Dealing with Behavioral Problems as a Result of a Head Or Brain Injury
People who have suffered a brain injury usually undergo a range of neuropsychological problems. This can range from changes in personality, problems with memory, difficulty with making decisions, and an inability to control impulses to problems with concentration.
These changes greatly impact the patient and their family and caregivers. It is important for the family of a person with a brain injury to learn to change the way they communicate and deal with their family member and understand the scope of abilities the impaired person has. Many brain injury victims undergo both cognitive and behavioral rehabilitation either as an outpatient or in a residential setting. This rehabilitation teaches strategies and skills the impaired person needs to be able to function again in society.
Many of the newly learned skills, strategies and support comes through the help of a neuropsychologist, a psychologist who specialized in studying brain behavior relationships.
Below are some of the possible problems and changes brain injury patients and their families must learn to deal with and some suggested strategies for help with these problems.
- Changes in Personality – No matter how minor the brain injury is, a person who suffers from a brain injury is prone to some changes in personality. It is important for family members not to compare how they’re loved one used to act or behave. For example, before his injury the patient might have been described as laid-back, lively and considerate but now appears more frustrated, selfish and negative. No matter, family members should try to be more understanding and not critical of their loved one’s personality changes.
- Memory Problems – Head and brain injury survivors might experience problems with short-term memory retention or even amnesia regarding certain periods of time. The most difficult challenge faced by brain injury victims is the ability for new learning. In order to help a brain injury person learn new concepts and ideas, family members should try to eliminate distractions, like background noise, and music. It is best to tackle one new task at time. Repetition of a person’s name or an object is helpful for those with severe brain injuries. Another helpful tool is for the person to write down notes and information such as phone numbers, a list of chores, etc. Also important is for a brain injury patient to develop a set of routines. Family member might also find it helpful to label cabinets and doors or to even use arrows to help with direction. Brain injury victims should always carry pertinent information with them from addresses and phone numbers to emergency contact information.
- Lack of Emotion – It is not uncommon for a person who has suffered a brain injury to be unable to show emotional responses like laughing, crying, anger or even smiling. They can also show a lack of enthusiasm to situations. It is important to show empathy and to understand that they’re lack of an emotional response is due to the aftereffects of the injury. Sometimes providing encouragement to the person to recognize smiles in a humorous situation or tears in a sad situation can help them.
- Emotional Mood Swings – Intense mood swings or extreme reactions to daily situations are often experienced by persons who have suffered a head injury. Reactions range from outburst of anger or sudden tears to laughter. Caretakers and family remembers should remember that their loved one has lost some measure of control over their emotions because of the brain injury. The best way to react in a situation involving a sudden mood swing is to remember that the behavior is not intentional. It is just as important for caregivers to remain calm and exhibit calming and soothing behavior and to avoid provoking more stress by not being critical or judgmental.
- Aggressive Behavior – Here are some suggestions that have worked in diffusing hostile and aggressive behavior:
- Ignore the behavior and remain calm.
- Where appropriate, agree with the person to avoid an argument.
- Demonstrate extra affection and support to deal with the person’s frustration.
- Confirm the person’s emotions by identifying the person’s feelings as being legitimate. It is important to remember that frustrations will occur because of the loss in functional and cognitive abilities.
- It is best not to challenge or act confrontational with the person. In lieu of challenging, it is best to negotiate.
- Provide the individual with alternative methods to express theanger. For example, a list of complaints, a punching bag orpillow are some other ways to help a person express anger.
- Ask whether there is something that can help the person feel better. This simple question allows the person to have a feelingof control.
- Try to treat each incident as an isolated experience. It might bebest to separate the aggressive person from others. Always think of the safety of yourself and others. Where possible tryto encourage all family members to use non confrontational responses. Even children can learn some simple ‘dos’ and ‘don’ts’ when reacting to aggressive behavior.
- It is also important to have a means of support for all caregivers. Contact and get involved with support groups,professional therapists and even local law enforcement.
- Self-Centered Behavior – Many brain injury patients are unable to show empathy because of the injury they’ve suffered. In other words, it might be difficult for head injury patients to see things from another’s perspective. Sometimes this leads to thoughtless or hurtful remarks or even difficult and impossible demands. This is a direct result of the brain’s inability to think in the abstract. Develop cues to signal the person that he/she is acting in a thoughtless way. Often times, other’s feelings may have to be re-learned.
- Lack of Concentration – Brain injury patients may have a more difficult time concentrating and focusing. Developing and using cues can benefit a person who is experiencing poor concentration. Repeating a question and not providing too much information at one time are some ways to help increase concentration. Always make sure the person is not tiring. Brain injury persons can do simple self checks…questions they ask themselves like, “Did I understand everything?”, “Did I write it down?”, “Is this what I’m supposed to be doing?”
“I made a mistake or I’m not sure,” should cue a person to say to themselves, “let me slow down and concentrate so I can do this correctly.”
- Inability to recognize Deficits – It is very common that person who has suffered from a brain injury will not be able to recognize his/her own shortcomings. They are not being stubborn. It is equally important for caregivers to recognize that denial may be a way for the person to cope and to conceal the fear that he/she is unable to perform a particular task. Sometimes the person will respond to a task by saying it is stupid or it can’t be done. Caregivers need to recognize and respond appropriately to these cues from the patient like building their self-esteem through encouraging words or suggesting an activity the patient is able to do. Verbal and visual reminders (like smiling or saying, ‘good job).
- Inappropriate Sexual Behavior – After suffering a head injury, a person may experience increased or decreased interest in sex. This is sometimes due to the brain’s regulation of hormonal activity or an emotional response to the injury. Spouses of brain injury persons should not take a decrease interest in sex personally. Avoiding sexual contact might be because of concern or embarrassment about sexual performance. It is important not to pressure a person into resuming sexual activity until they are ready. Support them by helping them to dress nicely and to maintain good hygiene so they feel good about themselves. It is important to remind the person that inappropriate behavior due to the injury is not acceptable. Examples might be making a pass at a married friend, making a crude remark, touching someone in an inappropriate setting or demanding sexual attention from a spouse or significant other. Caregivers and spouses must remember that this behavior, though unacceptable, is the direct result of the brain injury. Sometimes support groups are beneficial in helping a person recognize the consequences of inappropriate sexual behaviors.
- Coping and Getting Support – The best way to cope with a loved one or friend’s inabilities as a result of a brain injury is through identifying and understanding a person’s deficits. Make sure the patient has undergone a complete neuropsychological assessment. This should provide the survivor and the family with a better way to understand neurological and cognitive deficits. It might be easier in the long run for a caregiver to recognize changes in personality rather than to try and resolve the behavior. Targeted strategies may be used to help cope with specific behavioral issues. As mentioned before, it is important for caregivers and family members to receive support (through other family, friends, counseling, support groups) in dealing with their own emotional responses when caring for a brain injured loved one.