Recovering from an acquired brain injury (ABI)

An Acquired Brain Injury (ABI) is an injury caused by trauma, such as a fall or road accident or a neurological event such as a stroke or an infection.

Immediately after a brain injury, patients may experience a loss of consciousness. There may be bruising or bleeding and specific parts of the brain may be affected. Some may experience a period of confusion and an inability to lay down new memories. We call this state post traumatic amnesia (PTA). It is normal not to remember a period of your hospital stay, although some people find this distressing. Many patients recover well from a brain injury, particularly in the early stages and after a period of rest. Some people may experience some changes in cognition, emotion or behaviour.

Cognitive Difficulties after an ABI

What is Cognition?

Cognition is a term used to describe our thinking, language and memory skills. This is our ability to remember things, use and understand language, concentrate on information and make decisions. After leaving hospital, you may experience some of the following problems:

• Speed of thinking: You may find your thinking feels slower after your injury.
• Attention and concentration: You may find it harder to focus on tasks.
• Memory: You may find it harder to remember new information such as recent conversations or an upcoming appointment.
• Executive functioning: It may be harder to plan, organise, reason or make decisions.
• Impaired insight: You may have difficulty understanding or appreciating the impact of your brain injury and it may be other people that notice the change.
• Visual-perceptual changes: You may notice changes in processing shapes or objects despite vision and eyesight being good.
• Language changes: You may experience difficulties understanding what is being said, or problems finding or using the correct words.

Other causes of cognitive difficulties

There are several other things that can contribute to cognitive or memory problems after an ABI. These may include:

• Fatigue
• Pain
• Low mood
• Anxiety
• Effects of Medication
• Ongoing physical health problems

Emotional and behavioural changes after an ABI

Emotional

You may experience a range of different emotions, some of these might include:

• Irritability: Getting angry or frustrated more quickly or feeling agitated.
• Anxiety: Worry about the future, or of getting ill again.
• Depression: Feeling low in mood, tearful, hopeless or experiencing a sense of loss.
• Emotional lability: Mood swings where you laugh or cry more easily.
• Identity changes: Feeling that you are a different person to the one you were before.

Behavioural changes

It is common to experience changes in personality or behaviour. Symptoms could include the following:

• Impulsivity: Acting without thinking about the consequences.
• Disinhibition: Not having a filter, or saying or doing things that others may regard as inappropriate.
• Inflexibility: Being more fixed or rigid in your thinking and finding it difficult to see another person’s point of view.

When to seek further support

If any of your cognitive or behavioural symptoms persist for more than three months, please speak to your GP or hospital consultant to seek a referral to your local community neurorehabilitation team.

For emotional support, you can self-refer to your local wellbeing service. In Cambridgeshire, this would be the CPFT Psychological Wellbeing Service, which is also known as Improving Access to Psychological Treatment (IAPT).

Tel: 0300 300 005

Website: CPFT Psychological Wellbeing Service Website (opens in a new tab)

Important note: You must inform the DVLA that you have had a brain injury. They will tell you what you should do next.

How to help yourself

After a brain injury, it is important that you have a period of rest for a few weeks in order for your brain to recover. Please take advice from your doctor or neuropsychologist with respect to how quickly to return to normal activities such as work and childcare.

Tasks that involve thinking (e.g. making decisions, planning, writing emails and socialising) can cause as much or more fatigue than physical tasks.

This period of rest should be followed by a gradual return to normal activities. Returning gradually is crucial as you test how easy things are for you to do. This will also allow the brain time to heal as you begin to resume day to day tasks. The following strategies will help guide you as you recover.

Self-help strategies

Establish a routine and be organised – Find a single place to put your keys, phone and diary.

Memory – Make a ‘to do’ list and use your mobile phone to support your memory by using the calendar and notes section. Set alarms as reminders.

Attention – Reduce distractions and focus on one thing at a time.

Executive function – Stop and think before acting, break down tasks into smaller steps, and write down the pros and cons of options when making decisions. Seek feedback from other people regarding your behaviour, and advice from a neuropsychologist as necessary.

Managing fatigue – Avoid overexertion, rest when needed and alternate between more demanding thinking tasks and lower energy activities.

Sleep – Aim for a regular sleep routine and avoid caffeine and screens before bed.

Relaxation – Engage in activities that will promote calm.

Stay connected – Maintain social connections with friends and family.

Engage in pleasurable activities – Do things you find enjoyable regularly.

Coping strategies – Use coping strategies that have worked well in the past and avoid unhelpful strategies (caffeine, alcohol, drug use).

Self-care

– Stay active and take regular exercise with guidance from a doctor.

– Eat and drink healthily with small and regular meals/ snacks.

– Get as much sunlight, nature and fresh air as possible.

Wellbeing apps

Unmind – offers coping strategies

Headspace – meditation to improve wellbeing

Sleepio – to improve sleep

Daylight – ways to combat worry and anxiety

Websites

Headway (opens in a new tab)

Stroke Association (opens in a new tab)

CUH Neuropsychology Department