Injury . . . Effects . . . Impairments . . . Impacts

Impairments following TBI

Each traumatic brain injury is unique and severity varies greatly from one person to the next. The specific impairments and the impact on functioning are particular to each person. These can be profound and long-term with personality and behaviour change leading to significant lifestyle effects that flow from neurological and cognitive impairment, as summarised in the Table below.

Category	Specific Impairment
Neurological impairment (motor, sensory and autonomic)	Motor function impairment – coordination, balance, walking, hand function, speech Sensory loss – taste, touch, hearing, vision, smell Sleep disturbance – insomnia, fatigue Medical complications – spasticity, post-traumatic epilepsy, hydrocephalus, heterotopic ossification Sexual dysfunction
Cognitive impairment	Memory impairment, difficulty with new learning, attention and concentration; reduced speed and flexibility of thought processing; impaired problem-solving skills Problems in planning, organising, and making decisions Language problems – dysphasia, problems finding words, and impaired reading and writing skills Impaired judgment and safety awareness
Personality and behavioural changes	Impaired social and coping skills, reduced self-esteem Altered emotional control; poor frustration tolerance and anger management; denial, and self-centredness Reduced insight, disinhibition, impulsivity Psychiatric disorders – anxiety, depression, post-traumatic stress disorder, psychosis Apathy, amotivational states

 

Psychological distress and adjustment challenges after TBI

Psychological distress post TBI is highly prevalent after a TBI and can present with mixed mental health issues with features of depression, anxiety, anger and stress.
Gould, K. R., Ponsford, J. L., Johnston, L., & Schönberger, M. (2011). The nature, frequency and course of psychiatric disorders in the first year after traumatic brain injury: A prospective study. Psychological Medicine, 41(10), 2099-2109.

Changes in behaviour

Sabaz et al found that challenging behaviours for community-dwelling adults with severe TBI were widespread, having an overall prevalence rate of 54% - with inappropriate social behaviour, verbal aggression and adynamia being the most common.

Over one-third of the adult study sample displayed more than one type of challenging behaviour
Behaviour can include impulsivity, self-centeredness, increased anger or aggression, apathy, disinhibition, and  problems with initiation and task completion (Ponsford et al 2013; Sabaz et al 2014).

51% of 8-18 year olds who were active clients of the paediatric BIRPs and living in the community met criteria for challenging behaviour. While the most prevalent challenging behaviours were the same as for adults (inappropriate social behaviour, verbal aggression and adynamia) the prevalence across all the remaining categories was different.

Co-morbidities

In the Sabaz et al study, co-morbidities were explored using the HoNOS-ABI. Adults with pre-existing mental health or drug and alcohol issues were more likely to exhibit challenging behaviour following a TBI. 122/276 rated as having challenging behaviours plus at least one of the comorbid mental health conditions at a moderate/severe level. Challenging behaviours were significantly associated with the presence of comorbid drug and alcohol problems, hallucinations, depression, and other mental health issues with a trend for self-directed harm. In addition, because of their brain injury, people had difficulties accessing non-acute services to manage comorbidities once discharged home.

Physical disability

The greatest majority make a good physical recovery with few requiring mobility aids
Neurological impairments such as loss of taste, vision impairments, headaches and problems with balance can continue up to 10 years post injury. (Ponsford, Downing et al., 2014.)

Cognitive impairments

A not uncommon pattern of impairments is a mix of retained cognitive skills with areas of lower functioning. Commonly included are slowed information processing, memory and more complex thinking (dealing with complex ideas), being rigid or perseverative, lack of social awareness (Ponsford et al 2013); Tate et al 1991).

Planning and organising

People may have a number of difficulties in this area. For example, cooking a meal becomes a disaster because the steps were not done in the correct order. A lack of self-monitoring means that it can be hard for people to learn from their mistakes. Up to 48% of people with TBI reported some planning problems (Ponsford et al., 1995).

Insight

People may be unaware of their limitations or have unrealistic goals or expectations. [Typology – on the mark, over/under report of symptoms due organic reasons/denial and protectiveness (ref. Tamara Onsworth)]