Cognitive Changes after Brain Injury: FAQs

 Cognitive Fatigue after Brain Injury

By DeAnna Frye, Ph.D. and JoAnn M. Ovnic, M.A.,CCC/SLP 

When I wake up in the morning I feel good and am usually able to get a lot of things done.  By afternoon, however, I’m pretty tired.  I’ve been told this may be due to cognitive fatigue.  What is cognitive fatigue and what can I do about it?

Everyone has a limited amount of energy available each day to accomplish our goals.  The amount of energy we have varies due to a variety of factors, including how well we sleep at night.  How quickly we “spend” our energy during the course of the day has an effect on our level of fatigue.

After a brain injury, individuals typically find that certain activities require more energy than they did before the injury.  For example, eating at a busy restaurant can use up more energy for an individual who has difficulty with attention and is easily distracted. Cognitive fatigue occurs when you are reaching your limit with regard to the amount of energy you have left to spend.

One strategy to combat cognitive fatigue is pacing.  Pacing involves first identifying how long an individual can work at various tasks before becoming fatigued.  For example, you may find that you can work for an hour on a task, such as paying bills, in a quiet environment but can handle attending to conversations  in a crowd for only thirty minutes.

Identifying your limits and then scheduling breaks throughout the course of the day can help you combat cognitive fatigue.  Planning your day in advance when possible can also help.  For example, if you know you have a family reunion to attend on Saturday afternoon at the park, you may want to plan quiet activities at home in the morning, instead of going to the grocery store.

I have difficulty focusing on what I’m doing. How come?

Attention is a vital part of our everyday functioning.  All of us from time to time become distracted, whether it is a phone call in the middle of cooking dinner, or being interrupted to attend a meeting while in the middle of writing a report.  When a person sustains a brain injury, attention is an area of cognition that impacts the ability to concentrate and focus for various amounts of time and in various conditions.  The following types of attention may be affected:

  • Focused: the ability to attend to an activity or task with no other distractions. For example a person might do a crossword puzzle in quiet.
  • Selective: being able to attend to a task and block out unimportant information. For example reading a book while playing background music.
  • Alternating: the ability to switch between tasks. This is especially noted in real-life situations. For example: working in an office and being interrupted by phone calls, filing and greeting clients.
  • Divided: The ability to do two or more tasks at the same time. One of the most common examples is driving a car while changing radio stations and looking for an unfamiliar exit.

Why would my doctor prescribe a medication that is used for people with attention deficit disorder when I have had a brain injury?

While Attention Deficit Disorder  is not the same as a traumatic brain injury, research has shown that individuals who have experienced a change in their attention abilities after a brain injury benefit from the same medications that are used for Attention Deficit Disorder.  Quite simply, attention is a function of our brains.  When attention abilities are impaired, certain medications may help to correct the problem, regardless of the underlying cause.

Dr DeAnna Frye has a B.S. in Psychology, M.S. in Counseling Psychology, Ph.D. in Counseling Psychology. She is currently employed by Neurology Neuroscience Associates of Akron. Her special interests are psychotherapy and counseling to patients with neurological disorders with special expertise in brain injury. She is a founding member and the current co-chair of the Summit County Traumatic Brain Injury Collaborative located in Akron, Ohio.

For more information, see:

Hero’s Journey

By Kit Malia, B.Ed., and Anne Brannagan, M.Sc.

Educational group curriculum on brain injury for adults and survivors to increase understanding and adjustment. For use by clinicians, caregivers and families in rehabilitation, community and home settings.


Survival Kit, A Planner and Organizer for Survivors of Brain Injury

By Debbie Leonhardt, M.A., N.C.C., L.P.C.

TBI workbook and organizer for persons with brain injuries and cognitive disorders affecting memory, planning and organization. For use in rehabilitation, community programs or home.


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