Adults with Brain Injuries

Cognitively impaired people typically require special care. That care includes supervision—often 24-hour supervision—and help with activities of daily living (ADLs). ADLs include bathing, eating, transferring from bed to a chair or wheelchair, and toileting. They may also need help with communication, remembering things, daily routines, behavior management, and incontinence.

Ironically, though they need this assistance, they may not recognize or accept the extent of their functional limitations, and may not welcome your offer of help. You may see substantial changes in the injured person with regard to

• Learning and remembering
• Personality
• Anger and frustration
• Sexual behavior

Learning and Remembering

Learning new information often presents the greatest challenge to the individual with ABI. The ability to focus and concentrate are keys to overcoming short-term memory problems. Cueing can be helpful in improving concentration and attention. Here are some other considerations.

• To assist the person with learning, keep distractions (e.g., music, noise) to a minimum.
• If memory impairment is severe, have them repeat the name of a person or object after you.
• Whenever possible, have them write down important information (e.g., appointments or telephone messages).
• It may be helpful to keep household objects (including the individual's personal belongings) in the same place.
• As much as possible, maintain regular daily routines, such as using the same route to walk to the mail box.
• When going outside the home, accompany the individual for safety reasons.
• If the individual is able to be outside the home without assistance, always provide them with a list of emergency telephone numbers.

Personality Changes

Most individuals who sustain a brain injury undergo some type of personality change, whether it is permanent or temporary.

Some changes may be quite striking. Whereas prior to the injury, your loved one may have been "easygoing" or responsible, they may now seem combative, argumentative, or "forgetful." Or they may appear to lack emotional responses, especially upon discharge from the hospital.

It's important to remember that a person with an ABI might have lost some degree of control over his/her emotions. This is a normal part of the brain injury recovery process.

Family members should avoid comparing the individual with ABI to the way he/she was before the injury. Always avoid criticizing his or her deficits. Criticism will result in feelings of frustration, anger, or embarrassment. Try to demonstrate calm behavior and help the person recognize when his/her emotional responses are under control.

Anger and Frustration

Depending on the individual, a caregiver may experience a great deal of anger from the individual with the brain injury.

It is relatively common for a head injury survivor to be unaware of his/her deficits. They may insist that an activity cannot be done, or is "stupid." Build their self-esteem by encouraging them to try. Providing cues as they successfully perform the activity should improve their confidence to carry out activities more independently.

Frustration over the loss of functional and/or cognitive abilities is a reasonable, natural response, and it may manifested as anger. Again, try to understand that the anger may not be intentional.

• Try to remain calm and even disregard some of the behavior if possible.
• Although it may be challenging, you will help your own and the injured person's progress if you can avoid argument and focus on his/her underlying feelings and frustrations.
• Try not to challenge or confront the person; understand the source of the anger.
• Treat each incident as an isolated occurrence, because a person with ABI may not recall acting this way in the past.
• Try to establish consistent, non-confrontational responses from all family members (children may need to learn some dos and don'ts for reacting).
• Realize that awareness of other people's feelings may have to be re-learned by the individual with ABI.

ABI research reveals that emotional responses to an individual with ABI may vary based on gender. Research indicates that male relatives of brain-injured people report their distress in terms of anger and fatigue, rather than as depression and anxiety. Seek support for yourself as a caregiver through support groups and professional counselors. If necessary, protective services or law enforcement may be contacted.

Sexual Behavior

A change in interest in sex may occur following a brain injury, due to change in hormone regulation.

If the individual is disinterested in sex, don't take it personally; it may have a complicated source within the individual. Try to avoid pressuring the person to resume sexual activity before he/she is ready.

Conversely, increased sexual interest may be stressful and embarrassing to families and caregivers. If they lack impulse control, the individual might make crude remarks, touch someone in an inappropriate setting, or demand sexual attention from a spouse or significant other.

It is acceptable to remind the person of how such behavior is inappropriate. If the behavior cannot be controlled, they may need counseling to help them realize the consequences of inappropriate sexual behaviors.