Using Help to Pinpoint Proper Care Following Brain Injury After a brain injury, many survivors require help in one form or another. Some people require extensive support, while others need only a limited amount of services. This is often reduced with time and rehabilitation, but chronic complications with some injuries may create an increased need for assistance years after a diagnosis is made. Identifying the help that is needed is often a fluid, unfolding process; but being aware of the different categories of caregiving options can provide guidance when searching for the correct level of support. In persons with brain injury, the amount of outside assistance required to carry out essential functions in everyday life is formally known as acuity. An interdisciplinary team of neurological professionals can help determine a person’s acuity by identifying what, if any, supports are needed. By reviewing documentation and collaborating with caregivers who provide supporting information about behaviors they observe from their clients or loved ones, risks, and care needs are identified relating to three specific areas:
- Tasks of Self-Care: Personal care activities like dressing and bathing are often referred to as basic activities of daily living (BADL). More advanced tasks that require deeper thinking elements, such as scheduling or budgeting, are considered independent activities of daily living (IADL). If an individual needs assistance when carrying out either — or both — of these categories of self-care tasks, they are in need of what’s called attendant care. Attendant care provides hands-on assistance with physically managing daily routines that may be limited by weakness, fatigue, or thinking problems like memory or attention. Generally, attendant care is hands-on care provided to make up for physical limitations of an injury.
- Replacement Services: Some survivors struggle with effectively carrying out typical responsibilities around the home, such as yard work, childcare, or home repairs. In these cases, they may need to assign or purchase these services for others to do. These needs are called replacement services, and are considered another category of caregiver support.
- Protective Supervision: Brain injury can create an inability for individuals to recognize problems or advocate for help. Protective supervision is care that stands in reserve, monitoring for emerging risks, and stepping in with support when an injured person demonstrates behaviors that might lead to harm if left unchecked. Protecting a person from fall risk when he or she is unaware of poor motor skills, monitoring a meal for choking risks, or providing orientation support for a person with confusion are examples of why protective supervision is often necessary.
Director of Neuro Rehabilitation
Hope Network Neuro Rehabilitation
- Visual acuity and perception
- Memory to recall directions or destination
- Hand-eye coordination
- Reaction time
- Safety awareness and judgment
- Sustained and alternating attention
- Range of motion and strength of arms, legs and neck
- Confidence behind the wheel
- Anxiety level
- Classen, S. e. (2009). Traumatic brain injury and driving assessment; and evidence-based literature review. American Journal of Occupational Therapy, 580-591.
- Schultheis, M. T., & Whipple, E. (2014). Driving after traumatic brain injury:evaluation and rehabilitation interventions. Current Physical Medicine and Rehabilitation Reports, 176-183.
Occupational Therapist + Therapy Best Practices Coordinator
Special Tree Rehabilitation System
- Loss of Consciousness (only occurs in ~10% of all concussions!)
- Delayed verbal/motor responses
- Confusion/Disorientation/Memory deficits
- Lack of focus/Concentration
- Speech disturbances such as slurred speech
- Physical Exercise
- Visual and Vestibular Retraining
- Cervical Spine-Alignment and Musculature Issues
- Balance Retraining
- Rest Initially 24 hours
- Light Cognitive Activity
- Half Day of School
- Full Day of School
- Clearance for Physical Activity
- Light Non-Contact Sport Specific Activity
- Higher Intensity Non-Contact Sport Specific Activity
- Full Contact Sport
- Return to Competition
- Prien, Et al. “Epidemiology of Head Injuries Focusing on Concussions in Team Contact Sports: A Systematic Review” Sports Med. 2018 Apr:48(4):953-969.
- Langlois Et al. “The epidemiology and Impact of Traumatic Brain Injury: A Brief Overview” Journal of Head Trauma Rehabilitation: September-October 2006: Vol21. Issue 5. Pg 375-378.
- Patel, Et Al. “Aerobic vs anaerobic exercise training effects of the cardiovascular system” World J Cardiol. 2017 Feb 26:9(2):1324-138.
- Viano Et al. “Concussion in professional football: biomechanics of the struck player part 14” Neurosurgery. 2007 Aug:61(2):313-327.
