Brain Injury: Why Does My Loved One Act Out?

Jodi Burgard, Rehabilitation Institute of Chicago, LIFE CENTER
Brain Injury: Why Does My Loved One Act Out?

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.

8. Be calm around your loved one. He or she can sense when those around are upset and agitated about something, which may in turn cause them to become upset.

9. Do not make unrealistic demands on your loved one. If they feel that they are being pushed to do things that they cannot achieve, it may make them feel worthless and as though they are not making any progress.

10. Bring in some familiar things that your loved one may recognize. Often pictures and stuffed animals may trigger memories that your loved on may have. This will allow staff to make references to those things when family members are not around.

11. Explain what you are going to do. Give you loved on a short explanation of the things that you may be doing with them.

12. Reorient your loved one to where they are and what happened if they do not remember. It’s okay to tell them they were in an accident and now they are in the hospital. Reassure them that there are people around to help them.

13. Talk to your loved one about things that they may remember. Tell them what’s going on at home, or what you did that day.

14. Later in recovery, bring your loved one back to reality if they are speaking about things that don’t make sense. Help them refocus, but in a non-threatening way. Don’t approach them by accusing them of always talking about the same thing. Instead, quietly try to take their mind off of what they are presently thinking about and direct them to a different thought process.

15. Join a support group. Knowing that there are others in your situation may help you to cope with your situation. Visit with and talk with your pastor or church leaders, and confide in those around you. Share with them your frustrations as well the good things that are being accomplished.

16. Take some time for yourself. You don’t have to be at the hospital everyday and every moment.

17. Stay educated. Read material that is relevant to the situation that you are in. This will help you to identify some of the things you may meet on the road to recovery. It may also help to take away some fears of the unknown.

18. Don’t expect to be able to handle everything by yourself. Be willing to ask for help and realize that you can’t do it alone.

19. Talk to the staff and stay informed so that you know what is going on with the care of your loved one.

References

Behavioral management strategies for working with persons with brain injury. (1998). Chicago, IL: Rehabilitation Institute of Chicago Academy.

Kneafsy, R., & Gawthorpe, D. (2004). Head injury: Long-term consequences for patients and families and implications for nurses. Retrieved April 24, 2006 from CINAHL

Lapinski, A.M., Lee, P.A., & Remer-Osborn, J. (Eds.). (1999). Brain injury: Educational guide for patient and families following brain injury. Chicago, IL: Rehabilitation Institute of Chicago, Wesley M. & Suzanne S. Dixon Education and Training Center.

Orto, A.E.D. (2000). Brain injury and the family. Boca Raton, FL: CRC Press, LLC.

Strum, C.D., Forget, T.R., & Sturm, J.L. (1998). Head injury: Information and answers to commonly asked questions: Family’s guide to coping. St. Louis, MO: Quality Medical

TRINITY CHRISTIAN COLLEGE Palos Heights, IL 60463

Posted on BrainLine November 25, 2008

From the Rehabilitation Institute of Chicago, LIFE Center. Reprinted with permission. http://lifecenter.ric.org.

Comments

I am 71 years old and have a TBI from an accident at work. I have a hard time coming to terms with the fact that I am no longer the same person I was before my accident. I find myself acting up over little things. I think that's because I don't know how to deal with things rationally. Memory is a problem also. I can look at someone I know very well and yet I can't remember their name. I can think about things I have known all my life but I can't remember the name for it. I like movies and the actors are people I have seen several times for years but I can't remember their names. For some reason my long term memory has sharpened unbelievable. I moved from Detroit at the end of third grade and I still know address, phone number, even details of things in kindergarten that happened. I can remember vividly things I did, and saw back as far as 3yrs old. But to go to get things at the store for my wife, I'm only good for 3 items. Sometimes I don't have emotions and sometimes I I find myself crying about little things. I have a tremendous love for animals. I can't stand to see them hurt. If I ever became wealthy I would buy many acres (100+) and devote my life to caring for them. I would build a huge building so I could shelter them and provide food for all of them. I would hire a veterinarian to see to their health. I would fence the entire piece of land so none would ever get run over and would advertise for people that don't want them to bring them to me rather than just leaving them behind. I love all animals and will defend them. God bless all of you that suffer a TBI.

