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40-60% of brain injury survivors report significant unmet needs one year post incident (Finkelstein, Corso, & Miller, 2006). Trauma and community centres cite time deficits and lack of expertise personnel for effective treatment (Ashley et al., 2009). Indirect consequences of sub-optimal recovery will include emotional stressors faced by family and caregivers and increasing costs to society for dependants of wage earners (Worthington, 2006). Much of this trouble can be avoided by appropriate post discharge care.
Post discharge monitoring of this patient will increase his options for recovery and quality of life. Family members can be instructed to monitor recovery with the help of the SCAT instrument which offers guidance on warning signs and suggests examples of simple status checks such as having the patient remember words, match pictures, and manipulate simple numbers out of sequence. These are easy to use low resource tools and guidelines are available free of charge online. Scroll down to Rivermead Post Concussion Symptoms Questionnaire and the Sports Concussion Assessment Tool (SCAT) for medical practitioners (http://www.mayoclinic.com/health/balance-exercises/SM00049. He could be trained to move his body and head together when turning to avoid vasal-vagal syncope (dizziness and fainting) and we suggest he could be instructed to lean against a wall, sit or lie down or to roll as he falls to avoid further injury. His co-morbid diagnosis of diabetes and stroke put him at high risk for complications should he fall, lose mobility and require extended care.
Each brain is a unique combination of genetics, environment and lived experiences (Kandel, 2000, 2007) Delivering positive brain results without a working knowledge of where and how that brain will benefit is a little like building a freeway with no blueprint. Follow up is critical for full recovery. Physicians, patients and carers may find it helpful to review the TBI IJUDH (2012) issue dealing with traumatic brain injury from the medical professional, patient and policy-makers perspective. This could serve as an aid for counselling survivors, families and as an aid to assist the shareholders with informed shared decision-making.