Behaviour Management after Traumatic Brain Injury What is it? Traumatic brain injury (TBI) is an injury to the brain from an external force such as a sudden violent blow or jolt to the head. Patients’ behaviour may change after TBI and this can cause difficulties for those caring for the patient. It is important to recognise and manage the behavioral problems as they may interfere with recovery. What type of behaviour problems happen with TBI? Behaviour problems are common in people with TBI especially if the front or side portions of the brain (frontal and temporal lobes) are injured. People with TBI can be: • Frustrated easily • Aggressive • Yelling and cursing • Overly suspicious • Forgetful or easily confused • Acting impulsively – doing things without thinking of the consequences
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Losing socially appropriate inhibitions such as removing clothes in public Getting agitated or irritated easily by noise, light, smell or taste Getting stuck on a certain thought, idea or movement Replacing gaps in memory with false information that the patient believes to be true Holding a false and sometimes paranoid belief about what happened
It is important to remember that TBI patients do not behave this way on purpose. Damage to the brain causes these behavioural changes.
How is this treated? The team of therapists, doctors and nurses will work together with the patient and family, to create an appropriate behaviour management programme. This will help everyone to share the same attitude and expectations towards the programme. How do you deal with it? • Give direct and immediate feedback Cues and feedback should be simple and direct. Give praise for doing something well or when a negative behaviour was stopped. • Create a calm environment Reduce noise and over-stimulation as this can cause confusion and agitation. • Be mindful of their age Do not treat the patient like a child as this can cause frustration and anger. • Praise and encourage Being positive about good behaviour is usually more successful than punishing bad behaviour.
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Set realistic goals Break long-term goals into smaller ones that are easier to achieve. Modify Change interactions as behaviour improves and recovery progresses but be consistent. Consult a doctor If negative behaviour continues and disrupts the recovery plan, medications can be combined with the behavioural plan to aid recovery. Restrain as needed Though unpleasant, this may be necessary if there is a threat of harm to self or others. Consult a nurse for information about the least-restrictive options.
The patterns of behaviour after a traumatic brain injury depend on the severity of injury. The healthcare team will work closely with all who interact with the patient to understand the behaviour and support the individual recovering from brain injury.
Yishun Health is a network of medical institutions and health facilities of the National Healthcare Group. Admiralty Medical Centre • (65) 6807 8000 • www.admiraltymedicalcentre.com.sg Khoo Teck Puat Hospital • (65) 6555 8000 • www.ktph.com.sg Yishun Community Hospital • (65) 6807 8800 • www.yishuncommunityhospital.com.sg The information is correct at the time of printing and subject to revision without further notice.
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