There are different types of acquired brain injury (ABI). Traumatic brain injury (TBI), usually results from an impact to the head such as a violent blow or jolt which results in damage to the brain. TBI can be caused by things such as road traffic accidents, falls, physical aggression, sport injuries and gunshot wounds. Non-traumatic brain injuries (Atraumatic), are due to internal causes. This can be because of a condition inside the body for example infective, vascular, anoxic, metabolic and autoimmune.
Mild/moderate brain injury is when an individual experiences loss of consciousness, this could be from 15 minutes to 6 hours or a period of post-traumatic amnesia of up to 24 hours. Concussion is caused by a bump, jolt or blow to the head, the sudden movement of this happening can cause the brain to bounce around or twist inside the skull. However, severe brain injury involves loss of consciousness and can be caused by for example falling from a great height or hitting the head at high speed.
Brain injury caused by major trauma usually causes a person to be unconscious. Initial effects of ABI can be that the individual may experience mental and/or physical fatigue. They may have some slowing down in how fast they can process information and plan and solve problems. Changes to the individual’s personality and behaviour are also common. Their sensory abilities may also be affected.
The individual may need an advocate to act on behalf of them.
Physical effects: An individual’s mobility can become affected by ABI. Balance can be affected and movement can become very slow and coordination becomes affected. They may experience limited movement or stiff or weak limbs and muscle spasms. ABI can cause uncontrolled movements tremors. It can lead to paralysis in areas of the body. Due to disruption to parts of the brain seizures are a common side effect also. These affects may lead to the individual needing a wheelchair or mobility aid.
Functional effects: Functional effects of ABI effects the ability to be able to perform everyday tasks. Speech is a factor that can be affected by ABI, speech can become slowed, slurred or rapid. Because the brain has to work harder than it did before ABI this can cause excessive fatigue. Taste and smell can be affected after an ABI and individuals may experience dysphagia. Vision problems or impaired death perception are also a common affect. ABI can cause constipation and incontinence.
Cognitive effects: ABI can affect the way an individual is able to use and develop skills such as memory, attention, concentration and executive functions such as reasoning, problem solving and the use of and understanding language. It can have a significant impact on all aspects of learning. Some people may be unable to remember faces or names.
Behavioural: Individuals can experience personality changes and lose sense of their own identity. ABI can cause individuals to feel grief, denial and anger all which can lead to depression and mood swings. However sometimes the impact on ABI means that the individual remains unaware of what has happened to them and how they have been affected. Individuals can begin to feel very isolated. Anxiety can be a consequence of ABI and this can lead to frustration and anger. ABI can lead to changes in emotional control centres and hormonal release that can cause severe mood swings. PTSD is another effect that an individual can experience. ABI can cause disinhibition which leads to inability to stop them saying/doing things.
Dysphasia is a disorder of language. There are two types of dysphasia. Receptive dysphasia and expressive. Expressive dysphasia is when an individual has difficulty putting words together to make meaning. However receptive dysphasia is difficulty in comprehension. Dysphasia is a disruption in the links between thought and language. Receptive dysphasia causes an individual to not be able to understand what they are saying even though their language is fluent with a normal rhythm however this is meaningless as they fail to comprehend what they are saying. People with expressive dysphasia are not fluent and have trouble forming words and sentences. People with expressive dysphasia usually understand what is being said to them however they won’t speak spontaneously.
Dysarthria is a disorder of speech caused by brain damage. A person with Dysarthria may be difficult to understand. In some cases they may only be able to produce short phrases, single words or no intelligible speech at all. Dysarthria doesn’t affect a person’s intelligence or understanding, but a person with the condition may also have problems in these areas.
People suffering from the above may face many communication challenges. For example people with dysphasia often can’t find the words to communicate what they want or need. The meaning of a sentence may be misheard or misunderstood as they struggle to understand what is being said to them. Dysarthria can lead to changes in tone and rhythm of speech which may lead others to misunderstand what the individual is trying to communicate. People with dysarthria struggle to form words.
There are various ways to support an individual with specialist communication needs. It is very important to be patient whilst trying to communicate with someone who may struggle. You can try and determine an individual’s preferred communication method. Different communication methods could be things like writing/drawing, electronic devices, sign language and phrase cards. Ensure that you communicate with family/friends of the individual as there may be certain methods the individual may use to communicate for example their own signs which you can then adapt to. Speech and language therapists may also play a part in improving an individual’s communication.
