An Acquired Brain Injury is sudden onset of brain damage that was sustained after birth. Acquired Brain Injury is not hereditary, cognetial or a genetic disorder. Acquired Brain Injury can result in physical, cognitive, behavioural and emotional changes, the symptoms can vary dependant on the extent and the locality of the trauma. These changes may not always be permenant dependant on the ABI (Acquired Brain Injury) but most often do cause substantial alterations in a persons character and physical abilities. ABI's are very complex and no two persons can expect to have the same difficulties, although some of the changes will be similar they are rarely the same.
There are many causes of an ABI. Traumatic Brain injury is caused by physical traumas, for example an accident, neurosurgery, head injury or even an assault. Brain injury can also be caused by non traumatic circumstances such as a stroke, brain tumours, infections, hypoxia, ischemia or substance abuse. Brain damage caused by neurodegenerative disorders are not classed as an ABI. Injury is referred to as either open or closed. A closed injury is when the brain has been damaged from the brain being bounced around the head or severe shaking, for example when in a road traffic accident.
Open brain injury is a lot less common than closed and is incurred when a foreign object enters the brain, usually fracturing the skull. An example of this is a bullet entering the brain. These injuries are usually more localised and result in specific damange to the brain. Although traumatic brain injury is classed as part of ABI, it is different as ABI takes place at a cellular level and can affect different zones within the brain. Traumatic Brain injury will only affect the area of the brain in which the trauma occured.
The level of a persons consciousness is often initally afected by ABI. Impairments from ABI can be mild, moderate or severe. Impairments usually effect more than one area such as, speech, memory, cognition, attention and concentration, psychosocial behaviour, information processing and reasoning. If the individual is unconscious for a prolonged period of time or put into an induced state of unconsciousness this is classed as a coma. This will often happen after an ABI to help with recovery. After an ABI an indiviual may be able to complete normal day to day living tasks such as personal care and eating. As mentioned before cognition is likely to be affected which will in turn effect an individual in their decision making. Due to a lack in congnitive ability the individual may require an advocate after an ABI to represent them and make serious decision regarding their welfare and care.
As previously mentioned brain injury effects cognitive behaviour. This means that the way the individual thinks, learns and remembers both new and old information changes. The brain has different zones, each zone serves a different function, which means not all cognitive functions are nessacarily affected.
ABI will result in changes to emotional reaction and behaviour. Sometimes these changes in an individual will be difficult to see.
It is not very common for people to suffer physical difficulties as a long term effect of brain injury, although it is possible, for example it is likely to cause physical difficulties for people who have suffered from a stroke. Most people will make an exellent physical recovery. Often the pyhsical problems are not so apparent but can have a great impact on daily life.
An individuals functional skills are often severely affected. Functional skills are not only how physically capable a person is but it is also how a person is also mentally effected for example they can lose motivation which in turn can affect their every day living activities such as cooking, cleaning and personal care. After an ABI it is highly likely that a persons behaviour will change and alter their personalilty. The part of the brain which manages and procresses emotions is the frontal lobes. Emotional and behavioural changes can be divided into eleven different areas, some of the key areas are; explosive anger and agititation, lack of awareness and insight, self centeredness and sexual problems. A person with damage to the frontal lobes may not be able to manage their emotions as they once would and minor agititations can cause explosive bursts of anger.
Again the frontal lobes control our ability to make decisions and adjust our behaviour accordingly. Damage to the frontal lobes can affect someones self awareness, not understand the effects of their actions, can stop them from feeling empathy. This means that a person may not understand the impact the brain injury has had on not only their lives but their friends and families. The hypothalamus, a small nerve centre in the middle of the brain affects a persons sex drive. The sexuality of a person who has suffered a brain injury can either descrease or increase for a variety of psychological reasons. As previously mentioned another behavioural change is a lack of awareness and inhibtions can be lost. This can cause the sufferer to be sexually inappropriate. The changes in someones personality can have a dramatic impact on their friends, family and the people providing them care or support.
