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Clinical Hub,Patient Education,Health and Nutrition Facts For You,Neuro, Rehab

Understanding Brain Injury A Practical Guide (6203)

Understanding Brain Injury A Practical Guide (6203) - Clinical Hub, Patient Education, Health and Nutrition Facts For You, Neuro, Rehab

6203











Understanding Brain Injury
A Practical Guide

ii








Understanding Brain Injury
A Practical Guide



This booklet will provide more insight about the effects of a brain injury. The effects will not be
the same for each person. Some of this information may not apply, or it may not be helpful until
later on.

You or your loved one may have a mild brain injury or a severe one. For those with a severe
injury, please use Health Facts for You binder “What You Need to Know about Brain Injury”
(#3041) as well as this booklet. More details about mild injuries can be found at the end of this
booklet.

Share this booklet with family and friends. Please let staff know if you have questions or if you
need extra copies.

If you have questions or concerns, call:

Rehabilitation Clinic at (608) 263-6540
The Brain Injury Association of America at 1-800-444-6443




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Table of Contents




Behavior Changes ........................................................................................................................... 1
Cognitive Abilities .......................................................................................................................... 2
Language and Communication ....................................................................................................... 3
Agitation ......................................................................................................................................... 4
Impulsivity ...................................................................................................................................... 5
Judgment ......................................................................................................................................... 5
Initiation .......................................................................................................................................... 6
Neglect ............................................................................................................................................ 7
Memory ........................................................................................................................................... 8
Pathfinding ...................................................................................................................................... 9
Returning to Work or School ........................................................................................................ 10
Brain Injury and Alcohol .............................................................................................................. 11
Driving .......................................................................................................................................... 12
Sexuality ....................................................................................................................................... 13
Returning to Sports ....................................................................................................................... 13
Mild Traumatic Brain Injury ......................................................................................................... 17














1

Behavior Changes


Many changes in the brain can occur because of a brain injury. These changes can affect your
loved one’s thinking. It can change how he feels (his ‘mood’) and expresses himself (his
‘affect’). You can expect your loved one to improve, but the final level of recovery is hard to
predict. We know this “wait and see” approach is not easy, but our focus right now is helping
your loved one to become as independent as he can be.

You might hear staff use these words to describe your loved one’s behavior.

 Emotional lability- frequent mood
shifts that include showing no emotion
or a “flat” response, or crying and
laughing at inappropriate times. These
responses can be exaggerated, especially
when your loved one feels he has
performed poorly.

 Disinhibition- when your loved one has
an impulsive response that is socially
inappropriate. This could be physical or
verbal aggression, like using profanity,
or striking out at someone.

 Lack of initiation- problems beginning
a task or activity. A brain-injured person
can also have trouble knowing when to
stop a task, as well as when to go to the
next step.

 Impulsivity- when a person responds
too quickly before thinking through his
actions, or before considering the
possible consequences. (Example:
trying to get out of the wheelchair before
he realizes that he can’t stand alone)
 Depressed- symptoms of depression
include physical, mental, and emotional
changes. Physical symptoms may
include loss of appetite, sleep
disturbance, and lack of energy. Some
mental symptoms may include loss of
interest in activities and slowed thinking.
Emotional symptoms might be feelings
of sadness and hopelessness. Some of
these symptoms are often present after a
TBI.

 Blunted affect- after a TBI, a person
may lose the ability to show emotions.
Your loved one may not experience
feelings of happiness, humor, affection,
or other common emotions. As a result
they may not be able to recognize how
others are feeling, or care what happens
around them

2

Cognitive Abilities


Cognitive abilities are thinking skills. The thinking skills listed below are needed to help a
person focus, learn, and solve problems. Many of us take these skills for granted, but those
with a brain injury struggle to think clearly.

