Challenges After Brain Injury: Insight

Let’s talk about insight. Other terms may include self-awareness or self- evaluation, but no matter what you call it, it is one of those things that we as humans rely on every day.

How about we start with a definition from “The Essential Brain Injury Guide” (offered through the Brain Injury Association of America – www.biausa.org ):

Self-Evaluate: independently assess behavior; respond and make changes as needed

It’s a difficult topic to talk about (especially with patients who struggle with it after an injury), but when I talk with my patients or their caregivers about insight, I am talking about the individual’s ability to understand the functional impact of the cognitive and/or physical changes that have occurred as a result of their brain injury and that are ultimately affecting how they function safely and independently.

Often after an injury, especially to the frontal lobe or right hemisphere of the brain, patients can have a difficult time understanding exactly how much they have changed.

This can mean:

- Having unrealistic goals/expectations related to recovery – “I can’t wait to get back to playing soccer next week”, despite having significant right-sided weakness and needing direct assistance/supervision to transfer from their wheelchair

- Attempting things that are unsafe – getting up without help and falling out of their chair because of right-side weakness; attempting to drive a car while having difficulty with visual attention to the left

When we have inaccurate ideas of what we are capable of doing, we can really get into trouble. While it can happen to anybody, regardless of a brain injury (how often have you watched the initial try-outs for American Idol and thought “Doesn’t that person know how bad they sound?”), we have more cause for concern when the stakes are raised (e.g. driving a car, going back to work, returning to sports) and the patient just isn’t ready.

It is important to understand that often when insight is an issue, it’s not that you are trying to be unsafe, deliberately trying to make a ‘bad decision’, it’s that your brain is not automatically considering the consequences of what might go wrong or simply why something is no longer an option. Who can totally blame you? One minute you were perfectly independent and now your life is completely different.

It just means that we need to put some external things in place to ensure safety while allowing for as much independence (and ultimately, quality of life) as possible.

One of the first things we talk about is supervision. Initially, the best thing is to have someone around you at all times (or at least nearby) to help keep your brain in check.

When do we know when it’s safe to ask for more space?

One of my go-to indicators is:

Are you able to identify when you need help? – This might simply mean asking for help when transferring from your wheelchair before trying to do it by yourself or as complex as paying a bill online and asking someone to check over your work before submitting a payment.

The take away is: Do you know when you are attempting a task that has been more of a struggle since your injury and would it be ‘safer’ to ask for help than to give it a shot by yourself and possibly suffer a negative consequence?

Insight is so tricky because it can be the root of frustration. When someone is unaware of having difficulty with completing a task or recognizing a skill that is different after a brain injury, the result can often be fighting with those that are just trying to keep them safe. I feel like some of the biggest challenges we face when trying to help someone after a brain injury is helping them see that things are different and they require some help with things they didn’t need help with before, all while not making them REALLY mad.

The truth is, we can’t always avoid making a loved one mad or, as a survivor, you can’t avoid feeling those feelings and occasionally lashing out at those you care about the most. This is when my favorite strategy comes into play: communication.

I know I’ve said it a million times, but it is usually the best place to start. Try taking time to sit down and talk about the things that you (as a survivor and a caregiver) have been having a hard time with, what the other person could do to make it easier, and find an agreement that allows for a happier environment, as much independence as possible, and most importantly, the best way to keep everyone safe.

For more ideas on helping you or your loved one deal with insight issues at home, schedule you evaluation with Life Beyond Rehab today. Visit our ‘Services’ page and find the price package that works best for you.

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