The Disability Information and Resource Centre

Brain Injury Awareness Week (BIAW) is occurring from the 16th to 22nd August 2010.

The Brain Injury Network of SA (BINSA) are organising a number of events during this week. Have a look at their calendar of events.

This document contains invitations to both the Launch Event on 16th August and the Achievement & Service Excellence Awards Ceremony on 20th August.

Nominations for the Achievement & Service Excellence Awards have been extended until 11th August.

Brain Injury, Psychiatric Disability, Intellectual Disability
- Are They The Same?

NO – each type of disability is different. This Fact Sheet is only a summary of these three types of disability.

Brain Injury

Brain Injury is defined as a loss of brain function caused by:

• Accidents (motor vehicle accidents are the cause of 70% of all brain injuries)
• Poisoning
• Stroke
• Brain tumours
• Infections
• Lack of oxygen.

As a direct result of a brain injury a person may develop impairments in one or several aspects of their life including:

• Loss of mobility
• Difficulty in solving problems or making decisions
• Fatigue and tiredness
• Problems with memory & concentration
• Sticking to the one idea for a long time
• Easily distracted
• Quickly aroused to anger or sadness.

A brain injury that is “acquired” as an adult does not affect previously stored memories & experiences. A person may have little or no change in their I.Q. test scores because they can still draw on their past memories and skills. However, a person’s level of adaptive functioning (problem solving, organisation, personal management) is often impaired. The individual’s self identity and expectation’s of life are still strongly shaped by their social and intellectual development before the brain injury.

Brain injury cannot be “cured”. The impairments are caused by permanent damage to the brain. However, over time, many people return to work and maintain a healthy and enjoyable lifestyle.

Psychiatric Disability

Psychiatric Disability is a range of functional difficulties often linked with a past or current mental illness, associated institutional dependence or the adverse effects of medications.

Mental illness is characterised by the presence in a person of one or more symptoms including:

• Delusions
• Hallucinations
• Serious disorder of thought form
• Severe disturbance of mood
• Sustained or repeated irrational behaviour.

A person who has a mental illness or has had a mental illness in the past does not necessarily have a psychiatric disability. The three most common disorders are:

• Schizophrenia
• Manic-depressive disorder
• Depression.

Medication can often be used to assist the person cope with their disability. However, some medications create a range of additional problems. People who have a psychiatric disability can enjoy a satisfying and fulfilling life.

Intellectual Disability

Intellectual disability refers to a slowness to learn and process information which can affect how a person functions in society. Intellectual disability is not a sickness, it cannot be cured and it is not medically “treatable”. While people with intellectual disability often encounter difficulties in learning and development, it is not an inability to learn. People with intellectual disability can and do learn a wide range of skills throughout their lives. It is through appropriate levels of support, early intervention and educational opportunities that the effects of intellectual disability can be minimised.

Intellectual disability is often evident from birth. The period of one’s life between birth and adulthood, 0-18 years, is referred to as the “Developmental Stage”. The fact that intellectual disability occurs during the developmental stage is one important factor which distinguishes it from other types of disability.

There is no one identifiable cause for intellectual disability, however there are some reasons that we do know about which include:

• brain damage before birth due to conditions such as rubella, a drug or diet problem.
• brain damage resulting from a lack of oxygen during the birth, eg as a result of a prolonged labour.
• brain damage after birth due to an illness such as encephalitis or an accident.
• abnormal chromosome count resulting in eg Down Syndrome.

Multiple Disabilities

A person can have more than one form of disability. For example, a child can develop an intellectual disability and a physical disability as a result of a brain injury.

A person who sustains a brain injury or has an intellectual disability has the same chances of developing a psychiatric disability as any other member of the community.

Any form of disability can have very serious effects on the lives of people who have the disability and those that support and assist them.

Conclusion

People who have a disability have the same rights as any other member of the community. Just like every other member of the community they are individuals who have personal needs that are unique to them.

