Understanding Brain Injury A Guide for the Family

Page 1 of 64 mc1298-01 Understanding Brain Injury A Guide for the Family
Understanding Brain Injury
A Guide for the Family
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Table of Contents
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Introduction ........................................................................................................................ 3
A Team Approach ............................................................................................................. 5

Brain Structure and Function .......................................................................................... 7
Causes of Brain Injury ...................................................................................................... 9
The Recovery Process ...................................................................................................... 11

Stages of recovery ....................................................................................................... 12

Treatment of brain injury .......................................................................................... 13
Compensation Strategies ................................................................................................ 15
Thinking Changes After a Brain Injury ...................................................................... 16

Perceptual changes .......................................................................................................... 20

Behavioral Changes ......................................................................................................... 23
Emotional Changes .......................................................................................................... 26

Depression .................................................................................................................... 27

Self-esteem ................................................................................................................... 29
Communication Changes .............................................................................................. 30
Other Physical Effects of Brain Injury ........................................................................ 33

Fatigue .......................................................................................................................... 33

Seizures ......................................................................................................................... 34

Spasticity ...................................................................................................................... 36

Swallowing ................................................................................................................... 37

Bladder and bowel ...................................................................................................... 38
Life After Brain Injury ....................................................................................................40

Going home.................................................................................................................. 40

Relationships................................................................................................................ 40

Sexuality ....................................................................................................................... 42

Driving .......................................................................................................................... 43

Returning to work ....................................................................................................... 43

Returing to school ....................................................................................................... 44

Recreation and leisure ................................................................................................ 45

Use of alcohol and drugs ........................................................................................... 46

Activity restrictions .................................................................................................... 47
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Available Resources ........................................................................................................ 48
Contacting Health Care Providers ................................................................................ 50
Appendix A: A Partnership Approach ....................................................................... 51
Appendix B: Memory and Organizational Aids ...................................................... 52

Calendar ....................................................................................................................... 52

Cue Cards ..................................................................................................................... 54

Appendix C: Problem-Solving Worksheet ................................................................ 55
Appendix D: Americans with Disabilities Act ......................................................... 56
Summary ............................................................................................................................ 57
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Introduction
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Key Messages
• Brain injury affects virtually every area of a person’s life.
• The relationships, roles and responsibilities of family members and other
people close to the person will experience a period of adjustment.
• Adjustments are best made in small steps with the instruction and guidance
of health care team members.
Brain injury is a life-altering event which affects every area of a person’s life —
including his or her relationship with family members and others close to him or
her. The phrase acquired brain injury refers to medical conditions that occur to the
brain (usually after childhood), changing its function. These conditions include
stroke, traumatic brain injury, tumor and other diseases of the brain.
The effects of brain injury often change roles and responsibilities within the family.
Family members and others close to a person with brain injury may struggle
to cope with behavioral changes caused by the brain injury. The injured person
also may struggle to adjust. Family members and others close to the person
may feel stressed, burdened, even depressed by the major changes in activities,
responsibilities, daily schedules, leisure and support that are required to adjust to
the consequences of acquired brain injury.
Often, major adjustments are best made in small steps. Simple changes may help
the person with brain injury, family and friends to find more enjoyment in their
relationships and activities. By taking each stressful situation one step at a time,
the person with brain injury and family may feel that life is becoming a little more
“normal” again.
This booklet contains information on the human brain, causes of acquired brain
injury, the recovery process, and behavior, communication and physical changes
after brain injury. It also outlines examples of stressful behaviors and situations
that people with brain injury may experience. Possible solutions follow each
example. A solution that works well for one person may not work for another. For
this reason, the best way to use this booklet is to try one solution for two or three
weeks. If that solution does not work, try another.
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Sometimes, the ideas in this booklet stimulate families to develop unique solutions
to challenges. If, after trying several solutions to a problem, nothing seems to
work, seeking advice from a professional may help. A brain injury psychologist
(neuropsychologist), clinical social worker or other behavior specialist can help
analyze and develop an approach that considers the special features of the patient’s
situation.
Recovery from brain injury is a process that takes time. In recent years, brain
rehabilitation as a specialty has advanced in its understanding of ways to
encourage and maximize recovery. Your team will use all available knowledge
and techniques while caring for your loved one. Consult any member of the
health care team to address your concerns and questions.

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A Team Approach
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Key messages
• Many people play a role in a person’s recovery after a brain injury.
• You and your loved one with brain injury are the most important members
of the health care team.
The health care team is an important source of information and support to the
injured person and family. The team can recommend a treatment plan and help
you learn skills to meet specific needs. Health care team members may include:
• A primary care physician.
• Physiatrists — Physicians who specialize in physical medicine and rehabilitation,
including brain injury rehabilitation.
• Rehabilitation nurses — Nurses with training and expertise in brain injury
rehabilitation and discharge planning.
• Neuropsychologists — Professionals with training and expertise in evaluating
and treating thinking, behavioral and emotional changes caused by a brain
injury.
• Physical therapists — Professionals who evaluate and treat changes in physical
abilities.
• Occupational therapists — Professionals who evaluate and treat thinking and
perception problems, and help an injured person maintain or learn independent
living skills (for example, swallowing, eating, dressing, managing money and
safety awareness).
• Speech language pathologists or speech therapists — Professionals who
evaluate and treat communication and thinking problems.
• Recreation therapists — Professionals who help a person with brain injury
explore and participate in leisure activities.
• Clinical nurse specialists — Professional nurses who help coordinate care of
patients with brain injury and support and educate their families about the
injury and recovery process.
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• Social workers — Professionals in the hospital and outpatient settings who help
guide the adjustment to acquired brain injury. They provide information on
discharge planning, assessment of financial resources, and community resource
referrals. They may also assist in addressing stress management and the
development of effective coping and adjustment strategies.
• Other professionals, such as respiratory therapists, child life therapists,
chaplains, dietitians, and vocational (employment) counselors.
You and the person with brain injury are important members of the health care
team. Active participation in treatment and rehabilitation is essential to recovery.
The involvement of other family members, caregivers, friends and co-workers
also can help the person with brain injury successfully return home and to the
community.

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Brain Structure and Function
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The human brain has billions of nerve cells. They are arranged in patterns that
work together to control thought, emotion, behavior, movement and sensation. For
reference, it helps to know about the brain’s structure and function.
The brain is divided into two halves that look nearly the same but differ
in many functions. The halves are called the cerebral hemispheres (figure 1). These
are further divided to create four separate areas called lobes.
Midline
Right
Left
hemisphere
hemisphere
Figure 1. Cerebral hemispheres
For most people, the left half of the brain controls verbal functions including
language, thought and memory involving words. The right half controls nonverbal
functions. These include, for example, recognizing the differences in visual patterns
and designs, reading maps and enjoying music. The right hemisphere also is
involved in expressing and understanding emotions.
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Although each half of the brain has distinct functions, the two parts actually
work closely together to control the activity of the body. The left side of the brain
controls movement and sensation in the right side of the body, and the right side
of the brain controls movement and sensation in the left side. Thus, damage to the
right side of the brain may cause movement problems or weakness on the body’s
left side.
Specific parts of the brain control specific functions. The effect of a brain injury is
partially determined by the location of the injury (figure 2).
Touch
Movement
Perception
Speech
Vision
Planning and
problem-solving
Smell
Balance and
Hearing
coordination
and memory
Heart rate,
breathing and
blood pressure
Figure 2

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