Helping a family member or friend with ABI

For those who have someone in their lives with an acquired brain injury, we offer some suggestions on how to help the person.

These suggestions may also help you cope, by giving you some new ideas to try, in situations that may be frustrating for both of you.

Area of difficulty Effects Suggestions
Social Interactions - Lacks awareness of social cues
– Not aware of personal space (stands too close)
– Interrupts others, doesn’t alternate speaking turns (i.e. person won’t stop talking when you are trying to leave)
– Social isolation
– Doesn’t interact with others
– Doesn’t initiate social contact
- Provide feedback and alternatives
– Peer mentors/life skills
– Find community activities that they are interested in
– Provide information to social network/friends
– Building self esteem
– Provide education re: social cues
Impulsiveness - Inappropriate, sometimes hurtful remarks
– May disregard social cues
– May take risks & ignore safety rules
– May act irresponsible and refuse to follow rules and regulations or follow directions
- Provide alternatives to inappropriate behaviours (i.e. for sexually inappropriate comments, provide them with a more appropriate opening remark)
– Teach self-monitoring
– Identify clear set of expectations and rules
– Positive reinforcement and praise
– Role models/appropriate peer feedback
– Talk through and review activity in advance
Lack of insight - Doesn’t understand other’s reactions to behaviour
– Interrupts others
– May become involved in altercations
– Resents supervision
– Doesn’t recognize physical and cognitive limitations
- Increase social awareness
– Use role play/modeling
– Avoid confrontation
– Stress need for safety
– Adjust activities to limitations
– Build on success rather than failure
Irritability / frustration tolerance - Less tolerant of noise/distractions
– Gets frustrated with help
– Refuses to participate in group activities
- Help the person pinpoint problems and find ways to cope
– Redirect away from source of frustration and provide alternatives
– Be proactive (identify triggers and avoid if possible)
– Attempt to provide feedback when they are in a better mood
– Stress reduction techniques
– Allow time to get away from situation
– Learn to detect behaviours leading up to outbursts
– Provide empathy
Aggression - Hitting etc
– Swearing, foul language
- Develop a cueing system
– Assertiveness/anger management training
– Provide professional counselling
– Non-violent crisis intervention training
– Recognize and reinforce positive coping and communication skills
– Allow them to leave and regroup. Provide feedback at a safer time
Non-compliance - Does not comply with rules and expectations - Write down instructions so they can work independently.
– Encourage peers to get involved.
– Give feedback
– Don’t argue, provide clues from the environment
– Provide time for fun or interesting activities.
Social Immaturity - Makes inappropriate comments
– Laughs out loud during serious discussions
– Tells anyone who will listen about their injury
– Acts as if things revolve around them
- Provide immediate feedback and offer alternatives
– Role play and “what if” scenarios
– Develop non-verbal cueing system
– Videotape behaviour and review together
Apathy - May appear ”lazy”, lethargic, unmotivated
– May not think to plan and initiate activities
– Appears to forget to complete tasks
- Assist them with keeping a list of activities to be completed daily
– Give a choice between doing one thing or another
– Help them explore what they want, set easy goals for them to achieve
Attention - Difficulties with focusing, attention, filtering out distractions.
- Difficulty maintaining attention, shifting from topic to topic
– Difficulty dividing attention between activities and tasks
– May appear lost, may wander
– Chores/activities incomplete
- Use short concise instructions
– Use clearly defined objectives
– Use novel, unusual, relevant and stimulating activities
– May need one to one instructions
– Minimize distractions
Memory - Appears forgetful
– May be unable to remember names, faces  tasks or appointments
– Can’t learn new information
– Has little recall of details when reading
– May appear disoriented
- Use visual reminders such as schedules, check lists, calendars, post-it notes etc and teach/remind them to use them
– Use alarms/cues to signal transitions
– Traditional memory strategies (rehearsal, mnemonics) may not work
Reasoning & abstract thinking - Difficulty grasping abstract language
- Misses sarcastic humor or jokes
– Responses may be lengthy and provide very little information
- Explain things in concrete terms
– Speak plainly
– Be aware of deficits and adjust your expectations for spontaneous conversations
Problem solving - Unable to “think” their way through processes
– Difficulty perceiving exact nature of the problem
– Difficulty identifying more than one solution and comparing them
– May have difficulty making choices
– Difficulty knowing when, where and how too ask for help.
- Post rules where everyone can see them.
– Give feedback
– Provide supervision and monitoring
– Encouraging peers to get involved
– Break large tasks into smaller tasks.
Judgment - Is easily persuaded by others
– Is careless about safety
- Use signals to cue the person to their behaviour
– Help them create boundaries for themselves
– Work with them to recognize unsafe relationships using role play, feedback, etc
Speaking and writing - Can’t find the words to express themselves
– Does not provide much detail
– May speak to quickly or too slowly
– May make up stories and information to fill in gaps
– Uses cliche phrases or uses same sentence structure over and over
- Provide structure by asking specific questions
– Give immediate feedback
– Encourage word retrieval through descriptions
– Be patient
– Encourage them to know their limitations so they can explain it to others
