Cognition

                                                      Cognitive Changes 

Cognitive changes following a stroke are common. Each part of your brain is responsible for controlling your ability to do different things, so cognitive changes vary depending on the location of the damage.


Video source: Stroke Foundation

Attention 

Depending on the area of your brain where your stroke occurred, your ability to attend can be affected. There are three different types of attention:

  • Sustained attention: Your ability to focus on a task (reading a book)
  • Divided attention: Your ability to focus on more than one task at a time (driving a car)
  • Selective attention: Your ability to focus on small details (reading a book while in a noisy, distracting room)

Some solutions:

  • Attention-enhancing exercises can challenge your brain to improve your attention. Try these attention games on Happy-Neuron.com
  • Break the activity into manageable chunks and give yourself breaks (read a book for 5 minutes, take a break, then return to the book)
  • Remove distractors (put your smartphone in a drawer so it doesn't tempt you to check it, wear headphones to remove distractors)

Memory


You may experience difficulties with short-term or long-term memory. 

  • Short-term memory helps you remember things that just happened, like someone's name when they introduce themselves or a phone number you just read. 
  • Long-term memory refers to things that you need to remember longer, like past events, a family member's birth date, or how to drive a car.
  • Working memory refers to taking the information you learned from short term memory and using it (walking to a phone and dialing a number that someone just told you)

Some solutions:

  • Use a memory notebook or daily planner to keep track of information
  • Memory-enhancing exercises can challenge your brain to improve your memory. Try these memory games on Happy-Neuron.com
  • Play memory-enhancing tabletop games like Memory, Trivial Pursuit, Checkers, or Chess. 
  • Place checklists and reminder notes around the house where you can see them
  • Set reminders in your smartphone, use a timer in the kitchen to remind you to turn off the stove, use an adapted strategy to remember to take your medications. 

Planning & Problem Solving

Initiation:  You may have difficulty beginning a task (sitting down to pay your bills)

Planning and Prioritizing: You may require help planning how you will complete a task, or recognizing the next step during a task. (planning what you are going to make for dinner and prioritizing what you should complete first)

Perseveration: Moving from one activity to the next. (Getting "stuck" bathing one arm repeatedly without moving on to bathe the rest of your body)

Problem solving: You may not be able to work out a solution when a problem arises unexpectedly. (hitting another persons car in a parking lot, and then driving away)

Some solutions:

  • Make to-do lists each morning, use numbers to prioritize the most important task to the least important task on your to-do list. Check off your to-do list as you complete each task.
  • A timer is a great tool for anyone who needs help with task initiation and perseveration. Use the timer to remind you to move onto the next step of the task.
  • Divide the problem solving process into steps: 1) Define the problem 2) Generate several solutions 3) Consider the consequences of each solution 4) choose the best solution

                                             Executive Functioning 

Our executive functions allow us to monitor ourselves while we are planning, carrying out, and completing tasks. In other words, it's like a computer hard drive that makes sure that all of our other cognitive systems are working efficiently. It often accompanies emotional changes such as anxiety and depression. Research has shown that 75% of people with stroke have executive functioning difficulties. 

Some solutions:

  • Break the problem into small pieces that are easier to tackle (organize your billing statements by the date that they are due)
  • Give yourself positive self-statements when you are performing a stressful task ("One step at a time, I'm going to be ok")
  • Take a 3 minute rest break if needed when you start to feel overwhelmed 
  • Rewrite instructions in your own words and repeat them verbally as you do them.
  • Executive function computer games and worksheets challenge the brain. Download free executive function worksheets on Happy-Neuron.com


References: 

Chung CSY, Pollock A, Campbell T, Durward BR, Hagen S. Cognitive rehabilitation for executive dysfunction in adults with stroke or other adult non-progressive acquired brain damage. Cochrane Database of Systematic Reviews 2013, Issue 4. Art. No.: CD008391. DOI: 10.1002/14651858.CD008391.pub2: 

Visser, M. M., Heijenbrok-Kal, M. H., van 't Spijker, A., Ribbers, G. M., & Busschbach, J. J. (2013). The effectiveness of problem solving therapy for stroke patients: study protocol for a pragmatic randomized controlled trial. BMC neurology, 13, 67. https://doi.org/10.1186/1471-2377-13-67

Page last updated: 12/2020