Posts Tagged brain injury

[BLOG POST] Stroke, Brain Injury, and Dementia: is there a link?

Experiencing a stroke or a brain injury is a huge, life-altering event. But even after the rehab, the outpatient therapy, and the lifestyle modifications, there can be another fear- will having a stroke or brain injury lead to dementia in the future?

In this article

dementia definition

What is the link between stroke/brain injury and dementia?

Dementia is an umbrella term for a collection of cognitive and communicative deficits. Memory loss, executive functioning deficits, communication impairments and challenging behavior are the hallmarks of a dementia diagnosis. This can be extremely difficult for the person and their family, who have already endured a stroke or brain injury.

The link between stroke/brain injury and dementia is clear. Dementia affects 50 million people worldwide, and studies show that people who sustain an injury to the brain are twice as likely to develop dementia post-injury.

Both stroke and dementia can cause brain atrophy, disrupting brain cell connections and communication.

Why might a stroke or brain injury lead to dementia?

Why certain injury to the brain can cause dementia in older age is not always clear, though there are many working theories.

Alzheimer’s disease (AD) is the most common form of dementia, estimated to affect 5.5 million people in America today. AD accounts for between 60-80% of all cases of dementia, and is caused by an abnormal buildup of proteins in the brain, which interrupt and disrupt the messages being sent within the brain itself.

Some research shows that injury to the blood-brain-barrier, a membrane that selectively filters nutrients from the bloodstream into the brain, has a strong link to subsequent development of Alzheimer’s. The blood brain barrier can be damaged by hypoxia- oxygen deprivation that may be caused by a blockage- or by a traumatic brain injury.

Vascular dementia (VD), the second most commonly experienced dementia, is a step-wise decline in function as a result of several strokes. Strokes often cause temporary or long-lasting damage to the tissues in the brain, and the amount of recovery to these tissues may vary. When multiple strokes or brain injuries occur, the brain is not be able to heal fully, in time leading to VD.

Chronic Traumatic Encephalopathy (CTE), is a brain condition associated with multiple blows to the head and sometimes experienced by football players, boxers, or those with repeated falls. CTE has been linked with early onset of dementia, likely owing to some of the reasons above- non-healing injuries, and disruption to the BBB leading to accumulations of protein tangles in the brain.

dementia Alzheimer's brain cells
From left to right: a healthy neuron (brain cell), a neuron with amyloid plaque buildup as seen in Alzheimer’s disease, and a dead neuron being digested by microglia cells.

Who is at risk of developing dementia post-stroke?

The incidence of those who develop dementia after a stroke or brain injury is estimated to be about two-fold of those in the general population. The risk factors that may make someone more susceptible to dementia include:

  • a Hemorrhagic versus Ischemic stroke (a bleed versus a blockage). This may be linked to the diffuse nature of a bleed, and the possible disruption of the blood-brain-barrier.
  • a stroke occurring at a younger age; regardless of type of stroke, people who sustain a stroke at a younger age are at an increased risk of developing dementia over the course of their lifespan.

Persons are also at the highest risk of dementia one year post-injury. After the one year mark, the increased risk persists across all types of stroke/brain injury, but at lower levels than before.

What can be done to reduce the risk of developing dementia?

Decreasing the risk of developing dementia when a stroke or brain injury has occurred is all about working on brain health and recovery. Keeping the brain healthy and allowing the damaged tissues to repair to their fullest extent may delay or even arrest later development of dementia.

The gold standard of dementia risk reduction includes physical activity, healthy living, cognitive engagement, and taking control of the reasons that a stroke or brain injury may have occurred in the first place.

Physical rehabilitation post-stroke/brain injury is essential to make sure that physical and medical issues are addressed. It is so important to be able to operate at the highest level possible, to live as healthfully as possible, even after a stroke/brain injury. Regular cardiovascular exercise will increase oxygenation in the body, which is necessary to help heal and improve brain health.

Eating more healthfully and avoiding overly fatty and processed foods will also improve brain health. Some research shows supplementation with vitamins, especially Vitamin K and Omega-3s, can help reduce risk of developing dementia.

