TBI Basics - Self Awareness and Memory After a Traumatic Brain Injury

By David S. Casey Jr
After a TBI, even a mild one, most people experience significant changes in their self-awareness and their memory. If you're the caregiver for a person with a TBI, you'll need to know the kinds of awareness and memory changes that your loved one is coping with and techniques for helping both of you manage. Each person's situation is unique, and you'll want to be in close communication with the rehab treatment team to learn about the specific deficits your loved one is dealing with, what challenges they present, and what your loved one needs from their family and other caregivers. This article describes in general terms how changes in self-awareness, and memory can affect a person with TBI, and how caregivers can help.

A lot of the brain's most important functions proceed unnoticed. Like breathing, we don't notice them when they're working smoothly. We take self-awareness and memory for granted until something interrupts them.

Reduced self-awareness refers to the situation after a TBI in which the injured person is unable to see that their capabilities have changed, and that they can't do what they used to do. Reduced self-awareness is not the same as denial. It's a neurological change caused by the injury. The brain's ability to make a realistic evaluation of its own functioning is diminished. A person with reduced self-awareness may believe that he's fine, and that he still can do everything he used to do. Reduced self-awareness tends to be uneven: a person might recognize that he has problems with word finding and memory, but insists that he can play sports as well as ever.

You can help a person with reduced self-awareness by providing them with visual cues that organize their surroundings. Keep the things they need and tend to forget in plain sight and close at hand. For example, in the bathroom, toothbrush and toothpaste should be together, razor and shaving cream, hairbrush and hairdryer. You'll also want to provide calendars, checklists and schedules. These kinds of reminders can help keep a person on track and allow them to see what they'd missed without a painful confrontation.

Where safety is not an issue, allow the person to learn their own limitations first hand. They may need to get on the soccer field or choose their clothes or read a complicated document to get a sense of their capabilities and limitations. You can be available to talk with them about their experience, and what they've learned.

Memory problems are very common after a TBI. A person is more likely to remember events and information from before the injury, while learning and retaining new information may be much more difficult. Routine tasks, like feeding a pet, or the time a favorite TV show comes on are easier to retain. Non-routine events, like the date of a party or a doctor's appointment or a new bus route will be harder to remember. Other memory problems include:

Names, especially of people they've recently metForgetting where things are stored, Repeating questions or telling the same story over and over,, Forgetting information they're just learned, Misplacing or forgetting things like keys, wallet, purse, outerwear, etc., Forgetting medication, or taking it more than once.,

Memory problems can range from the inconvenient to the dangerous. You and your loved one will need to work on memory aids that enable him or her to keep track of important objects and essential information. Every TBI rehab program teaches people to make checklists, keep calendars, and carry a notebook with all their important information. As a caregiver you can remind your loved one to check their calendar and when they have new information, to enter it in their notebook.

You can organize your home in ways that support memory. Digital clocks and watches help a person know the date and time. Every important item (keys, kitchen tools, clothing, outerwear, medications, etc) should have a designated place, and everyone should follow the drill: things go back in their place. People with memory impairments can learn new habits with time and practice, and a person can learn always to look in the same place for the item. Drawers, cabinets, closets, and other storage areas should have clear, easily readable labels. Organize medications in a pill box by day and time.

Supporting another person's memory deficits is very demanding work. It requires patience and planning, building in extra time for tasks, and a continual appreciation that the person with a TBI can accomplish a task, but may need many more repetitions to accomplish something or learn a new skill. The payoff is reduced frustration for everyone, and for the person with a TBI, an increased sense of mastery and competence in their environment.