This chapter on rehabilitation after a brain injury is excerpted from Garry Prowe's book, Successfully Surviving a Brain Injury: A Family Guidebook.
In 1997, Garry's wife, Jessica, sustained a severe brain injury in an automobile crash. "At the time, I spent way too much time accumulating the information I needed, not only to understand the medical aspects of Jessica's brain injury, but also to handle the myriad insurance, financial, legal, personal, and family issues that accompany a serious blow to the brain. I recognized the need — that stil exists today — for a book that comprehensively addresses the wide variety of issues families face in the first few months after a brain injury.
"To research this book, I assembled a panel of more than 300 survivors, caregivers, and medical professionals who resonded to my email questions and reviewed portions of my writing.
"For us, this project is a labor of love. All profits fromt he sale of this book will be donated to brain injury organizations."
* * *
My goal with this chapter is to prepare you for the next step in your survivor’s recovery: rehabilitation. I begin by discussing post-traumatic amnesia, a state of awareness survivors pass through on their way from a coma to full consciousness. Many survivors, when they begin rehabilitation, are going through post-traumatic amnesia. Next, I present an overview of the rehabilitation process, focusing on the critical role of the family. One of your responsibilities is to select a rehabilitation facility for your survivor. I offer some guidelines for making this important decision. I close this chapter with a few thoughts about nursing homes, as some survivors will be placed in one of these facilities as they wait to enter a rehabilitation program.
When your survivor emerges from her coma, she likely will have little or no short-term memory. She may be disoriented, agitated, angry, impulsive, or extremely emotional. She may be disinhibited, demonstrating a complete disregard for social conventions. She may act like a child. She may behave bizarrely or in a manner completely alien to her personality.
This is a normal part of the healing process. It is called post-traumatic amnesia (PTA). For years, PTA was defined as the period of time after an injury when the brain is unable to form continuous day-to-day memories. More recently, the definition has been broadened to include a state of disorientation to time, place, and person. In this condition, the survivor may not understand who she is, where she is, and what is happening to her. She may be unable to recall very basic information, such as her name, your name, the season of the year, or the name of the current president.
Memory is the slowest part of the conscious mind to recover from an injury. It can be weeks or months before your survivor is able to routinely store new memories.
In general, post-traumatic amnesia lasts three to four times longer than the preceding coma. Jessica’s coma lasted two to three weeks; her PTA lasted more than ten weeks.
The duration of PTA is one of the better — but still not very reliable — predictors of long-term outcome (see page 101). As the weeks of post-traumatic amnesia pass, the odds of a good recovery diminish.
While in post-traumatic amnesia, the patient is somewhat responsive, but baffled by her surroundings. She doesn’t remember her daily activities. She can’t think ahead. She goes robotically from place to place and from task to task as directed by her therapists. If she’s able to speak, she asks the same questions repeatedly because she can’t remember the answers.
She may ask, “Where have you been all day?” when you have left her bedside for just a moment.
Answer her questions with simple words and short sentences. Don’t ask her questions until you are certain she will be able to respond easily. She doesn’t need any additional frustration.
Your survivor may temporarily or permanently lose some memories from before her injury. A young adult, for example, may forget she finished college ten months before her injury. Or, she may not recognize family members or friends. She may develop familial connections with her medical team as she tries to understand her environment. This can be distressing to unrecognized and ignored family members. It is usually temporary.
When Jessica became more lucid toward the end of her post-traumatic amnesia, she couldn’t recollect from day to day that I had stopped working eighteen months prior to her accident. She continually worried that I would return to work — leaving her alone, perplexed, and scared—despite frequent reminders that I was retired.
During this period of disorientation, the patient can become extremely agitated and resist attempts to calm her. This is understandable. Just imagine what she’s going through. She is unconsciously and frantically trying to sort through a lifetime of experiences and reconcile them with her current infant-like condition. Some patients become aggressive and uncontrollable and must be medicated to calm down. Others become psychotic, experiencing delirium and/or hallucinations.
Survivors in PTA also may confabulate. They are utterly confused by their situation. Seeking some explanation for their plight, they may mix imagination and memory to create a sometimes fantastic scenario. This scenario will probably make little sense to you, but will temporarily satisfy your survivor’s unconscious need to find some logic behind her confusion. For example, many survivors imagine that the doctors and nurses are guards, imprisoning them for bad behavior, such as swearing or striking visitors.
