Making a Difference #4: The Consequences of Injury

Learn about the most common changes that can occur after a TBI -- from memory problems to an unawareness of one's deficits.

[Module 4: The Consequences of Injury] [10 Common Changes After Brain Injury] >>What I'd like to talk to you about now are the different types of injuries and changes that can occur after someone has had a brain injury. [1. Mobility] >>One of the things that you can see is problems with mobility. This means being able to walk and being able to coordinate your body movements, and be able to do all the types of things that you and I take for granted every single day. [2. Communication] >>Other problems can occur in the area of communication. This can mean that people can have problems with speech and being able to speak properly. It can also mean that they have trouble understanding what you are telling them. Those two problems don't always occur together. People can understand you sometimes and not be able to speak with you or to be able to reply back to you. Or sometimes people will be able to speak but will really not be able to understand what you're telling them. There's also something called a word salad, where people are forming normal words and speaking with you, but the words don't make any sense and they're all jumbled up. So there are many different types of communication problems that can occur. Sometimes people will have to speak very, very slowly. Sometimes their speech will be slurred or difficult to understand. Sometimes they will repeat themselves. [3. Memory] >>Memory problems can also occur. And memory problems are some of the most frustrating problems that people can have. You yourself will probably know what it's like to forget somebody's name or to forget what somebody told you. And you can find that very annoying, but it doesn't happen to you all that often. For people who have sustained a brain injury, the typical types of memory problems that they have are short-term memory problems. What this means is that they cannot really remember the types of things that you tell them on a day-to-day basis. So, for instance, if you're at work and your boss comes by your desk and says, "Will you please remember to call so-and-so?" and you say "Sure," and your boss moves on and you don't write that down, you will forget, if you have a brain injury. We tend to not be aware of how much we rely on our short-term memory from day to day. It helps us remember little things that people say to us, and we don't have to write those things down, whereas someone with a brain injury is going to forget those things. And it will cause significant problems at work and at home. [4. Attention] >>Attention problems are also something that is very common in a brain injury. If you think about being at work or being at school, one of the things that helps you function is being able to pay attention and focus on something. Someone with a brain injury can frequently have difficulties with their attention wandering, so that they cannot complete tasks. [5. Speed of Thought or Processing] >>Another type of problem is how quickly you can think. It's called speed of thought or information processing. One of the things that happens is that frequently people will take longer to understand information, and they will not be able to keep up with information that you give them. So someone who has this type of problem may be sitting in a lecture or may be even watching a movie or watching television, and they cannot understand the information as quickly as everyone else. So whereas they may watch a program and they understand the first two or three minutes, they may still be processing that information and ten more minutes have gone by and they will have missed all the rest of that information. It's the same thing at work. Someone comes in and gives somebody an instruction, and the instruction has many different steps to it. The person may understand only the first one or two steps and will completely miss the second or third or fourth step in the instruction because they will have been unable to process it that quickly. [6. Planning] >>Similarly, people can have problems with planning and organization. So if you come in and you ask somebody to do a task that has many different steps, and somebody has to think about "What do I do first and what do I do next and what do I do last in order to get the task accomplished?" someone with a brain injury will have difficulty figuring that out. [7. Fatigue] >>Fatigue is also a very, very common problem. Frequently, people who have had brain injuries and strokes will get tired very, very easily, and they often need a nap or they must sit down and rest. And so think about people who have to work an 8-hour day or go to school all day long. Most of the times these people get tired so easily and so quickly that they really can only sustain activity for 30 minutes or an hour, and then they need to stop and they need to rest. [8. Judgment] >>Judgment is another big issue. Judgment is what helps us make good decisions on a day-to-day basis. It helps us figure out what is the right thing to do. It helps us make choices. It helps us make decisions between two different courses of action, one of which may have a better outcome than the other. Many people who have sustained a brain injury have very, very poor judgment. They are unable to evaluate information and figure out the right course of action. Frequently what this will result in is somebody making a bad decision and oftentimes sustaining a second or a third brain