Emergency Preparedness Guide for Post-Brain Injury Patients

Article by Moody Neuro

Early June brings hurricane season to Texas, and with that comes a fresh reminder of the need to plan for emergencies. People often don’t realize the full extent of consideration that new challenges require following a brain injury. They particularly may not understand new challenges regarding emergency situations, such as sheltering and evacuation.

In this blog, we’ll tell you some useful and effective ways to approach those new challenges when planning for an emergency with a brain injury survivor. We’ll cover how to address transportation issues, medical and health concerns, and cognitive and emotional difficulties in the wake of a traumatic brain injury.

Emergency Preparedness Post-Injury: Transportation Issues

After a brain injury, many possible issues may arise concerning transportation preparedness during an emergency. We’ve listed some of those issues below.

Ask These Questions

Is the brain injury survivor able to drive independently to safety?

If the survivor hasn’t been cleared to drive, it’s vital to identify a responsible person capable of transporting them to safety.

Can a friend or relative drive the survivor, or does the survivor need to be evacuated through a municipal program?

If they must use a municipal program, are they registered for the program?

Register With State-Provided Emergency Services

Many states provide emergency evacuation services for the disabled and elderly. We recommend that all persons with disabilities register with their local 211 system or another similar emergency evacuation system, even if they already have an emergency plan in place.

Registering with an emergency evacuation system doesn’t mean the survivor has to use the services it offers. However, it provides a safety net in case an emergency plan doesn’t work. Additionally, 211 services are free, so there should be no issues regarding registration costs.

Consider a Vehicle

Deciding which vehicle will be best to use during an evacuation is an important step when preparing for an emergency. Consider whether you have a vehicle that can accommodate everyone who would evacuate, as well as the necessary equipment (wheelchairs, walkers, etc.).

If the brain injury survivor has a physical difficulty that may affect their ability to enter or exit a vehicle, it’s important that other people in the vehicle know the appropriate transfer process and can assist them.

Plan Accessible Rest Stops

Preplan and locate rest stops that people with disabilities can access. If the brain injury survivor is incontinent, it’s important to find rest stops that have enough room for clothing changes and cleanup. Rest stops often simply put a grab bar in a regular-sized stall to comply with accessibility laws, but unfortunately such restrooms remain inaccessible from any practical perspective.

Store Medication

For those who take medication or frequently use assistive equipment, make sure you store that medication or equipment in an easily accessible location in the vehicle. You should definitely not store medication in an area of the vehicle prone to excessive heat because the medication may lose its potency.

Be Timely

The cardinal rule of evacuation is that the earlier you leave, the less potential you have for transportation problems.

Emergency Preparedness Post-Injury: Medical/Health Issues

In addition to transportation, it’s important to consider medical and health concerns for post-brain injury patients when preparing for an emergency. We’ve listed some of these concerns below.

Pack Enough Medication

When people must evacuate from areas affected by a natural disaster, evacuated cities immediately experience a population surge. This puts a remarkable strain on any local medical system, particularly pharmacies.

For example, let’s say a city has pharmacies normally prepared to have enough on-hand medication for a population of 50,000. Following an evacuation, the population may increase to 70,000 or more. Most pharmacies aren’t equipped to deal with this increase, and medication shortages inevitably occur.

Most government agencies recommend that people bring one to two weeks’ worth of medication with them when they evacuate. You may want to err on the side of caution and bring enough for two weeks to one month. You should use this same general rule when preparing a stock of disposable medical items, such as syringes, incontinence supplies and testing strips.

Properly Store Medication

Most medications are sensitive to heat. Keeping medications in the trunk of a car or a similar location on a warm day can cause them to degrade. Furthermore, many medications (such as insulin) require refrigeration. When in a vehicle, consider storing such medications in an icebox with cold packs or a portable refrigeration device.

You should also keep medications in their original boxes or bottles and transport them in a container you can seal and reseal. Plastic bags with a zipper work great for this situation.