The transition from coma to PTA can be joyful as well as painful for the family. The patient, previously motionless, now is moving and may be speaking. Everyone is relieved; their worst fears have vanished.
The patient’s behavior, however, is childlike at best and, often, totally out of character. For the first time, visitors can see just how far their survivor has to recover. They are alarmed and cannot help but panic at the prospect of a grim future.
The first two weeks of Jessica’s PTA were my most challenging days. With a grimace of pain and bewilderment on her face, she writhed about her bed, moving incessantly with no destination in mind. She had no idea who I was. She was unappreciative of my attempts to help her.
I don’t remember ever feeling so helpless and alone. After sitting with Jessica for an hour or two, I ached for someone, anyone, to relieve me at her bedside. And once they arrived, I often fled, hoping that a short break would help me regain my optimism and fortitude.
Eventually, as Jessica gradually began to comprehend her new world, we found ways to calm her. At first, she viewed any physical contact as punishment. Since she was always trying to free herself from the tubes and lines tormenting her, we had to restrain her arms, which infuriated her.
But then something clicked and she remembered that holding hands and hugging were good things. Her behavior, however, was exasperatingly inconsistent. She was sweet and serene one moment, frantic and combative the next. I never knew what to expect.
Slowly, Jessica’s disorientation and fear eased and she grew to trust that I was a good guy. Though, she had no idea I was her husband or even understood the concept of marriage.
When a person is experiencing PTA in the early days of her rehabilitation, she is able to learn some new things, including:
- Skills that require limited attention
- Activities that can be learned through repetition
- Motor skills
- Self-care activities
- Mobility and locomotion
In addition, some behavioral problems can be addressed with success during post-traumatic amnesia.
With patience and persistence, you can guide your survivor through the fog of PTA. Be careful, though, and do not confront or argue with her. Consistent behavior and steady assurances are important. Determining when your actions won’t agitate your survivor takes some practice. Often, especially in the early stages, the best environment for the patient is little or no stimulation.
Here are some guidelines to follow when your survivor is in the throes of post-traumatic amnesia:
- Always identify yourself when you enter her room.
- Tell her that it is morning, afternoon, or evening, to help her orient to time.
- Warn her when you are going to touch her.
- When she trusts you, talk about her favorite things and pleasant, shared experiences.
- Talk about her pre-injury life, but avoid suggesting that she will need to create a new life.
- Show her photos of familiar people.
- Surround her with familiar objects.
- Tell her she has been injured and is in the hospital. Repeat this often.
- Assure her that she is safe from harm now.
- If you’re not already keeping a journal, begin now. You’ll probably spend more time with your survivor than anyone else. You may be the first to spot significant changes in her behavior. Alerting her doctor to these changes makes you a valuable member of her medical team.
- Don’t ask her to recall her injury. She can’t and this certainly will frustrate her.
- Most importantly, be patient with your survivor. Neurological healing takes time, a lot of time. Trying to accelerate the process only will upset her.
- Don’t take any of your survivor’s hurtful words or actions personally. This can be a challenge, especially if she is swearing at everyone who approaches her or takes a swing at you when you try to comfort her.
- Always remember, when a person has post-traumatic amnesia, she truly does not know what she’s doing and she should not be held responsible for her actions.
All survivors of a serious brain injury acquire a mix of lifelong impairments, but through hard work they can regain some abilities lost to their injuries. How is this possible? As described in Chapter 4:
- The brain begins to heal once the patient’s condition is stabilized.
- Damaged — but not dead — brain cells or neurons repair themselves.
- The brain rewires itself, growing new pathways among the billions of still-healthy neurons.
- Through a process called plasticity, healthy portions of the brain assume some of the functions previously performed by the injured areas.
This spontaneous recovery is not sufficient, though, to enable a patient to reach her full post-injury potential. For the best possible outcome, your survivor must participate in a specialized rehabilitation program.
In rehabilitation, your loved one will be evaluated and treated by a team of specially trained medical professionals, who will design a therapy program to treat her particular needs.
Depending on the severity of her deficits and how well she recovers, there may be three stages to your family member’s rehabilitation:
- Acute inpatient rehabilitation in a specialized facility offering a full range of therapies
- An outpatient day program in a structured group setting with a full range of therapies
- Individual outpatient therapy to treat more troublesome impairments
Relearning and Compensating
Rehabilitation has two primary components:
- Relearning forgotten skills
- Compensating for more enduring impairments
Much of what a survivor has learned in her lifetime still is present in her brain after the trauma. Severed connections block access to this information and the patient can’t recall how to perform many activities. Through directed training and persistent practice, rehab reprograms the brain, establishing new connections among these still-present pockets of information, enabling the patient to reacquire forgotten skills.
