Brain Injuries and Behavioural Problems

Behavioural problems quite often are a result of brain injuries. There can be many problems or few depending upon the severity of the injury and in what part of the brain the injury is located. Some of the potential problems are as follows:

Mood swings, depression, hyperactivity, aggression, sexual inappropriateness and/or promiscuity, lack of initiative or motivation, changes in emotional control, lack of impulse control, poor concentration, lack of empathy, fatigue, thoughtless or hurtful remarks, difficulty in relating to others, excessive demands, personality changes, a tendency towards being frustrated, irritated or angering easily. Unawareness of others' feelings is other another deficit and may be something that has to be relearned. Another serious and very common problem is short-term memory difficulties, as is a lack of awareness of their deficits.

If a brain injury survivor is affected with any of these behavioual problems, it is very stressful for family members and caregivers. It may be important to have cognitive and behavioural rehabilitation and possibly the help of a neuropsychologist. It will also be important to have an assessment done which will help both the survivor and the family member. And because behavioural problems not only affect relationships but performance in school and work, it will be necessary to attempt to alleviate the problems or at the least, to help cope with their impact. The following are some of the things that can be done in order to help minimize problems associated with behavioural changes following a brain injury:

- to be calm and speak in a soothing manner when the brain injured survivor is angry or frustrated;

- help them attempt to problem-solve their difficulties;

- use anger management strategies and remain low-key;

- avoid confrontation if they are angry;

- attempt to distract;

- attempt to identify any triggers so as to avoid future difficult situations;

- encourage the survivor to join a support group;

- be non-judgmental;

- help a sufferer of a brain injury to have positive experiences by offering encouragement and support;

- avoid arguments and criticism;

- help them to have a schedule and structure in their lives;

- don't give too much information at one time;

- establish consistency and always remain calm;

- and, if depression is suspected, have survivor see the doctor and if necessary, ensure that he/she gets treatment.

A total reversal of behavioural problems following a brain injury may not be possible. Modifying behaviour may be a more realistic goal while working towards improved quality of life and successful community integration.

Developing adaptive behaviour requires recognizing triggers and anticipating factors preceding the behaviour. These may be internal such as fatigue or hunger. External factors may be a frustrating task or increased levels of stimulation. Prior signs to difficult behaviour may be pacing, becoming fidgety, their face may become flushed, or they may begin muttering to themselves. Early intervention when a problem arises may assist them, over time, in changing their behaviours.

Brain Injuries and Sensory Deficits

Sensory deficits following a brain injury are usually the result of damage to either the right side of the brain or the parietal and occipital lobe region. Sensory deficits are those to do with hearing, smell, taste, touch and body language such as emotional and non-verbal signals. These deficits can lead to lack of communication, confusion and frustration. Some may even develop tinnitus, a ringing in the ears.

Other problems may be auditory perception having to do with sounds and visual perception relating to colour confusions, shapes, size, depth and distance. Those who suffer from the sensory deficit of vision loss, problems with hand-eye coordination or having blind spots or double vision may, as a result, be somewhat clumsy.

Another sensory deficit is textile perception relating to pain, pressure and temperature. The skin may also tingle or itch excessively. Olfactory perceptions relates to smells where everything has an unpleasant odor, and gustatory perceptions relate to taste where everything tastes bitter are some of the other deficits.

Those suffering from sensory deficits may also have problems copying or recognizing objects, being able to tell their left from right, doing mathematics, or analyzing and remembering visual information. They may also have a problem with awareness of their body such as when climbing stairs, following directions or constructing even simple objects.

One well-known syndrome involves ignoring something from, typically the left side, i.e.: food on the left side of their plate. They may also have an inability to recognize faces, even those very familiar to them, such as their own spouse, and are often unable to determine emotional cues of any kind. In some cases, they will not even be able to recognize a picture of themselves.

Identifying any object requires most of the senses: sight, (What does it look like?); touch, (What does it feel like?); sound, (What does it sound like if chewed? Does it even have a sound?); smell, (Does it have a smell?), and by taste, (What does it taste like?). If one or some of these senses don't work, the person will have to rely on their other senses.

Other solutions may be retraining which would include repetitive and intensive exercises of the necessary skills. This can be effective with specific skills, i.e.: recognizing faces of their closest family members. Compensatory strategies may be another solution. Modifying their environment may also be necessary using safety devices such as hand rails, ramps or by moving furniture, etc. to make movement within their home environment easier.

Some sensory deficits may initially go unnoticed by others such as the sense of smell or taste but can be unpleasant for the sufferer. Whereas others can cause severe problems such as vision or communication deficits. Helping to find a solution to these deficits will be important for your loved one.

Brain Injuries and Cognitive Disabilities in the Classroom

Cognitive disabilities can be the result of learning disabilities from birth or from a brain injury. Regardless of the reason for it, those children who have these disabilities can have difficulties in the classroom.

Disabilities can include sensory impairments such as visual or hearing; physical or motor difficulties or, cognitive disabilities with mental tasks and processing. This can include difficulty with reading or comprehension because of problem-solving difficulties, and memory or attention/focusing. Problems such as these can be the result of a traumatic brain injury, autism, dyslexia, ADHD or a health or emotional problem.

For those children that have a brain injury or a learning disability, the classroom can be a scary place to be. Classrooms are often overcrowded and may appear chaotic to a child with a disability.

The prevalent philosophy is for all children to be treated equally so they feel that they fit in. But this is obviously not working. Many of these children need to be treated differently in order to learn because many of them have different learning requirements than those in the general education classroom. These problems often require an appropriate learning format for their type of disability.

Some children have difficulty with time constraints and work more efficiently at their own speed. This is very difficult in a general classroom situation where everyone is supposed to be working together and keeping up. These children are likely to be left in the dust and the spotlight will be on them. This will make them feel even more different than if the teaching had been geared to their own learning requirements right from the beginning.

