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Agitation After Traumatic Brain Injury: Causes, Symptoms, and Management

man laying on couch clutching pillow and pulling his hair because he has agitation after traumatic brain injury

Agitation is a common behavioral problem that can occur after traumatic brain injury. Typically it appears during the early stages of brain injury recovery, but it can also develop later on.

This article will cover the causes and symptoms of agitation after TBI, plus the different treatment methods you can use to manage it.

Causes of Agitation After Traumatic Brain Injury

Agitation typically occurs in the early stages of brain injury recovery, when the patient experiences post-traumatic amnesia.

During this time, the individual does not remember what happened to them, and their brain cannot form new memories. The brain also has difficulty filtering information and attending to multiple forms of stimuli at once, which leads to frequent sensory overload. As a result, the person enters a state of extreme disorientation and confusion.

Additionally, some individuals can become agitated when certain basic needs are not met in the moment. For example, they are hungry, tired, or need to use the bathroom (but are unable to do so without assistance in some cases).

All these factors contribute to severe agitation after traumatic brain injury.

Symptoms of Agitation

Annoyed young man feeling despair and holding head in hands because he has agitation after traumatic brain injury

Agitation is one of the many secondary effects of traumatic brain injury. Symptoms of agitation include:

As patients progress through the later stages of recovery, they should begin to regain control of their actions. Over time, these behaviors should decrease.

However, sometimes agitation continues even after amnesia disappears. We will examine the reasons for that below.

Why Agitation Appears in Later Stages of Brain Injury Recovery

Agitation can appear later in the recovery process as well, even after their amnesia fades, although this is less common. This can have a negative impact on the person’s relationships and health if left untreated.

There are multiple reasons why agitation can occur later on in recovery. The most common include the following conditions:

Sensory Overload

Even after post-traumatic amnesia passes, the injured brain is still vulnerable to sensory overload, which will cause agitation. Some reasons for this include:

  • Cognitive fatigue. The injured brain devotes most of its resources to repair itself. This means the brain has minimal energy left to process incoming sensory information, such as sounds, light, noise., etc. As a result, even a little stimulation can cause an overload.
  • Reduced concentration span. Similarly, attention and concentration skills are limited after brain injury. Therefore, if too many things compete for your attention, the brain will get easily overwhelmed.
  • Increased stress. Finally, the stress, pain, and fatigue you naturally experience after TBI can intensify your senses and put you on edge.

When sensory overload occurs, the person can become agitated and distressed.

Depression and PTSD

man lost in thought, sitting in shadow, with harbor in the background

Depression and PTSD are also common causes of agitation.

Specifically, PTSD and depression can cause psychomotor agitation, which refers to unconscious, restless movements. Some examples of these movements include:

  • Pacing a room
  • Pulling at hair
  • Wringing their hands
  • Tapping their feet and fingers
  • Talking very rapidly
  • Fidgeting
  • Moving objects around for no reason

These behaviors are not concerning on their own, and many people do these out of habit.

But someone with psychomotor agitation might do these things in a way that seems frantic, jerky, and frustrated. That is usually a good sign that they may be struggling with depression or anxiety.

Since both PTSD and depression are common after traumatic brain injury, they could also trigger your agitation.

Managing Agitation After Traumatic Brain Injury

If the person’s agitation puts them at risk for bodily harm, doctors may prescribe some sedative medications to help them calm down.

This can be helpful in the short-term; however, sedatives can suppress brain activity and slow TBI recovery. Therefore, they are not a permanent solution.

If agitation does not decrease naturally, other medications, such as antidepressants or anti-anxiety meds might prove useful.

In addition, counseling and behavioral therapy can help patients learn to control their behavior again. These are only suitable for persons who have improved their insight after brain injury, however.

There are also some quick, helpful ways to reduce agitation after TBI which we will look at below:

1. Limit exposure

man standing outside, closing eyes and taking deep breaths to reduce his agitation after traumatic brain injury

The best way to avoid agitation is to limit exposure to stimulation.

For example, turn off any devices such as the TV that might make any unnecessary noises. If that is not possible, invest in some noise-canceling headphones so you can quickly have some peace and quiet.

Family members should also avoid asking their loved ones too many questions at once, especially during the beginning of their recovery. Speak briefly and clearly; anything more complicated can risk agitating them. Also, don’t be around too many people at once in the beginning of recovery.

You’ll also want to modify your environment to create a space to decompress. If possible, dedicate a room in your house where you can relax, free from distraction.

2. Understand your limits

Learn to monitor yourself so you can tell when things are becoming too much. A cognitive therapist can teach you how to recognize when you are getting agitated.

It helps to come up with a safe word you can use with family and friends when your agitation increases. That way they can modify their behavior before things go too far.

It’s also a good idea to pack headphones with you wherever you go. These can help you calm down, especially in loud environments.

3. Exercise Regularly

woman sitting on board walk putting on her running shoes

If possible, try to get outside and exercise for at least fifteen minutes every day. Consistent exercise releases endorphins that reduce stress and agitation.

In addition, meditation and deep breathing are excellent ways to relieve stress. In fact, research shows that taking deep, controlled breaths activates the parasympathetic nervous system, which calms feelings of anxiety.

To practice deep breathing, simply close your eyes, and slowly inhale through your nose. Let the air completely fill your lungs, then hold for three seconds.

Finally, exhale slowly through your mouth. Repeat several times until you feel more relaxed.

4. Avoid Triggers

It’s possible that your agitation is triggered by physical feelings, such as hunger, thirst, or fatigue.

If that is the case, try to take steps to minimize these feelings. For example, set a timer on your watch or phone every two hours as a reminder to eat. And take short naps every few hours to prevent fatigue.

While these measures will most likely not eliminate your agitation, they can prevent it from overwhelming you.

Dealing With Agitation After Traumatic Brain Injury: Key Points

Agitation after traumatic brain injury typically occurs at the beginning of recovery, when the brain is in a vulnerable state. It can also be a secondary effect of depression, PTSD, and sensory overload.

In most cases, agitation will resolve on its own as the person progresses in their TBI recovery. If this does not occur, medication, counseling, and other tactics can often prove useful.

It can sometimes take time to find the right combination of treatments for agitation. Patients should consult with their doctors to find the best techniques for managing their condition.

©iStock/yacobchuk/MangoStar_Studio

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