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Acquired brain injury

Acquired brain injury (ABI) refers to an injury to the brain resulting in deterioration in cognitive, physical, emotional or independent functioning. It can result from traumatic causes such as car accidents, falls and assaults, or from non-traumatic causes such as stroke, hypoxia (insufficient oxygen), infection, tumour, substance misuse (including overdose) and degenerative neurological diseases.

People who misuse alcohol or other drugs have an increased likelihood of developing an ABI due to their alcohol and/or drug intake and their risk-taking lifestyle.

What to consider when working with a person with an ABI

The nature and severity of an ABI

Cognitive, physical and sensory disabilities vary in their severity, may be temporary or permanent, and often exist in combination. The nature and severity of disability will be influenced not only by the type and level of damage to the brain but also by other medical, personal and social factors (Fortune & Wen 1999). It's important to remember that, although a person may be experiencing cognitive and communication difficulties, they may not necessarily have lost their inherent intellectual capacity or IQ.

The hidden disability

ABI is often referred to as a 'silent' or 'hidden' disability, and can involve long-term problems with thinking and behaviour that are not always easy to identify and are often misunderstood by other people.

Even close family and friends can often find it hard to understand and accept cognitive problems or changed behaviour in a person with an ABI, and they may often regard them (unfairly) as lazy or hard to get along with. Someone who's confused, frustrated or apathetic as a result of their ABI may be misunderstood as belligerent, antisocial or lazy.

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Common indicators

Typical cognitive (thinking) changes after brain injury can include (but are not limited to):

  • Being easily confused and overwhelmed
  • Difficulty paying attention - short attention span
  • Difficulties with learning and storing new information
  • Problems with memory - short term or long term
  • Being stuck on ideas and having fixed patterns of thinking
  • Reduced levels of initiative, and difficulty starting activities
  • Being slower at processing information.

Typical emotional changes after brain injury can include (but are not limited to):

  • Sadness and/or grief
  • Depression and/or anxiety
  • Loss of self-esteem
  • Changes in personality, including difficulties in emotional control
  • Irritability.

Typical physical changes after brain injury can include (but are not limited to):

  • Overwhelming fatigue
  • Headaches
  • Changes in smell, taste, hearing, and/or vision
  • Weakness or paralysis, often in one side of the body
  • Difficulties with speech and communication
  • Sensitivity to light and/or noise
  • Seizures and epilepsy.

The level of cognitive, emotional and physical changes depends on a number of factors, including:

  • The seriousness or severity of the brain injury
  • The location of the brain damage
  • How well the person has integrated back into the community.

For some people who sustain an ABI, some or all of these changes may gradually improve, but it's impossible to predict how this will happen or how long it will take. For many people these changes will be lifelong.

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Grief and loss

Depression is common following an ABI, leading to further isolation and additional complex issues such as drug and alcohol misuse, other mental health conditions, or involvement with the criminal justice system. This may be due to the person experiencing prolonged and unresolved grief when they compare how they were before and after their injury. It's also extremely common for people with an ABI to lose some, many or all of their important family and personal relationships. Combine this with other factors such as loss of accommodation, employment or financial security and the impact can be overwhelmingly devastating.

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What does this mean for drug and alcohol services?

When working with someone with an ABI who has problems with drugs and/or alcohol, different and individualised approaches may be needed, as their executive functions may be affected. For example the ability to:

  • Be proactive
  • Plan and organise and make judgements and decisions
  • Problem-solve
  • Learn from their mistakes
  • See the consequences of behaviour.

Therefore, for many people with an ABI, a commitment to change should be regarded as a treatment goal rather than as a prerequisite for entering drug and alcohol services. Drug and alcohol workers should focus on engagement and person-centred motivational strategies to address individual needs.

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Find out more

For practical strategies for working with people with ABI see Practice Tips for Workers.

For screening and assessment considerations see Screening and Assessment for Cognitive Impairment.

See also:

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