It is difficult for a student to receive this type of support for their cognitive disabilities within the school system because of the lack of funding. It is very difficult, if not nearly impossible, for one teacher to handle a mixed bag of disabilities with the necessary strategies required to suit each disability. In order for there to be success, it is necessary for there to be some assistance within the classroom but this is often not the case. Funding in many schools has been lost and there are few teachers aides available in many schools.

There have been some suggestions made such as the restructuring of how classrooms operate. Another idea has been differentiated instruction (tailoring instruction to meet individual needs) done with a flexible and individual approach; using peer tutoring and, grouping students who struggle.

There is no easy solution but it is clear that the present classroom situation does not work for all children. Although there are approaches that can help, it boils down to the need for further funding for schools, with more teachers aides, so that all children can receive the education they require.

Brain Injuries and Communication

Communication involves not only speaking but listening to words, observation of facial expressions, hand movements and comprehension. Many brain injury sufferers have difficulty with communication because of cognitive and memory problems as well.

Often brain injury sufferers will have difficulty in maintaining a topic in conversation, they may use an inappropriate tone of voice, i.e.: possibly speak in a belligerent manner; have difficulty determining the difference between a sarcastic remark and a serious comment, or have a problem understanding a fast-paced conversation. Others may have difficulty taking their turn in conversations or may not be able to find the correct word to express themselves in either speech or the written word, or they may have difficulty understanding not only conversations but with comprehension when reading books or newspapers. Following the story line in a movie may also be hard for them to do. Some may also become overemotional when communicating with others or be unable to respond to another person's body language.

For others, their thinking skills may have been affected which will in turn make communication difficult. Memory problems will also affect their communication abilities because the thread of a conversation may be lost. Or they may have trouble concentrating if there are distractions. Their ability to process what others are saying if they speak too quickly may make understanding more difficult as well. Organizing their thoughts and becoming confused easily may hinder communication also. Social situations may become more difficult because of communication problems. In some cases, they may place the blame for these difficulties on the person to whom they are speaking.

Other problems with brain injuries and communication which may exist are: difficulty when given too much information at one time and therefore, have an inability to understand the meaning; have difficulty paying attention when others are speaking; problems following instructions; may take jokes, etc. too literally, or they may repeat the same thing over and over again.

Difficulties with communication after suffering a brain injury will depend on the severity of the injury and what part of the brain was affected. What can the brain injured sufferer do to help himself/herself?

They can make an effort to remain calm when understanding is a problem; they can ask others to speak more slowly; plan ahead what they want to say; turn off the television and other distractions; repeat what has been said to them to make sure they understand, and ask for an explanation if they don't.

What can others do to assist someone when communication is a problem? Give them time to speak, don't make them feel rushed, don't speak for them, encourage them, don't force anyone to speak if they are reluctant to do so, use short and simple sentences, don't interrupt them when they are speaking and include them in general conversations.

Communication is probably one of the most important skills we can possess. Cognitive and memory difficulties can affect communication so it may be necessary to deal with those problems first in order to be able to resolve communication difficulties. Just like it takes a village to raise a child, the brain injury sufferer will require assistance with his/her communication problems as well.

Brain Injuries and Self-Awareness

A brain injury can make it very difficult for sufferers to understand their impairments and limitations. Often a lack of self-awareness is a form of denial but it can be much more than that too.

Self-awareness is the ability to understand the difference between the deficits they now have and their pre-injury self. A lack of self-awareness makes it difficult to understand what their current deficits mean to their future and to the goals they may have once had.

It is the ability to monitor and correct behavior; self-awareness is not only the ability to recognize and understand their cognitive deficits but their physical and social behaviors as well. Those with this deficit cannot perceive themselves in an objective manner, often not realizing that they, in fact, have any limitations or impairments.

This lack of self-awareness will cause them to be unmotivated and they will see no need for their therapy and rehabilitation. They may lack judgment or make unrealistic goals which will make rehabilitation difficult. A lack of self-awareness may appear to be a denial of their deficits.

Those with more self-awareness will be willing participants in their rehabilitation and therefore, will be more successful in coping with their deficits and becoming integrated into the community. However, with self-awareness there is the possibility of depression when realization of their disabilities is fully recognized.

Many with brain injuries are more aware of their physical disabilities than they are of their social and emotional ones. Memory deficits can also affect the ability to be self-aware because they may not remember their behaviors and think of themselves as they were pre-injury not realizing there's a difference.

To help someone who may be suffering from lack of self-awareness, allow them to do what may be beyond their capabilities, when it is safe to do so, giving them the opportunity to learn through trial and error situations. Give them realistic and supportive feedback in a non-judgmental way, help them to set realistic goals and develop plans towards accomplishing these goals, and have them keep track of their progress.

When lack of self-awareness is a problem, making mistakes and looking for others to blame is common. Failing in their job performances may be another example of their lack of awareness. Therapists will try to get those lacking self-awareness to see the difference between their perceived levels of functioning and their actual levels of performance.

The deficit of impaired self-awareness is the most difficult to overcome and can take a long time before improved self-awareness will be noticeable in brain injury survivors.

The Therapeutic Benefits of Music for Those With Brain Injuries

Studies have shown that music can promote new neural connections for those with brain injuries. As well, music has been proven to trigger memories possibly assisting with memory loss as well as cognitive and physical functions.

For help in overcoming such syumptoms as short term memory loss and impaired decision making skills, music is being considered as a therapy for those with brain injuries. Some therapists are introducing neurological music therapy to their patients because studies indicate that music can promote new neural connections.

Music assists with speech and language skills, physical functioning and social interaction. Because music is a whole brain function, it can affect emotional well-being and assist with motor skills such as learning to walk again or in using fine motor skill development to manipulate small objects. Music offers an opportunity for those suffering from brain injuries or strokes to relate to others. It can increase confidence and self-esteem as well as help to reuild self-identity.

