How do you set treatment goals for patients with brain injury?
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[Dr. Heechin Chae] Goal setting is such an important part of my treatment plan. As I said earlier patients enter care— What I mean by that is I have to understand what the person is thinking, what they value. It's really understanding who that person is. Goal setting is based on that. Actually, interestingly, it does take a lot of time. I used to think that goal setting was, "Come on, just give me the list. I'll help you." But most of the time they give you vague goals. Most classic, I would say more than 75% of the time it's, "I want to get better." That's the goal number one, which is a great goal. I hear you. I want to help you get better too. But let's break it down a little bit more. What does that mean? Better from what? This is where, again, if I did my job I can understand what that person means by now, because I did all these exhaustive interviews getting to know their background and premorbid condition. When they say, "I want to get better," I have a vague idea what they mean. But I still want something specific. Okay, but what areas are the most important? We walk them through. I never force anything, because this is a very important part of my treatment formulation, so that's why I say upfront, "Actually, the program I'm devising for you is like this. It's like you have to be the driver of this car. I cannot drive it for you, but I will be next to you, and my team will be next to you and help you, coach you to drive and actually be the person that you can be or go back to who you were. But we need you to help us participate in this actively. You cannot just come and show up and expect to get better." We are on the same page, so we walk through it. I'll give you an example of this IT guy that's like, "Doc, I'm going to lose my job, because I can't read these emails, or I can't read all these things that I'm supposed to read, and I can't do anything." "Certainly any kind of visual activity, improving visual activity is very important, right?" And he goes, "Yeah." "Well, let's put that as a goal." That's goal number one. That actually triggers a lot of things. To me it's not just visual, like vision therapy per se. Actually there is a lot of cognitive training that can be done, so I'm thinking already what kind of team members I'm going to bring up to help achieve these goals. Then the next person could be, "I cannot play with my son as I used to," for example. That's actually a very difficult goal too, because what does that mean? The way I think about playing with my son is throwing balls with them. But I was surprised to find some people playing with their son is laughing, talking. There are a lot of cues, body language going on. It's not so much about action. So that changes. If there is action, then you definitely have to use your arms and back, and if you have back pain, if you have shoulder pain, how are you going to do that? That's the point. Then we have to get a physical therapist to help you focus on that. Forget about the balance. This guy needs to throw. Get his shoulder worked up. Don't even bother with the balance things. Things like that, so I'm thinking all these different— I'm starting to formulate the treatment plan as we develop the functional goals. I call it functional goals. Don't tell me you want to get rid of headaches, because I will help you with that. That's a given, but tell me more specific activity-related goals that you want to achieve, and those are the things that we go through. Then after I look at the list of goals, then I think about the team members that I have, my staff, and the tools that we have to put it together to come up to achieve these goals. That is the treatment phase, or I call it rehab phase that I'm thinking about with the patient.
Posted on BrainLine September 10, 2013.
Heechin Chae, MD was appointed site director of DVBIC at Fort Belvoir and chief of the Traumatic Brain Injury Department at Fort Belvoir Community Hospital in 2011. He will become the director of the National Intrepid Center of Excellence satellite at Fort Belvoir in 2013.
Produced by Victoria Tilney McDonough, Lara Collins, and Ashley Gilleland, BrainLine.