The family and friends of a person with a brain injury are important members of the team. Your knowledge about the patient's emotional and physical needs is valuable, and so is your participation in helping take care of these needs.
The following are suggestions for things you can do that correspond with the stages of recovery.
Stage 1. Unresponsive Stage
At this stage the patient appears to be in a deep sleep and does not respond to their surroundings. The goal is to obtain a response to touch, sound, sight or smell.
- When speaking to the patient, assume he or she understands what you are saying. Speak in a comforting, positive and familiar way.
- Speak clearly and slowly about familiar people and memories.
- When visitors are present, focus on the patient. Keep the number of visitors to 1 or 2 people at a time. Visits should be short. Other distractions (TV, radio) should be turned off when visiting.
- Provide the patient with pictures, music, and personal items that are comforting and familiar. Use poster board or a bulletin board near the bed.
- The nurses and therapists may encourage you to assist in care of the patient. You may be asked to help with hair care, shaving, applying skin lotion or gently stretching and positioning the patient's arms and legs. If you don't feel comfortable with these activities, that is okay. The staff will understand.
Stage 2. Early Responses
At this stage the patient is beginning to respond to people and hospital surroundings. The responses may range from turning toward a familiar voice to moving an arm or leg on request.
The goal is to increase the consistency of responses.
- There may be a delayed response time when asking the patient to move, speak, or pay attention. Always wait 1-2 minutes for the requested response. Repeat your request only a couple of times during this time period.
- Be aware that the patient's attention span may only be 5-10 minutes before fatigue and frustration set in.
- Allow for rest periods. Turn off the TV, music, and lights, and limit visitors. The patient can become stressed by too much noise, light or stimulation.
- Continue with suggestions listed in the "unresponsive" stage.
Stage 3. Agitated and Confused Responses
During this stage, things are confusing. The patient may begin to remember past events but may be unsure of surroundings and the reason for hospitalization. The goal is to help the patient become oriented and to continue to treat his or her physical needs.
- Provide one activity at a time and expect the patient to pay attention for only short periods. Keeping the noise level low helps the patient focus.
- The patient may repeat a word, phrase, or activity over and over. Try to interest the patient in a different activity.
- The patient may do socially unacceptable things during this time, such as swearing or hitting. This is common. Calmly tell the patient the behavior is not appropriate.
- Help orient the patient to his or her surroundings with both
visual and verbal information (such as the suggestions below).
Remembering information from one time to another is difficult.
- A calendar with the days marked off
- A sign in the room telling them where they are
- A posted schedule with meal times, therapies, and special appointments
- To decrease frustration, allow the patient to move about with supervision.
Stage 4. Higher Level Responses
At this stage the patient is able to take part in daily routines with help for problem solving, making judgments, and decisions. Most of the suggestions from the previous stage continue to apply here. The goal is to decrease the amount of supervision needed and increase independence.
- Help make the environment safe. Safety decisions may still be difficult for the patient to make. Praise safe decisions and give calm explanations about unsafe decisions. Learning is still difficult.
- Encourage the use of memory aids, such as a date book, to help with appointments and daily routines.
- Encourage brief rest periods because the patient will continue to need more rest.
- Check with the health care team on activities that may be completed with or without supervision. These activities may include work or school re-entry, taking medications, driving, or managing money.