Challenging your cognition, and maintaining engagement with cognitive tasks will also help to strengthen your brain. The process of learning may increase neural connections in the brain, essential for communication, memory, and other cognitive functions.

Meditation and mindfulness has been shown to increase grey matter in the brain, unequivocally improving cognition and brain health.

Resources for those at risk

Family conflict abounds in the diagnosis of dementia- seek out support groups through the Alzheimer’s Association.

Looking for cognitive solutions for someone with a stroke, brain injury or dementia? Check out Neofect Cognition and the Neofect Smart Pegboard.

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[BLOG POST] Living with a brain injury in an ableist society – #jumbledbrain

Living with a brain injury in an ableist society

I don’t like trending buzzwords much as they always leave a sour taste in my mouth where it feels like people are just being quick to jump on the latest bandwagon. That’s why I’ve been reluctant to bring up the subject of how much of the modern world is still behaving as an ableist society…. that is until now. Yes I’ve spoken before in Living with invisible disability, brain injury  about how having an invisible disability can mean both able bodied and disabled people can misjudge you, but the other day I witnessed something that proved to me how far some people still have to come in their understanding of those for are not like them. 

Trigger warning: This level of ignorance I’m about to describe is likely to upset some. 

I’m very active on Twitter and often tweet about brain injury and many other forms of chronic illness (if you don’t already you can follow me via @michelle_munt.)  The other day I retweeted an announcement of the company that a guest blog for that the latest blog post by another of their guest bloggers was now available to read. The blogger, Lauren has a spinal injury and so we blog about different things but as CFG Law is a law firm for personal injury they are keen to highlight how the disabled community can cope with their injuries. The tweet said: “Laurens latest blog with @CfgLaw is now available and Laurens experience of care at home… #sci #careathome #cfglaw”.

Laurens spinal injury came from being hit by a van 11 years ago as she crossed the road at the wrong time. She was distracted and unfortunately stepped out and the driver couldn’t stop in time. The accident left her completely paralysed, but since 2016 she has set up and runs the charity Road Safety Talks Charity to raise awareness and better educate others.  I haven’t had the opportunity to meet Lauren myself, but she sounds pretty awesome to me! I can’t begin to imagine the amount of work it takes to set up a charity. She also is a motivational speaker, so I take my hat off to her.

One particular response to this made me see the ableist society at its worst.

Now the tweet has been taken down so I can’t quote it, but one lady put “Rest in peace whether he recovered or not.” WTF? I did ask her what she meant by “rest in peace”, pointing out that Lauren is a female blogger, ie alive and SHE has a brain which she is putting to good us, but I never got a response.

Clearly this person didn’t read the article so didn’t understand Laurens situation, and this person isn’t one of my followers so I don’t what her situation is either. But what shocked me about this was that she seemed to be implying that Lauren might as well be dead because of her disability. I had understood that some people may well think like this, particularly if they haven’t ever met someone who is doing so well in life despite their disability, but I never thought anyone would dare share this ignorant view so publicly. I mean it’s Twitter! Hello, now we all know how stupid you are!

This got me thinking about examples of ableism I’ve experienced that I might have overlooked.

Again on Twitter (sorry Twitter I mostly have a very positive experience of you and find the community very supportive so I don’t mean to make you look bad) a “well meaning” health coach responded to a tweet about my brain fog. I did mention I have a brain injury (because I do mention it constantly) but she still told me that if I changed my diet and lifestyle I could solve my problems, including brain fog. Symptoms like this, she told me, are just a reflection of the imbalance that I had created within my body.

Now don’t get me wrong, I do realise a healthy diet and active lifestyle can help, I’ve even advocated for this myself.  But I have a brain injury, I have to fight against the imbalance in me every day! The structure of my brain is difference and so are the chemicals in it. This also gave my hypothyroidism and so my hormone levels are not where they need to be. But there isn’t a formula which I can follow everyday to correct these issues. Everyday is different, some days I’m doing well, and others I’m not. Living with a brain injury isn’t as simple as doing exercise and eating the right foods to remove symptoms such as brain fog. 

