In this episode, we discuss concentration and attention after a traumatic brain injury and how you can help improve this.
Ashwini 00:00:22 - 00:02:08
Hello - so in this episode, we're going to be looking more at the impact of brain injury on cognitive function. We've already touched a little bit on your memory difficulties, Brooke, but I think we'd like to explore more about difficulties that you've experienced with attention and concentration in particular.
It is important to point out, of course, that brain injury affects people in different ways, and so when we're talking about cognitive function, there could be all sorts of impacts in relation to attention, memory, and concentration as we've mentioned, but also processing, understanding, communication, decision making, planning and organisation. There are so many different avenues that we can go down.
But I really would like to focus on your experiences, in particular. So in an earlier episode, Brooke, we touched on, for example, how you tend to do things that require a lot of cognitive function, a lot of thought, a lot of brainpower, in the morning because that works better for you, with anything more physical being in the afternoon. We mentioned then, as well, but obviously, different things work for different people.
Another thing that can be really helpful is therapeutic input to help come up with strategies around attention and concentration. But it's not always easy to actually concentrate, particularly when you're recovering from a traumatic brain injury. So, what sort of techniques did you work through with your therapist?
Brooke 00:02:08 - 00:04:45
That's a big thing to go, people's attention and concentration. I mean, it started off in the early days, I couldn't even concentrate on an advert. I remember that, what's it called - the meerkat's thing? That was about at the time, and I used to forget what it was about towards the end of the advert! My concentration levels were 20 seconds tops.
But I worked with a neuropsychologist and what he drilled into me was that concentration is actually the main function of your brain that you can train like you can in the gym; it's something that you can improve.
One of the tasks that I got set was to start a film, and you know you have a synopsis on the back of a film with the summary of the film you've watched? Anyway, how it would work is we'd set a timer for a minute. At the end of that minute, you would write down what just happened. The idea was you quickly increased the time that you would watch the film for to 5 minutes, to 10 minutes, to 20 minutes and hopefully, at the end of it you can watch a full film.
I wouldn't say I don't have any problems with it now, but it's certainly a lot better than it ever was. But another thing to note as well is distractions because you just become horribly prone to distractions. So if you're trying to do something, make sure you're just doing that one thing and not trying to do two things at once. Although it's meant to be multitasking, people with brain injury generally are really bad because at it, because they're so distracted.
I was told at this course that I used to do at a charity called BASIC that nobody can multitask, as in do two things at once. What the people who are supposedly good at multitasking can do is they have the ability to divert their attention from one task to another task and then back to another or several tasks at once. But at no one time they are actually concentrating on two tasks at once. They just concentrate on dividing their attention between different tasks.
It's difficult for people with a brain injury because they just get so distracted. You know you try and flip between tasks, and you just, you forget about the other one. The idea is that if you're doing something, you need to minimise your distractions and concentrate on that one task at hand.
Ashwini 00:04:45 - 00:04:58
Yeah, I suppose yes, that ability to jump from one to the other requires quite a lot of elasticity in a way—lots of flexibility of your brain to fire from one thing to the other.
Brooke 00:04:58 - 00:04:59
Something that you don't have anymore.
Ashwini 00:04:59 - 00:05:04
Do you think that's gotten better for you?
Brooke 00:05:04 - 00:06:11
It's gotten better, definitely, but it's definitely not fixed. That's the thing with brain injury, some things do naturally get better, but a lot of things don't get better. But you have to learn just to do those things differently. So by that, I mean different strategies.
For instance, I use my phone a lot, and I drive people mad with the alarms going off on my phone, but it works. If you set if, for instance, I have to take medication at 9 o'clock every night – I have to give myself an injection and I've been doing that for what must be like 13 years now and my alarm goes off at nine every night. And what I do is, I snooze it if I haven't done it, and I keep snoozing until I've done it, and that's what drives people mad. It goes off every nine minutes, and quite often, if the alarm goes off and I snooze it, then 9 minutes later I've forgotten again, and so it does work for me. So I just have to make sure I do it and do it now.
Ashwini 00:06:11 - 00:07:18
Yeah, I suppose with your concentration, especially where there are lots of things going on, it's about trying to make things simpler. To break things down a bit. Do things one thing at a time and just thinking about some things that you know involve a lot of natural multitasking or a lot of distractions just by their very nature; an obvious activity that comes to mind is driving. I'm sure many of the people listening to these podcasts will be in a position where perhaps they're not able to drive, but they want to get back to driving. But there are lots of things to think about; you're concentrating on the road ahead, you might have the radio on, there might be pedestrians and you're thinking about them and obviously, the actual process of driving, changing gears, steering, etc., operating your pedals, and there's a lot going on. How did you find returning to driving incidentally?