. Therapy includes listening to familiar music, relating to the rhythm and tempo, singing songs or playing an instrument such as the drums. Music therapy is used in a clinical setting by a qualified therapist to stimulate brain functions, encourage social interaction, emotional and cognitive requirements and to rehabilitate speech and language disabilities.

Music therapy is believed by many to improve the quality of life. Studies indicate that rhythmic auditory stimulation will help with movement, musical improvisation is good for emotional expression, and singing can assist with speech. Listening to music is believed to be a benefit in controlling pain and in increasing auditory processing. It is also believed that music therapy will help prevent depression as well which is often a serious symptom of brain injuries.

In many of these therapy sessions traumatic brain injury patients each have a drum and match rhythms and tempo set by the instructor. Studies of music therapy have indicated that there have been improvements that when used have also been instrumental in relieving frustrations for those sufferers who have exhibited displays of violence as one of the symptoms following a head injury.

Congresswoman Gabby Giffords, who suffered a brain injury from a sniper's bullet, was given music therapy. This therapy has been credited with her ability to speak again by training her brain to use a less traveled pathway. The ability of the brain to be able to do this is called neuroplasticity. It is believed that few other things activate the brain as extensively as music.

Music therapy helps to promote new pathways in the brain (called neuroplasticity) thereby creating new neural connections which in turn increase the brain's ability to heal. Studies indicate that music is a great step towards brain injury recovery.

New Drug May Treat Brain Injuries, MS, Parkinson's and Alzheimer's

Studies indicate that a new drug recently tested may reduce or prevent neurological damage. It is expected that it will protect users against cognitive impairments.

The new drug, MW151 and MW189, is expected to reduce inflammation in the brain. Neuroinflammation is increasingly believed to play a major role in the diseases of Multiple Sclerosis, Parkinson's, Alzheimer's and dementia as well as brain injuries and strokes. Besides preventing the development of these neurological diseases, it is believed it will reduce the neurological damage caused by closed head traumatic injuries and strokes especially if introduced within a certain time period.

These two drugs are believed to prevent the damaging overproduction of brain proteins which contribute to the development of degenerative neurological diseases as well as the neurological damage caused by brain injuries and strokes. It is believed that it will protect against the damage associated with learning and memory deficiencies as well as other cognitive impairments.

The therapy time window, however, is considered critical. A study indicated the best time for the drug to be given someone with a brain injury or stroke is three to six hours following the injury. By doing so, it could possibly prevent future problems such as cognitive impairments or the risk of epileptic seizures.

Studies indicate that by giving the drug, a pill taken orally, before symptoms become readily apparent, in the case of Alzheimer's Parkinson's or Multiple Sclerosis, may be a promising therapeutic strategy for these neurodegenerative diseases. It is considered to be a preventative drug when given during the early stages of a neurological disease before the disease progresses. If taken in the early to middle stages, it will help to reduce inflammation.

The first human Phase I climical trial has been done on the drug and it has been found to be safe in humans. Researchers are now waiting for funding in order to begin further clinical trials. Those working with the drug feel that it will best be used in combination with current therapies targeting neurodegenerative disorders, brain injuries and strokes.

The body has proven itself to have great repair mechanisms if given a chance. If a pill can control, prevent or reduce cognitive impairments, then the body has a chance to rebuild itself. This healing process can be done when obstacles have been removed from the body and mind. But it can also heal with determination and sometimes just because that's what the body does. But with neurodegenerative diseases, etc. extra help with this drug will go a long way in warding off these debilitating diseases and eliminating the devastating results of head injuries.

It is believed that this drug will help many people in their fight against these neurodegenerative diseases, brain injury and strokes saving many sufferers and families from hopelessness and despair.

The Importance of Adequate Care for Those With Brain Injuries

For those who have had a brain injury, life becomes a challenge. It is imperative for those who have suffered a brain injury to receive adequate care because sustaining such an injury will increase the challenges they will face throughout their lifetime. A brain injury can lead to the development of neurodegenerative and neuroendocrine disorders. And because of the limitations they will face day-to-day, psychological treatment will likely be an advantage, if not necessary also. In the case of a broken leg, you know it will repair itself in about six to eight weeks but there is no predictable end in sight for those who have suffered from brain injuries.

Doctors and therapists can encourage the brain's plasticity with proper therapy which will encourage the growth of new brain cells. Only stimuli that encourages adaptive functions should be used, therefore a structured rehabilitation environment is important. As patients improve so too will the intensity of the therapy increase. One example of learning correct adaptive behaviors is a patient learning to walk again but who may occasionally lose his balance. It will be necessary for them to learn appropriate reflex actions so as not to hurt themselves when their balance is precarious. For these reasons, specialized rehabilitation settings usually lead to better results.

Many brain injury survivors unfortunately, don't receive adequate care following their injury either because it is not available in their area, they are unable to afford the care or do not have medical coverage, they adamantly refuse further specialized therapy, or they have not been diagnosed as requiring specialized therapies. This is particularly true of the thousands of Iraq and Afghanistan war veterans who have suffered traumatic brain injuries. For them, in some cases it is because Veterans Affairs officials have not determined their diagnosis. However, even following diagnosis, there has been little follow-up for reasons such as computer glitches, insufficient staffing and disorganization.

In many cases, brain injury sufferers not receiving adequate and appropriate care will endure a lifetime of frustration and challenges, not only for themselves but for their families as well. It could also mean a high cost in human life when violence is a result of brain injury, as well as a heavy financial burden to not only the family but to the community as well. Continuing depression and the possibility of suicide are also results of inadequate follow-up care for those with brain injuries.

