Changes after a brain injury
Thinking changes | Perceptual changes | Behavioural changes | Emotional changes | Communication changes | Physical effects
Thinking changes
Brain injury can disturb:
Alertness and concentration
Self-awareness
Perception
Memory and learning
Reasoning, planning and problem-solving
Speech and language
Motor control
Emotions
The information that follows will help familiarize you with behavior, memory and thinking problems that a person with brain injury may experience. Also included are techniques to help the person participate more effectively and comfortably in the family. Consistent and frequent repetition of these techniques listed will increase the chance of success in recovery.
PROBLEM & SIGNS
WHAT TO DO
Problem: Confusion
Signs:
Confuses times/ tasks in schedule of activities
Confuses past and present events
Confabulates (makes up convincing stories
to fill memory gaps; this is not intentional lying)
What to do:
• Encourage the use of a notebook to log events and encourage the person to refer to it for details of daily events.
• Gently remind the person of correct details of past and present events.
• Confirm accurate information with other people.
• Arrange for consistency in routine tasks (use calendar and notebook).
• Limit changes in daily routine.
• Provide clear, concise explanations of even the most basic changes in daily routines.
Problem: Difficulty remembering
Signs:
Unable to remember tasks from day to day
Unable to remember new information
What to do:
• Establish a structured routine of daily tasks.
• Encourage the consistent use of memory aids such as calendars and notebooks to plan, record and check off tasks as completed.
• Encourage the person to write new information in the memory notebook.
• Encourage other family members also to write any information they need to communicate to the person.
• Encourage review and rehearsal of this information frequently throughout the day.
• Provide opportunities for repeated practice of new information.
• Try to pair new information with facts the person can recall.
• Provide spoken cues as needed for recall and, if necessary, help fill in memory gaps.
Problem: Attention problems
Signs:
Limited ability to focus
Distractible
Difficulty in attending to one or more things at a time
What to do:
• Focus on one task at a time.
• Be sure you have the person’s attention before beginning a discussion or task.
• Decrease distractions when working or talking with the person. (Eliminate or reduce noises.)
• Praise any improvement in length of attention to activity.
• Gently refocus the person’s attention to specific details of the activity as needed.
• Keep abrupt changes to a minimum.
• Ask the person to repeat information that was communicated to be sure the person understood the conversation.
• Schedule brief rest periods between short periods of work or activity (for example, 20 to 30 minutes of work, a five-minute break; 20 to 30 minutes of work, etc.).
Problem: Difficulty with decision making
Signs:
Hesitation with decisions
Inappropriate or potentially harmful decisions
Difficulty reasoning
Ineffective problem solving
What to do:
• Encourage the person to “stop and think.” Many people with brain injury benefit from a note or a stop sign on the front of their notebook reminding them to “stop and think.”
• Help the person explore various options to solving problems.
• Have the person write possible options in the notebook.
• Discuss advantages and disadvantages of each option.
• Role-play to prepare the person for various situations.
Problem: Difficulty with initiation
Signs:
Has trouble getting started
Appears disinterested or unmotivated (this is typically not intentional)
What to do:
• Help the person develop and follow a structured daily routine.
• Provide specific choices for daily tasks. For example, ask, “Would you like to do A or B?”
• Simplify tasks. Break down tasks into simple steps
and complete one step at a time.
• Encourage use of the notebook or calendar to set specific deadlines for tasks to be completed.
• Praise the individual for starting without assistance.
• Establish a time frame for accomplishing tasks.
Problem: Difficulty carrying out a plan of action
Signs:
Lack of follow-through to completion with a task
Difficulty planning a sequence of tasks
Appears disorganized
What to do:
• Begin with small, realistic projects.
• Include the person in planning the activity.
• Provide a clear explanation of an activity before starting.
• Break down new or complex tasks into several easier steps.
• Have the person write the a step-by-step list as a plan.
• Ask the person to tell you these steps to ensure understanding.
• Encourage the person to refer to the plan, and check off each task that is completed.
Perceptual changes
Perception is the brain’s ability to gather information and make sense of it. Perceptual changes may cause people with a brain injury not to realize what they feel, see or hear, even though their senses of touch, sight and hearing are fine. Perceptual changes may impair the ability to judge distance, size, position and speed of movement.
