Brain injury - discharge

First, health care providers provided treatment to prevent any further damage to the brain, and to help the heart, lungs, and other important parts of the body.

After the person became stable, treatment was done to help them recover from the brain injury. The person may have stayed in a special unit that helps people with brain injuries.

People with a serious brain injury improve at their own pace. Some skills, such as movement or speech, may go back and forth between getting better and then worse. But usually there is improvement over time.

People may display inappropriate behavior after a brain injury. It is OK to point out when behavior is not appropriate. Explain the reason and suggest a different behavior. Offer praise when the person calms down or changes their behavior.

Sometimes suggesting a new activity or a new place to go is the best option.

It is important for family members and others to stay calm.

• Try to ignore angry behavior. Do not make a face or show anger or judgment.
• The providers will teach you how and when to decide to step in and when to ignore certain behavior.

At home, the person who had the brain injury may need to practice everyday activities. It may help to create a routine. This means certain activities are done at the same time each day.

The providers will help you decide how independent the person can be and when you can leave them alone. Make sure your home is safe so injuries do not happen. This includes making the bathroom safe, for either a child or an adult, and protecting against falls.

Family and caregivers may need to help the person with the following:

• Exercising the elbows, shoulders, and other joints, to keep them loose
• Watching for joint tightening (contractures)
• Making sure splints are used in the correct way
• Making sure arms and legs are in a good position when sitting or lying
• Caring for muscle spasticity or spasms

If the person is using a wheelchair, they will need follow-up visits with their provider to make sure it fits well. The person also needs to change positions in the wheelchair several times an hour during the day, to help prevent skin ulcers.

Learn to make your home safer if the person with the brain injury wanders inside or from the home.

Some people with brain injuries forget about eating. If so, help them learn to add extra calories. Talk with the provider if the person is a child. Children need to get enough calories and nutrition to grow. Ask the provider if you need the advice of a dietitian.

If the person with the brain injury has problems with swallowing, help them follow any special diet that makes eating safer. Ask the provider what the signs of swallowing problems are. Learn tips to make feeding and swallowing easier and safer.

Tips for making clothing easier to put on and take off:

• Do not give the person too many choices.
• Velcro is much easier than buttons and zippers. If the clothing has buttons or zippers, they should be in the front.
• Use pullover clothes when possible and slip on shoes.

Tips for talking to the person with a brain injury (if they have problems understanding):

• Keep distractions and noise down. Move to a quieter room.
• Use simple words and sentences, speak slowly. Keep your voice lower. Repeat if needed. Use familiar names and places. Tell them when you are going to change the subject.
• If possible, make eye contact before touching or speaking to them.
• Ask questions so the person can answer "yes" or "no." When possible, give clear choices. Use props or visual prompts when possible. Do not give the person too many options.

When giving instructions:

• Break down instructions into small and simple steps.
• Allow time for the person to understand.
• If the person becomes frustrated, take a break or consider redirecting them to another activity.

Try using other methods of communicating:

• You may want to use pointing, hand gestures, or drawings.
• Develop a book with pictures of words or photographs to use when communicating about common topics or people.

Have a routine. Once the person finds a bowel routine that works, help them stick with it. Pick a regular time, such as after a meal or a warm bath.

• Be patient. It may take 15 to 45 minutes for the person to have bowel movements.
• Try having the person gently rub their stomach to help stool move through their colon.

The person may have problems starting to urinate or emptying all of the urine out of their bladder. The bladder may empty too often or at the wrong time. The bladder may become too full, and they may leak urine out of the overfilled bladder.

Some men and women may need to use a urinary catheter. This is a thin tube that is inserted into the bladder. Learn how to care for the catheter.

Contact the person's provider if they have:

• Problems taking drugs for muscle spasms
• Problems moving their joints (joint contracture)
• Problems moving around or it is getting harder for them to transfer out of a bed or chair
• Skin sores or redness
• Pain that is becoming worse
• Choking or coughing when eating
• Signs of a bladder infection (fever, burning with urination, or frequent urination)
• Behavior issues that are hard to manage

Head injury - discharge; Head trauma - discharge; Contusion - discharge; Shaken baby syndrome - discharge

Brain Injury Association of America website. Adults: what to expect at home. www.biausa.org/adults-what-to-expect/adults-what-to-expect-at-home. Accessed September 11, 2023.

Dobkin BH. Neurological rehabilitation. In: Jankovic J, Mazziotta JC, Pomeroy SL, Newman NJ, eds. Bradley and Daroff's Neurology in Clinical Practice. 8th ed. Philadelphia, PA: Elsevier; 2022:chap 55.

Family Caregiver Alliance; National Center on Caregiving website. Traumatic brain injury. www.caregiver.org/traumatic-brain-injury. Updated April 2020. Accessed December 2, 2022.

Updated by: Evelyn O. Berman, MD, Assistant Professor of Neurology and Pediatrics at University of Rochester, Rochester, NY. Review provided by VeriMed Healthcare Network. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.