* Source : Brain Injury Association of NSW

Changes That May Result From A Brain Injury

Brain Injury results in a wide range of changes to a person’s behavior, their sensitivity to surroundings and their thinking capabilities.

• Some changes are permanent.
• Some changes are only temporary.

Which Changes Are Permanent?

Sometimes, a person who has had a brain injury can appear to overcome all of the effects of their injury.

For example, a person had over 40% of their brain removed after a serious accident. After intensive rehabilitation, it was hard to tell if they had an injury at all. Another person had a relatively mild brain injury and now has to live with chronic pain, a short attention span and many other difficulties.

When a person sustains a brain injury its impossible to predict how much they will recover and how long it will take. There is no formula to tell you which results are permanent and which are temporary. The incredible ability of the human brain to compensate for a loss of some functions continues to amaze medical professionals.

Neuropsychologists and neurologists test the functions of a person’s brain after a person sustains a brain injury. This allows the medical team to establish a rehabilitation program aimed at helping the person overcome their specific difficulties.

What Are The Changes?

There are too many possible changes to list them all here. Changes may (but not always) involve the person’s personality, thinking and learning and physical abilities.

Personality Changes

• The person may be quick to anger – a loud noise, or someone disagreeing with them may trigger an outburst of aggression. This is particularly common when the person is still in Post Traumatic Amnesia (PTA).

Many people who have had a brain injury also become more aggressive as the years pass by. This may be due to a range of factors such as frustration at living with the effects of their injury receiving inappropriate care, and boredom due to limited opportunities for recreation and personal development.

• The person won’t always think of others – for example, the person may become annoyed they can’t watch their favorite television program, even if someone else was watching their favorite program first. Or, the person may become agitated if they aren’t served immediately they walk into a shop or bank.

• The person is very talkative – they may also jump from one topic to another during a short conversation, or, find it very hard to stay focused on the point they were trying to make.

• The person may rush into things – they may rush into a job, make lots of errors and then rush onto another job without checking the first one.

• The person doesn’t believe they have changed – they may remember a lot about what they used to be able to do and think they can still do it. Even when tests confirm the person has lost the skills they might not believe its true.

• The person has less control over emotions – the person may laugh or cry at the slightest suggestion of joy or sadness.

• The person may make inappropriate sexual advances – They may be unable to control their sexual urges as a direct result of their injury. This may result in varying degrees of harassment or others or increased levels of sexual activity.

Physical Changes

• Loss of sight or hearing – the person may have complete or partial loss of their sight or hearing. This loss may be temporary or permanent.

• Reduced control over movements – the person may have slow movements or total loss of control of some muscles.

• Slow or slurred speech – the person may speak slower or be difficult to understand.

• Fatigue – the person may need to have a rest several times during the day as they get very tired very quickly.

• Paralysis – the person may have permanent paralysis in some parts of their body.

Thinking-Learning Changes

• Memory – loss of short-term memory may result in “forgetting”. For example the person may forget to attend meetings, forget why they went to the shop or forget what they have just been taught. Sometimes the person’s long term memory may be affected as well, so that they don’t remember past events.

• Problem solving and decision making – The person may have difficulty seeing how an action caused an effect. This may mean that the same mistakes are made over and over again, as the person can’t understand what is causing the problem.

• Concentration – the person may switch from one task to another, or may have difficulty staying focused on the one thing. They may also be easily distracted by sights, sounds, feelings or temperature.

• Getting started – the person may have difficulty starting something, or they may not feel like doing anything.

• Inflexible or sticky thinking – the person may need to stick to a rigid routine, or they may get stuck on one idea.

• Understanding things – the person may have trouble taking phone messages, understanding a good joke, following meetings, or reading.

• Saying what they mean – the person may have trouble finding the right words, using the right body language or getting to the point.

• Sequencing – the person may have trouble getting things in the right order. For example, remembering to wash the dishes before you dry them.

