Cognitive and behavioural deficits following brain injury

Family pressures

It is cognitive and behavioural deficits which prevent return to a normal life for the injured individual and it is these deficits which cause stress for family members on a daily basis.

Two of the most common reasons for problems after a head injury are firstly overestimating or underestimating the cognitive and behavioural abilities and limitations of the injured individual and secondly failure to understand the practical implications of deficits. Expecting too much from the injured individual frequently causes significant behavioural problems; expecting too little may also cause behavioural problems but, more importantly, limits recovery and the acquisition of new skills. At either extreme, the stress experienced by family members is exacerbated and increases over time.

Neuropsychological evaluation is useful in determining which cognitive functions are intact and which are impaired. When discussing medical results, the words used by the neuropsychologist may be quite technical and family members may not understand how things like "impaired initiation", "left neglect", or "apraxia" might be observed in daily life. If you are able to discuss results with the neuropsychologist, make sure you ask for specific examples of how you might see the deficits in daily life. If you don't understand, ask for additional examples. Make sure you have a clear picture of how the test results apply to daily life. Ask what specific activities the injured individual should be able to do independently, which can be done with assistance, and which are probably totally beyond current ability levels.

Although it is relatively easy to understand the injured individual's limitations in physical endurance, limitations in cognitive endurance are more difficult to observe and to understand. It is important that you keep track of time as well as activities as you observe the injured individual: how long the individual can work with words, with visual information, and on motor tasks and see how abilities in these areas deteriorate over time.

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