Neurobehavioral Problems after Severe Brain Injury
Neurobehavioral Problems and Deficits after Severe Brain Injury
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Neurobehavioral problems and neurobehavioral deficits after severe brain injury are the most difficult to deal with because they impact the access to care. Technically, neurobehavioral problems may begin at the acute stage of an injury, with anyone who is confused and agitated, fighting their restraints when being intubated. Neurobehavioral problems could also include those patients who are forced to be restrained or put in locked units because they are elopement risks. In the acute stage, the more confused and agitated the survivor is, the more challenging it is to get them the appropriate care.
However, when addressing the issues of neurobehavioral problems after a severe brain injury, we are primarily talking about extreme moods swings and inappropriate behavior that occurs after a person has fully emerged from the coma. The term nuerobehavioral problems primarily refers to difficulties adapting to dramatically changed life circumstances after injury, with a brain far less flexible in its ability to adapt. Thus, we think of neurobehavioral problems as being at the intersection of the organic change to the mind and the extreme change in the life circumstances that the survivor has to deal with post-brain injury.
Anger is a neurobehavioral problem. While everyone one gets angry, the cause, the nature and magnitude of a survivors anger is quite different. Frustration is a neurobehavioral problem. While everyone gets frustrated, their is something completely unique about the kind of things a survivor gets frustrated with and the way in which that frustration builds into a complete meltdown.
On our next page, we will talk about some of the more subtle neurobehavioral problems, things such as disinhibition. Here I want to focus on the danger to the entire chance at recovery, from neurobehavioral extremes in the sub-acute stage of the injury, the period in the early months after the coma. Neurobehaviroal problems with temper and rage can become extreme. They can become violent. Even when they do not involve physical violence, anyone who is the target of such anger, will feel the victim of abuse. It is not just the magnitude of the anger, but the irrational explanation for the anger. Further, it is most dangerous stage, there will be no doubt that the anger is directed at someone who is trying very hard to help the survivor, particularly a spouse.
My first brain injury clients were not personal injury clients. At the time, I was a general practice lawyer in small Wisconsin town. I was appointed by the Court to represent severely brain injured individuals who had battered their spouses. In each case, I was able to get the charges dropped, but the marriages were over. Without the bond of love from a caregiver, the best chance of ongoing brain injury recovery for that survivor was lost.
We heard several stories of severe neurobehavioral problems in our TBI Voices project. The best glimpse into the problem comes from the loved one who was the target. But even the now more fully recovered survivor can recognize how serious this problem was early in post-institutional recovery.