Jessica had to relearn, not just how to dress herself, but even how to move from a prone to a sitting position. With the support of her therapists, Jessica gradually relearned her activities of daily living, also known as ADLs, which include bathing, dressing, walking, eating, toileting, and grooming. Mastering your ADLs is the first goal in rehab. From there, the patient and her therapists work on increasingly complex activities, with one accomplishment building on another.
Despite the best efforts of your survivor and her rehab team, serious brain damage always results in some impairment that cannot be remedied. To lead a full life, your survivor must learn ways to work around her new deficits. In rehabilitation, she will be taught to recognize and compensate for her impairments.
Sometimes, compensation means a change in behavior. This is called applying compensatory strategies. For example, a person with a diminished memory — nearly everyone with a brain injury — is taught to keep a detailed, daily schedule to keep her from aimlessly or inefficiently passing her time.
Jessica, for example, is lost when she forgets to consult her daily planner. Before going to bed, she organizes the items she will use in the morning — medications, cosmetics, her day’s schedule, and even the clothes she will wear — neatly in the bathroom. This allows her to start her day quickly and without that nagging feeling of having forgotten to do something important. When she remembers to set her alarm clock and if she climbs out of bed when it rings, her day is off to a good start.
At other times, compensation means using assistive devices, such as a watch alarm to remind the survivor to check her daily schedule, or to get ready to go to the movies. Three or four times a day, I remind Jessica to consult her daily planner or to stay focused on finishing one task before she starts two more.
Treating the Whole Person
As described in Chapter 12, a brain injury has the potential to transform your loved one in many areas: physical, cognitive, communication, emotional, behavioral, and social. Rehab is designed to treat all of these complaints.
Your survivor may have a variety of physical problems. Some may be related to the accident that caused her brain injury, such as bones fractured in a car crash. Others may be directly related to her brain injury, such as spasticity, impaired balance, or partial paralysis. A physical therapist will help her resolve, moderate, or adjust to these physical problems.
Brain trauma always upsets cognitive processes, such as memory, attention, and language. In rehab, your survivor will perform exercises to improve her memory, concentration, communication skills, and other cognitive functions.
A blow to the brain also can disturb the emotional and behavioral stability of your survivor. She may be atypically angry, depressed, or paranoid, for example. Or, she may act oddly at times: obsessive-compulsively, violently, or overly passive, for instance. A neuropsychologist or a rehabilitation psychologist will evaluate your patient and treat any emotional and/or behavioral complaints.
Finally, interacting with others in a socially acceptable manner is a learned behavior that can be skewed by a brain injury. In rehabilitation, your survivor gradually will be introduced to people: beginning with her medical team, then other hospital staff, fellow patients, and their families. When she is ready, the survivor is reintroduced into the community and her social skills are tested. A therapist may escort her to the library where she will be asked to locate books about her favorite hobby or to a restaurant where she will order lunch.
When Should Rehabilitation Begin?
In an ideal world, rehabilitation begins as soon as the survivor is medically stable. No patient should be kept in an acute hospital setting or a nursing home any longer than necessary. Combining the brain’s natural healing process with rehabilitative therapy is crucial to the success of one’s recovery.
We live, however, in the age of managed health care. Rehab dollars are doled out grudgingly by health insurers. Patients sometimes are limited to two weeks of inpatient rehab. Most receive only four to six weeks.
Researchers have learned that survivors benefit most from rehabilitation when they have reached Level 3 or 4 on the Rancho Scale. One of the most agonizing times for me was helplessly watching Jessica suffer the bewilderment of post-traumatic amnesia in an acute ward of the hospital, waiting for her doctor to agree with us that she had reached Level 4.
The value of rehab cannot be overstated. Maddeningly, nearly all survivors do not receive all of the rehab they need to reach their maximum recovery potential. Because of this short-sighted stinginess, all of society pays in two ways: (1) the high cost of caring for a survivor who would be more independent if a few more dollars were spent on her rehab, and (2) the loss of the potential productivity of a fully rehabilitated patient.
Selecting a Rehabilitation Facility
Selecting a rehab facility is a crucial decision. It should not be rushed. There are hundreds of rehabilitation programs. They vary considerably in the philosophy, quality, and variety of the services they offer.
