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Supporting People with Acquired Brain Injury by Louise Cato, Clinical Lead

An acquired brain injury can occur to anyone at any time in life, due to a range of different causes such as impact injury, stroke, tumour or infection. The resultant effects can be devastating for the individual, their families and carers.

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When a person suffers an acquired brain injury we may see changes in their physical abilities, speech and language skills, senses (hearing, seeing, smell/taste, feeling pain and temperature), thinking and memory.

It is common for people to suffer damage to the frontal lobe especially after an impact injury. Because the frontal lobes are vitally important for controlling “executive functions”, injury to this area can result in deficits in:

  • Judgement, insight, planning, reasoning, problem solving
  • Attention and concentration
  • Understanding social conventions/how to behave with others
  • Regulation of emotions

These deficits can cause a range of challenging behaviours which require management by Carers and Support Workers. After a brain injury, a person may not be aware of what is appropriate and inappropriate behaviour. They may also have trouble interpreting facial expressions or non-verbal language that others are upset. Immediate, appropriate and clear management of the behaviors is essential to increase their awareness.

The following information may assist you in managing these Customers with challenging behaviours.

This can be achieved by:

  • Developing rapport with your client. This can be difficult especially if the person you support has anti-social or unpleasant behaviours. It is important to find a connection point via an activity or a topic of interest to the client.
  • Establishing consistent routines. This provides a predictable comfort zone for the client to function in. If they know what is happening day-to-day they will be more secure and less anxious.
  • Try to be calm and respond positively during a behaviour
Controlling and managing behavioural triggers

Learn what the triggers are*

Where possible avoid or minimise the triggers

Use distraction or redirection away from the trigger. This is often effective in managing repetitive behaviors.

* If the client can be reasoned with, discuss the triggers and work together on possible coping strategies

Using positive reinforcement

Providing incentives immediately after a desired behaviour occurs is the most effective reinforcement for minimising negative behaviours.

It is important to differentiate between positive reinforcement and bribery – reinforcement comes after a task is completed, bribery is offered before. Ensure the positive reinforcement happens immediately after the desired behaviour.

Ignoring the behaviour

If a behaviour is used to gain attention the most effective strategy may be to ignore it. As with many of these techniques, tactical ignoring is best linked with positive reinforcement.

by Louise Cato, Amity Health

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Photo of Clinical Lead of Amity Health, Louise Cato

Clinical Lead of Amity Health – Louise Cato

Louise Cato has worked with people with acquired brain injury for over 30 years – first as a speech pathologist and then as a Community Case Manager. She trains CLA staff who support people with ABI.