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Are we offering a fish or a fishing lesson?

You will almost certainly have heard the proverb

“Give a person a fish, and you feed them for a day. Teach a person to fish, and you feed them for a lifetime.”

How could this possibly be relevant to the role of rehabilitation following brain injury? I would like show that offering Care & Support packages without Rehabilitation is like offering the person a fish.  It supports their daily needs but offers no hope of improvement for the future.  On the other hand a properly designed rehabilitation programme offers the opportunity for personal growth, improved independence and enhanced quality of life which will last for a lifetime. 

What do I mean by Care & Support?

Care does things for, and to, patients.  It is often the focus when a patient first returns home from hospital, particularly if they have both physical and brain injuries.  What I call Support services step in next, this type of assistance allows patients to do things for themselves up until they meet a challenge they cannot master.  This is where a Support service is invited to provide assistance. 

Both types of assistance can be invaluable but they do have disadvantages.  One major problem is patients becoming dependent on this type of help.  After experiencing a major trauma a patient may be very cautious about moving out of their comfort zone and letting go of their support network.  This can result in patients never regaining full control of their life hence the need for care and support is increased and perpetual.  Assistance can also dilute their enthusiasm for rehabilitation, which requires dedication and effort, despite the pay-off being increased independence.

What is good rehabilitation?

Rehabilitation teaches and practices strategies to improve performance of physical and psychological tasks which have become more difficult following the accident.  Rehabilitation should have clear goals, in set timescales, for the patient to aim for while recognising that not all problems can be fixed.  It may be provided by a private company or statutory services and ideally takes place within the clients own home.

reach have been providing home-based brain injury rehabilitation programmes for 24 years and in our experience the earlier rehabilitation starts the greater the improvements achieved.  The involvement of the family is key to a successful programme as they can encourage the patient to practice and use the techniques they are being taught.  Good rehabilitation should happen regularly, flexibly and should respond to the changing needs of the patient.  Most importantly the rehabilitation worker should be aiming to make themselves redundant.  Rehabilitation is not a permanent process, it is there to help the patient achieve their objectives not to provide an ongoing support structure.

What can rehabilitation achieve?

A good rehabilitation package is designed to help the patient regain a level of independence which cannot be achieved while heavily reliant on others.  It may enable them to regain their role as a parent, return to work or start training in a new area/occupation.

reach recommend that at an early stage in the rehabilitation process the clinician identifies with their patient what they would like to change and discuss the best way of doing this. For example:

• Coping with anxious/stressful situations is a frequent problem and a good package can address ways of internally using strategies or utilising emotional cues to cope better when stress arises. 
• Memory problems can be addressed either internally, using external techniques or addressing environmental modifications such as introduction to appropriate Smart phone Apps.

How can Care, Support and Rehabilitation work together?

The three types of intervention can be mutually supportive in helping a patient to maximise their potential for independence but the providers need to understand how they inter-relate.  A daily Care regime might be vital to enable the client to return home but while still adjusting to being home is the time to develop a robust rehabilitation package.  This should be realistic and tailored to the needs and aims of the individual and their situation.

Once the rehabilitation has optimised the individual’s capacity and independence then the needs of longer term Support and Care can be properly assessed.

The fish versus the fishing lessons.

An injured person returning home may need to be provided with fish in the form of daily Care, however it needs to be provided in a way that it encourages them to take the risk of finding out what they are really capable of.  This means embarking on fishing lessons in the form of a rehabilitation programme to learn new techniques and skills. These enable the individual to optimise their potential and to enjoy a level of independence which they may never have imagined following their accident.