Lost & Found: Dealing with Sensory Overload After Brain Injury

Strategies for Coping with Sensory Hypersensitivity

If it seems like your sense of touch, taste, smell, hearing, or vision is extra sensitive or heightened after your brain injury, it’s not your imagination. Sensory hypersensitivities are another major, yet not as obvious, contributor to fatigue and overload after brain injury. What we experience with our senses is essentially more information for our injured brains to try to process and organize. You can have difficulties processing sensory information just like any other information in your brain. Some examples of sensory hypersensitivities are:

• Sounds that you barely noticed before are alarming and startle you.
• It feels like you have megaphones in your ears.
• Background sounds and stimulating environments become overwhelming.
• Fluorescent and bright lights give you headaches.
• Clothing that was comfortable before feels irritating now.
• Large gatherings of people feel overwhelming.

Pain and fatigue can intensify sensory hypersensitivities, putting you in a hyper-sensitive or hyper-vigilant state. When you are in a hyper-sensitive or hyper-vigilant state, even subtle stimulants feel overwhelming. Especially sights and sounds that didn’t bother you before, may now trigger anxiety and the fight-or-flight response where your whole being feels threatened and out of control. You may shut down and not be able to do any more or you may feel compelled to escape from the situation. It can be very taxing, physically and mentally.

Stress management, movement and using all of your senses can help your brain organize and integrate the senses. This is similar to what children do. Consider how physically active children are as they grow and develop!

See Brain Recharging Breaks at the end of this chapter for some basic meditation techniques. Meanwhile, following are suggestions for coping with sensory hypersensitivities.

General Coping Suggestions

Limit exposure to avoid sensory overload.

• Avoid crowds and chaotic places where there are a lot of stimuli, like shopping malls.
• Do shopping and errands early in the week and early in the day, when stores are less crowded and quieter.
• Shop in smaller, quieter stores when possible.
• Eat out in restaurants when they are quieter, in between regular meal times.
• Hold conversations in a quiet place.
• Ask people to please speak one at a time. Explain that you’d really like to hear what everyone has to say but you can only hear one person at a time.
• Sleep during car trips.
• If you want to attend a function that you expect will be taxing, plan to stay only a short while. Take your cap, sunglasses and earplugs. Sit towards the back to minimize the sound and where you can easily exit to a quieter place or the car.

Monitor your pain, stress and fatigue levels.

Lights and sounds will bother you the most when you are stressed or fatigued. If you are feeling especially sensitive, use it as a cue that you need to take a break and use some relaxation techniques.

Try avoiding nicotine, caffeine and alcohol.

They may make the symptoms worse. If you have vertigo, try limiting your salt intake, which can cause fluid retention. Consider strengthening exercises for your neck with the guidance of a physical therapist.

When you are starting to feel stressed or anxious, try incorporating another sense.

• Put something in your mouth to chew or suck on. Strong flavors like peppermint or cinnamon are especially effective.
• Put on some soothing music.
• Apply some deep pressure. Give yourself a hug or press your palms firmly together or on the table. Squeeze the steering wheel if you are driving the car.

Experiment with activities and alternative therapies that involve your senses.

Listen to music, experiment with movement, dance, yoga, water, art, aromatherapy, etc.

Challenge your sensitivities.

Gradually increase your exposure and tolerance when using earplugs, sunglasses, etc.
Don’t eliminate the senses completely or you set yourself up for super-sensitivity.

Specific Coping Strategies

Sensitivities to sound

• Limit your exposure to noisy stores and loud situations like sporting events, the movie theatre and children’s school activities. Don’t participate or plan to stay for a limited amount of time. Sit on the outskirts so you can gracefully escape to a quieter place if needed.
• Use earplugs, try different kinds, and carry them with you.
• Use headphones for TV and music:
  • For others, when you don’t want to hear it.
  • For yourself, when you want to hear it better.
• Minimize distractions from snacking while doing things like working in groups or playing games. Use bowls for food instead of eating directly from noisy bags.
• Add some background sound – a fan, white noise machine, soothing music.
• Remove yourself from the situation and go to a quieter place as soon as possible, even the bathroom, when you feel overwhelmed or anxious. Then try:
  • Closing your eyes
  • Taking slow deep stomach breaths
  • Putting an ice pack on your forehead and eyes
• Gradually expose yourself to different sounds and louder sounds to increase your tolerances.

Sensitivities to light

• Avoid bright light and fluorescent lights.
• Use sunglasses or a cap with a brim, even indoors.
• Try yellow tinted glasses if florescent lights are a problem.
• Try polarized sunglasses if driving glare is a problem.
• Try yellow tinted glasses if night driving is a problem.
• Make sure you are getting plenty of vitamin A (but not too much!).
• Eat orange colored fruits and vegetables like carrots, sweet potatoes, squash, and cantaloupe.
• Take a moment to just close your eyes for a few minutes when you are starting to feel stressed or anxious. This blocks out the visual stimuli.

Sensitivities to touch, taste, and smell

• Experiment! Cultivate an awareness of how things feel, taste and smell.
• Rub different textures on your arms, increasing the intensity to gradually decrease sensitivities.
• Add texture, contrasting temperatures and flavors to your food, like ice cream with crunchy nuts or chips with spicy taco sauce.
• Notice the textures.
• Pay attention to smells.
• How do different aromas make you feel?

If your sense of smell is altered, make sure to have functioning smoke and gas detectors in your home.