Cognitive Ability Definition Someone with a brain injury may
have…
Attention Ability to concentrate
or focus
 Short attention span
 Easily distracted
 Difficulty paying attention to the
environment
 Difficulty paying attention to more
than one thing at a time
Awareness/Perception Ability to make sense
of surroundings
 Trouble interpreting both verbal and
nonverbal communication, including
the actions of others
 Trouble interpreting what is
happening in the environment
 Little to no awareness of his deficits
and limitations
Memory Ability to recall
immediate, short
term, and long term
events
 Problems remembering things from
moment to moment or day to day
 Problems learning new information
 Difficulty with orientation (like
knowing their age, the date, where
they are, and the reason they are here)
 Problems recalling old memories
(this is relatively rare)
Problem solving Ability to identify,
approach, and resolve
problems
 Hesitate when making decisions
 Make poor decisions
 Problems completing tasks
 Problems planning the sequence of a
task
 Do things too quickly, offer the first
thing that pops into his mind, or
appear disorganized
Initiation Ability to start tasks  Have trouble getting started with
activities
 Appear uninterested, or not motivated
during activities
 Respond slowly


3

Language and Communication


People who have a brain injury often have problems with language. Language involves
understanding, thinking, talking, reading, and writing. Speaking requires us to make sounds, and
use words in phrases and sentences to convey thoughts. Again, most of us do not think of
speaking as a complex task, but you may notice your loved one having trouble.

Social Communication

Having close ties with family, friends, and co-workers is a valued part of life. Keeping these
close ties is not easy as an injured person struggles to communicate. Studies have shown that
people with brain injuries often have fewer people in their social network (family, friends,
neighbors).

Why?

▪ Changes in verbal and non-verbal communication
▪ Problems staying on topic
▪ Problems starting conversation, or may not respond to questions
▪ Word-finding problems
▪ Over-talkative
▪ Speech is slurred
▪ Problems with eye contact, facial expressions, or body language
▪ Changes in listening skills
▪ Less likely to pay attention
▪ Easily distracted (background noise, two people talking at once)
▪ Problems waiting for a turn to talk; interrupt others

Family and friends as well as the person with an injury can become frustrated. This can lead to
isolation. Because of this, feeling lonely tends to be a large problem. For this reason, therapy
will work to focus on social skills. If your loved one has problems with communication, a
speech therapist will work to improve these areas.

What Families Can Do To Help

 Try ways other than speaking to get a message across (writing, drawing pictures,
gestures, or picture board).
 Describe a thought, idea, or situation rather than using one word.
 Talk to the person in a normal voice.

What Someone with an Injury Can Do

 Stop talking: Be sure to stop talking when others are speaking to get the whole message.
 Show the speaker you are interested: Make sure you look at them, say “uh-huh”, “yes”,
and give non-verbal cues like nodding your head.

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 Remove distractions: If you are having a difficult time focusing, reduce distractions
(turn off TV, don’t look at computer, don’t flip through mail, or go to quiet place).
 Ask questions: Ask the speaker to repeat questions or explain statements that you do not
understand.
 Summarize: When you want to remember something important, you may want to sum up
or repeat what has been said.


Agitation


Your loved one may feel irritable, restless, and nervous. This is common after a brain injury. It
is more common if there is a lot of activity around your loved one. Someone with a brain injury
is easily over-stimulated. The injured brain cannot process stimuli fast enough to stay calm and
relaxed. You might notice your loved one:
 Not being able to sit still.
 Talking a lot.
 Saying things you know she doesn’t mean.
 Striking out.
 Yelling at others.

Your loved one may be frustrated and overwhelmed, and will need as much support from you as
possible.

What Families Can Do to Help

 Use calm, quiet voices. It is not helpful to yell or argue no matter how much you would
like to.
 Give brief and firm directions or rules. Repeat as needed. Trying to reason with an
agitated, brain injured person won’t work.
 Let your loved one know that the way she is acting is not appropriate.
 Provide frequent reminders about where she is, what the date is, and the situation.
 Keep familiar personal items nearby.
 Do not try to make your loved one feel badly about the way she behaves. The actions are
because of a medical problem. The person is not to blame.
 If your loved one is getting more agitated, try to get her involved in something else rather
than tell her what she did wrong.
 If your loved one becomes verbally or physically aggressive, call for help. Ensure your
safety first.
 Let your loved one know you are willing to listen, and are concerned about how she is
feeling.
 Make a list of things that seem to upset your loved one and things that are calming.
 Set limits that ensure safety. Remove objects that could be used as weapons.



5

Impulsivity


This means a person does things without thinking or planning ahead. The person may do things
too quickly, and miss an important step. When this happens, the task may become unsafe. For
example, if the person stands up from a wheelchair without locking the brakes, she is at greater
risk of falling. If a person gets into the bathtub without checking to see if the water is too hot or
cold, she may get hurt.

