Choices, Wants, and Personal Goals of Individuals with Traumatic Brain Injury are Equally as Important as the Clinical Recommendations Made by Professionals To Help Produce Successful Outcomes
Donna Check, MBA, and Jolie Parker, MS, CCC-SLP
Most traumatic brain injury rehabilitation 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 and preferences frequently are not addressed. The entire focus of the program becomes what the injured person needs to be able to do to become more functional, independent, and remain safe. The clinicians conduct detailed assessments and write extensive, objective, functional goals to increase independence, the 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 want?
Try to imagine for a moment if you were this person. Suppose you were involved in a terrible car accident or work related accident and suffered a spinal cord injury, traumatic brain injury, or amputation, or perhaps all of the above. What would be important to you? Would you want to recover? Yes, of course, but there would be certain preferences that would be very important and specific to you individually as you are actually residing in a facility while you are participating in rehabilitation. Maybe your favorite hobby before the 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 facility. However, the man in the room down the hall may have never cooked anything that didn’t involve a microwave before his car accident, and he 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 frustrating to him or both.
People with catastrophic injuries most typically feel an increasing sense of loss of control during recovery from their injuries. During the hospital and rehab course of recovery, most decisions are made for them by others, including family members. They are given very few choices about anything that happens to them on a daily basis. This can cause feelings of dependency, disempowerment, sadness, fear, 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 which incorporate wants are much more motivating and uplifting to people who desperately want to rebuild and renew their lives. Staff working in residential post-acute facilities can best serve their clients when they take the time to discover what each client’s wants are as thoroughly as they investigate each client’s clinical needs. Each client needs to be very involved in the entire process of establishing individualized personal goals and having input into clinical recommendations. Family members can also provide information that is most beneficial to aid the team in developing and implementing a meaningful and purposeful treatment plan.
There are certainly some clinical needs the person may have which must supersede some of the person’s personal wants. A person with a TBI may not be aware of his or her disabilities and the amount of supervision or assistance which 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 motor vehicle accident, may feel that he has fully recovered. His primary wants may be to return home to his wife and children and go back to work as a truck driver. Robby may feel that he is ready to do that right now. However, clinical testing and observation in his current residential program 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 establishing goals and developing related skills which will be meaningful and important to Robby. He may also have wants which include spending time with his family, doing outdoor activities, and playing the guitar. It’s important to incorporate some of Robby’s 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. Personal fulfillment and enjoyment should be part of every clinical goal plan.