Karley graduated with her Doctorate of Physical Therapy from Central Michigan University in May of 2009. She has been employed at The Lighthouse Neurological Rehabilitation Center, Caro location, since July of 2009. Karley has continued education in the areas of Hippotherapy, NDT, and Concussion Management. Karley is also a CrossFit Level 1 Trainer at Davison CrossFit and Flint CrossFit with a special certification in Adaptive CrossFit.
What is a Brain Injury?Just as there are no two people alike, no two brain injuries are the same. An acquired brain injury is an injury to the brain that has occurred after birth; these injuries are not a result of heredity, nor are they congenital or degenerative. There are two types of acquired brain injuries, non-traumatic and traumatic. A non-traumatic brain injury is caused by damage to the brain by internal factors, such as lack of oxygen, exposure to toxins, pressure from a tumor, and so on. A traumatic brain injury is an injury to the brain that is caused by an outside force or impact that is sudden and damaging.
Common Causes of Brain Injury
- Anoxia/hypoxia (lack of oxygen to the brain)
- Neurotoxic poisoning (ingestion of insecticides, solvents, lead)
- Motor vehicle accidents
- Struck by an object
- Improvised Explosive Device (IED)
Brain Injury RecoveryFollowing a brain injury, it is imperative to receive the proper rehabilitative care. Brain injury survivors can experience an array of cognitive, physical, and emotional/behavioral challenges. These symptoms can often concur feelings of hopelessness in survivors and caregivers, but there is hope. The goal of brain injury rehabilitation is to maximize function and encourage survivors to achieve their fullest potential. Origami Brain Injury Rehabilitation Center brings together a team of experts from the following disciplines including physiatry, psychiatry, psychology, physical therapy, occupational therapy, speech-language pathology, recreational therapy, rehabilitation nursing, vocational, and more in order to tailor a care plan to the needs of each survivor. The rehabilitation journey begins with a thorough assessment to identify the individual’s exact needs and goals. At Origami, survivors and their support systems are an essential part of the interdisciplinary team and the rehabilitation journey. It is important brain injury survivors and caregivers know they are not alone on this journey. If you have a question about brain injury or if you are interested in learning more about brain injury rehabilitation, please visit our website at origamirehab.org or call us at 517-336-6060. For those looking for support, visit BIAMI's Support Group page or call them at (800) 444-6443. Origami Brain Injury Rehabilitation Center is a 501(c)(3) non-profit organization located in Lansing, Michigan. Origami provides comprehensive rehabilitation care for survivors of brain injuries and their families. Through their compassionate and innovative services, Origami creates opportunities and transforms lives.
- Remove tripping hazards such as rugs or uneven thresholds in your home
- If you use an assistive device, make sure you are using it correctly
- Wear supportive shoes with a rubber sole to prevent shuffling feet and slipping.
- Use night lights in order to increase visibility at night. Alert systems can be used for individuals requiring more assistance.
- Shovel snow and apply salt to reduce the risk of slippery sidewalks
Emily Wolf, PT, DPT
Physical Therapist, The Lighthouse Neurological Rehabilitation Center
- Kallin, Kristina, et al. "Predisposing and precipitating factors for falls among older people in residential care." Public health 116.5 (2002): 263-271.
- Lord, Stephen R., Hylton B. Menz, and Catherine Sherrington. "Home environment risk factors for falls in older people and the efficacy of home modifications." Age and ageing 35.suppl_2 (2006): ii55-ii59.
- Peterson, Michelle, and Brian D. Greenwald. "Balance problems after traumatic brain injury." Archives of physical medicine and rehabilitation 96.2 (2015): 379-380.
- Thurman, David J., Judy A. Stevens, and Jaya K. Rao. "Practice parameter: assessing patients in a neurology practice for risk of falls (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology." Neurology 70.6 (2008): 473-479.
- Woolcott, John C., et al. "Meta-analysis of the impact of 9 medication classes on falls in elderly persons." Archives of internal medicine 169.21 (2009): 1952-1960.
Emily graduated from Arcadia University with a Doctorate of Physical Therapy. Her academic focus was primarily on treatment of adolescents and adults post-concussion. She has been practicing as a physical therapist at The Lighthouse Neurological Rehabilitation Center in Kingsley, Michigan since 2017.