BRAIN INJURY JOURNEY BULLETIN “Brain Injury Behavior Aftermath”

“Behavior after Brain Injury – Why? What? How?”

August 2017

by Marilyn Lash, MSW and Lee E. Horton, LCAS/CCS

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Traumatic Brain Injury changes many things for the survivor and the caregiver(s).  Perhaps the most disconcerting ones are the behaviors that surface post-injury.  For example:

  • “He never acted like that before.”  “He’s so impatient with everything and then he gets mad at me when I try to help him.”
  • “I feel like I’m living with a stranger.”  “We’ve been married for 30 years but she is not the person I know.”
  • “We’re all walking on eggshells at home.”  “He blows up at the least little thing and yells at the kids. They’re afraid of him now.”

Do you recognize or identify with any of these comments?  These are just a few of the comments often made by families, friends and caregivers when the behaviors of a person with a brain injury change. The person may be more . . .

  • irritable
  • impulsive
  • distracted
  • impatient
  • make insulting remarks or insults
  • act rudely, or
  • ignore others.

This can all be surprising, confusing, and frustrating for those on the receiving end, or for those who witness the changes. It can be especially frightening for children who see a parent acting “strange” — differently. Changes in behavior are stressful for spouses and may lead them to silently questioning “if” and “how long” they can continue like this.

Why? — Will he always be like this?

Sadly, a brain injury cannot be reversed, and may impact a person for the remainder of his or her life.  Remember, certain parts of the brain have been damaged, and depending on where the damage has occurred, determines how a person will act, react, and behave.

Why is this happening?

An injury to the brain, especially the frontal lobes behind the forehead, can directly affect behavior. This is the area that controls what are called the “executive skills.” They affect how a person thinks and learns. Cognitive changes in memory, and/or, information processing and/or problem solving can be related factors. Even physical things like loud noises, bright lights, or crowded spaces, can affect behaviors. The bottom line: behavior changes for a reason – an injury to the brain.

It’s easy to focus on the behavior and why it is “wrong” or “inappropriate.” It’s more important to understand what is causing it and develop strategies and supports to reinforce “positive” behaviors and decrease “negative” behaviors.

WHAT should you do?

Dr. Thomas Novack suggests some strategies for families, friends, and caregivers in his tip card “Positive Interactions after Brain Injury.”  He suggests the following:

  • Speak clearly in short phrases.
  • Take turns talking (between survivor/family).
  • Avoid repeated disagreements.
  • Explain what you intend to do.
  • Avoid sudden touching or grabbing.
  • Redirect attention and change focus of conversation.
  • Sandwich negative feedback with positive statements.

Marilyn Lash, in a series of workshops with injured veterans and spouses, asked the participants which cognitive and behavioral changes were having the greatest impact on daily living and personal relationship.  Repeatedly, ANGER and MEMORY were the top responses.  Do you agree, or disagree?  If this is happening in your family . . . how should you respond?

HOW should you respond?

Many have heard the slogan – “Prevention is the best strategy” — and it makes sense.  Dr. Samantha Backhaus offers a few tips for survivors to use to prevent irritability. (Information obtained from “Irritability and Anger After Brain Injury,” a Tip Card written by Samantha Backhaus, Ph.D.)

  • Control your environment. Even simple things can help:
    • lower the volume on the TV or the radio
    • spread out visits with other people – don’t be entertaining or visiting others so often
    • avoid noisy areas.
  • Become aware of warning signs and possible triggers and “catch” them early. For example:
    • hunger,
    • feeling tired
    • pain
    • mood (how you are feeling – anxious, apprehensive, scared, etc. – about a situation).
  • Structure your daily routine and keep it consistent.
  • Keep household objects in the same place.
  • Keep distractions to a minimum and focus on one task at a time.
  • Use a memory aid system (calendar, cellphone/iPad/iPhone Apps, sticky notes, rubber band around wrist, etc.).

Families and caregivers can help with prevention too…

  • Give simple directions.
  • Avoid coming straight home and criticizing if things are incomplete or unfinished
  • Pick your spot (time, place) to talk about problems or situations
  • Use empathy (put yourself in survivor’s shoes) by showing understanding and respect.
  • Give cues, not criticism.

Remember: Prevention is done to avoid problems, not create more!

Changing Behavior Takes Practice and Cooperation from Everyone

What do you do when prevention just doesn’t work? Dr. Backhaus has some “time-tested” suggestions for survivors on how to manage your anger . . .

  • Practice self control – you have the power to control your own anger despite having a brain injury. Remember: it is a learned skill
  • Speak in a calm voice
  • Take time outs
  • Catch early warning signs
  • Use deep breathing or counting slowly to calm down
  • Find new ways (alternatives like – walking, asking permission to leave a situation to calm down, do something unrelated to situation, etc.) to release anger and manage stress
  • Remember your triggers
  • Talk to therapist or counselor
  • Consider taking medication.


Brain injury behavior aftermath can create difficulties and problems.  Understanding “why” a behavior is happening takes patience, understanding, and a willingness to work with the person acting a certain way.  “What” the response to a specific behavior is will determine how that behavior is altered or changed.  “How” a behavior changes is directly related to the tools, attitudes, and effort put into the process of change.  It is critical to remember that changing behaviors takes practice, time, and cooperation.


  1. BACKHAUS, Samantha, Ph.D. and IBARRA, Summer, M.A

Brain Injury Coping Skills

Brain Injury Coping Skills: A support and education program for adults with brain injury and their caregivers

Item: BICS

ISBN#: 978-1-931117-63-0





  1. BACKHAUS, Samantha, Ph.D.

Irritability and Anger: After brain injury” (Tip Card)

Item: IRRA






  1. BACKHAUS, Samantha, Ph.D., BELL, Kathleen R., M.D., and LASH, Marilyn, M.S.W

Sleep after Brain Injury” (Tip Card)






  1. KAROL, Robert L., Ph.D.

BEHAVIOR PLAN WORKBOOK: Step-By-Step Guide to Writing Plans to Treat Behavioral Issues After Acquired Brain Injury


ISBN#: 9781931117548





  1. Editors LASH, Marilyn, M.S.W. and STAHURA, Barbara, CFJ/MSW

Beyond Brain Injury: Perspectives on Progress, Reflection, Rehabilitation, and Recovery“–Volumes 1 & 2





  1. SULLIVAN, Cheryle, M.D.

Brain Tips: Inspirational and Motivational Calendar


ISBN#: 978-1-931117-40-1




 Related BLOG Articles:

  1. Behavior – Help for Families and Caregivers by April Groff, PhD —

8. Managing Anger and Agitation at Home by Janet Cromer, RN —

4 responses to “BRAIN INJURY JOURNEY BULLETIN “Brain Injury Behavior Aftermath””

  1. Well thanks for posting such an outstanding idea. I like this blog & I like the topic and thinking of making it right.

  2. P Muller says:

    It took 20 min.of CPR to get my husband to breath and his heart to start beating. Although the say he made a 100% recovery it seems like with the years he becomes more agitated, loose his tempor and do things without any consideration to me. When he sleeps his hand and feet has sudden jerks that I cannot sleep close to him. He will at at least 4 out of 7 days just announce that his tired and go’s off to sleep, sometimes still during the morning or early evening.
    Can these symptoms increase over time, or is it only catching up with me now? He also works excessively, sometimes till 4 in the morning or he will start up his laptop at 10 at night in bed and does not care that it bothers me!
    It just feels like a adgetated stranger that does not care.

  3. 87654 says:

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