As I didn’t have the energy for an argument, and because I knew she meant it in the nicest possible way, I just let it go. But actually I was hurt at the suggestion that my symptoms were my fault. You could say that as I was “complaining” about my brain fog she was trying to offer a solution, but as a fellow coach and blogger I don’t accept this. I’m a blogger who uses her experiences to offer a voice for other brain injury survivors and raise awareness, I’m not actually asking for a solution. Of course I am grateful of any new information others can offer, but simply blaming me for my struggles is not helpful. What’s more, it’s not even like we discussed my lifestyle for her to be able to identify what I might be doing wrong, it was just “obvious” to her that I MUST be doing it wrong to be experiencing these symptoms.

And then there was the guy who said “what, so people actually read your blog about brain injury?”

Ugh, honestly it was only because this guys behaviour made me think that he might either been damaged or was on the autistic spectrum that I didn’t roll my eyes at him. Yes, people read it. Just because you’re not interested, assume it’s boring, has no value or whatever, doesn’t mean that’s how the whole world feels. The idea that writing about how my life has changed due to my brain injury must have struck him as self centred. Why would anyone want to hear me droning on about it? The funniest part about this conversation was I’d hired him to clean my drive at the time. Yep, his idea of building rapport with his clients was to belittle them! You won’t be surprised when I tell you I never hired him again.

I’m sorry to say that there are people out there whose ideas of the world are very much stuck in the ableist society. Do I lose sleep over it? No. There will always be things that as individuals we can do better and ways in which we can expand our understanding of others. Just like I’m sure I understand very little about the tribes who live in the Amazon and are untouched by the modern world, there will always be some people who don’t understand the disabled community. I do believe that overall things are improving and we have to accept it’s a work in progress…. for now.

Other articles you may like:

Have you experienced the ableist society? What can we do to improve attitudes?


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[Abstract] The effect of music therapy on physiological parameters of patients with traumatic brain injury: A triple-blind randomized controlled clinical trial


Traumatic brain injury (TBI) is known as a silent epidemic and leading cause of death and disability. .

Hospitalization in the ICU is stressful for TBI patient and can lead to an increase in their physiological Parameter.

Auditory stimulation with a familiar voice is one of the non-pharmacological interventions for stress control.

The result of this study showed that familiar auditory stimulation can control and reduce SBP, DBP, HR, and respiration. .

Familiar auditory stimulation did not have a significant impact on temperature and O2 saturation.



This study aims to investigate the effect of music therapy integrated with family recollection on physiological parameters of patients with traumatic brain injury who are admitted to Intensive Care Units.


Sixty patients were selected through convenience sampling and were then randomly assigned to the intervention group and control group. In the intervention group and for 6 consecutive days, the patients received a combination of music and auditory stimulation twice a day for 15 minutes. The patients’ physiological parameters were measured before the intervention, and then 10 minutes and finally 30 minutes after the intervention. The data were analyzed using multilevel modeling method through MLwiN version 2.27.


The results showed that there was no significant difference between the two groups in terms of demographic factors and the duration of coma. However, the results of the two-level multiple linear models which were performed for 6 consecutive days indicated a significant decrease in systolic blood pressure, diastolic blood pressure, respiratory rate and heart rate for the patients in the intervention group as compared to the patients in the control group (P < 0.0001). Nevertheless, no significant difference was observed in temperature and oxygen saturation (P > 0.05).


Integration of music therapy with family recollection can moderate physiological parameters. Therefore, it is recommended to use this cost-effective treatment along with the routine treatments, especially for patients with traumatic brain injury.


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[ARTICLE] Sleep Disruption After Brain Injury Is Associated With Worse Motor Outcomes and Slower Functional Recovery – Full Text