What Families Can Do to Help

 Give reminders to do the task more slowly.
 Ask your loved one to describe what she is going to do before she does it.
 Ask her to say each step aloud before she does it. After she does the step, she should
check to make sure she did what she wanted. Then, go on to the next step.
 Make a checklist for daily activities. Cross off things once finished so that nothing is
missed.
 Stay with the person in situations that may be unsafe (getting into a bathtub or cooking).
 Post signs to serve as reminders to stay safe. “Lock your brakes” would remind someone
to lock wheelchair brakes before standing up. Signs might also help remind someone
about wearing splints, braces, taking medicines, or weight restrictions.
 Lock up things that could be used as weapons, like knives, darts, guns, or hammers.
 Secure things that may be hazards, such as car keys, recreational vehicles (ATV),
machines, or power and hand tools.
 Place safety locks on cupboards that hold alcohol, cleaning products, or medicine.


Judgment


Often times someone who has had a brain injury has a hard time with safety, judgment, and
insight. The person is not aware of what is safe and what is not. He does not realize that he is
not able to make good judgments. This may be seen in people who have poor memory, have
problems with vision, and have problems finding their way (see Pathfinding). For instance, the
person might think he is ready to drive or go back to work when, in fact, he is not.

What Families Can Do To Help

 Provide constant supervision to ensure safety (especially during things like cooking or
pathfinding).
 Adapt the home based on your loved one’s unique needs or deficits to make it as safe as
possible. Talk with the therapists about how to do this.
 Support the need for therapy to improve thinking skills, memory, and safety.
 Keep a daily routine. This may mean setting limits on what extra activities can be done.
 Lock up anything that could be used as weapons like knives, darts, guns, or hammers.



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 Secure things that may be hazards such as car keys, recreational vehicles (ATV),
machines, or power and hand tools.
 Place safety locks on cupboards that hold alcohol, cleaning products, or medicine.
 Help might be needed with managing money, fixing meals, taking medicines, and getting
back to being active in the community.


Initiation


At first, your loved one may need help to begin tasks. This can be seen when a person is doing
self-cares, like brushing teeth. The toothbrush, toothpaste, and water may all be at the sink and
ready, but the person may not start brushing the teeth without a cue from someone else.

What Families Can Do To Help

 Give a verbal cue such as “pick up your toothbrush”.
 Guide the movement of the person to get him started by picking up his hand, and giving
him the toothbrush.
 Discuss what you are going to do with the person before you start.
 Have the person visualize the steps first. Then, have him talk through what each step will
be as he is doing the task.
 Get into a routine so the person can do the steps in the same sequence each time.
 Write down the steps. Put them in front of the person.
 Group the task into smaller parts. The person is then able to check off the steps as they
go along.
 Use an alarm clock or wristwatch to remind a person to start a task, or to go on to the
next step.

7


Neglect


Neglect means that the person ignores a certain side of her body or a specific limb. For some
reason, the part of the brain that controls that area is not able to realize or notice signals from that
part of the body. Most of the time a person’s head or body may be turned away from the side
that is involved. She may even deny that the side or limb is there, or that there is something
wrong with it. In many cases a person can learn to make up for the neglect.

What Families Can Do To Help

 If the neglect is severe, objects should be presented to the person from the side that she
favors.
 If the person has begun to compensate for the neglect, begin giving her objects from the
center. Slowly start to move the object to the side she ignores.
 Remind the person often to notice the side she neglects.
 Use the “lighthouse technique” (turn the head from side to side like a lighthouse when the
person is having trouble finding something).
 Keep the limb in sight even when it is not being used.
 When you are talking to the person, sit on the side she does not favor. Persuade her to
look toward you.
 Assist the person by helping her to use the affected arm or leg.
 Have the person rub or massage the arm or leg. This may help improve the person’s
awareness of that side.
 Have the person put weight on the affected side or limb to help them become more aware
of that side. Standing or shifting weight to that side, or lying on her stomach propped up
on her elbows to get weight on her arms can help.
 Help protect the neglected side when the wheelchair is moving, or when she is walking.
 Stay on the neglected side to prevent the person from running into things on that side.
 Stay very close to your loved one in the community. Neglect may prevent her from
seeing things like moving cars.
 When reading or writing, highlight the edge of the material that the person is ignoring.
Use colored paper or book markers to underline words being read.
 Help might be needed with managing money, fixing meals, taking medicines, and getting
back to being active in the community.

