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Common effects of brain injuries

The most common causes of brain injuries in the modern context are motor vehicle accidents, assaults, and falls from heights. In these accidents, the frontal lobes are most commonly injured because this area is in a vulnerable position, and is covered with an uneven surface of bone that may cause injury. A blow to the front, back, or side of the head may cause damage to the frontal lobe. Even a whiplash type injury has been seen to cause injury to this area.

Non-impact accidents may also damage the frontal lobes because this region of the brain is particularly susceptible to oxygen deprivation. As examples, partial drownings, heart attacks, drug overdoses and attempted suicides may cause brain injuries if they deprive the brain of oxygen.  These latter type of injuries are termed “anoxic” brain injuries.

The primary role of the frontal lobes of the brain is regulation of higher thought and behavior. The frontal lobes understood to coordinate attention, memory, language, perception and social behaviors, and as a result, certain problems are known to result from an injury to this area. Any or all of these issues may occur to varying degrees, and how they are manifested is dependent not only on the type injury suffered, but also on the personality of the person before the injury. The most important variable, however, is a person’s own awareness of their injury and their ability to learn new behaviors. Both these factors are very difficult for doctors to assess, as is how the brain may be able to recover.

1. Lack of Insight and Impulsiveness

The most complex consequence of brain injuries may be the effect they have on a person’s thought processes. Brain injured people often have great difficulty reviewing their actions, or recognizing and accepting changes in thinking and behaviour. The relationship between act and consequence may not be fully understood.  For example, once brain injured people have an impulse, they may be unable or unwilling to change their mind. The result is that brain injured people may appear to have one-track minds that operate on a very superficial level. They may repeat themselves and become argumentative.

A related problem is impulsiveness, which is manifested differently in each person. Some have aggressive responses that they cannot control, while others may take items on impulse, or may touch people in a sexual manner that is inappropriate. All these responses may be impulses that the non-brain injured person would unconsciously resist.

Therapists deal with insight problems by providing frequent clear instructions. One of the rules often given to higher functioning people is “stop, think, act.” Anger management may be necessary.  Some individuals are prescribed medication such as mood stabilizers, depressants, anti-depressants, and other cognitive medications.

2. Memory Problems

This is the most common effect of brain injuries, and it is particularly severe in anoxic brain injuries. People may have trouble remembering names, appointments or where articles have been put. At higher severity, they may forget activities they have planned, or what they are doing from moment to moment. For example, a person may not remember how to get to a particular store, even if they go there regularly.

Brain injured people may deal with this problem by relying on a notebook and using lists or maps to assist them. One problem is that learning to remember to rely on a list is a learned response that may be difficult for some to master consistently.

3. Poor Concentration

Brain injured people have a tendency to get distracted from what they are doing. Tasks that require concentration may be frustrating or impossible. For example, previously favorite activities such as reading or watching TV may be difficult, if not impossible.  Note that this problem exists alongside and in contrast to the uni-directional thought problems connected to a lack of insight.

This problem is most often addressed by controlling the environment. If activities require concentration they should be of short duration, and free of distractions. Many activities may be adjusted, such as reading short stories or magazines instead of books. Other activities may be impossible.

4. Slowed Responses

Brain injured people are often slow to answer questions and make decisions. The result of this problem is that brain injured people may have difficulty in group situations, as they cannot keep up with conversation. Another common effect of this problem is that their responses may be misinterpreted by people who do not know of their condition. They could, for example, be seen, incorrectly, to be impaired by alcohol or a drug, or they may seem unresponsive in a disrespectful or hostile manner.

Response time is dealt with through medication and by controlling the person’s environment. This is most important where a person could put themselves at risk. For example, some brain injured people are not permitted to drive, and may require supervision at times.

5. Lack of Initiative and Poor Problem Solving

Many brain injured people lack initiative. In spite of their intentions, they may have trouble starting even simple activities such as bathing or cooking. They may have difficulty starting interaction with others, even if that is exactly what they hope for.

A related problem is that brain injured people have great difficulty making decisions, and they may be unable to plan a sequence of activities. Open-ended decision making, such as independently finding a solution to problem, may be impractical unless it can be broken down into discrete and concrete components.

Therapists deal with initiative and planning problems with tools such as lists of tasks and alarm clocks to prompt the person to start the activity. Breaking all decisions and activities down into component parts is also helpful.

6. Emotional Rollercoaster

Brain injured people may have difficulty controlling their emotions in the same manner that they cannot control their thoughts or behaviour. They may laugh or cry at inappropriate times or more than is reasonable. In spite of this overly dramatic reaction, the underlying emotion may not be as strong as the reaction. For example, brain injured people may appear very angry when they are only mildly so. They may laugh hysterically at something that they know is only mildly amusing.  Like many of the problems experienced by brain injured people, emotional responses are handled most often with understanding, frequent repetition and common sense.

7. Depression and Dependency

Depression is very common among brain injured people because most have a degree of insight into their deficits and may recall how they functioned before their injury. Specifically, most may be aware that they cannot process information properly and that their behaviour is inappropriate. Similarly, they may know that they cannot cope with social situations because of their slowed responses, lack of initiative and emotional reactions. More generally, they may become distressed because they lack the ability to consider their problems in a reasoned way, or to decide on practical solutions.  Deepened depression is also a serious concern where brain injuries are caused by suicide attempts initially motivated by depression.

One of the consequences of depression in injured individuals is that they are known to become very dependent on family or friends. They may be manipulative in order to secure the support or security they crave.

Depression and emotional dependency may be treated through counseling, if a person has the cognitive ability and memory to benefit from it. Otherwise, anti-depressants may be used. Nevertheless, an unfortunate reality is that brain injured people attempt suicide at a significantly higher rate than the general population.