Brain Injury Association
of Prince Edward Island

Aquired Brain Injury - What Is It?

Brain injury can be traumatic (caused by an external act) or non-traumatic (caused by disease or health difficulties). Common traumatic causes include falls, motor vehicle collisions, assaults, being struck by an object, sporting accidents, drownings, poisonings, and so forth. Non-traumatic causes include strokes, aneurysms, brain tumours, seizure disorders, meningitis, heart attacks, arteriovenous malformations, and so on.

Brain Injury occurs suddenly, without warning. In an instant a life is changed, forever. Everyday we participate in activities that produce endless risks for sustaining a brain injury. Events include a car accident while driving to the grocery store, a fall from a bike, or a blow to the head from a badly thrown baseball. These occurrences and many more happen daily. Brain injury is not a disease, there is no cure. It is a long-term injury, over which survivors have little control.

Brain injury has become a significant medical and societal concern over the last 40 years. With advances in medical technology, many people who previously would have died are now surviving severe brain injuries. At times the cost is astronomical; financially, socially and emotionally.

In Canada, the most commonly quoted incidence figure is that 500 out of every 100,000 people suffer a head injury requiring hospitalization.

The highest incidence of brain injury caused by external trauma is in the 15 to 25 year age group. According to the National Head Injury Foundation of the United States, head injury is the major cause of death in North America for people under the age of 34. Two-thirds of all persons who sustain a brain injury are under the age of 30. Statistics indicate that the incidence of brain injury is two times greater in men.

Effects of Brain Injury

The brain is an extremely complex organ. An injury to the brain can result in a variety of effects with varying levels of severity, and can have a devastating impact on a person's life.

Although each individual is unique, the symptoms resulting from a brain injury often have similarities. Some of these symptoms can include difficulty with memory loss, impaired reasoning skills, and a tendency toward “one track thinking.” Brain injury is not always visible; it is referred to as the “unseen injury.”

Imagine not remembering names and faces of lifelong friends or turning on a burner with a pot on it and not remembering having done so. Imagine how difficult it would be to rely on others to plan your day.

Many persons with brain injuries will also have physical disabilities such as paralysis of the limbs, frequently on one side of the body, or loss of vision and/or hearing. Some people experience varying degrees of speech impairment. Others may be able to speak, but due to cognitive impairments, have difficulty organizing their thoughts into meaningful speech. Some people lose their sense of smell, experience debilitating fatigue, suffer from severe headaches or have to cope with having seizures. Many people must cope with a combination of losses.

Emotional effects vary as well. The person with a brain injury may have changes in emotional control. This may be related directly to the brain injury or to the frustrations that the person feels as he tries to adapt to his new self.

Imagine the embarrassment of not being able to stop crying when you aren't feeling sad.

Realization of the effects of the injury combined with an increased dependence on others and/or a loss of control over one's life may be cause for depression to occur. Depression may also be caused by the physical damage to the brain.

The social consequences of a head injury can be devastating. Many people report losing old friends and having difficulty cultivating and maintaining new friendships. These difficulties may result from the person experiencing problems with communication. Imagine the frustration of having difficulty remembering ideas and communicating them coherently and logically during a conversation. In addition, subtle social skills may have been lost. Loudness of speech and knowing when it is appropriate to speak are examples of social skills we all take for granted.

Having described the many challenges facing people living with the effects of a brain injury, it is important to note the strength and character of many of these people. Once again all persons are unique with varying injuries, personalities and supports available. Although there may be a tremendous amount of loss to cope with, many people with brain injuries remain determined, sensitive and positive in their approach to life.

Although the effects of a brain injury may make it necessary for the injured person to have assistance for up to 24 hours in a day, families often remain or become the primary caregiver and support persons. Many families are left to cope on their own, with little understanding of the effects of the injury and the demands of living with an injured family member. They may become the brunt of the brain injured person's frustrations. Families need the support of others who understand the stress within these family systems.

What Can You Do?

The effects of a brain injury can be as varied and unique as the individuals who sustain them. Since brain injuries occur in different areas of the brain with varying degrees of severity, to different types of people, no two people will be effected in the same way. An injury to the brain may effect a person in several ways including his personality, thinking, communications, or mobility.

