Categories of Care: What They Are, and Why They Matter
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
Licensed Psychologist
Hope Network Neuro Rehabilitation
Look Twice, Save A Life! Loud Pipes Save Lives!

- Ride defensively: Always be aware of the vehicles in your surrounding area. At stop signs, take caution and never assume the other drivers will stop! Car drivers are often the cause of motorcycle accidents. With distracted driving on the rise, being defensive and aware while on a motorcycle is more important than ever.
- Select the Right Ride: Purchasing a motorcycle that is properly suited for your height and size is essential. When selecting a motorcycle, ensure your feet are easily resting on the ground and the handlebars and controls are within easy reach.
- Make Time for a Tune Up: In addition to tuning up your motorcycle, see if your riding skills are in need of a tune up as well. If your riding skills are a little rusty, sign up to take the Motorcycle Safety Foundation (MSF) riding course. This course covers the basics as well as some advanced riding techniques. As an added bonus, taking this course may qualify you for an insurance discount.
- Dress for Success: Wear clothing that will protect you from wind, flying bugs, debris, and road rash. Avoid clothing items such as shorts, tank tops, and t-shirts.
- Protect Your Head: Riders who do not wear helmets have a much higher risk of fatality. If you are injured in a motorcycle accident, you are also three times more likely to sustain a head injury if you do not have your helmet on. Helmets save lives; grab yours before hitting the road.
- Protect Your Eyes: If you do not wear a full-face helmet, make sure you have the proper eye protection. You never know what you may encounter on the roads; take this small precaution to ensure your eyes are safe.
- Avoid bad weather: Rain makes the pavement slippery, reduces your margins for error and decreases your overall visibility. Watch for road hazards including potholes, sand, gravel, wet leaves, and grass.
Language Pathologist (and avid motorcyclist)
Origami Brain Injury Rehabilitation Center
Being Mindful on Independence Day

- Plan ahead: speak with family and friends to identify a safe and enjoyable way to enjoy the holiday
- Manage fatigue: be well-rested leading up to the celebration and take breaks when needed
- Reduce sensory overstimulation: taking noise-cancelling earphones, sunglasses, or hats may reduce the sensory input during fireworks and around large crowds
- Choose your location carefully: if you choose to enjoy a live celebration of fireworks, choose a seat furthest away from the action
- Explore your options: forego the live fireworks and watch them from the comfort (and quietness) of your home
- Ask first: ask the person with brain injury their preference for activities for the holiday
- Offer support: if they choose to sit out on certain activities, join them and provide company
- Find a balance: compromise on traditions and swap out events with new activities your loved one is most comfortable with
- Have a back-up plan: identify alternative activities if your loved one is not feeling up to the festivities at that time
- Plan your escape: in the event that your loved one is triggered by something during the activity, have a plan for minimizing distress and moving to a more comfortable place
- To learn more about Post-Traumatic Stress Disorder, visit:
https://www.nimh.nih.gov/health/topics/post-traumatic-stress-disorder-ptsd/index.shtml - To access current fireworks laws, visit:
http://www.legislature.mi.gov/(S(slxzhmxcsrhoczty345osjsv))/mileg.aspx?page=GetObject&objectname=mcl-28-457 - For more information on quiet camping options, check out:
https://www.michigan.gov/dnr/0,4570,7-350-79133_79205_84947---,00.html
Psychology Supervisor
Origami Brain Injury Rehabilitation Center
To Drive or Not to Drive? Getting Behind the Wheel after a Traumatic Brain Injury
- 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

References:
- 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
Brain Injury Association of Michigan: One-Sided No-Fault Reform Bill Doesn’t Go the Distance
Association joins Gov. Whitmer and House Democrats in calling for strong consumer protection, permanent rate relief, and long-term solutions
FOR IMMEDIATE RELEASE
For more information:
Janna Wilson
(248) 810.229.5880
LANSING, Mich. (May 9, 2019) – The passage of SB1 and HB 4397 may now be a reality, but those who protect consumers want more. In response, President and CEO of Brain Injury Association of Michigan (BIAMI) Tom Constand issued the following statement:
“We thank Gov. Whitmer and House Democrats for standing up for Michigan consumers in rejecting the bill as written. Although it addresses the basic tenets of reform, it does little to ensure a permanent solution. Moreover, instead of allowing for constructive committee discussion and debate, this 82-page bill was railroaded through the House in the middle of the night with no opportunity for thoughtful deliberation.”
“We are looking for fair, reasonable and sustainable legislation that provides strong consumer protections, offers immediate rate relief and protects benefits for the insured. This bill provides weak concessions that don’t ensure ongoing rate relief, provides a pittance of coverage options, and will leave survivors and their families even more exposed to the unethical and predatory practices of the insurance industry. We must do better than this.”
About the Brain Injury Association of Michigan
The Brain Injury Association of Michigan is dedicated to enhancing the lives of those affected by brain injury through education, advocacy, research and local support groups, and to reducing the incidence of brain injury through prevention. Founded in 1981, Brighton, Michigan-based BIAMI is a national leader in its efforts on behalf of the approximately 200,000 Michigan residents who live with disabilities as a result of a brain injury.
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Brain Injury Association of Michigan
7305 Grand River, Suite 100
Brighton, MI 48114-7379
BIAMI.ORG