Brooke 00:07:18 - 00:08:04
When I first returned to driving, the first thing I did was I just went with a normal driving instructor who used to put the radio on – we used to always drive with the radio and I really struggled at my driving lessons. I then researched a brain injury driving instructor or a disability driving instructor and the first thing he did was there was no radio and he changed me to an automatic car.
Although people used to say that when they were driving a manual car, you'd think that them driving and changing gears, particularly if they have been doing it a long time, just becomes automatic, and it's second nature. But what he explained to me was, on some level, you are thinking about that. Taking that need a way to process that you…
Ashwini 00:08:04 - 00:08:10
You're making it simpler, aren't you? You're not giving your brain too many things to think about. It reduces your cognitive load.
Brooke 00:08:10 - 00:08:13
Yeah, cognitive load. That's the one, yeah.
Ashwini 00:08:13 - 00:08:25
Definitely, so you know, that's perhaps something that many of our listeners could identify with and think about. Do you still drive an automatic car now?
Brooke 00:08:25 - 00:08:28
I still drive an automatic car, yeah. I don't think I'd ever go back now.
Ashwini 00:08:28 - 00:08:51
We've also touched on this before in a previous episode when we were talking about fatigue, but I suppose building in routines and activities can also help with training your concentration, your attention—maybe doing things in short bursts and planning them in.
Brooke 00:08:51 - 00:09:31
The thing I've found with having a brain injury is that in many ways, I sometimes think I've got no problems at all, but they tend to be the times that I'm well-rested, refreshed and I've got plenty of energy.
The times when I do suffer is when I've been doing something for too long. So I think, yeah, doing something in short bursts is definitely the answer. Do something and do it well rather than just drag it out, and after a little while, your concentration starts to go and then you become tired and you become sloppy.
Ashwini 00:09:31 - 00:10:10
So I guess, to sum up, in terms of help and tips that we can offer to our listeners, decreasing distractions is a big one. Turn off your television, your phone, anything that can cause you to lose attention—perhaps going into a quieter area if you struggle with lots of people talking or lots of noise, removing yourself from that situation. Deal with one thing at a time, break things down into smaller tasks. Brain training might help, as you suggested before.
Brooke 00:10:10 - 00:10:47
Improving your concentration, yeah. That was one thing when I started driving - my neuropsychologist used to give me these different concentration tasks to do as homework and I was never good at doing homework at school, so it was something I never really took to. But I found that when I was driving, driving was something that I really wanted to do and I was quite passionate about. So whenever I was driving, I'd give it my full concentration, and when I was driving, that became a concentration exercise in itself, and the more I did it, I found, the better my life improved.
Ashwini 00:10:47 - 00:11:11
I suppose when you've got the confidence, when you are able to regain some element of concentration through that, and you build your confidence to be able to apply those strategies to other areas as well.
Brooke 00:11:04 - 00:11:56
You do, yeah. There's a knock-on effect like I mention with the memory. I think you've got to approach every situation, being as well-rested as you can be and with a view not to do it for too long. Sometimes you have to leave the situation before you're ready, particularly if you're going into a social situation. And I mean, social situations can be really fatiguing. That was something that I really, really wanted to get back to because when I had my injury, I was a student at the time. So my big thing was to get back to my social life and I didn't realise actually how cognitively demanding and how exhausting my social life was at that time. So there's a situation where you can still be there, you can be present, but you can't be there, if you know what I mean?
Ashwini 00:11:56 - 00:12:21
Yes, and as we've discussed in a previous episode, the importance of rest, it all ties in really, and the impact of fatigue can then have a knock-on effect on your attention, your memory, your concentration. So the importance of taking regular breaks, not trying to overload yourself, so that you can really try and get the best out of your recovery.
Brooke 00:12:21 - 00:13:10
Fatigue has been for me, it's been the biggest thing in my recovery really, and it's the thing that outside parties least understand. I think it's just taking a balance, and you know what, after 15 years, I don't even know if I've got it right, but I'm obviously a lot better than I was. But sometimes, what you tend to do is a critical mistake is not to rest too late in the day. You can go to bed at like 6 o'clock for an hour sometimes; then obviously, when you go to bed to go to bed, you can't sleep and then that messes up your next day. Structure and planning is the way to get through it.
Ashwini 00:13:10 - 00:13:27
Planning, you know, we've talked about setting alarms, for example, and maybe that's it; depending on how your injury affects you, it might be helpful to set alarms for regular intervals so that you know to move on to the next thing.
Brooke 00:13:27 – 00:13:43
Yeah, be in a rigid structure and alarms are something that helps you keep that structure and you know you might not remember that it's something you have to do at 2 o'clock every day, but your phone will so as annoying as it is, it does keep you keep you straight.
Ashwini 00:13:43 Speaker 2
Yeah, absolutely. I mean, I think phones and technology generally can have so many benefits for people with brain injuries, just in terms of the multi-functionality of it. To take those elements away from your own brain, let the tech do the work.