Improving Study with a History of Brain Injury

Reader’s Question

I am now a Disabled American Veteran, with anoxic brain injury (executive dysfunction) and have always struggled with ADHD. I am attempting to rebuild my life by taking some college courses in an attempt to transition to a less physical demanding job than being a marine engineer (my previous occupation).

I am in Seminary, via the computer and have signed up for taking art school classes. The problem is that although I have paid for these courses, I find it extremely hard to discipline myself to sit still long enough and read the course materials and apply myself to the course standards. I have tried to apply myself to studying, and ended up often napping instead. This situation has caused me much frustration with myself, and some depression as I try to rebuild my life. What should I do?

Psychologist’s Reply

Cerebral injuries secondary to anoxia (loss of oxygen) often impair executive functions but they create additional difficulties as well. One way to think of executive functions is an orchestra — all music sections having the ability to play independently. Without a conductor however, the sounds are poorly organized, out of time/sync, and uncoordinated. Our “executive functions” are the brain’s conductor. When impaired, we experienced significant difficulty organizing our thoughts, activities, and plans. On the surface, it might look like a short attention span or poor memory — but it’s more complex than that.

Additionally, cerebral anoxia also produces additional symptoms, and one of the most common is rapid fatigue. Individuals with brain injuries often experience “thinking fatigue” — becoming quickly exhausted with cognitive tasks (reading, math, studying, etc.). As part of your recovery, you will need to increase your “thinking” duration much in the same way that a person in physical rehabilitation increases their standing and walking tolerances.

For your situation I’d recommend:

  1. Don’t push yourself too hard, and don’t be hard on yourself. Recovery from a brain injury is a long process. Give yourself a break.
  2. Use methods we have developed for ADHD folks when they study. Take frequent breaks. Organize your study efforts rather than just “start studying”. Decide small goals for each study period.
  3. Obtain a waiver from your school based on your medical history — a waiver that allows additional time to complete courses or take tests.
  4. Seek treatment for depression if needed. Many antidepressants such as Wellbutrin may actually improve your attention span (it increases Dopamine…just like ADHD medications!).
  5. Recognize that there’s a significant difference between an anoxic brain injury and a specific brain injury. Anoxia typically produces a diffuse, global impairment at some level (mild, moderate, severe), while some brain injuries can be very specific such as a cerebral vascular accident (stroke). As you study, you may find additional weak skills that may require more rehabilitation focus. You may also find cognitive areas that are working well — maximize them if possible.
  6. Look for head-injury support groups in your area. Many participants in such programs may be years ahead of you in the recovery process and may have found tricks of the trade they are willing to share.

Good luck as you transition into a new career.

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