Cause to impact
The cause of the ABI makes a physical injury to the brain (in one or more parts of the brain) which in turn has an effect in areas such as cognition, communication and language, etc which can be seen through specific impairments (e.g. memory difficulty, difficulty with problem solving) and these in turn impact on the person's life ( self-care, relationships, work).
Each person with an ABI is different because:
- the exact nature of the injury to the brain is different from one person with an ABI to the next and
- this in turn means the general effects and specific impairments are different from one person with ABI to the next and
- this in turn means the impacts on life of the person with ABI are different from one person with ABI to the next.
Introduction
Common effects of Acquired Brain Injury are:
- Cognitive
- Communication/language
- Physical/sensory
- Emotional/behavioural/personality
There is overlap and interconnections between these effects. The specific effects will be unique to each individual and their injury. The extent of the effects and challenges for the person with brain injury depends on:
- The severity of the ABI
- The location of the brain damage in ABI
- The length of time since brain injury
- The extent a person has been able to integrate back into the community
- The support available to the person.
i) Cognitive changes and difficulties
Thinking difficulties are common after an ABI.
Thinking difficulties can have a big impact on everyday life.
Some common thinking difficulties are:
- slower thinking processes
- reduced flexibility in thinking
- memory difficulties
- difficulties learning new information
- attention and concentration problems
- poor planning and organisational skills - executive ability
- poor reasoning and judgement
- difficulties in recognizing objects (changes in vision perception).
Based on material from: Brain Injury Association of NSW - www.biansw.org.au
ii) Communication/language changes and difficulties
The brain controls speech and language. If the parts of the brain responsible for speech and language are damaged there can be difficulties with communication.
The difficulties will depend on the nature and extent of the damage to the brain.
Speech, language and communication difficulties can have a major impact on everyday life.
Some common speech language and communication difficulties are:
- difficulty understanding what is said to you
- difficulty finding the words you are looking for
- difficulty in moving and coordinating the muscles used for speaking.
In addition cognitive difficulties such as memory problems, information processing problems and control problems impact on language and communication.
There are three principal sources of communication difficulties arising from damage to the brain:
a) damage to the communication areas of the brain which may cause:
- Dysphasia: Word finding, sentence construction and comprehension difficulties
- Dysarthria: Muscle control difficulties
- Dyspraxia: Muscle co-ordination difficulties
- Nonverbal communication difficulties.
b) damage to the cognitive areas of the brain which may cause:
- Memory problems
- Information processing problems
- Planning problems
- Inflexible thought process
- Initiation problems
- Control problems.
c) damage to the brain's frontal lobe which may cause social communication deficits for example:
- difficulty following the social rules and conventions of communication.
(c) Copyright - See: Module 2: Communication - www.TBIStaffTraining.info
iii) Physical - sensory changes & difficulties
Our body functions are controlled by our brain.
After a severe ABI, motor difficulties, swallowing difficulties, sensory deficits, loss of bladder and bowel control and epileptic seizures are common.
After a severe ABI there can be difficulties with movement.
Dizziness, headaches and fatigue also occur after both mild and severe ABI.
There are rehabilitation strategies to help with most of these symptoms.
Some common difficulties are:
- motor/movement problems e.g.
o muscle weakness (e.g. weakness on one side of the body, weakness in both legs)
o muscle spasticity (e.g. where limbs become stiffer and when you try and move them you can feel resistance and the person with the ABI can feel pain).
- sensory problems e.g.
o loss of vision
o loss of smell
o loss of hearing or ringing in the ear (tinnitus).
- dizziness and balance problems
- pain and headache
- fatigue
- bladder and bowel problems
- epileptic seizures.
Based on material from: Brain Injury Association of NSW - www.biansw.org.au
iv) Emotional/behaviour/personality changes and difficulties
Changes in emotion and behaviour are common after an ABI.
The emotional and behaviour changes are often what families and friends find most difficult to deal with.
The emotional and behaviour changes are both:
- a consequence of the areas of the brain that have been damaged
- the process of dealing with having an ABI and the impact on your life and those around you.
Common emotional reactions to an ABI include:
- depression
- anxiety and fear
- anger
- frustration
- mood swings.
Common behaviour changes include:
- apathy or reduced motivation
- increased irritability
- aggressive behaviour (verbal and/or physical)
- socially inappropriate behaviour
- difficulties relating to others
- restlessness /agitation.
Changes in sexual functioning after an ABI are also common. Sexual functioning involves physical, emotional, social factors all of which can be affected by an acquired brain injury
Based on material from: Brain Injury Association of NSW - www.biansw.org.au
Impacts on life
The common effects of ABI described in the previous section impact on peoples lives and relationships.
For people with moderate or severe acquired brain injury the impacts on life and relationships can be extensive.
Work
Many people are unable to return to the work they had previously done.
For people with TBI with severe injuries, a Melbourne study found that only 40% of people were employed at five years post-injury.
Leisure pursuits
Many people either lose all their leisure activities or have to change activities.
The Melbourne study found that at five years post-injury, 63% of people with TBI had had to make changes to the sort of leisure activities that they had enjoyed prior to their injuries.
Marriage or relationship
Marriage or relationship breakdown are common.
A Sydney study found that at six years post-injury, 55% of marriages had broken down. For marriages that do stay together, there can still be a number of changes, for example, the loss of the sexual component of the relationship.
Friendships
Loss of friendships is common.
The Melbourne study found that at five years post-injury, 50% of people with TBI reported that they had lost friends and become more socially isolated since the injury.
Impact on family
The majority of people with a brain injury are discharged from an acute rehabilitation unit to return to their parents or partners. This often produces enormous changes and stress for the family unit as well as for individual family members.
Many families find it a rewarding experience to provide support for a family member with ABI. However, in other cases, it can be extremely stressful.
Sources of stress can relate to:
- Family members having to give up work, and being financially worse off
- Increased level of conflict due to temper control problems
- Family members (especially partners) having to take on new roles if partner with TBI no longer able to play these roles (e.g. financial manager, home maintenance, disciplinarian with children, etc.)
- Family members who play a caring or support role losing touch with their own social networks, becoming more socially isolated
- Family members experiencing grief or depression mourning for the person "they knew before" the ABI
- Family members experiencing post traumatic stress if they witnessed or were involved in the accident that caused the injury.
- Changed relationships with siblings taking on greater responsibilities and needing to be more grown up.
Psychological reactions
People with ABI can experience a range of differing psychological reactions. This can include depression, anxiety, low self-esteem and thinking about suicide. Between 30–40% of people can experience periods of depression.
Almost 1 in 5 people will attempt suicide after a TBI.
(c) Copyright - See: Module 1: An Introduction to Traumatic Brain Injury www.TBIStaffTraining.info for full references.