After acquiring a brain injury, the person may experience some of the following:
• Unilateral neglect (neglect of one side of the body)
• Visual field cut (each eye sees only half or a portion of its visual field)
• Apraxia (inability to use an object or do familiar tasks)
• Difficulty with spatial relations
Perceptual changes following brain injury can be temporary or permanent. The following information is intended to help identify perceptual changes and how to adapt to them.
PROBLEM & SIGNS
WHAT TO DO
Problem: Visual field cut
Signs:
Suddenly notices objects that seem to appear or disappear
Bumps into objects on the affected side
Turns the head toward the unaffected side
Cannot see food on the side of the plate on the affected side
Loses track of the last location on a page where the person was reading or writing
When reading, cuts words in half and they cannot be understood
What to do:
Remind the person to look around the environment, especially on the affected side.
Mark “on” and “off” switches of frequently used items, such as televisions and kitchen appliances, with bright pieces of tape so the person can easily know when equipment is on or off.
Position bright objects or favourite things to the affected side and ask the person to turn his or her head until they spot the objects.
Draw a straight, brightly coloured line down one side of a book or notebook as a cue indicating the edge of the page. Do this on the right side of the page if the right side is affected, and on the left side if the left side is affected.
Problem: Apraxia
Signs:
Uses objects incorrectly; for example, might use a toothbrush to comb hair or a fork to eat soup Fails to follow spoken directions due to an inability to understand or do what is asked; for example, may not give the “thumbs-up” sign when asked
Puts clothes on backwards, upside down or inside out
What to do:
Stop the person from continuing a task the wrong way.
Show the person what to do by demonstrating the position or movement.
Place your hand over the person’s hand and move it through the correct motions to perform a task.
Redirect the person to put on clothing in correct order, one step at a time. Develop a daily routine for hygiene and dressing.
Problem: Spatial relations
Signs:
Mistakes the location of a chair when sitting down
Has difficulty finding items in a cluttered room
Has trouble using a fork or spoon to pick up food from a plate
Misjudges distance; for example, misses the cup when pouring coffee
Misjudges space between steps when going up or down stairs
Reaches too far or not far enough to get objects
Stands too close or too far away from others in social situations
Requests eye appointments often, because of perception that vision is affected
What to do:
Limit clutter; keep the home and drawers organized and neat.
Keep items used often in the same location. Provide cues with words and pictures.
Place brightly-coloured tape across the edge of each step on stairways.
Remind that handrails should be used when available.
Encourage using both hands to feel for objects.
Provide gentle reminders and ask the person to move when standing too close or too far away.
Wait for six months after the brain injury — or the time recommended by your physician — to schedule an eye appointment. It is unlikely that the problem with perception is the result of a new problem with the eyes.
Behavioural changes
A person with a brain injury may experience changes in behavior, including self-control, self-awareness and response to social situations. The following are common behavioral problems for a person with a brain injury, what you may see and suggested ways to help.
PROBLEM & SIGNS
WHAT TO DO
Problem: Difficulty with self-control
Signs:
Acts or speaks without all the information or without considering the consequences Impulsiveness or poor judgment
Lack of inhibition Inappropriate comments to or about others
Gets stuck on one idea or activity (perseveration)
What to do:
Limit the person’s choice of options.
Suggest alternatives for behavior.
Explain the reasons for tasks.
Be fair in your expectations.
Respond immediately to inappropriate ideas but
maintain the original focus of the discussion. Encourage the person to slow down and think
through tasks or responses.
Provide supportive verbal and non-verbal feedback for reassurance.
If undesired behavior occurs, calmly and confidently discuss the consequences in private. Praise and reward desired behavior.
Problem: Impaired self- awareness
Signs:
Lack of awareness of deficits and limitations (this is not typically intentional, but rather a common phenomenon following traumatic brain injury in particular)
Overestimates abilities; underestimates problems
Inaccurate self- image/self-perception
What to do:
Anticipate lack of insight.
Prompt accurate self-statements.
Use feedback generously and supportively.
Give realistic feedback as you observe behavior
Problem: Difficulty participating in or being part of social situations
Signs:
Acts or speaks without all the information or without considering the consequences
Difficulty taking turns
Impulsiveness
Socially inappropriate behavior or comments
Not always sensitive to social boundaries
Acting out of place in unfamiliar social or public settings
What to do — before the event
Provide clear expectations for desirable behavior in social settings or in special circumstances such as job interviews, attending a funeral, or going to church.
Plan and rehearse social interactions so that they will be familiar, predictable and consistent.
Establish verbal and non-verbal cues to signal the person to “stop and think.”
