Thinking Problems: Chest, Heart & Stroke Scotland

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Thinking Problems

The brain is a complex organ so it is likely that any damage to it caused by a stroke may also disrupt the way it works in relation to thinking. These effects are also known as ‘cognitive’ problems.

Skills that involve processing—recognising objects, identifying familiar faces, learning new information—and many others such as communication, memory and concentration may be affected.

Need For Assessment

The severity of these cognitive problems varies from person to person, and the passage of time often brings improvement. However, if problems are longer lasting the solution lies in finding new ways of doing things.

With severe difficulties, a cognitive assessment from a clinical psychologist may be beneficial. A clinical psychologist specialises in how the brain processes information and may be able to identify your particular strengths and weaknesses to help you plan your own strategies and goals for managing difficulties. (A clinical psychologist is not the same as a psychiatrist who primarily looks at mental health issues.)

Occupational therapists are also very helpful in assessing and teaching exercises and tactics to overcome difficulties.

Problems Processing Information

This section concentrates mostly on the process of using our senses to provide information about our surroundings and environment. This is known as perception. If the messages being relayed back to the brain are not being interpreted properly it can make simple tasks very difficult. These problems can be quite frightening and stressful.

Sometimes impairment of these abilities can be missed or misunderstood. For example, a visual perception problem such as not recognising objects can be confused with poor eyesight. In that case new glasses will not be of any help!

Specific Perception Problems

The idea of this list of quite technical terms is to help you recognise that there may be a problem and to let you know there are strategies that will help. An occupational therapist or clinical psychologist will be needed to assist with identifying problems and the management of them.

Agnosia

Agnosia describes the inability to recognise information coming from our different senses as follows

sight—visual agnosia—difficulty recognising objects or choosing objects for an activity, or being unable to describe an object’s use when presented with it
touch—tactile agnosia—inability to recognise objects by touch despite having sensation when doing things without looking e.g. doing up zips, finding coins in pockets etc.
hearing—auditory agnosia—inability to recognise differences in sounds such as car sounds, different household appliances, identifying voices
smell and taste—olfactory agnosia—inability to recognise smells and tastes. Apart from the loss of pleasure and appetite there is a danger of not recognising noxious substances such as gas and smoke.
recognising people—prosopagnosia—inability to recognise your own or familiar faces.

Difficulty Judging Depth, Distance Or Space

Distance impairment, for example, can make things seem closer or further away so you cannot judge where things are properly. It is hard to imagine not being able to perceive the depth of a step from the pavement to the road, or misjudging the length of your reach or grasp.

Inability To Find Your Way Around

Topographical orientation—this is the inability to understand and remember the relationship between one place and another. This causes route finding difficulties e.g. around the ward, house, supermarket etc.

Altered Body Image

Visual and mental memory image of your own body are affected. You may perceive parts of your body to be larger/smaller than they actually are. This can cause problems such as getting dressed, choosing clothes sizes and estimating how much space is needed to accommodate your body.

Apraxia/Dyspraxia

Terms to describe loss or reduction of ability in planning or carrying out specific movements or tasks, even though there is no paralysis

apraxia affects people in different ways. You may have the ability to do something spontaneously but be unable to do it if you are asked to, or if you think about it first.
someone may be unable to put stages of a task in the right order, like knowing the order in which clothes should be put on, socks before shoes etc.

These difficulties can cause a great deal of frustration and be particularly disabling as they reduce a person’s ability to be independent.

Inattention

‘Inattention’ is used to describe the inability to process information in relation to the affected side of the body. This means the person may have a tendency to ignore the affected side of their body or the environment on that side.

This is often associated with poor sensation on that side, risking damage to the affected limb by knocks or burns.

In some people this affects their perception of what they see so that they only comb one half of their hair, or shave or apply make up to one side of their face but not the other.

How Can Other People Help?

Below are examples of strategies used to help someone with perception problems

remember that the person is not confused or stupid
allow plenty of time for the person to carry out any tasks
if the person gets tired and stressed and is unable to do an activity leave it, suggest they take a break and come back to it later
try to keep the environment simple and uncluttered
avoid unnecessary stimulation such as background noise, or distracting lighting
ensure adequate lighting
lay things out in an orderly way so that it is easier to process the information and identify things more easily
write an 'order of doing things' for the person to follow, if they are able to read
use colour coding to help identify objects
mark edges of plates, steps etc. with coloured tape

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