The Impact of Family Support on the Rehabilitation Process

When 25 year-old, L.Z. planned his vacation to Mexico with his friends, he never thought that it might be his last. While golfing in Mexico, L.Z. fell off the back of a golf cart and hit the back of his head. Fortunately, L.Z.'s friends realized that his injuries were severe and called an ambulance. Family was called and informed that L.Z. might not live through the night. L.Z.'s family flew to Mexico and were by his side as they learned that he had suffered a severe head injury that required a craniotomy to remove a subdural hematoma, or collection of blood in the brain.

Five days after the accident, L.Z. was airlifted back to the United States where he underwent four brain surgeries to repair the cranial defect that the injury had caused. Brain surgery is complicated but was even more so in L.Z.'s case due his premorbid von Willebrand disease. This is a disease in which the person lacks an important protein that is used for clotting blood. In instances of a severe accident, blood may not clot and this could cause a person with von Willebrand's disease to bleed to death. This was obviously a concern in L.Z.'s case.

L.Z. was unable to do many of the things that he used to do. He could no longer work, drive or take care of himself. He participated in a rehabilitation program to try to gain back the ability to do these tasks independently. After completing 30 days of a hospital-based rehabilitation program, L.Z. returned home with his family and received in-home therapy. He was making progress performing his activities of daily living and was even able to walk independently. However, L.Z. developed a condition called hyperphagia, which is excessive hunger to the point of eating abnormally large quantities of food. His condition was so severe that he gained 30 pounds in 2 weeks and a lock had to placed on the refrigerator in his home. He also developed insomnia and his behavior was out of control. Medication changes may have been the cause of the significant decline in L.Z.'s condition. Although his family did the best that they could, L.Z.'s hitting, kicking and attacking prevented them from continuing to care for him in the home.

While at the hospital, L.Z.'s behavior including hitting, kicking and trying to exit from therapy continued. In addition to his severe behavioral problems, L.Z. had significant insomnia and excessive drooling. The acute hospital that L.Z. was admitted to, realized that he needed a more intense therapy program that could manage his severe behavior. Even though the rehabiliation program that was recommended to the family was out of their home state, the family knew that L.Z. needed the intense therapy that this program could offer. Although it would be difficult, L.Z.'s family agreed with the doctors at the acute rehabilitation hospital that L.Z. needed to be treated at Centre for Neuro Skills® (CNS).

In July of 2006, L.Z. was admitted to the CNS in Bakersfield, CA, a post-acute, brain injury rehabilitation program.

While at CNS, L.Z. was engaged in up to six hours of occupational, physical and speech therapies per day, as well as, individual and group counseling. An individualized program to address and manage L.Z.'s severe behavior was implemented as a part of every therapeutic discipline and at the residential setting. After a full day of therapy, L.Z. returned to the residential-apartment site and completed meal preparation, laundry, and other tasks under the supervision of CNS staff. Areas of deficit included speed of information processing, long-term memory, attention to detail, orientation and awareness of his surroundings, swallowing issues, balance and gait problems, impulsivity, confusion, behavioral outbursts, and organization and problem solving difficulties.

Graduated compliance, structure and lots of positive reinforcement were part of L.Z.'s behavior program. Eventually, reliance on medications to manage behavior was reduced and eventually, the use of medications for behavior was not used at all. In fact, when L.Z. was admitted to CNS, he was taking Risperdal, Depakote, Ativan, Inderal, and Trazodone. Upon discharge, L.Z. was only taking Prozac.

Once L.Z.'s behavior was under control and manageable, he achieved more independence and was able to integrate back into the community more regularly. L.Z.'s memory problems were improving, he had increased his speed of information processing, his balance and gait issues had resolved and the insomnia and excessive drooling that were present when L.Z. was admitted to CNS had resolved. L.Z. had a deep love of animals and as part of his rehabilitation program, he volunteered at the local SPCA. He also went skiing, fishing, and on numerous other community outings with other clients in the rehabilitation program.

After completing 9 months of treatment at CNS, L.Z. returned home to his family. He required minimal supervision, as his behavior was under control, he was alert, oriented, and able to independently complete his activities of daily living. Family support, especially from L.Z.'s grandmother, made a huge impact in L.Z.'s successful return home. Every day for nine months, when L.Z. arrived at the clinic the familiar face of his grandmother greeted him. She spent her entire day at the clinic, visiting with L.Z.'s therapists, case manager, and other families that were in a similar situation. There are many factors that influence recovery from a traumatic brain injury; medications, expertise of the rehabilitation team, early entry into a rehabilitation program, etc. In this case, family support was a major factor that allowed for behavioral changes to occur and for L.Z. to achieve a successful outcome. It is true that sometimes family can make all the difference in the world.