Doing cognitive work

• Plan to do cognitive work when your environment is quiet. Eliminate as many distractions and interruptions as possible.
• Screen out distractions by using earplugs or headphones, playing soothing music, or using a fan or white noise machine if you have sensitivities to sound.
• Turn down the volume on the phone and let the machine get it.
• Work in an uncluttered space or use a three sided table screen, to help screen out visual distractions.
• Give children headphones for the TV if you are having trouble screening it out.
• Do your “thinking” work while children are in school or asleep.
• Still having trouble concentrating? Try bringing in another sense.
  • Put on some soothing nature or instrumental music, something without words at a low volume.
  • Try chewing or sucking on something while you are working. Coffee stirrers can substitute for fingernails. Strong flavored or fizzy candies and gum can aid alertness.
  • Try using some deep pressure by giving yourself a hug, pressing your palms strongly against each other or on the table.
  • Try sitting on a large therapy ball while you work. A great strategy if you have trouble sitting still!
• Take a physical break, every 15 min. at first. Resist the urge to push through. I know it feels counter-intuitive but taking breaks will actually help you work longer! Gradually you will find you can increase the time between breaks.
  • Use a timer - without a ticking sound!
  • Pause and stretch, drink some water or make a cup of tea, walk around the house or the yard, rock in a chair, walk the dog, pat the cat.

Visual Processing Problems

Vision is an extremely important and complex source of sensory information. What you see with your eyes travels through your brain to the back area of your brain, where it is processed in the occipital lobe. There is a lot of territory between the eyes and the back of the brain where an injury can occur. The occipital lobe may be damaged directly from impact to the back of the head or it may be damaged indirectly from the ricochet of the brain inside the skull when the front of the brain is impacted. Damage to the occipital lobe frequently occurs in car accidents, falls and sports injuries. Even subtle visual problems following a brain injury can have a significant impact on cognition and functioning.

I wish I had known about visual problems and visual therapy when I had my car accident. I thought I was really going crazy! Fortunately for me, my issues improved with time but not without mishaps, like falling off a curb!

Some common problems after a brain injury related to vision include:

• Double vision
• Trouble tracking words on a page
• Impaired depth perception
• Hypersensitivities to light
• Difficulties remembering and recalling information that is seen
• Difficulties “filling in the gaps” or completing a picture based on seeing only some of the parts
• Trouble seeing objects to the side
• Low tolerances to changing light or clutter
• Impaired balance, bumping into objects
• Feeling overwhelmed when there is a lot of visual stimuli

If you notice problems in areas related to visual processing, please consult a visual therapist or a neuroopthalmologist, they can help!

Tips:

• Don’t eliminate any sense completely or you set yourself up for a super-sensitivity.
• Gradually expose yourself to more light, sound, touch, smell, and taste.
• Be patient, in many cases your sensory hypersensitivities will decrease in time!
• Ask for physical therapy or occupational therapy with a therapist with a background in sensory integration for help with sensory sensitivities.

Some good news about sensory hypersensitivity is that it is also associated with a heightened sense of awareness and intuition. You may find that you feel more aware of your intuition and more creative since your brain injury. This is not uncommon. Enjoy!

Brain Recharging Breaks

If I had to choose one strategy that helped me the most after my brain injury, it would be learning to meditate. Meditation is especially helpful when you are experiencing sensory overload. It can help you calm yourself down from that hyper-sensitive state. It was also the only way I have found to give my brain a rest, to put it temporarily in a “cast”, like you would a broken limb. Often, after meditating for 15-20 minutes, the “logjam” in my brain clears up and I am somehow able to think again!

I recommend using some stress management or meditation techniques at least once a day. Plan it, schedule it in your planner, make it part of your daily routine. Meditation is not as mysterious as you might think. Try these basic steps:

• Get in a comfortable position on the bed, in a recliner or even in the car; uncross your arms and legs. Cover yourself with a blanket if you are cool.
• Close your eyes and do some slow deep breathing.
• Slowly inhale, expanding your stomach and counting to 7.
• Exhale gradually, contracting your stomach towards your spine, counting to 7.

Repeat. Repeat. Repeat.

When you are feeling more relaxed, as you continue your slow deep breathing, experiment with the following suggestions to increase the effectiveness of the experience.

Do a body scan checking for areas of pain or stress.

• Eyes closed, inhale deeply, picture your forehead and notice any stress or pain.
• Exhale and imagine the pain floating away with your exhale.
• Inhale, picture your eyebrows and notice any stress or pain. Exhale and release it, imagining the stress floating away.
• Repeat for your eyes, ears, jaw, throat, back of neck, shoulders … down to your toes. Breathe in relaxation, breathe out stress and pain.

Notice how you feel after you get to your toes!

• Visualize or imagine yourself in a warm, secure, relaxing, happy, peaceful place; floating on a cloud, floating in the water, or recalling a happy memory.
  • Continue slow deep breathing.
• Focus on a picture or artwork that you like, noticing each detail.
  • Continue slow deep breathing.
• Listen to music, any music that is soothing to you. Nature sounds or instrumental music is a good place to start experimenting.
  • Continue slow deep breathing.
• Use aromatherapy – any scent that smells good to you. Favorite scents are often from childhood memories!
  • Continue slow deep breathing. 

Strive to let go of that never-ending tape of worries and “shoulds” that plays in your head. Focus on your senses – your breath, the music, a relaxing place, a comforting aroma. If thoughts drift in, gently push them away. It gets easier with practice, you’ll find what works best for you and you’ll be amazed at how much it helps you!