I was in no condition — physically or mentally — to carefully research, visit, and compare rehab facilities. I relied heavily on my sister Barbara to handle this. You may want to ask someone to help you with this time-consuming job.
To start your search, compile a list of rehabilitation facilities to consider. Ask for recommendations from the following folks:
- The hospital social worker or case manager
- The physicians treating your survivor
- Your family doctor
- Your health insurance company, as your choices may be limited by your policy
- Your state brain injury association
- Families with rehab experience
- The Brain Injury Association of America has an online searchable database which includes a list of rehab programs (800-444-6443 & www.biausa.org).
- If your employer offers an Employee Assistance Program (EAP) or a Life Events Benefit, it may include Adult/Elder Resource and Referral Services, which may help you identify facilities in your area or elsewhere.
I believe that one factor — proximity to your home — is paramount in the selection of a rehabilitation facility. As I wrote earlier, support from family and friends during rehab is an invaluable motivator for the survivor. If the rehab facility is close to home, this support role can be shared. If it’s far from home, supporting the individual typically falls on just one person — usually Mom — or no one at all.
It also is easier to participate in decisions to be made about your survivor’s care and to monitor the way she is treated at the rehab facility, if it’s convenient for you to be there frequently.
The choice of a rehabilitation program, however, should not be based solely on location. Some folks who live in more rural areas have no choice but to travel a long way to a rehab facility.
To help you begin your selection process, here’s a list of fourteen services every brain injury rehab program should have:
- Evaluation and assessment of the patient's unique physical, cognitive, communication, emotional, behavioral, and social impairments
- Physical therapy to regain mobility, strength, balance, coordination, and endurance
- Occupational therapy to relearn self-care and daily living skills
- Speech and language therapy to treat communication and swallowing disorders
- Cognitive rehabilitation to treat deficits in attention, concentration, memory, problem-solving, planning, and decision-making
- Neuropsychology or rehabilitation psychology to help the survivor accept the consequences of her injury and to treat any emotional and behavioral problems
- A social skills group to relearn how to interact with others
- Recreational therapy to relearn leisure skills and, maybe, develop new interests
- Access to other medical specialists, such as neurologists, orthopedists, and pain management doctors, to provide treatment for other medical problems
- Education for both the patient and the family in living with a brain injury
- Family counseling to help everyone adjust to their survivor’s impairments
- Substance abuse counseling
- Trips outside the rehab center to reacquaint the survivor with the community and to determine any special needs
- Vocational therapy to help higher-functioning survivors return to work
All staff members should be well trained and experienced in treating people with brain injuries. If the facility uses students, interns, or less experienced therapists, they should be monitored closely by seasoned practitioners.
The staff of a rehabilitation facility should include:
- A board certified physiatrist or neurologist as the team leader
- A neuropsychologist or a rehabilitation psychologist
- Physical, occupational, speech, recreational, and vocational therapists
- A rehabilitation nurse who will assist the patient with her therapy homework in the evening and on weekends
- A clinical dietitian, as survivors often have little appetite when they begin rehab
- A case manager who will negotiate with your health insurer the duration of your survivor’s therapy
When evaluating rehabilitation facilities, it’s best to visit at least twice, the first time with an appointment, the second time unannounced.
Here are ten things to look for as you inspect the facility:
- Adequate space for many different types of therapy
- Staff professionalism, attention, and compassion for their patients
- Openness: Do you feel welcome observing activities, walking around, and asking questions?
- Are the patients clean and well kept?
- Do they appear content with their treatment?
- Is the food appealing?
- Is there a home orientation suite, which enables the patient to practice skills in a home setting?
- Do you feel rushed or pressured?
- Are there conveniences for families, such as a cafeteria, meditation room, clergy, and lounges?
Don’t be swayed by how nice the facilities appear or how wonderful a brochure looks. Ask questions. Record the answers so you can compare facilities later. Consider using a tape player to record conversations and your impressions of the facility. Also, don’t be shy about approaching families with patients at the facility. They are valuable sources of information.
Here are some questions to ask:
The Rehabilitation Program
- How long has the program existed?
- Is the program CARF-accredited? The Commission on Accreditation of Rehabilitation Facilities (CARF) sets quality standards for rehab programs. If the program isn’t accredited, be wary and ask why not. You can obtain a list of CARF-accredited providers by calling 866-888-1122 or at www.carf.org.