Don’t take medications and place them all into one container. This can be a nightmare to sort through later and can lead to crucial delays. It can even lead to dangerous errors in administering medication.

Additionally, you should protect medical devices and equipment from water and other environmental hazards.

Bring a Power Source

If a medical device or piece of equipment operates on electricity, make sure to bring an emergency power source, such as extra batteries or a car adapter power cord.

Document Medical Information

Keep a list of all important medical information. This includes health history, medications (with dosages), doctors, allergies and immunizations. The Centers for Disease Control and Prevention has an excellent example of such a list available for download on its website. You can download another excellent example of this kind of checklist from the AARP website.

Locate the Nearest Medical and Health Facilities

When you reach your new location, make sure you know where the nearest medical and health facilities are. Knowing where the closest pharmacies and hospitals are will help if a medical emergency occurs after evacuation.

Remember Dietary Needs

Following a brain injury, many survivors require a special diet, such as a diabetic diet. When purchasing food for evacuation, make sure to keep this diet in mind. For example, you may need to check boxed foods (crackers, cookies, etc.) for their sugar and sodium levels.

Don’t Forget ID and Communication Items

If a survivor has an item that helps communicate the difficulties they suffer, such as a medical bracelet or aphasia card, remember to bring that item. Left at home, it’s of no use.

Emergency Preparedness Post-Injury: Cognition and Emotion

Read on to learn about issues that can arise regarding the cognitive and emotional difficulties left after a traumatic brain injury.

Have Calming Items at the Ready

Post-injury, brain injury survivors generally become far more susceptible to stress and agitation in their lives. Therefore, it’s often handy to have items that you can use to help them remain calm. Music played on a portable radio, phone or pair of headphones that the survivor finds relaxing is an example of such an item.

Calmly Repeat the Evacuation Plan

For survivors who have cognitive difficulties such as memory problems, the evacuation process can be very confusing. They may forget why they’re evacuating or where they’re going. Calmly repeating the evacuation plan and/or having the evacuation plan in writing can help reduce confusion.

If a survivor has issues with impulse control, they may be more likely to make hostile comments or rashly suggest an unwise action during the evacuation. At these times, loved ones should calmly remind them of the evacuation plan and that the loved one has the situation under control. If the loved one reacts with anger, emotions are likely to escalate.

Plan Breaks During Travel

Most people, even without a brain injury, find extensive car travel stressful. Keeping to a regular schedule of planned breaks during an evacuation often helps reduce that stress.

Provide Extra Emotional Support

Because many brain injury survivors have already experienced significant loss due to their injury, an evacuation and worries about potential losses resulting from a disaster may trigger difficult memories. Some survivors may need extra emotional support at this time as memories of old losses and new concerns for fresh ones result in significant emotional struggles.

Create a Daily Schedule

All people, especially those with brain injuries that affect cognitive skills, do best when operating under a stable schedule. Survivors and loved ones should try to create a daily schedule to reinforce stability in the evacuation environment.

Practice Your Evacuation Plan

The more you plan and review an evacuation plan, the less stress you’ll have when it’s time for a real evacuation. Regularly going through evacuation plans will make the process less stressful for a person with a brain injury, too.

Hopefully, this guide can help bring attention to the important issues that brain injury survivors and their loved ones need to consider regarding emergency preparedness post-injury.

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Strokes are medical conditions that affect millions globally. In the United States, more than 795,000 people have a stroke each year, with about 610,000 cases being first or new strokes.

These can lead to a wide range of physical and cognitive impairments. Speech and language disorders are among the most common and most challenging consequences of strokes, occurring in about a third of stroke survivors.

Understanding Stroke-Induced Speech & Language Disorders

Stroke-induced speech and language disorders significantly impact communication abilities. Among these, aphasia, dysarthria, and apraxia of speech are prevalent. Understanding how they are diagnosed and their specific symptoms can aid in prompt and effective management.

