Neurobehavioral Issues
Did You Know?
Cognitive, physical, and perceptual changes may follow a traumatic brain injury, affecting how a person experiences the world and interprets events. These changes are likely to affect how the person interacts with others and responds behaviorally.
Behavioral issues often constitute the biggest challenge for the family, community, and others who become involved with an individual after a brain injury. These issues can be characterized in a number of different ways. At the neurological level, particular areas of the brain may be characterized as contributing to behavioral issues (e.g., frontal lobe injury is often associated with behavioral disturbance). Or, particular cognitive or perceptual functions may be connected with certain behaviors (e.g., problems with memory, concentration, attention, or language).
As time passes following an injury and assessment continues, it is likely that behavioral issues will be represented in progressively more specific ways. For example, behavioral problems are frequently characterized as being the result of problems with initiation, agitation, learning difficulties, self-awareness, judgment, planning, organization, problem solving, impulse control, and social disinhibition. Health care providers might consider these more descriptive “executive functions” in their attempt to interact, understand, treat, and provide more targeted assistance.
At another descriptive level, behavioral issues following brain injury are often characterized with action verbs including shouts, resists, disrupts, cries, uses (substances), cusses, threatens, or aggresses. Typically, it is these “unwanted” behavioral ramifications of neurological involvement and cognitive impairment that produce the biggest concerns for families and communities, and bring the individual to the attention of professionals or service agencies. There can be a great deal of variability in the intensity of unwanted behavior, from an awkward social comment to potentially dangerous property destruction, self injury, or aggression.
Many individuals who exhibit intense, or potentially risky or challenging behavior following a brain injury are treated by professionals who have not been trained in brain injury and in settings not designed to address brain injury. This can occur because many rehabilitation programs and families are not well-equipped to address the risks that some individuals pose and because other settings are more typically associated with mental health/psychiatric behaviors. It may also occur because the behaviors are not viewed as being related to a brain injury or because specific brain injury services and supports are not yet well-developed. In either case, the potential pitfalls are clear. When persons with brain injury are served by systems not sensitive to the unique issues they face, there is increased chance that the relation between the brain injury and the behavior will become blurred, disregarded, or sometimes completely lost.
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