e) Key messages for case managing people with ABI   

Goal

The overall goal of case management for people with ABI is to enable them to become as independent as possible.

The goal is for the person to return to their previous abilities, activities and way of life as much as they possibly can. It means enabling the person to live with their remaining abilities and develop strategies to enable them to compensate and overcome new difficulties.

Rehabilitation process

Rehabilitation is the process of ongoing recovery.

With people with ABI the process of rehabilitation experienced by each person is unique. Just as a brain injury is unique, the type of rehabilitation program the person is engaged in is uniquely tailored to target individual needs. Rehabilitation addresses specific areas of physical difficulty, thinking or cognitive processing, perception, social skills and relationships. It also addresses broader areas of returning to work, getting about in the community, and adjusting to changes a person may experience following brain injury.

With people with ABI rehabilitation is ongoing.

It may also be episodic - as new situations and opportunities arise.

Rehabilitation is based on working with the person to achieve things that matter to them. Therefore, for it to be successful, the individual needs to participate actively in the rehabilitation process. The type of rehabilitation offered needs to be meaningful and relevant to the person. This means the person, their culture, pre-injury lifestyle, family and environment are critical to ensuring the success of rehabilitation.

The person's abilities will determine how the person is able to participate in the rehabilitation process.

Where recovery to the person's pre-injury life pathway is not possible rehabilitation involves choosing another meaningful but different pathway to a life worth living.

With people who have damage to the frontal lobe

People who have damage to the frontal lobe of the brain often have difficulty with

  • planning
  • coordinating
  • initiating

One of the consequences of this is that often people who have frontal lobe damage are also the ones who need ongoing case management. In these situations the Case manager's roles is to act as their frontal lobe. The case management is likely to be episodic as it will be needed when new situations will continue to arise in his/her life - moving house, changing job, getting sick.

People with frontal lobe damage will need episodic case management for life.

To provide an appropriate service case management services need to ensure there are policies and procedures in place so that a person can re-enter case management quickly. If case management doesn't happen quickly when needed the person's life may spiral out of control.

One case manager noted:

When everything is running smoothly the person can seem to be functioning well. They may hold down a job, be able to get themselves to and from work. But if their job role were to change or if they had to decide whether or not to sell a property they are no longer able to cope. Case management is needed at this point.

Working through emotions and relationships with the person, their family and friends

A person with an acquired brain injury has had a life before the injury. Unless they are very young when they had the injury they will remember the life they had. They will have experienced loss and grief.

The acquired brain injury may have effected their

  • thinking skills - cognitive
  • communication/language
  • physical/sensory
  • emotional/behavioural/personality.

These can impact on their emotions - e.g. they may have a period of depression, they may have some personality change.

These emotional changes caused by the brain injury are not mental illness.

In addition to experiencing these changes the person with the ABI has to respond to and come to terms with their new life situation.

They also have to deal with their family members and friends coming to terms with the changes in them.

Friends often can't understand the changed nature of the person that they used to know and so friends fall away (even though their friendship is still very important to the person with the ABI).

Emotional challenges for the case manager

It can be hard to get to know people with ABI - I need to give myself the time I need to do this.

Sometimes people with ABI can be abusive or aggressive or difficult to relate to in other ways. I need to not take this personally.

Gains with ABI clients can be slow in coming - I need to make sure I don't give up to soon. Or get caught in the disillusionment process.

Service providers are often not flexible enough for the needs of people with ABI. I will need to advocate on the behalf of people with ABI for services to be more flexible, change their policies to make them more appropriate. I may need to be ready for some fights.