The main impact on the people providing support for the individual is often emotional. It can be difficult for the people supporting the individual to accept that this person has changed. It can also be emotionally draining for them as they have to change their lifestyles to adjust to the individuals presentation and often challenging behavourial impulsions. A persons language skills which are fully or partially impaired by brain injury is called Dysphasia Dependent on how the disruption to the language centres of the brain manifests dysphasia can occur in a variety of forms. Dysphasia typically affects one or more of the basic language functions such as understanding spoken language and naming items with words. Dysphasia can cause people to not remember their words for example they would be able to describe something as brown, wooden and comes off trees but would not remember the word stick. Whereas dysphasia is a language disorder there is a disorder called Dysarthria which affects speech. Speech uses the bulbar muscles.
Dysarthria is caused by nuerological injury to either the central nervous system or the peripheral nervous system. The damage can cause weakness or paralysis of the motor-speech system. The effect of this causes control over the tongue, throat or lips to be lost, in turn affecting someones ability to talk, although they will know the words they want to communicate, someone with Dysarthria will not be able to always pronounce the word they want to due to loss of control over their verbal functions. Dysarthria is only a speech disorder caused by neurological damage and not by structural abnormalities. An individual with specialist communication needs may often require a lot of support. Patience is the key factor in supporting someone with communication difficulties. To be able to support someone with these needs you often require a good understanding of non-verbal cues and gestures.
You may also require the skills to use communication aides such as a light writer and cue cards. There are many different ways to communicate with someone who cannot verbalise their words, dependant on the person and their abilities. An example is that you can ask a question and ask for a hand gesture such as a thumbs up or a thumbs down for a yes or no answer. Body language and tone of voice are also very important when communicating and you need to posses the skills to adapt these accordingly. As previously mentioned you need to be patient with the person but also show empathy as it can be very frustrating for the person if they are having difficulty communicating.
There are many different behaviours which may be considered challenging. Any behaviour that causes someone to feel discomfort, frustration or fear would be classed as challenging behaviour. Some examples of challenging behaviour include; self neglect, impatience, paranoia, verbal aggresion, physical aggression, alcohol or drug abuse, self harm and tactlessness. It is important to remember that someone may find an individuals behaviour challenging but someone else may feel this behaviour is acceptable. Once you know an individuals personality you will learn to recognise triggers that cause the individual to present challenging behaviour. You should support the individual through these triggers and try to keep them calm and not let the situation escalate, distraction methods may come in useful. Every person is different and people require indvidualised care as some methods may have a postive outcome for one individual they may have the opposite effect on another.
There are many options of support for individuals who present challenging behaviour, for example someone with agitation and anger problems could have therapy for anger management. It is also important to make the individual aware that their behaviour is not acceptable, although make it clear to them that it is the behaviour that is unacceptable, not their personality. It is important to try positive diversion methods to change someones behaviour before punishing them for their actions as most people do not respond well to punishment. As mentioned above there are many different methods to support an individual who is presenting challenging behaviour. Support can range from giving the person feedback on their behaviour to looking at any medication which may be effecting their behaviour. Another effective way of supporting someone with challenging behaviour is to teach them new skills and behaviours. It is important that if their is a change in an individuals behaviour or the individual is presenting challenging behaviour that it is reported so that the individual can be assessed for any potenial further medical conditions which may be causing this behaviour.
As a care worker it is important that you report any challenging behaviour to your manager, you will then need to discuss with management the next steps, such as informing the individuals doctors, social worker and family. As part of Occupational Health and Safety regulations you need to complete an incident report for any inappropriate behaviour. By documenting challenging behaviour it also helps to identify any triggers or trends in the individuals behaviour. Challenging behaviour can cause the care giver to sometimes feel frustrated or angry with the individual. It is important not to show these feelings and have patience with the individual, negative body language and tone of voice could cause a situation to escalate. Everyone has their own attitudes and values. As a health care proffesional it is important not to influence someones behaviour based on your own values and to curb your own behaviour and attitudes whilst in a professional environment.