Traumatic Brain Injury (TBI), the Proper Care

 In Community Living, Conditions & Treatments, Disability
Graphic of the spine and brain - Text reads Traumatic Brain Injury

When it comes to caring for someone who has sustained a Traumatic Brain Injury, (TBI) having the resources that your loved one needs is crucial. The residual challenges following rehabilitation play a deciding factor in whether living at home is an option. Persons with a TBI can express a range of associated movement disorders, cognitive deficits, changes in personality and behaviors. Managing behaviors can be particularly challenging as they range from impulsivity through anxiety and paranoia to extreme self-centeredness and even hostility and aggression. Sometimes this conduct proves too much to manage safely in the immediate home situation. Physically and emotionally, the demands are high. In some instances, it doesn’t take long to realize that the care required is more than any one family can provide — it takes a “village.”


Valley Vista Care of Sandpoint has one of the only non-acute care options for long term living for someone with a TBI. A secure setting is available with trained staff who are prepared to deal with the myriad of behavioral challenges possible for those who are unable to function safely in a less controlled setting. This special unit for men is known affectionately as “The Lodge.” There is also a secure women’s unit referred to as “The Cottage,” but most of the TBI residents are male.

The Lodge is physically secured yet family members and those chosen by family are given coded access to make visiting loved ones easy. To ensure the safety of each resident, Valley Vista’s Lodge has a high staff to resident ratio. These staff are specially chosen for their caring and sen-sitivity which are necessary to re-direct and de-escalate when tensions start to spiral. A full-time behavior nurse is part of the team. Physicians from Kaniksu Health provide medical intervention and Dr. Abhilash Desai is available through telehealth for psychiatric care.

The consistency of the Lodge staff helps to develop a sense of “family.” The residents call for staff members by name and the staff know the likes, dislikes and particular challenges of each resident. Live music is frequently on the agenda and the Activity Department works hard to pro-vide interesting diversions that are individualized and geared to maintaining the level of stimula-tion that is appropriate.

Customizing care is the norm, with the nursing staff working closely with the Occupational Therapists in addressing ways to facilitate independence with dressing, hygiene as well as feed-ing, which can be incredibly challenging for some. With the physical and emotional/behavioral hurdles present, it is not surprising that Occupational Therapy services are on the front lines. Several residents have been able to decrease some of their medications by using lavender oil regularly to soothe anxieties and lessen aggressive tendencies. Bright light at 10,000 lux is used also to reduce depression and supplement other treatments for sleep disorders. A giant bean bag has been found to increase the comfort for a couple of residents with movement limitations, get-ting them out of a wheelchair and facilitating activity at the level available to them.

Physical therapy is frequently called to reassess and optimize the patient’s ability to transfer and walk with whatever assistive device provides greatest freedom. Also, determining the cause of various pain presentations and whether improved positioning, stretching tightened muscles or massaging to increase tissue perfusion can provide the desired relief.

Cognitive along with communication struggles are sensitively explored and often benefited through sessions with the Speech and Language Pathologist. Encouragement for small victories is necessary and small victories are cumulative, often adding up to measurable progress making all the energy expended worthwhile!

As you can see, no one member of the team carries the whole bag. Many persons working in concert come together with each individual who has sustained a TBI to provide the needed re-sources for them to live to their fullest. Yes, it really does take a village! And at Valley Vista this village is known as “The Lodge.”

by Lyle Harder, RPT – Valley Vista Care Sandpoint

Lyle Harder has been a practicing Physical Therapist since 1982 focusing on orthopedics  and working with all ages in neuro rehabilitation as well. He was with Boundary Community Hospital in Bonners Ferry for 15 years and has been with the rehab group at Valley Vista Care Center since 2009. Lyle works with residents, out-patient as well as home health clients in the greater Sandpoint vicinity.

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