Aphasia

Aphasia is a common outcome of stroke, manifesting as difficulty in speaking, understanding, reading, and writing. There are many different types of aphasia, depending on the affected brain area, and are categorized based on the symptoms present:

Expressive Aphasia (Broca’s Aphasia): Characterized by broken speech, limited vocabulary, and difficulty forming complete sentences. Patients often understand what is being said to them but struggle to verbalize responses.
Receptive Aphasia (Wernicke’s Aphasia): Patients can produce fluent speech but may lack meaning or include nonsensical words. They often have significant difficulty understanding spoken language.
Global Aphasia: A severe form of aphasia where individuals have extensive difficulties with both speech production and comprehension.
Anomic Aphasia: Individuals have difficulty finding words, particularly nouns and verbs, making their speech sound vague.

Dysarthria

Dysarthria is a speech disorder that affects 20-30% of stroke survivors. It occurs when stroke impacts the muscles responsible for speech, leading to slurred or slow speech that can be hard to understand. It is typically diagnosed through a physical examination and a series of speech evaluations conducted by a speech-language pathologist (SLP).

It is characterized by the following symptoms:

Slurred or slow speech that can be difficult to understand
Monotone or robotic-sounding speech
Difficulty controlling the volume of speech, which may be too loud or too soft
Challenges with the rhythm and flow of speech, including rapid speech that’s hard to interrupt or slow, drawn-out speech
Respiratory issues affecting the ability to speak loudly or for extended periods

Apraxia of Speech (AOS)

Apraxia of speech is a neurological disorder characterized by difficulty sequencing the movements needed for speech. This is caused by the impact of the stroke on the brain’s pathways involved in producing speech.

Patients with AOS know what they want to say but struggle to coordinate the muscle movements to articulate words correctly. This results in distorted speech, difficulty initiating speech, or the inability to accurately produce speech sounds or sequences of sounds.

How Long Is the Stroke Speech & Language Recovery Time?

According to one study on post-stroke speech and language therapy, approximately one-third of stroke patients experience speech problems after a stroke. Many of these individuals begin to recover within a few months, with significant progress typically observed within three to six months.

In another study, 62% of subjects had speech challenges after suffering from a stroke. By six months post-stroke, 74% were able to completely recover their communication abilities.

However, the figures above provide a general timeline for post-stroke speech and language recovery. Stroke speech recovery time is highly individualized and can vary depending on several factors. These can include the following:

Severity of the Stroke: More severe strokes often lead to extensive brain damage, resulting in longer and more challenging recovery periods for speech.
Location of the Brain Injury: The brain’s specific regions control different speech and language functions; damage to these areas directly impacts recovery complexity and duration.
Age and Overall Health of the Patient: Generally, younger patients with better overall health before the stroke tend to experience faster and more complete recoveries.
Pre-existing Conditions and Comorbidities: Conditions such as diabetes or hypertension can slow down recovery by complicating the overall health scenario and rehabilitation process.
Individual Variability and Resilience: Personal resilience, the support system’s strength, and the individual’s motivation significantly influence the pace and success of speech recovery efforts.

The first three months after a stroke is a crucial period for recovery, as a majority of stroke patients see the most significant improvement during this period. However, it’s also important to note that, although at a slower pace, recovery can continue well past the 6-month mark with continued therapy and practice.

This underpins the importance of early intervention and ongoing rehabilitation efforts, including speech therapy, to maximize each patient’s recovery potential.

What Does the Stroke Speech & Language Recovery Process Look Like?

The journey to regain speech and language after a stroke is multifaceted and varies significantly from one individual to another. Understanding the structured phases of recovery can provide insight into what patients and their families can expect during this challenging time.

Here’s a closer examination of each phase in the stroke speech recovery process.

Initial Assessment and Diagnosis

Before recovery can begin, a thorough evaluation is conducted by a team of healthcare professionals led by an SLP. This assessment aims to identify the type and severity of the speech and language disorder, be it aphasia, dysarthria, or AOS. The evaluation may include cognitive-linguistic assessments, comprehension tests, speech production analysis, and functional communication measures.

