Thinking & Communication

Ways to cope

Attention is a thinking process that involves being alert and focusing on information in the environment or on our thoughts. After mild traumatic brain injury (mTBI) and concussion, changes in attention can make it harder to focus on what’s important.

There are different types of attention that we switch between every day. For example, at times you might need to stay focused on one thing. Or, there may be times when you might need to switch your attention between more than one thing.

Paying attention involves different levels of thinking effort, depending on the type of attention. Other factors like pain, being tired, stress, or noisy places can make paying attention harder.

Using tools to pay attention can help you feel in control and focus better. Tips to help stay focused include:

• Limit distractions. Do things like turn off the TV, turn off your phone when you need to focus, or work in a quiet room with the door shut when you need to pay attention.
• Do one thing at a time. Finish what you are doing before starting something new.
• Break bigger tasks into smaller, easier steps.
• When you do need to change between tasks, say to yourself what you are doing to help stay focused or leave notes to remember where you left off.
• Pay attention to whether you are paying attention. Check in with yourself often.
• Use self-talk to stay in the moment and focused.
• Use timers on your watch, fitness tracker, or phone to remind you to take breaks or to check in on whether you are staying on task.
• Relax to help get your mind ready to focus. Try deep breathing, stretching, going for a short walk, or listening to music.
• Do tasks that need more attention to detail when you have the most energy.

How others can help

• Ask the person what tools they use to support their attention and how they prefer to get help.
• Have conversations in areas that are quiet and not too busy.
• Allow time for enough rest breaks to reduce the load on their brain.
• Make eye contact when you are talking to get their attention.
• Reduce giving a lot of instructions or information quickly at one time.
• Look for signs that the person you are supporting is losing their focus.
• Reduce clutter at home if you live in the same household.
• Be patient and remember that attention problems are a common symptom after concussion and using these tools is an important part of the recovery process.

Ways to cope

Auditory processing, also called central auditory processing, refers to how the brain identifies and interprets incoming sounds and then attaches meaning to what is heard. Auditory processing involves how the brain understands what the ears hear.

An auditory processing disorder (APD), also called a central auditory processing disorder (CAPD), is a hearing problem that occurs when the brain is unable to process sounds in a normal way. It requires diagnosis by an audiologist.

Challenges with auditory processing can be caused by a breakdown in any of the ways speech or sound gets from the ears to the right parts of the brain. This includes:

• Using both ears together to locate where a sound is coming from
• Listening to someone or something with noise in the background
• Processing speech and sounds when the message is unclear (like talking to someone with a mask on)
• Distinguishing between different sounds or words

People with APD may have a hard time hearing small sound differences in words. Other symptoms include:

• Taking longer to answer when being asked a question
• Difficulty or frustration with understanding what people say in noisy or loud places
• Inconsistent or inappropriate responses to questions or during conversations
• Difficulty following or remembering spoken instructions, especially if there are multiple steps
• Often asking people to repeat what they said
• Difficulty understanding what someone is saying even when the information can be heard
• Challenges listening and understanding when talking on the phone, when the other person is talking fast, or if the other person has an unfamiliar accent

Here are some ways to manage related challenges:

• Ask people to repeat or re-word what they have said as soon as you know you are having trouble understanding
• Look directly at the speaker’s face when talking
• Reduce or limit background noise
• Have important conversations in quieter areas
• Sit at the front of larger places like classrooms, theaters, or during larger group presentations

How others can help

• Be sure you have the other’s person’s attention when you are talking.
• Ask the person if it would help to have information repeated or re-worded if you think what you are saying hasn’t been understood.
• Speak slowly and clearly.
• Have conversations somewhere quiet whenever possible.
• Allow enough time for the person to process what you have said and respond to the conversation.
• Try not to give too many instructions or directions at one time.
• When giving instructions follow up with written instructions, such as in a text or email, when possible.

Ways to cope

Communication is the act of giving, receiving, and sharing information, and occurs in both verbal and nonverbal formats.

• Verbal: The use of words to share information with other people. This can include both spoken and written communication, including speaking, listening, reading, and writing.
• Nonverbal: This how we communicate information without words and includes aspects such as body language, gestures, facial expressions, tone of voice, body posture, and eye contact.

Communication can be challenging while the brain is recovering from a mild traumatic brain injury (mTBI) or concussion. Common challenges include:

• Coming up with the right words at the right time
• Organizing what you want to say or write
• Losing track of conversations, especially if there is more than one other person involved
• Listening to a conversation in a noisy or busy environment
• Increased effort or time needed to process information that is heard or read
• Speaking clearly
• Interacting socially with other people

Other factors can affect your brain’s ability to understand and speak. These factors include things like distractions (like being in a busy environment), fatigue, pain, feeling worried or under stress, and changes in other thinking skills.

