Coma
Rancho Level VII - VIII Family Strategies for Interaction
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Rancho Level VII is characterized by Automatic, Appropriate Behavior. Most persons at this level are at home, and are returning to school and possibly work environments. Deficits in memory, information processing, fatigue, behavioral control, and social interactions may hamper performance in these settings, and may be perceived as intentional. Intervention at this level should involve persons involved at the school, community, or work environments.
Family members should know that judgment may still be impaired and close supervision may be necessary. Because of the transitional nature of this level of recovery, support for families as well as the individual can be particularly helpful.
Rancho Level VIII is characterized by Purposeful, Appropriate Behavior. Persons at this level are consistently oriented to person, place, and time. They initiate and carry out steps to complete familiar personal, household, community, work and leisure routines with stand-by assistance and can modify the plan when needed with minimal assistance.
When relating to a person at Rancho Levels VII and VIII, family and friends should:
• Treat the person in the same way as they did before the brain injury. For example, provide guidance and assistance in decision-making but respect the individual’s opinions.
• Speak with normal speech patterns and vocabulary. Simple words or phrases are no longer needed.
• Be careful about teasing or using slang, as the individual may misperceive intentions. Sometime humor is not understood.
• Talk through problems about the person's thinking skills, problem solving or memory challenges without criticizing. Reassure the individual that problems may persist because of the brain injury.
• Encourage the person to remain in therapy, to improve their cognitive skills.
• Check with the physician regarding any restrictions on driving, sports, drinking.
• Encourage person to use note-taking and tape-recorders to help with memory deficits.
• Discuss situations where person may have had difficulty controlling emotions.
• Talk with the person about feelings and offer outside support such as counseling and/or support groups.
Dr. Kiefel holds both a Masters and Doctoral degree in psychology with a specialty in clinical neuropsychology. Her specialty training in clinical child psychology was completed at Mount Sinai Medical Center in New York City and postdoctoral training completed at Childrens Hospital in Columbus, Ohio. Dr. Kiefel, a licensed a Psychologist in Georgia has been on staff at Children's Healthcare of Atlanta since 1996.
References
Some information obtained from Family Guide to The Levels of Cognitive Functioning, Communication Disorders Department, Rancho Los Amigos Medical Center.