Survey for Action for Brain Injury Week 2020

This survey is being conducted by Headway - the brain injury association as part of our Action for Brain Injury Week campaign Memory loss: a campaign to remember. 

It has been designed to be completed by brain injury survivors or family members/carers completing it on their behalf. 

We would like to find out about how memory is affected by brain injury and the impact that memory loss has on brain injury survivors. 

Please try to answer the questions honestly. All responses will be kept anonymous, although you will have the option at the end of the survey to share your individual experiences of memory loss to support our campaign.

This survey will close on 29th March 2020 and results will be published in May 2020. 

Thank you.

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* 1. What is your name? (optional)

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* 2. How old are you?

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* 3. What best describes your gender?

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* 4. How long ago did you sustain your brain injury?

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* 5. What caused your brain injury? Please check all that apply.

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* 6. How long were you unconscious/in a coma for?

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* 7. Please review the following statements, both positive and negative, and state whether you agree or disagree with them.

  Strongly disagree Slightly disagree Neutral Slightly agree Strongly agree
I struggle to remember day-to-day things
I struggle to recall personal memories
I struggle to remember important dates/appointments
I struggle with recognising people or places that were familiar to me before my brain injury
Memory problems have a negative impact on my life
I need/needed help to understand the effect memory problems have on me
People in my life do not understand my memory problems
I socialise less because of my memory problems
I am optimistic about my future despite my memory problems
Memory problems are the most debilitating effect of my brain injury
I have found ways to manage my memory problems to reduce their impact on my life
I struggle with learning new things because of my memory problems
My memory problems affect my behaviour and emotions
My life would be improved if people had a better understanding of my memory problems

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* 8. Please tell us what impact memory problems have had on the following aspects of your life:

  Much worse Worse Not changed Better Much better
Self-esteem
Employment
Home life
Social life
Romantic relationships
Financial circumstances
Independence
Rehabilitation and recovery

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* 9. Do the following people in your life have a good understanding of how memory problems affect you?

  Yes No Not sure Not applicable
Spouse/partner
Other family
Friends
Employer
Colleagues
GP
Other medical professionals

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* 10. Do you think you have been unfairly judged or treated as a result of people not understanding your brain injury-related memory problems?

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* 11. Which people/services have helped you to cope with memory problems? Check all that apply.

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* 12. If a Headway group/branch has supported you, please tell us which one:

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