Background. Sleep is important for consolidation of motor learning, but brain injury may affect sleep continuity and therefore rehabilitation outcomes. Objective. This study aims to assess the relationship between sleep quality and motor recovery in brain injury patients receiving inpatient rehabilitation. Methods. Fifty-nine patients with brain injury were recruited from 2 specialist inpatient rehabilitation units. Sleep quality was assessed (up to 3 times) objectively using actigraphy (7 nights) and subjectively using the Sleep Condition Indicator. Motor outcome assessments included Action Research Arm test (upper limb function), Fugl-Meyer Assessment (motor impairment), and the Rivermead Mobility Index. The Functional Independence Measure (FIM) was assessed at admission and discharge by the clinical team. Fifty-five age- and gender-matched healthy controls completed one assessment. Results. Inpatients demonstrated lower self-reported sleep quality (P < .001) and more fragmented sleep (P < .001) than controls. For inpatients, sleep fragmentation explained significant additional variance in motor outcomes, over and above that explained by admission FIM score (P < .017), such that more disrupted sleep was associated with poorer motor outcomes. Using stepwise linear regression, sleep fragmentation was the only variable found to explain variance in rate of change in FIM (R2adj = 0.12, P = .027), whereby more disrupted sleep was associated with slower recovery. Conclusions. Inpatients with brain injury demonstrate impaired sleep quality, and this is associated with poorer motor outcomes and slower functional recovery. Further investigation is needed to determine how sleep quality can be improved and whether this affects outcome.


Sleep disturbance is a common complaint after brain injury, including stroke, with a high proportion (30%-70%) of patients presenting with impaired subjective sleep quality and meeting the criteria for at least one sleep disorder.14 Sleep disturbance could be resulting from direct damage to brain areas, or due to secondary effects such as being in the hospital environment, depression, anxiety or pain, and could potentially have an impact on rehabilitation through reduced engagement or impaired learning and consolidation.5

There is some evidence for improvements in sleep quality from the acute to the chronic stage of stroke6,7; however, stroke survivors at the chronic stage continue to have impaired subjective and objective sleep quality and worse quality of life than controls.8,9 Interestingly, the longer the time since stroke, the worse the perceived daytime sleepiness becomes.10 This suggests that sleep disturbance may be persistent throughout the rehabilitation period for some, and changes within this time frame in patients with different types of brain injuries are yet to be determined.

The link between sleep quality and function after stroke and brain injury is currently emerging. Siccoli et al11 demonstrated a cross-sectional correlation between the National Institute for Health Stroke Scale (NIHSS) score and wake after sleep onset (WASO), in a small sample of acute stroke patients. A larger study12 found a cross-sectional relationship between subjective sleep quality and the functional ambulation score after stroke but had no objective sleep measures. Similarly, Kalmbach et al13 found that patients with subjective difficulties initiating sleep had lower function at multiple time-points over the first 6 months of recovery from traumatic brain injury (TBI). Sleep variables, such as total sleep time, WASO and daytime napping, have also been shown to explain significant variance in Barthel Index (BI) score at the acute stage of stroke,14,15 and the percentage of sleep stages I and rapid eye movement (REM) are negatively associated with NIHSS.16

However, there is little research to indicate whether sleep quality over the rehabilitation period correlates with outcome or change in function over time, and studies that are available are somewhat inconsistent in their findings. The presence of sleep-disordered breathing at the acute stage has been found to be associated with reduced modified Rankin scale (mRS) and BI at 6 weeks poststroke17 and other studies have demonstrated that stroke patients categorized with a “poor” functional outcome have a lower sleep efficiency, less REM sleep or a reduced REM sleep latency at the acute stage than those with a better outcome.16,18,19 In contrast, Joa et al20 found no difference in the change in NIHSS or BI between patients reporting sleep disturbance at 1 month poststroke and those reporting no disturbance. They did, however, find that the group reporting no sleep disturbance had a greater improvement in the Berg Balance Scale (BBS). This was particularly evident for the moderate-severe stroke patients compared with mild (on the basis of NIHSS score at 1 week poststroke), suggesting sleep may have a greater impact on functional recovery in those who have the most relearning to achieve. The studies by Iddagoda et al4 and Joa et al20 used only subjective sleep measures and many of the studies have divided participants into groups based on outcome or the presence/absence of sleep disturbance, rather than examining both sleep quality and outcome as a continuum which may be more sensitive to differences across participants. Studies that did assess objective sleep quality as a continuum are mixed in their findings. Bakken et al15 found no correlation between sleep variables in the acute stage and BI at 6 months poststroke whereas Vock et al7 found that higher WASO or lower sleep efficiency at the acute stage poststroke was associated with worse outcome (mRS or BI score) at discharge. Similarly, Huang et al14 demonstrate that total sleep time correlates positively, and sleep latency correlates negatively, with the change in BI with rehabilitation.