Lack of adequate medical care and rehabilitation can also possibly lead to higher levels of medical complications, permanent disability, family dysfunction, job loss, homelessness, impoverishment, involvement with crime, drug and alcohol abuse, psychiatric disorders and lost productivity. It can also minimize social interaction within the community.

For those whose family members have sustained a brain injury, fighting to obtain adequate follow-up care for your loved one will ensure a better quality of life for them and for yourself.

Violence With a History of Brain Injury

The link between brain injury and violence is strong. The possibility is even stronger if post traumatic stress disorder (PTSD) has also been a factor.

Studies indicate that there is a correlation between brain injuries and violence. It is suspected that personality changes brought about as a result of a head injury may predispose a sufferer to violent behaviour. The cognitive and behavioral effects of a traumatic brain injury, particularly if it is a frontal lobe injury can cause aggression and/or violent behaviour. According to a recent study, a brain injury can also cause problems in reasoning, impulsiveness and aggression.

The U.S. soldier who is suspected of recently leaving his base in Afghanistan at night and killing sixteen civilians, mainly women and children, in their homes had suffered a traumatic brain injury in 2010. The brain injury occurred while involved in a vehicle roll-over accident while on tour in Iraq. He was treated and returned to duty in December, 2011. Studies show that recovery from brain injuries is not quick. Take a look at Sydney Crosby, the hockey player, and the tough road he has had to travel to recovery.

The additional problem is that many of these soldiers are not only returned to duty while still suffering from their brain injury but many have undiagnosed brain injuries. As well, it is likely that many are suffering from post traumatic stress disorder (PTSD) too.

PTSD is marked by sleep problems, irritability, difficulty concentrating, jumpiness and is often associated with anger, hostility and aggression. Flash backs can trigger an aggressive act meant to ward off a threat. Those with PTSD are more likely to perceive or imagine a threat. Also those suffering from post traumatic disorder may lack empathy, be depressed, aggressive and be unable to grasp the seriousness of a violent act.

An estimated 200,000 soldiers have been diagnosed with a traumatic brain injury since the Iraq and Afghanistan wars began with many more undiagnosed. Because brain injuries impair their judgment, a traumatic brain injury will increase the risk that a sufferer will behave violently.

The frontal lobe portion of the brain influences impulse control, understanding right from wrong and being able to anticipate the consequences of one's actions. The frontal lobe is particularly vulnerable to injury so is the most often affected. It is estimated that nearly forty percent of all TBI sufferers have exhibited violent behaviour compared to only eleven percent of those who have not had a TBI.

A study done of Iraq war veterans who had suffered traumatic brain injuries indicated that they experienced significantly more mental health problems in the years following their injuries, particularly those associated with PTSD. These problems also often lead to drugs, substance abuse and severe depression.

The soldier suspected in the recent massacre was on his fourth combat deployment. Many soldiers have three, four and five combat tours up to a year each in length. And at the height of the Iraq fighting, these tours often lasted as long as fifteen months.

This has to take a huge toll on any soldier even one without a brain injury or PTSD. Studies indicate that a high rate of Iraq or Afghanistan veterans either commit suicide or attempt suicide. Also domestic violence has surged by over thirty percent among military families. This is an unbelievably high human cost of war on many levels - of the needless killing of innocent people such as the sixteen recently killed, on the soldier himself, on his family and on the health care system.

Brain Injuries and Suicide

According to research, many of those who have suffered a traumatic brain injury are at a higher risk for suicide than those in the general population. What are the risk factors and how can they be prevented?

Where brain injuries and suicide are concerned, the following are some of the risk factors: depression, anxiety, post traumatic stress disorder, lower levels of psychosocial functioning, aggressive behavior, and those with poor decision making skills. Other risk factors are panic attacks, issues with anger, memory loss and impaired thinking, substance abuse, a tendency to withdraw from society and impulsive behavior.

Mental health disorders are a major factor contributing to suicides as well as having such pre-injury problems as a seizure disorder, (either pre or post injury), bipolar disease, personality disorder, psychosis,history of psychiatric illness or a history of suicide in other family members.

Other issues relating to the risk of suicide is a feeling of hopelessness, those who have a perception of loss, isolation, poor family relationships, feeling lonely, suffering from lack of initiative, experiencing extreme fatigue, having few friends, no significant other, an inability to get a job, cognitive issues, feelings of low self-worth, feelings of unhappiness and those who are likely to engage in high risk behaviors.

The largest percentage of brain injury sufferers at risk for attempted suicide or suicide are males in the 25 - 35 year age range. Suicides and attempted suicides are particularly high amongst soldiers in the military. The rate has increased despite programs for suicide prevention and intervention particularly since the wars in Iraq and Afghanistan.

In order to help a friend or family member decrease the risk of suicide, what can we do? It is necessary to identify any psychiatric or psychological issues. If any are suspected, contact a Mental Health Association with your concerns. Other issues leading to a high risk situation are economic problems, inability to adjust to their disability, pre-injury problems such as a dysfunctional and chaotic family background and a lower economic status.

It is also important to be aware of any non-verbal behaviors or cues, to maintain contact with the person and be aware of their whereabouts, encourage communication, avoid arguments, help to establish a safety net, let others know of the risk potential, encourage counseling, try to identify triggers that may initiate suicidal thoughts, recognize their moods and to provide alternatives to high risk behaviors.

Most head injury sufferers are definitely not predisposed to suicide. However, if the patient is at high risk, it is important to be aware of this so that measures can be taken to ensure his/her safety.

Tools to Help With Recovery For Brain Injuries

More is being learned about brain injuries all the time as there is more awareness of them. And with awareness comes better ways of assessing injuries and finding tools to assist in recovery.

