How Can We Balance the Needs and Wants in a Recovery Program for an Individual With Traumatic Brain Injury?
Most traumatic brain injury recovery programs perform very well when it comes to addressing the needs of a person who has suffered a TBI, but unfortunately, the person’s wants frequently get swept under the rug. The entire focus of the recovery program becomes what the injured person needs to be able to do, or what she needs in order to keep her safe. The neurological post-acute rehabilitation staff perform detailed assessments and write extensive, objective, functional goals to increase safety and independence, ability to walk, talk, tie shoes, avoid falls and accidents, and solve problems, but what does the person who has suffered a traumatic brain injury really want?
Try to imagine for a moment if you were this person. Suppose you had been involved in a terrible car accident and suffered a spinal cord injury, traumatic brain injury, amputation or perhaps all three. What would be important to you? Would you want to recover? If your answer is “Yes,” there would be certain preferences that would be very important and specific to you. Maybe your favorite hobby before the car accident was cooking and it would be very motivating and meaningful to you if you could rebuild your cooking skills during your therapeutic activities at your post-acute residential recovery facility. However, prior to his accident, the client in the room down the hall may have never cooked anything, that didn’t involve a microwave, and does not care at all about improving his cooking skills. Cooking activities for him would not be motivating at all and could actually be overwhelming or irritating to him.
If the rehabilitation staff working in post-acute residential facilities will take the time to discover what each client’s wants are as thoroughly as they investigate each client’s needs, the recovery process could be greatly improved. People with catastrophic injuries feel a debilitating sense of loss of control during recovery from their injuries. They typically have very few choices about anything that happens to them on a daily basis throughout the entire recovery process. This causes feelings of dependency, disempowerment, anxiety and frustration. If the wants of the clients were addressed more thoroughly, they would feel more involved and powerful in the recovery process, as if they have regained at least a small amount of control over their lives. Goals that incorporate wants are much more motivating and uplifting to people who want desperately to rebuild and renew their lives.
There has to be a balance between the needs and wants of a person with TBI who requires supervision and treatment within a neurological post acute residential facility. There are certainly some needs the person may have which must supersede some of the person’s wants. A person with a TBI may not be aware of the disabilities acquired and the amount of supervision and/or assistance that may be needed as a result of the injury. For example, “Robby” who sustained a traumatic brain injury as a result of a near fatal car accident, may feel that he has fully recovered. His primary wants may be to return home, return to work as a truck driver, and return to taking care of his children independently. Robby may feel that he is ready to do that right now. However, clinical testing reveals Robby continues to have balance problems when walking, and difficulty with impulse control, memory, reasoning, and judgment skills. It may not be clinically possible or prudent to give Robby all of his wants at this time. However, what he wants can still be a guide for developing goals that will be meaningful to Robby. Robby may also have wants which include spending time with his family, doing outdoor activities, and playing the guitar. We can certainly incorporate some of his wants into his treatment plan, while still meeting all of his needs for safety, supervision, assistance and recovery. The perfect balance of wants and needs optimizes the efficiency, practicality and enjoyment of rehabilitation for people who have suffered traumatic brain injuries.