8

Memory


After brain injury, problems with memory often occur. This may frustrate and embarrass the
person with the problem. It can impact on how a person performs tasks. Also, it can pose
serious safety problems.

What Families Can Do To Help

 Be patient with your family member.
 Limit the things you want the person to remember. Don’t overload the person with
information.
 Make sure the person is paying close attention before you start talking.
 Avoid things that might distract the person such as TV, radio, or other people talking.
 Ask the brain-injured person to repeat what he has heard to ensure he has listened to what
you have said. Wait about 15 to 20 seconds, and ask him to repeat it. If he cannot,
prompt him with cues.
 Ask the person to write down notes while he listens, or after he learns something new.
Hearing the message and doing something with it will increase the chance of
remembering it later.
 Ask the person to visualize what he is supposed to do. For example, if the person needs
to turn off the radio when he leaves the house, ask him to see himself turning off the
radio as he is leaving.
 Keep important phone numbers and addresses in an appointment book or journal.
 Leave notes as reminders.
 Establish a structured routine of daily tasks.
 Ask the person or help him write a “to do” list.
 Use a watch with an alarm to remind the person to look at the “to do” list.
 A tape recorder can be used instead of a written “to do” list. Record important messages.
 Show the person pictures of vacations or other family events in which he took part. Talk
with him about the events.
 Use a calendar to keep track of events. Review it daily.
 Write down all activities to be done in a given day, and include times to do each one.
Include time for self-care, exercises, medicines, and appointments. Review the schedule
several times a day. Try to do daily tasks in the same order every day.
 Keep personal items in the same place in the house.
 Help might be needed with managing money, fixing meals, taking medicines, and getting
back to being active in the community.

9


Pathfinding


People who have had a brain injury may have trouble with pathfinding. This means that people
may have trouble remembering how to get to and from places familiar to them. They may
become lost or confused by complex directions. They may not even know that they are lost.
Also, they may deny that they are lost to others.

What Families Can Do To Help

 Go with the person on all trips outside the home.
 Have the person carry her name, address, and phone number at all times, and who to call
in case of an emergency.
 Have the person carry change for a phone call at all times.
 Remind the person to use signs. Point out cues from her environment to help her figure
out where she is.
 Routines at home can help lessen confusion about pathfinding within the home.
 Have the person write down on paper the directions to where she is going, before she
leaves.
 Take the same route each time to places like the grocery store, pharmacy, church, bank,
or other important places. Point out landmarks along the way that could cue the person
next time.
 It may be helpful to make signs for around the home, yard, or driveway to help the person
be aware of where she is, or as a reminder to get help before going somewhere.
 Practice pathfinding in the person’s own neighborhood.
 If it is not safe for your loved one to drive yet, make sure the keys are out of sight and
secure.

10

Returning to Work or School


Getting and keeping a job after a brain injury can be a major hurdle. There is no one approach
that will help all people.

Going Back to Work

Return to work is often a main goal.
Therapies can be geared toward this.
Returning to work after a brain injury
depends on several factors.
 Health and physical abilities
 Desire to work
 Job interests and abilities
 Ability to adjust to changes
 Willingness to receive further
training

Vocational-Educational Therapists

These highly trained rehab counselors help
plan for return to work if a person is able.
Here are things they will be thinking about:
 Can your loved one return to his
former job?
 What changes are needed in terms of
job duties, tools and equipment, and
education?
 What are the options for a change in
career, and need for return to school?
 What community resources are
available?

School

Planning for return to school may be a part
of the rehab program. Voc-ed counselors
and other therapists will help in this process.
The goal is to create a safe, thoughtful plan
in a timely manner. Staff will talk with your
loved one’s school to arrange a plan for the
transition back to school. While your loved
one is in the hospital, he might be able to
enroll in the hospital’s school program.

What Families Can Do To Help

 Give the person a chance to shadow
a family member on the job.
 Offer encouragement.
 Allow the person to explore his
interests.
 Take a class with the person.
 Help the person explore volunteer
service.
 Have him practice work activities at
home (like answering phones or
taking messages).
 Role play interview questions.