Many of the changes that a survivor of a brain injury experiences cannot be seen. It is often more difficult for others to understand and accept changes in personality and thought processes, as these changes are not visible.

Some of the more common effects of a brain injury are changes in:

Following a brain injury, the person may experience any number of these effects in varying degrees. Individuals working with a person with a brain injury, will need to be particularly sensitive, observant and flexible.

The effect

Memory

The issue

People with brain injuries may have difficulty remembering names, appointments, phone messages or details of newspaper articles. They may forget where they have put things and they may become easily disoriented. Extreme recent memory difficulties may prevent the person from remembering conversations, details or direction within a few minutes of having received them. Although some memory problems may be lessened as the brain recovers from the injury, a memory problem cannot be “cured.” The best way to deal with it is to develop ways to compensate for it. The goal is to minimize the effects of the memory problem on the person's life.

What might help

By developing ways to compensate for a memory problem the person may gain a greater sense of independence and control.

One strategy is to encourage the person with a brain injury to carry a notebook to record names, addresses and telephone numbers. The same notebook can be used to record details of how to get from one place to another or to outline what must be done in a day. Family members and service providers may need to help the person develop the habit of writing things in the notebook and to refer to it regularly. Likewise, the individual may also need help in developing a method for recording the information clearly. The use of tape recorders or electronic day timers may also be useful in certain situations such as in the classroom or at the office.

Other strategies include using bulletin boards and calendars to record information in strategic locations. Lists identifying important items in the home and where they are stored could be posted for easy reference. Instructions for some tasks could be written down and kept handy. In this way, you do not need to keep repeating the instructions.
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The effect

Concentration

The issue

A person with a brain injury may be easily distracted and unable to concentrate. Activities that were enjoyed before the injury may no longer be enjoyable due to decreased ability to concentrate. This may appear to an outsider as a lack of interest. Too many distractions may also interfere with the person's ability to focus his attention on one activity.

What might help

Strategies can be used to offset the effects of poor concentration and attention on the person's life. One way is to lessen any distractions. This may mean turning off the radio or television and reducing the number of people in the room at one time.

When helping a person with a brain injury to schedule activities, encourage short periods of activities with regular breaks. Incorporating activities which require less concentration, such as physical activities like walking or working in the garden, may be useful at times.

If the person is interested in reading, recommend short stories or magazine articles until he is able to handle more concentrated reading.
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The effect

Response Time

The issue

As a result of a brain injury the person may need more time to answer questions, to keep up in a conversation and to perform tasks.

What might help

Allow ample time for the person to respond and to complete tasks so that he will not feel frustrated.

Avoid posing multiple questions. Arrange conversation with one topic and/or one question being addressed at a time.
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The effect

Planning and Problem Solving

The issue

Planning and problem solving is a complex process and may be difficult
for a person with brain injury.

What might help

One method of compensating for this is to break tasks into steps. For a particularly complex task, suggest that the person define the steps clearly and write them down. Each step can then be checked off as it is completed.

It may be useful to help the person identify several possible solutions to a problem. Decision making may be easier if the person can choose from two or three alternatives.
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The effect

Initiative

The issue

It may be difficult and sometimes impossible for a person with a brain injury to start a task. The person may be able to identify what needs to occur, but not be able to actually get started. This may be a result of the injury – and does not necessarily mean that the person is lazy. Sometimes fatigue or depression may contribute to the person having difficulty with self-initiation.

What might help

Help the person structure his day to avoid periods of inactivity. Activities for each day can be recorded in a step by step fashion on a schedule. By following the schedule the person can lessen the need to take initiative.

Using an alarm or a watch as a reminder to refer to the schedule may also be helpful. The ability to rely on the schedule rather than on constant reminders from others will help to create a feeling of independence.

Encourage the person to get plenty of rest and to become aware of when he is becoming tired.
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The effect

Flexibility

The issue

Changing a train of thought or seeing another person's point of view may be a challenge for the person with a brain injury. Sudden changes in routine may be difficult and confusing.

What might help

It may be helpful for the family member or service provider to offer other points of view from their perspective, but they should be careful to avoid arguments and confrontations. Sometimes the person may need assistance shifting their focus.

