Thinking Changes

Brain injury can disturb:

  • Alertness and concentration
  • Self-awareness
  • Perception
  • Memory and learning
  • Reasoning, planning and problem-solving
  • Speech and language
  • Motor control
  • Emotions

The information that follows will help familiarize you with behavior, memory and thinking problems that a person with brain injury may experience. Also included are techniques to help the person participate more effectively and comfortably in the family. Consistent and frequent repetition of these techniques listed will increase the chance of success in recovery.




Problem: Confusion



  • 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



  • 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



  • 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



  • 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



  • 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




  • 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.