Who’s that Girl

About frontal lobe disinhibition…

At age 35, my daughter Sarah is very lively and animated. She is loud and has a great sense of humor, almost at a comedian’s level. When she walks in the room, she fires humor back and forth at everyone, and with her witty and quick comebacks, the atmosphere is cheerful. But Sarah has not always been that way. In fact, she was shy and introverted since elementary school. But there were gradual and dramatic changes that were evident after her brain injury.

So, what happened?

Traumatic brain injuries cause a collision of skull and brain. On impact, the skull stops, causing the brain to collide with the skull twice: first in the direction of travel, then in the opposite direction. Depending on the severity of the injury, the biological changes that take place can be immediate, shortly after, or as in my case, years later. On the other hand, Acquired Brain Injury is all about the hormonal and biological changes in the brain that result from a disease or hereditary condition. In Sarah’s case, an AVM condition, followed by brain hemorrhage that damaged her brain, followed by 5 sessions of Gamma radiation surgeries over the next 20 years, caused the variety of changes that followed.

Most Brain Injuries affect the frontal lobe, and when that happens, there are obvious changes in inhibition. Inhibition is controlled by the two frontal lobes that lie immediately behind the forehead. They are responsible for behavior, learning, personality, and voluntary movement. Depending on the type and level of brain injury, changes can be mild, moderate, or severe. It is important to monitor and document those changes, and their impact, especially when it comes to social isolation.

Social Isolation is the subject of Sarah’s dissertation!

Thankfully, while Sarah’s personality changes have been gradual, and toward the extraverted side of the spectrum, her inhibition changes added to the witty and humor component, which is drastic. However for months after a concussion she had sustained, Sarah was not herself, feeling dizzy, agitated, and snappy at times. But the doctors said that was normal, and she eventually returned to her dynamic self.

With brain injuries, emotional and behavioral changes can be subtle and gradual or dramatic and drastic. Navigating through those changes is super tricky. For one thing, when such changes occur, you don’t know whether they are due to a temporary stressful situation, or new changes in brain injury symptoms. For the patient, the changes can be confusing and draining, while drowning in racing thoughts can be the real battle. A supporter watching and reacting must decide whether changes are temporary requiring no action, or a permanent change in the patient’s emotion and behavior requiring attention.

Logging and documenting changes, along with having a Neuro-Psychological assessment when necessary, might prove a helpful tool in navigating through the changes. In fact, from time to time, Sarah and I read through those reports when faced with cognitive or behavioral changes, in hopes of finding explanations.