With both clinical and scientific research, it has been proven that there are benefits with music. It is one of the tools that has been discovered that help benefit those who have been victims of a brain injury. It helps to re-organize the structure of the brain. Music, such as Mozart will help with organizing thoughts, activities and emotions. It also helps with memory, sequencing, concentration, verbal communication, self-esteem, depression and frustration. Music can be used to reeducate and retrain the injured brain. It can help with language and speech problems. It has been been discovered that although a patient may be unable to speak or put several words together to form a sentence, they can sing those same words in a song that is known to them. It has also been shown to help build relationships and facilitate positive behavior. It helps to improve movement in limbs and increases their strength as well.

Music therapy can enhance cognitive skills. Classical music especially increases brain activity but all types of music can be beneficial. There is growing evidence that demonstrate music is a valuable resource tool for those with head injuries. Another of those benefits is that it increases dopamine levels and changes the brain's chemistry. Many professionals working with survivors of brain injury have discovered that music is a powerful tool.

Another tool is the use of technology devices that are being used by virtually everyone but are recently being used in brain injury recovery. They have been found to help survivors, particularly those who have speech difficulties. It allows them to be able to communicate with caregivers, medical professionals and friends, helping them to stay connected with others. Some of these assistive devices offer a voice generated option. These digital devices can help them to relearn simple tasks such as reading. The use of these devices also improves cognition and helps with memory and organizing as well as giving reminders of daily tasks eliminating the necessity of using a diary.

Computers can also be powerful tools in rehabilitation. This is especially true if programs are selected to meet the needs of the brain injury survivor. Introduction to computer use though should only be when the recipient is open to using a computer and not forced if they are adamantly opposed to it.

Another tool that is being used in some instances to treat brain injury and stroke is hyperbaric oxygen therapy (HBOT). It is a high concentration of oxygen within a pressurized chamber. It is considered somewhat controversial as a treatment for brain injuries. However, it is claimed by some that many of the conventional treatment methods are not working. In some cases it is claimed, hyperbaric oxygen therapy can dramatically increase the oxygen carried in the blood stream and therefore assists with recovery.

It was once thought that between six to eighteen months following a brain injury, there could be little hope of recovery. But with more awareness and knowledge of the brain and the discovery of tools that can now be used in rehabilitation, it is now known that a brain injury survivor can continue to improve indefinitely.

Brain Injury, Alcohol and Dementia

Alcohol and substance abuse often follow a brain injury. And the combination of alcohol and a brain injury can lead initially to dementia-like symptoms which could become dementia if there is a continual heavy use of alcohol.

Brain injuries can cause a permanent decline in cognition in the process of thinking, remembering, understanding, reasoning and communication as well as changes in emotions and behavior, depending on the location of the injury. This is even more the case with older patients.

The symptoms of dementia include difficulty in interacting with others, problems with memory, thinking clearly, memory loss, irritability, slowed thought processes, neglecting grooming and hygiene, apathy, psychosis and mood and behavior difficulties. Dementia creates a significant loss of intellectual abilities and can be severe enough to interfere with social and occupational functioning. Someone suffering from dementia will have difficulty solving problems, maintaining emotional control and may have periods of delirium. Dementia is the result of the death of nerve cells.

Alcohol impairs brain functions and abstract reasoning also. For someone who has suffered a brain injury, there is no safe amount of alcohol to drink. Both a brain injury and alcohol affect memory, cognition, reasoning, judgment and executive function. A person who drinks heavily, and consistently over a long period of time, may have brain deficits that will continue even after they are sober, which may lead to dementia.

Heavy drinking can further permanently impair the brain over and above the injuries sustained from the head injury. Even moderate drinking can lead to brain impairment. The influence of alcohol combined with a brain injury can precipitate the potential for dementia depending on: how much and how often a person drinks; how long they've been drinking; their age, level of education, and family history of alcoholism. Heavy consumption of alcohol can result in serious and persistent changes in the brain. The combination of a brain injury and alcohol can significantly impair cognitive abilities, as does dementia.

Often, because of the brain injury, a sufferer may have difficulty seeing the relationship between their behavior and the resulting consequences of their heavy consumption of alcohol, i.e.: they don't understand why drinking is a problem; that they are too drunk to drive; that alcohol is creating a health problem for them; that it creates a problem with their relationships, or in understanding that heavy and consistent drinking can lead to the strong possibility of developing dementia.

It is difficult to deter someone from drinking if they are determined to do so but particularly if they have had a brain injury. It is even more difficult if the consumption of alcohol has been a behavior pattern before their injury as well. But it is important to attempt to do so as continual drinking combined with a head injury has no good outcome.

Multiple Brain Injuries Compound Already Existing Problems

Repetitive head injuries are when someone has sustained a second injury or concussion before the symptoms from the first have been resolved. Multiple injuries over time, regardless of the success of their recovery, can result in functional deficits as well.

Following medical recovery after an injury, there should be rehabilitation to assist in learning the use of adaptives strategies and in applying skills to solve problems. The recovery process can only be measured individually because of the brain's complexity and because no two injuries are the same. This is because each person has a different personality and way of coping, etc. The difficulties resulting from a head injury and the subsequent deficit symptoms could continue for years following such an injury. Follow-up rehabilitation puts the focus on replacing skills and functions that have been lost by working on the deficits. Rehabilitation sometimes may need to be extended for years beyond the initial injury.

Most brain injuries affect more than one aspect of brain based functions. Subsequent injuries can emphasize any lingering deficits from the initial injury and also may increase the risk of long-term damage that affects personality and cognitive abilities. This can accentuate the problems for not only the victim but for his family and the community at large.

A Bill passed recently in the United States was implemented mainly to help young athletes and to increase the awareness of the short and the long-term impact of brain injuries and concussions.

