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Self Care After a Brain Injury

After a brain injury, if physical, cognitive, visual, or perceptual impairments are present, your loved one may be unable to complete basic care needs without assistance. You may need to give verbal assistance to help your loved one think through a task completely, such as giving a reminder to put toothpaste on a toothbrush before brushing. Physically, you may have to help hold the toothbrush.

Self-care skills include eating, oral hygiene, hair and facial care, dressing, bathing, and toileting. To complete these activities, a person must be able to move adequately as well as be able to organize, sequence, and perform tasks in a reasonable amount of time. After a brain injury, a person may no longer be able to perform self-care.

Dressing

Dressing activities include finding where clothes are kept, gathering clothes, and putting them on.

  • Recalling all items needed
  • Selecting desired items from similar ones
  • Remembering safety during dressing activities
  • Planning the dressing process
  • Telling front from back of clothing
  • Finding sleeve holes
  • Locating and placing legs in pants
  • Dressing all parts of the body


Grooming

Grooming skills include safety with setting up and performing oral care, hair grooming, washing the face and hands, and either shaving or make-up application.

A person may have difficulty with:

  • Finding the place grooming items are kept
  • Seeing objects on counter-top
  • Reaching too far, or not far enough, to turn on a faucet
  • Putting toothpaste accurately on a toothbrush
  • Holding a comb correctly for combing hair
  • Safety during shaving
  • Shaving or applying makeup to one side of the face
  • Completing all grooming skills thoroughly
  • Stopping tasks without cues
  • Recall and sequencing series of grooming tasks


Bathing

Bathing is the process of cleansing the entire body in the shower, tub, or at the bedside.

A person may have difficulty with:

  • Finding grooming items/supplies
  • Planning set up of bathing process
  • Turning on the correct faucet for hot or cold water and regulating water temperature
  • Finding the shampoo bottle and/or soap in the tub or shower
  • Washing all body parts
  • Safety during bathing process and when drying off
  • Recall and sequencing for washing and drying all body parts
  • Completing tasks without cues


Physical, Cognitive, and Other Impairments Affecting Self Care

The person may experience problems that interfere with performance.

Physical problems may include:

  • Lack of joint movement
  • Balance and/or coordination problems interfering with positioning and smooth movements
  • Muscle weakness or paralysis
  • Decreased sensation
  • Visual and perceptual problems

Cognitive problems may also interfere with self-care:

  • Lack of initiation and follow through
  • Difficulty sequencing
  • Difficulty problem solving
  • Difficulty with attention to details
  • Poor memory
  • Short attention span
  • Poor judgment and safety awareness and/or behavioral problems 

Other impairments that may interfere with self-care include visual and perceptual deficits such as:  

  • Difficulty judging distance
  • Difficulty seeing in all directions
  • Difficulty locating objects
  • Difficulty with depth perception
  • Double or blurred vision
  • Spatial deficits

Sometimes physical assistance is required. For example, if your loved one has poor coordination or muscle weakness, you may need to help by bringing the fork to his or her mouth during meals. In some instances, equipment is used that is adapted to meet individual needs. For example, if a patient is not able to fully extend an arm, a long-handled reacher can be used to reach objects and places that the hand cannot.

 

If poor judgment or safety awareness is evident, the patient may need to have suggestions or reminders given to ensure safety. A variety of dangers are present in the home such as electrical appliances near water, harmful chemicals (cleaning products, cologne/perfume), medications, appliance cords, sharp objects (knives, scissors, razors), hot stove tops or ovens. To us, self-care activities seem simple and familiar so it is easy to overlook potential dangers.

What to Do

The patient with a brain injury may require increased time to complete tasks. The patient may perform best in a structured and uncluttered environment without visual and auditory distractions. The family may need to provide guidance, cues, or physical assistance to avoid unsafe situations. Self-care skills may take time to relearn. Independence can be enhanced with practice, adaptive equipment, and written and verbal assistance. It is important to allow the patient to perform self-care tasks that he or she is capable of performing to help the individual be as independent as possible. It is also important to allow the patient extra time for pacing and conserving energy.

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