If you have a loved one who suffered a brain injury, you might be asking yourself — What should the goal of rehabilitation be? What can I do to ensure that I am helping, not hindering, the process?
There is no “going back to normal”
The first thing to understand about brain injury is, full recovery — “going back to normal” — is highly unlikely. A brain injury is not a broken bone, and, thus, we should not expect it to just “heal up”. While we should not underestimate the extent to which the injured person can recover, we must remain realistic in our expectations.
The first step for setting rehabilitation goals is to redefine what “normal” will mean to you and your family. Communicate with the professionals — doctors, care staff — that are working with your loved one. Ask them questions.
- What can the injured be expected to do?
- What can they be expected to, eventually, be able to do?
- And, most importantly, what can they be expected to not ever be able to do?
The last one is, possibly, the most important question. If the injury has, for example, severely impaired the person’s motor skills, then it is unlikely that they would be able to go mountain climbing. Getting an honest view of what to expect can be crucial in avoiding future disappointment and frustration.
Each step is a step forward
Setting unrealistic goals can blind us to the small but meaningful improvements the injured makes. This is why our goals should be realistic, keeping in mind with the injured’s condition. Redefining “normal”, and striving for the most productive, independent quality of life possible is the best strategy — and the building blocks to life after injury.
Technology has helped society evolve, enabling us to work and stay connected more efficiently — social networks are, nowadays, one of the best ways to keep in touch with loved ones who are far away. Computers and smartphones have become tools that we use in our work and personal lives.
The question is, then, how can technology be used to help someone who has suffered a brain injury? Learning — or even relearning — how to work with computers can help the injured get a more firm grasp on certain skills, such as:
- Planning and organizing
- Increasing concentration
- Hand-eye coordination
There are, however, a few things to consider when deciding if technology should be a part of your loved one’s rehabilitation.
Is the patient ready to use a computer?
Learning new skills can, for someone who is living with brain injury, turn into an ordeal full of frustration. Before deciding if technology is something you would like to add to your loved one’s rehabilitation just yet, consider — Has their impulse control improved, at least slightly, so that they will not lash out in frustration? Have their physical injuries healed, so that they can comfortably use the equipment?
It might sound like a great idea to expose the injured person to technology, but, remember — unfamiliar territory can be frustrating for the injured.
Like any rehabilitation program, the computer must meet the injured’s needs
Most likely, you will want the injured person to work with rehabilitation software — which will provide stimulating, fun exercises. This is why you need to carefully select the equipment that will fit your loved one’s needs. Some things to think about:
- Will the person need additional adaptive equipment, such as a screen reader or enlarger?
- How easily can it be customized to accommodate the injured’s needs?
- In cases where the injured is an adult, what are the options for software geared towards their age group?
- Is the software you intend to use compatible with the computer model?
Beware of using children’s learning software
The injured might need help remembering and relearning skills that he or she first learned as a child — an instance where, obviously, a lot of the software you will find will be targeted towards teaching these skills to young children. Most of us learn basic arithmetic at a young age, so it is no wonder that a lot of learning software for it uses colorful cartoons and quirky mascots!
Many injured individuals cope with feeling that they have lost their status as an independent, responsible adult who is able to take care of themselves. In these instances, software that is very clearly designed for children could do more harm than good, and set off unwanted emotional responses.
When dealing with injured adults, simple software that is devoid of distracting and childish themes is usually more successful.
In conclusion — When used correctly, technology can be a great aid in rehabilitation. But, as with any program, care must be taken so that it meets the specific needs of the injured. With the right software, and the right amount of attention and care, technology can be an important and beneficial part of life after injury.
“Where can I find the best rehabilitation program in the country?” is a very common question, one that families of those recovering from injury often ask — and it is easy to understand why. If there was a place, anywhere in the world, that would help our loved one get “back to normal”, who would not want to give it a try?
The problem with seeking the “best” facility or physician is, “best” has no real definition. What we must understand is that every injured person will have different needs, and our search should, instead, be focused on finding the right professionals for their needs. Every patient is different, and while someone might benefit from more physical rehabilitation, another patient might need more help relearning social cues and appropriate behaviors.
So, what can you do to help your loved one find the right team for their rehabilitation?
