Acquired Brain Injury

Due to the large number of potential causes of ABI, the symptoms vary from person to person depending on the location and extent of injury to the brain, and several other factors that can affect recovery. Cognitive changes can be widespread and severe across many thinking abilities or specific and mild. Some cognitive symptoms are also more common than others due to the vulnerability of their supporting brain networks, for instance proximity to bony structures, blood vessels or sensitivity to oxygen deprivation.

Memory difficulties are the most common cognitive symptoms following an ABI. Memory changes can range from a greater frequency in misplacing important items, like keys, wallet and glasses or in forgetting the details of conversations, to severe memory impairment such as forgetting entire conversations, recent events or what happened a few minutes ago. Executive functions, also often affected by ABI, are made up of a diverse set of cognitive abilities including reasoning, mental flexibility, organization, problem solving, multi-tasking, prioritizing, planning, sustaining attention, goal attainment, as well as motivation, impulse-control (not doing or saying the first thing that comes to mind), judgment, social appropriateness, self-awareness and empathy. Other potential cognitive challenges can include slowed mental speed, difficulties interpreting visual information, and speaking or understanding language. Cognitive challenges further interact, such that difficulties in one area (e.g., organization) can create challenges in other areas (e.g., learning and recalling new information, planning, goal attainment).

An ABI is a major life event. It is normal to feel sad, down, angry, anxious and/or worried about what happened to you and what it means for your future. Adjusting to the changes you are experiencing as well as future uncertainties can be difficult to cope with. Many people describe their lives as “who I was before ABI” and “who I am after ABI”. The change to self-image, which may be due to changed employment status, physical abilities, and family and social roles, can be significant and have a negative effect on self-esteem. Many people benefit from supportive therapy to process these changes, the loss of their old life and to develop a new sense of identity and purpose.

Psychological disorders are common following an ABI. The most common conditions include depression, anxiety and anger. Often when psychological conditions are diagnosed, there is a pre-existing history of issues or risk factors (such as family history), but this is not always the case. Damage to certain brain structures resulting from ABI can also reduce emotional control which can exacerbate anxiety, anger and the ability to cope with day-to-day stressors. People who have experienced an episode of depression before ABI are at a greater risk following ABI of becoming depressed. Other risk factor for depression often experienced by individuals following ABI include reduced social contact, sense of purpose, meaning and engagement in activities they once enjoyed. Depending on how the ABI happened, a subset of people go on to develop post-traumatic stress disorder. Fortunately, cognitive behavioural therapy approaches have proven effectiveness with the above psychological conditions. As people with ABI may also have cognitive symptoms that interfere with traditional therapy administration (e.g., changes in memory, attention span), in many cases we may be able to adapt therapy to enhance treatment benefit.

This is one of the most common questions asked following an ABI and one of the most difficult questions to answer, which can be very frustrating in planning your future. Many factors influence recovery. These can include the location and extent of brain injury, complications, the responsible medical condition(s) causing cognitive and/or emotional symptoms, the severity and nature of symptoms early on in recovery, age, intelligence and educational attainment, motivation, family and social support, availability of comprehensive brain injury rehabilitation, psychological health, continued mental and physical activity, alcohol or drug use, sleep and nutrition.

The content on this website is for informational and educational purposes only and is not intended to be a substitute for medical advice, diagnosis, or treatment.

The type of injury, resulting symptoms, degree of recovery, in combination with your motivation, the nature of your job, flexibility at work and support of your employer can determine whether returning to work will be successful. Being aware of your challenges and learning strategies to effectively compensate, can also determine whether you will sink or swim at work.

The content on this website is for informational and educational purposes only and is not intended to be a substitute for medical advice, diagnosis, or treatment.

Neuropsychological assessment involves an examination of the brain and behaviour. Your performance on a variety of paper-pencil and computer tests provides a cognitive profile and information about the integrity of your brain function. Cognitive testing can take several hours to complete depending on the reason for referral. For many conditions, objective cognitive tests are more sensitive in detecting brain dysfunction or changes than current neuroimaging methods.

Thinking abilities tested can include attention, IQ and academic abilities, processing speed, learning and memory, language skills, visuoperceptual abilities, motor coordination, and executive functions, such as problem-solving, planning, reasoning, impulse control, and working memory (the ability to hold and manipulate information in mind). Psychological psychometric testing is also completed.

All psychometric scores are compared to normative datasets. Normative datasets can control for the effects of age, education, gender, and neurological or psychological conditions on test scores. In addition to cognitive and psychological testing, neuropsychological evaluations include a detailed clinical interview, diagnostic psychological evaluation, and review of medical, psychological and/ or neurological documentation. Interpretation of the comprehensive neuropsychological profile and formulation of diagnoses are informed by considering the interplay and impact of many variables.

Questions that can be answered by a neuropsychological evaluation, depending on the nature of the referral, can include the following:

• Diagnosis of neurological or neurodevelopmental disorders and their impact on cognitive function.
• Provision of clinical opinions and information to assist multidisciplinary care teams in reaching diagnoses of complex conditions or determining whether a medical intervention or medication was successful in improving cognition.
• Diagnosis of psychological conditions, including their impact on cognitive function.
• Types of cognitive abilities impaired or preserved.
• The severity of cognitive difficulties.
• Factors likely contributing to or causing cognitive difficulties.
• Improvement or decline in cognitive functioning over time with repeat testing.
• Recommendations pertaining to treatment plans for neurological and/or psychological conditions.
• How to optimize cognitive functioning via intact cognitive abilities (cognitive rehabilitation).
• Recommendations pertaining to accommodations for work and academic settings.
• Whether cognitive changes are normal for age or indicative of a neurodegenerative process.
• Guidance on future planning and decision-making in cases of neurodegenerative or brain injury conditions (dealing with finances, medication administration, meal preparation, and driving).
• Informing prognosis and/ or recovery in neurological and psychological conditions.

Neuropsychologists have advanced training in the administration and interpretation of psychometric tests, psychological and neurological diagnoses, neurocognitive and behavioural interventions, and psychotherapy.