Acquired brain injury (ABI)

What is an acquired brain injury (ABI)?

An acquired brain injury is when something has caused damage to the tissue of the brain. The affects can be temporary or permanent. Brain injuries can be caused by many different things. These can include the following:

• road traffic incident
• hit to the head
• surgery on the brain (neurosurgery)
• brain tumours
• bleeding in the brain
• stroke
• brain illnesses like encephalitis or hydrocephalus
• a period of not breathing such as hypoxia
• seizures

Recovery from a brain injury can take a long time. On the outside, someone may look like they have recovered well (their bruising will heal, and they may have an old scar). However, on the inside, the brain can still be finding things difficult for a long time, or sometimes permanently.

What might be affected by a brain injury?

How an acquired brain injury affects a child will vary according to:

• the severity of the injury or illness
• the parts of the brain affected
• whether or not there were any complications in treatment or recovery
• the age of the child at the time of the injury
• the child’s personality before the injury or illness will also play a part.

Things that can often be affected by an acquired brain injury:

• thinking skills
• physical skills
• senses (how people see, hear, feel the world)
• social skills and friendships
• speech and language
• mood
• personality
• sleep
• snergy (being tired a lot)
• headaches or other pain

Not all children will experience every one of these problems.

How can thinking skills be affected?

Children may have difficulties in some or all of the following areas:

• Orientation such as knowing things about themselves, who other people are, and where they are (particularly in the early stages after the injury)
• Short-term memory such as remembering what someone has asked long enough to go and do it
• Long-term memory such as remembering information from a while ago, such as a specific event from a family holiday
• Concentrating such as listening, paying attention to or staying focused on an activity
• Information processing such as responding promptly and accurately to a question
• Understanding what they hear or read
• Getting a message across such as through speech or writing
• Planning or being organised (such as getting sports kit together)
• Understanding or being able to do things in the right order such as getting dressed
• Making decisions such as deciding what to wear
• Being able to solve problems such as deciding what to do if the food gets spilt on clothing

How can physical skills be affected?

Children may have problems with:

• Moving limbs such as sitting, standing or walking
• Holding a pen or pencil such as to write or draw
• Using zips, buttons and small objects
• Being able to chew or swallow food and drink safely
• Co-ordination – they may seem clumsy and out of sync

How can sensory skills be affected?

Children may have difficulty making sense of things, causing difficulties such as:

• Changes to how things taste or smell
• Misjudging depth or distance such as how deep a step is on a staircase
• Not recognising things such as a hat
• Quiet sounds appearing louder such as they may find it hard to tolerate normal background noise such as a sibling chatting quietly
• Not recognising words when they are spoken

How can social skills and friendships be affected?

Children may have difficulty with:

• Making and keeping friendships
• Understanding what other people think or feel

Behaviour change can also impact on social skills and friendships (see below)

How can behaviour be affected?

A child with acquired brain injury can show a change in behaviour, such as:

• Being easily distracted
• Being easily irritated
• Acting impulsively
• Not acting in a way that is appropriate to the situation such as swearing at school or in church
• Mood changes such as being withdrawn, anxious, depressed, overexcited, frustrated, angry

Behaviour can happen for many different reasons and it is important to work out what causes a behaviour to help manage it. Reasons for behaviour that can be challenging may include (and is not limited to):

• Difficulties with communicating needs or wants or dislikes (verbally and non-verbally)
• Sensory sensitivities
• Emotional sensitivities
• Reduced ability to manage stresses
• Fatigue
• Boredom
• Frustration
• Not being able to do things someone used to be able to do
• Needing more help to do things
• Lack of sleep
• Physical illness or pain

How can speech and language be affected?

Children may have difficulty in:

• Expressing themselves
• Finding the right words
• Mixing words up
• Understanding and using language
• Using language which is appropriate to the situation
• Recalling familiar words to use when talking or writing
• Talking clearly

The experience of friends and family

The changes caused by acquired brain injury can be challenging for the friends and family of a child with acquired brain injury. They may feel the person they knew before the injury has changed, and also be learning how to support the child with any additional needs they have acquired since the injury. It is important that family and friends of those with ABI feel supported and are able to take care of themselves as much as possible.

What can help?

• Learn about brain injury – the more you know, the more you can help. There are lots of resources available to learn about brain injuries in the link below.
• Seek information from relevant voluntary organizations (see links)
• Talk to the people (such as therapists, psychologists and outreach teachers) working with your child – they will be happy to answer your questions. They will also be able (with your consent) to share information with schools.
• Keep the people working with your child informed about things you notice at home. Ask their views, and make suggestions.
• Keep copies of any reports or letters you receive or send.
• Get into the habit of writing down anything that is discussed. When sharing information with others, make a copy of any paperwork. Keep your original!
• If they are able to express their views, seek the child’s views before passing on information about their injury or illness
• Other leaflets in this series will give information in greater detail about issues identified as relevant to your child.

A list of External Resources including Websites and Downloads