- What is the staff-to-patient ratio?
- Are special accommodations made for special populations, such as children, seniors, and drug and alcohol abusers?
- How many people with brain injuries has the facility treated?
- How many people does the facility treat at one time?
- What is the average length of stay?
- Who determines the length of stay?
- How flexible is the program? We were very disappointed with our program’s lack of flexibility. Jessica was anxious to improve her soft and halting speech. But her request for more speech therapy and less recreational therapy — which she felt was a waste of time — could not be accommodated.
- Does the program maintain records on patient outcomes?
- Does the facility provide outpatient rehabilitation? This allows for a smooth transition from inpatient to outpatient therapy, which is helpful since you and your survivor will be coping with many other issues when she returns home.
- How often will you be able to speak to the doctor who heads your patient’s treatment team?
- Is it possible to get the names and contact information for three or four survivors and their families who completed the program? I didn’t do this and I wish I had. I might have been more aware of problems with the program and acted more quickly to correct them.
- What are the program’s weaknesses? What services do you not provide?
- What recourse is there if you question or disagree with the quality or necessity of services being provided?
The Role of the Family
- What role do family and friends play in the program?
- Is the family welcome to regularly attend therapy sessions? If the answer is “No,” you may want to look elsewhere.
- What is the visitation policy? Family and friends should be allowed to visit at any time.
- Can a family member sleep in the survivor’s room?
- Are there regularly scheduled meetings with the family? How frequently? An initial meeting should be held to discuss the patient’s impairments and rehab goals. Then, all parties should meet again at the halfway point to discuss the patient’s progress. A third meeting should be held to discuss the patient’s homecoming and need for additional therapy.
- Is reading material available to educate the family about brain injury?
- If you live far away, how much telephone contact will there be with the patient and the medical staff?
- Also, what housing arrangements can be made for you?
The Rehabilitation Team
- What are the rehab team members’ credentials?
- How long has each team member been on staff?
- How frequently do team members meet to discuss a patient's condition?
- Will you have access to all team members?
- How are student therapists used in the program? Jessica frequently had a student speech therapist, who was not monitored closely by a more experienced staff member.
Addressing Behavioral Problems
- How does the program treat behavioral problems?
- Are restraints, safe rooms, secure and/or locked rooms used? In what circumstances?
- Is the family consulted about the use of them?
Addressing Cognitive Impairments
- What approaches are used to treat cognitive deficits?
- Is neuropsychological testing used to determine the patient’s core cognitive problems?
- If neuropsychological testing is not performed, how are cognitive problems diagnosed?
- How are the results of these tests used?
- Are patients retested at a later date to determine progress?
- What are the rights and responsibilities of the patient?
- Is there therapy on Saturday and Sunday? Jessica had therapy only on Saturday mornings. These sessions, which were led by a junior therapist in a group setting, were a waste of time and precious health care dollars.
- What will your survivor do in the evening and on weekends? Jessica found Sundays unbearably boring, especially near the end of her stay when she was desperate to go home.
- How frequently is the patient bathed?
- How many workers are on the night shift? What are their responsibilities? Jessica dreaded nighttime. She had difficulty sleeping, was not allowed to go to the bathroom by herself, and often found the night staff indifferent to her needs. We later learned that this is common in many facilities.
- Can the program accommodate any special cultural or religious needs?
- How does the program accommodate special diets and personal food preferences?
- Is outside food permitted for your patient? Jessica had little appetite and was shedding pounds. I was able to tempt her a bit with her favorite foods.
- Are conjugal visits allowed?
- How long will your survivor be at the facility?
- Who decides when inpatient rehab ends?
- How is this decision made?
- Where will your survivor go after inpatient rehab?
- What role does the survivor and family have in these decisions?
- Does the staff teach the family how to cope with their survivor's impairments when she returns home?
- Does the staff teach the family how to continue rehab at home?
- How is the patient prepared for going home?
- Will therapists visit your home and help you prepare for the special needs of your survivor?
- Will your survivor be allowed home visits before she completes the program? Home visits provide a clearer picture of a patient’s functional problems and should be used to identify therapy goals and exercises.
- Are there follow-up services after discharge? How frequently? We had five follow-up appointments with the doctor who headed Jessica’s rehab team.
Paying the Bills
- How much does the program cost?
- How much of this cost will your insurer pay?
- Are there any charges not covered by insurance?
- How much will you pay out-of-pocket?