Resources for You and Your Family

State Division of Vocational Rehabilitation Office (608) 225-5070
Job Accommodation Network (JAN) 1-800-526-7234
Brain Injury Association of America 1-800-444-6443
Social Security Administration 1-800-772-1213
Goodwill Industries (608) 246-3140
Agrability (promotes success in agriculture) (608) 262-9336
Brain Injury Alliance of Wisconsin 1-800-882-9282

11

Brain Injury and Alcohol


Alcohol affects how well the brain is able to work. If a person with a brain injury drinks alcohol,
uses illicit drugs, or uses prescribed drugs in excess, it can further affect how he thinks. It can
result in more damage to the cells and nerves in the brain. It blocks the parts of the brain that
makes him cautious and careful. Alcohol affects the injured brain differently than the non-
injured brain. It may slow recovery and increase the risk for seizures.
Alcohol affects many things.
 alertness
 concentration
 self-awareness
 perception
 memory
 learning
 motor control
 speech and language
 emotions
 reasoning
 problem-solving

Using alcohol may increase the risk of a second head injury. This is due to poor decision
making, increased risk taking, and poor problem solving.

What Families Can Do To Help

 Remove alcohol from the home.
 Identify positive ways that a person can cope with tough situations rather than by
drinking.

What Someone with an Injury Can Do

 Change your activities. If you often see your friends in a bar, try meeting them for a
movie instead.
 Involve yourself in sports or other activities.
 Involve yourself in a hobby to replace the time you would have spent drinking.
 Make new friends with people who do not drink.
 Say no!
 Join a support group such as AA
















12

Driving


Your loved one may have lost some abilities in certain areas that can make driving unsafe.
Before driving again, a number of factors must be assessed.

Medicines
Do any impair driving ability?

Insight
Is your loved one aware of problems with
thinking, seeing, or other physical
problems? Without insight, people are not
able to compensate for their deficits, and are
more at risk for accidents while driving.

Physical Ability
Does your loved one have coordination,
sensation, movement, and strength to drive a
car? Can your loved one work the gas
pedal, brakes, steering wheel, and seat belt
without help?

Processing speed
Can the person quickly respond to traffic
situations? Has reaction time been affected?

Attention
Is the person able to pay attention to
multiple things at the same time? Could
your loved one react to traffic lights
changing, lanes merging, and people
crossing the street while it is raining?

Vision
Is there any problem with blurred vision,
peripheral vision, double vision, scanning
(moving eyes left and right, up and down),
or recognizing objects?

Problem-solving
Is the person able to make safe choices,
thinking through the outcomes of actions
while driving?

License Status
Does the person have a valid license? Are
there any restrictions, or concerns with their
driving history?

Doctors may need to let the Department of Transportation know about someone who has had an
acute injury or illness. The person would then be contacted about how to proceed. The doctor
may suggest a driver readiness screening test. This helps decide if the person is ready for a
behind the wheel road test. In other cases, the doctor may simply refer the person to the
Department of Transportation for the road test.

What Families Can Do to Help

 If the doctor suggests that your loved one NOT drive, make sure he is not driving. If he
does drive, he may be putting himself and others at risk. Some families need to lock up
keys to ensure the person does not drive.
 If recommended by the doctor, schedule a driver readiness screening. Ask the doctor or
therapists for a list of places that offer these tests.



13

Sexuality


Sexuality involves how we express feelings of affection and closeness. It is also how someone
interprets the feelings and behaviors of others. Your loved one may express feelings and respond
to others in a different way. A person may be more open or vocal about sex because of impaired
judgment.

Changes that Affect Sexuality
 Lower sex drive
 Medicines (can affect sexual function)
 Fatigue
 Physical problems
 Inability to initiate feelings or actions
 Unable to communicate
 Memory (hard to remember things like using birth control)

A female with a moderate to severe brain injury is advised not to become pregnant for at least
one year. Discuss any questions or concerns with your doctors or nurses.


Returning to Sports


People who have had brain injuries should not be in contact sports. There is a greater risk for
further head injury. Someone who has had one brain injury is three times more likely to suffer a
second one than someone who hasn’t. After a second brain injury, a person is eight times more
likely to have a third one.

