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Attention Problems

*Attention gives us the ability to focus on a task or thought

*Many different parts of the brain manage our ability to focus

*Outcomes are unique to individuals

*People may lose one set of skills but retain others

*Environmental factors can make things worse

*Complications with filtering

Introduction

Most of us understand that attention includes the ability to focus on a task or a thought, but we often don’t consider that it is also a complex thinking ability that includes many different skills.

Many different parts of the brain manage these skills. When brain injury disrupts the executive systems, there can be complicated outcomes and effects. Everyone will experience unique and distinct problems.

Attention skills include: –

Self-regulation and planning

Being able to envisage or ‘see’ the desired outcome and being able to plan the steps towards this goal in a disciplined and ordered fashion, taking into account any possible obstacles.

Understanding instructions

Being able to process verbal or written instructions and break them down into manageable step-by-step pieces.

Maintaining focus

Resisting the temptation to do something else when challenges arise or the next step is not understood. Being unable to manage ‘interrupting’ thoughts about another matter and wanting to deal with this instead.

Being attentive

Mentally following and remembering the steps that have been taken to form a narrative or thought sequence about the actions already taken.

Ability to ignore distractions

Being able to prioritise and make rapid decisions about events external to the activity so they do not interfere with focus, for example, remembering there is an answering machine if the telephone rings.

Ability to control impulsivity

Wanting to do tasks in the wrong order or abanding a project in favour of a different solution without thinking through the consequences or new challenges.

Switching attention

Pausing to deal with something else and being able to either understand the new task or return to the previous one. Difficulty changing topics during a conversation, needing to fully complete one subject or task and needing a break before the next one.

Multi-tasking

Difficulty understanding the multiple processes of a task or being unable to switch to something else before the first task is complete. For example, turning on the washing machine and waiting for the programme to finish and not doing anything else in between.

Difficulties experienced

The outcomes of a brain injury affect these abilities to varying degrees and so, for some, it can feel that these skills are lost. Many people have significant difficulty with sticking to one thing and completing it and will often leave a path of part-completed jobs behind them.

An example of how brain injury can affect attention is to think about an every-day skill – multi-tasking. Being able to maintain our focus allows us to resume previous thinking or tasks after needing to pause to do or think about something else – in effect, we are multi-tasking when this happens.  Difficulties with this and other attention problems can cause frustration and worry for people struggling with an injured brain which, in turn, exacerbate the problems.

Problems with attention will also affect people’s ability to remember things if they can’t focus long enough to take in new information.

Other things people struggle with include:-

  • Difficulty listening to other people talk and keeping up with a conversation – especially if more than one other person is present or when there is background noise or distraction
  • Reading or watching anything from start to finish
  • Driving or undertaking any activity that requires multiple skills to be used

Complications

The following can exacerbate symptoms and difficulties, especially in those who also have filtering problems.

  • Noise
  • Busy environments
  • Interruptions
  • Multiple people/subjects
  • Rapidly changing events
  • Fatigue and lack of sleep
  • Stress
  • Feeling unwell / illness
  • Illicit drug use
  • Doing something that you are not interested in
  • Side effects of medication
  • Depression
  • Anxiety
  • Poor diet
  • Filtering incoming information and processing in a timely way

Things you can do to help yourself

  • Exercise regularly and get fresh air and daylight every day
  • Eat for nutrition
  • Use supplements to improve the brain environment
  • Get plenty of sleep and practice good sleep protocols
  • Take breaks during the day to allow your brain to process and catch-up
  • Follow a daily, weekly, and monthly routine to help build new habits
  • Try only to do one thing at a time to minimise confusion
  • Make sure you have enough light to see what you are doing
  • Do activities in a quiet place or when others are out so that you can focus
  • Turn off the TV or radio or wear earplugs so that your brain isn’t trying to do more than one thing
  • De-clutter your home and car to minimise distractions
  • Get organised and try to do at times of the day when you have the most energy, for most people, this is first thing in the morning
  • If you have a family, it can help to wear ear-plugs when you are reading or earphones when you are watching something.
  • Ask people to speak slowly and clearly and to repeat things for you when you notice you haven’t understood