Although it was initially passed with athletes in mind, perhaps it should be used with military personnel who have been involved in combat as well. It has recently come to light that the soldier suspected of shooting sixteen civilians in Afghanistan recently had suffered more than one injury while in Iraq, possibly as many as three. In interviews with family, friends and neighbors, there is every indication that this soldier had displayed no tendencies towards aggression or violence before his injuries.

Studies indicate that injuries such as these change personalities, especially if post traumatic stress disorder (PTSD) has been part of the problem too. So is it any wonder that with multiple concussions or head injuries there is an increasing potential for depression, aggression and violence? Are those in the military properly assessed following a head injury? Are they being given rehabilitation and a proper amount of time to recover before they are sent out on another tour of duty?

Studies indicate that even those with a mild brain injury can have psychological problems such as depression and anxiety, and substance abuse and alcoholism. Then when post traumatic stress disorder is in addition to a head injury, the psychological abilities to respond to issues created by the injury will be further impacted.

When we see a tragedy such as the needless killing of civilians happen, it increases the importance of ensuring that there is full recovery and rehabilitation following a head injury. And also that proper assessment be done not only to determine the injury, and any subsequent injuries, but also to assess the possibility of post traumatic stress disorder being a factor.

What Can You Do For Brain Injury Awareness Month?

March is Brain Injury Awareness Month. It is important that people be made aware of the dangers they put themselves in and the risks they take so that they can avoid being included in the statistics of a brain injured survivor. What can you do to help others avoid the pitfalls?

There are many ways you can do your bit to help make people aware. Brain injuries are considered a hidden disability. You can help to bring it out into the open by doing some of the following things.

Start with your workplace. Ask if you can highlight the effects and causes of traumatic brain injuries, acquired brain injuries and concussions. Help your colleagues realize that brain injury is the number one killer and dis-abler of people under the age of forty-four. The incidence is two times greater in the male population.

Make sure that your colleagues know also that these injuries will result in impaired cognitive, physical, emotional and/or behavioural functioning. The social and economic consequences can be devastating not only to the survivor but to his/her family members and caregivers as well as to the entire community.

Perhaps put a container in your office and encourage everyone to donate their change to the local Brain Injury Association. Every penny counts as there is a serious lack of funding for brain injuries.

If you are a survivor or a family member of a survivor, tell everyone you know or meet about the consequences of such an injury and the efforts they can make to avoid suffering a tragedy such as this. What are the causes? They are automobile and motorcycle accidents, sports injuries, falls, strokes, tumours and aneurysms.

The consequences can include short-term memory difficulties, motivational problems, anger issues and many other cognitive-behavioural challenges. You can lessen the chances of getting a brain injury by avoiding high risk behavior, wearing appropriate head gear, eating a healthy diet and ensuring that you are doing everything you can to look after your personal well-being by living a healthy lifestyle.

You can also encourage your state/province and municipal governments to become involved in making people aware of brain injuries. Another idea is to write letters to the editor of your local newspaper. You can ensure that the parents of the children on your son or daughter's sports teams are aware of the seriousness of concussions as well. Until recently most people downplayed concussions.

Hopefully by making people aware of the life altering results of brain injuries, everyone will think seriously before they drink and drive, speed, have their mind on other things when they are behind the wheel of a motor vehicle; will take proper precautions when they are playing sports and if they have suffered a concussion that they will take the time to rest and let the damage repair itself before returning to the sport.

It is important for people to remember that taking risks is not smart. It can be the dumbest thing you ever did. But after the fact is too late to wish you hadn't done it. Be smart now before it's too late. Remember the old saying, 'Better safe than sorry.'

Brain Injuries and Addictions

Which came first, the chicken or the egg? The same might be said about brain injuries and addictions. Are those already suffering from addictions more likely to have brain injuries? There is a theory that this may be the case.

If this is the case, where does one begin to help keep brain injuries from happening? There is evidence to indicate that substance abuse often becomes a factor following a brain injury. But there is equal evidence to indicate that some of those who have had substance abuse problems before their injuries have contributed to them by putting themselves into high risk situations.

When does it begin? Learning disabilities, behavioral problems and emotional dysfunction are some of the childhood issues that could contribute to the risk of brain injuries later in life. These children are usually not identified early enough. Teens who abuse alcohol and drugs have been discovered to have brain abnormalities which sometimes leads to cognitive impairment. This also places them at a higher risk for brain injuries. And even more serious is that a high percentage of the prison population, males in particular, have suffered a brain injury and have also had a background of teen substance abuse. According to some experts in the field, more programs are needed to address these childhood problems before they experience more serious issues by putting themselves at risk.

Following a brain injury, many sufferers, once released from the hospital may resume their previous patterns of behavior because they have more free time, fewer activities to keep them busy and they find drinking or using drugs is a way of dealing with the emotional consequences of their injury.

Even those brain injury survivors who have not previously been substance abusers may do so because of boredom and the fact that former friends may rarely visit. Tolerance for alcohol is decreased following a head injury and even small amounts can further decrease cognitive and physical functioning. Because of memory deficits, survivors are unlikely to be aware of the extent of their substance abuse or at the very least will not be willing to admit to the extent of their use. As family members, by necessity, return to work and other activities, it is difficult to monitor so it is easy for the brain injured patient to become involved in a lifestyle of substance abuse.

And because symptoms of alcohol abuse such as an unsteady gait and slurred speech can be similar to some symptoms of brain injury, it is difficult to determine whether in fact they have a problem with substance abuse. But many types of alcohol and a drug such as marijuana especially have a distinctive odor. It may be necessary also to notice whether these symptoms are only noticeable when the patient has been on his own. Unfortunatelhy, brain injury recovery is difficult, if not impossible, if alcohol or substance abuse is a factor.

It is important to know when there is a risk for brain injury to happen and to take the necessary steps toward prevention. This is particularly true in the case of children who, because of various situations in their lives, are more at risk.

