Excerpts

Cognitive and Behavioral Changes

These are the changes after a brain injury that are often more difficult for families to adapt to than the physical challenges. This holds true whether the person with a brain injury is a spouse, parent, sibling or child. It is easy for most people to understand how a physical disability can affect a person’s life because the changes are often visible. It is often obvious why a person has difficulty when an arm or leg is missing or damaged.

Changes in how a person acts or thinks after a brain injury usually do not have such obvious markers. Damage within the brain cannot be seen so easily. It’s not unusual to hear a family member say, “I just don’t understand why she gets so angry now and doesn’t take responsibility for anything.” The family member’s frustration or irritation may be confusing to the person with the brain injury. This can be stressful and frustrating for everyone. These changes can pose the greatest challenge to a person’s independence and a productive life at home and in the community.

Most people with brain injury go directly home from the hospital. A few are admitted to inpatient rehabilitation programs for short periods before returning home. It is difficult to educate and prepare families during this brief time. As a result, families are rarely prepared to understand, much less supervise, a family member with cognitive and behavioral challenges. Yet, with proper education, guidance and direction, most families and people with brain injury can avoid or minimize the negative long-term effects of these challenges.

Work Toward Success

The challenges of life with brain injury can affect all family members. Services work best when they focus on promoting everybody’s success. Structure, consistency, concreteness, patience and everybody’s participation are critical for success. Here are some common beliefs about managing challenging behaviors at home and in the community with tips on strategies for success.

Belief #1: Behavior programs are principally designed to stop unwanted and dangerous behaviors.

False - Successful behavioral programs focus on helping people be more productive, engaged and involved in their daily lives according to their interests, responsibilities and abilities. Programs principally designed to stop “bad behavior” are rarely successful. They can actually increase rather than improve the problem over time.

Strategies for success…

• Focus on abilities over disabilities.
• Include the person with a brain injury in all program planning from the beginning.
• Involve all family members and caregivers.
• Identify problems and opportunities early and start to work on them as soon as possible.