More ways to help yourself

  • Face the person you are speaking with to focus your attention on the conversation
  • When talking with another person, summarise or repeat the key ideas back to them to show what you have understood
  • Remind your brain to “focus” as you are doing an activity
  • Take notes – write down things you noticed went wrong
  • Say the steps of a task out loud while you do the task – speaking to yourself help your brain to focus
  • Set aside distracting thoughts when you are trying to focus or write them down if you are worried about forgetting
  • Practice doing the things that are hard for you, in small steps. Repetition will help you ingrain tasks as habit freeing up your thinking space

A neuropsychologist or occupational therapist will be able to help, and you may find that it is best to seek a referral from your doctor if you find that:

  • You are unable to complete normal daily activities, including tasks at home, work, or during leisure time
  • You are unable or struggling with caring for yourself or your family
  • You have thoughts or feelings that affect your ability to pay attention
  • Your attention problem seems to be getting worse

What is happening on the inside

How each person understands their inner world is as unique as each brain injury. What happens to one person, and how they individually perceive their difficulties can be variable from one person to the next.

From the inside, many people are unaware of the extent of the difficulties they have with attention and are often unable to break these down or understand what is going wrong well enough to be able to make changes – changes that always take time and practice to achieve.

They may also be unaware of how other people see them and may struggle with understanding that other people can see the changes and outcomes that difficulties with attention bring. Because of this, people may struggle with handling feedback and may feel criticised rather than supported.

People often forget that many tasks are now challenging and so they set out with enthusiasm thinking they can do something only to find out they can’t. For them, it may feel as though they have forgotten how to do things. They might fail to remember or be reluctant to ask or be shown how to do something.

Many people struggle with their brain not being able to understand that it can’t do things – even when the person has worked this out themselves. This problem occurs when their habits or auto-pilot are at work, and it causes real problems, especially when someone is on their own for long periods. It can even prove to be dangerous when people automatically set off to go and do something they have always done, like have a bonfire, and yet no longer have the capacities to consider safety or dangers and to stay focused.

People may misunderstand the confusion they feel, so they may, for example, think that someone else is speaking too fast or are saying too much rather than relating this to slowed processing causing problems with staying focused. When things go wrong, they may believe this is due to being given unclear/inadequate instructions or that the people around them don’t understand or help enough. Often the impairments make it extremely difficult for people to associate their experience with the actual cause. Some people can’t remember what things were like pre brain injury – sometimes, all they know is that their brain now works differently.

When undertaking tasks, it may feel like it did before, and there may be no internal indicators lighting up the fact that things are going wrong. The inner intentions are still the same. Because of this, when things do go wrong, and people comment, people can feel judged.

From the Outside

It can be incredibly hard for family and friends to know and understand what is going on with any aspect of the array of impairments caused by brain injury and it can also take a while for them to incorporate new understandings into their behaviours. When we learn something new, we all need time to practice utilising this information, so it is essential that everyone is gentle with themselves – and each other – while this is going on.

Where there is a lack of information, in general, many people struggle with understanding and can easily misinterpret and misunderstand what they are seeing. So what you think you are seeing – might be something else entirely.

For example: –

Difficulty making plans or knowing they are needed – is often misinterpreted as laziness or selfishness

When someone needs instructions repeating – this may be interpreted as thinking someone wasn’t listening/paying attention

When someone is struggling to recognise that a topic has changed – this may become – you are obsessive or procrastinating

Brain injury ripples out and affects everyone – everyone needs to make changes, learn what they can, and do the best they can to help themselves.

Caring for your brain environment

There are many aspects of brain injury that can affect our ability to focus and maintain thinking. Other executive impairments and symptoms such as headaches, fatigue or depression can all interfere with how well we manage daily activities.

The brain relies on the health of our body to function well. A brain injury can disrupt how our biology operates and can quickly use micronutrient reserves. Depletion of our vitamin and mineral reserves makes it harder for the body to support the manufacture of neurotransmitters – the hormones that allow messages to pass across the synapses successfully.

The brain automatically rewires to restore neurological pathways broken by physical damage. Called neuroplasticity, this ability to rewire is dependent on many factors, including how severe the injury is, how early someone receives treatment, and how aggressive rehabilitation is.

Neuroplasticity is also enhanced when the brain environment is improved. This enrichment is why exercise, fresh air, daylight and nutrition are so important following a brain injury. The reduction or elimination of chemicals and recreational toxins is also crucial. The cleaner the brain environment and the healthier the body, the more significant improvements will be.

All executive functions and symptoms can improve when the effects of the ‘secondary injury.’ are addressed. You must speak to your doctor before following the ‘one, two, three plan’ suggested to support this process.

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