Traumatic Brain Injury 151to lose sexual regulatory functions. Some of them proposition medical staff and visitors and make
sexually suggestive remarks to strangers.
Patients with traumatic brain injury may also be aggressive and even violent. In the blur of
confusion, they may strike out and injure staff, family, and friends. Some of them are verbally
aggressive and dismissive of others. Patients may be excessively territorial, not allowing others to
enter their room or sit with them at the dinner table.
Whereas some patients are agitated and aggressive, others are indifferent and seem emotion-
ally distant from family and friends, a condition called flat affect. Affect refers to the emotions
associated with a thought and how they are manifested. Patients with f lat affect appear uncon-
cerned about others, even friends and relatives, and thoughts about their predicament are not
accompanied by the expected emotions. They do not display the emotions experienced by normal
persons under similar circumstances. Family and friends often report that the patient’s unusual
reactions to persons, things, and situations are chronic personality changes following traumatic
brain injury.
In response delay, another common be hav ior change seen in patients with traumatic brain
injury, the patient takes excessive time to perform certain tasks. This is particularly apparent in
taking turns during conversations. In turn- taking, timing is impor tant. If one person talks longer
than is acceptable, the other may interrupt. Patients with response delay may take much longer
than usual to answer a question or make a remark. They appear to be pro cessing information very
slowly or to have tense speech muscles that cannot be moved. Also, some patients, particularly
those with damage to the frontal lobes, lack initiative. This reduced spontaneity, when combined
with spastic speech muscles, sometimes produces extremely long response delays.
Post-Traumatic Psychosis
Post-traumatic psychosis is a generic label for psychotic illness in a person who has suffered
a traumatic brain injury; it may affect as many as 50% of these patients (Smeltzer, Nasrallah, &
Miller, 1994). Patients with post-traumatic psychosis have prob lems with real ity testing and often
develop hallucinations and delusions. Hallucinations are distorted interpretations of information
coming from the senses. Delusions are false beliefs that are rigidly held even in the face of proof
to the contrary. The diagnosis of post-traumatic psychosis is difficult when the patient suffers
from communication disorders such as aphasia. The patient may appear to be experiencing delu-
sions and hallucinations when, in fact, he or she is simply reporting real events with paraphasias.
Table 8-1 lists the prominent cognitive, behavioral, and communication disorders of traumatic
brain injury.
Pediatric Traumatic Brain Injury
Children with traumatic brain injury often have a better prognosis for rehabilitation than
adults, but they also have unique challenges. Because a young person’s brain is more pliant than
that of an adult, when a par tic u lar area is damaged, other areas of the brain may more readily take
over the lost functions. Children with traumatic brain injury may also compensate more easily for
impaired function by learning to work around deficiencies and using existing strengths. On the
negative side, children may be more vulnerable than older people in certain critical areas of func-
tioning (Ylvisaker, 1998). Unlike many adults with traumatic brain injuries, rehabilitation for the
child involves returning to school and a lengthy period of formal learning. Teaching and learning
strategies for the child must be adjusted to accommodate the cognitive, behavioral, and emotional
changes resulting from the injury. And, of course, children are in a period of rapid mental, physi-
cal, and emotional growth and have dif fer ent perspectives and needs. For example, family support
and peer ac cep tance are more impor tant for children than for most adults.