But of course it’s not deliberate disorganisation-it’s a consequence of injury. And the “surprising discoveries” may be the novel and innovative ways to deal with this.
Cognitive communication difficulties
Communication is a complex process involving many aspects of thinking and social skills. If brain injury impairs any of these skills then it affects the ability to communicate successfully. ‘Cognitive communication difficulties’ is the term most often used for the resulting problems.
The frontal lobes are particularly important for cognitive communication skills because of their role in the brain’s ‘executive functions’, including planning, organisation, flexible thinking and social behaviour. However, many other parts of the brain interact to perform the skills and are also important, such as areas of the temporal and parietal lobes.
Attention and concentration difficulties
This consequence of brain injury can be one of the most difficult to deal with, as it is easily mistaken for, or misunderstood as, other things, such as rudeness or doing embarrassing or inappropriate actions, often in social situations. It can be just as embarrassing for the injured person, who may not appreciate that what they are saying or doing may be considered unacceptable and they can become bewildered or even frightened by reactions. They can even become violent as a defence mechanism.
For instance, a brain injured person may suddenly start a loud conversation in a cinema, which affects other people’s viewing.
They may have difficulty concentrating on conversations. So they end conversations abruptly or avoid them altogether, which can appear rude. Similarly, people can get upset if they see the brain injured person doing something, but appearing to ignore them. They’re not. They often just can’t concentrate on more than one thing at once.
If the brain injured person lacks attention skills, they can miss important information. Thus they are told that someone’s parent has died, so try to avoid asking how their mum is. But if they’ve missed they, it may be the first thing they ask!
This is where it can be difficult to access information that you ‘know’. It affects skills such as word recall and remembering people’s names, which are very important when communicating socially. If they can’t do this, then people with brain injuries may avoid social situations altogether, thus becoming more “hidden”.
Brain injured people can interpret verbal information absolutely literally and may not understand the little nuances, such as irony, humour or sarcasm. This type of difficulty can result in the person taking things the wrong way and lead to embarrassment and arguments.
Similarly, it can make it hard for the person to understand common expressions. For example, if you use an expression such as “I’ll just be a minute” they may take it literally and get upset if you take longer than one minute.
So you have to learn to understand how the brain injured person may be interpreting what you say; perhaps try and find more neutral ways of saying things.
To move away from Winnie the Pooh’s wisdom and move to Thomas Edison
“There are no rules here-we’re trying to accomplish something”
That’s one reason why for lawyers, handling brain injury and similarly, serious spinal injury cases is so interesting, because they often require an innovative approach rather than following the “rules”. Of course, we have to follow legal and procedural rules, but why not try and think differently to actually “accomplish” something with the case? No brain injury case is the same and therefore we don’t try and deal with each case in the same way. We look at what we can use the litigation for to best achieve what we can for each client so as to get the most for the future in their changed situation.
Our strapline says “Where individuals count”. That is never more true than when acting for brain injured clients. Or as Tigger might put it:
“The wonderful thing about Tiggers is that I’m the only one!”