Some of the most common deficits are: lack of motivation, short-term memory loss, personality changes, perseveration and rigidity of thinking, inability to remain focused, impatience, inability to follow written instructions, self-centeredness, lack of empathy, frustration, anger, poor judgment, social withdrawal, inability to learn new facts, depression, task performance difficulties and lack of enthusiasm for anything. My partner, although having many of the above deficits, admits to only his short-term memory loss and his lack of motivation. He is completely unaware that his deficits affect his functioning or how they affect our relationship.
Denial, according to my research, is an adaptive strategy to protect themselves from the reality of their situation. But, in many cases, the failure to recognize deficits leads to a high risk of conflict with family members because they are unable to understand that a function is impaired; they don't recognize the problem when it occurs and they are unable to anticipate that a problem will occur because of their deficit. When brain injury survivors become aware of deficits, it allows them to adapt to the physical, mental and emotional losses they have incurred. Hard work does not completely eliminate deficits. Deficits, for the most part, will have to be adapted to.
In the words of a brain injury survivor, those who have had a brain injury have suffered a terrible insult to the insight portion of their brain and in many cases they simply just don't 'get it'. I had also noticed this with my partner.
She also said that denial is not stubbornness as it appears to be - it is brain injury - and it leaves one without the ability to see oneself as one really is. Knowing what one is doing and saying, and to be aware of one's thoughts and behavior is a deliberate action. She said you can't alter behavior and attitudes until you know that you are doing something. The behavior follows a thought so if the behavior is unacceptable, you have to recognize the thought that generated the behavior. The process is called metacognition. She further commented that self-evaluation is the beginning of metacognition which is the beginning of real rehabilitation.
Cognitive therapy is training in the use of compensatory strategies for cognitive deficits. It utilizes the patient's strengths and because no two injuries are the same, treatment plans and goals are designed specifically for each person.
Suggested strategies to help with adapting to deficits are: to have a positive attitude, to keep trying things that are challenging, to write things down because it is more likely to get into the memory bank and to join brain injury support groups to learn what strategies others have developed.
After reading personal stories of some brain injury survivors, I asked my partner, at 26 months post injury, if he would like to write his own story. He said he wouldn't know what to write.
"You could say how your accident happened, what you remember of your hospital stay and how you feel about what has happened to you," I suggested.
"I don't think it's my head. I think it's my legs, so I could only write about my legs," he answered.
"You don't think you have a head injury?" I asked him.
"I don't know. I know my memory isn't very good but I think the reason I haven't been motivated is because of my legs."
I decided at this point he is still not ready to discuss the issue of his deficits.
