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 injury survivor 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. They 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.

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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.

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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.

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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.

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