Brain Waves: UAB Traumatic Brain Injury Model System Newsletter Volume 14 | Number 2 | Page 3

Your second step is to learn how
to best prevent your loved one from
becoming agitated and plan how you
can handle problems if they happen.
Here are a few general guidelines to
follow.
• Create a calm environment.
Your loved one may not be
able to remain calm in an
overstimulating environment.
A lot of stimulation, such
as a loud television, a loud
conversation, and crowds of
people can lead to agitation.
When overstimulation is causing
agitation, it may be best for
your loved one to be in a quieter
room. You might close a door to
keep outside noise out and turn
off the television.
• Speak slowly and clearly during
your conversations. Your loved
one may need a bit more time to
process and understand what
you are saying, but your loved
one does still understand.
• Avoid arguments. It is important
to gently correct your loved one
when incorrect or confused
about something, but you do not
want to argue about the issue.
Simply correct the error when it
first occurs, but do not correct
the issue again if your loved
one insists on being correct.
In a state of confusion, people
with TBI do not think logically,
so do not try to logically reason

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with your loved one because it
will probably lead to agitation.
Instead, you can simply change
the subject or make comments
that neither agree nor disagree.
For example, your loved one may
think something is lost when you
know it is not. If your loved one
does not take your word that the
item is not lost, simply reassure
your loved one that the lost item
will turn up shortly.
• Ask permission before
touching or starting an activity.
This approach helps to explain
what you intend to do and helps
to avoid startling your loved one.
Be very direct and brief in what
you say. For example, it is better
to say, “Can I comb your hair?”
rather than, “You wouldn’t mind
if I combed your hair, would
you?” If your loved one is prone
to answering “No” to questions,
try rephrasing things in a positive
way that does not require
agreement. You might say “It’s
time to comb your hair,” and
gently proceed.
Avoid sudden touching or
grabbing. You should only grab
suddenly or hold firmly if there
is obvious danger to your loved
one or if he or she is told to stop
but does not.
Formally end your contact. Your
loved one may not pick up your
body language and other cues

that suggest that you intend to
leave or end a conversation.
You might have to state your
intentions. You can simply say, “I
have to leave now (name).”
What can I do if my loved one
becomes agitated?
• Remember to stay calm and
speak in a low, calm voice.
• Redirect attention. If your loved
one starts to become agitated,
you can change the topic or
activity to something less
upsetting. Sometimes using
humor is a good distraction
because laughter shows that you
are not too rigid or formal. Just
make sure that your loved one
does not feel laughed at.
• After asking permission, provide
gentle physical contact such
as rubbing your loved one’s
shoulder.
• Remove yourself from the
situation instead of trying to
control or restrain your loved
one.
• Ask your loved one’s doctor if
medication is an option. Some
medications can have good
results in decreasing agitation.
For example, you may have a
problem getting a person with
TBI to stay in bed and go to
sleep at night. A mild sedative
would be a better choice than
restraining your loved one.

Questions and Answers: Medical Management of Agitation
Under what circumstance are medications used to
treat agitation after traumatic brain injury?
The most important thing to remember is that you
cannot expect to prevent all episodes of agitation.
Instead, the focus of treatment is to use various
environmental and behavioral techniques to reduce the
chance that an episode of agitation will happen and
manage episodes that do happen. So the fact that there
are occasional episodes of agitation does not necessarily
mean there is a need for medication.
Medication use is only considered when environmental
and behavioral management techniques are not
working to reduce episodes of agitation or episodes
are unmanageable. If a medication is prescribed, those
environmental and behavioral techniques are still needed
with the medication.

How do you decide on which medication to use?
Some medications work for some patients but not
for others, and medications usually have side-effects
to consider. We not only try to select a medication that
works to red uce agitation, but we also think about how to
also use the side-effects to an advantage. If a side-effect
of a medication is sedation, for example, that medication
can help with sleep as well as with reducing agitation.
When is the use of restraints appropriate?
Restraints are only appropriate in a supervised setting
with licensed personal around. That basically means only
during hospitalization. Anyone in restraints needs to be
evaluated on an hourly basis. The goal is to always try
and have someone out of restraints unless absolutely
needed for the patient’s safety.
UAB Traumatic Brain Injury Model System Information Network

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