Following brain injury, the person may develop behavioural difficulties at any stage (from the early stages of recovery through to the long term). There may be many contributory factors including pre-injury factors, direct neurological damage and a range of post injury factors including:
- Medical issues during the early stages of recovery e.g. post traumatic amnesia, drug and alcohol withdrawal issues.
- Issues related to nutrition and hydration i.e. poor nutrition and dehydration may contribute to increased confusion, distress and discomfort.
- Discomfort and pain.
- Anxiety, fear, distress.
- Environmental factors e.g. noise, high levels of stimulation, heat, having to live with other brain injured people.
- Psychosocial factors e.g. missing home, family, friends, social activity and work/education.
- Physical and cognitive fatigue.
- Sleep disturbance.
- Cognitive and communicative impairments potentially resulting in confusion and agitation.
- Visual/perceptual and/or hearing impairments may go unrecognised and contribute to confusion and distress.
- Feelings of overwhelm arising from cognitive and/or communicative difficulties, physical impairments etc.
- Boredom and frustration.
- Embarrassment e.g. in the context of personal care interventions being carried out by others, being unable to manage everyday activities independently and changes in communication/cognitive abilities.
- Bladder and bowel dysfunction.
- Physical illness e.g. infections (urinary tract infection, chest infection) and chronic medical conditions potentially resulting in pain, distress, discomfort, anxiety and fatigue).
- Increased confusion caused by sedative medication
- Psychological and psychiatric difficulties e.g. adjustment difficulties.
- Seizure activity may be associated with increased levels of confusion particularly in the post ictal phase potentially resulting in agitation and/or aggression.
- The approach adopted by those providing support, treatment and care. Please see information below.
Those who are providing support, treatment and care for the person following brain injury may inadvertently contribute to the occurrence of challenging behaviour. Reasons for this include:
- Expectations of the person’s abilities are unrealistic i.e. believe the person is more able than they actually are. Carers etc may be unaware of the extent of the person’s difficulties and the impact upon their cognitive, communicative and physical functioning including the ability to manage activities of daily living.
- Limited time to spend with the person, i.e. ‘quality time’ and reduced opportunities for social interaction i.e. relationships may become characterised by the care interventions alone rather than the development of good therapeutic and social relationships.
- Not providing sufficient, understandable explanation and orientation prior to and during care interventions.
- Not taking account of the person’s information processing abilities and not allowing sufficient time for the person to process all the relevant information before engaging in each stage of a care intervention.
- Speaking too quickly, giving too much information, potentially resulting in the person misunderstanding, especially in the context of communication impairments and/or cognitive impairments.
- Not remembering to repeat necessary information if the person has memory problems and requires regular reorientation to their circumstances and/or the care intervention.