Family guide to a low cost rehabilitation program

Those activities which have the highest survival value (daily routines such as showering, grooming, toileting, dressing, sleeping and eating) should receive concentrated attention in the initial phase. Goals should address the mechanics of completing the task as well as the amount of time required. These goals are accomplished when the person is able to awaken on their own, independently complete morning hygiene routines, prepare and clean up after eating, and dress appropriately to go into the community. 

Concentration and attention can be particularly challenging for people who have sustained a brain injury, and this can negatively impact on community-based activities. Initial cognitive retraining activities should probably be conducted within the home setting. Appropriate activities might include working on craft projects, playing simple board or card games, or playing simple video games. Since pre-injury information and skills are frequently relatively intact, the injured person may be able to play games which were learned pre-injury without having to learn new rules. At this stage, the ability to learn is not being addressed, only the ability to attend and concentrate. 

While such activities may initially require a quiet distraction-free environment, the amount and type of distractors should be increased as attention and concentration improve. The amount of consecutive time devoted to such activities can also be gradually increased until the person is able to continue at the task for a realistic amount of time.

When the person is able, at least at minimal levels, to attend and concentrate, to learn, and to remember, behavioural contracts can be used to reduce the frequency and severity of specific targeted behaviour problems such as verbal aggression, perseveration, or social skill issues. Information about behaviour management strategies can be obtained from your brain injury association. 

It is critical that not all the points are negative, e.g. Designed to stop behaviours. You must balance behaviours to be stopped with those you wish to see started so that the person is not left with a behaviour void. Your behaviour management program should utilise appropriate rewards to encourage the person to behave in more positive ways.  

At this point in time you should begin to give honest, objective feedback to the injured person on specific behaviours and your reactions to them. Although such direct oral feedback is not customarily given in most social settings, the injured person may not understand why he/she fails to make friends unless provided with such information.

One of the most frequent complaints voiced by people with a brain injury is the lack of friends and social opportunities. The reasons for this are varied but physical limitations, behavioural issues, decreased cognitive capacity and poor social skills are often major culprits. In many cases, the person may lack insight into the nature, range, severity or even the existence of impairments following the brain injury and may seem generally unable or unwilling to modify his/her behaviour. This could be the case even in the face of interpersonal cues which are not at all subtle. Once the person’s behaviour is positively altered in the home setting, community recreation activities are often introduced in the rehabilitation program. Your local brain injury association should have a list of recreation programs set up for people with disabilities. Don’t be limited by disability programs, however. If you feel able, reach out to other recreation programs in your community – try your hand at opening their eyes to inclusive practices, and including your family and loved one in their group. This can take time and education sessions, however may be more advantageous in the long-term.

Some people with a brain injury may be able to successfully enrol in academic programs once their basic cognitive and behavioural impairments have been remediated or despite remaining deficits. The line between rehabilitation and education begins to blur at this point, especially when the courses or subject areas had not been attempted prior to the injury. If you are considering including a formal academic component, you should determine whether the person can keep track of class times, take notes, study for an examination, and learn the information presented. Also to be considered is having to deal with transportation to the campus, locating a specific classroom or dealing with distractions in the classroom. Speak with the campus’s disability service. Most will have one and they can generally offer services such as notetaking, recorded lectures and one-on-one tutorials to assist. 

Some people with brain injuries may recover sufficiently to return to their pre-injury employment, perhaps with modified hours or duties, particularly in the short term. Others may find they are able to work, but in a different field, and vocational re-training may be necessary. People who are unable to resume paid employment may be able to contribute to their communities in volunteer positions. If and when re-employment is a realistic goal, disability employment services (des) providers can assist people to find and maintain employment, and in turn help employers put practices in place to support employees.