Goal setting with TBI…

Introduction

                As a 19-year severe Traumatic Brain Injury Survivor people will never fully understand or know what it took to get back to where I am today.  I am definitely not back to where I’d like to be, but I am blessed to be doing as much as I am.  Maybe my expectations were too high or I did not fully understand the extent of my injuries.  One may wonder what it was that allowed me to push, battle, and fail numerous times, but never pushed me to the point of quitting.  Honestly, I believe that the athlete in me (who participated in sports in high school and college) was very aware of the need to push myself to the ‘edge’ to get better and make a positive influence on my coaches.  I am going to provide a disclaimer that all athletes don’t make great recoveries.  But I am going to keep it 100% with you…  When I played I never gave up due to pain, being tired, or not being able to perform an activity at my best.  I might have asked to come out to get a break, asked for ice, tape job, or even Icy Hot to relieve pain, but I knew that I was going back into the game to compete!!  I did not have time to get frustrated, or pout about my issues on the bench for the rest of the game.  I knew that in order to win, my team needed me to make the best effort to complete the task at hand regardless of feeling frustrated, tired, or not being 100%.  I personally believe it is about setting goals and putting forth your best effort to complete those goals!

                In my inpatient experience, I do not remember talking with my therapist and setting goals to complete, however, I remember doing a lot of this in Day Rehab.  At this point, I was in a wheelchair and my left arm was not moving and I had no idea what brain injury recovery included.  As an inpatient, I saw other survivors walking during their therapies and because I knew we all had brain injury, I expected walking to be a part of recovery and it was only a matter of time until I would be walking again.  Little did I know that performing a task that I had done many times per day without thought previously, was like learning how to jump double-dutch for the first time.  After learning how difficult this previously mastered skill would be, I decided that I had to relearn the process in separate steps, until I could finally put them all together.  First, I needed to be able to stand up and be comfortable.  Second, I needed to be comfortable taking steps at the right length and pace.  And finally, I needed to learn how to use an assistive device like a walker, cane, or the wall to guarantee I’d be safe.  Sounds like I needed to be smart approaching these three steps. 

I did some research, and I learn these goals could be mitigated by using a SMART approach or “setting goals that are Specific, Measurable, Achievable, Relevant, and Time-bound” with a therapist.  Your therapist should be able to set goals that can be completed safely during the time frame of rehabilitation.  However, if the goal cannot be accomplished within the time frame, the goal can be changed to be redirected, or broken down into smaller, more achievable components.

“Studies have found that measuring patients’ satisfaction in their performance of specific brain rehabilitation goals—both before beginning therapy and after therapy—is a good method of assessing patients’ perception of their own progress. Assessing patient satisfaction with their abilities has been found to strongly correlate with goal achievement, and is used as a measurement that can inform the value of health care.”

Goal setting isn’t only about creating goals that sound good, but it is about setting goals that will put you in a better place to test what you have practiced.  For example, one of my early steps to walking was standing up comfortably.  I needed to be able to stand up from the hospital bed, the therapy bed, the floor, or from a stair and stay perpendicular!  “When setting appropriate and functional therapy goals, it is important to involve the patient (and their caregivers) at the very start of therapy.  If patients have a hard time thinking in terms of recovery goals, the following questions can be good prompts:

  • What can’t you do since your injury that you want to get back to?
  • What are you finding more difficult since your injury that you’d like to be easier?
  • How will you know when you’re ready to stop coming to see me(therapist)?

                The key here is to have patients respond with goals that are very general or based on the survivor’s impairment, such as ‘improving balance’ or ‘be more social’, or ‘go back to work’.  All of the SMART goals should incorporate ‘I will…’.  For example, I will stand upright for 5 minutes unassisted, or ‘I will safely walk up and down the stairs 5 times in one hour.’

Conclusion

                When I was trying to meet my goals, it was important that I was able to practice with the therapist as well as on my own.  If walking included getting good at the three steps mentioned above, I would make sure I could accomplish one task at a time.  When I could perform all three tasks, I would do each until I felt I could perform each flawlessly.  After performing all of the tasks successfully, I would try putting them all together as one complete movement.  Some things came easier than others, but I was determined to complete the tasks so I did not stand out when I was in the public.  I never wanted to stick out.  I wanted to look like I was a functioning member in the community.  I did not want to appear limited by what I could or could not do in public.  Even though you might have heard about me and my struggles in rehab, I wanted to be sure that what you saw LIVE was better than expected!  My motivation was that I would tell visitors that I was getting better and it was my goal to show them!  I wanted to recover the best I could.  I was not focused on what others thought about my capabilities, or even what they had seen other patients do.  Just like all injuries are unique, like a snowflake, my recovery was unique and specific to me.  To get the most during recovery and rehab, I had to stay positive and focused on the goals I set for myself.  I have not achieved every goal set, but I know that I have tried everything I wanted to try!  AND as an athlete in this sport called life, I know you win some and you lose some.  I’ve never been fond of losing, but TBI has taught me to be gracious at winning and losing!  I encourage all survivors to not accept the ‘normal expectations’ of your injury.  It’s okay to accept the ‘L’.  But I say you should only accept it after you have tried everything you SAFELY can!

Keep pushing survivors!!

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