Maintain routines and structure as much as possible. Try to avoid sudden changes in routine, which can confuse the person.

Give advance notice and explanation for change as much as possible so that the person will feel prepared.
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The effect

Insight

The issue

An injury to the brain may effect the person's ability to monitor thought processes and behaviour. This may make it very difficult for the person to understand and accept his own unseen injuries and effects of that injury. It is extremely important that family members and service providers are sensitive to these issues.

What might help

The person with a brain injury needs clear and simple explanations of his disabilities if he tries to deny or rationalize them. Arguments should be avoided, as they will only upset both people. Over time the person may gain insight into the effects of their injury.
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The effect

Impulsivity

The issue

A brain injury may affect the control system, which enables a person to stop and think before he acts. The person with a brain injury may be overly impulsive which can lead to embarrassing or potentially dangerous situations.

What might help

Family members or service providers will need to encourage the person to slow down and think before acting. It may be useful to develop a system of cueing the person to slow down. Cues may include body language, verbal gestures, specific phrases or words to name a few. Eventually you may be able to help the person to develop a way to cue himself.
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The effect

Control of Anger

The issue

Following a brain injury, the person may have a lower tolerance for frustration, leading to problems with controlling anger. It is important to remember that irritability may be the result of the brain injury. Try not to take the anger personally.

What might help

Attempt to identify the kinds of things that irritate the person and try to avoid these situations.

When outbursts occur, if possible, remove the person from the situation that provoked the outburst, leave the room yourself, or change the subject. When the person has calmed down, discuss better ways of dealing with the situation next time and let him know that you are willing to help him. Do not be critical and do not hold grudges.

Help all family members, friends and fellow employees develop strategies to react consistently when the person with a brain injury becomes irritable or aggressive.
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The effect

Talking

The issue

Another example of poor self-monitoring following a brain injury is to talk excessively.

What might help

You can deal tactfully with this behaviour by changing the subject, by letting the person know that he is repeating what he has said or by telling him that you have something else to discuss. Above all, try to respond consistently.
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The effect

Socially Inappropriate Behaviour

The issue

Judging social situations may be difficult for a person with a brain injury.

What might help

It may be helpful to try coaching the person before social events. One should never reinforce inappropriate behavior or embarrass the person by responding to it or by trying to cover up the situation.

Sometimes depending on the behavior, the best approach is to overlook it for the time being. This situation can then be discussed with the person in private. Once again, it may be helpful to develop cues to assist the person to identify inappropriate behaviour.
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The effect

Dependence

The issue

Due to the many possible effects of a brain injury a person may become overly dependent on others.

What might help

It is advisable to encourage the person to remain active and maintain friendships.

Be careful not to let yourself become his only friend. A brain injury support group may be an opportunity for the person to develop a new group of friends.

Avoid the temptation to be overprotective. A person with a brain injury should have as much responsibility as can be managed. The person will need to take risks to challenge himself and be successful. This may help to increase the person's independence, confidence and self-esteem.
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The effect

Emotional Stability

The issue

Frequent crying or laughing at inappropriate times may indicate that the person with a brain injury has trouble controlling his emotions. This can be embarrassing to both the individual and to those with him.

What might help

Even though the response may be intense, the underlying emotion my not be that strong. It may be useful to discuss this difficulty privately with the person in an open and direct manner. Ask the person what he finds helpful.

When the person is successful at controlling his emotions, acknowledge and support him.
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The effect

Depression

The issue

A person with a brain injury may suffer from depression that is either physiologically based (resulting in neurological changes from the injury to the brain itself) or psychological (resulting from the emotional adjustment to the effects of the brain injury). If the depression is physiologically based, then the person may have less control over his depression.

What might help

In either case it is important to be supportive. It is recommended that the assistance of a trained counselor with an understanding of brain injury be sought. Counseling is generally helpful; however, on occasion, medication may be required.

Finally, it is crucial that family members and others who spend a lot of time with people who have brain injuries, look after themselves. They should be encouraged to take time out to relax and enjoy themselves. It is only with adequate self care that they will be capable of providing the help and support to the person with a brain injury.
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