Listening comprehension - Misunderstands instructions and comments
– Needs information repeated
– Can’t follow conversations
– Easily confused by too much information
– Takes everything literally
- Use concrete language
– Use clear, short explanations accompanied by written directions
– Use simple vocabulary and short sentences
– Summarize and repeat information
– Use visual aids to reinforce verbal information
Organizational ability - Difficulty organizing events into appropriate sequences
– Get lost in daily routine
– Disorganized or incomplete tasks
- Limit number of steps in a task
– Give cues
– Provide written schedule of routine, maps, etc
– Sequence instructions
– Check off steps as completed
– Use/develop compensatory tools
Information processing - Thinks and answers more slowly
– Can’t complete task within allotted time
- Present information in small chunks
– Allow extra time for them to answer
– Be patient
Tangential communication - Rambles, doesn’t acknowledge listener’s interest or attention
– May monopolize conversation
- Interrupt rambling speech
– Focus attention on key issues
Fatigue - Looks pale & tired
– Tunes out and doesn’t pay attention
– Cognitive ability deteriorates at the end of the day
– Disinterest in normally appealing activities
– Unable to complete tasks
- Review medical information
– Check on sleeping patterns
– Avoid over stimulation
– Provide frequent rests
– Schedule most demanding activities due peak performance times (i.e. late mornings)
– Closely monitor time of day that fatigue sets in, medication and fatigue factors. See if medication schedule can be adjusted.
Headaches - Complains of pain
– Unable to pay attention or concentrate
- Allow them to leave activity to lie down
– Monitor the activity and time of day to identify patterns to the headaches
– May be soft tissue related
– Talk to physician re: medications, massage, physiotherapy or other alternatives.
Seizures - Seizures range from petit mal to grand mal - Familiarize yourself with warning signs (aura)
– Identify possible side effects of medication
– Check with the physician
– Educate yourself on seizure protocol:
1. Keep calm.
2. Protect from further injury.
3. Do not restrain the person.
4. Do not insert anything in the mouth.
5. After the seizure subsides, roll the person on their side.
6. If a seizure lasts longer than 5minutes, or repeats without full recovery, SEEK MEDICAL ASSISTANCE IMMEDIATELY.
7. Talk gently to the person. Let them rest.
Muscle paralysis and weakness - Unable to write neatly
– Clumsy
– May tire easily
– Can’t carry items for any distance
- Provide adaptive equipment (computer, tablet, voice recorder)
– Consult with occupational therapist for seating, safety issues around the home etc?
– See if they will use a backpack
Balance and coordination - Appears clumsy, unstable and prone to accidents
– Unsafe in crowded areas
- Review medical history and medications
– Consult with occupational therapist re: safety in the home such as railings, supports for bathtub/shower etc?
Fine motor coordination - Prints and writes slowly/messily
– Hand tremors during activities
– Can’t pick up or manipulate small objects
- Consider a computer or tablet
– Consult with occupational therapist
– Use hand grips for pens/pencils
Oral-motor coordination - May drool or have difficulty swallowing
– Can’t articulate words clearly
– Slow rate of speech
– Breathy, hoarse or nasal voice quality
- Allow adequate time for them to express themselves
– Sit face to face
– Keep working with them to ensure that you understand what they are trying to communicate
– Consult with speech and language therapist
Visual deficits - Difficulty seeing objects in part of their visual field
– Difficulty perceiving spatial orientation of objects
– Difficulty picking out the important object from the background
– Difficulty scanning and reading material
– Difficulty recognizing objects if they pass by too quickly
– May be overwhelmed in visually stimulating setting
- Review medical information
– Consult with physician, ophthalmologist, neuro-opthalmologist, optometrist, occupational therapist or CNIB.
– Provide large print books or books on tape
– Place materials in best visual field
– Limit the amount of visual information on a page
– Assess and monitor safety in the community
– Check with CNIB for accommodations for visual impairments and services
Sense of touch - Reduced ability to sense touch or temperature
– Hypersensitive to sense, touch or temperature
- Provide reminders or cues to check temperature if needed
– Monitor closely for injuries
– May require a gradual desensitization program for hypersensitivity
Hearing - May have partial or full hearing loss in one or both ears
– May seem to not be paying attention or non-responsive
– Misses direction or information
- Install a flashing light system for smoke detectors, phone etc.
– Consult with resources for people with hearing impairments for accommodations/adaptations
– Assess and monitor safety in the community
Emotional - Difficulty controlling emotions
– Crying too much or laughing inappropriately
- Recognize that even though the response is overtly dramatic, the underlying emotion may not be at all that strong.
– Ignore the behaviour when it occurs and
– Model calm behaviour yourself
Depression - Lack of interest in life
– Excessive sleeping
– Lack of motivation
– Sexual withdrawal
– Excessive TV watching
– Flatness of affect
- Although people with acquired brain have difficulty benefiting from traditional forms of counseling, it is definitely worth seeking help to deal with depression especially if suicidal thoughts are expressed
– Therapy for depression needs to be concrete and task oriented and requires repetition
– Use diversionary tactics to get their minds off depressive thoughts
– Structure their schedules
– Familiarize yourself with other indications of their emotions rather than relying just on facial expressions.