A brain injury can strike anyone, at any time, in any situation. Many of the injuries that we see come as a result of a road traffic accident, but people also suffer severe head (brain) injury in a fall, or an assault. The brain can be injured in other ways by, for example, a stroke, or infection or lack of oxygen.
Although there are many different ways in which the brain can be injured, the results show a fairly common pattern, with damage to physical function, cognitive function, and to emotions and behaviour. Different people have different combinations of disability in these areas.
The problems here can range from complete inability to move one side, to a very subtle weakness. There may be difficulties in coordination. There may be difficulties in seeing or hearing, and, commonly, in the ability to smell and taste. These difficulties range from subtle, to profound. Some subtle difficulties (for example in the sense of smell) can have a major impact on quality of life.
The word “cognitive”, is used by psychologists and others as convenient shorthand. It refers to a whole range of abilities to do with how we handle information about the world around us. It refers to the ability to attend to important information and ignore irrelevant information; to decide to remember that information, to commit it to memory, and then to retrieve it accurately later; to think and reason and make plans, using information about success or failure of those plans to change plans. These abilities are easily damaged by a head injury, and many of our clients have tremendous problems in attending and concentrating, remembering, thinking, planning and problem solving. These obviously have a major impact in daily life, and can also make the injured person very vulnerable.
The importance of cognitive deficits is emphasised in the code of practice for the Mental Capacity Act (Code of Practice). This makes it clear that the criteria for capacity (for example capacity to manage property and affairs) are cognitive, involving the ability to attend to, retain, and use relevant information to make appropriate decisions. One of the major challenges for case managers is to find ways of helping clients deal with the cognitive difficulties.
Emotional and Behavioural
Brain injury can have a profound impact on how someone feels about themselves and others, and how they behave towards themselves and others. After injury, it can be much more difficult to control emotions, and the injured person can be on a very short fuse, easily getting upset, sometimes to the extent of physical violence, often by minor problems or incidents. Sometimes these problems are caused by a particular kind of epilepsy, and in those cases help from a neuropsychiatrist can be invaluable. Brain injury is a well-known cause of depression, and anxiety is also very common. These problems are probably a result both of direct damage to the brain, and of the “existential change”, in that the life expectations and life opportunities that were available before the accident, may no longer be available. For the client, the challenge then is to build “a new you”, and for the case manager this is often a major goal of intervention.
Case Management and Brain Injury
The phrase “whatever it takes” appears frequently throughout this website. This is not an accident. We know that there are few “off the shelf” approaches for case management. Our approach to treatment is simple (but not easy). Our case managers assess the nature and severity of the client’s difficulties in the relevant areas, assess risk, and then work with the client and others as appropriate, to develop a plan that meets the client’s unique needs. That plan will involve a range of inputs, including help from statutory services, private therapy, medical and other services, volunteer and charitable services, and whatever else is appropriate for the client.
Dr Neil Brooks
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