Based on this assessment, a personalized therapy plan is crafted to address the patient’s specific needs.

Acute Phase

The acute phase typically occurs within the first days to weeks following a stroke. During this period, medical stabilization is the primary focus, with healthcare teams working to manage the immediate effects of the stroke.

Speech therapy may begin with simple exercises or assessments to gauge the patient’s abilities. However, intensive therapy usually does not start until the patient is medically stable. During the acute phase, the goal is to support overall recovery and prevent complications immediately after the stroke.

Subacute Phase

The subacute phase generally spans from two weeks to three months post-stroke and is characterized by more intensive speech therapy interventions. As the patient’s medical condition stabilizes, the focus shifts to active rehabilitation. Therapy during this phase is tailored to the individual’s specific speech and language deficits and may include:

Exercises to improve articulation, fluency, and voice control for those with dysarthria.
Language therapy to enhance understanding, speaking, reading, and writing skills in patients with aphasia.
Motor speech exercises and strategies to improve speech planning and production in apraxia of speech.

The subacute phase is crucial for taking advantage of the brain’s natural recovery processes and neuroplasticity, where the brain begins reorganizing and adapting to the loss of function.

Chronic Phase

The chronic phase of recovery extends from several months to years after the stroke. It focuses on long-term rehabilitation and adjustment to any residual speech deficits. During this time, patients may continue to see gradual improvements in their speech and language abilities, although the rate of recovery may slow. Therapy in the chronic phase often includes:

Advanced communication strategies to cope with ongoing challenges in daily life.
Maintenance exercises to preserve and enhance speech gains achieved in earlier phases.
Supportive technologies and aids, such as communication devices, to assist in effective communication.
Community reintegration activities to help patients return to as normal a life as possible, engaging in social, vocational, or recreational activities.

What Is the Role of Neuroplasticity in Speech & Language Recovery?

Neuroplasticity refers to the brain’s fundamental property to change and adapt its responses to new experiences, learning, and environmental changes. This adaptive capacity enables the brain to reorganize itself by forming new neural connections.

When the brain, or a part of the brain, is damaged after a stroke, neuroplasticity is what allows the other parts of the brain to take over the functions of the damaged area. Through targeted rehabilitation and therapy, such as speech therapy for stroke survivors, patients can retrain other brain areas to perform the lost functions and facilitate recovery.

Enhancing Stroke Speech & Language Recovery Time

Adopting a comprehensive approach involving several key strategies is vital to enhance the stroke speech and language recovery time. This multifaceted approach can maximize the chances of regaining speech and communication abilities.

This comprehensive approach must incorporate the following strategies:

Early intervention to leverage the brain’s highest potential for neuroplasticity in the initial period following a stroke, significantly improving the chances for recovery.
Alternative communication strategies, such as gestures, writing, and visual aids, to help maintain communication during the recovery process.
Adopting technology, including speech-generating devices and software applications designed for speech rehabilitation, for personalized exercises and continuous practice, which is vital for progress.
Providing continuous support from psychologists, support groups, and therapy to help manage feelings of frustration, depression, and anxiety, fostering a positive mindset essential for rehabilitation.
A healthy diet and lifestyle to supply essential nutrients that support brain function, along with regular physical activity, adequate sleep, and management of medical conditions.

Begin Your Post-Stroke Recovery Journey With Moody Neurorehabilitation

Moody Neurorehabilitation understands the complexities and challenges that come with post-stroke rehabilitation. We are dedicated to supporting patients and their families through this critical time with specialized care and personalized treatment plans.

Since our inception in 1982, Moody Neurorehabilitation has been a leader in brain injury rehabilitation. Our approach centers on providing comprehensive care tailored to each patient’s needs and goals. We believe in treating the whole person, not just the symptoms, to improve overall quality of life.

We invite you to start your recovery journey with us. Contact Moody Neurorehabilitation today to schedule a consultation with our experts. Let us help you navigate the path to recovery with care, compassion, and expertise.