Post Traumatic Stress Disorder

PTSD (Post Traumatic Stress Disorder) often follows a Traumatic Brain Injury. It is an anxiety disorder triggered by stress such as physical or sexual assault, combat or the witnessing or involvement in a traumatic event. Veterans returning home from war often experience PTSD.

This disorder is diagnosed in almost thirty percent of patients suffering from a Traumatic Brain Injury. It is important for clinicians to get as much detailed history of the injury as possible to properly determine the treatment process for PTSD. Diagnosis is sometimes difficult to determine because the symptoms of Traumatic Brain Injury and Post Traumatic Stress Disorder can overlap.

Some of the symptoms of this disorder are flashbacks, repeated upsetting memories or nightmares, emotional numbing with feelings of detachment, the tendency to block out important aspects of the trauma, lack of interest in normal activities and feelings that they have no future. They may also have difficulties with concentration, outbursts of anger, difficulties sleeping, dizziness, rapid heart beats and headaches.

Those suffering from brain injuries as well as PTSD may also have difficulties with substance abuse which can complicate recovery. Other problems may include feelings of lack of control, difficulties with positive emotions, amnesia of the event, reduced cognitive abilities, sleeping disturbances, irritability, concentration deficits and almost certainly memory challenges. Many may also have feelings of survivor's guilt. For those who had an extended period of unconsciousness following a brain injury, it is believed there is less likelihood of Post Traumatic Stress Disorder occurring. Psychological, physical, genetic and social factors are usually involved when there has been both a Traumatic Brain Injury and PTSD.

It is important to get early diagnosis. Treatments by qualified personnel to help reduce some of these symptoms include having the sufferer attempt to remember the traumatic event and express their feelings about it. Joining a support group will also be important and having a strong support system of family and friends. If depression or other related medical conditions are a factor, it will be necessary to deal with these before treatment for PTSD can be begun. It will also be important to overcome alcohol or substance abuse before any treatment can be successful.

Other treatments include talk therapy, cognitive-behavioral therapy, psychotherapy, exposure therapy and/or medication. Treatment can require from three to six months or possibly longer.

It is important for both Traumatic Brain Injury and PTSD sufferers to ensure that early diagnosis and treatment is established for the best chances of a successful recovery.

Memory Loss and Frontal Lobe Injuries

Many memory issues following a brain injury are never resolved. Damage to the brain's memory produce corresponding impairments in the brain's ability to remember conversations and events.

Various things, such as anxiety about the memory lapses, can interfere with the ability to remember. It takes a lot of effort and concentration to compensate for short-term memory loss. It drains energy levels and can often result in chronic fatigue. Intellectual functions may then deteriorate causing feelings of inadequacy, discouragement, irritability and possibly even depression.

There are strategies to help with short-term memory loss, other than the obvious ones of using a diary, calendar or day timer. They are to: live in the moment; learn to trust your instincts; focus on one thing at a time; use repetition; use a system of reminders; plan ahead and be prepared; be organized; avoid alcohol consumption; eliminate distractions and have a routine and stick to it.

There are different types of memory. They are the following:

- Sensory-motor which are things like remembering how to walk, tie a shoelace, get dressed or make a cup of coffee.
- Semantic memory is the ability to retain general knowledge like how to add numbers or how to read .
- Narrative or episodic memory is remembering experienced events in any sort of detail.
- Short-term memory loss is the inability to remember what one did the day before or even earlier in the day, recent conversations or appointments.

Short-term memory loss may cause difficulty in remembering faces of those met recently, reading for pleasure or in watching television or a movie. It can also interfere with educational and personal goals. It is the inability to store and recall current information. Current information is not being recorded. Conversations can be held based on long term memories as long as it doesn't relate to recent conversations or events. There may be difficulty in learning new material and remembering it or forming new memories. Some brain injury survivors may fill in the forgotten details with imagined events or memories. Others may only have difficulty remembering words and thoughts.

One brain injury survivor said that the benefit of having short term memory loss is that it is difficult to carry on an extended argument or to hold a grudge so they appear much more forgiving of others. As well, she won't need to rehash the argument and get upset about it over and over again.

To help improve short-term memory loss, besides the benefits of using memory aids such as diaries and calendars, increase mental activity and challenge your brain. Reading also helps with concentration and memory. Cognitive therapy is also necessary when someone is suffering from short-term memory loss.

There are things that can be done when someone who has suffered a brain injury experiences short-term memory loss. The difficulty sometimes is in motivating them to get into the habit of doing the things that will assist them.

Concussions, Brain Injuries and Personality Changes

Personality changes will be dependent upon the location and severity of the injury. Prisons and mental hospitals sadly are full of people who have suffered brain injuries which resulting personality changes have made aggressive, violent and often unable to make good choices.

Being aggressive, violent and unable to make good choices can be some of the changes in a survivor of brain injury or someone with repetitive concussions. They may also suffer from mood swings, mental rigidity, impulsive behavior, be apathetic, lethargic, are unable to show emotion, have no interests, be bored and may feel intellectually dull. If they once liked to play games, they may no longer wish to do so because they are unable to concentrate as they once did. If memory is an issue, which it often is, playing games will be increasingly difficult.

They may feel a great sense of loss after suffering a brain injury because they will feel as if they have lost their personal identity and personal power. They will feel that they don't know who they are any longer. If this is the case, they should try to find a Neuro-Psych doctor and a speech therapist who, through therapy, will help them try to fill the holes in their personalities that survivors often feel they have in how they identify themselves.

Many survivors of brain injury feel there is a stigma to having such an injury and will deny and cover up or isolate themselves rather than own-up to a brain injury. They will blame their problems on other things that are physical such as chronic pain in legs that were broken or other health issues which may or may not have been sustained in their accident.

