Following Acquired Brain Injury ‘capacity’ for decision making will be affected by the severity of the brain injury sustained. The stage following brain injury, at which capacity is being assessed is also important as the person’s level of cognitive functioning is likely to change over time. For example the person may be assessed as lacking capacity in the early stages of recovery (e.g. Post Traumatic Amnesia) as they may be unable to make decisions due to still being very confused. However as their cognitive and communication skills improve they may later regain the capacity to make some decisions for themselves. Subsequently the person’s capacity for decision making will be affected by the severity of their ongoing cognitive and communication impairments as well as the complexity of the particular decision in question. The person should be provided with the necessary information and support in order to maximise their ability to make decisions for themselves, where possible.
Following a significant brain injury impairments in attention, memory, information processing and executive functioning will influence the person’s decision making ability. Executive functioning skills include effective problem solving, planning/self-organisation, judgement, insight and reasoning. The person should be supported to participate in the decision making process as much as is possible, utilising appropriate strategies relevant to their cognitive difficulties.
Language processing impairments (receptive dysphasia and expressive dysphasia) may
also adversely affect a person’s capacity. If the person can be supported to overcome a language deficit, then they can be facilitated to make decisions for themselves.
Dysarthria (difficulty producing intelligible speech) can impact upon the person’s ability to communicate decisions, but is not of itself a disorder affecting capacity. The person with dysarthria should be supported to communicate their decisions using appropriate Augmentative and Alternative Communication.