Brain injury: the hospital phase
A brain injury has an immediate
effect on the family as they battle a wide range of emotions while
coming to grips with the hospital system.
It is important to become familiar with the hospital's
departments, wards and key staff providing treatment for the brain
injury. In some hospitals, all patients with a traumatic brain
injury are admitted to the neurosurgical unit and cared for by the
neurosurgeon. However, patients with multiple injuries may be
attended by a number of specialists.
In the Intensive Care Unit (ICU), a registered nurse is always
available and assigned to patients. Most hospitals should have a
social worker available who can assist with information and coping
with the hospital system.
Emotional reactions for the family
It is very stressful for families when a loved one acquires
traumatic brain injury, stroke or similar brain
disorder. A period of shock or disbelief is common at first. Many
report a sense of unreality and being on "automatic" so it is hard
to take information in. It can help to write everything down.
Everyone reacts differently - you may feel despair and blame
yourself while another family member may be very angry and looking
to blame others. Try to be supportive of each other despite the
different ways everyone will cope.
Waiting for the prognosis -
predicting the future
Predicting the level of recovery after a brain injury is
difficult, and doctors are usually cautious about early prognosis.
Family members and other visitors have the right to ask questions,
express a point of view, and receive clear and timely information.
Sometimes the answer may be "we don't know" and this may be the
only honest answer available. Patience and persistence are required
in the search for information.
Understanding medical terminology can be difficult, especially
during times of stress. However, it is better to ask questions than
not understand what is happening. If hospital staff use words you
don't understand, ask them to explain it in a simpler way.
Some hospitals hold meetings with family members where you can
ask questions. Write these down and record the answers. Examples
- What are your treatment goals?
- What is being done to achieve these goals?
- Do you have any idea of how much recovery can be expected?
- What ongoing effects from the brain injury are expected?
- How can the family help at this point in time?
- Should we be doing anything now to prepare for discharge?
Talking with the patient
When a person is in a coma, it is very unlikely they can hear
and understand others, but nonetheless there have been rare cases
of people emerging from a coma and remembering what family members
said. This is worth keeping in mind when visiting the patient - see
our coma fact sheet for more information.
Sometimes a patient will have post-traumatic amnesia, a
period of confusion and disorientation that will pass. It is best
to not stimulate the patient with too much noise or activity. Talk
quietly and calmly in short sentences and remember the person will
tire quickly and probably not remember what was said. See
our fact sheet about post-traumatic amnesia.
This is a very stressful and emotional time for family
members. Look after your own emotional and physical health so that
you can provide support for the patient and each other in the weeks
ahead. A common reaction is the family feeling they should be
at the hospital as much as possible but remember to go home
regularly and recharge your batteries for the long
haul. Tips for self-care include:
- Remember to eat well and get regular sleep
- Organize a rotating schedule for visits by family members
- Talk with others about your feelings and experiences
- Reduce other sources of stress in your life
- Accept support e.g. talking things over or help with
- Be aware others may deal with the situation very differently to
- Maintain a sense of normality with routines and structure in
- Learn as much as you can about brain injury
- Ring your nearest Brain Injury Association about available
Hospital staff you may
There are many professionals who may form part of the medical
team for treating a stroke, traumatic brain injury and other brain
disorders. The following are brief explanations of those likely to
be involved in acquired brain injury situations.
Nursing team: specific nurses are usually
assigned to a patient and are responsible for the immediate care of
the patient. A more senior member of the nursing staff usually
coordinates the overall management of the ward including patient
care, staff and support services
Medical specialists: they are involved in a
patient's care depending on the type and extent of the injuries.
Some specialists who may be involved include:
Intensive Care Physician: a doctor who specializes in the
management of patients who require the complex support available in
an intensive care unit.
Registrar: a senior doctor who
directs the hospital unit team and patient management. The
registrar may also assist the specialist/consultant in caring for
Resident: a junior doctor who will
rotate through all the specialist areas of a hospital in order to
gain experience and skills unique to these areas.
Visiting Medical Officer: also known
as a VMO or consultant, a visiting medical officer is a senior
doctor subcontracted by the hospital to provide oversight and
mentorship for registrars and residents.
Medical director: a senior doctor
responsible for a department or unit.
Ward Consultant: a doctor who is assigned to a particular ward
to oversee the care of patients in the ward.
Neurosurgeon: a surgeon who is a
specialist in the management of disorders of the nervous system,
brain and spine.
Neurologist: a medical specialist
who diagnoses and treats disorders of the brain, brain stem, spinal
cord, cranial nerves and their functioning. People are often
referred to neurologists if they experience headaches and
Neuropsychologist: a psychologist
who is specifically trained in understanding how the brain works
and how it affects behaviour, thinking, memory, learning and
personality. A neuropsychological assessment is designed to
identify changes in a person's thinking and behaviour after the
brain has been injured and how this impacts upon day-to-day
Occupational therapist: a therapist
who has the expertise to improve or maintain independent
functioning in all aspects of daily living. An occupational
therapist is also involved in assessing and treating the person's
functional skills in the areas of physical, cognitive and social
Orthotist: a specialist technician
who develops and fits mechanical devices such as a brace, splint or
Physiotherapist: a therapist who is
trained to deal with the patient's physical problems caused by the
brain injury in order to maximize physical functioning. This
includes treating associated injuries such as fractures and
ligament damage and any weakness or spasticity resulting from long
periods of inactivity or bed rest.
Speech language pathologist: a
specialist who assesses and treats communication and swallowing
difficulties. Sometimes there may be damage to the voice and
articulation mechanisms, such as the breathing, tongue and facial
Social Worker: a social worker
provides a wide range of social services including support,
information, and referral and counselling to patients and
Other professionals who may be involved in monitoring a person's
condition or providing care at different stages of recovery include
a dietician, ear nose and throat (ENT) specialist, ophthalmologist,
psychiatrist, radiologist, recreational therapist and