Brain Injury Functioning Issues #3

Disinhibition
Definition	A syndrome marked by difficulty properly directing and controlling energy and emotions.
Signs and Symptoms of Problems	Impulsivity:  Doing or saying things without considering the consequences.  Making decisions before thinking about all of the information. Feelings or behaviors come on too strong and/or too fast:  Feelings come to the surface and are hard to hold back.  Reacting to small things with too much emotion.  Talking too loud or too fast when the topic is emotional.  Restlessness:  Hard to keep still.  Intense and frequent need to move or fidget. Irritable and Easily Frustrated:  Hard to forget even small irritations.  Brooding.  Often require others to help calm down. Emotional Flooding:  Can become easily overwhelmed when feeling challenged socially or cognitively.  Mind “goes blank.”  Once flooded, it is temporarily impossible to think clearly or act purposefully.
Strategies for Survivors and Significant Others	Visually/verbally cue the person to slow down.  Build in delays.  Establish automatic “pauses” between each task.  Use a stopwatch if needed. Ask the individual if they would do better if they put more thought in to a decision.  Consult a coach or family member before acting and gather further feedback Use this sequence “Stop, Think, Act, and Evaluate” and analyze how they did afterward Use self-talk strategies (i.e. Could I go slower? Did I think about this long enough? ). Be direct in response to inappropriate behaviors (i.e. interruptions, inappropriate remarks, tone of voice, awkward facial expressions) Teach relaxation strategies In a tactful way, let the person know how they are coming across (i.e. “when you say I do this, it makes me feel…”). Ask permission to videotape an interaction with the person and later analyze with the person Verify what was really seen, heard, or felt to know if feelings are justified Encourage use of breaks to relax, calm down, and re-attempt communication when ready Seek coaching Ask the other person to slow down if they are making you irritated. Excuse self from current situation if too upset “SAVE” strategy (Stop, Ask, Verify, Evaluate)
Attention/Concentration
Definition	Staying awake, alert and ready, focusing, and keeping a train of thought.
Signs and Symptoms of Problems	Hard to Stay Alert:  Not enough mental energy to engage fully in the environment. Hard to Focus Attention:  Easily distracted by noises and things around you.  Distracted by personal thoughts, feelings, and worries. Lose “Train of Thought:” Once able to focus, a person may lose “train of thought” or concentration if distracted.  It may be hard for a person to make a point without getting off track and “rambling.”
Strategies for Survivors and Significant Others	Allow extra time for task completion Limit distractions during task completion Provide cues as needed to sustain task focus.  Set timers/use alarms to remind to re-focus.  Verify performance for accuracy Direct person back to the current topic when conversation becomes unfocused Encourage eye contact and participation during conversation (asking questions, nodding/shaking head) Reduce environmental distractions (i.e. closing doors, reducing glares) Teach strategies such as using a line guide to reduce amount of information to attend to on a page Improve visual attention by scanning left to right and top to bottom while using finger to anchor               eyes Repeated verbal/visual cues to “slow down and pay attention to details”