For survivors of stroke or TBI | strategies for reducing sensory overload in social settings

Neighborhood barbecues, block parties, weddings, holidays, and family events – these are social settings in which we’re all likely to find ourselves in. For survivors of brain injury (TBI) or stroke, these events can be difficult, uncomfortable, and downright exhausting – filled with something called sensory overload. Here’s what this is.

For almost every survivor of brain injury or stroke, nearly all their energy is needed just to function. When they experience extra background noise, movement, lights, and general chaos typically associated with social situations, it is too much information for the brain to process and organize. Then, sensory overload (also known as cognitive overload or fatigue) occurs and can result in increased anxiety, irritability, or a full-blown meltdown.

When helping your patients and their caregivers develop coping skills for living with stroke or brain injury, consider sharing strategies to minimize stress and cognitive overload in social settings.

Just as each brain injury is different, experience with sensory fatigue varies with every survivor. Here are the most common symptoms of overload, and helpful ways to manage through them.

What is sensory overload?

After a brain injury, some people find their brain’s sensory filters no longer work properly. Unlike a healthy brain, which can identify and filter out irrelevant or unnecessary sensory information, an injured brain often cannot.

Imagine your brain is a gas tank.  Every single thing a survivor does, whether physical or mental, requires more fuel now than before their injury. The more fuel that is used, the more it needs a rest stop.

For survivors, even normal, everyday stimuli can be uncomfortable or unbearable. Sounds that before injury were barely noticeable may be alarming. Crowds can feel overwhelming. Bright light can be distressing or cause headaches.

“Mental Flooding” is a highly descriptive phrase that is sometimes used to describe an overloaded brain in this situation. When a brain is “flooded” it can “freeze,” and then it can be difficult or impossible to continue a conversation or make decisions. Other symptoms include:

• Agitation/Anxiety
• Fatigue
• Panic Attacks
• Difficulty Breathing
• Nausea / Vomiting

One survivor of brain injury, Jeff Sebell in his When We Snap After Brain Injury blog, explained sensory overload as “snapping”:

“TBI dries out the invisible ‘rubber band’ that helps us adjust to the pressures of daily life, leaving it more brittle…This rubber band we have always relied on to steady us is… more prone to snapping when placed under duress. Since my TBI, when my own rubber band has snapped… it has led to screaming, throwing things, punching walls, slamming doors, stomping away or generally making a spectacle of myself. “

What triggers sensory overload?

Sensory overload can be caused even when a sensory experience is something enjoyable. Be on the lookout for and try to avoid triggers like these at the next social gathering:

1. Sound

• Groups of People Talking or Shouting
• Loud Music
• Sounds of Traffic or Sirens

2. Sight

• Busy; Multi-Colored Displays or Decorations
• Visiting New Places or Unfamiliar Surroundings
• Bright or Flashing Lights

3. Taste

• New and/or Exotic Tastes
• Strong or Unpleasant Tastes

4. Touch

• Being Patted or Poked
• Touching New or Unusual Things, Including Petting an Animal
• Sitting in a Chair made of an Unique Texture or Material

5. Smell

• Scents such as Candles or Perfume
• Cleaning Materials, like Paint or Glues
• New Smells
• Strong Food Aromas – Good or Bad

6. Movement

• Being Bumped or Shoved in Crowds of People
• Unfamiliar Movements; Rolling, Rocking, Tipping – Such as a Boat

Best strategies for reducing sensory overload in social settings

Consider the following 16 tips and strategies before going to the next social event, so they can help minimize sensory overload before it becomes overwhelming.

1. Get Plenty of Rest — Plan ahead, and consider taking a nap before the event, so you are refreshed when you arrive.

2. Make an Early Getaway — Consider staying only a short while at the gathering. Let the host know beforehand so they know your intentions. Plan to rest afterwards.

3. Put Your Plan in Your Pocket — Make a list of strategies that work and carry it with you, so you or a caregiver can refer to it at the event. Plan what you will do if things don’t go as expected.

4. Communicate — Let family and friends know which stimuli are troublesome for you and what they can do to help. Be as specific as possible.

5. Avoid Crowds — Sit towards the back or in a less crowded area from which you can exit early if necessary.

6. Channel Your Inner Zen — Find peace through order. Hold conversations in quieter areas, such as a corner of the room. Ask people to please speak one at a time. 

7. Stay Hydrated — The brain functions best when it is fully hydrated. Avoid dehydration by carrying a water bottle with you, refilling often.

8. Pretend the High School Principal is Watching — Avoid nicotine, caffeine, and alcohol, as they often make sensory overload symptoms worse.

9. Block It Out — Bring earplugs with you to use if it’s too noisy.

10. Prepare “Quiet” Food — Try to use bowls or plates for certain foods to reduce crunching sounds, such as eliminating those noisy chip bags.

11. Stay Away From Bright Lights — Wear sunglasses or a hat with a brim, even indoors.

12. Limit Screen Time — Reduce exposure to TV, phone, and computer screens that can cause headaches.

13. Eat Simple — Stick with known foods that don’t contain unusual textures or overly spicy flavors.

14. Stay Balanced — Monitor your pain, stress, and fatigue levels.

15. Recharge Your Brain — Take regular brain-recharging breaks, even if you’re feeling fine. Every hour or so, take a break to the car, a bathroom, a calm corner, or anywhere you can relax, close your eyes, and breathe deeply for a few minutes.

16. Remove yourself from the situation:

• Go to a quieter place as soon as possible.
• Close your eyes and take slow, deep breaths.
• Put an icepack on your forehead or eyes.
• Visualize a warm, secure, relaxing, happy, peaceful place or a happy memory.

If you are a caregiver of a survivor of stroke or brain injury, the best thing you can do is to be supportive. Ask your loved one or their clinician what seems to trigger sensory overload for them and actively try to create a social environment that is not overwhelming for them. When planning to attend social gatherings, keep in mind that heat, pain, and lack of sleep can intensify cognitive overload. Be understanding if they need to cut the outing short.

Additional references:

• Dealing with Sensory Overload After Brain Injury
• Recovering from Traumatic Brain Injury: The Important Role of Brain Filters
• Tips to Avoid Overstimulation