Besides their loss of personal identity, sense of power and self-awareness, they may also lack self-determination, be unable to keep and make friends, have lost some of their memories, be unable to socially interact with others, understand the needs and desires of others as well as be unable to feel compassion and empathy. Very often their likes and dislikes will have changed as well as their sense of humor. They may no longer have a sense of humor or be interested in anything at all.

With so many losses, it is little wonder that a brain injury survivor's personality is likely to change at least somewhat. Not only is it difficult for the survivor but it is difficult for his/her family and spouse. They have lost the person they once knew and will feel the loss themselves. They have to get to know that person again as he/she may be quite different from who he had previously been.

In the case of concussions, some damage, regardless of severity will be sustained so multiple concussions can cause more damage. Both concussions and brain injuries can leave the survivor with deficits. Personality changes are the result of deficits.

Sometimes personality changes may only be really evident to those closest to the brain injury survivor. Others may say, 'He just isn't the same.' or 'Something seems off.' without being able to pinpoint exactly what the difference may be. But often it is enough of a change for even those unsure of what the change is for friends to not visit as often as they once did.

Brain Injuries Involving Military Personnel

Most brain injuries are life-long, life-altering and will require life-style adjustments. And most will affect not only the victim of the injury but his/her family, friends and the community as well. This has been evidenced by the thousands of military personnel who have come home with brain injuries.

It is suspected that as many as 320,000, possibly more, military personnel have come home with brain injuries that have affected their lives. Brain injuries affect personalities, emotions and often their mobility. Some will have an inability to understand speech but will still possibly be able to read, some will no longer be able to laugh, they may suffer post-traumatic stress disorder and other psychological problems such as denial of any problems. Some may not be able to recognize faces, may be flat and robotic in his speech, be unable to retain information, unable to feed themselves or be unable to form complete sentences. Depression and aggression can also be the results of brain injury. The ability to maintain social relationships quite often is another consequence of a TBI. And one soldier who, although he could see, was only able to see to the left. These are only some of the consequences of their injuries.

Many services will be required for these fighters of their country. They will require speech therapists, life skills coaches, some will need to learn to walk again, and to talk again. Some will suffer the consequences of having problems with drug and alcohol, they will display reckless behavior without considering the consequences, will make poor choices, will behave in unacceptably appropriate ways socially, or will behave impulsively. It is estimated that approximately twenty per cent of all service men who have suffered a traumatic brain injury will drive dangerously, partly as a consequence of the brain injury and partly because of the necessary training they have had while fighting.

Many of the causes of concussion and brain injury is blast-induced neurotrauma caused by a sudden increase in air pressure or when their body has been propelled through the air and the sudden impact as they land. And fragment penetration is another large reason. Approximately 1,400 troops sustained concussions or mild traumatic brain injuries because of blasts during a ten month period in Afghanistan and Iraq. They suffered such symptoms as loss of motor control, dizziness, headaches and difficulty processing their thoughts. Many of these troops are now taking time out when involved in or have been near a blast situation until their symptoms dissipate. Those within one hundred and sixty-five feet of a blast are examined for signs of concussion or brain injury.

Blast-related injuries are the signature wound of the Afghanistan and Iraq wars with many of the troops having been exposed to multiple explosions. Military personnel often don't get the necessary treatment in a timely fashion which can possibly worsen their condition.

Work is now being done on advanced MRI-based methods in order to be able to make more accurate diagnoses so that treatment inventions can begin earlier for those with brain injury. It is also being evaluated whether, or when, those who have suffered from multiple exposures to blasts should return to active duty. These types of follow-up will help to determine the future health of returning military personnel.

Frontal Lobe Injuries and Their Resulting Damage

The frontal lobe is often involved in traumatic brain injuries. When the head is struck, the frontal lobes will hit the inside of the skull which can cause considerable damage. This resulting damage can alter life following an injury especially if there has been no rehabilitation.

The frontal lobe is made up of the precentral cortex, prefrontal cortex, orbitofrontal cortex and the superior mesial and inferior mesial regions. Each area has a particular function. But the frontal lobe, in general, is the brain's emotional center and is responsible for higher functioning. Although this is true, no part of the brain works in isolation.

Frontal lobe injuries can affect motor functions, problem solving, memory, social and sexual behavior. It can also affect language skills, impulse control and make changes to the personality. The damage incurred affects feelings of empathy, sympathy, humor and whether appropriate judgments are made.

Functions of the frontal lobe areas involves the ability to recognize future consequences resulting from current actions, an ability to choose between good and bad actions and to recognize the similarity or differences between things.

The frontal lobe assists in retaining long term memories. When this area has been injured, mental flexibility will be impaired. Talking may increase or decrease dramatically. Also, there may be impaired perceptions, possible loss of taste or smell, potential attention difficulties which will make a person easily distracted. Thinking may be inflexible showing perseveration which is an inability to switch from one line of thinking to another. Those with frontal lobe injuries may also lack motivation, the ability to plan and organize and may have difficulty making decisions. Abstract and complex thinking may also be problematic.

Damages such as these often make holding a job more difficult because of the inability to perform work consistently and because problem solving and motor skills have usually been affected.

The hope of successfully returning to work is through rehabilitation. The multidisciplinary approach to rehabilitation is mostly favored which includes specialists from neurology, psychology, occupational therapy, physical therapy, speech therapy and cognitive therapy. Other rehabilitation is developing strategies to overcome deficits. It is important that rehabilitation encourage, motivate and empower.

Rehabilitation involves working on functions that can be restored and learning how to do things differently. Neuro-functional strengths and weaknesses are considered. After strengths are developed, more complex skills can be added. The large brain skills must be retrained or developed before the small skills can be developed. And this must happen before intellectual activity can be worked on and be successful.

When there has been an injury to the frontal lobes, rehabilitation is important and the goal is to help individuals progress to the most independent level of functioning possible.