The document discusses various cognitive, behavioral, and emotional challenges that may arise from traumatic brain injury (TBI), including issues with problem solving, disinhibition, anger management, emotional regulation, impulse control, and organization/planning. It then provides strategies in each of these areas that individuals with TBI and their support systems can use, such as identifying triggers, using relaxation techniques, setting reasonable goals, and enlisting help from others.

1. Who needs them?

2.  The person’s ability to use thinking, planning,
organizing, and problem solving (cognitive skills) may
be affected.
 Disinhibition is a lack of control shown toward rules of
society,
 acting in risky
 inappropriate behavior to a situation that often result in
undesirable consequences
 poor risk assessment
 Disinhibition affects
 motor behavior
 Instinctual (survival) behavior
 Emotional behavior
 Overeating behavior
 aggressive/angry outbursts.

3.  Taking turns in conversations, truly listening to
other participants
 Use of appropriate eye contact
 Awareness of and respect for interpersonal space.
 Awareness and appropriate use of non-verbal
communication skills (e.g., gestures, facial
expressions, body language).

4.  Practice anger-management strategies before anger occurs.
 Learn to identify early signs of anger.
 Learn to identify situations ("triggers") that can lead to anger
 Avoid triggers if possible, or learn and use anger-
management strategies in those situations.
 Get help from family, friends, and others in efforts to learn
and use anger-management strategies.
 Seek to include regular activity, hobbies, and other sources
of enjoyment in one's life.

5.  Acknowledge and allow self to grieve changes/losses that
occurred since the TBI.
 Accept support/encouragement offered by others.
 Work to move from focusing on TBI-related difficulties to instead
recognizing current strengths and abilities.
 Enlist the help of trusted family and friends in identifying
strengths.
 Identify new, reasonable goals given strengths and weaknesses.
 Work with family members, friends, and healthcare providers
(rehabilitation psychologist/neuropsychologist ) to develop strategies to
achieve these goals.
 In addition to striving for accomplishment, pursue hobbies and/or other
sources of enjoyment.

6.  Attend to early signs of emotionality.
 Be aware of factors that contribute to increased emotionality
(e.g., fatigue, pain).
 Try to minimize exposure to situations that are associated
with increased emotionality, particularly when at risk for
increased emotionality (e.g., due to fatigue, pain, etc.).
 Use strategies to cope with high emotionality, including:
 Using words to express emotions.
 Removing self from the stress-inducing situation.
 Using relaxation techniques (can be developed with the aid of
psychologist).
 Enlist the help of trusted family member, friends, healthcare
providers in developing strategies to manage emotional responses.

7.  Identify triggers to impulsive behaviors with
help of trusted others (e.g., family, friends,
healthcare providers).
 Develop strategies to reduce the likelihood of
acting before considering consequences.
 Have family members/friends give a signal to help
with stopping and considering behaviors before
acting further.
 Accept feedback from trusted others (e.g., family,
good friends) regarding when it is important to stop
and consider behaviors even if it is difficult to
recognize the need for this.

8.  Accept help from trusted others (e.g., family,
friends) in identifying plans/schedules for
activities.
 Use a timer to provide prompts when a task
needs to be done (e.g., a watch alarm can
sound when medications need to be taken).
 Set appropriate goals for activities each day,
with the help of trusted others.

9. Define and build a shared purpose
Set goals
Be fully committed to reaching these goals
Develop an atmosphere of contribution
Everybody needs to pitch in whenever necessary
Develop processes that facilitate collaboration
Make certain that two people on your team both have to
sign off on reaching a goal

10.  Independence does not mean we aren’t
supposed to ask for help
 Being a part of your community is more than
shopping at a local store.
 It can mean starting a book club there
 It can mean going to a church there
 It can mean getting a job there
Find a purpose, set a goal, then find ways to make
things happen! USE your resources!

11.  http://wealthmanagement.com/opinions/consequenc
es-apathy
 http://en.wikipedia.org/wiki/Disinhibition
 http://braininjuryeducation.org/TBI-
Basics/Behaviorial-and-Emotional-Impacts-of-TBI/
 http://www.ldonline.org/article/6165/
 http://www.focusonthefamily.com/parenting/effecti
ve_biblical_discipline/approaches_to_discipline/beha
vior_and_consequences.aspx