Geriatric Medicine/unable to walk after hitting head
Hi, you may not know about this, but there was no expert listed under neurology. My mother is 91 and has had balance issues for many years and has had many falls, none serious. But recently, she
wasn't so lucky. She had a bad fall and hit the back of her head and was in ICU for several days. They said she had a small amount of bleeding on the brain, but it stopped. She is now in a rehab facility, where they are working to get her stronger, doing occupational therapy, it's been five days. But since the fall, she can't walk or stand by herself, without help, she's too wobbly. I asked the staff about this and forgot what they told me... do you know what the connection is between hitting her head and having difficulty walking? Thanks
You're correct in your assumption that I do not have much experience in neurology. However, the reason I didn't just decline the question is because I think I can get you started in finding out the information you need to know. So please don't consider this a complete answer and keep on asking questions of your mother's healthcare providers until EVERY question is answered.
A couple definitions first:
Ataxia - a medical condition whereby an individual has problems with posture, walking, and balance. It is usually caused by a problem within a certain part of the brain. This can be due to a stroke, a fall, a car accident, a tumor, or any number of things which affect the brain.
Cerebellum - the part of the brain which when injured may cause loss of the ability to walk, as well as problems with balance and coordination.
I would tend to ass-u-me that if your mom was sent to a rehab facility it is believed that she has the potential to improve either partially or fully by receiving physical, occupational, and/or speech therapy. You don't state if dementia is or has been an issue. I only state that due to age and the fact that sometimes physical types of neurological problems follow the initial brain insult. I realize that in this case the most recent brain injury was due to her fall. You state that she has had balance issues for years but I cannot tell is the cause behind the balance issues and falling had previously been determined. This can be caused by heart problems (irregular heart beats and rhythms), dehydration (not enough fluid intake in the very warm or very cold weather, any of a number of brain malfunctions caused by a growth on or within the brain, neurological diagnoses such as muscular dystrophy, multiple sclerosis, ...
If this is a progression of a previously diagnosed condition which is deteriorating, there may not be much that can be done to stop it or slow it down or perhaps there might be some new medications. In any case, you will want to make sure of the following things while she is in the rehab facility: 1) that she is protected against falling to the best of their ability; 2) that her room is close to the nurse's station so that if she rings the call bell or calls for help someone will respond promptly so that she will not try to get up herself and risk falling again; 3) if appropriate, and falling out of bed or trying to get out of bed during the night is a possibility, they should consider putting thick matts on the floor to help "break" her fall; 4) if she is at a high risk for confusion and getting out of bed then you should discuss with them and the doctor if having a light "posey" jacket applied at night would be a prudent thing to do to prevent further injury; 5) she probably should not be given sleeping medication as this causes confusion in the elderly but if she cannot sleep and it is necessary, they should consider natural solutions such as Melatonin or Benedryl as they cause the least amount of confusion.
You should ask to have a Patient Care Conference (assumes you are the power of attorney or have written permission to make decisions for your mom and she would want you to be making decisions for or with her). In fact, if they say no, I'd encourage you to INSIST on it. This is a meeting where all of her care givers will be present either at the same time or intermittently during the meeting to provide their input. I think after she's been there about 7-10 days the staff should have an idea about her potential or anticipated outcome. I'm not looking to cause an uproar for you or your mom at the facility, however, I do want you to know that every state has either one or more LONG TERM CARE OMBUDSMANS. I live in CT and we have four, one for each direction in the state, N/S, and E/W. It is the job of the LTC ombudsman to protect the rights of patients in nursing homes (aka rehab facilities) and to ensure that the family is being kept informed and everything is being done to help the patient to return to his/her former state of health and well-being.
Each facility has a medical director who should be overseeing patient's care unless their private attending physician or family doctor will be going to the nursing home to see them. They may also have a private practice outside of the facility, but they are OBLIGATED to make time to answer your questions.
In the event that you still are not able to get answers to the questions you need answered to feel comfortable about your mom's care, if you live in CT we have an info line, which is 2-1-1, and they will help you find whatever information or resource you need help obtaining. If you need to contact the Office of the Health Care Advocate or the Insurance Commissioner because you are having difficulty with your mom's care in a facility, by all means contact them. Also, you may call the Board of Health in your state.
I regret that I was not able to answer your questions. I do hope that I was able to provide you with resources to contact in the event that you feel the rehab facility is not cooperating with you or providing your mom with the type of care that she needs.
Lastly, I find a couple websites online that appear to be user-friendly and deal with providing information to the public about head injuries or more specifically brain injuries. In your mom's case since it appears that inability to walk and maintain equilibrium and balance are the body systems that are affected, I'd suggest spending your time more specifically on the areas pertaining to the part of the brain called the Cerebellum. www.headinjury.com and The Brain Injury Recovery Network at tbirecovery.org
Thank you for the opportunity to provide you with some (however minimal) advice regarding your mom's care and treatment after a recent fall with a brain injury.
APRN, MSN, MBA
P.S. I'm sorry I didn't have time to proofread this response. It's Halloween tonight and my door bell has just started ringing...gg