What to do —during the event
Treat the person appropriately, according to
age.
Encourage the person to slow down and think through responses.
Prompt the person to consider consequences of
behavior.
Provide positive feedback for appropriate behavior.
Encourage a break in activity when frustration or fatigue are evident.
Respond immediately to inappropriate ideas but
maintain the original focus of the discussion.
If undesired behavior occurs, calmly and confidently address the behavior in private. Be
objective and explain that the behavior, not the person, is inappropriate
Reassure and be fair in your expectations.
What to do — after the event
Review the behavior, the effectiveness of verbal and nonverbal uses, and the overall success of the outing.
Praise appropriate behavior and responses to cues and redirection.
Emotional changes
A brain injury can affect the areas of the brain that control emotions. The following are common emotional problems for a person with a brain injury and suggested ways to help.
PROBLEM & SIGNS
WHAT TO DO
Problem: Difficulty controlling emotions
Signs:
Mood swings ranging from anxious to sad to angry
Inappropriate laughing or crying
Lower tolerance for frustrating situations
What to do:
Expect the unexpected.
Remain a model of calm assurance and confidence if an emotional outburst occurs.
Take the person to a quiet room or area for time to calm down and regain control.
Provide feedback gently and supportively after the person regains control.
Avoid comparing past and present behaviours.
Gently redirect behaviour to a different topic or activity.
Recognize that the person may use negative
comments or refusal as a means of control.
Understand that brain
injury often prevents the individual from feeling
guilt or empathy.
Recognize your emotional reactions to the person with brain injury.
Problem: Intermittent distress (comes and goes)
Signs:
Unhappiness and irritability
Cries easily
Responds angrily for no apparent reason
What to do:
Acknowledge feelings.
Give the person a chance to talk about feelings.
Listen and express your desire to understand those feelings.
Encourage behaviours that have helped cope with stress in the past.
Problem: Grief
Signs:
Tearfulness
Restless sleep
A change in appetite
What to do:
Remind the person that grief is a healthy and normal response.
Explain that coming to terms with the loss of some abilities may take time.
Offer whatever support you can provide.
Seek guidance from a professional.
Depression
Feelings of sadness, frustration and loss are common after a brain injury. Such feelings often appear during the later stages of recovery, when confusion decreases and self-awareness improves. However, if these feelings become overwhelming or interfere with recovery, the person may be suffering from depression.
Depression can arise as the person struggles to adjust to temporary or lasting disability caused by a brain injury. Depression also may occur if the injury has affected areas of the brain that control emotions.
Being depressed is not a sign of weakness, nor is it anyone’s fault. Depression is an illness. A person cannot get over depression by simply wishing it away, using more willpower or “toughening up.” Depression after brain injury may result from biochemical and structural changes in the brain. Fortunately, medication and other therapies can help most people who have depression.
These are symptoms of depression:
Persistent sadness
Irritability, moodiness
Anxiety
Loss of interest or pleasure in life
Neglect of personal responsibilities or personal care
Changes in eating habits or sleeping patterns
Fatigue, loss of energy, lack of motivation
Extreme mood changes
Feeling helpless, worthless or hopeless
Physical symptoms such as headaches or chronic pain that do not improve
Withdrawal from others
Thoughts of death or suicide
If the person with brain injury has symptoms of depression, his or her health care provider should be consulted. Effective treatments are available, including individual and group therapy, medication or a combination. Early treatment can help prevent needless suffering. If your loved one expresses suicidal thoughts or threatens self- harm, immediately call your local emergency services provider.
Self-esteem
Self-esteem is a person’s assessment of self-worth and is often adversely affected by brain injury. A problem may be more significant if the person with brain injury has had a mild to moderate injury or a severe injury with good self-awareness. The more aware the person with brain injury is, the more likely are changes in self-esteem.
What to do:
Focus on the positives.
Allow the person to express feelings.
When necessary, redirect conversation to positive or neutral thoughts.
Express your concern and desire to understand the person’s feelings.
Point out the person’s successes, even partial successes.
Encourage as much independence as possible.
Do not criticize.
Give caring, realistic feedback.
Help the person plan ahead to maximize opportunities for success.
Choose activities and tasks that the person can successfully complete.
Challenges vary among people with brain injury. Be aware of how you reference the person with brain injury. Avoid labelling, categorizing or stereotyping a behaviour or communication skill that was altered by the injury. Learning as much as possible about brain injury and exercising patience and compassion are good steps toward understanding and nurturing the self-esteem of the person who has brain injury.
