1. NDBIN
2. Brain Injury In North Dakota

Quick Strategies for Common Cognitive Symptoms

Learn about strategies for common cognitive symptoms and management of some routine tasks.

Common Cognitive Symptoms

Try these strategies, if a brain injury survivor has difficulty with attention, processing, memory, or executive functioning.

Attention

• Use attention grabber
  Example: Make sure to have their attention before beginning by ensuring eye contact. Attention can be gained through active participation, pointing to the task, or showing client the supplies used for the task.
• Break it down
  Example: Keep instructions brief, simple, and to the point.
• Hands-on
  Example: Movement and participation in the activity increases attention to the task. Let the brain injury survivor do as much as they can without help.

Processing

• Keep it simple
  Example: Simple, one-step, short phrases.
• Check-in
  Example: Ask "how are you doing?" or "what are you have difficulty with?"
• Slow it down
  Example: Give the person 30 seconds to process before restating the direction or giving them a new direction.

Memory

• Write it down
  Example: Step-by-step instruction written on paper or supplies needed written down.
• Repeat
  Example: Ask them to repeat the new information back to you in their own words to improve recall of information.
• Be proactive
  Example: Teach strategies such as writing down steps before starting the task or using a calendar to assist with initiation. Practice and reinforce these strategies until they are automatic.

Executive Functioning

• Set an alarm
  Example: Use a timer or alarm on their phone to start or end a task.
• Stop, think, act
  Example: Encourage the brain injury survivor to slow down and think through the steps of the task they are doing.
• Set short-term (attainable) goals
  Example: If a task is challenging, make shorter goals that the person is more likely to achieve.
  Example: Instead of saying "Organize your medication for the week" say, "Put __ amount of ____ medication in each slot" - fill in the blank to march the brain injury survivor's needs.
  Example: Provide incentives when completing the short-term goal such as taking a break from the task or doing something that the brain injury survivor enjoys after they meet the expectation.
• Follow a routine to predictable
  Example: Encourage the individual to maintain consistent routines throughout each day. Example: Identify a designated place for items for tasks such as envelopes, medications, pill organizers, checks, and other items.
• Rehearse
  Example: Practice the task with the brain injury survivor multiple times to build their confidence with the task.
• Promote positive behavior
  Example: Promote positive behavior by addressing and interrupting negative/undesired behaviors immediately and using positive comments such as "good job doing ___", "I like how you did ___", "that seemed to work really well."

Management of Routine Tasks

Some step-by-step instructions for the management of money, mail, and medication. There are associated video demonstrations that a caregiver may use to assist a brain injury survivor.

Money Management

1. Gather necessary supplies
2. Identify amount due on bill
3. Fill in date, company, amount, memo, and then sign the check
4. Enclose check in an envelope

Video Demonstration: How to Pay a Bill (4:33 minutes)

Mail Management

1. Gather envelope, stamp, pen, and material being mailed
2. Fill out returning name and address
3. Fill out mailing name and address
4. Place stamp
5. Insert mail into envelope and seal
6. Place envelope in appropriate spot to be mailed

Video Demonstration: Preparing to Mail a Letter/Bill (4:55 minutes)

Medication Management

1. Gather medication bottles and organizer and place on flat surface.
2. Thoroughly read medication directions and check understanding of directions.
3. Open the medication organizer.
4. Place the medication in organizer following correct dosage and time.
5. Close the medication organizer.

Video Demonstration: How to Fill a Pillbox (2:17 minutes)