As there is no clear consensus on the relationship between sleep quality measures and the rate of recovery with rehabilitation, and it is unclear how sleep quality changes over the course of rehabilitation, we sought to conduct a prospective assessment of sleep quality in neurological inpatients and explore the relationship with neurorehabilitation outcomes. We therefore assessed objective and subjective sleep quality at up to 3 time-points throughout the rehabilitation period and examined the relationship between sleep quality and motor and functional outcome measures. Specifically, we aimed to address the following questions:

  1. Does sleep quality at a single time-point correlate with function/impairment at that time-point?
  2. Does sleep quality change over the inpatient rehabilitation period?
  3. Does objective sleep quality averaged over the inpatient rehabilitation period explain variance in motor outcomes over that explained by baseline function?
  4. Does objective or subjective sleep quality averaged over the inpatient rehabilitation period explain variance in the rate of recovery in addition to covariates such as initial independence, age, and time since injury?



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[WEB PAGE] How music therapy can help heal the brain

Music can restore some of the cognitive functions, sensory and motor functions of the brain after a traumatic injury.


music therapy

via How music therapy can help heal the brain |

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[VIDEO] THE BRAIN DISCOVERY SERIES Issue 4: What to do when chaos in the brain occurs? — Dr. Kester J Nedd

Screen Shot 2020-08-07 at 11.22.20 AM.png

After injury to the brain- what happens to you and to your brain? I detailed this process on my latest Instagram post (and in the image below/to the right), but the big question remains of what should one do when injury happens and chaos in the brain takes over?

In this video blog, I identify and describe the steps that should be taken when this chaos occurs


2. Restore

3. Compensate

followed by how the Brain Hierarchical Evaluation and Treatment (BHET) Method is used to achieve them.

Since the BHET Method’s main focus is understanding the levels of disorganization and the degree of disruption of brain cycles, this approach allows us to predict outcomes and offer appropriate restorative treatments.

Screen Shot 2020-08-07 at 11.27.37 AM.png

The brain has over one hundred billion nerve cells that communicate through over one thousand trillion connections

These connections are the command center for what we do, feel, and for just about everything that makes us who we are.

Just imagine what happens when these connections get messed up and break.

via THE BRAIN DISCOVERY SERIES Issue 4: What to do when chaos in the brain occurs? — Dr. Kester J Nedd


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[BLOG POST] Anger and Frustration After Brain Injury

Anger is a very common problem after brain injuries. When someone with a brain injury has a problem with anger, there are usually several causes acting in combination.

Some people are angry about the injury or problems that may have come with it, such as disabilities and loss of job, friends, money and control over one’s life. Some people were angry people before their injuries and still have that problem. People who have always been angry may need psychotherapy to help them learn to cope, and in some cases medication is required. (In our experience, people unfamiliar with the person or with brain injury are often too quick to assume that personality alone is to blame.)

But many people also develop impulsive anger as a direct effect of the damage to the brain. In other words, the parts of the brain that normally inhibit angry feelings and behavior have been damaged and do not do their jobs as well. This means that the person’s anger threshold is lowered so that he or she becomes angry more easily and more intensely. We can tell that this impulsive anger is directly due to the brain injury when:

    • The anger begins with the brain injury or is made much worse by it
    • Angry feelings come and go relatively suddenly
    • Anger episodes may be in response to minor events
    • The person having the angry episodes is surprised and embarrassed or distressed by them
    • The anger is made worse by physiological stress such as fatigue, pain or low blood sugar

This was the problem Joe had. Joe was a quiet man, an accountant; active in his church and an assistant little league coach. He never drank or used street drugs; he was healthy; and he had never been in a fight or in trouble with the law. He was well liked in the community. His wife said that he rarely got angry, and when he did he usually sulked.

When his car was hit by a drunk driver and Joe hit his head on the window, all that changed. He had been knocked out for five minutes but after he was checked out at the Emergency Room they sent him home. He went back to work a week later but had trouble concentrating and remembering. Worse, he started yelling at his wife and children, often for little things like laughing loudly at the TV.

