Learning to Trust the World After a Brain Injury
Learning to trust the world, to trust caregivers, can be equally if not more effective than drugs for people with executive function or behavioral problems post-TBI.
There are ways to try to teach people to function better if they have executive function impairments, and one of the great ways is you got to learn to trust the world. And therefore, you have to choose people in the world that can help you. If you do that, then the environment--in essence-- helps guide your behavior. This can be done in all sorts of ways from having a device that reminds you what you have to do next in a series of actions during the day, how to carry out your plans, how to remember what to shop for when you are going shopping. All that kind of thing can be prompted by devices, and I'm sure into the future apps and other kinds of computer applications that are really going to be on you all the time, and will be part of how you navigate through life. So that's one way to do it, but you have to adhere to that. You can't dismiss it, you can't throw it out of your pocket. You have to say and learn that this is something you should trust. And that guidance can help us a little bit. And the world helps all people, whether you have traumatic brain injury or not. You're not--there are very few lone wolves that go out there and just do what they want, and they don't adhere to rules or guidance. So society gives us rules, but families can help us too and loved ones and trusted friends. And so you do wind up having a greater sense of dependence in those circumstances, but you--as a health care provider--can work with caregivers to help train them to know how to behave and respond to situations, and--in essence--to have their own foresight to prevent bad situations occuring by giving feedback and working with the person who has had the traumatic brain injury. So there's a combination of things that we can do in the world that can be potentially as effective as any drug in helping people accomodate to any executive function deficits they have. We've also talked about social dysfunction, and there are some drugs that can help manage and modulate aggressive tendencies, but--in fact--cognitive behavioral therapy is very effective in many people in helping to teach them manage their aggressive behavior. So that's a therapy, it's not a drug; it's a talking therapy. You learn to manage your behaviors. For many other aspects of social behavior, we have no effective therapies yet. And this is something that's being worked on at the moment.
Posted on BrainLine February 12, 2013.
Jordan Grafman, PhD, is director of Brain Injury Research, Rehabilitation Institute of Chicago. His investigation of brain function and behavior contributes to advances in medicine, rehabilitation, and psychology, and informs ethics, law, philosophy, and health policy.
Produced by Victoria Tilney McDonough, Justin Rhodes, and Erica Queen, BrainLine.