Communication changes
Difficulties with communication can be caused by many factors, including changes in behaviour and thinking skills, problem solving, judgment, reasoning, awareness, memory loss and lack of self-awareness. Language ability and speech also may be affected by brain injury.
People with a brain injury may have changes in one or many of these areas. The severity and combination of problems vary among people.
PROBLEM & SIGNS
WHAT TO DO
Problem: Initiating conversation
Signs:
Does not respond to another person’s conversation, questions or comments
Does not start, or is slow to start conversations, ask questions, or make comments
Leaves long pauses
Has difficulty with explanations
What to do:
Encourage the individual to participate. For example ask, “What do you think about that?”
Ask open-ended questions such as, “Tell me about...”
Give the person time to organize thoughts. Extra time may be necessary to respond to any request or question.
Give the individual your full attention until the thought is completed.
Rephrase what he or she has said such as, “Do you mean…?”
Problem: Following conversation
Signs:
Has difficulty paying attention to what is said
Misinterprets what is said
What to do:
Get the person’s attention before speaking.
Be clear and concise.
Reduce distractions.
Emphasize important information.
Offer to repeat what was said.
Ask the person to look at you when speaking. Invite the person to ask questions or request clarification.
Problem: Taking turns in conversation
Signs:
Talks non-stop, does not give the listener a turn to speak
Does not appear to adjust communication style
or behaviour for the situation
Has a hard time selecting topics for conversation
Has a hard time keeping up when topics change Introduces a new topic abruptly
Does not always stay on topic
What to do:
Politely interrupt and ask for a chance to speak.
Ask the person to, “Please make it brief,” or announce that you would like to speak.
Ask about the person’s interests and opinions.
Clarify new topics as they arise.
Ask how the person’s comment relates to the topic, for example, “Do you mean… ?”
Tell the person you are confused or “getting lost” in the conversation.
Tell the person you did not understand and ask to hear it again.
Establish and use consistent gestures or cues (for example, cup your hand to your ear as a reminder to speak louder).
Problem: Problem with intelligibility
Signs:
Slurred speech
Speaks too loudly or softly, making the message hard to understand
Speaks too rapidly
What to do:
Tell the person you did not understand and ask to hear it again.
Establish and use consistent gestures or cues (for example, cup your hand to your ear as a reminder to speak louder).
Problem: Nonverbal communication
Signs:
Does not seem to understand common non-verbal cues
Stands too close or too far from conversational partner(s)
Uncomfortable number or type of physical contacts
Body language that does not seem to “match” what is said
Facial expressions that do not seem to “match” what is said
Distracting, repetitive or excessive body movements
Poor eye contact
Staring at others during conversation
What to do:
Ask the person to maintain a comfortable distance.
Politely ask the person to modify his or her physical contacts because you feel uncomfortable; offer an explanation if necessary.
Tell the person you are confused by the difference in body language and spoken message.
Ask what the person is feeling.
Politely ask the individual to stop distracting movements.
Physical effects
A brain injury can affect physical abilities such as balance, mobility, coordination and muscle strength, tone and control. It may also affect the body’s senses (hearing, vision, smell, touch and taste). In addition, a brain injury can cause fatigue and conditions such as seizures, spasticity and swallowing difficulties.
Fatigue
Fatigue is very common during brain injury recovery. Fatigue may result from the injury (and other injuries in cases of trauma) or from additional physical and mental effort required to do tasks that once were performed with little or no effort. Physical functioning, attention and concentration, memory and communication can be adversely affected by fatigue.
When a person with a brain injury first returns home, knowing how much that person can or should do can be difficult. Often during this transition, the person and family members become discouraged with the slow pace of recovery, changes in responsibilities, or they may try to do or expect too much. This is just one step in the recovery process. In time, the person’s stamina and energy level likely will improve, and the ability to engage in activities may be increased.
The following strategies may be useful in helping the person with brain injury learn to manage fatigue:
Encourage use of a calendar or planner to help manage mental fatigue.
Set a schedule that includes regular rest breaks or naps. (For example, one nap in the morning and one in the afternoon after some activity, physical or mental.) Rest breaks or naps should not exceed 30 minutes.
Avoid evening naps.
Gradually decrease the length and number of breaks as the person’s ability to tolerate activities with less fatigue improves.
Resume activities gradually, over weeks or even months.
