Blog

Cognitive impairment is common following brain injury. A person may have minimal, or no physical effects, yet be significantly changed by cognitive damage.

This makes it important to understand what ‘cognitive’ really means.

For some reason the idea of spelling bees came to mind. Do you remember them? The teacher says “Spell Cognitive” and an earnest voice says “COGNITIVE, C-o-g-n-i-t-i-v-e spells COGNITIVE”.

Well spelling ‘cognitive’ might be a whole lot simpler than trying to understand its meaning. Still let’s have a go, how hard can it be!!  Well I do know when I started out I found the meaning of “COGNITIVE” difficult to grasp:

• How did it differ from intellect?
• What did it do for us in everyday life?
• What kinds of functions would be damaged when someone had ‘cognitive impairment’?

At a conference on brain injury, during my early working life, I bought a cassette tape (that dates me a bit!) that described cognitive and executive functions. I listened to it over and over, as I drove to and from work. Struggling to understand the meaning and impact as much as I could.

I sensed that understanding cognitive impairment was a key to learning about brain injury. Below is a summary of what I began to learn from those tapes, and a bit more.

‘Cognitive’ – Having a go at a definition:

Warning to newcomers!! The information that follows may seem confusing, my aim is to ‘un-confuse’ you so stick with it, and let me know if it helps in the end!

[unordered_list style=”tick”]

• Think about “cognition” as the way we think, reason, remember and use our intellect.
• Cognitive functions are not our intellect. They are the tools we use to access our intellect, in our daily life.
• It is not our knowledge, it’s the way we process and use our knowledge.
• It is about the thinking part, not our physical (motor) functions[/unordered_list]

So very simply you could say

“Cognition is the way we use our brains to think”

Why does cognitive function matter in brain injury?

It means a person with brain injury may have the intellect they had prior to brain injury, but they are not able to access it in the same way because of cognitive impairments.

Commonly in brain injury there is damage to a range of cognitive processes such as memory, reduced attention, altered judgement, making it harder to remember and process information.

It is cognitive impairment, without physical disability, that leads to the description that brain injury is the invisible or hidden disability.

I well remember a gentleman who had studied quantum physics, calculus and higher level mathematics. A severe brain injury left him with a significant cognitive impairment including memory loss, difficulty with new learning and poor decision making processes.

While he knew he had once been able to solve complex mathematical problems, he was no longer able to carry out even basic maths. He used to say he knew the knowledge he had was there, but he could not use it.

A fuller definition of COGNITIVE:

For those of you who want a definition with a bit more meat, here is one from ‘Oxford Learning’

“Cognitive: the process of obtaining knowledge through thought, experience, and the senses. From Latin “to consider” — it means to think deeply on… knowing or apprehending by the understanding of something.

We use cognitive skills whenever we try to understand anything. This is how it works:

1. You are taught something — some new info
2. You think about it
3. You talk about it in your own words
4. You notice how this new info fits into other things that you know”

What does cognitive impairment feel like?

While it is not possible to fully understand, here is a little bit of an experience; a short simulator of what it’s like to have a cognitive impairment:  [box style=”rounded” border=”full”]Mimic a Cognitive Impairment[/box]

For more,  including the SlideShare presentation below, you can visit the work of Ruth Ellison at UX Australia. Yes this is focussed on web use, but the information is useful in understanding cognitive impairment in a simple clear way.

‘Executive function’ – Having a go at a definition:

When reading about cognitive impairment you might also see the terms “executive function” or “higher order function”. These terms sound lofty and important, maybe this will help you to remember what they mean: they are lofty and important!

They are like the big boss – they pull together and combine cognitive processes to get the best work from the brain.

As a way to picture, this I remember an article somewhere long ago that I found useful:

Think of an orchestra (the cognitive functions of the brain),

Lead by the conductor (executive function) who has the role of keeping it all together and making sure all sections work together.

If one section is not available to play (cognitive impairment) the conductor does what he/she can to make sure the remainder are able to work together to make beautiful music.

Remember all parts of the brain are linked and work together.

We will talk more extensively about individual cognitive impairments and strategies as we go along. For now some examples of common cognitive impairment (or damage to thinking abilities) are: cognitive fatigue, learning and memory problems, difficulty with planning and organizing, trouble with problem solving, poor concentration, and rigid thinking.

Finally

I think this slide show by Ruth Ellison, whom I mentioned earlier, has some simple messages that can help us understand a bit more about cognitive impairment in brain injury.

The presentation focus is on design and technology, yet is has relevance, in understanding and supporting a person who has cognitive impairment. I suggest you focus on the headings on each slide as potential actions and look at the design ideas as examples.

If anyone knows of any short easy to understand video or audio explanations about what “cognitive” means, I would welcome you letting me know in the comments below.