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Part 6: Caregiver Boundaries

(Text Used from CTDSSMAPS Training (9/23/2020). 


(you may skip this section if you do not work with clients with acquired brain injury)


Acquired brain injury is any type of brain injury that happens after birth.


When the head is struck hard, the brain slams against the inside of the skull, causing physical injuries such as bruising, swelling or bleeding. The person with an ABI may have a variety of physical and emotional symptoms.


Causes of traumatic brain injury include:

  • Car accidents

  • Blows to the head

  • Sports injuries

  • Falls or accidents

  • Physical violence


Acquired brain injury may result in problems such as:


  • Memory

  • Learning

  • Reasoning

  • Judgment

  • Attention or concentration

  • Problem-solving

  • Organization

  • Planning

  • Decision-making

  • Beginning or completing tasks


Communication problems may include:

  • Difficulty understanding speech or writing

  • Difficulty speaking or writing

  • Inability to organize thoughts when trying to speak

  • Trouble participating in conversations, starting or stopping conversations


Changes in behavior may include:

  • Difficulty with self-control

  • Lack of awareness of abilities

  • Risky behavior

  • Difficulty in social situations

  • Verbal or physical outbursts


Emotional changes may include:

  • Depression

  • Anxiety

  • Mood swings

  • Irritability

  • Anger


Some clients may:

  • Be unable to say what they want.

  • Be unable to explain something.

  • Be unable to understand others.

  • Feel frustrated and aggravated.


What You Should Know

  • Some clients may have trouble concentrating or organizing their thoughts. If you are in a public area with many distractions, consider moving to a quiet or private location.

  • Some clients may have a hard time understanding what you say so you may have to repeat it. If you are not sure whether the client understands you, offer assistance with what the client is trying to do. The client may need extra time.

  • Be patient, flexible and supportive.

  • Be patient if the client repeats his or her stories and experiences, and avoid interrupting the person.

  • A client may have trouble remembering things and learning new things


Behavioral problems are common following acquired brain injury. Many people with brain injury experience changes in behavior, personality and mood. 










How to Handle Angry and Aggressive Behavior


Acquired Brain Injury

Individuals may become angry, hostile or violent. Do not argue. Staying calm is very important. Use a gentle, soft voice, speaking slowly and confidently and avoid raising your voice or talking too fast.


  • Speak to the person in a calm, soft voice in an attempt to calm the person down. 

  • Do not stand close to the client. Avoid arm and hand movements.

  • Attempt to distract the person, change the subject and re-direct his attention to something else.

  • Do not restrict the person’s movement.  If he/she wants to stand, allow it.  Do not corner the person.

  • Do not touch the person or make sudden moves.

  • Do not threaten the person.  Threatening could increase the person’s fear, which could cause aggression.

  • Show an interest in resolving the issue and meeting the client’s needs and concerns.

  • Avoid having too much noise, such as loud music, television, loud conversation


Contact your supervisor immediately if you believe that you may be physically harmed if the situation gets worse.  Call 911 if you are in danger.


Persons with Alzheimer’s Disease or Dementia - Causes of Agitation and Aggression


Most of the time individuals get angry and aggressive for a reason. Try to find the cause. If you figure out why the individual is angry or agitated, you may be able to calm the person down.


Possible reasons for anger or aggression:

  • Pain, depression, or stress

  • Too little rest or sleep

  • Constipation

  • Soiled underwear or Depends®

  • Sudden change in a well-known place, routine, or person

  • A feeling of loss—for example, the person may miss the freedom to drive, friends, activities

  • Too much noise or confusion or too many people in the room

  • Being pushed by others to do something—for example, to bathe or to remember events or people—when Alzheimer’s has made the activity very hard or impossible

  • Feeling lonely and not having enough contact with other people


Look for early signs of agitation or aggression. Try to figure out what is causing it. Don’t ignore the problem because if you don’t try to help, it can make things worse.

Brain Sketch
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