Start with familiar tasks that the person can complete without fatigue.
Gradually increase the complexity of the task, encouraging breaks as needed, to slowly increase the length of time.
Become familiar with indicators of fatigue for the person.
Watch for signs of fatigue, such as increased inattention or distractibility, repetition of tasks or comments, irritability or increased errors.
Encourage breaks, every five minutes, during tasks, before or as soon as signs of fatigue appear.
If the health care team recommends, use assistive aids (for example, a cane for walking) to conserve energy or a wheelchair for long distances.
Plan ahead for fatiguing activities, such as visitors, trips, going out. Schedule a nap before visitors come or before going out.
Consider limiting the person’s time with visitors or a rest break during visits.
Seizures
A medical condition that may occur after brain injury is post-traumatic seizure. Seizures can be caused by a sudden, excessive, disorderly electrical discharge of brain cell activity. This risk of ongoing seizures is related to the severity and characteristics of the brain injury, such as the type and location of the brain injury. Risk seems to be greatest in the months after injury, then gradually declines with time.
Several types of seizures may occur after brain injury. The most frequent types are generalized (grand mal, tonic/clonic) and partial (partial complex and simple partial) seizures.
Generalized seizures
Grand mal, tonic/clonic seizures usually involve involuntary jerking or shaking of most or all four limbs, unresponsiveness, and loss of bladder control. Most seizures are self-limited and last only a few minutes. The person may cry out, stiffen and fall, have jerking movements, turn flushed or blue and have some difficulty breathing. Remain calm and take the following steps:
Make sure the person is in a safe area and lay the person’s head on something soft if a fall occurred.
Loosen tight clothing such as a necktie or belt and remove eyeglasses.
Clear away hazardous objects that may be nearby.
Position the person lying on his or her side to keep the chin away from the chest. This will allow saliva to drain from the mouth.
Do not force your fingers or any object into the person’s mouth.
Do not restrain the person. You cannot stop the seizure.
After the seizure, the person usually will be temporarily confused and drowsy. Do not offer food, drink or medication until the person is fully awake. Someone should stay with the person until fully recovered. Check for a medical identification tag on a bracelet or necklace.
Until a predetermined seizure-free interval has been maintained (often six months to one year), driving privileges can be restricted. During this time, extreme caution should be taken if the person will be working around heavy or dangerous equipment.
In the following situations you should call your local emergency service:
Breathing does not resume after the seizure and mouth-to-mouth resuscitation is necessary.
Before the person recovers from the first seizure and another seizure begins.
The person has been injured during the seizure.
The person has awakened and requests an ambulance for emergency medical attention.
The seizure continues for more than five minutes.
Prompt medical care is also recommended if this seizure is the person’s first or if the person’s level of alertness remains impaired.
Partial seizures
Partial complex seizures may involve loss of awareness, inappropriate verbal response, purposeless movement, staring or repetitive chewing, swallowing or lip-smacking motions.
Simple partial seizures are involuntary jerking or shaking of one part of the body without loss of consciousness. These may spread to other body parts and become generalized. In this situation:
Do not try to restrain the person unless safety is jeopardized.
Try to remove nearby hazardous or harmful objects.
Arrange for someone to watch the person until full awareness returns.
Medical assistance generally is not necessary when partial seizures occur except when one seizure follows another in a continuous series, or when a partial seizure develops into a generalized seizure and the person is not recovering.
Even if someone develops seizures following acquired brain injury, the health care team will work on treatment options to effectively manage the seizures.
Spasticity
Injury to the part of the brain that controls movement can cause spasticity, an abnormal increase in muscle tone. (Tone is the amount of tension or resistance to movement in a muscle). Unlike a normal muscle, when stretched, a spastic muscle does not easily relax. Instead, the muscle remains stiff or perhaps non-moveable.
Spasticity usually is not immediately present after a brain injury, but may develop gradually over weeks or months. Spasticity symptoms range from slight to severe muscle stiffness. Spasticity can impair the ability to dress, eat, write, balance, move and walk. Managing spasticity may be a lifelong process. Treatment varies depending on the person’s age, severity of symptoms, and related conditions or complications.
Swallowing
Problems that affect swallowing (dysphagia) may occur after brain injury. Swallowing is coordinated by the brainstem and the brain’s frontal lobes. The brainstem, which connects the brain to the spinal cord, relays messages to and from the swallowing structures (mouth, tongue, throat). The brain’s frontal lobes control the muscle action of the swallowing structures.