I am just now beginning to cope with my TBI. I see how my marriage is deteriorating right before my eyes. I've had a major personality shift and as hard as I try (including meds) the same caring, loving, always positive part of me has gone. I battle depression terribly. My ability to drive, work, and even be left alone at times have all vanished. Gone in the blink of an eye. I have a beautiful family, precious children and the wife of my dreams...all of this feels vulnerable to me now over something I cannot control. My wife has shut down to me. Just an hour ago she tearfully broke down and said she is on the verge of a nervous breakdown, because of the changes in me. I have damage to two separate lobes of my brain. I have been diagnosed with CTE, Absent seizures, acquired severe sleep apnea...I sleep with a literal ventilator, acquired ADHD, and a host of other injuries. For the last 4.5 years, I've thought it was a phase...it would pass, but things really feel like they've worsened. Today, I'm finally understanding that I need help or I'm going to lose my family due to short outbursts. I never raise my voice, but I'm deeply cynical and negative. I need help. I'm willing to talk with other people that are battling similar issues. My name is Eric. espeters11@gmail.com

Before I was born, my older brother (by ten years) was hit by a car and suffered frontal lobe damage. As a result, he lost much of his ability to empathize, control emotions such as anger, and worst of all, he's prone to violent outbursts.

I cannot recall a time in my life when I was not frightened of the man. When I was a tiny child, threats such as dangling me over the railing of a high bridge, setting fire to my clothing, and rendering me unconscious by cutting off my oxygen supply were almost commonplace. Bear in mind that at five years old, my fifteen year old sibling was utterly gigantic by comparison. Profoundly traumatized, I later paid for his abuse with deep, frequent bouts of depression and suicidal ideation which started in my teen years and continue even now. 

People become adults, make their own lives, and are able to finally escape such vicious relatives. I moved away and avoided contact with him for years, but because of a large family, my presence was unavoidably required at funerals, weddings, Mom's birthday etc.  It was at these gatherings when the adult phase of his mistreatment took place.

Unfortunately, my brother learned a 'sport'- martial arts, otherwise known as beating people to death. It was at family functions when his menacing behavior continued. From then on, at nearly every familial assembly, he would demonstrate his ugly aggression toward me. A decade ago, I finally told the man never to come near me again.

Yes, there's a point to this description. Frontal lobe damage is an absolute horror for its victims, but there are others who suffer from it as well.

I am 31 years old and have TBI from a terrible car accident I was in 6 months ago. I am still trying to cope with everything and come to terms with the fact that I'm no longer the same person. This website has been such a big help to me. Understanding there are other people out there going thru the same thing makes me feel like I can do this. I know my life is changed forever but I am now learning to cope with it.

I love this website. I am 2 years since my TBI. It is so frustrating. I lost everything but am slowly clawing my way back to independence, my husband is blind and has some hearing loss. One of the first things I remember after the injury was a caregiver telling me it is time I got up and to start looking after my husband. I was horrified as I could barely take care of myself plus well-meaning people came to our house and treated me like I was a 2 year old child. no one asked what I needed and at the time I could not voice what was going on for me. All I could do was cry. Then the mental health team came and said it was a mental illness as there was no proof of a TBI on the scans. Now, 2 years later, I have no faith in the medical profession at all. Why do people not understand it is all too much to deal with?  The more aware I get, the more I do not like what I see. Too much to understand. So thank you for this website. It helps me understand that I am not going crazy, to take one step at a time, and to deal with the stuff that is important to me and my immediate family. My dog, Molly, has become the best therapy dog ever as she NEVER JUDGES ME AND ALWAYS LOVES ME

Boy do we need more education on how to handle / deal with Brain injury. But also how to give back what help others have done for the care received. I am older TBI 61years old and my accident happened when 58 years old . And I sure had to endure what others were trying to help me become better, which I dearly appreciate . Both sides have great ways to deal with issues to get a life back. I can say, as an adult / oldie, Accepting I am a TBI was my first step for me. Then letting others help since they could see me as a TBI, not the same me  "oh how I wish I was never in accident ", but was, sigh! I think the TBI person fights inside to go back to Old Self... but can't so so so frustrating. A inside battle, that anger for me, then defeat inside and out. Even though we are all injured, we just can't force back to being then / old self. How to let go of so many years that you worked at becoming who you were? Let go, it's okay. Please folks know we are different and trying to heal, similar to a fragile broken bone it takes time to heal. And that bone is more acceptable to weakening now. Care for it, protect it and learn to be okay with it, Now. Thanks for sharing  We all could use tools / people to keep us all going .

My 7mos. W/ Tbi has brought Eons of sorrow. Hard to take. Feels like he can dish out & I cant. Ur article makes me aware of my errors. I do love him and wonder if this is the life I want. I have more to offer and I know im a good woman for him. But the pushing away is killing it. Ive mentioned therapy. I believe he thinks he doesnt need it; or, he.s ashamed due to daughter. ....

I am 31 years post injury and have experienced most of the issues mentioned. I appreciate the effort you've made to educate society.

# 5 hits home with me. Lots of people have spoke to me and treated me like I don't understand and that I'm pretty out of it or somewhat stupid when they learn I've had a brain injury. Even while speaking to me and I'm acting more alright than them. Is very frustrating to feel they think I'm that messed up because I suffered a brain injury. I feel sorry for them they have no better comprehension than that.

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