(Kiosk 3) Safety in the Rehab Unit: When Brain Injury Patients Speak Softly and Carry a Big Stick

Case Diagnosis: Three patients with minimal mobility deficits but severe aphasia after acquired brain injury leading to unique behavioral challenges.

Case Description: Patients with severe language deficits following acquired brain injury (ABI) often experience neuropsychiatric disturbances. When such patients concurrently have minimal mobility deficits, this often presents a challenging and unsafe clinical scenario characterized by impulsivity, elopement attempts, irritability, and even aggression. To our knowledge, no formal studies have investigated the behavioral challenges in this specific subset of patients. This case study provides insight into the presentation and behavioral management of these patients.

Discussion: Preventative safety measures and individualized BMPs are essential to the effective rehabilitation of these patients. Interventions such as consistent staffing, ongoing behavioral observation, and frequent team communication will promote effective behavioral management while minimizing the need for physical or chemical restraints thus promoting more rapid neurologic and functional recovery and ultimately better outcomes.

Setting: Inpatient rehabilitation.

Assessment/Results: All three patients presented with fluent or global aphasia, and all demonstrated the ability to ambulate without assistance. Constant and exceptionally close supervision was needed to prevent them from entering other patient rooms, wandering from the unit, and/or attempting elopement. Staff attempts at redirection were often met with considerable resistance including physical aggression. To promote patient and staff safety, a detailed behavior management plan (BMP) was established for each patient identifying specific behavioral antecedents and optimal nonpharmacologic interventions. With consistent utilization of the BMP, a reduction in the frequency and severity of behavioral escalations was observed for all patients.

Conclusion: Patients with ABI experiencing confusion and language deficits while retaining good mobility can pose unique behavioral challenges and safety risks in the inpatient rehabilitation setting. Early identification of these patients and quick implementation of thoughtful and individualized nonpharmacologic interventions can minimize these challenges while promoting a safe and effective rehabilitation environment for both patients and providers.