By Dr. Douglas Lee
Dr. Lee is a retired clinical psychologist who was also Board Certified in Behavioral and Cognitive Psychology and was a Board-Certified Behavior Analyst. He has over 30 years experience working with children and adults with moderate to severe brain injury. He consulted throughout BC and occasionally in Alberta. His focus was on developing individualized treatment plans for a wide range of behavioral and cognitive issues. Due to the severity of most client’s injuries, he saw them in their local homes and communities. He is currently a board member of Fraser Valley Brain Injury Association.
One of the most common effects that occurs for individuals with brain injuries is brain fatigue. We have all likely had occurrences of this in our lives where we have had to manage too much information within a certain period of time and get to the point that we just can’t take in any more information and need to shut down. We have all likely also experienced how this fatigue can come on even for regular information management if we are sleep deprived. This is an issue independent of the person also possibly having specific memory impairments. Brain fatigue may give the appearance of a memory impairment but the two issues are fundamentally different.
Most people I worked with were far more sensitive to information overload leading to brain fatigue than your typical experience. Many people I knew effectively could not handle more than 20-30 minutes of more intensive “brain work”. Not only that but going beyond their limit results in more or less falling off a cliff rather than a gradual inability to manage more information. As an example a client of mine attended a large team meeting of about 12 people. He sat across the table from me. He was engaged for about the first 20 minutes and then I could observe him switch off for the remainder of the 90 minute meeting. Talking to him afterward he was clearly able to remember the first 20 minutes but had no idea what the rest of the meeting was about. He was also unaware of having no memory of the remainder of the meeting. Others in the meeting were aware that he was fairly quiet for most of the meeting but were unaware of how little of the meeting he actually comprehended.
This example occurred on a day when he was well rested. Of course many individuals with brain injuries, including this person, also have issues with poor sleep. When you add possible poor sleep on top of the already limited cognitive stamina people with brain injuries can have extreme difficulties processing even fairly simple and routine information on a particular day.
Recovery from overload can also be a major issue. Another client I worked with had a partner who was well aware of her brain fatigue. We would meet together for about 20 minutes before my client would be prompted to excuse herself. She would spend over two hours in a low light small room that was completely bare except for the chair she sat in. Her partner and I would continue and she would then slowly relay the information to my client over several small sessions with such recovery sessions for each session. With such a supportive system my client was able to gain greater independence in several areas.
On a day by day basis the combination of cognitive demand, level of cognitive stamina and sleep disturbance can be major factors in an individual having quite wide variability in their ability to competently manage on a day to day basis. Such factors can have major impacts on treatment or therapy plans. For instance, shorter more frequent sessions over a longer period of time may be the most effective option to adapt to such brain fatigue. Patience is essential to being able to work with such issues. No amount of trying to speed things up is going to work.