Following brain injury, it is important to remember that the person may have experienced a very difficult and complex background history but nevertheless may respond extremely well to care and rehabilitation. Those who have had adverse life experiences may require a greater degree of understanding and additional support from health and social care professionals.
For the person who has had adverse life experiences, recovery following brain injury may have added complexities. Eventual prognosis may also be adversely influenced by their previous life experiences.
Pre-Injury Personality
The person’s pre-injury personality may have an impact upon how they present after brain injury and how well they are able to engage with treatment, care and support. After brain injury, some pre-injury personality traits may be exaggerated in an unhelpful way e.g:
- A previously sociable and chatty person may become inappropriately verbose, loud and possibly display some socially disinhibited behaviours.
- An appropriately assertive person may become highly demanding of others and over controlling and sometimes challenging.
- A person who exhibited aggressive behaviour prior to their injury may be more likely to present with challenging behaviour after brain injury.
- A person who previously lacked motivation, may become further demotivated after brain injury.
It is important not to interpret the person’s challenging behaviour after brain injury as being solely due to pre-existing personality traits. Prior to brain injury, most people live perfectly normal lives and their personality traits may not have caused them any particular problems. However, following brain injury, there may be significant changes in personality which may lead to major difficulties in interpersonal interactions potentially adversely affecting familial and social relationships.
Social Background
Some factors relating to the person’s lifestyle, social and cultural background may have an important effect on their presentation following brain injury. A socially chaotic background, particularly where there has been exposure to aggression and/or a disregard for social boundaries may cause difficulties after brain injury. The person may potentially present with challenging behaviours and find it very difficult to engage with care. It is important to recognise that a chaotic lifestyle may be associated with mental illness (which may or may not have been recognised prior to the brain injury).
A person who has a history of involvement with the criminal justice system (e.g. has been charged with breach of the peace, theft, drug offences, assault charges) may be more vulnerable to sustaining a brain injury and may display challenging behaviours and reluctance to co-operate with care.
Alcohol and/or Illicit Substance Misuse
A history of alcohol and/or substance misuse increases the risk of sustaining a brain injury. In addition, it is possible that the person with a history of substance misuse may have already sustained previous head injuries (as a result of falls and/or assaults) or alcohol related brain damage (ARBD). This may have an impact on their mental state, behaviour and level of co-operation with care and support. Additional problems often include drug and alcohol withdrawal issues, seizures and other medical complications.
Developmental and Educational Background
It is important to be aware that the person’s developmental and educational history will have a significant impact on cognitive functioning, communication and potentially behaviour following brain injury. These factors will also influence the eventual outcome following brain injury. A history of learning disability, autistic spectrum disorder or attention deficit hyperactivity disorder etc will complicate recovery following brain injury.