Problems that affect swallowing after brain injury can vary widely and may include one or more of the following:
Poor head or upper body control
Decreased lip and tongue strength, range of motion and coordination
Impaired memory or concentration
Any or all of the above may cause aspiration (inhaling food or liquid into the lungs)
If a person seems to have trouble swallowing, a clinical swallowing evaluation and videofluoroscopy (a videotaped X-ray of the swallowing process) may be done. With test results, decisions can be made about treating any swallowing problems.
A person who has trouble swallowing, may need nutrition through a nasogastric or gastrostomy tube (feeding tube in the nose or stomach). Having either tube does not rule out the possibility of eating by mouth, but ensures proper nutrition and hydration (fluid intake). How long the tube is in place depends on the person’s progress.
Exercises, treatment techniques and positioning may help improve a person’s ability to chew and swallow. An occupational therapist or speech therapist will teach the person with brain injury and caregivers how to perform these exercises and techniques. As a caregiver, your encouragement and help with the swallowing program are essential. Most people regain the ability to swallow after brain injury, though it may take longer for some than others.
Bowel and bladder changes
Brain injury may affect bowel and/or bladder function. The injured person may need help re-establishing and maintaining a pattern of regular bowel and/or bladder emptying.
Bowel management
The goals of bowel management include establishing a regular emptying pattern, maintaining dry, healthy skin, and avoiding incontinence, diarrhea, andconstipation. Each person is assessed by a physician and recommendations are made as needed.
Bowel problems can occur if the person with brain injury cannot:
Control bowel emptying voluntarily
Recognize bowel fullness and the need to have a bowel movement
Ask for help to the bathroom
Walk to the bathroom
Eat enough food with fiber and drink enough fluids
Plan ahead and allow enough time to get to the bathroom
To maintain optimal bowel function, a person with brain injury should eat at regular times, focus on eating foods with fiber, drink the amount of fluids recommended by the dietitian or physician, and be as active as possible. Meeting with a dietitian to discuss a diet plan may be helpful. The person also may be asked to follow a bowel care schedule, which includes attempting to schedule a bowel movement at the same time daily and establishing regular times for meals.
At certain stages of recovery, the person may need to use other methods for bowel emptying (fiber supplements, stool softeners, suppositories, and/or laxatives). These methods typically are not used regularly because they decrease the colon’s natural abilities, and these methods may be habit forming. Most individuals with brain injury regain the ability to regularly and effectively empty their bowels.
Bladder management
People with brain injury also may have a problem with urination (bladder emptying) during the post-injury period. Difficulties with urination that were present prior to the injury (an enlarged prostate in men or a pattern of infrequent urination in men or women) may add to bladder problems after brain injury.
The goals of bladder management include preserving kidney function, preventing incontinence (accidental urination), preventing bladder overfilling and bladder infections, establishing a regular patter of urination with complete bladder emptying, and maintaining dry, healthy skin in the genital area.
Problems with bladder management may include:
• Urinary retention (an inability to void or pass urine)
Urinary incontinence
Increased urgency to urinate
Increased frequency of urination
Incomplete emptying of the bladder
Bladder infections
Skin problems because of incontinence
The most common reason for bladder problems after brain injury is damage to the frontal lobe of the brain. A less common cause is direct damage to the part of the brain that controls behaviors and memory. Damage to these areas may result in the inability to:
Ask for help
Control urination
Recall when last urination occurred
Plan ahead to get to the bathroom
Walk to the bathroom in time
Recognize the sensation of bladder fullness or the need to urinate
Early in the care of someone with brain injury, the bladder may be drained continuously through an indwelling catheter (a tube that is inserted and left in the bladder). The urine empties through the catheter into a drainage bag, which also allows for accurate recording of urine output. As the patient improves, the catheter usually is removed.
If the person cannot sense the need to urinate, other approaches to bladder management are considered, including:
Keeping the indwelling catheter in the bladder
Intermittent catheterization (inserting and removing a catheter several times a day to regularly empty the bladder)
Scheduling attempts at urination
Using an external condom catheter for men
Using an adult diaper
Other methods of bladder retraining to control urination may be recommended
To maintain optimal bladder function, a person with brain injury should drink fluids as recommended by the dietitian or physician. It may be helpful to meet with a bladder therapist to develop an individual plan. The majority of individuals with brain injury regain the ability to regularly and effectively empty their bladder.