Traumatic Brain Injury An explanation of behaviors and suggestions for cooperation

Traumatic Brain Injury An explanation of behaviors and suggestions for cooperation Acknowledgements Brain Injury Association of Michigan and The Teaching Research Institute Is the person . . . unkempt? Or does the TBI cause . . .    limited self-awareness; or poor grooming? Is the person . . . inappropriate? Or does the TBI cause . . .    difficulty with selfdirection; or impulsivity (need for immediate gratification)? Is the person . . . lying? Or does the TBI cause . . .    confabulating; or filling a memory gap with a falsification believed to be true? Is the person . . . irresponsible? Or does the TBI cause . . .     minimal memory and organization capacities; poor time management and procrastination; or reduced initiation? Is the person . . . being helped too much or too little? Or does the TBI cause . . .   challenges with adult expectations? Is the person . . . having difficulty learning? Or does the TBI cause . . .   short attention span or poor time management? Is the person . . . lazy and unmotivated? Or does the TBI cause . . .    reduced initiation; or apathy? Is the person . . . out of control; or impulsive? Or does the TBI cause . . .      inhibition; lack of concern for others; or social inappropriateness and crude humor? Is the person . . . overwhelmed; or giving up? Or does the TBI cause . . .      frustration due to multitasking; poor organization, distractibility, and social and test anxiety; or loss of interest and lack of emotional reactivity? Is the person . . . unable to get along with others? Or does the TBI cause . . .      inability to pick up social cues; misperceptions, shortterm memory challenges, social anxiety, and poor judgment; disinhibition and social inappropriateness; or lack of emotional reactivity? Suggestion – Consistency is important.    meet regularly and develop common strategies for use by all; view individual from all sides; and recognize that changes for individual are difficult to deal with. Suggestion – Treat the individual as an adult.    although his or her behavior may be immature at times, accept that: individual is easily embarrassed and will resent being talked “down to”; and individual may be suffering acute awareness of being “different” (even if denying problems). Suggestion – Recovery from brain injury is a learning process.    behavior and learning theories can be helpful; technique employed, however, must align with cognitive and emotional capacities and deficits; and over-stimulation or techniques employing little repetition may not be useful. Suggestion – Be patient.    recognize that change is slow; not all problem areas can be addressed at once; and take small steps which reinforce progress. Suggestion – Over stimulation can hinder progress.    individual often takes in information more slowly and this takes longer to process; “normal” pace of conversation and activity may be too much to follow or understand; and individual should be observed for overload and signs of frustration. Suggestion – Model calm and controlled behavior yourself.     non-verbal cues may be perceived better than verbal cues; individual may have keen perception of those really concerned; body language conveys a lot – be calm and friendly; and your calm behavior will help reduce his or her fear and anxiety. Suggestion – Expect the unexpected.    individual with brain injury may be more subject to “ups and downs,” mood changes, and differences in alertness and attention span; ability to cope may vary day-to-day or minuteto-minute; and helping individual regain and maintain control and steadiness important. Suggestion – Individual with brain injury may be more sensitive to stress.     changes in routine (i.e., sleep patterns, cold temperature, minor illnesses, fatigue, unexpected events, unkept appointments, etc.) can drastically affect function; individual must concentrate 100% on task; any distraction or interruption may produce the inability to perform; and individual may need structure, guidance, reasonable demands, and more frequent breaks for mental rest. Suggestion – Individual may get worse before getting better.    as recovery continues, individual may become more aware of limitations and more frustrated with inability to deal with day-to-day demands; behavior may worsen; and if this response not recognized and treated appropriately, further progress may be blocked. Suggestion – Redirect individual.   recognize that the individual with brain injury may be very suggestible; and if agitated, confused, frustrated, or otherwise behaving inappropriately, getting his or her attention and introducing another topic, stimulus, or person may be very effective.