- How much flexibility is there with your insurer? We were able to obtain extra outpatient therapy sessions by agreeing to leave inpatient rehab a week early. This worked well because both Jessica and I were ready for her to go home.
If your survivor is not yet ready for rehabilitation, but no longer requires the special care of an acute hospital, your health insurer will no longer pay the hospital bill. In this situation, you have three options:
- You can pay the bill yourself, if a bed is available.
- You can care for your patient at home, but this is a demanding job that requires medical skills.
- You can place your loved one in a long-term care facility, such as a nursing home, until she’s ready for rehabilitation.
Given that some nursing homes provide substandard care and most have little expertise in brain injury, this can be a chilling prospect.
According to one study, an estimated twenty to thirty percent of people hospitalized with a moderate or severe traumatic brain injury are discharged to nursing homes. Within one year, eighty percent of these survivors move to a private home, a community-based residence, an assisted living facility, or a rehabilitation hospital.
Federal and state government agencies monitor the country’s approximately 17,000 nursing homes. They compile service quality information in such areas as accurately administering medications, preventing abuse or neglect, improperly using restraints, and failing to prevent or properly treat bedsores. While this information paints an incomplete picture of service quality, it will help you weed out the worst offenders.
The folks who administer Medicare (800-633-4227 & www.medicare.gov) have a service called Nursing Home Compare, which provides detailed information about the past performance of every Medicare- and Medicaid-certified nursing home. Each nursing home is rated on a one-to five-star system to help you compare facilities and identify areas for closer scrutiny. There are ratings in three areas: health inspections, staffing, and ten quality measures. You can learn more about this system at www.cms.hhs.gov.
Additional information on nursing homes is available from the following organizations:
- The American Association of Homes and Services for the Aging (202-783-2242 & www.aahsa.org)
- Your state’s Office of Elder Affairs
- Your state’s Office of Health Care Administration
The best way to evaluate a nursing home is to visit it regularly, sometimes with an appointment and sometimes without. It’s also best to visit at varying times throughout the day and evening. During these visits, talk to everyone, including staff, residents, and visitors. If you feel ill at ease, you may want to look elsewhere.
Nursing homes are not the best environment for a person with a serious brain injury. If you have no other options, make the best of the situation by heeding these nine suggestions:
- Provide the staff with short, easy-to-read material on the basics of brain injury, perhaps portions of this book.
- If necessary, teach the staff how best to treat your loved one.
- Be vigilant. Visit often. An overworked staff will be more likely to treat your survivor well if they know you are watching.
- If your survivor is not getting the care she needs, keep detailed notes and take photographs to bolster your argument that she needs more attention.
- Arrange for therapy, even if it’s just range-of-motion exercises, from either in-house staff or outside therapists.
- Remember, your objective is to have your loved one moved to a rehabilitation facility as soon as possible.
- Stay in touch with the rehabilitation facility you have selected for your patient.
- Be sure the attending physician and therapists document even the slightest progress in your survivor’s condition.
- Be sure a professional with specialized training in brain injury recovery examines your patient regularly to determine if she’s ready for rehabilitation.
Finally, paying for nursing home care can become an issue if your survivor does not have long-term care insurance and does not qualify for Medicaid. Your health insurer will pay the bills only if your patient is regaining function.
Checklist for Success #5
Planning for Rehabilitation
___ Do you know that if your survivor is transferred to a regular ward in the hospital, she may receive inadequate care as her nurses will have little experience with brain injuries?
___ Do you know that regaining the trust of your survivor, who probably will be very confused when she emerges from her coma, may require some time and effort?
___ Are you familiar with post-traumatic amnesia? This is the state your survivor will likely pass through on her way back to full consciousness. Do you know how to interact with a patient in post-traumatic amnesia?
___ Do you understand how the brain heals from an injury and what role the survivor and her caregivers play in the recovery process?
___ Do you know that the two major components of brain injury rehabilitation are relearning and compensation?
___ Do you know how to select a rehabilitation facility for your survivor?
___ Do you understand the role of the family in rehabilitation?
___ Do you know how to select a nursing home for your survivor, if necessary?
___ Do you know what to watch for while your survivor is in a nursing home?
___ Do you know how to get a copy of your survivor’s medical records from the hospital? You will need them for consultations with doctors for years after the brain injury. Also, these records are important evidence for health insurance, disability benefits, and legal claims. Getting a copy of these records may take some assertiveness.