?
• Do you dive into a task without planning it out first?
• Do you feel overwhelmed in situations that you would have been fine in pre-injury?
• Do you unintentionally repeat steps in tasks, or have repetitive thoughts that distract you from tasks?
• Do you find yourself straying away from your goal without intending to?
• Do you focus on the details of a task and have difficulty seeing the “big picture?”

 So how do you improve on these skills?  Brain injury rehabilitation professionals are currently debating this very topic.  The challenges faced by professionals and survivors as they try to come up with a suitable answer to this question lies in the nature of brain injury itself.  Because each brain injury…and each survivor of brain injury is unique, it is very difficult to standardize techniques that will work for each and every survivor.

 The two aspects of good cognitive rehabilitation upon which all should agree are that cognitive rehabilitation should seek to improve the survivor’s awareness of their own strengths and challenges and that it should seek to equip the survivor with strategies to use their strengths to overcome the challenges.  A basic overview of this “thinking about thinking” process should look something like this: 

• Before beginning a task, the survivor should generate questions about the skills required, predict challenges associated with the task, predict performance (accuracy and time required) and generate possible strategies to overcome predicted challenges.
• The survivor should pause during the task to evaluate their own performance, and modify strategies if appropriate.
• When the task is complete, the survivor should compare performance with predicted performance, review strategies, and ask questions about what else could have improved performance.

 I know this all sounds overwhelming.  During part 2 of this series I will walk you through a step-by-step process for completion of a task using this model for a common daily task.  In the mean-time, practice the first step during some of your daily tasks (setting the table, grocery shopping, basic meal preparation).  It’s the first step in facilitating your highest level of independence.

 Thanks for listening.  Talk to you next month.

Dave