Behavior Basics: The ABCs of behavior after brain injury

Behavior Basics: The ABCs of behavior after brain injury

Thomas Novack, Ph.D.
This tip card helps explain behavior changes in survivors after brain injury and describes problems commonly faced by their families and caregivers. Learning how to manage difficult behavior can ease the stress of family members once they understand the causes and consequences of these behaviors and learn what they can do to improve the situation.
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Full Description

Survivors of brain injury often have problems with behavior that are stressful for families and caregivers. This tip card helps them understand how and why these behaviors occur, what the consequences are, and the frustration felt by survivors. It is important to know how to deal with difficult behavior, such as inappropriate comments and irritability, by learning basic strategies to improve the situation. Tips give strategies to build positive behaviors that can be used by families and caregivers.
Pages 8
Year 2011


Thomas Novack, Ph.D.

Dr. Novack is a professor of physical medicine and rehabilitation at the University of Alabama at Birmingham. He is one of the co-authors of the new book, Living Life Fully after Brain Injury, with an entire chapter devoted to managing behavioral changes.


Why Do They Behave That Way?

  • There's a reason
  • Getting down to basics
  • There is always a consequence to behavior

The ABCs of a Behavior Program

  • Focus on something obvious that can be measured
  • Be realistic
  • Draw it up!
  • Change the environment
  • Do as I say...and do as I do!
  • Graph some more
  • Expect an increase in the behavior
  • Fade the change and observe

Other Things to Keep in Mind

  • The role of medication
  • When to seek help




Sample excerpt. Preview only – please do not copy.

Why Do They Behave That Way?

Managing difficult behavior of a family member can be one of the most stressful aspects of caregiving. Irritability, inappropriate comments, unpredictable responses, poor self-awareness, impulsive behavior, lack of motivation, or refusing to do things – these are just some of the behaviors that family members and caregivers may see when a person survives a severe brain injury.

How does a caregiver deal with this while still helping with the survivor's recovery and maintaining one's own sanity? First, understand why this is happening and, second, learn what you can do to improve the situation.

Survivors with more serious brain injuries may find it hard to communicate clearly and also may have difficulty understanding what is said to them. Following long instructions or conversations and staying on topic may be difficult. A survivor of a brain injury may have difficulty using and following social cues such as body language, tone of voice or facial expressions during conversations.

It's hard for others – family, caregivers, even therapists and clinicians – to understand the frustration that a person living with a brain injury often feels. In addition to depending on others, they are often told they can not work, drive, drink, or go out as they did before.

There's a reason. Trauma to the frontal part of the brain (just behind the forehead) can affect behavior directly. This area controls what are often called “executive skills.” Like an executive of a company, the frontal areas of the brain help a person establish goals, choose patterns of behavior to achieve those goals, and inhibits (stops) behavior that is not consistent with those goals.

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