Common Behavioral and Emotional Challenges Associated with Traumatic Brain Injuries (TBI’s)

It is commonplace for an individual who has sustained a traumatic brain injury (TBI) to experience or to display outward behavioral and emotional changes following it. The traumatic brain injury (TBI) may have been mild, such as a concussion, more severe or somewhere in between.

Two main kinds of occurrences account for most traumatic brain injuries (TBI’s):  a blow to the head by an external object, or rapid acceleration or deceleration of the head. The former usually results in injury, sometimes catastrophic injury, to the scalp, skull, and brain surface such as contusions, lacerations and hematomas[1]. Frequent sites of such injury are the anterior temporal poles, lateral and inferior temporal cortices, frontal poles, and orbital frontal cortices.

A traumatic brain injury (TBI can also result from an acceleration/deceleration occurrence, sometimes called an “inertial injury.” It is no less, at least potentially, a catastrophic injury. As the terms suggest, the injury results from rapid acceleration and/or deceleration of the brain. This can cause shear, tensile, and compression forces within the skull and cause the brain to hit the inside of the skull. In addition to or instead of the impact, this kind of traumatic brain injury (TBI) can have a serious result on axons and blood vessels. The dynamics of the injury can result in axonal injury, cerebral tissue tears and intracerebral hematomas. These kinds of injuries tend to produce more widespread brain injury to the frontal white matter of the brain[2].

Some brain injuries cause focal – or localized – brain damage. That is, the damage is confined to a fairly small area of the brain that controls a relatively small range of physical, mental, cognitive, behavioral and/or emotional functions. The result is that the range of effects is smaller in dimension or effects a smaller scope of cognitive functions.  It is nonetheless a catastrophic injury. Other kinds of traumatic brain injuries (TBI’s) result in diffuse brain damage. This means that damage extends to several or to broader areas of the brain. For example, if both sides of the brain are damaged and the nerves are stretched throughout the brain, diffuse axonal injury may result[3]. Some traumatic brain injuries have characteristics of both focal and diffuse injury.

In either case, it is critical that acute care be immediately rendered. Thereafter, and once the individual has been medically stabilized, post-acute rehabilitation is required at a premier post-acute rehabilitation facility such as NeuLife Rehab in Mount Dora, Florida. When an individual becomes a Client of NeuLife Rehab he or she undergoes an independent functional evaluation by a multi-disciplinary team of professionals that may include the following:

• Board Certified Neurologist
• Board Certified Behavior Analyst
• Board Certified Physiatrist
• Neuropsychologist
• Psychologist
• Board Certified Psychiatrist
• Speech Language Pathologist/Cognitive Therapist
• Physical Therapist
• Occupational Therapist
• Nurses
• Certified Rehab Counselor

The behavioral or emotional challenges that an individual who sustains a traumatic brain injury (TBI) could face depends upon a variety of factors. A major one is the area of the brain that the traumatic brain injury (TBI) most greatly affected. Even so, it is important to recognize that all individuals who experience traumatic brain injuries (TBI’s) are different before the catastrophic injury and that in most cases, there is no available baseline against which to measure their current level of function. Therefore, once an individual has been medically stabilized in an acute care facility and progresses to post-acute rehabilitation at a facility such as NeuLife Rehab in Mount Dora, Florida, it is vital that an independent functional evaluation be conducted by a multi-disciplinary team of professionals. This will permit baseline evaluations of progress throughout the course of post-acute rehabilitation.

All of that said, some generalities may be drawn concerning the behavioral and emotional challenges that may be experienced by an individual who has sustained a traumatic brain injury (TBI). Not all individuals experience all of them; not all individuals experience them at the same point in their post-acute rehabilitation, and yet others may not experience them at all. But for those who do, when they become Clients of NeuLife Rehab in Mount Dora, Florida, they are consistently provided with the highest standard of care in the delivery of clinically relevant services to achieve successful, sustained outcomes that exceed the expectations of all persons served.

• Changes in cognition. Initial and persistent cognitive deficits are the most common complaints after a traumatic brain injury (TBI). This is usually the major problem that an individual has in normalizing his or her life in the areas of independent living, social adaptation, family life and vocational endeavors. Several cognitive areas are usually impaired, including frontal executive functions (problem solving, set shifting, impulse control, self-monitoring), attention, short-term memory and learningspeed of information processing and speech and language functions.
• Change in personality/emotions. Families of individuals who have had a traumatic brain injury (TBI) often describe changes in emotional and behavioral regulation; this is usually characterized as a “change in personality.” It often takes one of two forms: (1) exaggeration of pre-injury traits or (2) fundamental changes in response patterns. As to the second, there can be either changes in the frequency or in the intensity of predictable responses, or the development of unpredictable response patterns.

Impulsivity sometimes arises in the category of changes in personality or emotions. Sometimes this comes in the form of utterances, physical actions, abrupt decisions or poor judgment resulting from an inability or failure to consider consequences of the decision.

Another challenge can be irritability. The individual may encounter an objective and legitimate aggravation, but his or her response may be greatly out of proportion. In other words, there is a deficit in the individual’s ability to modulate his or her response.

“Affective instability” is another area of potential personality change that can result from a traumatic brain injury (TBI). It relates to an exaggerated display of emotional response out of proportion to the causative event. One way to measure this is to consult with friends or family members to obtain a baseline as to the individual’s pre-injury response to similar events.

Apathy, or lack of motivation, is sometimes observed after an individual sustains a traumatic brain injury (TBI). Sometimes it is characterized as “laziness” or is linked to depression. The main challenge here is that apathy may limit an individual’s progression toward independence during the course of post-acute rehabilitation.[4] It is therefore all the more critical that, as NeuLife Rehab does, have on its multi-disciplinary team, psychiatrists, psychologists, neuropsychologists and other mental health professionals to assess and, as needed, treat behavioral dysfunctions such as these.

Proper and timely post-acute rehabilitation that may determine the difference between disability and independence is what NeuLife refers to as the “platinum post-acute period” —  the crucial window following acute care that is needed to nurture the whole person to health with specialized, clinically relevant services.

NeuLife’s philosophy is that healing, wellness and personal fulfillment are best achieved in a positive and uplifting therapeutic environment where caring staff encourages, assists and supports each client so he or she may achieve specific goals. NeuLife believes personal fulfillment is equally as important as goals to achieve function and independence.

NeuLife, in Mount Dora, Florida, is an accessible residential post-acute program providing specialized rehabilitation to individuals diagnosed with Traumatic Brain Injury (TBI), Spinal Cord Injury (SCI), Amputations, Burns and other Catastrophic Injuries and Challenging Diagnoses.

2725 Robie Avenue

Mount Dora, Florida 32757

[1] Gennarelli T, Graham D, Silver JS, McAllister TW, Yudofsky SC. Neuropsychiatry of traumatic brain injury. Washington: American Psychiatric Press. 2005:27–50.

[2] Ibid

[3] http://www.webmd.com/brain/brain-damage-symptoms-causes-treatments

[4] http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2327235/