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
- 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
- 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 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
- To decrease frustration, allow the patient to move about with
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
- 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
- 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