Patients who are suffering from an acquired brain injury often have unique neurobehavioral needs. During recovery from a catastrophic brain injury, it is not uncommon for patients to experience confusion or exhibit challenging behaviors. This is an expected part of the recovery process.
The Neurobehavioral Program at TIRR Memorial Hermann offers a unique opportunity for individuals with brain injury to maintain participation in their rigorous rehabilitation program despite these behavioral challenges. As one of the few programs in the nation to accommodate neurological behavioral concerns while maintaining an intensive rehabilitation regimen, we are uniquely qualified to care for patients in a calm, controlled and skilled environment. We provide rehabilitation services in the least restrictive manner to allow for the best possible outcomes.
TIRR Memorial Hermann’s Neurobehavioral Program has the necessary resources to be proactive in managing challenging behavioral situations while minimizing use of medicinal or physical restraints. Our unique physical space and equipment allow our highly qualified clinical staff to safely wean patients off sedating medications as they manage behavioral challenges, so patients can be more alert and actively participate in their recovery.
Our rehabilitation physicians have the ability to optimize both cognitive and functional recovery within a controlled environment and allow patients to follow their recovery plan and reduce the need for sedating medications. To empower each patient to access all necessary equipment and therapeutic resources, we have a specialized team of clinicians who can effectively and safely de-escalate highly charged emotional and behavioral situations that can occur during recovery from a brain injury.
Patients with neurobehavioral needs benefit from a dedicated area with limited foot traffic. This controlled environment allows us to manage external stimuli and disturbances and to provide a calm environment that is essential to brain-injury recovery.
In addition to highly trained neuropsychologists and therapists, our nursing staff and patient care technicians are essential to providing the specialized care that individuals with brain injury need. These frontline caregivers stay with patients throughout the day to manage behavioral challenges so that both short-term and long-term rehabilitation goals can be met. Patient care technicians are trained to navigate a range of neurobehavioral concerns and promote a safe and productive environment.
At TIRR Memorial Hermann, patients with neurobehavioral challenges participate in the same intensive rehabilitation program as patients without behavioral issues, regardless of their level of alertness.
Because we are able to safety de-escalate patients during transient episodes of challenging behavior, patients can be weaned off many medications so they can better participate in a rigorous rehabilitation plan and avoid potential delays in therapeutic progress.
Our staff collect a thorough history and review of available documentation to identify the likelihood of expected behavioral concerns and plan accordingly. We are proactive and intentional about managing expected behavioral challenges so that patients can actively participate in therapies in one of our many dedicated treatment spaces. We aim to have patients up and out of their rooms each day in order to actively engage and participate in their recovery process.
Our internationally renowned rehabilitation program consistently produces industry-leading outcomes; the process starts with a comprehensive behavior management plan. Each patient is unique and receives a customized plan developed by a neuropsychologist to address existing or potential challenging behaviors, to optimize a patient’s adaptive behaviors, and to plan for safety contingencies. With the oversight of dedicated case managers, our patients’ needs are constantly evaluated and family and loved ones are involved from the beginning.
Patients participate in at least three hours of therapy each day, regardless of their neurobehavioral status. These activities aim to improve strength, balance, coordination, communication and other functions that are necessary for overall health and independence. Initially, these activities may occur in a less-structured manner so that patients have the opportunity to work through a period of confusion or agitation. Over time, as memory and other cognitive functions improve, therapeutic activities take on a more structured and traditional format.
Constant, clear communication between physicians, therapists, nurses, family members and other staff members helps ensure patients are cared for appropriately and are moving forward with their recovery. Patient response to behavioral interventions, including the physical setting, individuals present and other preceding factors, are documented so that all team members can build off previous successes.
Managing medications is essential to positioning patients for the most effective rehabilitation progress following brain injury. The care team monitors the effects of medications that can cause drowsiness or impede balance, with the aim of reducing or eliminating them, to optimize therapies and manage behavioral responses.
We developed an innovative method for observing, documenting and evaluating patient behaviors. The behavior observation tool allows staff members to record a range of data: description of behavior, time of day, location, observers present, behavior intervention and outcome. With this behavior-centered approach, we are able to better understand the patient, their behaviors and their responses to different interventions.
Our groundbreaking observation tool has been presented at national conferences as a model for other rehabilitation programs.
When a patient is admitted to the program, we immediately begin the process of getting to know them as an individual and developing a personal relationship. In many cases, individuals with brain injury experience agitation because they have an unmet need and are unable to adequately communicate this need to others. Utilizing staff experience, training and the behavioral observation tool, we can anticipate patient needs before they arise. This effort allows us to better mitigate and minimize expected periods of agitation or confusion as the patient adjusts to a new and unfamiliar environment.
Identifying appropriate and compassionate methods for behavioral management is largely dependent on the patient’s cognitive status. We tailor our behavioral plans to a patient’s current cognitive status and update our approach as their cognition improves.
TIRR Memorial Hermann staff are trained in brain-injury specific de-escalation techniques to permit expression of a state of agitation in a safe environment. This allows to support behavioral episodes while serving as a comforting presence during a patient’s state of agitation and keeping safety top-of-mind for the patient, staff and others. Family members may be called upon to speak with the patient, either in person, on the phone or via video chat, to offer additional comfort when appropriate.
To learn more about the TIRR Memorial Hermann Neurobehavioral Program, or to refer a patient, please contact (800) 447-3422 or (713) 797-5942.