Living with Brain-Behavior Challenges - Part 2

Wednesday, September 29, 2004 | 0

By Tina M. Trudel, PhD

The first part of this article series introduced patterns of brain-behavior relationships. This article will provide a basis for understanding behavior.

Understanding Behavior

Needless to say, with the complexities and inter-related neural networks throughout the brain, the syndromes described in the first article of this series have many exceptions, and are only the tip of the iceberg. They do serve to raise our understanding of what to expect and therefore, how to respond to behavioral changes following brain injury.

When thinking about behavior in general (yours, mine and everyone else's) common rules apply - behavior makes sense. In general, we act to get something we want, or to stop something we don't want. Some of those actions are automatic (here comes the old Pavlov dog example - drooling over food). Many of the actions are operant or voluntary, and serve to change the world around us.

Even automatic behavior can be changed by brain injury. We often assume this is 'hard wired', but brain injury can change the wiring. Examples of these changes include hyper or hypo sensitivity to pain, under or over arousal, distorted senses and appetites, intensified startle and autonomic responses, just to name a few.

It may take months, even years, for the affected individual and their family to fully understand these changes and how to adjust to them. Many are best addressed through avoidance, managing the environment, educating the circle of support and service providers and/or developing countering strategies depending on the nature of the problem. Strategies may include progressive muscle relaxation and deep breathing exercises for autonomic nervous system overarousal, intermittent use of earplugs or sunglasses for intense settings and desensitization treatment for hypersensitivities. Of course, many autonomic nervous system problems are also treated with medication.

Voluntary or operant behaviors used to impact the world around us are typically the target of behavioral concerns and treatment. Problems fall into one of three categories - too much behavior, not enough behavior or the right behavior at the wrong time. Each has different implications, but all can be addressed through three general approaches: help the person change or develop a skill; change the environment so the person succeeds; or provide an assistive device or system to compensate. Determining which approach will depend on personal preferences, the challenge at hand, the resources available, and our understanding of the function of that behavior. For more high risk or persistent behavioral issues, it's a good idea to consult with a professional experienced in neurobehavioral treatment to provide guidance and support along the way.

The next article in this series will review personal intervention plans and pragmatic behavioral strategies.

Tina M. Trudel, PhD, 1-800-473-4221 Vice-President of Clinical Services, Lakeview NeuroRehabilitation and Adjunct Asst. Professor of Psychiatry, Dartmouth Medical School. Dr. Trudel can be e-mailed at ttrudel@lakeview.ws.

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