Brain Injury: Why Does My Loved One Act Out?

Jodi Burgard, Rehabilitation Institute of Chicago, LIFE CENTER

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A family guide to emotional and behavioral changes after a brain injury

Understanding Brain Function
Your doctor may have told you that your loved one has suffered from a brain injury. What exactly does that mean? The brain is highly functioning organ that controls your entire body. It is divided into two main parts: the left brain and the right brain.

The left brain is responsible for controlling the right side of your body. It is also responsible for things such as reading, writing, arithmetic, and memory retrieval, which is bringing back things that have already happened in the past. One thing that is special about the left brain is that it is very detailed.

The left brain helps to recall the specific parts of thought, though only in a language format. It also remembers little things such as the rules of the English language, or whatever language you may speak.

In contrast, the right brain is responsible for controlling the left side of the body. The right brain is also seen as the creative side. It controls and contributes to activities like art, music, and non-verbal actions. Memory of sounds and sights is stored and recalled on the right side of the brain.

Some Things You Can Expect From a Person with a Brain Injury
Each person’s injury is unique to their situation. Therefore, each person reacts and recovers in a different way. Your loved one may experience some or all of these reactions.

Restlessness and agitation
When a person suffers a brain injury they are often unable to focus for large periods of time, therefore becoming restless or agitated. It is important to remember that these responses are normal, and that the person should only be given small amounts of information to process at one time. They will be able to think through and process small bits of information easier than complex ideas.

Lack of extreme emotional response
Due to the brain injury, your loved one may not show emotion over things that they may have been very concerned about prior to the injury. This is not because they don’t care, but because their emotional responses are simply not there. If the front part of the brain, which controls emotions and behavior, is damaged, it may cause your loved one to act out more. In addition, your loved one may have emotional outbursts or crying for no reason or when it may seem inappropriate. Be willing to give them support and talk to them. Ask them what they are feeling or why they are frustrated. Ask them if there is something you can do for them.

Diminished insight
When your loved one is recovering from a brain injury, it is important to know that hey may not hold the ability to think clearly or make good decisions. Sometimes they do not even realize that they have limitations. The person may also act out by hitting you or swinging at you without warning. They may apologize because they realize that they have possibly hurt someone they love.

If your loved one does attempt to hit you, it is important to first protect yourself, but remember that they cannot necessarily control their actions. Early on, do not reprimand them for their actions. They cannot tell between right and wrong. When it is over, move on to the next subject to get their mind off of what just happened.

Common Family Reactions
Each family will act in a different way depending on the situation and the people who are involved. The following are a few of the responses that are often seen by those who are affected by the injury, and that you may also experience.

Anger
It is sometimes common for you to be angry with the situation both you and your loved one are in. This anger can stem from the fact that someone you love is now in a situation that does not allow the same enjoyment that they may have had in the past. You may feel that you or your loved one did not “deserve” any of this to happen.

Questioning
Sometimes you may wonder why this had to happen to someone you love, and if anything positive will ever come out of it. Keep in mind that this is a normal feeling.

Unrealistic expectations
Family members usually want what’s best for their loved one. However, sometimes this leads to unrealistic expectations of the staff and most importantly the loved one. This also adds unnecessary pressure on your loved one and the staff. It’s okay to set goals, but it is important to set ones that can realistically be reached. Since each person is different, each person’s goals will also be different. Realistic goals may range from your loved one being able to take several steps, to simply following a verbal command to raise their hand.

Acceptance
Families who have loved ones with a brain injury are not expected to simply be “okay” with the situation. However, families need to remain hopeful for themselves and their loved one. It is also very important to focus on the progress that has already been made as opposed to all the things that need to be done or changed.

Tips for Success

1. Be patient. Your loved one will require more time to put together thoughts and words. Allow them time to answer before you go on to your next thought.

2. You may need to introduce yourself when you come into the room. Sometimes short term memory is affected by the injury and if they don’t recognize you right away, it may frighten them.

3. Speak slowly to the person so that their mind has time to form thoughts and reactions to what you said. You do not have to necessarily speak louder, since hearing is usually not affected.

4. Avoid sudden movements of touching or grabbing. These actions should only be used in an emergency or if you or your loved one are in danger. Move slowly and tell them that you are going to touch them.

5. Always treat your loved one as an adult. Although your loved one may seem like they can’t understand you, no one can really measure the amount of comprehension they have. It is inappropriate to talk to them as though they are a child or cannot understand you.

6. Focus on the positive things and not just the negative things. Try to remind your loved one of the progress that they may be making and not how much more they should be able to do.

7. Do not allow too many visitors at one time. Too much activity in the room may cause confusion to your loved one. It may also make it more difficult for them to concentrate on a thought that they are trying to formulate.