(Cont’d)
2. Medical status should be continually monitored but is not the only goal of rehabilitation.
It is critical that neurological and physical examinations be conducted at regular intervals to detect new problems. Far too often head injured individuals develop undetected seizure disorders, visual disturbances, balance problems, or a host of other conditions which limit rehabilitation potential unnecessarily. The problem is that, as long as a physician manages the patient’s care, hope for a “cure” remains and the injured individual and family can believe that time will resolve all problems. Most head injured individuals are not medically ill and therefore should limit their involvement with physicians and the medical model.
3. Successful rehabilitation does not divide the patient into neat sections which deal intensively with a single body part or function at a time.
Since head injured individuals tend to have difficulty generalizing from one situation to another, rehabilitation efforts must consider the complete person at all times. Little progress will be made if speech therapy is conducted 2-5 times per week and never practiced outside the therapy setting. Similarly, if speech is only practiced in a seated position, the client may be unable to utilize new skills when standing or walking. The more new and emerging skills are practiced, the better they become. Repeated practice in a variety of settings facilitates making the new behaviors habitual.
4. Behavior control must precede cognitive and physical rehabilitation.
If the injured individual’s behavior is out of control, it is unreasonable to expect new learning to occur. Therefore, it is critical to develop effective behavior control by changing the environment, the caregiver, or the injured individual before directly addressing cognitive problems. Until the individual can attend and concentrate, learning will not occur. Inappropriate behavior may preclude admission to a rehabilitation program and severely increases the stress on family and the head injured individual. Many behavior problems of head injured individuals are unnecessary and have little to do with the injury.
5. There is no such thing as a “plateau”in rehabilitation.
Many rehabilitation professionals expect head injured individuals to “plateau”, i.e. cease making progress, at some point in their treatment program. This belief usually terminates the formal rehabilitation program and ignores what we know about human development: growth ceases only with death. It is much more useful to view periods of apparent lack of progress as times of “consolidation”, where the individual is gaining sufficient practice with the new skills to make them become habits. When learning skills are impaired, it is unreasonable to expect the individual to learn new information and behaviors every day. Allow time to glory in success before presenting new challenges.
6. Head injured individuals require tight structure in their daily lives to survive, grow, and improve.
Most of us lead highly structured lives: we awake at the same time, follow the same pattern in morning hygiene, eat meals at the same time, and work the same hours each day. Grocery shopping, laundry, etc. are done on a schedule. This kind of structure allows us to put most of our lives on automatic pilot and reserve creativity, memory, and novelty for more important areas. Far too often, head injured individuals have no structure in their daily lives and therefore accomplish very little each day: they nap throughout the day and then can’t sleep at night; they eat meals at varying times and therefore can’t recall if they have eaten at all; they leave things wherever they please and then can’t find them. Tight structure reduces the need to continually make decisions, vastly increases the capabilities of the injured individual, and significantly reduces the demands placed upon the caregiver.