One day at work, he broke a computer keyboard by hitting it with a stapler; and he sometimes tore up papers he was working on. After each of these episodes, he would be very embarrassed and apologetic. He came for help after loudly cursing at his daughter because she was playing with her program at a Wednesday evening church service.

With Joe, it was clear that he was having impulsive anger resulting from his head injury. When other more familiar causes of anger are also present, such as difficult personality, alcohol abuse, or anger at the injury itself, the impulsive anger resulting directly from the brain injury can get overlooked. It is important to try to identify and treat that part of the anger too.

Dealing with Impulsive Anger Resulting from Brain Injury

When a person with a brain injury first wakes up from a coma, they are usually disoriented and confused and often they are agitated. They do not understand what is going on around them, and they are not truly responsible for their own actions. It is up to the people taking care of then to keep them safe, even if this means restraining them or using medications when absolutely necessary. As they recover, they gradually come to be able to control their actions. Their staff and families can then gradually teach them about the best ways to manage their angry feelings. Because a person with a brain injury’s “anger thresholds” or “flashpoints” have been lowered, they need to relearn how to manage the changed reactions.

They need emotional rehabilitation in addition to physical and cognitive rehabilitation.

Understanding the Anger

The brain injury survivor is, in some ways, a different person. What makes him or her angry may be different. We need to learn what those things are. Here are some common factors that contribute to anger after brain injury.

Anger Factors

Stimulation factors:

  • High noise or activity level
  • Unexpected events
  • Lack of structure

Personal factors:

  • Frustration
  • Fear or anxiety
  • Embarrassment, shame or guilt
  • Discovery or confrontation of problems
  • Cognitive impairments – especially memory deficits and confabulation (remembering things that did not happen)
  • Communication impairments
  • Rigid thinking

Medical factors:

  • Pain
  • Fatigue
  • Hypoglycemia (low blood sugar)
  • Medications (levels low or high?)
  • Alcohol or drugs

Anger Warning Signs

Speech signs:

  • Loud high voice
  • Cursing
  • Name calling
  • Threats

Behavioral signs:

  • Making fists
  • Increased movement and fidgeting
  • Angry face
  • Moving towards the object of anger
  • Breaking things
  • Throwing things
  • Threatening people
  • Searching for or picking up weapons
  • Hitting, kicking and other forms of violence

Physiological signs:

  • Fast breathing
  • Fast heart
  • Sweating
  • Over-aroused
  • Tense muscles
  • Flushed face
  • Bulging eyes

Mental signs:

  • Fantasies of doing any of the speech or behavioral signs
  • Negative thoughts about others
  • Confusion
  • Feelings of frustration
  • Feelings of fear or anxiety
  • Feelings of embarrassment, shame or guilt
  • Feelings of hurt

Early Strategies

These strategies are for staff and families to use when the person with brain injury is too confused to be responsible for his or her actions. It is important for staff and families to remember during this time that the anger is due to the injury, and they should not take it personally.


Make the environment safe

  • Remove potential weapons
  • Keep alcohol and drugs inaccessible
  • Keep vehicles and dangerous tools inaccessible

Regulate Level of Stimulation

  • Some need to avoid over stimulation
  • Some need to be kept busy and distracted

Provide Appropriate Level of Supervision

  • Provide the least restrictive environment possible

Provide Reorientation as Needed

  • Much of the anger in an agitated confused and disoriented person can come from misperceiving and misunderstanding the situation
  • Staff and families should frequently remind the person of where they are, what is happening and why



  • Leave the person alone for a short period of time if this can be done safely. As you leave, tell them briefly what you are doing and why. “You are beginning to get upset. We are going to leave you alone for a few minutes so you can calm down.”


  • Change the subject, the focus of activity or the location
  • Use a concrete object as a focus when possible

Reorient and Reassure

  • Remind the person of where they are, what is going on and why
  • Try to clear up misunderstandings when this can be done without renewing argument
  • Direct the person in activities that may reduce agitation, such as guided relaxation

Self-Control Strategies

These strategies are to be phased in when the brain injury survivor has recovered enough learning abilities and awareness to begin to cooperate in learning to control anger.

