December 16th, 2021

Compensatory Strategies after brain injury
​ACC and Laura Fergusson Trust

These are simply strategies that you may need to use, to compensate for the difficulties you are having since your injury.

 For example: 

 You can never remember appointments anymore, so you now keep a diary with you at all times.
The diary is a memory strategy and helps you function on a day to day basis.

 Often people find the idea of a strategy difficult to grasp and will not want to use one, because they functioned perfectly well without it prior to their injury however many difficulties following a brain injury do not get better or go away. 

 At this point, if you want to be successful at home/socially or at work then you will need to find a way to “overcome” the problem.​

Some "tried and true" strategies
 
Managing Fatigue

• All difficulties following a brain injury are made worse by fatigue, so this needs to be managed effectively before progress can be made in any area of recover.
• Firstly, you need to be aware of how fatigue affects you. To do this you may chart your activities during the day and then note down how you feel. Do you get headaches, feel clumsy or irritable? You will become aware of how much you can do in a day before your brain gets overloaded and you start to make mistakes or forget things
• Once you have figured this out you can put in your rests and your fatigue management breaks during the day
• A good strategy here is to take a weekly planner sheet and plan your days. You can pace your activities during the day and balance physical and cognitive ( brain ) activities
• By looking at the whole week you can balance your days to avoid overload
• Your brain will have a much better chance of functioning well if you keep your mental energy at a consistent level.

 
 
Managing Attention and Concentration

• If your fatigue is under control then you have a much better chance of being able to concentrate on what you are doing
•  Most people after a brain injury find that multitasking/doing two things at the same time is not possible any more
• Again, in the first place, you need to be aware of when your concentration fails you and then a strategy needs to be put in place
• Noise/internal/external distractions will affect your concentration; you need to manage distractions
• Reduce the chance of noise and visual distraction distracting you by: turning off TV/radio, pulling blinds/curtains/repositioning your desk at work 
• Manage internal distractions i.e. stress/anxiety/worry by writing things down ,talking to someone about it, problem solving with help or simply letting yourself make a specific time to think about what is on your mind
• Multitasking will be too hard and cause too many difficulties (e.g. making the dinner while talking to children/talking on the phone and taking a message)
• Distractions can cause you to go from one thing to another without firstly completing what you were doing
• A strategy needs to be used - write a list and do one thing at a time, then tick it off to show it has been completed
• Talk through the steps aloud as you do them
• Write yourself sticky notes to stay focused/remind yourself what you were doing for example; what was in the oven 
• If you feel you are losing concentration have a phrase e.g. “stay on track” to keep your attention on the task
  

Managing Processing of Information
 

• If your fatigue is managed well and you are concentrating, then information is likely to get processed
• Information that you hear, see or read, for example, has to get sorted out and put into storage so you can remember it or relate to it later
• When you have had a brain injury, your processing can be slow and if information comes too quickly/is too complicated, or your brain is overloaded, then information gets lost
• It is very important to realise when this is happening and use a strategy such as:

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           - Dictaphone to record lengthy/complex information so you can listen to
             a number of times
          - Answering Machine to record phone messages rather than trying to
            write them down and listen 
          - Taking notes
          -  Asking for repetition/clarifications
          -  Repeating information back to people
          -  Breaking information into chunks
          -  Paraphrasing/summarising written information
          -  Asking people to slow down
         -  Getting rid of distractions (e.g. going to a quiet place if you are having to
           process complicated instructions)
 
Managing Memory

• To target memory it is important to look at fatigue, attention and concentration and processing in the first instant
• When strategies are in place for these areas and difficulties still remain it is important to look at what memory strategies are going to work for you
• What do you forget regularly?
• What systems did you have in place prior to your injury?
• Are you a visual or an auditory person?
• Strategies will need to be tried out and then practiced
• New learning is difficult following a brain injury, so strategy use won’t happen overnight
• Habits need to be formed
• Having a routine and using a daily planner helps you manage your memory problems

 
If you get into a routine things become habit – the pressure is taken off your brain to remember what you are supposed to be doing.

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• ​Diary – look at your diary at set times of the day – write ​everything down
• Organised systems – file bills, letters, reports
• Keep things that need to be dealt with in an obvious place
• Put things in the same place
• Make keys obvious by attaching them to a large key ring
• Use sticky notes around the house in prominent places
• Central notice board – for notes and reminders
• Calendar on the wall
• To Do lists
• Shopping lists 
• Watch/phone beepers/alarms
• Photos and names/significant features to help you remember new people

 
Managing Executive Functioning
 

• These are all the skills that help you plan and organise activities, initiate them, stay on track, monitor how you are doing, keep within a time frame and complete things.
• Strategies are extremely necessary if you have difficulties in this area, otherwise you could be thinking of great ideas and things to do, but nothing ever gets done.
• Try strategies such as:

            - step by step checklists
           - alarm/timer to go off when you need to do something
           - a daily plan will increase your chances of getting things done – when you see it written
           - specific times for planning and organising
           - prompts/alarms to get you up
           - feedback and prompts from others can also be a valuable strategy initially until you find a
             way of managing your difficulties independently
 
 
Managing Social Skills/Behaviour
 

• This is probably the trickiest area to tackle with a strategy
• To target difficulties with social skills and behaviour you have to be very aware of what you are doing
• Do you talk too much?  Are you rude to people without realising it?  Do you speak without thinking?  Do you talk about yourself all the time?
• Firstly you will need help from a family member/close friend/work colleague – someone you trust and feel okay with to give  Feedback
• Ask them to give you a signal/sign when you are perhaps talking too much/not turn taking/straying off the topic - this will increase your awareness
• Be aware of your listeners reactions – are they looking bored/surprised/offended?
• Do use the Stop – Think – Go strategy – this will slow you down and enable you to think before you speak
• If you find you offend people look at situations – where and when it is happening – Are you tired?  Is it too noisy?  Are you over stimulated and likely to be irritable?
• If you can identify what happens you can then plan for certain situations (rest prior to going)
• You can warn people…”I am very tired and sometimes I don’t think before I speak, please don’t be offended”.
• You can plan to keep to certain topics
• Role play prior to going, how you will be and what you will talk about

 
All strategies are quite simple and mostly common sense.  Often after an injury your brain is too tired to think of ways around things, even if they seem simple.
 
These are all just ideas. Your rehabilitation team will help you identify the need for strategies and assist you to find the ones that work for you.
 
 
Reference:  ACC 
                     Laura Fergusson Trust

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