18 January 2012

Adventures in TBI

I like burn care.  I'm good at it.  I understand it.  It makes sense.  It's logical.  The burn healing process is predictable.

Unlike that of traumatic brain injuries (TBI).  Which is anything but predictable!

Right now, on my caseload, I have two guys in their early 20's that both have a severe TBI.  And while at first I was a bit nervous about it, I'm having a ball!

Both were unconscious for five to six weeks . . . and are now slowly regaining speech and motor function.  We work on simple command following, visual processing, coordination, balance, ambulation, attention, reaction time, activity tolerance, short term memory and recollection, impulsivity control, active movement, and functional capacity.

Needless to say, they've come A LONG way, and have even further to go.

It's challenging to treat a brain injured patient when we can only communicate partially.  With one of the two, K., I can speak French . . . at least for the first 15 minutes . . . then as he starts to get tired, we move to Frausa, a mix of French and my sorry Hausa.  After about another 15 minutes, he's had too much and all my commands must be in his mother-tongue . . . let's just say I'm happy his brother is there to translate Deb.Hausa to RealHausa!

Another challenge to the process is that both boys are illiterate.  I tried, the other day, to do some cognitive retraining with K. by drawing shapes on a piece of paper.  I asked him to copy them, one by one.  With his typical three second response-time-delay, he picked up his pencil and began drawing circles all over the page.  'Look!' he started (three second pause) 'I'm writing in Arabic!'  We didn't go too much further with that activity.

So, when resources are limited, we get creative.

A few months back we had a surgical resident from the US come to work with us.  She left me all sorts of wonderful toys . . . uh . . . I mean . . . EQUIPMENT . . . therapeutic equipment . . . which included a bag of red balloons.  Which is nice, because I love red.

I pulled out a balloon and blew it up.


His brothers and I jumped.  Three seconds later, K. looked up to find the source of the noise.

I grabbed another balloon.

This time it held its shape.

I tapped the balloon in K.'s direction, not sure what the outcome would be.

He reached up, instantaneously, and hit it back in my direction.

We volleyed for about 10 seconds before the balloon hit the ground.  He impulsively lunged from his wheelchair toward it, nearly spilling onto the floor himself.

Once safely back in the chair, we started again.  I tapped the balloon, he swatted.


Our child's-party-favor-turned-therapeutic-tool hit me square on the nose.  I thought it was funny, but no one else responded . . . so I didn't either.

Three seconds later, K. erupted into uncontrollable laughter!


Kim -FBC_NJ said...

I love reading your blogs. Keep it up.

Deb. said...

Thanks Kim!

Shal said...

I love it! I once had a patient with Cajun roots who spoke in French after his TBI...except when he was singing loudly "Burnin', burnin'!" for all to hear. They sure keep you on your toes!

Deb. said...

That's AWESOME!!

The first time I had a patient that (I was told) had aphasia but who was not an English speaker was quite an adventure. This was long before I learned French . . . so I used google translator and looked up how to say 'Stand up!' . . . but I pronounced it as 'Wash yourself!' You can imagine her frustration . . . and how dumb I felt in the end!

Rosemarybluman said...

Love this, Deb.  I feel like I'm there watching you!  I can just picture it.