Supporting Recovery After Brain Injury: Tips for Family Caregivers

Traumatic Brain Injury (TBI)

I'm sorry to hear about your father's condition.
Here’s the translation of your message:
"My father fell from a height while working on November 11 last year and suffered a hemorrhage in the right side of his brain.
He underwent emergency surgery that night, and the doctors initially assessed his survival rate at only 30%.
It has now been almost three months, and he is currently in the intensive care unit.
His Glasgow Coma Scale score has improved from 5 before the surgery to about 8 or 9 now.
In January, he was taken off the supplemental oxygen, but he had to rely on it again due to an infection before the Lunar New Year.
He exhibits all the signs typical of a bedridden patient, including urinary tract infection and pneumonia (his lungs and heart were also impacted during the fall).
He cannot move his left arm and leg, and in the past two weeks, blisters have started to form on his left wrist.
He also has a lot of phlegm.
Given that he has been bedridden for less than three months, is this condition considered good? By the way, my father's left clavicle is fractured (the doctor initially suggested surgery, but due to my father's condition, it was not performed.
The doctor mentioned that without surgery, he would not be able to lift his arm after recovery.
He also has three broken ribs).
Our family can visit him twice a day.
What can we do to help him? In terms of rehabilitation, can we do some active rehabilitation work rather than just turning him and patting his back (which the nurses will do)? Do you have any good suggestions? I would also like to know about dietary recommendations and what precautions should be taken for long-term bedridden patients that family members might easily overlook.
Thank you so much! I appreciate your help as a helpless daughter."

Huang Wen, 30~39 year old female. Ask Date: 2004/02/08

Dr. Xu Zhenrong reply Rehabilitation

Dear Huang Wen,
I hope this message finds you well.
Your father has sustained a brain injury and intracranial hemorrhage due to a fall from a height, and his Glasgow Coma Scale (GCS) score has improved from 5 to 9 (the GCS ranges from a minimum of 3 to a maximum of 15, with 15 indicating full consciousness).
From a rehabilitation perspective, a patient with a GCS score of 9 is unable to follow commands or perform movements, so the focus of rehabilitation should be on preventing complications, which include:
1.
Prevention of pneumonia (turning, chest physiotherapy, and feeding).
Do not underestimate the importance of turning and chest physiotherapy, as patients often have a high risk of death from pneumonia and respiratory failure.
Additionally, once an infection occurs, fever can increase the risk of cerebral hypoxia, which is particularly detrimental for patients with brain injuries.
2.
Prevention of urinary tract infections.
3.
Prevention of gastrointestinal ulcers.
4.
Prevention of musculoskeletal complications (such as contractures).
5.
Nutritional imbalances (such as hypoalbuminemia and anemia).
Among these, family members can most effectively assist in preventing complications related to points 1 and 4.
Turning, chest physiotherapy, and passive range of motion exercises should be performed as much as possible.
These can be carried out by nurses or physical therapists, with the support of family members.
Additionally, the rehabilitation department has standing frames (also known as tilt tables) that can be used based on the patient's recovery status.
Rehabilitation is a learning process, and we hope for your father's early awakening (GCS score of 13 or above) so that he can undergo rehabilitation therapy.
In the meantime, it is crucial to prevent and manage various complications, meaning that before your father regains consciousness, we must ensure his body (respiratory system, musculoskeletal system, digestive system, urinary system, etc.) is well cared for.
As for when your father's brain will awaken, it will depend on the location and extent of the hemorrhage, as well as the surgical situation.

Finally, I wish your father progress and a speedy recovery.

Reply Date: 2004/02/08

More Info

Supporting a loved one recovering from a brain injury can be an overwhelming and challenging experience, especially when they have sustained significant trauma, such as in your father's case. Here are some comprehensive tips and strategies for family caregivers to support recovery after a brain injury, particularly for someone who has been bedridden for an extended period.

Understanding the Condition
First and foremost, it's essential to understand the nature of your father's injuries. He has experienced a severe brain injury, which can lead to various complications, including infections, mobility issues, and cognitive impairments. His Glasgow Coma Scale (GCS) score of 8-9 indicates a state of severe impairment, but it also shows some level of responsiveness, which is a positive sign.

Communication and Cognitive Support
1. Engage in Simple Communication: Even if your father is not fully responsive, talking to him regularly can help. Use simple sentences and encourage him to respond, even if it’s just through gestures or facial expressions. This can help stimulate his cognitive functions.

2. Familiarity and Routine: Maintain a routine in your visits. Familiarity can be comforting and may help him feel more secure. Bring familiar items from home, such as photographs or personal belongings, to create a more comforting environment.

3. Cognitive Stimulation: If he shows signs of awareness, engage him with simple puzzles, memory games, or even just discussing family news. This can help stimulate his cognitive recovery.

Physical Care and Rehabilitation
1. Regular Movement: While nurses may assist with turning and repositioning, you can also encourage passive range-of-motion exercises. Gently move his arms and legs to maintain circulation and prevent stiffness. This can be done several times a day.

2. Use of Rehabilitation Equipment: If available, inquire about using rehabilitation equipment like standing frames or tilt tables. These can help him gradually regain strength and mobility.

3. Professional Rehabilitation: If possible, advocate for a referral to a rehabilitation facility where he can receive specialized care. Rehabilitation can significantly improve outcomes for brain injury patients.

Nutrition and Hydration
1. Balanced Diet: Nutrition plays a crucial role in recovery. Ensure he receives a balanced diet rich in proteins, vitamins, and minerals. Foods high in omega-3 fatty acids (like fish) and antioxidants (like fruits and vegetables) can be beneficial for brain health.

2. Hydration: Monitor his fluid intake to prevent dehydration, which can complicate recovery. If he has a feeding tube, ensure that the nutritional formula is appropriate for his needs.

Preventing Complications
1. Infection Control: Given his history of infections, it’s vital to maintain strict hygiene protocols. Regularly check for signs of infection, such as fever or unusual discharge, and communicate any concerns to the medical team immediately.

2. Skin Care: Long periods of immobility can lead to pressure sores. Regularly check his skin, especially on bony areas, and ensure he is repositioned frequently.

3. Monitoring for Other Complications: Be vigilant for signs of other complications, such as deep vein thrombosis (DVT) or urinary tract infections (UTIs). Encourage the nursing staff to implement preventive measures.

Emotional and Psychological Support
1. Family Involvement: Encourage family members to visit and interact with him. Familiar voices and faces can provide emotional comfort and support.

2. Counseling and Support Groups: Consider seeking support for yourself and your family. Caregiver support groups can provide emotional relief and practical advice.

3. Patience and Positivity: Recovery from a brain injury can be a long and unpredictable journey. Celebrate small victories and remain patient. Your emotional support can significantly impact his recovery.

Conclusion
Caring for a loved one with a brain injury requires a multifaceted approach that includes physical, emotional, and cognitive support. By understanding the complexities of his condition and actively participating in his care, you can help facilitate his recovery. Always maintain open communication with healthcare providers and advocate for the best possible care. Your dedication and love are invaluable during this challenging time.

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