07 Nov Mid-Level Traumatic Brain Injury Managemen

If a person is agitated or confused, they require a need quite a lot of structure to keep them relaxed and prevent over stimulation. Both treatment and assessment should be holistically considered and involve activities that are well known and enjoyed by the person. This will directly affect the success of the rehabilitative management.

Transfers and mobility, ambulation must be considered in addition to ‘low- level’ management. Its is helpful to become creative if the person is irritable and cannot tolerate a formal evaluation. Goals should include but not be limited to:

• Maintenance and improvement of range of motion
• Prevent any deconditioning where possible
• Improve response to commands
• Environment control to reduce agitation
• Gross motor activities e.g. rolling, sit to stand, transfers, wheelchair propulsion, walking with assistance and aids, walking independently etc.

A good way to work is to work at the person’s physical capabilities and work on their management of said activities and endurance and fatigue before moving on to tasks especially ones that require new learning. Attention deficits and sort span must always be considered e.g., if a person does not want to walk aim to get the come to ‘come over here to play cards you enjoy’. Key aspects are relaxed environment, limited length of sessions to consider persons specific fatigue level, prompting, regular praise etc.

Things to consider and discussed below:

1. The person can be confused and quiet
2. Expect no memory and carryover unless presented
3. Calm behavior is responded with calmness
4. Offer options depending on mood, fatigue etc.

1. Confusion

Similar times, days, locations and clinicians all help alleviate this. Working with other health care professionals to establish a daily routine is also effective.

2. Carryover

Teaching new skills is not the primary aim at this time. This can and improve with time but the objective is to build foundation fine and gross motor skills through regular, repetitive even if changeable.

3. Model Calm Behavior

The person is much more likely to be calm and perceive and model the demeanor of the caregiver.

4. Options

Be prepared with numerous activities. Because of the limited attention span the person may not be able to concentrate on any given activity for a very long time. If the person cannot be redirected to the selected task, it is appropriate to attempt to engage4 them in another. Offer options to giver a sense of control.

Next up is Level 5 and 6 Traumatic Brain Injury Management.