Here are some practical tips that others have found helpful.

Provide "cues" to aid the survivor’s orientation.

The survivor may need help maintaining his orientation to time, place or people. Some survivors may have post-traumatic amnesia. It is common for the survivor to interact with friends, family and health care providers and have no recollection of the interaction. Be patient.

Provide a calendar and clock (preferable without a second hand) to help orient to time. Provide photographs of family, friends, pets and familiar places. These will help to orient the survivor to people and place. Smaller groups of visitors will usually be easier for the survivor to handle. This reduces the possibility of too much stimulation.

Help avoid frustration

Too much stimulation can be very frustrating for the survivor. Recognize that stimulation is needed in moderate doses. Please remember that the survivor may be thinking at a much slower speed and may require more attention and concentration to do the task at hand. Also the survivor may have to think about things that they could do automatically prior to the accident. Allow them enough time to work through their thoughts and actions. If a survivor experiences too much stimulation, he may "shut down". Other reactions that can be exhibited by the survivor are crying or becoming combative. If this happens, a quiet environment and rest may be helpful. Try to remain calm and be matter-of-fact and non-judgmental toward the survivor.

Keep conversations simple. Simple means uncomplicated, not simple-minded. Please do not be condescending. Speak to the survivor in an age-appropriate manner and about topics that promote normal interest. Conversation is important to the survivor. Even if he is unable to speak, try to keep the social environment as normal as possible. Speak clearly, use a normal tone and volume. Use short, simple sentences. Ask one question at a time. Allow the survivor more time than usual to process what you have said and to respond. Remember to look at the survivor when speaking to him. Don’t talk about him as if he was not in the room. Even if they aren’t able to respond verbally to you, they may be listening and understanding what you are saying. The survivor is entitled to every spoken and unspoken sign of respect. Questions with a "yes" or "no" answer may be easier for the survivor to process. For example "Are you tired?" rather then "Would you like a nap or to watch T.V.?"

Speaking may be difficult for the survivor. Give the survivor time to search for the word that he wants to say. Supply the word if frustration is apparent. Support and encourage the survivor’s communication efforts. If the survivor loses his place in the conversation, gently give him clues about the topic. Please remember that difficulty in finding a word does not mean that the survivor has lost intelligence.

The list below is intended to give survivors and family members a sampling of compensatory strategies that are available to assist persons who have sustained a brain injury. A therapist or physician is the best source for strategies that are appropriate for each survivor and their personal life activities.

• Write appointments in a daily planner

• Keep a pad and pencil near the bed.

• Use checklists, timers and alarms.

• Use a phone log to track calls and conversations.

• Have a consistent routine.

• Double-check work that has been completed.

• Allow for additional time to accomplish tasks, don’t over schedule.

• Pace yourself.

• Keep clutter to a minimum, it will slow you down and make it difficult to find things.

• Minimize distractions.

• Ask for repetition of directions and repeat them aloud or write them down.

References: Law, 1997, Brown, 1990, Covey, 1989, Lash and Osberg, 1999, Haddow, Hyde, Hague & Rastok, 1999 and Brown & Dudley, 1989

HOME AND SAFETY TIPS

Prior to returning home from the hospital after sustaining a brain injury, it is best to have a trained professional, such as an occupational therapist, evaluate the home environment for safety.

The following suggestions may seem to be common sense but they are critical in the home of an individual whom has recently sustained a brain injury. The survivor may be experiencing problems with perception, balance, awareness, any of his senses, as well as judgment and reasoning. The survivor may not realize how much he has changed. The purpose of this information is to prevent unnecessary secondary injuries. An individual who has sustained a brain injury is at a greater risk for further injury. Therefore, a partial list of suggestions is provided, but should not replace a through evaluation of the home environment.

• Electric cords should run along the baseboards or behind furniture. Extension cords should not be used unless absolutely necessary and should be out of the way to prevent tripping over them.
• Emergency phone numbers should be posted on or near the phone; they should be large enough and bright enough for the survivor to see. Phones should be in easy reach of the survivor.
• Smoke alarms are needed throughout the house, doubly so if the survivor is a smoker. Short-term memory impairment is one of the most common consequences of brain injury. The survivor may not remember that he has lit a cigarette and just walk away from it.
• Kitchen activities may require close supervision to avoid the possibility of unintentional fires on the stove or in the oven.
• Stepping stools should be removed from the kitchen. The survivor may have balance and/or coordination problems that make it unsafe to be climbing onto a stool.
• Rugs that are not securely anchored or do not have non-skid backing should be removed to limit potential falls.
• Stairs and other high traffic areas should be free of clutter. Remove unnecessary or unsteady furniture and other items that may be obstacles for the survivor who is experiencing balance, gait or walking difficulties.
• Secure handrails are needed on stairs.
• Tubs and showers should have a non-skid surface.
• Grab-bars in showers, tubs or beside toilets may be needed.
• A portable tub or shower chair provides a stable, safe platform for bathing. These can be easily removed when other members of the family wish to use the bath.
• Hot water temperatures can be problematic. Adjust the temperature setting on the hot water heater to "low" or 120 degrees to prevent scalding.
• Provide adequate lighting in halls, stairs and where one works or reads.
• Lock up all tools that are not used safely. Lawn mowers, trimmers and barbeques require careful supervision and should not be used until a competent individual assesses the safety capabilities of both the tool and the user. An occupational therapist may be able to help you with this task.