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Learn about TBI - For Individuals and Families

What to Expect: Stages of Recovery from an Acute Injury

"How long will it take for my loved one to get better?" Your health care team may have a hard time answering this question. Age, extent of damage, length of time since injury, and past mental and physical health of the individuals all impact recovery.

The family and friends of a person with a brain injury are important members of the team. Your knowledge about the patient's emotional and physical needs is valuable, and so is your participation in helping take care of these needs.

The following are symptoms of the various stages and suggestions for things you can do that correspond with the stages of recovery.

Stage 1. Unresponsive Stage

At this stage, which you may hear referred to as a coma, the patient appears to be in a deep sleep and does not respond to the surroundings. You may notice random movements of the arms and legs. The goal during this stage is to obtain a response to touch, sound, sight or smell.

• When speaking to the patient, assume he or she understands what you are saying.
• Speak clearly and slowly in a positive, comforting way about familiar people and memories.
• When visitors are present, focus on the patient. Limit the number of visitors to one or two people at a time and keep visits short. Other distractions (TV, radio) should be turned off when visiting.
• Provide the patient with pictures, music and personal items that are comforting and familiar. Use poster board or a bulletin board near the bed.
• The nurses and therapists may encourage you to assist in care of the patient. You may be asked to help with hair care, shaving, applying skin lotion or gently stretching and positioning the patient's arms and legs. Just do what feels comfortable to you.

Stage 2. Early Responses

At this stage the patient is beginning to respond to people and hospital surroundings. The responses may range from turning toward a familiar voice to moving an arm or leg on request and following simple commands such as opening and closing eyes, sticking the tongue out or gripping and releasing hands. The goal is to increase the consistency of responses.

• There may be a delayed response time when asking the patient to move, speak or pay attention. Always wait one to two minutes for the requested response. Repeat your request only a couple of times during this time period.
• Be aware that the patient's attention span may only be five to 10 minutes before fatigue and frustration set in.
• Allow for rest periods. Turn off the TV, music and lights, and limit visitors. The patient can become stressed by too much noise, light or stimulation.
• Continue with suggestions listed in the "unresponsive" stage.

Stage 3. Agitated and Confused Responses

During this stage, things are confusing. The patient may begin to remember past events but may be unsure of surroundings and the reason for hospitalization. The individual may be confused about where he or she is and will have difficulty with memory and behavior. The goal is to help the patient become oriented and to continue to treat his or her physical needs.

• Provide one activity at a time and expect the patient to pay attention for only short periods. Keeping the noise level low helps the patient focus.
• The patient may repeat a word, phrase or activity over and over. Try to interest the patient in a different activity.
• The patient may do socially unacceptable things during this time, such as swearing or hitting. This is common. Calmly tell the patient the behavior is not appropriate.
• Remembering information from one time to another is difficult. Help orient the patient to his or her surroundings with both visual and verbal information, such as:
  • A calendar with the days marked off
  • A sign in the room telling them where they are
  • A posted schedule with meal times, therapies and special appointments
  • To decrease frustration, allow the patient to move about with supervision.

Stage 4. Higher Level Responses

At this stage the patient is able to take part in daily routines but still needs help solving problems and making decisions. Most of the suggestions from the previous stage continue to apply here. The goal is to decrease the amount of supervision needed and increase independence.

• Help make the environment safe. Safety decisions may still be difficult for the patient to make. Praise safe decisions and give calm explanations about unsafe decisions. Learning is still difficult.
• Encourage the use of memory aids such as a date book to help with appointments and daily routines.
• Encourage brief rest periods because the patient will continue to need more rest.
• Check with the health care team on activities that may be completed with or without supervision. These activities may include work or school re-entry, taking medications, driving or managing money.

Unfortunately, there is no way to predict how long a person will remain in one stage or what the final outcome will be. The team will work during the hospital stay to achieve the best possible outcome.