Here are some tips to manage these challenges.

Verbal communication

• Eliminate or reduce background noise.
• Repeat information out loud to help with understanding.
• Ask people to repeat, rather than rephrase information when you are having a hard time hearing. If you are certain you have heard the words correctly, but don’t understand the meaning, then ask people to rephrase.
• Clarify what you hear.
• Look at people’s faces when they speak.
• Ask people to slow down if they are speaking too quickly.
• Stay calm by sitting down or having conversations in a quiet area.
• Plan and organize what you want to say prior to going to a meeting or appointment.
• When you get stuck and can’t get the word out, try to describe it, give the listener clues or hints, or try to think of another way to say the same thing.
• Pick a place to read and write that has minimal distractions.
• Limit reading and writing time based on how you feel. Shorter, more frequent breaks can help manage symptoms.
• Reduce screen time and eye strain by printing materials, listening to audiobooks, or manually writing instead of typing.
• Double and triple check your work. Read your writing aloud or ask a friend to review it.This includes materials like important paperwork, emails, texts, and social media.
• Take a deep breath before speaking.
• Sit or stand upright with your shoulders back
• Give yourself time to gather your thoughts and plan what you will say in stressful situations.

Nonverbal communication

• Look at people’s faces and keep good eye contact.
• Finish a thought or idea before changing the topic.
• Take turns speaking and listening.
• Pay attention to how words are said, not just what words are said.
• Speak up for your needs in a respectful but clear way.
• Know when help is needed and be willing to ask for it and accept it.

How others can help

• Speak respectfully and more slowly if needed.
• Try not to give a lot of information too quickly at one time.
• Break up directions into smaller steps.
• Make sure you have the person’s attention before having a conversation
• Allow time for breaks, if needed.
• Provide support but be careful not to speak for the person.
• Participate in treatment training sessions with medical providers to  learn more specific tools you can use to help support the person with mTBI or concussion.

Ways to cope

Memory is a thinking process where your brain takes in, stores, recalls, and uses information. It involves multiple structures of the brain that work together. After mild traumatic brain injury (mTBI) or concussion, memory can be affected by pain, stress, fatigue, lack of sleep, dizziness, and changes to mood like anxiety, depression, or anger.

Research has shown that using strategies to manage challenges with thinking supports recovery Here are some tips that can help.

• Stay focused. To remember something, pay attention to it. Limit distractions around you, like turning your mobile phone on silent mode.
• Keep a schedule. Create a daily routine and stick with it.
• Be organized. Keep track of what you need to do and when you need to do it with helpful tools like apps on your smart phone, using daily planner, or a calendar.
• Be consistent. Keep items that you usually take with you when you leave your house, such as your wallet, phone, and keys, in the same spot that is easy to see.

How others can help

• Try not to ask if the person remembers something, as this can be frustrating. Instead, give helpful cues to fill in memory gaps.
• Ask what memory tools the person is using and how they prefer to be supported.
• Keep up with steady routines if you live in the same household.
• Try not to give a lot of information too quickly all at one time.
• Break up directions or tasks into smaller, easier steps.
• Make sure you have the person’s attention before having a conversation.
• Be patient, and remember that memory challenges are common after mTBI and concussion.

Ways to cope

Everyone encounters problems many times throughout a day. Common symptoms of mild traumatic brain injury (mTBI) and concussion can affect thinking and make solving problems harder. These symptoms may include poor sleep, pain, stress, changes in mood like anxiety or depression, and changes in other thinking skills. As these improve, people usually see problem-solving get easier, too.

Here are some tips to help with problem-solving:

• Plan ahead. To help you feel in control.
• Think before you act. Taking the time to think through a problem can help you make the best decision.
• Ask for help. Talk about problems with someone you trust before making decisions, especially if it is something important.
• Ask questions. Make sure you understand all parts of the problem.
• Brainstorm. Think about all possible solutions to a problem, not just the ones that you think will work.
• Think about what happened after you solved the problem. Ask yourself what went well and what didn’t. This helps to remind you what can help to solve similar problems in the future.
• Change your environment. Remove distractions, sit down, or use relaxation tools to make it easier to think through the steps of solving a problem.

How others can help

• Give plenty of time for the person you are helping to solve a problem.
• Be patient and help them talk through problems, if needed.
• Limit the number of possible choices if you are helping someone that gets more easily overwhelmed.
• Look for signs that someone is tired, hungry, or under stress. It is better to wait until someone is thinking clearly before you ask for a decision.
• Avoid rushing last-minute decisions on an issue or topic.
• Remove distractions. Turn off the TV or mute your smart phone.