Sports to Avoid
 Football
 Boxing
 Baseball
 Basketball
 Soccer
 Tennis
 Other sports involving balls moving at high speeds

Choose Aerobic Exercise
Benefits
 Increases energy
 Decreases depression
 Improves overall health for people
who have had brain injuries
Examples
 Running
 Swimming
 Biking (with a helmet!)
 Walking
 Exercise equipment (treadmill, exercise
bike, etc.)

Always check with your doctor before starting any exercise program or sport. A person’s
balance, strength, coordination, and thinking skills will need to be assessed first.

14

Changes in Physical Ability


Causes of Weakness

 Prolonged bed rest causes general muscle weakness.
 Brain damage can lead to muscle weakness or a lack of coordination in the trunk or the
limbs. This can affect one side of the body, both arms and legs, and/or the trunk. It
depends on the part of the brain that has been injured.
 Other injuries may have happened at the same time as the brain injury.

Muscle weakness can mean that tasks that seemed easy before the injury like bathing, dressing,
speaking, eating, walking, getting in and out of bed, and using the bathroom are now harder to
do. A device like a walker or cane may be needed for walking and standing because of this.

What Families Can Do To Help

 Remind your loved one to use the device as ordered by the doctor or therapist.
 If the person needs help getting out of bed, getting up from a chair, walking, or with other
tasks, remind him to wait for help before trying to do the task alone.
 Remind the person to pace himself. Do not schedule several things in one day as this
may wear the person out.
 Remind the person to perform any home exercise programs given by the therapist. Assist
the person as shown by the therapists.

Tone

Muscle tone is the degree of tightness in a muscle. When tone is increased in a muscle, it is
harder to move that muscle. Also, the person may have spasticity in certain muscles. This is
when there is a sudden increase in muscle tone in response to a quick stretch of the muscle. The
person may also have decreased tone or flaccid muscles. In this case the affected limb will be
limp, and the person will have trouble moving it.

What Families Can Do To Help with Increased Tone

 Perform daily range of motion exercises as you have been shown
 If there is spasticity in a person’s legs, rolling the legs in and out in a rhythmic pattern as
shown by a therapist can decrease it. This is not a technique to use for the arms.
 Keep track of changes in the person’s tone in a log or journal. Note the time of day and
what might have caused the change, such as a change in medicines, an unpleasant
sensation, a fever, or a quick position change. This will help the doctor to decide how to
treat the tone.
 When the person is resting, position the limb as recommended by the doctor or therapists.
Often the position that is most comfortable for the person will increase their tone, and so
is not the ideal place for that limb.

15

What Families Can Do To Help with Decreased Tone

 If your loved one lacks tone in an arm or leg, you may hear it described as “flaccid.”
Avoid pulling on a flaccid limb during transfers or walking. Use a gait belt instead, and
protect the limb as you have been shown.
 If a sling or brace is needed to provide support for the limb, remind your loved one to
wear this when walking, moving from a chair to a bed or toilet and back, or standing.
 When the person is resting, position the limb as recommended by the doctor or therapists.
This will help reduce swelling and risk of injury to the limb.

Balance

Trouble with balance means that a device like a walker, cane, or another person is needed to help
maintain balance while standing or walking. Many falls occur when a person with balance
problems bends over while sitting or standing. A special wheelchair may be needed to help
keep a person upright. Some may need a wheelchair for safety most of the time.

Some people may not be aware of balance problems. For that reason, constant supervision may
be needed to stay safe.

What Families Can Do To Help

 Remind your loved one to use the device as ordered by the doctor or therapist.
 Remove clutter, toys, throw rugs, and power cords from the areas in which the person
will be walking.
 Keep a light on at night, particularly on the way to the bathroom.
 If recommended by the doctor or therapists, provide 24-hour supervision of the person.
 Use a gait belt and/or device to help keep the person balanced during walking or standing
tasks.
 Help the person do exercises given by the therapists to improve her balance.
 Keep frequently used items close to the person so that they can be easily reached even
from a sitting position.
 Many falls occur when people are trying to get to the bathroom in time to avoid an
accident. If the person needs help getting to the bathroom, offer help often. Remind the
person to ask for help as soon as she knows that she needs to use the bathroom. Helpful
tips to prevent falls on the way to the bathroom include setting up a regular schedule to
go the bathroom, and keeping a commode or urinal next to the bed.
 Falls also can occur when people are trying to reach the phone. Make sure your loved
one has a phone within easy reach from a sitting position if she is alone in a room.

