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Wednesday, November 21, 2018

Behavioral Effects of Brain Injury

People who have sustained a brain injury can experience a range of physical and emotional issues that can affect their identity and personality, relationships and their independence. The more severe or traumatic a brain injury, the more likely it is that the effects will be more pronounced and longer lasting. The way in which a brain injury might affect someone is complex, varied and unpredictable: sometimes a patient may display exaggerated manifestations of pre-injury personality traits whereas others might act in a fashion that is completely out of character. Indeed, often we see a mixture of the two. At the Mount Sinai Department of Rehabilitation Medicine we offer a dynamic and structured rehabilitation program to those who have experienced brain injury, Traumatic Brain Injury (TBI) or a stroke. This includes our TBI peer mentoring program, our Stroke Club, evaluation and treatment of vestibular and visual impairment as well opportunities to participate in TBI research studies.  Our brain injury rehabilitation program is an integral part of Mount Sinai’s Traumatic Brain Injury Model System of care and is one of only two CARF-accredited programs in New York City. Our brain injury patients can also access our CARF-accredited outpatient services available once they have been discharged from hospital. 

Let us go through some of the most common behavioral effects of brain injury, including what they are, what to look out for and ways to help. 



Disinhibition

A common behavioral change in early recovery is disinhibition, or an inability to control or manage socially inappropriate behavior. This might manifest itself through unpredictable anger or rage, divulging secrets to others too freely, inappropriate remarks and even exhibitionism or making unwanted sexual advances. This might be difficult for family and friends to handle, but the best advice is to try to be calm as appearing shocked or distressed might make the sufferer feel there is something wrong with them. It is also wise to discuss the inappropriate behavior with the patient – always in a non-judgement way – and to set firm boundaries as well as discovering appropriate ways for them to express themselves, their personality and their sexuality. 

Impulsiveness

Another common behavioral effect of brain injury is an inclination to speak or act without thinking about the possible consequences. Aside from a range of embarrassing, awkward or even threatening social situations, there are some practical implications that may affect one’s ability to manage their own life independently. One of the most salient issues is the ability to manage one’s finances as patients might impulsively spend money quickly, rashly and above and beyond what is affordable. In helping patients manage their finances it is important to have a situation that allows a guardian to help compensate for their inability to manage money while also allowing for the least restrictive solution possible. A common practice is to have the patient agree to not have access to credit cards and finances while not being supervised, but to allow them a credit card with a modest maximum a well as some spending cash for everyday needs. Depending on the situation and your relationship with the patient, it might be necessary to seek legal advice from a lawyer or local court’s guardianship office to obtain information about how to create a suitable and legal guardianship over a brain injury patient’s finances.


Apathy and Disaffection

After a brain injury a patient may become passive, unresponsive, apathetic, emotionless and lacking the capacity for initiative. In the early stages of recovery, a patient will often appear unaware or unconcerned with their injury and resulting inabilities. Others may demonstrate a will to be active and to connect with others, but are often unable to follow through. For the patient with a brain injury, this apathetic and disaffected state is not just the result of depression, but also from the physical damage endured by the brain. As such, it is essential that friends and family are extremely sensitive to the patient’s needs and emotions or inability to express emotion. Often the best way to help someone showing these signs of brain injury is to support, love and accept them, along with offering plenty of affection and practical help to make their lives easier.

If you, a friend or family member has suffered a brain injury and you would like to discuss the ways in which the Mount Sinai Department of Rehabilitation Medicine can help, please get in touch with us at (212) 241-6321.

1 comment:

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