During a short house visit yesterday afternoon by a VA-contracted physical therapist, Ray had a short conversation stating his height when asked, and joking back to the therapist after he called Ray tiny. This is a great sign of progress! Talking now is sporadic, not continual, so you may not see him speaking while visiting.
Ray still remains a fall risk but we are taking precautions through new medicine, a more relaxing environment, and a floor mattress with alarm at night. This should help Ray remain calm and safe while he remains at home for recovery. With that, we would like to have a coordinated approach for those wishing to visit with Ray. Stimulation still needs to remain low but short visits of familiar faces and voices are a great thing to trigger a positive response. House visits should be limited to only two at a time and no visits past 9 PM please. All visitors will need to schedule through Marlena (firstname.lastname@example.org). She has taken the charge on his healthcare and will be able to best answer when visits may be possible.
VA case management is now heavily involved doing what they can to have him enrolled in the TBI program at the Tampa VA. If all goes well, he may be ready for transfer in as early as two weeks. Much of Ray’s current behavior can be classified at a Level IV on the Rancho scale meaning that he can now participate more actively in a rehab program. Brooks is still on the table as an option but it may be a while before they can become involved. Tampa VA is the only more immediate option to us at the moment for TBI rehab. Please focus the energy / prayer / etc on getting Ray to the TBI unit in Tampa. Group power can be an awesome thing.
Go Team Ray!!!
Level IV as defined from the link above:
- Becomes more alert and active
- Shows unusual and inappropriate behavior
- Focus becomes basic, physical needs
- May scream out, be verbally abusive, behave aggressively, or attempt to remove restraints
- Speech is often confused or the content may be inappropriate
- Attention span is very short
- Memory and the ability to process information are impaired
- Begins to take some independent action, but is usually very dependent and needs significant help to maintain safety and meet basic needs
How can family and friends help a Level IV patient?
- Frequently remind the individual of the day and time
- Explain what is happening to the person
- Expect the person to be forgetful — you may need to repeat answers several times
- Demonstrate patience
- Limit distractions and stimulation
- Remain calm and provide a safe environment
- Limit the number of visitors to two to three people at a time
- Allow the individual to move to the extent that is physically safe
- Reduce stimuli (sights, sounds, activity) in the environment if the individual becomes agitated or restless
- Keep the room quiet and calm (close doors, keep TV off, do not have secondary conversations in the room)
- Simplify words you use when talking, decrease rate of speech, speak naturally