Recognizing the Need – Transferring Individuals with Behavioral Dysfunction
Recognizing the Need – Transferring individuals with behavioral dysfunction from acute and neurorehabilitation facilities to specialized residential post-acute neurobehavioral rehabilitation programs
Vanessa Bracero, MS, BCBA
The Center for Disease Control reports there are approximately 1.7 million people diagnosed with Traumatic Brain Injury (TBI) in the United States, either as isolated incidents or in combination with other injuries. These injuries are not just physical as the areas of emotional, behavioral, neurological, psychological and cognitive function can also be impacted. Family members, friends and the individual with TBI may not realize how much they have been affected and in how many ways life as it was before the injury has changed. Although generalizing and saying this happens in all cases would not be fair, often after being discharged from the hospital or acute rehabilitation or neurorehabilitation facility, the individual returns the familiarity of a home environment with the same people, same routine, schedule, and manner in which they managed their lives or coped with daily stressors.
Over time, situations occur where it becomes obvious that the individual with TBI is not as organized as he was prior to the injury, and he may not respond to frustration or challenging situations as calmly as prior to the TBI. We start observing patterns of behaviors that may include but are not limited to verbal aggression, banging, slamming doors, throwing objects, confusion, memory problems, and refusal to participate in normal activities and simple daily tasks. In some cases, physical aggression occurs. Family members attempt to do what is most obvious and what they believe is the appropriate way to respond, typically out of love. They more than likely will learn quickly that the methods they use out of love are ineffective in cases of TBI. Some methods may further escalate aggressive behavior.
Traditional rehabilitation and, more specifically, acute and residential post-acute neurorehabilitation programs provide some education related to preferred interactions with and support of individuals with TBI. In the acute phase of rehabilitation which typically consists of one to six weeks, training on behavior is very limited and it is difficult in the acute setting, to “practice.” Training needs to be a more intensive, consistent and integral part of rehabilitation when behavioral dysfunction is learned through the earliest stages of rehabilitation.
It is best to refer an individual with the earliest signs of behavioral dysfunction, often diagnosed in frontal lobe injuries, to a residential post-acute neurobehavioral rehabilitation program utilizing a holistic approach and not just on “managing” behaviors. Assessing each individual in all areas of function in the most realistic and homelike environment offers the best opportunity for success for each individual as well as for family members who benefit from the earliest training – and practice – possible.