• Slow to respond – it may take the person longer to understand and respond to what is going on.

• Perception – the person may confuse similar sounding words and numbers, and have trouble finding new places.

* Source : Brain Injury Association of NSW

What To Say, Or Do, To Someone Who Has Had A Brain Injury.

People who have had a brain injury have the same rights and entitlements as any other member of the community.

If you restrict a person’s activities in any way because you know they have had a brain injury, you can be charged with discrimination under the Disability Discrimination Act (1992).

What If A Work Colleague, Friend Or Relative Has Had A Brain Injury?

First things first. You may have noticed several changes in the person’s behaviour. No two people who have had a brain injury will have the same type or degree of impairment, so its important to determine exactly which changes affect the person you know. Examples of changes that may occur include:

• Fatigue – tiredness, even after only an hour of work.

• Concentration difficulties – trouble filtering out little distractions. This makes it hard to concentrate and stay focused.

• Memory difficulties – short term memory loss and some permanent memory loss is common.

• Slowed reaction time – taking longer than usual to understand you, and then still to give you a response.

• Headaches and chronic pain – the brain also controls feelings of pain, so the person may be in constant pain.

• Emotional highs and lows – laughing or crying when it does not fit the situation.

• Deafness and blindness – temporary or permanent loss of sight or hearing.

• Paralysis – one side of the person’s body, or an arm, or a leg may be permanently paralysed.

• Muscle control – slow movements or partial loss of control means it may take longer to complete certain activities.

• Speech difficulties – communication may be difficult because of slow or slurred speech.

• Problem solving and decision making difficulties – difficulty recognising a problem and then understanding what actually caused the problem.

• Socially unacceptable behaviour – swearing, being inappropriately crude or making unreasonable sexual demands.

When a person sustains a brain injury it often results in permanent disability. Although the person may be able to learn how to successfully manage these effects, it can take many years.

These permanent effects can’t be fixed by a good night sleep or a change in lifestyle.

What Do You Say Or Do?

Now you have an idea of the specific difficulties that people who have had a brain injury have to manage each day, you can begin to lend assistance and provide support.

BUT, you must ask the person if they want assistance first, then ask what you have to do. A person who has had a brain injury retains the right to make their own decisions and learn from their own mistakes.

To make it easier for you to assist or support a person who has had a brain injury, its helpful to follow these suggestions:

• Take it slowly – slow down your physical movements and your speech if the person seems confused, afraid or anxious.

• Maintain the person’s freedom of choice – you have no right to make decisions on behalf of the person, or restrain the person in any way, unless you are a Police Officer and the person has broken the law.

• Always explain what you are about to do and why – then do what you said you would do. Keep the person informed and keep surprises to a minimum.

• Listen to what the person is saying, even if it takes you a while to understand – ask the person to repeat anything you don’t understand.

• Don’t pretend you know what the person is feeling – if you haven’t had a brain injury, you can’t know what the person is going through. Don’t tell the person you know how they feel – this is an insult.

• Don’t try to win arguments – stick to the facts in all discussions. Its OK to agree to disagree.

• The person may get tired very quickly – don’t think the person is just being lazy. Allow the person to have regular rest breaks.

• Don’t tease, embarrass or get angry with the person just because they don’t do what you wanted – regardless of how hard the person tries or how much you want the person to succeed, some activities will be just too difficult at that time. Perhaps another attempt on the following day will be more successful.

• Be patient – it may take the person a while to finish but if they can do it, they will.

What About Returning To Work Or Driving A Car?

People who have had a brain injury have the right to return to work, or be retrained so they can continue to do their job. If the person still has the capability to do work, they should be given a chance to do so. Tests by medical and occupational professionals will provide you with the information about the person’s capabilities.

The person also has the right to relearn how to drive a car, as long as they have the capability to do so. Medical and occupational professionals make these judgements.

If you are seriously injured, how would you like to be treated?

* Source : Brain Injury Association of NSW