(Cont’d)
After you have carefully observed the injured individual’s current abilities for several weeks, all family members should meet to share the information collected and make sure you agree on what you have observed. The more you all understand about the individual’s current abilities, the more able you will be to help him develop appropriate skills and to continue the family’s recovery from head injury. At the end of the observation period, you should have a pretty good idea of which family member can work best with the injured individual on certain tasks.
Create a plan to develop those skills which are important to the injured individual and to other family members: As more individuals survive head injuries it has become clear that recovery continues as long as the environment is structured to maximize remaining abilities and the person is provided with opportunities to re-acquire skills. These two broad areas provide the framework for your recovery program. Far too often the lives of head injured individuals are incredibly disorganized: they go to bed and awaken at different times each day, nap throughout the day, eat meals at random times, and have no regularly scheduled activities. Such a pattern is grossly atypical of most adults and almost precludes productivity at even minimal levels.
Therefore, the most important first step in any program is to develop a daily schedule which is reasonable for both the injured individual and other family members. With a schedule, the injured individual is required to make fewer decisions throughout the day and family members can plan their own lives. Just being on a schedule makes the injured individual’s life and that of all family members more normal!
One of the most common deficits following head injury is significantly decreased performance speed: the individual is capable of completing a wide range of tasks but requires excessive time to do so. Rather than spend the extra time, family members choose to do the task for the individual; this may temporarily make life easier for the family members but almost guarantees that the injured individual will not develop that particular skill. Therefore, if morning hygiene requires 2 hours, schedule that much time initially. But at the same time, watch the individual do the routines and try to figure out how you can decrease the amount of time required and the amount of supervision or assistance you need to provide. If, for example, he forgets to brush his teeth, store his toothbrush and toothpaste on the sink rather than in the medicine cabinet so that seeing it can jog his memory. Train him to use a list in the bathroom, checking off each step as he completes it.
If his attention span is limited to 5 minutes, it is useless to schedule work on developing new skills for 10 minutes: the last 5 minutes may undo what you accomplished in the first 5 minutes. If distractibility is a significant problem, you need to make sure the environment is “neutral” when you are presenting new information (e.g., make sure he doesn’t need to go the bathroom and the TV is off; sit still while you are talking).
It is especially important that you take both cognitive and physical endurance into account when planning the daily schedule. All of us perform best when we are well-rested; most of us can engage in certain activities for limited periods of time (e.g., no matter how much you wanted to finish that last chapter, you fell asleep without doing so). Schedule the most difficult activities for those times of day when the individual is well-rested and switch activities before the particular system you are working with becomes fatigued (e.g., alternate reading with working on crafts or playing games).