Memory Problems after Brain Injury
By DeAnna Frye, Ph.D. and JoAnn M. Ovnic, M.A.,CCC/SLP
What are common memory problems following TBI?
Short term memory loss is a common impairment following TBI. Generally long term memory, such as recall of historical information, childhood and other events prior to injury are preserved. The degree and location of injury affects the severity of memory problems. Some examples of short term memory loss include:
- forgetting what happened during the day
- forgetting placement of items
- forgetting tasks completed throughout the day
- losing train of thought during a conversation
- having trouble with note taking
- difficulty retaining information in class
- difficulty recalling the main details of a recently read article or book chapter
What is the difference between short term memory, long term memory and post traumatic amnesia?
In general, most neuropsychologists define short term memory as an individual’s ability to remember information over the course of a few hours or across a day or week after a TBI. For example, the ability to recall what you did this morning is an example of short term memory.
Long term memory is generally reserved for recall of events that occurred prior to the injury. Remembering an incident from childhood is an example of a long term memory for an individual injured in their 30s.
Post traumatic amnesia is the period of time that the individual is unable to recall events following the injury. For example, some individuals may not recall the events of the day their injury occurred or being in the hospital for the next month after the injury. Post traumatic amnesia is then estimated to be about 30 days long.
Please tell me about post traumatic amnesia – how long does PTA last?
Post traumatic amnesia refers to a disruption in the memory system of the brain as a result of an injury. PTA begins at the time of the injury and includes the coma period. It does not end until the individual is able to continuously report events that have occurred. In other words, a person may be out of coma and talking with their family members but has no recall of the conversations. This individual is still experiencing PTA. As a general rule of thumb, PTA usually lasts 4 times the length of coma. So an individual who is in a coma for two weeks typically experiences PTA of eight weeks.
As an individual recovers from the injury, he/she will begin to remember events of the day and days before. However, the person will have no memory of the events immediately following the injury. This is not due to psychological trauma, but the neurological injury itself.
The inability to remember hours, days or weeks of your life can be stressful and uncomfortable. Reassuring the individual repeating what happened during this period may be helpful. Most important, however, is acknowledging that their PTA has resolved and that they can remember events now.
My CT scan of the brain was normal, yet I am still having problems with my memory. How is this possible?
CT scans are helpful diagnostic tests used by physicians to identify physical changes to the brain. CT scans can identify tumors, bleeding, swelling or bruises involving the brain. They are not sensitive enough to identify the microscopic tearing and shearing that commonly occurs after a traumatic brain injury. Therefore it is not unusual for a CT scan to be normal following a brain injury. This simply reflects the CT scan’s limitations with regard to identification of the physical changes in the brain.
A survivor of TBI may initially demonstrate abnormalities on CT scan, such as swelling or bleeding. A repeat CT scan several months later, however, may be considered normal. However, the survivor may still be experiencing functional changes such as memory problems
My doctor has recommended a functional MRI. How is this different from a CT scan or MRI?
A functional MRI or fMRI is an image of brain activation as a function of change in cerebral blood flow or blood oxygenation. Usually the analysis is based on blood oxygenation changes. When a part of the brain is activated there is an increase in oxygen rich blood. Changes in neural activity are evaluated by measuring changes in local blood oxygen levels in the brain during performance of a specific task.
During the completion of an MRI, the individual is required to complete some cognitive activities, such as memory tasks. The scan then reveals the changes in blood oxygen levels in the brain during the completion of the task. This allows your doctors to determine how your brain is processing specific types of information. Individuals who have had normal CT or MRI scans have shown abnormalities on fMRI.
I have been discharged from therapies but want to continue to work on improving my memory and other cognitive skills. What are some things I can do to continue to work on my cognitive abilities?
Just as physical exercise is good for the body, mental activity is good for the mind. Continuing with any strategies or home exercise activities that your therapists have recommended is important. In addition, continuing to challenge yourself with mental activities every day will help you maintain the abilities you gained in therapy and help you continue to improve. Reading the newspaper, magazine or a book can help with concentration, reading and memory. Watching the news keeps you up to date on what is happening in the world. There are many games that you can purchase that are not only good family entertainment but also require reasoning skills. Doing crossword puzzles or word searches can help if you have difficulty with language skills. The most important thing is that you find activities that you enjoy doing, as you will be more likely to continue them. Consistently applying the strategies you learned in therapy to your daily life will allow you to adapt more quickly and accomplish your goals.
How can I help my family member remember appointments and day-to-day events?
Daily routines are helpful. Encourage your family member to keep a calendar and write down appointments. If he can not do this himself, set aside a time during the day to review and write down information. Keep a notepad and pen near the phone to write any phone messages. Create a “To Do” list for the day. Have your family member check off each task or activity as it is completed.
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:
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By Douglas Mason, Psy.D. and Michael Kohn, Psy.D.
Workbook for families and adults explains types of memory and effects of aging, brain injury, and brain damage on memory. Includes practical exercises and tips for adults, family members and caregivers for brain injury rehabilitation. Recommended for persons with mild brain injury or mild cognitive impairments due to trauma, aging, or disease.