Changed Decision Making After Brain Injury

Decision making after brain injury. Grey cartoon figure scratching his head while standing on orange arrow with five direction points


Decision making after brain injury is commonly affected particularly after Frontal Lobe damage.

Decision making is an executive function. That is a fancy brain term that makes these functions sound very important – and they are! Executive functions help us use our intellect . They help us to look at information coming into the brain and decide what to do about it.

Decision-making along with other executive functions (such as planning, organising, and being able to start things) are often damaged after brain injury. Brain injury, particularly frontal lobe damage can affect our flexibility and ability to make decisions.

Being able to make good, thoughtful, decisions also helps other executive functions to work properly. You are more likely to be able to sort out a solution to a problem if you are able to make a decision – hopefully a good one. You can plan better if you are able to make decisions about the steps and priorities that are needed.

When we talk about functions of the brain, such as decision making, it can appear these work in the same way for each of us. Not so. We each have our own way of making decisions. This happens through things such as our past learning and experience, our emotions, our mood at the time, and possible genetic and gender differences.

Our basis or principles for making decisions are also different:

  • Some people might have regular principles that do not change with circumstance – “I will give 10% of what I earn to the support of others.”
  • Some of us will make decisions based on what is going on at the moment – “Last year I did not have regular work so I decided not contribute to the support of others. This year I have steady employment so I will give $2000 to support others.
  • And more than likely we will use a mix of both.  “I give 10% of what I earn to support others – there is a major earthquake in Z so I will give extra”.


Why am I explaining all this? I am trying to explain in my long winded way – that difficulties with decision-making after brain injury will likely be different for each person. This is partly based on the part of the brain damaged, and partly based on how decisions were made before brain injury.

The message here is we need to look at each person, individually, along with their individual outcomes. The impact on making decisions after brain injury will vary from person to person.

Other outcomes of brain injury can also affect the ability to make good decisions.  Being impulsive  could mean rushing into a decision without thinking through consequences. Difficulty with memory might mean not being able to remember all the things that need to be considered to make a decision.


Tips and Strategies For Decision Making After Brain Injury:

  • Having a step by step process to work through when making a decision. Recorded in a way that works best; such as a flow chart, checklist, picture board, or audio prompts.  An example of a flow chart can be found HERE from the Brain Injury Resource Center


  • Try to avoid having to make quick, or crisis, or last-minute decisions.  Better to take time to make a considered decision than to live with the effects of a quickly made, bad decision.


  • Be patient. Allow time to work through decisions. We have probably all had times when we make an undesirable decision because we were too hasty. For a person with brain injury decision-making is likely to take longer.


  • Try not to allow others push or rush a decision, stick to the process and work through the steps.


  • Avoid making decisions when tired, stressed, or anxious. Whatever affects the ability to manage other outcomes of brain injury – will also impact on decision-making: pain, stress, hunger, lack of time.


  • It may help to work through making the decision with another person. Weigh up the options and consequences of each choice – then together select the best action or response.


  • Ensure the right kind of assistance at the right level. This could include guidelines for what is OK and what is not.


  • If making decisions or choices is very difficult it may be better to have only a limited number of choices – the number that is most easily managed. That may be two choices.


Please add any other strategies you have discovered in the Comments below.

Next week more strategies in Tips For Making Decisions After Brain Injury



Illustration at beginning from ClipArtKid



  1. Tips for Making Decisions After Brain Injury - Changed Lives New Journeys - October 18, 2016

    […] researching last weeks article on Changed Decision-Making After Brain Injury  I came across a blog; Brain Injury Self Rehabilitation by Edie a Registered Nurse.  Edie had a […]