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Step 1: obtain detailed objective information

The injured person

Information about the person’s current level of cognitive and behaviour functioning is essential to develop a realistic program. Specific information is needed on factors such as:

  • how much can be learnt, 
  • what is the best way to learn, 
  • what activities are most likely to present problems, 
  • what limitations there may be perceptually, 
  • how the environment be set up to maximise abilities. 

The rehabilitation program must also take physical limitations into account. In addition to general information about the person’s medical status and physical abilities, thorough evaluation of both visual and auditory systems should be completed. Management of medical needs must be an integral part of the rehabilitation program. Adaptive equipment such as a wheelchair, braces, and communication devices, must be appropriate to the person’s current needs and in good repair. 

The support system

Family members must realistically determine how much time, money and emotional energy they can commit, and for how long. This includes consideration of who will provide transportation to activities, supervision in both the home and the community, and what materials will be needed. An organised program requires the effort of more than one person – unless it is undertaken in extremely small and manageable steps. 

Community resources

This is definitely the time to start ringing around. A wide range of community services are available in most communities and are appropriate for people who have sustained brain injuries. Most of these agencies do not advertise; many are not aware of the special needs of those who sustain brain injuries and how their agency’s services might be used by this population. Think outside the box and don’t be afraid to approach these community services for assistance. 

Step 2: develop and implement your program

Now you are ready to set specific rehabilitation goals. Since you are designing your own program, you are free to include only those activities which you feel will be helpful to the injured person and for which you have the time, resources and energy to follow through. Certain problems occur often enough that the broad areas which must be addressed can be identified even though specific activities must be decided by family members. Among these common areas, and in chronological order of importance, are: 

Step 3: monitor progress and update as needed

As the program progresses, you should find that the person’s cognitive and physical endurance, performance speed, and skills are steadily improving while the demands on your time are steadily decreasing. You must be able to fade yourself from the picture at appropriate times, even when you are not completely sure the person can perform the activity without your help. As the person’s skills improve, you must make certain that your expectations rise so they are commensurate with his new abilities. When indicated, set goals at higher levels. The myth of the plateau, which suggests that people who sustain brain injuries reach a certain point in their recovery and then stop making progress despite the best rehabilitation efforts, must also be challenged as your program progresses. When progress appears to be levelling off, it may be useful to think of that time as a period of consolidation of newly-acquired skills, a time for the repeated practice which is required to integrate the new information and skills with the old until they become as routine as possible. 

Ending rehabilitation

At some point in time the injured person and/or family members decide that they no longer wish to pursue rehabilitation. On rare occasions this occurs because all goals have been met; usually other factors such as extremely slow progress, the wish to pursue other activities, or burnout account for this decision. The fact that a structured rehabilitation program is no longer in place does not necessarily mean that the injured person will stop acquiring or refining skills, or that deterioration will occur, although both are certainly possible. The long-term success of your program may be contingent upon continued effort on the part of all family members, especially the injured person. 

Many thanks to Judith Falconer PhD for permission to adapt this article.