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Sensory & perceptual problems after a brain injury

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Brain injury effects

Sensory & perceptual problems after a brain injury

Sensory and perceptual problems can arise from damage to the right side of the brain or the parietal and occipital lobes of the brain.

These areas of the brain process the input from our senses. For example, when eating an our apple our brain will report on the following:

  • touch (it's round and smooth)
  • sight (it is red)
  • sound (it's crunchy)
  • smell (the apple is fresh)
  • taste (it's sweet and ripe).


Brain disorders such as traumatic brain injury (TBI) can disrupt our senses, and also how our perception of what our senses tell us. Our sensory and perceptual systems include:

  • auditory (sound)
  • visual (colour, shape, size, depth and distance)
  • tactile ( touch relating to pain, pressure and temperature)
  • olfactory (smells)
  • gustatory (taste).


Visuo-spatial skills

While problems can occur with our sensory systems, visuo-spatial problem are often more noticeable. Possible issues include:

  • drawing objects
  • recognizing objects (agnosia)
  • telling left from right
  • mathematics (discalculia)
  • analyzing and remembering visual information
  • manipulating or constructing objects
  • awareness of the body in space (e.g. climbing stairs)
  • perception of the environment (e.g. following directions).



A well known problem is neglect where the brain ignores one side of all it perceives - usually the left hand side. For example, a person may ignore food on the left side of a plate or fail to copy aspects on the left side of a picture.


Case study - Elsie Elsie was a 52 year old woman who had a stroke three years ago and since then had problems with side-swiping parked cars and posts on the left side of her car. Elsie visited her doctor to have here eyesight checked. She was referred to a neuropsychologist who diagnosed the problem as left-sided neglect. When asked how she managed to drive, Elsie said she stayed in the left lane and would know to steer right when she heard her tires going off the road. 


Face blindness (prosopagnosia)

Prosopagnosia is a less common example of neglect - the ability to recognize faces is affected, or even lost completely. In extreme cases, there is an inability to distinguish one face from another or read facial expressions (aperceptive prosopagnosia). These people must rely on things like the voice, hairstyle or clothing to identify others. 


Case Study - Lincoln:  After a car accident Lincoln could not even recognize a photo of himself. If separated from his family in a large crowd he cannot find them again. One of the biggest problems he faces is that others cannot understand his ability to see and recognize objects, but not other faces. 


Managing visuo-spatial problems

As shown with Elsie, neglect may be undiagnosed despite safety issues. A person with neglect may be unaware of their problems, or blame the problem on something else. It is important to identify problems like neglect during rehabilitation and then educate the person to increase their awareness of the impact of the problem in everyday living. 


Retraining skills is one way to manage visuo-spatial problems until the person regains the required skill as far as possible. Retraining usually involves repetitive and intensive exercises for a specific skill or task e.g. practice at drawing an object while receiving feedback. It tends to be more effective with specific skills.


Changing the environment or expectations involves modifying the environment to provide more support, or reduce the demands of a particular skill. For example, support could be fitting a handrail to make climbing stairs at home easier. Reducing the demands of a skill can be as simple as just shifting furniture at home so that walking around the house is easier. The person may also learn to adjust their expectations and educate other people about their difficulties.


Compensatory strategies  are very important in rehabilitation - they compensate for what a person has trouble doing after a traumatic brain injury or similar brain disorder. For example, Elise may be taught to turn her head or body to scan the environment properly due to her neglect of things on her left side. 


A range of specialized equipment is available to fit into a person's home or assist with community access.


External prompts are things like colour stickers for object recognition, bright lights on the floor, musical or sound prompts, stencils or transparent paper for copying, hand rails and other safety devices.


A compensatory strategy for failing to recognize objects could involve the person relying more on other senses such as touch, hearing and smell by shutting their eyes.


The rehabilitation strategies described may be developed by a neuropsychologist, occupational therapist or physiotherapist. The eventual goal of any rehabilitation program greater independence and use of self-management strategies. However, family members, friends and support workers can still provide valuable support.

References and further information

For a dynamic view of the brain take a look at InformED's Brain Map


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