The Brain Injury Association Of America offers information for families and friends of brain injury victims. In their guide to selecting and evaluating rehabilitation services (.pdf), they include some helpful tips:
- The patient and their family know best. You know the needs of your loved one, and you can decide what aspects of their care are important.
- Be involved. Stay in constant communication with the staff at the facility, and be a part of the decision-making process.
- Make sure everything you agree upon with the staff is put in writing, and keep all records up to date.
- Shop around! The first — or even fanciest — facility that you find might not always be the right one. Listen to the patient’s opinion, too.
Deciding who to entrust with your loved one’s rehabilitation is a very important decision. With the right professionals, the injured person will feel at ease and taken care of — and, when their needs are met, the success of rehabilitation increases, improving the patient’s life after injury.
Having a loved one who is suffering from brain injury can be devastating — many families of patients will cling to myths of miracle cures for brain injury that do not exist, and many will spend countless amounts of time and money searching for the “right” treatment of professional, hoping that “everything will go back to normal.”
However, in The Nature Of Head Injury — an article published in Traumatic Brain Injury and Vocational Rehabilitation — Thomas Kay, Ph.D. and Muriel Lezak, Ph.D, advise of the dangers of trusting miracle “cures.”
The Wizard has a computer (usually an Apple but now maybe an IBM clone) and an armful of software. They load a diskette, wave a magic mouse, and “presto,” cognitive changes begin to occur. “Your client is unable to work because of memory deficits? No problem. Send him (or her) to the Wizard for a 10-week course of memory retraining, remediate that deficit, and back to work he’ll (or she’ll) go.”
What we must understand about the injured brain, is that it not a muscle that can be “retrained”.
When understood in this context, cognitive remediation (in the narrow sense of specific, often repetitive tasks) or neuropsychological rehabilitation (in the broader sense of modifying maladaptive behavior and cognition using cognitive and psychological principles) can be an essential part of the rehabilitation process after head injury.
The key here is, then, to gear treatment towards helping the injured develop new skills and ways to cope with the limitations their injury has placed on them.
The Nature Of Head Injury is an article published in Traumatic Brain Injury and Vocational Rehabilitation, where Thomas Kay, Ph.D. and Muriel Lezak, Ph.D, attempt to debunk the most common myths surrounding brain injury.
In their article, Kay and Lezak discuss the validity of IQ testing as a measure of a patient’s progress — and why professionals and families alike should be careful about how much they read into these tests.
Often, upon request, naive psychologists will examine a head injured person on a traditional battery of intelligence tests, find that the IQ (the numerical average of the many subtest scores) is in the average range, and then pronounce the client “cognitively recovered”, or “capable of functioning intellectually in the average range.”
The danger here lies in that, upon receiving “normal” test results, professionals and families might set unrealistic expectations for just how much and how quickly things will improve — being told that the patient has a “normal” IQ can set the unrealistic expectation for a “full” recovery.
Also, it is important to note, IQ testing does not measure a person’s emotional state, ability to read social cues, and many other areas in which a brain injured person might now be facing challenges.
Head injured persons who can perform quite well on such tests may have such breakdowns in learning, memory, and especially executive functions (planning, organizing, self-monitoring) in the unstructured real world that they are totally unable to function. “Average range IQ” and even higher IQ scores should never be the basis for concluding that a client is cognitively intact, and therefore ready to handle mental stresses of the real world.
Believing that “normal” IQ test results mean the victim will “go back to normal” can set unrealistic expectations — especially when dealing with patients who were, previous to their accident, exceptionally bright.
Just as normal range IQ’s should not be mistaken for cognitive normalcy, a normal neurological evaluation -especially late after injury should not be mistaken as meaning that there is no brain dysfunction. As noted above, acute bleeding and contusion of brain tissue may clear up and disappear from brain scans over a period of months and years -even though nerve networks and biochemical balances may still be severely effected.
Similarly, “normal” brain scans and tests might not be an indicator that full recovery has taken place. Even when all of the physical damage to the brain has healed, the patient might still have cognitive and social hurdles to face.
It is important, when trying to help a loved one after an injury, that we tune in to their needs. The fallacy that normal tests results mean no more help is needed can cause unnecessary harm.