ABI can majorly change an individual’s personality in many different ways. Individuals may become frustrated, impulsive and aggressive. They may also suffer with lack of motivation and emotional lability. Other factors may be mood swings, depression, anxiety and a loss of social skills.
Self awareness is the ability of a person to observe and reflect on their own thoughts actions and behaviours. Individual’s that lack self awareness may struggle with the tendency to misread social situations. If something goes wrong in a social situation they may blame external factors as oppose to themselves. Individuals may not understand the physical, cognitive or behavioural changes that have happened to them and this may cause them to have unrealistic expectations for example playing a sport they are fond of or driving a vehicle.
When an individual such as a partner/family member is caring for a loved one with ABI they can begin to feel greatly distressed due to the individual they are supporting experiencing personality and physical changes. Friends/family/partners may feel a sense of bereavement after a loved one suffers with ABI. The people who are providing support may have to change roles from partner to carer and this can affect their life in many different ways. They may have to give up their own social life and social activities they once enjoyed to be able to provide full time care for the individual. This may lead them to lose contact with their own friends and family. They may feel a sense of guilt or blame themselves for what has happened this can lead to themselves being depressed or suffering with anxiety. Caring for a loved one can be very tiring and the individuals doing so may forget to take care of themselves.
Behaviour is challenging if it is harmful to the individual or others and if it stops a person achieving things in their daily life. Challenging behaviour can include things such as:
Firstly to avoid confrontation with someone who is emotionally agitated as a result of ABI you must be aware of or recognise the triggers to try and prevent the individual becoming agitated in the first place. Distraction and redirection are good techniques. For example if an individual is becoming very agitated in a busy, noisy lounge at dinner time then distract them initially before redirecting them to a quiet place where they can relax and calm down. Always use a calm tone when supporting someone with an ABI becoming agitated, use non defensive body language, speak to them at their own level, don’t tower above them or speak down to them. Show interest in how they are feeling and show understanding of what they are agitated about.
Challenging behaviour can impact feelings and attitudes of others for example if a family member is visiting a loved one with ABI and the individual is acting out of character from before the injury and presenting challenging behaviour they may take things personally and feel hurt by their actions this may be due to lack of understanding of ABI. Carers may feel frustrated in certain situations and hopeless if they can’t manage the challenging behaviours being presented to them. This may make a carer feel inadequate. Family members may be taken back by physically challenging behaviour from a loved one with ABI which may lead to them feeling afraid to come and see the individual.
Support for people with challenging behaviour should always be person centred. To start a behaviour support plan should be developed for the individual to set out what is likely to trigger the behaviour in the first place and how families and services should respond. Families should also always work in partnership with the professionals involved in their family members care and support when possible. Some people find a distraction can focus a person’s energies elsewhere and prevent them from displaying challenging behaviours. The next step for dealing with challenging behaviour would be their GP. Their GP can refer them to a behavioural therapist who can assess and monitor their challenging behaviours and help the carer to support/control them. In extreme cases when other methods to try calm an individual have been tried but have not worked and the individual is at risk of harming themselves or others the GP may prescribe medication. There are also many organisations for carers to connect with other carers in a similar situation. Respite care can be available in some situations through charities to give the carer a break. Nurse practitioners and social workers will also be involved in support for dealing with challenging behaviour.
It is important that all challenging behaviour is documented and monitored closely. Carers and professionals should record challenging behaviour using the ABC model. ABC stands for A – activating event, B – behaviour and C- consequences. Activating event refers to anything that could be a trigger for the behaviour. Changes of environment can be a common factor. Behaviour refers to the actual behaviour that the individual has displayed for example being verbally abusive towards a staff member. Consequence refers to outcome of the events for example the individual being taken to a quiet place to calm down. All ABC forms should be regularly reported to the appropriate manager or care professional. The manager can have regular contact with GP’s, community nurses, and other professionals involved with the care process to evaluate the individuals care needs. An agreed way of working will be implemented which will include any known triggers for the individual and the best ways to manage the challenging behaviour. It is important that information is reported back at meetings.
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