“Back Off, Calm Down, Try Again”

Because the impulsive anger resulting from brain injury often comes and goes suddenly, an effective way to deal with it is for the angry person to back off, calm down and try again. This strategy can be phrased in the individual’s own words or whatever expression is comfortable such as “retreat, relax, return” or “take a break” or “time out”.

Back Off

When warning signs appear, the person should leave the situation and go to a safe place. Others will have to cue him or her to leave. If the person will not leave, the other people present should leave instead, if possible.

Practicing backing off when not angry (like a fire drill) will help this go more smoothly when it is really needed.

Calm Down

When the person has backed off to a safe place, he or she should work on claming down. Many techniques can be used to calm down including:

  • deep breathing
  • soft music
  • meditation
  • prayer
  • closed eyes
  • physical exercise

Preparing to Return

Once calm, the person may need to rethink the situation and prepare to return.

Reviewing a list of questions is a possible preparation;

  • Do I need to apologize?
  • Do I need to explain why I left?
  • Do I need to tell anyone my feelings?
  • What can I do to avoid this next time?

Here are some statements to encourage rethinking the situation;

  • “I don’t hate my mother; I’m just angry with her”
  • “Maybe she had a point I should listen to”
  • “He’s not wrong, we just disagree”

Try Again

When the person returns from backing off and calming down he or she may need to

  • apologize,
  • talk through the issue,
  • explain the backing off and feelings
  • resume what he or she was doing.

Once a person has learned to back off, calm down and try again successfully, he or she can work on calming down in the situation without leaving.

Anger Cue Cards

Anger cue cards can be used to remind the brain injury survivor of their warning signs such as Loud Voice, Tense Muscles, Confusion, or Thoughts of Hitting. These cards should be carried by the person with a brain injury and optional copies can be placed where anger incidents often happen or where backing off takes place.

A Back Off card might say:

  • “I’m feeling angry, I need to back off”
  • Leave the room
  • Breathe deeply
  • Relax muscles.

Angry Reactions to Brain Injury

Anger at the cause of injury: The victim of an injury may be angry at the cause of the injury such as a drunk driver, an assailant, a corporation or a government. Such people often need help finding effective and satisfying channels for their anger. Often, they can talk this out with a trusted friend or family member.

Grief Reaction

It is part of human nature to grieve when we lose something, not just when someone dies, but also when we suffer an injury or illness. We try to find reasons for our losses. One part of a grief reaction is anger at what we think caused it. This anger can also get displaced onto any handy target. People can work through these reactions by talking out their feelings. This is such a human experience that it usually does not require a psychologist, just a trusted and understanding person. However, poor memory or judgment or emotional or personality problems can complicate grief reactions and psychotherapy may be needed.


When frustration contributes to angry reactions, the person needs to be trying easier things. Specific preparation can also be given before difficult tasks. For example,

“Now it’s time to go shopping. I know this is sometimes frustrating for you. How will you know if you are starting to get frustrated, and what will you do about it?”

Normal, Legitimate Anger

People with brain injury still have legitimate reasons to get angry. If their legitimate anger is discounted, ignored or “treated”, they may get angrier. If they have expressed their anger inappropriately, their angry actions should be dealt with separately from their legitimate complaint. They should not get their way just because they made a fuss, but the complaint should not be ignored.

Brain injury survivors often have impaired judgment which can contribute to anger problems. Cognitive rehabilitation for judgment can help. People with these difficulties need to check their judgments with caregivers or people they trust. Alcohol and drugs can contribute to anger problems. The clearest solution is abstinence but abuse programs or counseling may be needed. Not taking prescribed medications can also contribute to anger problems. The doctor should be told if the medications have not been taken as directed and if there have been any problems.


Anger is a common problem following brain injury. It has many causes, and there are many solutions to be tried. The rehabilitation team, the family and friends and the brain injury survivor can all work together to understand and manage the problem to help the person with brain injury to work towards recovering self control.

Shared from the Brainline website

via Anger and Frustration After Brain Injury – Spindpals

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[Myth #8] Recovery from brain injury only occurs…


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[Infographic] Sequelae of Brain Injury



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[Magazine] HOPE Magazine – Summer 2020

Serving All Affected by Brain Injury

Download BDF file

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