Supporting people with acquired brain injury and their families

Effects of ABI

Disabilities associated with acquired brain injury

Every brain injury is unique. Severity and types of impairments depend on the area and extent of the damage to the brain. The rehabilitation and support provided to a person who has received an injury has a major impact on the person's recovery.

ABI is known as an invisible disability due to the invisible nature of changes that may occur, such as memory loss, cognitive impairments, challenging behaviours and personality changes. People with ABI usually retain their previous IQ, past memories, skills and interests. But their ability to use this knowledge can be lost to varying degrees. ABI is not an intellectual or psychiatric disability so a person with an ABI has different needs.

The Human Brain

                                                                                                                                                                                           Reference; Brain Injury Association of Queensland Inc; Surviving Acquired Brain Injury;2002

Four broad categories of impairments can follow an ABI:

  • motor-sensory (Neurophysical Impairments)
  • communication Impairments
  • cognitive (Neuropsychological Impairments)
  • psycho-social (Neuropsychological Impairments).

People with ABI may experience one or more of these impairments simultaneously and their severity can vary over time.

Motor-sensory (Neurophysical impairments)
  • Sensory impairments such as loss of temperature control, smell and taste.
  • Poor balance (ataxia) due to loss of muscle coordination.
  • Spacticity due to increased muscle tone.
  • Paralysis, weakness (hemiplegia and hemiparaesis).
  • Poor bladder or bowel control.
  • Speech (articulation) difficulties and swallowing difficulties.
Communication impairments
  • Speech impairment such as slurred or jumbled speech due to injury to nerves supplying speech muscles.
  • Loss of the ability to read or write.
  • Loss of ability to understand or express language.
Cognitive (neuropsychological impairments)
  • Memory problems such as short-term memory loss or disorientation.
  • Loss of motivation and concentration, reduced attention, easily distracted.
  • Thinking including difficulty with complex ideas, rigidity, perseverance and concrete thinking.
  • Planning difficulties such as disorganisation, poor planning, poor self-monitoring, difficulties with problem solving, managing finances and time.
  • Learning difficulties, slowed thinking and trouble processing new information.
  • Failure to learn from mistakes.
Psychosocial (Neuropsychological impairments)
  • Lethargy, disturbed sleep, fatigue.
  • Lack of motivation and difficulty initiating activities.
  • Personality changes, more self-centred, reduced sensitivity to others, dependent.
  • Lack of inhibition and self control; uninhibited, impulsive.
  • Inappropriate social or sexual behaviour.
  • Lack of insight, denial, unrealistic expectations.
  • Poor understanding of the impacts of their behaviour.
  • Emotional, depressed, unrealistically happy and optimistic or sad, teary and having suicidal thoughts.
  • Temper outbursts, becoming easily irritated, angry or agitated.
  • Low tolerance of stress and frustration.
  • Epilepsy: around 5% of people with ABI develop epilepsy.

Wider impacts of ABI

A wide range of issues may cause difficulties for the person with ABI and their family including:

  • A lack of understanding and inability to deal with the changes.
  • Feelings of guilt, grief, unrealistic expectations, frustration and fear about the future.
  • Lack of motivation that may be seen as laziness.
  • Socially inappropriate behaviours such as swearing, sexually inappropriate touching and propositioning, inappropriate comments. Families often need assistance to deal with these behaviours.
  • Isolation through loss of friends and family breakdown due to behaviour changes.
  • Homelessness due to family breakdown, inability to manage finances, loss of employment.
  • Inappropriate accommodation in an Aged Care Nursing Home or Community Residential Units with people they don’t relate to due to the lack of suitable supported accommodation for young people with high needs.
  • Lack of understanding in the community and from professionals due to misinterpretation of behavioural problems.
  • Financial and emotional exploitation.

Triggers

Stress triggers that may also cause epilepsy, frustration, stress and temper outbursts:

  • Noise from children, music, engines, movies, large social gatherings.
  • Lights: bright lights, flashing lights and strobe lighting.
  • Heat due to loss of temperature control.
  • Crowds and feeling trapped or too much activity.
  • Being ignored, criticised or patronised.
  • Feelings of guilt, loss of control, pain, embarrassment.

Useful strategies

  • Structure routines and help the person plan and organise their tasks.
  • Use memory aids such as lists, white board, calendar, diary, alarms.
  • Be aware of possible stress triggers and avoid them.
  • Remove the person from stressful situations then reassure them and others.
  • Be calm, use a low voice and gentle actions.
  • Use patience, allow the person time to respond and deal with one thing at a time.
  • Always check with the person about their needs, don’t take things for granted.
  • Minimise change, or change gradually and one thing at a time.
  • Use visual and verbal cues to jog the memory.
  • Avoid patronising people with ABI and do not have preconceptions about their skill level.