Recordings from the 2025 Annual Conference-Brain Injury Behavior Management

Video Transcription

Video Summary

Cindy Bautista’s session focused on understanding and managing agitation after traumatic brain injury (TBI). Brain injury can cause excitotoxicity and disrupt neurotransmitters, while the location and extent of tissue damage shape a patient’s behavior and cognitive challenges.<br /><br />Agitation should prompt assessment for underlying causes, especially pain, urinary retention, infection, hypoxia, metabolic changes, medication effects, or neurological deterioration. Healthcare providers can also trigger agitation through overstimulation, rushed communication, or frequent environmental changes.<br /><br />The primary management approach is to modify the environment and support the patient’s behavior. Helpful measures include reducing noise and other stimuli, limiting visitors, maintaining consistent routines and staff, minimizing room transfers, and supporting day–night orientation and sleep. Familiar music, scheduled activities, and breaks after therapy may also help.<br /><br />When communicating, use calm, brief, clear sentences; speak one person at a time; explain tasks step by step; and allow patients time to respond. Reorientation, positive feedback, choices, and redirection can reduce distress. Teach practical strategies such as checklists, written reminders, self-talk, and structured problem-solving to support attention, memory, and self-control.<br /><br />Bautista encouraged staff to tolerate restlessness, avoid restraints and unnecessary medication when possible, identify and address the cause of agitation, and debrief after incidents. She also highlighted cognitive behavioral and goal-management therapies, support groups, and consultation with specialists. Beta blockers and amantadine were presented as evidence-supported medication options; Haldol was not recommended as the default response.

Keywords

traumatic brain injury

agitation

environmental modification

neurotransmitters

pain assessment

communication strategies

sleep orientation

cognitive behavioral therapy

beta blockers

amantadine