injury. It can also get people in trouble. [9. Emotional and Behavioral Control] >>Other significant difficulties after a brain injury are emotional and behavioral control problems. Most of us really never say exactly what is on our mind. We filter everything. We know that when we're angry with our boss we really can't go in and tell our boss what we think of them, because we know that will result in us being fired. However, people who have emotional and behavioral control problems cannot control those types of feelings and thoughts. If they become angry, they can lash out. They can become very aggressive. They cannot control their temper. And this will result in them losing a job; it can result in them being arrested. It can result in them being injured because somebody else can get very angry at what they say, and if they also have poor impulse control, they may get badly injured in a fight. [10. Initiation and Inhibition] >>Another problem is initiation and inhibition. This is what I talked about earlier with the start and stop button of the brain. It's very important that we know when we should start a behavior and when we should stop something, and it controls everything that we do. When we decide that we're going to get up and walk across the room, our brain is sending us all kinds of signals to do something like that. We're unaware of it. It helps us figure out when to move at the right time, when to say things at the right time, when not to say things. It helps us figure out when we should start doing something and when we should stop doing something. This can cause many, many problems in people with a brain injury. ♫ [Possible Behavioral and Social Effects] >>One of the significant issues that can occur with a brain injury are behavioral and social problems. Some of these problems may be due to difficulties with perceiving and evaluating social cues in the environment. What this means is that people can readily misinterpret what people say to them and can misinterpret their body language and their expressions on their faces. When people are unable to correctly interpret what people are saying to them, and what the meaning is behind it, they can frequently become very aggressive and angry. People with this type of problem can frequently lose their temper, can become physically aggressive or even verbally and physically abusive. Another problem is mood swings. A lot of people will have mood swings and will frequently move very quickly from being very angry or very happy. And so you can hear this in, sometimes, inappropriate laughter at different times or inappropriate responses of anger. People who have brain injuries can also be very impulsive. So in a social setting, impulsivity can cause great problems with other people when somebody is just speaking out inappropriately or approaching people inappropriately. A lot of times this may even be sexually inappropriate, which can cause great difficulty, and oftentimes it can occur with strangers. You can have a young man with a significant brain injury in a mall, and he will walk up to a complete stranger--a female--and may touch them inappropriately or say things inappropriately to them. Frequently this will result in somebody being arrested. [Low frustration tolerance] >>People with brain injury also have a very, very low frustration tolerance. What this means is that the normal annoyances that you and I might put up with every day can very, very easily derail someone with a brain injury. They can become overly upset or angry at very, very minor annoyances. [Unaware of deficits] >>Another major problem is frequently people who have brain injuries are completely unaware of their deficits. They have no idea what's wrong with them. They have no idea that their behavior is inappropriate. They may be completely unaware of the fact that they cannot do things the way they used to be able to do them. So, for instance, you can have someone who has problems walking or who may also have problems with their visual perception and they may know that they have these problems, but they still may be completely unaware of the fact that they can't drive. And for these people, they will continuously try to attempt to do things that they will not be able to do properly, and they may put themselves in danger or put other people in danger. [Unable to cope with stimulation] >>Lastly, one of the other major problems that people have with brain injury is they are unable to cope with lots of stimulation in the environment. So frequently what you see is someone with a brain injury cannot sit in a room and have many sources of stimulation going on. So, for instance, it will bother them to have a conversation going and the television going at the same time. They are often unable to screen out irrelevant sounds or even figure out what's important to pay attention to. This is particularly severe when somebody is in the early stages of brain injury recovery, but it is a deficit that persists and can persist for the remainder of the person's life. So, for these people, being in a room with several people having multiple conversations can be extraordinarily distressing. For them to be in a noisy environment or to be in a restaurant or in a mall where there are a lot of people can be very, very disturbing to them. Frequently this disturbance will manifest itself in being agitated, becoming angry, and losing their temper. [End of Module 4]
Posted on BrainLine April 8, 2011.

Produced by Texas Department of State Health Services and the Texas Traumatic Brain Injury Advisory Council.