Stimulating cognitive exercises for Clients, Professionals and carrers of those suffering with Brain injury; Introduction; This book has gradually evolved over the last 15 years, during which time I have continuously run outpatient therapy groups and courses for people who have had an acquired brain injury - mainly head injury. These groups and courses have been part psychotherapeutic and part educational and run on a semi- structured format. This book is a collection of exercises, games and information sheets used in these groups. These types of groups are enormously popular with clients as they provide the opportunity to bring people together with similar problems, to provide support and to share and learn from each other. Research suggests that this 'bringing people together' into small groups or a therapeutic milieu is an important component in rehabilitation (Ben-Yishay, et al 1985). Over and above that 'coming together and sharing', there are four main therapeutic aspects to this approach in these groups. (1) Focused stimulation One of the Headway coordinators used to call out before the start of one group, 'Come on get those little grey cells working'. There is increasing evidence from new research that particular types of mental exercises activate or 'light up' particular parts of the brain, and the more the brain is worked the more efficient the neural pathways become (Goldberg, 2001). As Robertson (2000) so succinctly put it, 'cells that fire together wire together'. Others talk about, 're-embroidering the damaged neural networks'. There is, therefore, increasing evidence that the brain might have more of the qualities of a muscle than originally thought, and therefore it needs exercising and training. (2) Learning compensatory coping strategies If you have a disability you need to find a way around it or a way of coping. Just as if you have a physical disability you may have to walk with a stick, if you have a memory problem you have to find a way of compensating or coping. This may mean something simple such as using a diary or may mean adopting an internal strategy such as using visual images to remember. This approach is largely based on the early work of clinicians such as Barbara Wilson (1900), who was one of the first people to write about 'Memory Training Groups'. There are psychological approaches to managing all sorts of problems, from improving your memory or executive skills, to managing your anger, stress levels or fatigue. (3) Acquiring insight and awareness Lack of insight and awareness is a major problem after brain injury, particularly after head injury. It is difficult to be objective about yourself at the best of times and even more so after a brain injury. The person gradually comes to realise exactly what sort of residual difficulties they have, rather like the mist lifting off the top of a mountain. George Prigatano (1999) talks about psychotherapy after brain injury as being a gradual process of helping the person to identify their problems, comparing it to 'slowly turning the lights on in a dark room full of bear traps'. This process may take years and then only be partial. Research has shown that lack of insight is one of the major obstacles to rehabilitation, returning to work and adjustment. These exercise are all aimed at improving insight, helping the individual see themselves more clearly and accurately, and to feel more in control and confident. (4) Emotional adjustment. A brain injury is a life-changing event, but often in the early stages the person is not aware of that. As insight improves the person begins to alter their expectations and accept their limitations. With this change comes a host of difficult challenges, which produces enormous emotional upheaval. Out of this upheaval come adjustment and then some form of accommodation and acceptance. The person accepts more that life has changed to some degree, and there is no going back. It is not dissimilar to the process of bereavement or mourning the loss of a loved one. With adjustment comes the ability to talk about what has happened, recognise what has changed, and to move on with life. The final section of the book contains exercises specifically designed to focus on adjustment. Evolved from working with head injured groups at Headway and those attempting to return to work, this is a rich, comprehensive and photocopiable workbook for clients, professionals and carers. Primarily for professionals where exercises or handout sheets can be photocopied and used therapeutically, The Brain Injury Workbook can also be used by carers or family members to provide stimulating activities for a head-injured person. In addition, the head-injured person themselves can work through the book on their own.