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article imageIt's A Skill Not A Pill

By KJ Mullins     Jan 29, 2009 in Health
Surviving strokes and heart attacks are a marvel of medical science. What needs to be addressed though is the second phase recovery. These advances come at a cost, brain injuries require rehab so patients can return to their lives.
Oxygen starved brains are damaged. There is no silver bullet that will reverse the damage that has taken place. Time is the only 'cure' and even that is not a guarantee. Between the time it takes for the brain to heal and the time that a person no longer needs to be in an acute medical centre is rehab. What are the challenges that face both the staff and the patient at this phase of recovery? The over whelming majority of both sides that I have interviewed have stressed communication as both the problem and the way to help patients get their footing back.
Acquired brain injury happens when a sudden, external, physical assault damages the brain. Often this assault comes from a physical cause like car accidents or physical assaults. Some brain injuries though are the result of infection, lack of oxygen, poisoning, tumors, ruptured aneurysms or other medical conditions.
Rehabilitation is needed for those facing the issues that a brain injury causes. Memory problems are a key factor when treating a patient for a brain injury. Concentration, making decisions, understanding others and communication are all skills that may be affected when the brain is injured. One common trait among those with a brain injury is that they often can not see what others do, the patient believes all is fine and that those around them are making a 'mountain out of a molehill.' There inlays the most difficult part of treating patients with this type of injury.
In the medical world there is often a magic pill or procedure that will fix the problem. That is not the case when dealing with a brain injury. Time and learning to adapt to new skills are the only way to handle these types of cases. There is not one 'rulebook' for all patients, each patient has to have a specialized treatment plan to deal with the issues that have risen from their personal injury. It's not an easy branch of medicine.
The primary goal of a rehabilitation centre is not to get the person back to where they were prior to their injury. While that would seem to be the answer the fact is once a person has suffered this type of injury a 100% cure is almost a fantasy. What is possible for many is being able to handle everyday activities with a new skill set.
After interviewing both staff and patients at one such institution the challenge is to break down barriers in communication. The staff may know exactly what the problems are but to be able to get the patient to understand the issues is a hurdle. When dealing with patients that don't understand they have a problem the staff has to try to find a way in.
The reward though is when the challenges have been met and the patient overcomes their disability, becoming independent and having pride in their accomplishments. The road to that victory though is a long and hard challenge.
The patient has to deal with the loss of who they were and face who they are now. Without being able to see that reality at times can make the recovery process a hurdle for both the patient and the therapists working together. Ed, a social worker expressed that the person looks like they understand what's going on and yet when questioned they no longer have that ability to so.
"When someone's first language is not English we get an interpreter, with brain injury that's the one language that we can't interpret."
To get the message across to someone who doesn't understand is the biggest challenge. Often the staff has to talk to the family for insight.
Because of denial and avoidance it is difficult to understand the issues of brain injury. That also goes for the family and friends of the patient. There is no magic bullet. You have to balance not taking away hope but also into addressing the reality of the situation.
A speech/language pathologist named Heather found that the most difficult aspect was finding the thing that motivates a patient. When a patient does not have the insight of their own problem it can take it is difficult to have then understand what the therapist is doing is actually beneficial. Getting buy-in from the patient is needed to proceed. Her motto of "it's a skill not a pill" quickly became the title of this article, because it sums the rehab process all up. Skills have to be learned without the use of a prescription pad.
One of the nurses, Elsie, at the centre told me that the language barriers can be a huge problem. Most brain injury patients are agitated because of their injury. Another nurse stated that it is hard to combine the fact that their brain isn't working properly with what has to be done. Communication and cognitive issues make it difficult to treat some of the patients. With the vast array of issues that these nurses deal with; speech, hearing, behaviour issues and confusion they have the difficult task in helping the injured find their way back into society. One nurse said that more staff educational training would be of benefit for the nurses.
One of the patients Henry said that having to deal with people treating patients not as an adult is a problem. He also said that the process would be better if the 'owner' of the brain was consulted more. When asked about the fact that brain injury patients often do not understand they have a brain injury, would change his ideas of delving into the working of the brain he responded it would be a difficult challenge to address. He still felt that the professionals should do more to delve into the core problems of a brain injury.
Craig and Chris are both patients but with physical disabilities that noticed the communication problems with those with brain injuries. Chris said that communication has been a problem for those patients. The biggest problem is not being able to communicate because of speech issues like language displacement. Chris related a story of a man who was asked what month it was and responded with the number one. He knew that it was January but the word could not go from his brain to his voice.
Craig believes that the staff is doing the best that they can. "They work out of a book" adjusting the needs for each patient.
And that is the crux of the rehab journey. The care has to be formulated for each patient. Each new case brings forth challenges. Communication is the way through the barriers. And sadly often communication is the largest barrier to break down.
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