1. 1 Changes in Personality, Behavior, and Thinking: Strategies for Coping & Adjustment after Brain Injury Kristine Cichowski, MS, Director Judson Paschen, Brain Injury Peer Mentor Rehabilitation Institute of Chicago - LIFE Center Community Life Skills Training Midwest Regional Traumatic Brain Injury Model System at the Rehabilitation Institute of Chicago - 2010

2. 2 Brain Injury – What does it mean?  Damage to the body’s command center – Central Nervous System  Impaired messages –Movement –Thinking –Speech –Behavior –Personality Image Source: http://www.infovisual.info/03/038_en.html http://www.infovisual.info/03/038_en.html

3. 3 How does the Brain work?  Left side controls Right  Right side controls Left  Each section (lobe) of the Brain controls specific functions Image source: reprinted with permission – Jamee Heelan, OTR/L artist Image source: RIC Patient / Family Resource Guide, 2009

4. 4 Understanding your Injury Changes & Challenges  Thinking  Behavior  Personality Changes are different for each individual. Think of your brain as your own personal “finger print”

5. 5 “Thinking” Changes & Challenges (Examples)  Memory, Attention & Concentration, Planning & Organizing, Problem Solving, Processing Information, Fatigue  Tips: –Develop a schedule - consistency is key –Use a memory book or daily planner –Minimize distractions One topic or task at a time –Structure activities - gradually extend complexity Break down activities in small steps Practice attention & memory skills - games Take breaks – allow for more time

6. 6 “Behavior” Changes & Challenges (Examples)  Impulsive, Short Temper, Mood Swings, Inappropriate Language, Social Skills, Sensitive to Time, Light, Noise, Commotion  Tips: –Get a good Coach Be open to supportive feedback and make a conscious effort to adjust behavior –Develop a signal that family and friends can use to help you know when you are out of line The Coach needs to be “fair” – no nagging –Work at being more flexible, open to change Try not to take things personally –Practice and think ahead to help develop your problem solving and reactions to others / situations

7. 7 “Personality” Changes & Challenges (Examples)  Mannerisms  Conversation Skills  Body language  Interests  Motivation Work towards embracing who you are now rather than constantly seeking the person prior to injury.

8. 8 “Personality” Changes & Challenges  Tips: –Pay attention to personal appearance Neat & Clean – look in the mirror –Pay attention to how you present yourself to others Friendly – SMILE Positive Body Language Eye Contact – Listening Skills Pleasant Tone of Voice Respect Personal Space of Others –Get Out and Be Involved Begin to redefine your relationships or build new friendships Create experiences so you can talk about something other than your brain injury –Help others understand what a brain injury is and what it is not

9. 9 Knowledge is Power! LIFE Center http://lifecenter.ric.org OR www.ric.org ~ “Quick Links”- LIFE Center Phone: (312) 238-LIFE(5433) Fax: (312) 238-2860 eMail: lifecenter@ric.org This program is supported in part by a grant from the National Institute on Disability and Rehabilitation Research (NIDRR) and is part of the Midwest Regional Traumatic Brain Injury Model System at the Rehabilitation Institute of Chicago. Special thanks to brain injury survivors and peer mentors – Marc Jacobs, Margaret Terry, and Judson Paschen for contributing personal insights and strategies for living with brain injury.

10. 10 References:  Behavioral management strategies for working with persons with brain injury. (1998). Chicago: Rehabilitation Institute of Chicago Academy.  Brain Damadj’d… Take II (film). (2006). Paul Nadler, Writer and Producer. Toronto: Apartment 11 Productions; dist: Films for the Humanities.  Brain Injury Association of America, Model Systems Knowledge Translation System. TBI Model System Consumer Information. (2009). Cognitive Problems after Traumatic Brain Injury; Emotional Problems after Traumatic Brain Injury. Washington, DC: Brain Injury Assoc.  Brain Injury Association of Maryland. (1995). Why Did it Happen on a School Day? Washington, DC: Brain Injury Association.  Brain Injury Circle of Caring – A family discussion guide. (2004). Chicago: Rehabilitation Institute of Chicago.  Brain Injury Program: Patient and Family Resource Guide. (2009). Chicago: Rehabilitation Institute of Chicago LIFE Center.  Burgard, Jodi. (Jan 2009). Brain Injury: Why does my loved one act out? A family guide to emotional and behavioral changes after a brain injury. Chicago: Rehabilitation Institute of Chicago.  Rehabilitation Institute of Chicago Brain Injury Team. (Jan 2008). Brain Injury: An Overview – What is it and what does it affect? Chicago: Rehabilitation Institute of Chicago.

11. 11 Tips for Family & Friends  Speak slowly and clearly, but not demeaning. Use meaningful examples  Focus conversations - one person, one topic, one task at a time  Minimize distractions – it can be hard work to interact with others  Be mindful of fatigue and how it affects thinking, behavior – brain and physical stamina  Be time sensitive and true to your word  Verify that information is understood  Write down information for recall at another time  Use visuals to simplify / clarify  Reinforce use of a to do list or memory book  Identify and communicate with the “Coach” Take time to get to know each other

12. 12 Tips for Family & Friends Coaching Tips  As you observe behavior, give supportive feedback - be fair  Establish a signal to help a person “stop & think” – use the signal in a fair way  Rehearse answers to questions - Keep it simple and positive.  Reach out to others to help them stay connected with you and your loved one  Clarify misinformation and misunderstandings – nurture relationships  Embrace the person for who they are now – refrain from comparisons to the old self  Practice forgiveness