Aim: Understand the causes and nature of perseveration and how it impacts upon the person with Acquired Brain Injury (ABI). To understand some of the ways you can help the person with ABI who has a problem with perseveration.
Every waking minute we perceive a stimulus and then initiate a response to it – usually a word, phrase or action. We are constantly experiencing different stimuli. We are constantly changing, switching, adapting our responses to ongoing, changing stimuli. Stimuli may originate in two ways:
- External: from our environment (things, events and people within our environment).
- Internal: from our own selves, our own internal thoughts, our emotional states, our wants and our needs.
Definition: A ‘stimulus’ is something which requires or causes a response.
Perseveration, within the context of Acquired Brain Injury, refers to the 
unintentional repetition of a response to a stimulus. For example, the person continues to repeat an action even though it is not the required action or continues to repeat a word or phrase. The unhelpful response may continue and be repeated despite the original stimulus ceasing or changing. This problem arises because of damage to the frontal lobe regions of the brain and other associated brain areas
The person who perseverates finds it difficult to inhibit (stop) one activity/response and ‘switch’ to a different activity/response. They struggle to modify their response following a change in stimulus; they struggle to change their behaviour. Even when the original stimulus has altered/finished and the need for that particular response has ended, the behaviour may persist.
Perseveration may affect physical abilities and therefore a person’s ability to carry out activities of daily living (ADLs). It may also affect communication abilities, impairing the person’s ability to communicate through speech, writing and gesture and may also impact upon their ability to use alternative methods of communication. The person may or may not be aware of their perseverative errors.
Examples of perseveration include:
- Keeping on brushing teeth for too long, unable to switch to rinsing.
- Repeatedly putting on and taking off an item of cloth
ing. - Unintentionally maintaining a grip on a door handle.
- Repeatedly switching T.V. channels.
- During meals, repeatedly putting food in mouth without stopping to chew and swallow. This can be dangerous, especially if the person is dysphagic.
- Not being able to stop putting salt on food.
- Repeatedly using the same word or phrase unintentionally. The word or phrase is intrusive and prevents the person using the correct vocabulary.
- Writing the same word or phrase over and over.
Perseveration is not deliberate, it is not a behavioural problem. Perseveration is a repeating pattern of responses that the person struggles to inhibit and change. It can be very distressing:
- If the person is aware of the problem but still cannot inhibit repetitive responses.
- If the person is not aware that they are perseverating and therefore does not understand why other people may be trying to help them stop the behaviour.
- If perseveration is not recognised as a neurological impairment but is misconstrued as the person being ‘difficult’; they may not get the supportive assistance required. The person who perseverates may not understand negative reactions they may get from others who misconstrue their behaviour as deliberate.
- For friends and family to witness perseveration and the distress it can cause.
Perseveration is rarely an ‘all or nothing’ problem. The person may successfully shift to an alternative response on one occasion, but not manage at another time. Problems of fatigue, confusion, anxiety, emotional distress, feeling unwell etc may all increase the likelihood of perseveration occurring. Perseveration may interfere with the rehabilitation process, especially if poorly understood.