Head Trauma and Cognitive Impairment

Cognitive Challenges may Occur after Head Trauma

The cognitive challenges affecting individuals who have suffered a head trauma, and moderate to severe traumatic brain injury, vary greatly. Some key factors that affect how well someone will recover their cognitive abilities include how severely the brain was damaged, skill level prior to the injury, and the individual’s personality.

There are a couple key terms to be familiar with when learning about cognitive function after head trauma:

Cognitive Function

Cognitive function is what a person can do, and how much of it they are able to complete. These are the basic “what” and “to what extent” activities used on a day to day basis.

Reading is an example of this. Can a person read words, and how many words can a person read at a time. Some individuals may be able to read 4-5 sentences without a break. Other individuals may be able to read 1,000 words without difficulty.

Executive Function

Executive function controls the “how” behind what is done. Consider the reading example above. Executive function is responsible for understanding the words being read, recalling what was read, and applying the information read appropriately, when necessary.

Both the cognitive ability to read, and the executive function ability to understand and integrate what was read, are necessary to make sense of the material.

In the same way an executive directs the activities of a large organization, executive function in the brain manages numerous tasks at one time.

Executive function is required for complex problem solving, making future plans and understanding consequences of actions.

Executive function is also necessary to navigate social situations and function independently. It impacts an entire range of skills, reactions and behaviors, so any problems with executive function are apparent in a wide variety of situations.

Common Cognitive Challenges

While every person’s cognitive reaction to head trauma is unique, there are some common themes. Areas where individuals face challenges include:

  • Making plans and staying organized
  • Recalling past events and future plans
  • Solving problems
  • Expressing the right words at the right time
  • Staying focused
  • Following multi-step instructions or processes

All of these challenges relate to executive function.

Why Is Cognition Impaired?

After head trauma there can be structural blocks inside the brain. Damaged nerve cells are limited in their ability to forward or receive impulses. Bleeding and swelling may also block the flow of those signals. This all results in the brain not being able to send signals between multiple areas of the brain that have to work together, to make executive function possible.

The challenge isn’t only with responding correctly and behaving appropriately in a variety of situations. There is also difficulty comprehending the environment as a whole.

For example, consider a suspenseful movie.

The plot of a good movie has a number of twists and turns. Clues are given to the audience, and in order to understand the story it’s necessary to remember characters and events throughout the film. The story may build until the end where there is a final reveal that ties everything together. At that point most people have an “aha” moment where everything makes sense and the story is understood.

After serious head trauma, following a plot and connecting all of the clues can be difficult, if not impossible. Characters, key events and actions are not effectively communicated by the brain. For someone with a moderate to severe brain injury, this may be their day to day experience.

Frustration Ensues

The person with a brain injury often ends up feeling disconnected and frustrated. There may be an awareness that the right words or behaviors are not expressed. Not being able to concentrate or complete tasks can be frightening and depressing.

Cognitive rehabilitation is important to retrain both cognitive and executive functions, and manage the emotional responses that are part of head trauma recovery. There are therapists trained to exclusively help brain injured patients.


Gould, K. R., Ponsford, J. L., & Spitz, G. (2014). Association between cognitive impairments and anxiety disorders following traumatic brain injury. Journal Of Clinical & Experimental Neuropsychology, 36(1), 1-14. doi:10.1080/13803395.2013.863832

Skandsen, T., Finnanger, T. G., Andersson, S., Lydersen, S., Brunner, J. F., & Vik, A. (2010). Original article: Cognitive Impairment 3 Months After Moderate and Severe Traumatic Brain Injury: A Prospective Follow-Up Study. Archives Of Physical Medicine And Rehabilitation, 911904-1913. doi:10.1016/j.apmr.2010.08.021

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