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Traumatic Brain Injury

Over the last two decades the number of people suffering from head injuries has increased so much that it has been described as the ‘silent epidemic.’ It is estimated the long-term effects of head injury will affect one family in every 300.

Relatives of people who have had a head injury report that the 10 most difficult problems are: personality changes, slowness, poor memory, irritability, bad temper, tiredness, depression, rapid mood changes, tension and anxiety and threats of violence.

The most common causes of head injury are road traffic accidents, domestic or industrial accidents, sports and recreational injuries and assaults. A traumatic brain injury (TBI) is defined as ‘damage to the living brain tissue that is initially caused by external mechanical forces.’ This is in contrast to brain injury caused by internal events such as blood vessels bursting (strokes), growth of tumours, or viruses and disease etc The brain on impact is buffeted in the skull, and the usual immediate effect is loss of consciousness.

The length of Coma or loss of consciousness, and the length of Posttraumatic amnesia are helpful in predicting the severity of the injury. 75 % of the injuries are considered mild (loss of consciousness less than 15minutes). With mild injuries standard neurological examinations are often normal, but sophisticated scanners may pick up nerve damage, often to the frontal and temporal lobes of the brain as they impact into the bony ridges at the front underside of the skull.

The results of mild head injury are an array of symptoms often called Post concussion syndrome and include headaches and dizziness, impaired concentration, difficulty processing new information, tiredness, irritability, intolerance of noise and light and intolerance of alcohol. These symptoms are often followed by anxiety and depression. Many with mild injuries recover over several weeks, but a small percentage do not make a good recovery. Up to 95% of head injuries are graded mild or moderate.

This writer has seen over 200 clients with varying levels of Traumatic Brain Injury, most frequently under his personal ACC Psychological Services provision contract, and as a member of the Rehab People team.

The psychology intervention includes support to manage the post injury adjustments. This includes addressing the emotional impact following the post injury changes in functioning .

There are a range of emotional and behavioural problems post TBI where psychological assistance is helpful.

These problem areas are often interrelated and include: agitation, explosive anger and irritability, lack of insight and awareness, impulsivity and disinhibition, emotional lability, self centeredness, family abuse, apathy and poor motivation, depression, anxiety, inflexibility and obsessionality, and sexual problems.

Not all people with head injuries will experience these symptoms.

The severity of symptoms vary due to :

1.The extent of direct neurological damage.

2. Exaggeration of previous personality traits and behaviours.

3. The stress of adjustment.

4  The environment the person lives in.

The focus of the psychological support is to help the client understand these emotional changes and behaviours, and encouraging the use of a variety of skills to manage e.g. anger management training, routines to assist motivation, anxiety management approaches , approaches to understand and improve mood, helping the client focus on their personal strengths, and reaching a level of acceptance.

This writer has also seen many couples where one partner has experienced a traumatic brain injury. The likelihood of increased  relationship problems and separation is high. Working with couples and families is a valuable process to educate, enhance communication, and reinforce the self-management skills.

The Clinical Psychologist can also help with approaches to improve memory, and cognitive functioning.

Clinical psychologists are often part of a Rehabilitation team e.g. with Speech Language Therapists, Occupational therapists, Social Workers, Physiotherapists, Psychiatrists.

The team works collaboratively utilising the skills of each profession to compliment each other and to  achieve goals in the best interest of the client and his family i.e. enhances the clients level of independent functioning and emotional wellbeing, educating family members.

  • Unit 10, 35 Riccarton Road
    Christchurch 8011
    New Zealand

    Phone: (03) 348 5595