Brain Injury: Why Does My Loved One Act Out?

AbilityLab, LIFE Center
Brain Injury: Why Does My Loved One Act Out?

The brain is complex organ that controls the entire body. The left side of the brain actually controls the right side of the body and the right side of the brain controls the left side of the body.

The left brain is responsible for reading, writing, arithmetic and memory retrieval, which is recalling information from the past. The left brain controls specific parts of thought and language.

In contrast, the right brain is the creative side. It controls and contributes to activities like art, music and non–verbal actions. Memory of sounds and sights are stored and recalled in the right side of the brain. The right brain also aids in controlling impulses and awareness of deficits.

Changes Following a Brain Injury

Each injury is unique and each person recovers differently. After a brain injury, these are some typical changes that can occur.

Restlessness and agitation

After a brain injury it can be hard to focus for large periods of time, and this can lead to restlessness or agitation. It helps for the brain injured person to process only small amounts of information at one time, rather than complex ideas.

A person who has experienced a brain injury may also act out by hitting or swinging without warning. If this happens, first protect yourself. Remember, however, that these actions cannot necessarily be controlled and so do not reprimand. The brain injured person may sometimes apologize, realizing that they have hurt someone. Do, however, provide feedback to the person with a brain injury about how their actions affect themselves and others.

Lack of extreme emotional response

Someone with a brain injury may not show the same emotion as before. This is not because they don't care, but because emotional responses are absent. If the front part of the brain, which controls emotions and behavior, is damaged, it may cause emotional outbursts or crying inappropriately. Be willing to give support and talk about the situation. Ask about feelings and frustration, and if there is anything you can do to help.

Diminished insight

A brain injury can affect the ability to think clearly, make good decisions and tell right from wrong, but the person who has experienced the injury may not realize these new limitations. When something troublesome happens, move on to the next subject instead of dwelling on issues that are not understood.

Common Family Reactions

Each family acts differently but here are a few of the common and normal responses.

Anger

It is normal to feel angry with the situation both you and your loved one are in. Anger can stem from the fact that someone you love cannot now have the same enjoyment in life. You may feel that you or your loved one did not “deserve” this to happen.

Questioning

You may wonder why this happened, and if anything positive will ever come of it.

Unrealistic expectations

Family members want what is best for their loved one. Sometimes this leads to unrealistic expectations and unnecessary pressure for the staff and most importantly the person who has experienced the injury. It is good to set goals, but goals should be ones that can realistically be attained. Since each person is different, goals will also be different. Realistic goals may range from someone being able to take several steps, to simply following a verbal command to raise a hand.

Acceptance

Families who have loved ones with a brain injury are not expected to simply be “okay” with the situation, however, it is important to remain hopeful. It can help to focus on progress that has been made instead of all the things that need to be done or changed.

Tips for Interacting with Patients

  • Introduce yourself when entering the room if necessary. Sometimes short term memory is affected by the injury and if the person does not recognize you right away, it may be frightening.
  • Be patient in conversations. It will take more time to put together thoughts and words. Allow extra time for an answer before going on to the next thought.
  • Speak slowly. This allows time for thoughts and reactions to what is said. Do not speak louder, since hearing is usually not affected.
  • Avoid sarcasm. This may be difficult for someone with a brain injury to understand and may cause confusion.
  • Avoid sudden movements such as touching or grabbing. These actions should only be used in an emergency. Instead, move slowly while explaining what you are doing.
  • Always treat your loved one as an adult. Although the injured person may seem to not understand, no one can really measure level of comprehension. It is not okay to talk to someone as if they are a child or cannot understand you.
  • Focus on the positive rather than the negative things. Remind your loved one of the progress being made, not how much they should be able to do.
  • Avoid too many visitors at one time. Activity in the room may cause confusion and make it more difficult to concentrate and express thoughts.
  • Be calm. People with a brain injury can sense when others are upset, which may in turn cause them to become agitated.
  • Do not make unrealistic demands. If the injured person feels they are being pushed to do things that are not possible, he or she may start to feel worthless and as though efforts are useless.
  • Bring in familiar things that your loved one may recognize. Pictures and stuffed animals may trigger memories. Also staff can use them for conversation when family members are not around.
  • Describe in advance what you are going to do, for example that you are going to touch them.
  • Explain what happened if they do not remember. It's okay to say that there was an accident and now they are in the hospital. Give assurance that there are people around to help. Reinforce that they are safe.
  • Talk about things that are familiar such as what is going on at home, or what you did that day.
  • Later in recovery, direct the conversation back if they start speaking about things that don't make sense. Help to refocus, but in a non–threatening way. If the conversation wanders, calmly bring the discussion back to the topic at hand.

Tips for Family and Friends

  • 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.
  • Join a support group. Being with others in the same situation may help with coping.
  • Visit with and talk with clergy, family and friends. Confide in those around you. Share your frustrations as well the accomplishments.
  • Take time for yourself. You don't have to be at the hospital everyday and every moment.
  • Stay educated. Read material that is relevant to the situation you face. This will help you to identify some of the things you may meet on the road to recovery and take away some fears of the unknown.
  • Communicate with staff. 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 persons with brain injury,1998. Chicago, IL: Rehabilitation Institute of Chicago (RIC) 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 AM, Lee PA, Remer–Osborn J (Eds), 1999. Brain injury:Educational guide. Chicago IL: RIC.

Orto AED. 2000. Brain injury and the family. Boca Raton, FL: CRC Press, LLC.

Strum CD, Forget TR, Sturm JL. 1998. Head injury: Information and answers to commonly asked questions: Family guide to coping. St. Louis, MO: Quality Medical.

This content is for informational purposes only. It does not replace the advice of a physician or other health care professional. Reliance on this site's content is solely at your own risk. Shirley Ryan AbilityLab disclaims any liability for injury or damages resulting from the use of any site content.

Posted on BrainLine December 12, 2016

From the Shirley Ryan AbilityLab (formerly Rehabilitation Institute of Chicago), LIFE Center. Reprinted with permission. www.sralab.org/lifecenter.

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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