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Other Precautions

People who have had a brain injury may have other injuries like broken bones or joint
dislocations. This may mean that they have certain restrictions like how much weight they can
put on the affected limb. It could also mean a restriction in terms of how far they can move the
affected joint.

Levels of weight-bearing precautions

 Non-weight-bearing (NWB): no weight on that extremity
 Touch down weight-bearing (TDWB): the limb may rest on the ground or bed but no
more pressure through the limb than would crack a raw egg
 Partial weight-bearing (PWB): usually the orthopedic doctor will specify a number of
pounds, often 40 or 60 pounds
 Weight-bearing as tolerated (WBAT): as much weight as someone can tolerate within his
comfort level

The doctor and therapists will explain what precautions your loved one has and how these will
affect daily activities and movements. A sling, splint, or brace may be needed to protect or
immobilize the injured limb.

What Families Can Do To Help

 Remind the person to follow the precautions when walking, sitting down, standing up,
and moving in bed.
 Remind the person to follow restrictions in how far he can move the affected limb.
 Make sure any adaptive equipment the person needs to perform daily tasks such as self-
cares are within reach. This equipment can include reachers, leg loops, sock aids,
walkers, or canes. The therapists will provide the equipment needed, and teach you and
your loved one how to use it.
 Remind the person to use devices that are recommended.













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Mild Traumatic Brain Injury


Mild traumatic brain injury occurs when someone loses consciousness for less than 20 minutes
after being struck in the head. The person may not be able to remember being struck in the head
for as long as 24 - 48 hours. Often patients are in the hospital less than 48 hours or may not be
hospitalized at all.

People Affected

Over 6 million mild traumatic brain injuries occur each year.

Recovery

Some people, but not all, will suffer a post-concussion syndrome.
Symptoms may include:
 A headache that doesn’t go away no
matter what you do
 Dizziness
 Tiredness
 Irritability/less able to handle
frustration
 Forget things
 Have trouble paying attention
 Take longer to do what used to come
easily
 Problems with sleep
 Anxiety/depression
 Trouble keeping track of many tasks at
one time

These symptoms may begin within days or weeks of the injury. They may last for weeks to
months after the injury. Most symptoms are gone within 6 months.

Activity Precautions

Ask your doctor when you can return to work or school. This will be different for each person.
There are some things that you should not do
 Contact sports (football, rugby, ice hockey, etc)
 Drinking alcohol
 Riding a bicycle or skating without a helmet
Avoid anything that could put you at higher risk for a second brain injury. The effects will be
more severe, and will limit what you are able to do on a daily basis.

When to Call the Doctor

Call the doctor if symptoms listed above get worse. Also call if taking part in your normal
activities becomes harder. The doctor may order more tests or arrange for an occupational,
physical, or speech therapist to evaluate your thinking skills and whether you are able to do daily
tasks safely. The therapists can suggest ways to improve your normal activities.

18

Resources

Brain Injury Association of America
The mission of the Brain Injury Association of America (BIAA) is to advance brain injury prevention, research,
treatment and education and to improve the quality of life for all people affected by brain injury. Dedicated to
increasing access to quality health care and raising awareness and understanding of brain injury. With a network of
state affiliates, local chapters and support groups, we are the voice of brain injury.

http://www.biausa.org/

Brain Injury Alliance of Wisconsin
Our Mission: "The prevention of brain injury and the full participation in life for individuals with brain injury",
guides the development of our Programs and Services.
http://www.biaw.org/


Federal Substance Abuse and Mental Health Services 1-800-729-6686
AA SupportLine (608) 222-8989























Your health care team may have given you this information as part of your care. If so, please use it and call if you
have any questions. If this information was not given to you as part of your care, please check with your doctor. This
is not medical advice. This is not to be used for diagnosis or treatment of any medical condition. Because each
person’s health needs are different, you should talk with your doctor or others on your health care team when using
this information. If you have an emergency, please call 911. Copyright © 2/2017 University of Wisconsin Hospitals
and Clinics Authority. All rights reserved. Produced by the Department of Nursing. HF#6203