How to Handle Brain Injuries for Families
From “A How to Handle Manual for Families of the Brain Injured”
by Dana S. DeBaskey PhD and Karen Morin MSW
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A "How to Handle" Manual for Families of the Brain Injured
Introduction
Dealing with a brain injury to a family member is an extremely trying time. Thinking about the future and having to deal with the new challenges and changes can be very difficult. Every case is different but by trying to educate families about the most common occurences we hope to prepare them for what may lie ahead.
Patient Behaviors
Agitation
Agitation can include a variety of behaviors. Some of these include constant movement, inability to focus one’s attention, pacing, getting up and down from a seat, repetitive purposeless actions, or self-destructive actions.
 
Resolving Agitation:
Be available as much as possible.
Move patient gently to new activities.
Redirect patient's focus away from the source of education.
Allow excessive talking.
Model calm behavior, even when you are not calm.
Structure the patient's time.
Move distractions from environment.
Monitor your own behavior and remove agitating behavior (eye rolling, frowning).
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Irritability
A brain injury has altered the patient’s ability to interpret situations accurately, perform simple tasks, discriminate between helpful and useless information. This results in patients being more inclined to display irritable behavior.
 
Resolving Irritability:
Do not confront patients about being in a bad mood.
Compromise when possible.
Structured the day so there are a few unexpected events.
Allow patient to be part of the planning and decision-making.
Do not take it personally.
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Verbal Outbursts
In cases of severe head injury most patients go through a stage where the first thought that comes to mind is said aloud. This is no different than the inability to control any physical responses. Excessive cursing is a common characteristic of these outbursts. As the patient becomes resocialized the outbursts usually diminish in intensity and frequency.
 
Resolving Verbal Outbursts:
Whenever possible, ignore the verbiage.
Do not take it personally.
Redirect the patient's attention elsewhere.
Warn friends and family about the outbursts.
When the patient begins regaining capability of control be directed by your feelings, but not critical (e.g. I am offended by the words you use).
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Temper Tantrums
Patients who have suffered brain injuries resort to physically expressing their anger and frustration because of difficulty verbalizing feelings, difficulty controlling impulses, and inability to cope with their environment.
 
Resolving Temper Tantrums:
Protect yourself and others by removal if necessary.
Ignore the behaviors.
Do not reminded the patient of the incident.
Verbalize what you think they are feeling, but without condemnation.
Remember they are not truly angry at you, so do not take it personally.
A redirect the patient's focus to a positive task or goal.
Do not show fear.
Do not hold a grudge.
Allow time for the patient to make amends and recognize the consequences of their behavior.
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Family Abuse
Often as patients develop behavioral control and becomes socialized with staff, friends, and others they remain difficult with family. This can occur because the person has never considered needing to control their thoughts or actions at home before the head injury. The patient is not thinking any differently than before, but is responding more spontaneously and must gradually learn to use self-control at home, something they have never had to do before.
 
Resolution of Family Abuse:
Do not take it personally.
Treat each occurrence as an isolated incident.
Maintain an outside contact with home you can express your feelings.
Educate family members to provide consistent responses to the abusive behavior to avoid.
The development of manipulative behaviors.
Do not let issues become "win-loose" battles.
Remember threats are an expression of fear of anger at the situation not the individual.
Do not live in a reign of terror.
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Egocentrism
Following a severe head injury patients often become completely self-centered. The ability to be empathetic to the needs of others decreases. Patients often misinterpret other people’s responses by thinking everything is related to them.
 
Resolving Egocentrism:
Do not relinquish everything to the patient's needs.
Do not allow the patient to expect that all their demands will be met.
Be aware that egocentrism may interfere with your desire to continue assisting in rehabilitation.
Do not expect the patient to respect your rights. You may have to do some demanding of your own.
Get the patient involved with a head injury support group, if patients see others acting selfishly they are more likely to criticize the results of selfishness.
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Impulsivity
A lack of behavioral control in action and/or vocalization occurs with many head injury patients. The patient acts before thinking their thoughts may be inappropriate or confused.
 
Resolving Impulsivity:
With the help of a therapist, counselor, or social worker behavior management systems can bring patient behavior under control.
Set a short-term rewards for brief periods of self-control.
Redirect the patient's attention to appropriate behavior.
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Lability
Lability is the loss of control over emotions. The fact that emotions are more quickly displayed does not mean the emotion is stronger than ever. It means that the patient cannot discriminate how and when to express feelings. Quick and frequent mood swings are often involved.
 
Resolving Lability:
Do not criticize.
Point out times when the patient controls their emotions and praise them.
Do not point out lability. It may embarrass the patient.
Address the behavior not the feelings by saying such things as "calm down".
Model calm behavior.
Structure environment to reduce stress factors.
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Denial
Head injury patients cannot recognize weak cognitive areas and see no reason for therapy and will sabotage therapeutic efforts. Patients may make excuses about not completing tasks by calling them “baby activities” that are unnecessary when in reality they fear putting out effort and not being able to perform the task. Denial helps the patient protect their self-image.
 
Resolving Denial:
Allow patient to try activities they are sure they can do if not dangerous.
When patient displays the deficit draw their attention to it without badgering or gloating to reorient a person place signs around the house.
Do not be fooled by threats of quitting therapy.
Remember uncooperative behavior may be an attempt cover up denial.
Involve patient in support groups to help them recognize and accept their deficits be patient.
When the patient can handle confrontation, it may be necessary to challenge them to keep them in therapy.
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